U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office,

http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,

U.S. Government Printing Office. Phone 202–512–1800, or 866–512–1800 (toll-free). E-mail, gpo@custhelp.com.

57–021 2010

QUALITY VS. QUANTITY: EXAMINING THE 

VETERANS BENEFITS ADMINISTRATION’S 

EMPLOYEE WORK CREDIT AND 

MANAGEMENT SYSTEMS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND 

MEMORIAL AFFAIRS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

MAY 6, 2010 

Serial No. 111–77 

Printed for the use of the Committee on Veterans’ Affairs 

( 


anorris on DSK5R6SHH1PROD with HEARING
ii 

COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

ANN KIRKPATRICK, Arizona 

GLENN C. NYE, Virginia 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

DAVID P. ROE, Tennessee 

MALCOM A. SHORTER, Staff Director 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS 

JOHN J. HALL, New York, Chairman 

DEBORAH L. HALVORSON, Illinois 

JOE DONNELLY, Indiana 

CIRO D. RODRIGUEZ, Texas 

ANN KIRKPATRICK, Arizona 

DOUG LAMBORN, Colorado, Ranking 

JEFF MILLER, Florida 

BRIAN P. BILBRAY, California 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


anorris on DSK5R6SHH1PROD with HEARING
iii 

C O N T E N T S 

May 6, 2010 

Page 

Quality vs. Quantity: Examining the Veterans Benefits Administration’s 

Employee Work Credit and Management Systems ........................................... 1 

OPENING STATEMENTS 

Chairman John J. Hall ............................................................................................ 1 

Prepared statement of Chairman Hall ........................................................... 30 

Hon. Doug Lamborn, Ranking Republican Member ............................................. 3 

Prepared statement of Congressman Lamborn .............................................. 31 

WITNESSES 

U.S. Department of Veterans Affairs, Diana M. Rubens, Associate Deputy 

Under Secretary for Field Operations, Veterans Benefits Administration ..... 21 

Prepared statement of Ms. Rubens ................................................................. 53 

American Federation of Government Employees (AFL–CIO), and AFGE National Veterans Affairs Council, Jimmy F. Sims, Jr., Shop Steward, Local 

1738, and Rating Veterans Service Representative, Winston-Salem, NC, 

Regional Office, Veterans Benefits Administration .......................................... 14 

Prepared statement of Mr. Sims ..................................................................... 51 

American Legion, Ian C. de Planque, Deputy Director, Veterans Affairs and 

Rehabilitation Commission ................................................................................. 12 

Prepared statement of Mr. de Planque ........................................................... 48 

CNA, Institute for Public Research, Eric Christensen, Managing Director 

of Health Research Policy .................................................................................... 3 

Prepared statement of Mr. Christensen ......................................................... 31 

Disabled American Veterans, John L. Wilson, Assistant National Legislative 

Director ................................................................................................................. 10 

Prepared statement of Mr. Wilson .................................................................. 45 

National Organization of Veterans’ Advocates, Inc., Richard Paul Cohen, Executive Director .................................................................................................... 7 

Prepared statement of Mr. Cohen ................................................................... 38 

National Veterans Legal Services Program, Ronald B. Abrams, Joint Executive Director .......................................................................................................... 8 

Prepared statement of Mr. Abrams ................................................................ 40 

Veterans of Foreign Wars of the United States, James D. Wear, Assistant 

Director, National Veterans Service ................................................................... 9 

Prepared statement of Mr. Wear .................................................................... 43 


anorris on DSK5R6SHH1PROD with HEARING

anorris on DSK5R6SHH1PROD with HEARING
(1) 

QUALITY VS. QUANTITY: EXAMINING THE 

VETERANS BENEFITS ADMINISTRATION’S 

EMPLOYEE WORK CREDIT AND 

MANAGEMENT SYSTEMS 

THURSDAY, MAY 6, 2010 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL

AFFAIRS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 2:00 p.m., in Room 

334, Cannon House Office Building, Hon. John J. Hall [Chairman 

of the Subcommittee] presiding. 

Present: Representatives Hall, Donnelly, and Lamborn. 

OPENING STATEMENT OF CHAIRMAN HALL 

Mr. HALL. Good afternoon. The House Committee on Veterans’ 

Affairs, Subcommittee on Disability Assistance and Memorial Affairs, will come to order for our hearing. 

Quality vs. Quantity: Examining the Veterans Benefits Administration’s (VBA’s) Employee Work Credit and Management Systems 

is the theme today, and I would start by asking us all to rise for 

the pledge of allegiance. Flags are at both ends of the room. 

[Pledge of Allegiance.] 

Thank you, and welcome to today’s hearing that is entitled, 

‘‘Quality vs. Quantity: Examining the Veterans Benefits Administration’s Work Credit and Management Systems.’’ 

The purpose is to examine how VBA’s employee work credit system and its claims processing improvement work management system model may contribute to diminished quality, accountability, 

and accuracy in compensation and pension claims processing. 

Today’s hearing continues this Subcommittee’s efforts to analyze 

various elements of the compensation and pension claims process 

over the 111th Congress and marks our fifth oversight examination 

this year focused on ensuring that our veterans and survivors properly receive their benefits. It is our collective quest to vanquish 

VBA’s backlog of claims and appeals, which currently exceeds 1 

million. 

