Clearing the Backlog and Facilitating 

Benefits for America’s Veterans

November 12, 2013

National Council on Disability
National Council on Disability

1331 F Street, NW, Suite 850

Washington, DC 20004

Clearing the Backlog and Facilitating Benefits for America’s Veterans 

This report is also available in alternative formats on the National Council on Disability 

(NCD) Web Site (www.ncd.gov).

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202-272-2022 Fax

The views contained in this report do not necessarily represent those of the 

Administration, as this and all NCD documents are not subject to the A-19 Executive 

Branch review process.
1 

National Council on Disability

An independent federal agency making recommendations to the President and Congress 

to enhance the quality of life for all Americans with disabilities and their families.

Letter of Transmittal

November 12, 2013

President Barack Obama

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear Mr. President:

The National Council on Disability (NCD) is pleased to submit the enclosed report, 

“Clearing the Backlog and Facilitating Benefits for Veterans with Disabilities.” The 

lengthy delays of benefit claims decisions that persist for Veterans returning home with 

injuries from recent (and past) conflicts confound their transition from military to civilian 

community living. Testimony before Congress, media coverage, and investigations by 

the United States Government General Accountability Office (GAO) have confirmed 

these delays and their impact, with a focus on the U.S. Department of Veterans Affairs 

(VA). With this report, NCD would like to emphasize opportunities for leadership outside 

of the VA, and offer the full support and assistance of the Council and staff in 

accelerating progress through these and other measures.

During NCD’s seven-month examination, the backlog affected an estimated 600,000 

former service members waiting for initial claims decisions by the VA. The impact of the 

backlog related to NCD through the lived experiences of veterans whose wait time was 

more than 125 days emphasizes the critical nature of this problem and the urgency of 

finding an immediate solution. NCD explored the current state of the backlog, including 

the impact of increased oversight by Congress and the VA’s benefits management 

system and support initiatives. Among predominant needs identified in the report are 

more deliberate VA-led interagency coordination and Department of Defense (DOD) 

cooperation on records management and access. The ongoing need for shared 

electronic DOD and VA records that are accessible to veterans and their authorized 

representatives is critical.

Although progress has been made, as the President has said, we are not yet “where we 

need to be.” Among other core points based on the findings of the report, NCD 

recommends that:

1331 F Street, NW■ Suite 850 ■ Washington, DC 20004

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2 

• DOD should adopt a data storage standard compatible with the VA’s Veterans 

Health Information Systems and Technology Architecture (VistA) in order to ease 

the transfer (and shared use) of medical record information. DOD should be 

directed by Congress to adopt the system as a first step toward record sharing. 

• Congress should revise the Veterans Claims Assistance Act (VCAA) for 

clarification on due process provisions, veterans’ rights to self-determination 

including control of claims, and the scope of the VA’s obligation to develop timely 

and accurate claims. This revision should include language that outlines 

responsibilities for other federal agencies. 

It is the hope of NCD that the potential solutions contained in this report can contribute 

to the President’s ongoing efforts to provide timely benefits to our country’s Veterans. 

These benefits will speed and promote healthy integration for veterans back into civilian 

life, allowing them to resume making meaningful contributions to their families, the 

community, and the American economy, and will allow our nation to show its respect 

and gratitude for the tremendous sacrifices that American service members have made 

for our country.

NCD looks forward to working with the Administration in continuing to encourage 

coordination and collaboration across federal entities and meaningful input opportunities 

for Veterans who have given so much for America. 

Respectfully,

Jeff Rosen

Chairperson
3 

National Council on Disability Members and Staff

Members

Jeff Rosen, Chair 

Kamilah Oni Martin-Proctor, Co-Vice Chair

Lynnae Ruttledge, Co-Vice Chair

Gary Blumenthal

Chester A. Finn

Sara Gelser

Matan Aryeh Koch

Captain Jonathan F. Kuniholm, USMC (Retired)

Stephanie Orlando

Ari Ne’eman

Janice Lehrer-Stein 

Clyde E. Terry

Fernando M. Torres-Gil, Ph.D.

Alice Wong

Pamela Young-Holmes 

Staff

Rebecca Cokley, Executive Director 

Stacey S. Brown, Staff Assistant

Julie Carroll, Senior Attorney Advisor

Lawrence Carter-Long, Public Affairs Specialist

Joan M. Durocher, General Counsel & Director of Policy

Geraldine-Drake Hawkins, Ph.D., Senior Policy Analyst

Sylvia Menifee, Director of Administration

Robyn Powell, Attorney Advisor

Anne Sommers, Director of Legislative Affairs & Outreach
4 

ACKNOWLEDGEMENTS 

The National Council on Disability expresses appreciation to the team of experts from 

Paralyzed Veterans of America (PVA) for their contribution to this project: Diane 

Rauber, Esq., Dr. Stephen Yerkovich, and Jim Fischl, for their valuable experience and 

technical expertise on this project; Carl Blake and Blake Ortner, staff of PVA’s 

Government Relations Department; Joseph Badzmierowski, Rickey Grant, and Jason 

Stephenson, for their help in collecting the data and the administrative staff who 

assisted with reviewing system databases; and Kelly Saxton, for her technical editing 

support. Special appreciation is given to Sherman Gillums, Jr., research project 

supervisor, for his professional guidance and valuable support to the NCD team. NCD 

also expresses gratitude to the key informants—veterans and subject-matter experts 

who provided perspectives based on their experiences—and to reviewers from PVA, the 

Disabled Veterans of America, the Veterans of Foreign Wars, Wounded Warrior Project, 

and the US Department of Veterans Affairs.
5 

TABLE OF CONTENTS

National Council on Disability Members and Staff..................................................... 3

ACKNOWLEDGEMENTS............................................................................................... 4

EXECUTIVE SUMMARY ................................................................................................ 7

Summary of Methodology...................................................................... 9

Findings ................................................................................................. 9

Recommendations............................................................................... 11

SECTION 1. Introduction........................................................................................ 15

SECTION 2. Background........................................................................................ 19

SECTION 3. Major Issues....................................................................................... 21

Extra-Regulatory Pressures................................................................. 21

Complex Claims Increase.................................................................... 24

Service Provider Problems .................................................................. 25

SECTION 4. 21st Century Transformation............................................................ 31

Background.......................................................................................... 31

Veterans Benefits Management System.............................................. 31

Support Initiatives ................................................................................ 33

Congressional Oversight and Executive Branch Efforts ...................... 33

Current State of the Backlog................................................................ 36

Interagency Collaboration.................................................................... 37

Impact on the Lives of Veterans with Disabilities................................. 41

SECTION 5. NCD Research Methodology and Results ....................................... 43

Key Informants..................................................................................... 43

Data Collection and Analysis ............................................................... 45

Qualitative Data ................................................................................... 45

Interview Themes ................................................................................ 45

Quantitative Data................................................................................. 46

Data Analysis....................................................................................... 47

Discussion and Conclusions................................................................ 47

SECTION 6. Summary Findings and Recommendations .................................... 51

FINDING 1:.......................................................................................... 52

Recommendation 1...................................................................... 52

FINDING 2:.......................................................................................... 52

Recommendation 2...................................................................... 52
6 

FINDING 3:.......................................................................................... 53

Recommendation 3...................................................................... 53

FINDING 4:.......................................................................................... 53

Recommendation 4...................................................................... 54

FINDING 5:.......................................................................................... 54

Recommendation 5...................................................................... 54

FINDING 6:.......................................................................................... 55

Recommendation 6...................................................................... 55

FINDING 7:.......................................................................................... 55

Recommendation 7...................................................................... 55

APPENDIX A. STAKEHOLDER INTERVIEWS LIST ................................................... 57

APPENDIX B. IMPACT OF 2010 PTSD RULE CHANGE............................................ 59

APPENDIX C. VETERAN INTERVIEW NOTES........................................................... 61

ENDNOTES ............................................................................................................. 69

LIST OF TABLES

Table 1. DEMOGRAPHICS OF STUDY....................................................................44
7 

EXECUTIVE SUMMARY 

When active-duty service members separate from the military, many face serviceconnected disabilities and health issues, financial uncertainty, and other adjustments at a 

time when federal budget cuts and constraints limit the government’s ability to provide 

assistance. Seamless transition from military service to civilian life often depends on how 

well service members understand their entitlement to benefits and how quickly they can 

take advantage of training, jobs, and other opportunities. 

Serious delays hinder service members’ obtaining the benefits that are so crucial to 

resuming their civilian lives. The US Department of Veterans Affairs (VA) has undertaken 

efforts to reduce a long-standing disability claims-processing backlog, close transition 

gaps, and provide supports and services that can assist with the full integration of 

veterans into their communities. VA’s efforts include the April 23, 2013, public 

announcement of a short-term solution to prioritize and provide provisional decisions for 

claims that have been outstanding for more than two years. Even so, service members 

returning from present conflicts may be forced to fall in line behind other veterans with 

pending, backlogged claims. 

Despite showing signs of slight caseload decline, the numbers remain high as service 

members separating from recent conflicts return with multiple and complex disabilities. 

Based on a June 12, 2013, hearing, the Senate Committee on Veterans’ Affairs reported 

that two-thirds of approximately 851,000 pending disability claims filed with VA are for 

veterans who have been waiting more than 125 days for an answer. This combination of 

existing and new claims raises concern about whether VA will meet its 2015 goal of 

resolving the backlog and completing disability ratings within 125 days to aid 

transitioning veterans and their families. 

Recognizing the urgency of the claims situation, VA has deployed a benefits business 

transformation strategy to develop a paperless, technology-driven process model. 

Features of the evolving model include electronic claims submission, automated decision 
8 

applications, improved interoperability, efficient in-process transitions, and targeted 

quality assurance. The centerpiece of VA’s 21st Century Transformation Plan is a 

paperless claims environment called the Veterans Benefits Management System. 

Whether this effort and its enabling technologies will be sufficient to reduce the backlog 

remains in question as VA, Congress, veterans, and veteran service organizations 

(VSOs) offer assessments and refinements that reflect the complexity of the issues. 

The US Department of Defense (DOD) decision to reverse its commitment to join VA in 

the development of a single electronic health record system adds complications. DOD 

also has rejected the adoption of VA’s Veterans Health Information Systems and 

Technology Architecture (VistA) system. Potentially, either option would streamline the 

transfer of military health records between the two departments. However, DOD 

maintains that VA’s system presents an imperfect alternative among several that may 

offer more viable and cutting-edge solutions. The debate on how to modernize DOD’s 

health records system and ensure records interoperability with VA continues as the 

disability claims backlog approaches critical mass.

The March 13, 2013, General Accountability Office (GAO) testimony (GAO-13-453T) 

before Congress stated that external and internal issues affect the VA disability claims 

backlog, and that the prospect for improving disability claims resolution remained 

uncertain because timely processing is still a daunting challenge. GAO’s December 2012 

report (GAO-13-89) provided findings that supported the testimony. GAO found that 

increased numbers of veterans separating from present conflicts, new regulations, and 

court decisions allowing eligibility for veterans from earlier conflicts have all contributed 

to the growing number of claims. GAO’s report also attributed the claims backlog to VA 

internal claims process design and implementation problems. 

In partnership with current and former service members, the National Council on 

Disability (NCD) adds its “voice” to call for long-term effective solutions to the disability 

claims backlog. “Clearing the Backlog and Facilitating Benefits for America’s Veterans” 

presents NCD’s findings and recommendations that include opinions and evaluations by 

key stakeholders and experts engaged in the VA disability claims-processing backlog. 
9 

NCD recognizes that the needs of veterans remain central to the discussion in order to 

ensure that the VA claims process becomes more timely, accurate, and cost-efficient. 

The direct contributions of stakeholders are critical to achieving positive public policy 

changes. Therefore, the voices and experiences of the veterans themselves are a 

central focus, along with the efforts of federal entities and VSOs. Of equal importance is 

the opportunity to facilitate reforms that can afford all veterans with service-connected 

disabilities and their families the dignity and quality of life they have earned—and that 

our nation has committed to provide.

Summary of Methodology

NCD reviewed relevant data from available literature, extant data in an existing VSO—

Paralyzed Veterans of America (PVA)—database, and stakeholder interviews. The PVA 

database is designed to assist service members who are seeking disability benefits. The 

privacy of individual veterans has been protected. Among the criteria for participation as 

a key informant was an initial disability claim pending for more than 125 days with 6 or 

more claimed conditions. Information derived from the database was compared with 

themes coded from the interviews that NCD conducted with the veterans. NCD also 

interviewed key informants from the numerous government agencies that are critical to 

the claims process or that administer the claims process, including VA experts, DOD, 

VSOs, service members in the National Guard and Reserves (Reserve Component), and 

Congressional staff. These participants shared perspectives based on their knowledge of 

and experiences in national public policy, the VA disability claims process, its history, its 

vulnerabilities, and current efforts to resolve the backlog. NCD formulated findings and 

recommendations through the data analyzed and the information contributed by the 

diverse and expert sources available. 

Findings 

Several major themes, challenges, and issues emerged from the data sources. 
10

Themes: Veterans who are still waiting for initial disability ratings identified VA system 

problems that focused on seven major themes: (1) lost or misplaced evidence; (2) 

additional evidence requirements; (3) transfer of the claims file; (4) delayed transfer of 

information from DOD to VA; (5) examinations requested by VA; (6) failure to take action; 

and (7) other challenges. Veterans spoke about the impact of the identified themes, 

which contributed to reduced quality of life, and risks including unemployment, 

deteriorating physical and mental health, homelessness, family breakdowns, and anxiety 

about the future. 

Challenges: Key informants linked lengthy waiting periods to veterans delaying 

decisions about their health care, education, meaningful employment, and community 

integration. Specific challenges included declining mental health and loss of job 

opportunities, retention, and promotion resulting from the mounting delays and denial of 

service-connected disability benefits. The daily living, self-sufficiency, and well-being of 

veterans and their families are impacted by these critical and sometimes life-threatening 

challenges. The veterans’ perspectives on these difficulties and their personal stories 

echo recent media focus on the problems that stem from the claims backlog. 

Issues: The data from two types of key informants—subject-matter experts and 

veterans—reveals three major issues that federal entities need to address through 

collaborative actions: (1) extra-regulatory pressures created by new federal 

requirements; (2) surges in the number of multi-issue disability claims; and (3) service 

provider problems. The passage of federal legislation, regulations, or other federal 

processes that create mandates without sufficient funding consistently worsens the 

backlog crisis. Surges in claims filing reveal implementation difficulties. Informant 

perceptions about service provider problems are attributed to VA’s resistance to change, 

insufficient preparation for handling the sheer volume of new claims (despite VA hiring 

efforts), difficulty adapting to an electronic claims-processing system, lack of in-service 

training, and management shortfalls, among other issues. 
11

The enduring tradition of sophisticated strategy and strong leadership in military life are 

equally relevant to public policy and decision making at home in order to forge 

meaningful solutions to the backlog. Focused attention, adequate budget appropriations, 

effective legislative remedies and oversight, sufficient training and management 

preparation, and outreach to increase cross-agency collaboration on relevant issues are 

essential to resolving the disability claims backlog. 

VA reforms that increase the number of fully developed claims also may improve the 

quality of life for veterans with disabilities and their families. On May 14, 2013, the House 

Appropriations Military Construction and Veterans Affairs Committee released a draft bill 

relevant to disability compensation funding, which was included in the June 4, 2013, 

appropriations bill. The bill would address the disability compensation claims backlog 

issue (paperless claims process system, digital scanning of health records, and 

performance-tracking requirements) through a VA funding increase for health and 

quality-of-life programs. The outcome of both short-term and long-term solutions for 

ending the initial claims backlog will depend in part on subsequent congressional 

actions, the leadership role that VA assumes, and interagency collaboration. 

Recommendations

As a core and overarching recommendation, NCD encourages deliberate coordination 

and collaboration among members of Congress, the Executive Branch, relevant federal 

agencies, and VSOs to resolve the claims backlog issues. The partnership is essential to 

creating and sharing a superstructure of online information and applications that allow 

ease and efficiency in processing disability claims. The goal is to finalize and implement 

a streamlined and accessible electronic claims application and health records system. 

The system is to be phased into effect after comprehensive testing ensures that it is 

modernized and simplified, and that the technological tools are ready for use. With 

congressional support—oversight, guidance, and appropriations—to accomplish these 

actions with VSO input, VA, DOD, and other federal agencies may develop a plan to 

tackle the identified problems and ensure timely and accurate records management. 
12

An efficient system must address digital health and service records, online claims 

applications, evidence files, and appellate procedures. Information and records must be 

shared easily to eliminate document loss and avoid interagency transmittal delays. 

Jointly, the appropriate entities can finalize, test, and phase in the implementation of a 

fully digital records and claims system that expands access to veterans and their 

authorized VSO representative. Ultimately, these reforms could empower veterans and 

service members in the management and maintenance of their own claims, speeding 

resolution and improving personal dignity, integration, and quality of life. 

Based on the research and findings, NCD recommends seven points of action:

Recommendation 1: DOD should adopt a data-storage standard compatible with VA 

Veterans Health Information Systems and Technology Architecture (VistA) in order to 

ease the transfer (and shared use) of medical records information. 

Recommendation 2: Congress should ensure that access to DOD’s Defense Personnel 

Records Information Retrieval System is accessible to the Title 38 accredited 

representatives who develop and submit claims on behalf of veterans (with appropriate 

privacy protections and veteran authorizations). 

Recommendation 3: Congress should revise the Veterans Claims Assistance Act 

(VCAA) to clarify due-process provisions, veterans’ rights to self-determination including 

control of claims and the scope of VA’s obligation to develop timely and accurate benefit 

determinations. 

Recommendation 4: Federal agencies involved in the claims process should ensure that 

staffing levels are increased proportionately to manage higher demand and that 

mandates by Congress include an estimated increase in government operating expense.

Recommendation 5: VA should adopt the Acceptable Clinical Evidence (ACE) process 

for nationwide implementation.
13

Recommendation 6: Congress should ensure that federal agencies develop policies that 

make responding to VA records requests a high priority and that define a timetable for 

response that is monitored and enforced. 

Recommendation 7: Congress should provide adequate funding to finalize, implement, 

and maintain the Veterans Benefits Management System (VBMS) and supportive 

technologies. 

Well-timed action is urgent. It is particularly critical to the transition from military to civilian 

life. Like the Iraq War surge of disability claimants, the anticipated end of the war in 

Afghanistan will strain VA’s resources as more service members file disability claims. 

Federal Government actions that facilitate an efficient and effective transition are needed 

to support each veteran’s goals for self-sufficiency and full integration. 
14
15

SECTION 1. INTRODUCTION

“The problem is very complex.... Veterans from Iraq and Afghanistan are 

coming home with more injuries. They’re surviving combat at a much 

higher rate, so claims for disabilities are five times more complicated then 

[sic] they ever were.” 

—Chief policy officer for Iraq and Afghanistan Veterans of America, a 

former Army Captain who served in Iraq1

American service members bravely volunteer to protect our citizens and the nation’s 

security, borders, and interests. When these men and women return home, between 20 

to 40 percent will need to recover from physical, sensory, and/or emotional injuries 

sustained during service.2

In 2009, the Ninth Circuit Court of Appeals rendered an opinion that documented 

frightening statistics—18 veterans were committing suicide daily, with a thousand more 

attempted suicides per month.

 

3 Citing disparities in treatment categories, claims 

services, and delays in the appeals process, the Ninth Circuit applied due-process rights 

squarely to military personnel returning from service with medical and other claims.4

VA, through its Veterans Benefits Administration (VBA), reacted swiftly and decisively to 

reach distressed veterans and their families. Changes at VA included expanding medical 

treatment categories to include emotional injuries, establishing a widely used hotline to 

deal with emergencies, and facilitating the creation of online benefits applications and 

claims procedures. Nonetheless, significant backlogs continue to exist, and veterans 

continue to live with (sometimes grave)

 

5

This NCD inquiry evaluates the perceived factors contributing to the sustained VA 

backlog and recommends measures to facilitate the resolution of initial disability claims 

and appeals. Also, NCD considers how national public policy changes may help to 

ensure that veterans with disabilities and injuries receive the benefits necessary to heal 

and to integrate successfully into civilian life. 

 risk. 
16

The nation’s debt remains unfulfilled as adjudication averages 262 days, the highest 

measure in 20 years for veterans who have submitted claims for benefits—a number that 

totals near 900,000 today—which includes close to 600,000 backlogged claims.6 In 

essence, more than half of these claims are pending in the VA claims backlog. Initial 

claims represent 25 percent of the total figure.7 Each claim represents a veteran, 

dependent, or survivor seeking support, ranging from payments for service-connected 

disability and death to education and insurance entitlements. For many veterans, their 

lives are affected adversely by delayed access to these benefits, particularly for those 

veterans transitioning from the military and adjusting to life with a disabling physical, 

mental, or sensory condition.

Thirty-seven percent of VA disability claims in the June 22, 2013, inventory of claims are 

for “backlogged initial claims,” according to VA’s Monday Morning Workload Report.

8 In 

this weekly updated report, the number of claims received by VA continues to exceed the 

number processed. Backlogged initial claims are defined as claims a veteran, 

dependent, or survivor has filed for the first time and that have been waiting for 125 days 

or more for a VA disability rating.9 A fifth of these claims are considered “complex” 

(where veterans claim eight or more disabilities for service connection). Many of the 

claimants need their VA monetary and health benefits to help them transition between 

active service and civilian life. For these men and women, the exhausting wait for a 

proper disability rating and subsequent decision may have devastating consequences. 

Lengthy waiting periods also complicate recovery and reinforce negative views, such as 

the perception that VA seeks simply to “delay, deny, and hope that I die”10 to avoid the 

cost of fulfilling the promise to assist in the reintegration and full inclusion into civilian 

community living. 

While extensive waiting periods affect claimants across all wars, one veteran key 

informant expressed his concern about the backlog’s detrimental effects on older 

veterans who live in small, rural areas. “Many didn’t ask for a lot, are receiving less as 

they age, [and are] afraid the government will simply ‘turns [sic] its back on us because 

we didn’t file earlier’” (see Appendix C). The fact remains that some veterans die while 

awaiting benefits. For those who manage to outlive the process, a retroactive check in 
17

any amount cannot buy back the dignity, relationships, and opportunities sacrificed while 

waiting months and years for an initial disability rating. Veterans’ personal stories reveal 

that these problems are compounded when they endure extensive waiting in line among 

hundreds of thousands11

NCD recognizes that the VA claims backlog problem has been discussed extensively 

and studied in an effort to find meaningful solutions. The scope of inquiry for this paper 

draws upon testimony before Congress; agency, commission and inspector general 

reports; VA workload reports; media articles; veteran service and advocacy resources; 

stakeholder interviews; and VA’s 21st Century Transformation Plan.

to get their VA benefits.

12

NCD’s analysis seeks to augment lessons learned and recommendations from other 

investigations. A critical focus is the impact that the VA claims backlog has on the lives of 

veterans with disabilities and their families, as evidenced throughout the analysis and 

recommendations in this paper.
18
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SECTION 2. BACKGROUND

“I just want this to be over. It’s causing my PTSD to get worse and adding 

to my stress and anxiety.”

—Veteran’s Interview (Appendix C)

War and peace have tremendous costs and consequences. Recruiting civilians and 

training for military service; equipping infantry and supporting forces; deploying to, from, 

and within combat theaters—all are expenses immediately associated with going to 

battle. But the greatest, often hidden, cost of war proceeds from a sentiment that dates 

back to 1865. President Abraham Lincoln admonished America “to care for him who 

shall have borne the battle and for his widow and his orphans....”13 These words 

reflected the government’s obligation to acknowledge military service with earned 

entitlements due to service-connected issues. Lincoln’s edict endured, as Congress later 

established a formal system of veterans’ benefits after the United States entered World 

War I in 1917. The evolution of a veterans’ benefits system continued during World War 

II, with an increased focus on vocational rehabilitation and education programs, home 

loan guarantees, and unemployment insurance. These benefits represented the nation’s 

expression of gratitude for the deep personal cost of time served in combat.

Throughout the development of the benefits system, and into the 1980s, the Federal 

Government agency now known as the VA14 saw continuous growth and bureaucratic 

reorganization. Within VA, as the benefits structure advanced, so, too, did its “veteranfriendly” philosophical underpinnings. Supreme Court Justice Samuel Alito distinguished 

the VA claims adjudication process from other government disability evaluation systems 

by its “unique administrative scheme.”15 

Uncommon in traditional law, the VA’s Veterans Benefits Administration (VBA) system is 

characterized by paternalism, the protection of and heightened deference for the rights of 

veterans. Examples of this extraordinary standard of protection range from a lower 

evidentiary burden to the general absence of statutes of limitations for claiming 

entitlements.16 Veterans who file disability claims rely on the benevolence of the system 
20

to provide information, develop claims, and administer benefits. However, some 

stakeholders participating in NCD’s interviews question whether this approach to 

providing ratings and decisions contributes to the problems many veterans face today.

Rory Riley, Staff Director and Counsel at the House Committee on Veterans’ Affairs 

stated, “We must redefine what it means to be ‘veteran friendly’ in this modern context. 

WWII veterans played a more passive role in the claims process, depending on the 

paternalistic nature of VA at that time. In the 21st century, veterans have more access to 

information and are better equipped to play a more active role in the process.”17 She 

concluded that facilitation of the non-adversarial, pro-claimant philosophy seems to have 

caused tension between opposing views on what should be the claimant’s burden versus 

VA’s obligation.

The idea of promoting the self-empowerment of service members and veterans as 

participants in the claims process has progressed from the abstract to the practical. The 

Army now mandates that all soldiers download their records prior to discharge, placing 

squarely on the soldier the responsibility for maintaining the quality of records crucial to 

determining entitlements.18 Veterans today are more knowledgeable, as information on 

medicine, disabilities, and VA benefits becomes more accessible; modern veterans are 

more likely to become active participants in the claims process. Veterans also are 

claiming more disabilities than before. The number is up—from an average of 8 to 16 per 

claim—and there is a 330 percent increase in the complexity of claims, according to 

Under Secretary of Veterans Benefits Allison Hickey.19 The increase in veterans’ 

awareness also contributes to the surge in VA disability claims. The surge in disability 

claims shows no signs of abating in the near future.
21

SECTION 3. MAJOR ISSUES 

The number of veterans filing initial disability compensation claims and supplemental 

claims for increased benefits has multiplied every year since 2000.20 In 2011, VA 

received double the number of claims compared to a decade earlier. A recent news 

headline, “VA Claims Backlog Hits Record 1.1 Million,” highlights the glacial pace of the 

VA claims process.21 The numbers demonstrate the depth of the VA claims backlog 

crisis. Currently, every pending claim is counted in the Compensation and Pension 

(C&P) Rating Bundle, as reported in the VBA Monday Morning Workload Reports. Within 

the C&P Rating Bundle, also known as the claims inventory, are all of the claims pending 

longer than 125 days. This is the actual backlog. On December 29, 2012, the claims 

inventory totaled 900,667 claims, of which 616,551 were considered backlogged.22 Six 

months later, the June 2013 VA report showed 801,931 total claims pending, with 65.4 

percent of those pending over 125 days.23

Reasons for little change in the number of pending claims are multifaceted: a higher 

percentage of veterans seeking benefits during a weak economy; an unprecedented 

number of reserve component members now eligible for benefits; greater access to 

information about VA benefits; greater survivability; and other legal, demographic, and 

cultural reasons. NCD has identified three major issues as contributors to the current 

backlog of pending disability claims: extra-regulatory pressures, complex claims, and 

service-provider problems. 

 

Extra-Regulatory Pressures

Historically, the backlog crisis has been worsened by the unintended consequences of 

changes in federal legislation, regulations, adjudications, or other decisions that create 

claims-related mandates that may not necessarily receive appropriated funding. 

Examples between 2001 and 2011 that stakeholders attribute to complicating and 

increasing the claims process include the Veterans Claims Assistance Act of 2000 

(VCAA);24 certain new federal agency actions creating presumptive disabilities and 
22

entitlements linked to Agent Orange, posttraumatic stress disorder (PTSD), and other 

illnesses; and court decisions. 

Under the VCAA, VA is obliged to obtain missing records and any other evidence 

needed for a disability claims application. This requirement slows the processing times 

exponentially. VA documents an 83 percent increase in VA claims-processing time and 

inventory since 2000.25 According to VA, of the 1.1 million Operation Enduring Freedom 

and Operation Iraq Freedom (OEF/OIF) veterans released from service between 2001 

and 2009, more than 37 percent, or approximately 405,000, have filed for disability 

benefits. Nearly 50 percent of those claims were filed with incomplete information.26 

In 2001, a change in federal law added several new disabilities to the entitlements list, 

including Type II diabetes mellitus. A 2002 GAO report cited the addition of diabetes to 

the presumptive service-connected disability for Vietnam veterans: 

VBA received about 56,500 diabetes claims through November 2001 and 

expect[ed] to receive an additional 78,000 claims during the remainder of fiscal 

year 2002. The influx of new claims processing staff during fiscal year 2001 also 

temporarily hampered the productivity of experienced staff. According to officials 

at some of the regional offices [which GAO] visited, experiences rating specialists 

had less time to spend on rating work because they were helping train and mentor 

new rating specialists.27

In Nehmer v. Department of Veterans Affairs, the Ninth Circuit Court of Appeals 

liberalized entitlement to benefits for thousands of Vietnam veterans who had been 

exposed to Agent Orange and their survivors.28 The decision mandated the immediate 

adjudication of thousands of claims by a set deadline under the threat of a class action 

lawsuit. The decision, for the first time in its history, required recompense to a class of 

claimants, many with complex disabilities and dates of entitlement that spanned more 

than 30 years.

To meet this requirement, VA reassigned the most experienced claims developers and 

rating specialists from appeals and fast-track offices to work on the complex Nehmer

claims. An unintended consequence was the addition of many initial and resubmitted 

claims to the backlog. VA’s strategy left existing non-Nehmer claims to sit idle for up to 
23

two years. Once the Nehmer claims were older than 125 days, those claims also 

became part of the backlog, which created a domino effect on other types of claims and 

related appeals. 

Some see the Nehmer mandate as a self-inflicted wound by VA. The National Service 

Director for Disabled American Veterans (DAV), Garry Augustine, states, “Nehmer

claims were VA’s mistakes, and the [VA] paid the price for misinterpreting the regulation 

for a long time.”29 

A 2010 VA rule relaxed provisions for establishing entitlement to service connection for 

PTSD.30 While the overall PTSD claims’ increase applies to veterans from all wars, 

veterans of the Vietnam and Gulf Wars comprise the vast majority of increases in 

numbers. The increase by 71,198 applications between 2011 and 2012 is the highest 

rate of increase recorded for PTSD claims (see Appendix B).31

New regulations that open presumptive service connections for veterans with 

Amyotrophic lateral sclerosis, or Lou Gehrig’s disease; the addition of seven new Gulf 

War illnesses; disability linked to contaminated water at Camp Lejeune; as well as 

initiatives supporting veterans experiencing unemployment and homelessness also 

impact VA resources. Tapping the resources once dedicated to claims processing, 

developing, and rating functions highlights the tension that VA faces with regard to 

existing capacity, increased demand, and unfunded new requirements.

For fiscal year 2010, VBA spent $32 million in overtime pay for employees performing 

claims-processing functions, completing nearly 250,000 actions related to rating claims 

by stretching its capacity.32 This included core activities of development actions and the 

preparation and promulgation of rating decisions in addition to collateral assignments, 

such as working Nehmer claims. This happened again in 2011—the same year that the 

national backlog nearly doubled—resulting in a backlog that now sits at more than half a 

million claims in VA regional offices across the country.
24

Complex Claims Increase

A veteran with multiple physical and mental health issues filing a disability 

claim reports “[I am] not getting any answers from VA [nor] know which 

records VA has or if they even have [my] records....”

—Veteran’s Interview (Appendix C)

As the number of newly entitled claimants seeking benefits continues to rise in the wake 

of new laws and regulations, so, too, does the complexity of many of those claims. There 

are more issues per claim, and disabilities such as musculoskeletal and neurological 

injuries prove more difficult to rate.33 Increases are seen in the number of service 

members who survive severe combat-connected physical injuries and mental illnesses. 

Advances in battlefield medicine and combat armor ensure the survival of more service 

members. Essentially, with each war, including current conflicts, medical advances 

change the type of injuries that wounded warriors can sustain and still survive.34

During a February 2010 congressional committee hearing on VA’s fiscal year 2011 

budget request, VA leaders were asked to estimate and justify a reasonable productivity 

goal for rating-related claims processed per employee.35 VA cited a 2009 metric study by 

the Institute for Defense Analyses (IDA) that was contracted to assess VBA’s productivity 

evaluation standards. That IDA study involved an analysis of rating-related claims 

processed and based on employee experience levels. It also included an assessment of 

the adequacy of the number of personnel assigned to each regional office for each type 

of claim adjudication position. Despite a recommendation of goals needed for claims 

processors, no goals have been revised based on that study.

VBA is piloting a new grading standard at the Salt Lake City VA Regional Office to 

overcome the challenges of working with complex claims.36 Under the pilot project, which 

began in 2012, claims examiners are graded on the number and accuracy of the 

separately rated disabilities in a claim rather than on the claim in its entirety. This issueclaim-based point system gives claims examiners credit for accurate ratings while 

highlighting areas where additional training is needed.37 According to Hickey, VBA’s 
25

accuracy review database, Systemic Technical Accuracy Review (STAR), has been recoded to “measure medical issue quality—NOT just claim level quality by Regional 

Office” to allow employees to assess the quality at the medical issue level and receive 

credit for those they accurately rate. Whether this new point system will facilitate a 

greater flow of complex claims through the process remains to be determined. However, 

cautious optimism is based on the concerted effort to recognize and resolve the issue.

Service Provider Problems

A veteran, who served in Iraq and was injured in an improvised explosive 

device (IED) blast, has multiple claims issues, including a severe traumatic 

brain injury (TBI) diagnosis. Based on interactions with claims examiners, 

he believes that his disability claim paperwork “was simply thrown away.”

—Veteran’s Interview (Appendix C)

The third major issue contributing to the claims backlog relates to the VA’s internal 

vulnerabilities and problems. The VA’s Baltimore VBA Regional Office exemplifies the 

difficulties, which resulted in Baltimore being rated the nation’s worst performing of VA’s 

56 offices, averaging 429 days for claims resolution—six times VA’s goal of 70 days, and 

162 days longer than the national average.38 Before the backlog problems surged again 

during the earlier years of the wars in Iraq and Afghanistan, Baltimore showed a 

manageable workload: its pending claims numbered 5,000 or fewer. In 2007, VA 

selected Baltimore to pilot a joint VA-DOD Integrated Disability Evaluation System 

(IDES), to improve the transition for service members leaving Walter Reed Army Medical 

Center and other military hospitals. Some critics maintain that VA officials failed to 

assess adequately Baltimore’s preparedness for the IDES project and according to 

former VA staffer and current Veterans of Foreign Wars Deputy Director Gerald Manar, 

problems in the regional office were longstanding.39 The top VA benefits rating 

specialists in Baltimore were assigned to the pilot project, leaving inexperienced 

employees to process complex claims. The number of pending claims in Baltimore 

began to skyrocket, reaching 6,200 by 2008 and 7,000 in 2009.40 In November 2009, 

when VA Secretary Eric K. Shinseki expanded eligibility for compensation for three major 
26

ailments linked to Agent Orange, a flood of new or renewed claims by Vietnam veterans 

exposed to the toxic herbicide added to the Baltimore office woes. 

On February 14, 2013, Hickey announced the end of the pilot program, returning the 

Baltimore office to a single-mission focus without a reduction in manpower as part of a 

plan to overhaul its workflow and management.41

As reflected in the 2013 VA Budget Major Appropriation Issues, the high cost of 

addressing internal operations is a critical consideration in providing benefits to eligible 

veterans, dependents, and survivors of the Global War on Terrorism, and the cost is 

expected to increase.42 Despite the hire of nearly 4,200 new employees into the VBA 

since 2007,43

Observers also perceive that interconnected internal problems include VA’s resistance to 

change and its failure to adapt to technology. “It took far too long for VA to embrace 

electronic processing. This may have better prepared VA for the foreseeable surge in 

claims,” remarked Riley. “It was not a secret that we were sending large numbers of 

troops to battle. Somebody should have anticipated the surge when they inevitably 

returned and discharged. This includes adequate staffing. They should have better 

anticipated the need for higher numbers [of claims to be processed].”

the sheer volume of incoming claims creates ongoing problems. 

44

Another example of internal inefficiency involves ordering duplicate or unnecessary VA 

medical examinations that increase the waiting periods, prove inadequate for rating, and 

reiterate the existing medical evidence of record. In 2009, VA’s Office of Inspector 

General (OIG) found that the percentage of incomplete C&P exam requests remained 

steady over the prior few years at around 17 percent.

 

45 Augustine remarked, “VA exams 

are overused. The culture in the field promotes the idea that a VA exam must be ordered 

no matter what. The non-VA evidence of record isn’t given the weight it deserves. This 

cultural mindset needs to shift.”46

To VA’s credit, a January 2013 initiative called Acceptable Clinical Evidence (ACE) was 

launched at the St. Paul VA Regional Office to explore the medical examination 

concerns. VA is weighing whether eliminating the requirement for an in-person medical 

 
27

examination for some veterans can shorten claims-processing times by using existing 

medical evidence, disability-benefits questionnaires, and telephone interviews.47

Evaluation of the effectiveness of this initiative in reducing the backlog is forthcoming.

Staff training is another internal problem as the focus on claims-processing accuracy 

intensifies. Linda Halliday, VA’s Assistant Inspector General for Audits and Evaluations 

in the OIG, testified during a June 2012 House Committee hearing. She based her 

testimony on findings that regional office staff did not adequately process claims. During 

testimony, Halliday attributed errors to inconsistent or insufficient training, VA medical 

examiners providing inadequate TBI medical examination reports, and rating veterans 

service representatives (RSVRs) not returning adequate reports to the medical 

examiners for correction as required.48 Beyond the health-related inefficiencies, Halliday 

reported:

... the need for “enhanced policies and procedures, training, oversight, quality 

review, and other management controls to improve the timeliness and accuracy of 

disability claims processing and enhance the effectiveness of VSC [Veteran 

Service Center] operations.” She concluded that VBA contributed to the growing 

inventory and time delays by failing to assign enough staff to process appeals 

and—since compensation claims processing was the highest priority—not 

ensuring that appeals staff acted promptly.49

The testimony supports an earlier (2010) GAO report that acknowledged VA’s efforts and 

recommended consistency reviews to address the identified deficiencies. VA proposed 

two actions—developing an annual consistency review schedule and hiring additional 

quality-assurance staff.50

While some stakeholders remain cautiously optimistic, critics continue to call for VA 

leadership to ensure VBA improvement of disability claims processing. In their annual 

joint report, Independent Budget for Fiscal Year 2014,51 the VSOs contributing to the 

document call for revised measures. The measures include increasing the quality and 

hours VBA devotes to annual training, changing how VBA assesses and rewards 

performance at every level, and using plain language in communications to veterans. 

Simplified notification letters or any other automated rating process can help VA continue 

to provide sufficient and specific communications to inform veterans and their advocates 
28

about the reasons and bases for benefits rating decisions.52

VSO representatives maintain that VA’s long-term success hinges on a cultural shift from 

focusing on speed to a new culture built upon quality and accuracy. In DAV’s 2012 

Annual Report, the organization emphasized the importance of focusing on long-term 

institutional fixes and reducing the number of backlogged claims in the short run. “It is 

not enough to simply lower the backlog, after all backlogs can return,” the report reads. 

“Moreover, it doesn’t matter how quickly a claim is completed if it is not done correctly.”53 

During testimony before Congress, the organization emphasized the importance of 

focusing on long-term institutional fixes and reducing the number of backlogged claims in 

the short run. DAV’s Joseph Violante stated that “while there can be a tendency in the 

media to talk only about reducing the backlog, we continue to argue that VBA and 

Congress must instead concentrate their efforts on addressing the underlying problems 

that created and continue to fuel the backlog.”

54

At least one vital aspect of VA’s internal inefficiencies can be linked to coordination and 

collaboration needs involving DOD. In April 2013, members of Congress noted that “in 

some cases veterans’ disability claims remain delayed because it takes up to 175 days 

for VA to receive complete records from DOD.”55 Many disability claims must be 

substantiated by records maintained by DOD. These records transfer from DOD to VA 

upon the service member’s separation from the military, a process that heavily relies on 

the expedience and efficiency of human-driven scanning and transferring activities. 

While this process was considered a viable short-term solution, VA and DOD were 

pressured to collaborate and devise a single electronic health-record management 

system that offered efficient access and exchange of records between the two agencies.

Recent efforts failed to create and implement a unified “superstructure” where VA and 

DOD health records could be managed without eroding the potential impact of such a 

solution on reducing the backlog of claims. Both departments were able to achieve 

limited interoperability for their respective electronic health records, but collaboration fell 

short in following through with the implementation of a joint Virtual Lifetime Electronic 

Record (VLER) for each service member as planned. 
29

DOD’s skepticism and resistance of VA’s electronic health-record system are based on 

the complexity and assumed higher probability of failure of the VA system of choice. 

During a hearing before the House Committee on Veterans’ Affairs, the Assistant 

Secretary of Defense for Health Affairs at DOD, Jonathan Woodson, expressed the 

department’s hesitation. “As good as VistA is, it isn’t one system,” he argued in reference 

to the Electronic Health Record (EHR) system’s variation as a result of its open-source 

nature. He concluded that DOD faces considerably more risk than does VA, which 

already owns the EHR, when considering VistA. DOD must compare it against other 

EHRs in terms of total cost of ownership, modernization, and how DOD can innovate 

with any EHR to keep pace with private-sector and federal standards development. 

Chairman Bernie Sanders (I-VT) expressed his view at a February 2013 Senate 

Committee on Veterans’ Affairs hearing: “I am deeply disappointed by the VA and 

Defense Department decision to back away from a commitment to develop and 

implement a truly integrated, single, electronic health record.” 

Using social and traditional media, some veterans and family members reveal their 

challenges, express frustration, and offer suggestions for progressive reform: 

IAVA’s Tom Tarantino told CNN “Men and women come home from war today to 

record-high unemployment rates, to a GI Bill that is not meeting all of its needs, to 

record-high disability backlog rates. We have to make sure that even when we 

bring troops home from Afghanistan, that we still have tak[en] care of these men 

and women as they transition from being a warrior back to being a civilian.”56

“The real solution requires hard work and careful planning.... A key component of 

the VA’s efforts has been involving veterans service organizations, such as 

Disabled American Veterans (DAV), throughout the process.... There is still much 

work to be done to create a system based on the cornerstones of quality, 

accountability, accuracy and timeliness; but DAV and other veterans 

organizations are committed to working with the VA so our veterans can receive 

the benefits they rightly deserve, when they need them. Bombs and bullets are 

essential to winning wars, but rhetorical bombs and magic bullets won’t solve the 

VA’s problems.... Instead of oversimplifying a complex process, we owe it to our 

nation’s injured heroes to examine the issue with due diligence and thoughtful 

care.”57
30
31

SECTION 4. 21ST CENTURY TRANSFORMATION

“VA’s Veterans Benefits Administration is aggressively pursuing its 

Transformation Plan, a series of tightly integrated people, process, and 

technology initiatives designed to eliminate the claims backlog and achieve our 

goal of processing all claims within 125 days with 98 percent quality in 2015.”

 —General Allison Hickey58

Background

Whether new technologies and processes will “revolutionize” VBA claims processing 

cannot be predicted. However, the agency’s transition from paper-based processing to a 

comprehensive digital processing system appears inevitable and could improve results. 

The VA embarked upon its transformation from print-based to digital processing on 

October 10, 2008, after the signing of the Veterans’ Benefits Improvement Act of 2008, 

Public Law 110-389.59 Section 221(a) of the law directed VA to carry out a one-year pilot 

program to assess the feasibility and advisability of expeditiously processing fully 

developed compensation and pension claims within 90 days of receipt. The development 

phase of the claims process, where information and evidence needed to support 

applications are gathered, often becomes the longest phase in the process. The fully 

developed claim (FDC) pilot would test whether the overall processing time could be 

reduced if VA received all of the available evidence when the claim is submitted and the 

claims decision process expedited without compromising quality. In 2009, VA 

implemented the FDC pilot in 10 VA regional offices before eventually expanding the 

program to all regional offices. There is some support within the VSO community for the 

use of the FDC initiative and advocacy for broader implementation.60

Veterans Benefits Management System

Ultimately, VA’s transformation strategy for the claims process revolves around 

redesigned business processes and technology improvements focused on streamlining 

the process.61 Under this strategy, the claims-processing target time would decrease 
32

from 180 days to 125, with the evidence-gathering and development activities 

compressed from approximately 140 days to 100. This ambitious time line was based on 

strategy to “break the back of the backlog,” as Shinseki promised in his comments after 

his first year at the agency.62 Shinseki’s strategy included 40 initiatives, linked to the 

centerpiece of the 21st Century Transformation Plan, the Veterans Benefits 

Management System (VBMS): a paperless, rules-based claims-processing work tool. 

The VBA developed VBMS to create electronic claims files; manage workflow; and 

increase production, timeliness, and quality for more than 1 million claims filed annually, 

added to the 4 million claims files already located in VA regional offices and millions 

more in archives. On February 11, 2013, VBA received approval from Secretary Shinseki 

to deploy VBMS to all remaining stations by June 10, 2013. Each station was to receive 

21 days to complete all necessary preparation activities before going live in VBMS.63 In 

February 2013, VA Inspector General George J. Opfer called for the development of a 

plan with milestones for resolving system issues that either adversely affect claims or 

add to the existing backlog.64 

Immediate problems hindering the transition to the new paperless claims process 

included disorganized electronic claims folders and improperly managed hard-copy 

claims.65 During a March 13, 2013, hearing before the US Senate Committee on 

Veterans’ Affairs, Daniel Bertoni, Director of Education, Workforce, and Income Security 

Issues, criticized VBA’s failure to outline a coherent plan that adequately established 

benchmarks for success or failure: 

[W]hen we reviewed VBA’s plan documents, we found that they fell short of 

established criteria for sound planning. Specifically, VBA provided us with several 

documents, including a PowerPoint presentation and a matrix that provided a 

high-level overview of over 40 initiatives, but, at the time of our review, could not 

provide us with a robust plan that tied together the group of initiatives, their interrelationships, and subsequent impact on claims and appeals processing times.66

Bertoni continued by highlighting the lack of established requirements and specific 

activities to obtain desired results, which would ensure accountability and mitigate 

risks.

 

67 
33

Support Initiatives

In addition to VBMS, the development of new technology remains central to the VBA 

transformation strategy. This includes the continued development of the Stakeholder 

Enterprise Portal, an expanded eBenefits system with the Veterans On Line Application 

Direct Connect, and the Virtual Lifetime Electronic Record initiative. The expanded 

system is designed to offer more access points for veterans filing claims and greater 

control of the information needed to substantiate those claims. In addition to these 

progressive initiatives, another promising development is the Segmented Lanes 

process—Express, Core, and Special Operations.

This Segmented Lanes process allows VBA to identify and manage more efficiently the 

adjudication of certain types of claims, such as claims that require expedited handling 

due to financial hardship, homelessness, advanced age, or terminal illness. Each lane is 

staffed with a dedicated team of claims processors whose skills and expertise correlate 

with the nature of the casework to which they are assigned. In place across the majority 

of regional offices, the process harnesses expertise where it is most useful. 

Congressional Oversight and Executive Branch Efforts

Lessons Learned or History Repeated? 

Some stakeholders worry that VA is driving the racecar while building the racetrack with 

the ambitious rollout of the VBMS. This begs the question of whether VA’s history of 

creating high expectations about the potential of new technologies is repeating itself. As 

one congressional staff member concluded, “VA has been bad historically about having 

no backup plan in situations like this. They just need to be more realistic and honest 

about the situation.”68

Concerns about VA’s move toward a paperless, technology-based era of claims 

management refer to past practices in the department. During the 1980s, VA sought to 

clean up and verify the data contained in its Beneficiary Identification Records Locator 

Subsystem (BIRLS) program, a tool used to aid claims processors, through an initiative 
34

called the BIRLS Redesign. Problems with BIRLS began when the system was 

implemented without adequate testing,69 resulting in the need for tens of thousands of 

records to be corrected or updated by hand at the huge cost of lost productivity. VA 

repeated this mistake in the 1990s with Rating Board Automation 2000, intended to 

assist rating specialists in the completion of rating decisions. Again, VA updated the 

program and deployed it to the field without sufficient testing. The rating process stalled 

as thousands of VAs’ most critical decision makers spent months identifying software 

bugs and struggling with “workarounds” while computer programmers fixed the 

problems.70

The most prominent platform, the Control of Veterans Records System (COVERS), was 

VA’s system for tracking the location of paper claims folders. An OIG’s regional report in 

201271 underscored earlier GAO findings that, within VA, the VBA’s control of veterans’ 

claims folders, which contain personally identifiable information, was not effective. VBA 

managers did not track the number of lost or rebuilt folders, consistently enforce 

COVERS policies, or establish effective search procedures for missing claims folders.72

Misplaced claims folders led to unnecessary claims-processing delays, increased the 

likelihood of documents being lost, added burdens on veterans waiting for decisions, and 

resulted in less time available for regional office personnel to process claims with a high 

level of accuracy. These examples illustrate VA’s persistent problems with managing 

change and implementing new technologies.

Former VA Under Secretary for Benefits Daniel Cooper’s testimony before the House 

Subcommittee on Benefits states, “The three priority areas where we are focusing our 

attention are, one, reducing the size of the backlog and the time veterans must wait for 

decisions on their claims; two, ensuring high-quality decisions while producing large 

numbers of claims; and, three, establishing greater accountability and consistency in 

regional office operations.”73 Cooper’s opinion was restated in issues identified by Hickey 

nearly 11 years later as well as in the July 2010 Senate committee hearing testimony of 

Senator Sherrod Brown regarding the claims process.74 
35

Past VA leadership’s failure to describe adequately the real workload led to the ongoing 

underestimation of the number of staff needed to process new and pending claims. This 

also was a barrier to making the case before Congress on appropriate funding for 

staffing. A statement about VA’s efforts to improve claims processing was attributed to 

former Under Secretary for Benefits Joe Thompson: “The Veterans Benefits 

Administration has undertaken a number of initiatives to bring about needed change. The 

reasons for the lack of success include inadequate planning, unclear goals and 

objectives, poor integration of interrelated efforts, a lack of coordination with other 

stakeholders, and insufficient implementation planning and follow-up.”75 Thompson also 

testified, “More than a decade after initial discussions were held between VA and DOD 

on the electronic exchange of service treatment records, the process remains 

paperbound. With the tremendous growth in claims activity, this is a problem that should 

not be allowed to continue.”

76 Today, shortages in critical claims-processing staff add to 

the challenges and limit VA’s ability to exploit new technologies.

Recently, the VBMS suffered a setback as the system virtually shut down in late 2012 

after the digitized process was expanded to 18 out of 57 regional offices.77 Claims 

examiners faced difficulties in accessing veterans’ files stored on remote servers and 

performing relatively simple transactions. VA Office of Information Technology officials 

explained that “the impact of excessive read/write activity” by removing “all nonessential, non-productive activities for the shared VA environment,” should fix the issue. 

In fact, Hickey has expressed that finding and fixing errors along the way are beneficial 

aspects of the “agile development” approach needed to maintain momentum as VBMS 

expansion continues.78

Allegations in a March 2013 news report79 questioned whether senior VA officials 

understated the extent of the claims backlog while overstating progress in resolving it. 

The report stated that initial claims processing takes longer by almost two months than 

VA publicly had acknowledged. The nationwide wait times ranged between 316 and 327 

days, and veterans waiting more than a year rose by more than 2,000 percent. Allegedly, 

this was the situation despite VA hiring more than 3,000 additional claims processors 

since 2010 to cope with the influx of returning Iraq and Afghanistan veterans. The hiring 
36

data is seen as misleading and not revealing such factors as high turnover and 

temporary positions that meant an actual net increase of fewer than 300 people added to 

review claims since September 2010.80

Current State of the Backlog

 

During 2012, H.R. 5881, the Access to Veterans Benefits Improvement Act, proposed to 

provide certain congressional staff and agencies with access to VA case-tracking 

information.81 H.R. 4481, the Veterans Affairs Employee Accountability Act, proposes to 

direct the Secretary of Veterans Affairs to ensure that no employee of VA, who knowingly 

violates any civil law, receives any retention incentive, payment, or award for or during 

the year of such violation.82 These and similar proposed legislation signal the intent of 

Congress to assume closer oversight of VA to address the backlog and other veterans 

issues. However, summary and status information on the proposed bills to expedite the 

disability claims backlog process discloses “no major actions” since 2012.83

Although Congress passed neither of the bills (H.R. 5581, H.R.4481), another measure 

for a pilot project, the Honoring America’s Veterans and Caring for Camp Lejeune 

Families Act, was signed by President Barack Obama in August 2012. The legislation 

called for a four-year pilot program at five VA regional offices to test the skills and 

proficiency of employees and managers who process claims and pension benefits, in 

order to determine where improvements can be made, including new training to speed 

the process. In addition to the pilot program, the law provides several measures to 

address veterans’ benefits and services.84 This legislation empowers the Board of 

Veterans’ Appeals to streamline its reviews of new evidence, and it requires VA to 

provide veterans the option of receiving claims-related communications via email or 

other electronic means.85

State efforts to improve the flow of benefits and services to veterans join congressional 

actions to more closely influence VA’s efforts to reduce the backlog. In 2009, Texas 

created a Claims Processing Assistance Team that helped reduce pending claims at the 

regional offices in Waco and Houston by 17,000 in less than two months.86 The state 
37

again took action in late July 2012, when the Texas State Legislature created a State 

Strike Force Team, led by the Texas Veterans Commission. With more than 68,000 

claims pending over 125 days, Texas officials reactivated the state team on September 

3, 2012.87 The State Strike Force Team was established to help veterans and their 

families receive disability compensation and pension payments faster than the traditional 

VA process offered. Congressional attention focusing on the State Strike Force Team as 

a potential model for other states may inspire the creation of a similar Federal Strike 

Force Team.88 In November 2012, Senator John Cornyn (R-TX), a member of the 

Senate Armed Services Committee, filed an amendment to the Defense Authorization bill 

that could elevate the Texas model to a national program.89 

As Congress moves toward greater involvement, VA initiatives aim to improve the claims 

process. VA officials announced plans for changes through a new processing model. 

Hickey recently predicted that the changes, new training programs, and completion of a 

massive claims project related to Agent Orange illnesses will put the VA on track to 

eliminate the claims backlog.90 By the end of 2015, changes that increase both the 

speed and accuracy of claims specialists are expected to boost the department’s output 

by up to 200,000 cases when it is fully implemented.91 However, some doubts and 

concerns remain. Representative Jeff Miller (R-FL), Chairman of the House Committee 

on Veterans’ Affairs, responded to Hickey’s vow with skepticism: “Until we see results 

and not just ink on paper, this is just another announcement.”92 This sentiment 

represents a commonly held view among veterans with disabilities and families whose 

everyday lives are impacted by a seemingly interminable wait to receive benefits.

Interagency Collaboration

The current Administration encourages federal agency collaboration to boost common 

solutions. In December 2012, VA announced the elimination of annual Eligibility 

Verification Reports (EVRs) for VA pension recipients. A new automated cross-agency 

referencing process will conjoin VA efforts with the Internal Revenue Service (IRS) and 

Social Security Administration (SSA) to verify continued pension benefits eligibility for 

more than 150,000 beneficiaries.93 By eliminating the annual reports, VA can redirect 
38

more than 100 employees who usually process EVRs to carry out critical functions 

related to eliminating the claims backlog.

Existing interagency efforts have received mixed reviews. Supporters indicate that IDES 

shows promise94 for expediting the delivery of DOD and VA benefits to injured service 

members.95 IDES supporters also consider 2012 data on performance an improvement 

over the legacy process the IDES replaced.96 However, a GAO report also released in 

2012 called for VA to enhance its monitoring of performance.97 GAO found in August 

2011 that case-processing times under IDES increased over time, and the measures of 

service member satisfaction had shortcomings. The yearly increase in processing time 

for active and reserve component members’ IDES cases changed from 394 days in 2010 

to 420 days in 2011—well beyond established goals of 295 and 305 days, respectively.98

In May of 2011, GAO’s preliminary observations showed just 19 percent of active-duty 

service members and 18 percent of reserve component members completed the IDES 

process and received benefits within established goals, down from 32 and 37 percent, 

respectively,99 one year earlier (in 2010).100 The medical evaluation board phase of the 

process fell short of the goals for timeliness and, within that phase, the time required for 

the military’s determination of fitness.101

Further cross-agency efforts relate to support for returning reserve component members 

who face transition delays because of status and jurisdictional barriers. According to a 

2008 Department of Defense report, total reserve component personnel ever deployed to 

Iraq and Afghanistan reached 254,894 at the end of 2007.

 

102 Following active-duty 

service and prior to discharge, reserve component members return to their assigning 

home state. Thus, each state becomes responsible for determining fitness for duty and 

maintaining custody of the service members’ military and health records. While the 

National Guard Bureau (NGB) functions as the unifying entity for all locations that have 

reserve component units, the NGB’s influence is advisory in nature. This leaves great 

variability in how these units manage their personnel and records. It also creates 

circumstances where reserve component members are held in lengthy medical-hold 

status. During this time, medical records that are inevitably needed to substantiate 
39

disability claims can be lost or delayed by staff shortages, unclear procedures, or low 

prioritization.103

When filing a claim, reserve component members separating from service are at the 

mercy of whether VA and DOD will collaborate, since the agencies do not share a 

common database for accessing medical evidence. Formal requests for evidence from 

DOD may take considerable time, and in some instances go unanswered. VA claims 

examiners have limited access to the Interactive Permanent Electronic Records 

Management System (iPERMS) used by the Guard, Reserve, and active components, or 

to the databases at the National Archives and Records Administration (NARA). NARA 

manages the official military personnel files of certain veterans and for limited periods of 

service. However, NARA does not have direct access to the military treatment records 

database systems maintained by each state’s surgeon general. Often, Guard and 

Reserve health records are aggregated from a variety of sources (e.g., DOD, VA, private 

hospitals, field medical units, private sector emergency rooms, etc.).

Provisions were established to have the records of reserve component members 

transitioning from active to inactive, or “M-day” status, automatically forwarded to VA. 

According to Marian Barry, Chief of the iPERMS Section, NGB, an April 2009 

memorandum of agreement provides VA staff with access to iPERMS through the 

Defense Personnel Records Information Retrieval System (DPRIS) effective since June 

2010.104 Soldiers can access iPERMS through VA’s eBenefits portal as long as they have 

the necessary clearance. However, service members must hand-carry their records to 

unit record custodians for transfer onto microfiche, which are maintained until the member 

discharges from service. Records that get lost must be reconstructed through other 

evidence (buddy statements, receipts, unit logs, etc.). This severely diminishes the 

likelihood of meeting the necessary evidentiary burden for substantiating a VA disability 

claim.

In many cases, veterans grant power of attorney (POA) to “accredited representatives” 

who gather evidence and develop claims on their behalf. Under 38 C.F.R. §§ 1.600- 

1.603, accredited service organization representatives may obtain read-only remote 
40

access to the electronic VBA claims records of the claimants they represent. 

Compensation and Pension Record Interchange (CAPRI) is a Department of VA 

application that provides read-only access to Electronic Health Record data found in the 

Computerized Patient Record System (CPRS) used by clinicians and administrators at 

more than 1,300 sites of care and information related to a veteran’s C&P examination(s) 

at a VA facility. Accredited VSOs submit a valid POA to the Veterans Health 

Administration in order access a veteran’s record in CAPRI. Once a POA is submitted 

and processed, the veteran’s records will appear automatically inside CAPRI to those 

who have been authorized to view the information.

However, this privileged access is limited to VA records, which presents barriers to 

processing claims, particularly for those records under DOD’s stewardship. DPRIS is a 

secure electronic gateway that provides authorized government users access to 

veterans’ official military personnel file information from each of the service-specific 

personnel imaging systems. DPRIS also enables individual service members and 

veterans access to their own personnel information. DPRIS users include: DOD, VA, 

Federal Aviation Administration, NARA, National Personnel Records Center, Department 

of Homeland Security, Customs and Border Patrol, National Reconnaissance Office, 

Office of Personnel Management, Defense Criminal Investigation Service, and Defense 

Finance and Accounting Service. However, accredited representatives for veterans 

seeking disability benefits are not given access to DPRIS, thus requiring lengthy request 

processes and wait times for service records needed to substantiate claims.

Measures have not been fully implemented that were approved to begin closing the gaps 

between agencies and to foster better collaboration. In January 2011, the VA-DOD 

Benefits Executive Committee approved a recommendation from the Medical Records 

Working Group to develop and deploy a scanning solution known as the Health Artifacts 

and Image Management Solution (HAIMS). A secure, web-based technology solution, 

the HAIMS was intended to be an interim measure while DOD and VA jointly developed 

a single electronic health records system to replace the paper exchange of information. 

The HAIMS was in testing and on track for accelerated deployment by September 

2013.105 However, the plan appears to have reversed course, with VA and DOD deciding 
41

instead to maintain separate systems while focusing on interoperability. During a Senate 

Committee on Veterans’ Affairs hearing in February 2013, Chairman Bernie Sanders (IVT) said: “I am deeply disappointed by the VA and Defense Department decision to back 

away from a commitment to develop and implement a truly integrated, single, electronic 

health record. President Obama charged the Departments with creating a seamless 

system of integration so that service members transitioning from active duty to civilian life 

don’t have to worry about whether their health records will be lost or their claims 

delayed.”106 

Valerie Melvin, Director of Information Management and Technology Resources Issues, 

GAO, attributes the breakdown in progress to poor management and accountability: “As 

a factor contributing to these weaknesses, the departments’ interagency program office 

which was to be the single point of accountability for electronic health data sharing has 

not been positioned to fulfill its key management responsibilities.”107 The decision 

against integrating systems, if sustained, could represent continuing institutional

difficulties that signal a lack of cooperation among federal agencies. Collaborative efforts 

among VA, DOD, SSA, NGB, and IRS are essential to improving the VA claims process. 

The day-to-day reality reveals a growing number of service members and veterans who 

wait in limbo. Meanwhile, VA claims examiners pursue records from multiple sources, 

schedule VA medical examinations, and work through the complex issues that many of 

these claims present. 

Impact on the Lives of Veterans with Disabilities

A veteran who is aging with a service-connected disability believes a decision 

would “take a lot of worry” out of his situation.

—Veteran’s Interview (Appendix C)

With more than 1.1 million troops deployed to Iraq and Afghanistan, the rates of physical 

and psychological injury will create a new wave of claims. Nearly a million claims now sit 

in the inventory. A great number of them will take years to resolve. The period of 
42

financial instability that often follows discharge from the military remains a time when 

veterans are at risk for homelessness or other serious or life threatening situations and 

challenges. A veteran with a catastrophic injury or disease is likely to be further 

encumbered with aspects of trauma associated with combat. Add to this the lingering 

effects of prolonged exposure to hostile enemy action, persistent feelings of imminent 

harm, survivor’s guilt, military-civilian transition obstacles, polytrauma associated with the 

uniquely devastating effects of combat injury, and the increasing statistics of suicides 

attempted and carried out.108

In March 2013, the Iraq and Afghanistan Veterans Association called for focus on 

veterans’ experiences as they relate to the VA claims backlog. The organization 

encouraged service members to “share your backlog stories” on a dedicated website 

(

 

http://iava.org/sth2013). The multiple medical conditions averaging 8.5 claimed by 

veterans who served in Iraq and Afghanistan reflect the increased complexity and time 

for administration. This figure contrasts with claims by veterans of earlier war eras. World 

War II veterans average 1 to 2 medical conditions; Vietnam veterans have 3 to 4; and 

Gulf War veterans report 9 to 11, increasing recently up to 15, even 20 or more for 

wounded, ill, and injured veterans.109

Through personal stories, veterans describe circumstances across different generations 

and warfronts, but with a central theme: The VA claims backlog has detrimental effects 

on the lives of many who have served the country and anticipate receiving VA benefits to 

help them overcome service-related life challenges.
43

SECTION 5. NCD RESEARCH METHODOLOGY AND RESULTS

Meaningful involvement of stakeholders, including veterans with disabilities in the 

process used to identify issues, concerns, and trends in the way that complex claims are 

managed, may help VA correct specific process vulnerabilities and provide more timely 

initial claims decisions. A four-phase exploratory process was utilized to: assess 

experiences of veterans with disabilities who endure delayed access to their earned 

entitlements; explore the factors that appear to contribute to the VA claims backlog; and 

examine whether these reasons can be generalized to the larger veteran population.

The phased inquiry was conducted using a stepped aggregate analysis:

Phase 1: Qualitative data was collected and analyzed.

Phase 2: Qualitative data was used to develop thematic codes.

Phase 3: A cohort design was developed using existing veterans’ database to 

examine similarity in apparent backlog factors. 

Phase 4: Findings that were interpreted as sources and strategies for data 

collection and evaluation include: (a) conducting a literature review to examine 

congressional testimony transcripts, official reports, media articles, commentaries, 

websites and blogs, and other materials related to the claims backlog and its 

consequences; (b) examining a primary-source electronic VSO database; and (c) 

conferring with key informants who also identified specific reports and related 

documents. 

Key Informants110

Information from semi-structured key informant telephone or in-person interviews present 

views of 12 subject-matter experts (see Appendix A) concerned with aspects of the 

claims process. These sources include leaders within VA, veteran advocates, 

government staff members, and service providers. In addition to the key informant 
44

interviews with subject-matter experts, informal interviews present the perspectives from 

10 veterans living with injuries or disabilities that have initial claims pending. The 

participants are among the people with information in the VSO database that this NCD 

investigation utilized. Table 1 provides a profile of the sample veteran population 

according to demographics of type of military service and combat era—including conflicts 

dating back to the Korean War, gender, and disability. 

Table 1. Demographics of Study

Descriptor Type Number

Military Service Reserve Component 5 

OEF/OIF 6 

Peacetime 1 

Vietnam 2

Korea 1 

Gender Men 6

Women 4 

Disability Category IED Blast/Polytrauma 2 

Neurodegenerative 2

Other 6 

Veteran participant identities are coded to ensure anonymity. Collectively, their stories 

exemplify the experiences of veterans with disabilities whose lives are compromised as 

they await a VA disability rating (see Appendix C).

NCD summarized the potential effectiveness of VA’s 21st Century Transformation Plan 

on the lives of veterans with disabilities and their families, and conducted a review of 

each initiative and its impact. A final task identified state and federal agencies, 

departments, and offices whose missions relate to the VA claims process and the 

backlog of initial claims. Among those entities, NCD examined the extent to which issues 

related to veterans with disabilities seeking benefits—including post-discharge support, 

barriers to economic self-sufficiency, and quality of family life—had been identified and 

addressed.
45

Data Collection and Analysis

The general process consisted of gathering new information and comparing that with 

existing data. The sources of information were: (1) the key informant qualitative data; (2) 

an existing VSO database used for quantitative data; and (3) data collected during 

interviews of veterans with disabilities.

Qualitative Data

Qualitative data was derived through interviews with key informants (See Appendix A for 

subject-matter experts and Appendix C for veterans with disabilities). Primary inclusion 

criteria for stakeholders considered individuals who have expert knowledge about and 

experience with the VA claims process, its history, its vulnerabilities, and current efforts 

to resolve the backlog. Selection also considered interviewees whose collective breadths 

of insight were likely to represent public policy perspectives (e.g., representatives of 

Congress and the US Senate, VA, a major VSO, DOD, and NGB). Additional 

considerations were given to open-ended guiding questions developed from a review of 

the literature on the VA claims backlog.

Interview Themes

VA’s claims-tracking system reveals several factors that contribute to delays in resolving 

complex initial claims. To quantify the qualitative data, the researcher used stakeholder 

interview information to develop themes. Each theme provided a qualitative category 

whose frequency of occurrence in the veteran interview population would formulate the 

criteria used to select quantitative data (identified from the VSO database). Thematic 

grouping allowed focus and identification of factors and consequences of the backlog. 

Codes were then developed to represent the identified themes and applied to the 

qualitative data. The thematic groupings of perceptions from the stakeholder interviews 

consist of seven major reasons for claim delays:

1. Evidence lost or misplaced by VA

2. Submission of additional evidence
46

3. Transfer of the claims file

4. VA’s need to wait for information from DOD 

5. Examinations requested by VA

6. No action taken

7. Other reasons

The analysis of the information included identifying the frequency of code occurrence 

and exploring complexities of meaning within the quantitative data set. The reliability of 

the analysis can be affected by the subjective definitions used to develop the thematic 

codes. This and the exploratory nature using open-ended inquiry, rather than an 

interview survey format, must be considered before implying broad generalization 

without further research.

Quantitative Data

Quantitative data was selected through the random sampling of specific types of pending 

initial, multi-issue claims contained in an existing PVA case management database. 

Selection was based on the date that the claim was filed and whether VA’s Modern 

Award Processing-Development (MAP-D) system contained enough accurate 

information on the status of the claim for consideration at key points in the process. The 

timeliness and accuracy factored into providing conclusive information that NCD could 

compare to the selectivity criteria (the seven coded reasons for claim delays) developed 

through the qualitative findings. The objective was to review information from veterans 

currently awaiting a decision on their VA disability claims and to determine whether there 

appeared to be convergence between what other stakeholders believe about the impact 

of the VA claims backlog and the perceptions of veterans who live with its 

consequences. The cohort-design dataset was drawn from a non-VA Case Management 

System (CMS) containing nearly 35,000 veterans, dependents, and survivors.111 These 

parameters were established for extrapolating the sample population from the CMS:

• Requisite privileged access to review the claim’s history.

• Claim was submitted for new service connection.
47

• Claim is currently unresolved and has been for more than 125 days.

• Claim was submitted between January 1, 2011 and December 31, 2011.112

Data Analysis

Using these criteria, 2,194 disability claims were identified that were filed for service 

connection. Of that number, 38 veterans had submitted claims in 2011 with eight or more 

disabilities (443 issues) that are still pending. The average number of issues per claim 

was 11, and claims with 8 issues were the most frequently submitted. The highest 

number of issues on any one claim was 28. The distribution of wartime eras—Gulf War 

18 percent, Vietnam War 16 percent, peacetime 11 percent, unknown 5 percent, and 

issues linked to the Global War on Terrorism zero percent—was determined to be 

acceptable as a representation of the distribution in the general veteran population.

To determine the suitability of the seven themes perceived as contributing to the backlog 

of complex initial claims, the codes were applied to the database. The status of each 

claim was reviewed in COVERS and MAP-D, and recorded. The outliers identified in the 

second phase of the study (e.g., VA claims with 20 or more issues) were helpful as they 

highlight the most serious vulnerabilities in the VA claims process; however, their 

characteristics were not generalized to the sample population given their relative 

infrequency. Based on this examination, determination was made about the extent to 

which the seven coded delay factors impacted the database sample population. 

Discussion and Conclusions 

A claimant alleges that VA letters are intimidating and may include 

unreasonable requests.... “If you don’t get the [requested] info your claim 

will be denied.” After receiving a 3-day advance notice to come for an exam 

in California, a veteran who lives in Phoenix, Arizona, believes failure to 

show would result in VA dropping the claim.

—Veteran’s Interview (Appendix C)
48

Information obtained through interviews with the veteran key informants confirmed the 

relevant contributing factors to the delays in processing claims. Reasons for delays 

focused on common themes. In descending order of frequency, the reasons for delay 

were attributed to these seven common themes:

1. Examinations requested by VA – Will a more efficient VA examination process, 

whether that entails scheduling fewer examinations or decreasing the wait time, 

have a significant impact on claim development and adjudication time? 

2. Submission of additional evidence – Stakeholders may underestimate the effect 

that submitting additional evidence has on the claim. It triggers inescapable 

requirements (per VCAA) on VA’s part to reconcile any new information that could 

be consequential to the claim’s outcome. In at least 30 percent of the veteran 

interviews, VA medical examinations played a role in the delay. In one instance, 

no medical exam had been conducted despite the claim being filed nearly three 

years earlier, in 2010.

3. Awaiting information transfer from DOD to VA – Anecdotally, service members 

shared during individual interviews a sense that their records were not being well 

managed—mostly based on lack of communication from VA or their units.

4. No action taken – This seems to reinforce notions of VA organizational culture, 

lacking resources, and stretched capacity. In one veteran’s case, her claim idled 

for three months simply because VA repeatedly switched claims-processing 

teams and reassigned her claim to different examiners. Examination of this factor 

may offer the most immediately applicable remedy.

5. Lost or misplaced evidence – Cases where the delay was attributed to claims 

evidence lost or misfiled occurred in less than 10 percent of those reviewed for 

this study, although the perception among the interviewed veterans suggests a 

higher incidence.

6. Other – Claims that fell in the “other” category reserved for causes beyond VA’s 

control, some caused by the veterans themselves, accounted for nearly 

15 percent of the delays. 

7. Transfer of claims files – This was the least common factor.
49

Based on the review of key informant interviews with veterans awaiting decisions, and 

analysis of the data, NCD’s findings suggest validation of common perceptions about VA 

delays in adjudicating claims—including perceptions among key informants and a 

veteran’s group. In identifying and highlighting the factors that are identified as 

contributors to the delays, and analyzing veteran perceptions, recommendations can be 

made to begin decreasing the 60 percent of the nearly 1 million backlogged claims. 

Considerations for initial steps toward ending the long-standing negative experience of 

veterans with disabilities in the delayed claims process might include highlighting the 

historical and current factors contributing to the delays, and raising public awareness 

about the personal costs to the veterans. Critical actions may call for investing in new 

solutions, focusing on and measuring outcomes, and sharing information with veterans 

and their families, using uncomplicated descriptive statistics and plain language. Their 

lives remain uncertain or compromised while they wait for determinations about benefit 

entitlements. As President Obama declared in his State of the Union message...

“We will keep faith with our veterans ... and giv[e] our veterans the benefits ... 

they have earned.”113

Doing so requires expedited actions. We can begin by agreeing on the factors 

contributing to the backlog and determining ways to prevent their reoccurrence. Finally, 

focus on providing all veterans with disabilities and their families the dignity and quality of 

life they deserve, and to which we, as a nation, committed. 

 

On June 4, 2013, a White House spokesperson stated that “President Barack Obama is 

‘deadly serious’ about wiping out the massive backlog in veterans’ disability benefits 

claims by 2015.”114
50
51

SECTION 6. SUMMARY FINDINGS AND RECOMMENDATIONS

Several causes of the VA claims backlog are broad and well documented, but the 

documentation often ignores the impact of process and procedure internal to VA on the 

timely adjudication of complex claims. The initial complex claims represent veterans who 

often present the most severe, cumulatively impacting, or life-altering disabilities. 

Evidence confirms that veterans with disabilities face sizable and systemic barriers to 

receiving benefits. Veterans encounter barriers particularly as they transition from 

military to civilian life. 

Examination of the VA claims backlog and the experiences of veterans with disabilities 

supports the need for recommendations to decrease backlogs and increase collaborative 

and innovative efforts to simplify and render the claims process more efficient, effective, 

and timely. A review of recent VA efforts to modernize the claims process and/or to 

collaborate with external stakeholders on these efforts demonstrates the potential to 

provide veterans with timely, accurate VA ratings that open access to other benefits. An 

analysis of state and federal action also reveals that the claims process can be 

improved. Suggested improvements and reforms create expectations and optimism that 

the nation can fulfill its promise to veterans with disabilities and their families by timely 

provision of benefits and entitlements they have earned.

As a major and overarching recommendation, NCD encourages collaboration among VA, 

DOD, other federal entities and VSOs to finalize and implement a streamlined, 

integrated, and centrally accessible electronic claims application and health records 

system. The system should be phased into operation for interagency use after 

comprehensive testing to modernize, streamline, and ensure that technological tools are 

utilized to address the existing backlog. To accomplish this goal, VA and affiliated 

agencies, with congressional support and oversight, must address identified problems in 

order to provide a superstructure of online, shared information and applications that will 

allow ease and efficiency in processing claims.
52

FINDING 1:

While the disability claims backlog remains within the VA’s domain of direct 

responsibility, resolving it requires a boost in coordination and collaboration among a 

number of federal agencies and non-governmental entities. VA and DOD share the 

responsibility of health care provision and record management, albeit at opposite ends of 

the military service spectrum. Limited accessibility and incompatible systems delay the 

exchange of records and information flow. As the foundation of VA collaboration with 

DOD to build a seamless health records system for service members and veterans, VA 

selected VistA, providing a core EHR System and an open, modular architecture 

supporting the integration of best-of-breed applications.

Recommendation 1

• DOD should adopt a data storage standard compatible with VA’s 

Veterans Health Information Systems and Technology Architecture 

(VistA) in order to ease the transfer (and shared use) of medical record 

information. DOD should be directed by the President or Congress to adopt 

the system as a first step toward record sharing.

FINDING 2: 

Veterans who seek help with filing claims often use accredited representatives at VSOs 

to help them navigate the application process. With permission of individual veterans, the 

representatives bear authority under Title 38 to access health records and other 

evidence on behalf of the veteran. Yet, pursuant to filing claims, the representatives are 

denied timely access to DOD records that are needed to substantiate disability claims.

Recommendation 2

• Congress should ensure that access to DOD’s Defense Personnel 

Records Information Retrieval System (DPRIS) is accessible to the Title 

38 accredited representatives who develop and submit claims on behalf 

of veterans (with appropriate privacy protections and veteran 

authorizations). In order to make fully developed claims the standard path to 
53

claims submission and timely adjudication, it is necessary to expand Title 38 

authority to include access to records under DOD’s control and, similar to 

Compensation and Pension Record Interchange (CAPRI), grant accredited 

representatives controlled access to DPRIS. 

FINDING 3:

The due process notices that VA sends to veterans under VCAA contribute to the 

backlog. Without plain language communication in the notices, veterans are not provided 

the necessary and consistent guidance to inform and assist interpretation of the federal 

requirements. VA’s letters often create confusion rather than inform veterans with 

disabilities who seek benefit determinations.

Recommendation 3

• Congress should revise VCAA for clarification on due process 

provisions, veterans’ rights to self-determination including control of 

claims, and the scope of VA’s obligation to develop timely and accurate 

benefit determinations. This revision should include language that 

outlines responsibilities for other federal agencies, including DOD and 

NGB, in support of VA claims development. VCAA letters to veterans and 

their families should be brief and clear, ensuring, if computer generated 

forms are used, standards for specificity are implemented to avoid 

confusion and delay.

FINDING 4:

Unfunded federal mandates erode VA’s capacity and exacerbate the current claims 

backlog. When a surge in service-connected disability claims can be anticipated because 

of federal mandates, there also should be an estimated increase in government 

operating expense. How will the cost be factored into the budget? What is the expected 

degradation in the current level of service that is being provided? The end of major 

combat operations and changes in federal legislation or regulation may trigger the need 

for funding actions.
54

Recommendation 4

• Federal agencies involved in the claims process should ensure that 

staffing levels are increased proportionately to manage higher demand 

and that mandates by Congress include an estimated increase in 

government operating expense. 

FINDING 5:

Unnecessary VA medical exams add substantial delays and factor into the VA claims 

backlog problem. In accordance with Title 38, Code of Federal Regulations, Section 

1.359(c)(4), VA will provide an examination when the claimant’s record does not contain 

“sufficient competent medical information to decide the claim.” However, too many 

examinations are unnecessarily ordered due to intensified quality review standards, and 

create excessive wait time in the claims development process. Follow-up examinations 

often are unnecessary and redundant because basic information is addressed in the 

initial examination. Even when examinations are warranted, too many are inadequate, 

resulting in (sometimes multiple) remands, greatly adding to the delay.

Recommendation 5

• VA should adopt the Acceptable Clinical Evidence (ACE) process for 

nationwide implementation. In order to improve the quality of exams, VA 

should ensure examining clinicians possess the requisite expertise to make 

proper assessments. When medical examinations are performed by the 

claimant’s VA primary care provider or a non-VA physician whose credentials 

can be independently verified, claims examiners should be required to apply 

38 CFR §1.359(c)(4). Through VBA, VA also should enforce the regulation that 

calls for ordering a VA examination only when the evidence of record or VA’s 

Compensation and Pension Records Interchange does not verify the existence 

or current level of disability. 
55

FINDING 6:

Current practice directs VA to obtain records in the custody of a federal department or 

agency and to submit as many requests as necessary to obtain relevant records for 

disability benefits claimants. Yet the slow pace of claims development is dictated by a 

lack of responsiveness on the part of external agencies that are responsible for storing 

health records or other military documents. Currently, it can take from several months to 

a year or longer to obtain some of these records. Often, several requests for the same 

information are made to the agencies without response. In some cases, after multiple 

requests and delays, VA is informed that the records are not available.

Recommendation 6

• Congress should ensure that federal agencies develop policies that 

make responding to VA requests for records a high priority and define a 

timetable for response that is monitored and enforced. The requirement 

should begin with DOD, NGB, and SSA, and include any other agencies that 

have records needed as evidence for disability claims applications. 

FINDING 7:

The Veterans Benefits Management System (VBMS) is anticipated to be vital technology 

for resolving the backlog in the near future. History demonstrates that the success of 

new technologies depends partially on continued development and adequate funding. 

The projected cost of VBMS development, sustainment, and deployment to all regional 

offices will be significant, including costs associated with future proofs of concept, 

operations, maintenance, and licenses to support VBA operations. The costs associated 

with VBMS reflect the complexity of the system development effort and scope of 

capabilities required to transform current paper-intensive processes to an electronic 

operating environment.

Recommendation 7

• Congress should provide adequate funding to finalize, implement, and 

maintain VBMS and supportive technologies.
56
57

APPENDIX A. STAKEHOLDER INTERVIEWS LIST

• Allison A. Hickey, Under Secretary for Benefits, Department of Veterans Affairs

• Tom Murphy, Director of Compensation and Pension Services, VBA

• Rob Reynolds, Director, Benefits Assistance Services, VBA

• Julie Carie, VSO Liaison, Benefits Assistance Services, VBA

• Garry J. Augustine, National Service Director, Disabled American Veterans

• Rory Riley, Staff Director and Counsel, House Committee on Veterans’ Affairs

• Brig. Gen. Carol Ann Fausone (ret), USAF, veteran advocate

• James G. Neighbors, SES, Executive Director, DOD/VA Collaboration Office, 

Office of the Deputy Under Secretary of Defense

• Dr. Rachel Mapes, Special Assistant for Policy, Planning and Evaluation, Office of 

the Deputy Under Secretary of Defense

• MSG Calvin T. Keller, National Guard Bureau, Headquarters

• MSG Josephine Keller, National Guard Bureau, Headquarters

• Marion Barry, Chief iPERMS Section, National Guard Bureau
58
59

APPENDIX B. IMPACT OF 2010 PTSD RULE CHANGE

PTSD—2010 RULE CHANGE

Year

Era of Service

(Number of Veterans)

WWII Korea Vietnam

Peacetime/

Other Gulf War TOTAL

2001 18,093 6,523 106,779 6,046 7,479 144,920

2002 21,295 8,020 126,542 7,123 9,262 172,242

2003 23,180 8,993 142,824 7,856 10,938 193,791

2004 24,587 10,016 161,000 8,733 13,519 217,855

2005 25,278 10,944 179,713 9,555 19,356 244,846

2006 24,926 11,382 193,112 10,162 27,465 267,047

2007 26,401 12,704 223,764 11,320 46,768 320,957

2008 24,145 12,381 229,682 11,792 66,758 344,758

2009 22,500 12,360 247,486 12,875 91,661 374,007

2010 20,898 12,516 268,865 14,577 120,454 437,310

2011 19,062 12,781 298,729 16,387 153,879 500,838

2012 17,295 12,790 326,110 19,081 196,760 572,036

Data provided by Performance Analysis and Integrity—Updated: 01/14/2013.
60
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APPENDIX C. VETERAN INTERVIEW NOTES 

Identifier: C5867 - Reserve Component, Staff Sergeant

• Served in Iraq, injured by IED blast in 2003 and suffered severe TBI 

• Filed a VA disability claim at the Atlanta VARO in June 2011

• While receiving treatment through a private care facility (Shephard), used exwife’s medical insurance to cover surgeries after initial separation

• Was reactivated in 2009 in order to undergo MEB process 

• Transition issues: Reserve pay and incapacitation pay delayed (still awaiting pay 

for 2012); believes paperwork that was submitted was simply thrown away 

• Filed 3 congressional complaints to no avail 

• Impact of having a long wait includes having to sell off furniture, endure effects of 

a poor economy, having half a chicken per day, divorce, no income because of 

delays in pay attributed to his reserve unit 

• Assisted by a Recovery Care Coordinator, found relief through the SHARE 

initiative program that he heard about through Tricare Reserve 

• Experienced PEB delay for 3 years, finally completed December 2012

Identifier: G8459 - US Army Reserve Component, Sergeant

• Served in Afghanistan from April 2009 to April 2010, injured by IED blast in 

August 2009, diagnosed with TBI, treated at private care facility (Shephard), and 

required two surgeries

• Was still on medical hold, but filed original disability claim in Atlanta two and a half 

years before this interview

• Transition issues: Family concerns since remarried after injury, has five kids and 

lives on military pay and spouse’s income; suffers cognitive deficiencies; fighting 

legal battle over child support; and is looking for work related to his military 

experience. A concern is that his Tricare entitlement will be cut while waiting for 

VA claim to be processed. This would leave him without health insurance. 
62

• Impact of having to wait includes dealing with everyday issues related to caring for 

his family of seven; believes “life just isn’t what it used to be before;” unable to 

return to same job at cable company for which he worked before deployment. 

Stated that “Military doesn’t pay as well as a cable maintenance tech” and 

expressed fear that “Uncle Sam is gonna screw me over.”

Identifier: R2611 - Vietnam-era veteran in US Navy

• During time in the Navy, service was on a submarine; left military service in 1974

• Filed original claim after leaving military service 

• Worked 23 years in the medical industry as a therapist. Slow deterioration of 

hearing led to retirement 

• Submitted claim for VA disability for hearing loss, tinnitus, and IU in Oklahoma 

2 years before interview, but claim was still pending

• Transition issues: A concern is that veterans who live in small rural area, many 

didn’t ask for a lot, are receiving less as they age, afraid government will simply 

“turn its back on us because we didn’t file earlier.” 

• Impact of having a long wait: Lost $55,000 a year in having to take early 

retirement, had no choice but to retire, tried to go back to work, needs income to 

maintain modest standard of living for him and his wife 

• Veteran was unaware of programs like VRAP

Identifier: M5896 - Korean War-era veteran

• Served from 1952 to 1954 

• Was suffering from ALS at time of the interview

• Filed a claim for presumptive service connection in Indianapolis in 2011, which 

still was pending 

• Reportedly receiving excellent medical care for his condition 
63

• Believes he might be assigned to wrong Priority Group (7), while eligible for 

Priority Group 4 based on catastrophic disability thus no co-pays (He needs 

evaluation). VA decision could give him even higher priority. 

• Transition issues: Believes a decision would “take a lot of worry” out of his 

situation

(Note: VSO interviewer checked SHARE, MAP-D, and COVERS, discovered that the 

claims folder was sitting in the file bank, contacted the coach of the team that rates 

ALS cases, and requested expedited handling)

Identifier: L6214 - Army Reservist

• Served since 2000 - active from 2000 to 2004, deployed to Iraq from 2004 to 

2005, mobilized from 2006 to 2008

• Filed VA disability claim for multiple sclerosis in Indianapolis in July 2011. 

Currently the veteran is in Troop Program Unit status. 

• Transition issues: Requested PEB but believes unit is avoiding the process. 

Currently within 5-year eligibility period for VA health care entitlement based on 

OIF service but concerned her claim won’t be decided before the eligibility period 

ends, leaving her to pay for her medications. She submitted her service medical 

records to VA after filing claim. VA reportedly lost her records and failed to update 

her change of address. Army boxed up all documents and sent them to a 

contractor, and denied her access because it was considered government 

property; she was instructed to go through her unit to obtain records, but veteran 

doesn’t have the required level of access and had to send an e-mail. 

• Impact of having to wait: She is the sole income earner in her family in a high cost 

of living area. Usual bills (gas, car payment, rent, etc.). Believes her professional 

career is jeopardized by her condition and fears future inability to pay for 

medications. Doesn’t know how she’ll maintain her standard of living. 

• Wants government to recognize that “we’re still at war” and service members get 

“trapped in the system” between not getting an LOD and not getting discharged. 

She wants to just carry on with life, but it takes over a year “just to get my 
64

records.” A review of her claim in MAP-D revealed that her case has been 

brokered to Cleveland and VA requested service records from her reserve unit. 

The delay is apparently attributed to the Reserve Unit at this point.

Identifier: Y6526 - US Army Service Member

• Served from 2000 to 2005. Suffered TBI and PTSD in Iraq after a suicide bombing 

in October 2003; endured losing her commander and having several comrades 

killed in firefight, December 2003 in Karbala. 

• Submitted VA claim for Gulf War illness in January 2011 after law changed. Filed 

claim in Wilmington, which was subsequently sent to Indianapolis. A claim has 

been pending for 2 years, although she received a partial rating in July 2012 due 

to her persistence. This helped quell her anxiety a bit but she was later 

disheartened after discovery of a processing error, which was denied. Upon 

inquiry, it was discovered that system screens were not updated and her claim sat 

for 6 months. Data was not input and veteran still is awaiting exam results. CAPRI 

showed exams were completed and forwarded but no one associated exams with 

claims file until the veteran persuaded a senior-level person to look into it, after 

which there were 15 updates added in January 2013. She believes this added at 

least a year to the claim delay. She also discovered through conversations with a 

VSR that her claim had sat for 3 months due to 3–4 “team swaps” and “other 

priorities.” Her claim then awaited secondary authorization until it was sent back 

for records gathering although the information sought was already of record. 

• Transition issues: She believes the VA examiner missed several issues and was 

unqualified to conduct an adequate exam. Veteran said of the process: “I just 

want this to be over. It’s causing my PTSD to get worse and adding to my stress 

and anxiety.” Has husband in service and two small children, 8 and 5. Alone 

during “out processing” because her unit was deployed during her pregnancy, did 

not know about her full benefits. Didn’t know she had a TBI (symptoms had been 

attributed to pregnancy). Has a one-income family. Fears stigma of being female 
65

and having her combat experience ignored. Believes it was a factor in her past 

claim problems. 

• Impact of having to wait: Veteran could not continue career as civilian police 

officer, tried to go back to school but has been limited because of memory and 

related cognitive issues.

Identifier: G5430 - US Air Force

• A Major for 18.5 years, both active and reserve duty, the veteran served as a flight 

nurse in Iraq. Was in her 50s when deployed. Medically retired due to injuries 

suffered in Iraq following a 2-year MED board process in which her commander 

harassed her. She filed a claim for VA disability in California, which was later 

changed to Arizona after the veteran moved. Claim has been pending for 2 years 

and she is deeming it a “real mess.” Veteran inquired into claim status after 

hearing nothing from VA for approximately 4–6 months, triggered by a chance 

meeting with a VA official at an orientation event. 

• Transition issues: She believes VA letters are intimidating because “they sound as 

if you don’t get [obtain and provide] the info, your claim will be denied.” She 

reportedly received cold calls from VA informing her of scheduled exams in 

California (she lives in Phoenix) for appointments occurring 2 days after 

Christmas with 3 days of notice. Believes her failure to show would result in 

dropped claim. Regarding TAP training, she believes “they” make the VAS sound 

like it’s the military and they’ll take care of everything.

• Impact of having to wait: Has anxiety about budget cuts, has friends who lost their 

benefits. She went from making six figures to 0 for a year. Reportedly “put 

everything on credit card and lived poorly” during that period.

Identifier: A4859 - Iraq & Afghanistan Reservist 

• Veteran is currently an active reservist who served in Afghanistan and Iraq. Filed 

a claim in San Diego in September 2011 and is undergoing PEB process.
66

• Transition issues: Faces uncertainty about his continued reserve component 

service and when he will be discharged; has 3 children and a wife; is worried 

about making his house payment. He heard that the VA disability claim process 

will take over a year or two. Plans to rely on savings and GI Bill stipend, but only 

has 6 months of entitlement remaining. Spouse works but doesn’t make enough. 

Veteran believes “people aren’t hiring vets with specialized skills.” He has 

attended job fairs and employment workshops. Feels the economy is causing the 

backlog of claims. (Note: Interviewer will send Veteran Skills Jobs Act info)

Identifier: K4503 - Vietnam

• After serving during the Vietnam era, he filed a claim in January 2011 in 

Indianapolis, which was subsequently sent to Cleveland. Claim is for the effects of 

an ischemic heart disease due to Agent Orange exposure. Veteran learned about 

liberalizing legislation by reading the Agent Orange Review publication. Became 

paralyzed during an accident in 2002, no longer employed. Wants VA to “keep 

vets wholly informed more about what’s going on.” 

• Impact of having to wait: He said waiting has caused him anxiety, heard from VA 

only once in 2011. It was the only time he heard from them in any respect.

Identifier: E5772 - US Army 

• Veteran served in the US Army from 1980 to 84 and from 1984 to 85 (Peacetime 

era). She filed a VA disability claim for MS and musculoskeletal conditions in 

August 2011 originally in North Port, Florida, which was moved to St. Petersburg.

• Transition issues: She worked for a temp agency following discharge from military 

service. After childbirth in 1992, she started having health problems. Has been 

unemployed since 2003 and believes she received bad information about getting 

both VA and SSDI, however, she has received better health care once she 

switched to the VA Women’s Clinic. Hasn’t had a VA exam yet. 

• Impact of having to wait: Needs dental services but cannot receive until rated. 

Veteran drives a 14-year-old car that badly needs repairs, but she has no extra 
67

money to “keep it up.” Mental challenges have worsened the whole situation. She 

reports not getting any answers from VA, unable to challenge disagreements or 

show records. She does not know which records VA has or if they even have 

records. Reportedly she never asked for the records. “I wish the VA system would 

update their help to veterans; OEF/OIF veterans get everything. Us older veterans 

... they won’t give us older veterans anything.”
68
69

ENDNOTES 

1. Ledyard King, “House VA Chair Wants to Cut Claims Backlog,” 

AirForceTimes.com, accessed February 15, 2013, 

http://www.airforcetimes.com/news/2013/02/

gnt-house-va-chair-wants-claims-backlog-020813/. 

2. Witness Testimony, Department of Veterans Affairs Under Secretary for 

Benefits Allison Hickey, “VA Claims Process: Review of VA’s Transformation Efforts,”

House Committee on Veterans Affairs, March 13, 2013, 

http://www.veterans.senate.gov/hearings.cfm?action=release.display&release_id=5e82b

bf7-0117-4a19-8255-ea38ec8513a7. 

3. Veterans for Common Sense v. Shinseki, http://cdn.ca9.uscourts.gov/datastore/

opinions/2011/07/12/08-16728.pdf. 

4. Due process in the administration of VA benefits informs the beneficiary of a 

proposed adverse action that could reduce or terminate benefits, and provides the 

beneficiary with the opportunity to provide additional evidence to contest the action, 

and/or hold a hearing before VA decision makers. US Department of Veterans Affairs, 

“Veterans Benefits Administration References Web Automated Reference Material 

System,” Part 1. Claimants’ Rights and Responsibilities, Chapter 2. Due Process, 

http://www.benefits.va.gov/warms/M21_1MR.asp.

5. Bill Briggs, “Military Suicide Rate Hit Record in 2012,” NBC News.com, January 

14, 2013, accessed March 27, 2013,

http://usnews.nbcnews.com/_news/2013/01/14/16510852-military-suicide-rate-hit-recordhigh-in-2012?lite. 

6. Chris Adams, “VA Claims-Processing Delays Hit 20-Year High,” McClatchyTribune News Service, November 30, 2012, accessed December 26, 2012, 

http://www.military.com/daily-news/2012/11/30/va-claims-processing-delays-hit-20-yearhigh.html. 

7. Of the more than a half million disability compensation claims that are older 

than 125 days, about 60 percent are claims for increased entitlement based on an 

additional or higher level of disability submitted by claimants already receiving benefits. 

Veterans Benefits Administration Monday Morning Workload Reports, December 29, 

2012, accessed January 15, 2013, http://www.vba.va.gov/REPORTS/mmwr/index.asp. 

8. Veterans Benefits Administration Monday Morning Workload Reports, June 22, 

2013, accessed July 3, 2013, 

http://www.vba.va.gov/REPORTS/mmwr/index.asp#characteristics. 
70

9. Id.

10. Responses to VA blog entry “VA Expediting Claims Decisions for Veterans 

Waiting a Year or More,” Vantage Point—Dispatches from the U.S. Department of 

Veterans Affairs Blog, posted April 19, 2013, http://www.blogs.va.gov/VAntage/9217/vaexpediting-claims-decisions-for-veterans-waiting-a-year-or-more/. 

11. Currently, every VA claim that is pending comprises the “Compensation and 

Pension (C&P) Rating Bundle,” as reported in the Veteran Benefits Administration

Monday Morning Workload Reports. The C&P Rating Bundle, also known as the claims 

inventory, also consists of all claims pending longer than 125 days, this constituting the 

actual backlog. As of March 30, 2013, the entire claims inventory totaled 850,395 claims, 

of which 588,248 are considered backlogged claims. 2nd Quarter, April 1, 2013, 

accessed April 18, 2013, http://www.vba.va.gov/REPORTS/mmwr/index.asp.

12. A key informant list is included at the end of this paper.

13. Abraham Lincoln, (Second Inaugural Address; endorsed by Lincoln, April 10, 

1865), accessed January 5, 2013, Abraham Lincoln Papers at the Library of Congress,

http://memory.loc.gov/ammem/alhtml/malhome.html. 

14. The US Department of Veterans Affairs (VA) was established on March 15, 

1989, succeeding the agency called Veterans Administration.

15. Henderson v. Shinseki, 131 S. Ct. 1197, 1204 (2011).

16. Veterans Law Library, “Articles on Veterans Law,” accessed August 17, 2013, 

http://www.veteranslawlibrary.com/Article_Index.html. 

17. Phone interview, February 7, 2013. 

18. Phone interview, February 12, 2013.

19. Interview with VBA staff, February 4, 2013.

20. Statement of Michael Walcoff, Associate Deputy Under Secretary for Field 

Operations Veterans Benefits Administration before The House Committee On Veterans’ 

Affairs, Subcommittee on Disability Assistance And Memorial Affairs, “Personal Cost of 

the Claims Backlog: Growth of Disability Claims Workload,” October 8, 2007, 

http://www.va.gov/OCA/testimony/hvac/sdama/071009MW.asp. 

21. VetLawyers, “VA Claims Backlog Hits Record 1.1 Million: Bergmann & Moore 

Testify at April 18 Congressional Hearing,” accessed August 18, 2013,

http://www.vetlawyers.com/va-claims-backlog-hits-record-1-1-million-bergmann-mooretestify-at-april-18-congressional-hearing/. 
71

22. Veteran Benefits Administration Monday Morning Workload Reports, supra 5.

23. “Compensation and Pension Rating Bundle,” Veterans Benefits Administration 

Monday Morning Workload Reports, June 22, 2013, accessed July 3, 2013, 

http://www.vba.va.gov/REPORTS/mmwr/index.asp. 

24. Government Printing Office, “Veterans Claims Assistance Act of 2000,” 

accessed December 27, 2012, http://www.gpo.gov/fdsys/pkg/PLAW106publ475/pdf/PLAW-106publ475.pdf. 

25. US Department of Veterans Affairs Strategic Plan Refresh 2011–2015, supra 

15.

26. Id.

27. US Government Accountability Office, “Veterans’ Benefits: Despite Recent 

Improvements, Meeting Claims Processing Goals Will Be Challenging,” GAO-02-645T, 

April 26, 2002, accessed January 27, 2013, http://www.gao.gov/assets/110/109296.html. 

28. “VA Publishes the Retroactive Benefit Rules for Agent Orange Claims 

Required by the Nehmer Court Order,” USVeteransCompensationProgram.com, 

accessed December 27, 2012, http://www.veteranprograms.com/id1748.html. 

29. Phone interview, February 7, 2013.

30. US Department of Veterans Affairs, Veterans Benefits Administration,

“Questions and Answers on the New Post-Traumatic Stress Disorder (PTSD) 

Regulations,” accessed January 25, 2013, http://www.vba.va.gov/VBA/ptsd.asp. 

31. Email from VBA Liaison Julie Carie dated February 5, 2013.

32. Witness Testimony of Gen. Allison Hickey, Under Secretary for Benefits, US

Department of Veterans Affairs, “Reclaiming the Process: Examining the VBA Claims 

Transformation Plan as a Means to Effectively Serve our Veterans,” June 19, 2012, 

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33. AL.com Alabama (Jon Solomon), “America’s Newest Veterans Claim to Be 

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34. For every US soldier killed in World Wars I and II, there were 1.7 soldiers

wounded. As of June 1, 2013, in Operation Iraqi Freedom and Operation Enduring

Freedom, for every US soldier killed, seven are wounded. Combined, over 48,000

servicemen and women have been physically injured in the recent military conflicts. 

http://www.woundedwarriorproject.org/mission/who-we-serve.aspx.
72

35. “Hearing Before the Committee on Veterans’ Affairs United States Senate,” 

One Hundred Twelfth Congress First Session Together With Additional Statements 

Submitted for the Record, March 2, 2011.

36. Progress update during VA presentation by Under Secretary of BenefitsVeteran Service Organization Quarterly Meeting, October 11, 2012.

37. Id.

38. Steve Vogel, “Veterans in Maryland Seeking Disability Benefits Can Face a 

Perilous Wait,” The Washington Post, February 3, 2013, accessed February 4, 2013, 

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6fc488f3fecd_story_1.html. 

39. Id.

40. Id.

41. Meeting on February 14, 2013, at VA Central Office attended by VBA Under 

Secretary Allison Hickey and Big 6 Veteran Service Organizations.

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March 31, 2013, 

http://www.va.gov/budget/docs/summary/Fy2013_Fast_Facts_VAs_Budget_Highlights.p

df. 

43. Committee on Veterans’ Affairs, United States Senate, “Veterans’ Disability 

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44. Interview, supra 10.

45. VA Office of the Inspector General, “Audit of VA Incomplete Compensation 

and Pension Medical Examinations,” June 25, 2009, accessed May 23, 2013, 

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46. Interview, supra 20.

47. US Department of Veterans Affairs, “Disability Claims Initiative Reduces 

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73

48. Statement of Linda A. Halliday, Assistant Inspector General for Audits and 

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49. Id.

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52. Id.

53. Annual Report of the Disabled American Veterans National Legislative 

Department, Joseph Violante, National Legislative Director, accessed on January 23, 

2013, http://www.dav.org/voters/documents/AnnualReport.pdf. 

54. Statement of Joseph Violante, National Legislative Director, Disabled 

American Veterans, “VA Claims Process—A Review of VA’s Transformation Efforts,” 

Senate Committee on Veterans’ Affairs, March 13, 2013, http://www.dav.org/wpcontent/uploads/Violante20130313.pdf. 

55. Patricia Kime, “DOD Chastised for Role in VA Claims,” Military Times, April 

16, 2013, http://www.militarytimes.com/article/20130416/BENEFITS04/304160024/DoDchastised-role-VA-claims-backlog. 

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2012, http://www.gpo.gov/fdsys/pkg/PLAW-110publ389/pdf/PLAW-110publ389.pdf. 
74

60. Thorn Wilborn, “Fully Developed Claims Partnership Works,” DAV.org News,

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https://www.dav.org/news/NewsArticle.aspx?ID=556. 

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63. Email from VBA Liaison Julie Carie dated February 11, 2013.

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65. Id.

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67. Id.

68. Stakeholder phone interview, February 1, 2013. 

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70. Id.

71. US Department of Veteran’s Affairs, VA Office of Inspector General, Office of 

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241.pdfhttp://www.va.gov/oig/pubs/sars/VAOIG-SAR-2012-2.pdf. 
75

72. “Audit of Veterans Benefits Administration’s Control of Veterans Claims 

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80. Id.
76

81. H.R. 5881: Access to Veterans Benefits Improvement Act (Introduced in House 

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85. Id.

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88. Id.

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90. Leo Shane, “VA Unveils New Process to Eliminate Backlog Critics Await

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91. Id.

92. Id. 
77

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96. Id. 

97. US Government Accountability Office, “Improved Monitoring Needed to Better 

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98. Id. 

99. US Government Accountability Office, “Military Disability System: Preliminary 

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100. Id. 

101. Id. 

102. Congressional Records Service Report to Congress, “National Guard 

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103. Id.

104. Interview, supra 11.

105. Witness Testimony of Mr. James Neighbors, Director of DOD/VA 

Collaboration Office, “Wading through Warehouses of Paper: The Challenges of 

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System,” February 6, 2013, accessed February 21, 2013, 
78

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committee-leaders-fault-va-and-dod-on-integrated-health. 

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110. Key informants were stakeholders identified in this section of the paper. They 

include non-veterans and veterans.

111. CMS database, Paralyzed Veterans of America, accessed February 8, 2013.

112. The claims backlog surged in 2011, making these claims the most 

significantly impacted. 

113. President Barack Obama, State of the Union Address, February 11, 2013.

114. Olivier Knox, White House Correspondent, Yahoo! News, “Obama ‘deadly 

serious’ about shrinking veterans benefits backlog: Aide,” June 4, 2013, accessed 

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