We also intended for today’s hearing to provide an opportunity 

to examine a Congressionally mandated report on the VBA’s work 

and management systems outlined in legislation that was developed by me and other Members of this Committee during the 110th 

Congress, the Veterans Disability Benefits Claims Modernization 


anorris on DSK5R6SHH1PROD with HEARING
2 

Act of 2008, H.R. 5892, codified in Public Law 110–389. The goal 

of this legislation, among other things, was to provide VBA with a 

valuable road map to assess and improve its work credit and management systems to produce better claims outcomes for our veterans. 

The deadline for this report was October 31, 2009, and I note 

that we have yet to receive it. However, the VA has authorized an 

independent research contractor that was retained to complete this 

report, the Center for Naval Analysis (CNA), to testify before us 

today concerning a summary of the report’s findings and recommendations, the Cliff Notes version of the report, I guess. The 

U.S. Department of Veterans Affairs (VA) advised the Subcommittee that the report is still under review by the agency and 

Office of Management and Budget (OMB) and should be submitted 

to Congress soon. 

We look forward to hearing today when the report will be ready 

and submitted to Congress and to getting a better understanding 

of why it has not yet been delivered. 

Since 2007, the VBA has added over 7,100 claims processing personnel; and Congress has funded these requests. Yet the backlog 

still climbs. This is not to say that adding additional workforce has 

not been beneficial. Had Congress not provided these new claims 

processors, the backlog might be much worse than it is today, given 

the exponential growth in claims receipts. 

As the VA itself acknowledged during Chairman Filner’s Claims 

Roundtable in March, this is a sign of a broken system. The mounting claims backlog is a symptom that cannot be addressed until the 

VA refocuses itself on adjudicating claims correctly the first time. 

We need to continue to look at the system with fresh eyes and determine how a new outlook can help VA fix its claims processing 

system and get the backlog under control. 

In convening today’s hearing, the Subcommittee seeks to further 

explore how the VBA work credit incentives and the flawed Claims 

Process Improvement (CPI) Model might be contributing to delays 

and errors in the claims process. It is my hope that we will—in 

continuing to examine this issue—be able to help veterans secure 

the benefits they deserve and prevent them from suffering further 

injury as a result of delays in receiving disability benefits. 

That is why I want to revisit the issue of partial, provisional, and 

temporary ratings. I believe that if the VA increases the use of this 

authority and also awards a credit to claims processing personnel 

who use it, it will go a long way in making sure that more veterans 

can begin to receive their benefits more promptly. I would like the 

VA to address this issue when it testifies. 

Today, we will also hear from veterans service organizations 

(VSOs) and advocacy groups who will explain their vision for how 

the VA should address this problem. From them, I know we can 

get a better understanding of the underlying issues that led to such 

an unmanageable backlog at VBA, as well as if they believe that 

the efforts of the VA are in the right direction regarding this issue. 

Specifically, I would like to know if the VSOs and advocacy groups 

agree with VBA’s assertion that it emphasizes quality on a par 

with quantity and timeliness. 


anorris on DSK5R6SHH1PROD with HEARING
3 

I look forward to your testimony and insightful comments and 

questions from my colleagues, and I would recognize Ranking 

Member Lamborn for his opening statement. 

[The prepared statement of Chairman Hall appears on p. 30.] 

OPENING STATEMENT OF HON. DOUG LAMBORN 

Mr. LAMBORN. Thank you, Mr. Chairman, and I look forward 

also to this afternoon’s hearing on VA’s work credit system. 

The purpose of this discussion is to ascertain whether proper performance measures are in place to effectively gauge both efficiency 

and accuracy of work. A system that rewards work credits based 

on production alone undermines quality; and, as we all know, poor 

quality work has ramifications throughout the entire system that 

has contributed to the backlog of claims. At the same time, there 

is also clearly a need for VA to maintain a high level of efficiency 

so that veterans can be receiving compensation in a timely manner. 

Where does the proper balance lie? True quality means being effective and efficient. The key to achieving this balance lies in how 

employees are rewarded for the work they accomplish. For too long, 

it appears that VA has placed too high an incentive on production, 

but it is simply counterproductive to strive for high numbers if the 

work has to be revisited at a later time. Yet, it would be equally 

detrimental to veterans if there was an overemphasis on quality 

and the average handle time was off the charts. 

This Subcommittee passed legislation during the past session to 

obtain a study of the effectiveness of the VA’s employee work credit 

and work management system. From this, we hope VA will be able 

to develop a more effective means of improving its claims processing performance. I look forward to working with my colleagues 

and Department officials to delve into this issue and hopefully 

identify how the work credit system can help incentivize the proper 

balance between quality and quantity. 

I want to thank the witnesses in advance for their participation 

and their testimony, and I look forward to our discussion today. 

Mr. Chairman, I yield back. 

[The prepared statement of Congressman Lamborn appears on 

p. 31.] 

Mr. HALL. We just had a vote call, but I would like to move 

ahead with our first witness, and then we will have to break so we 

can go across the street and vote and ask the rest of you to be patient, as you always are. 

So we will first welcome Eric Christensen on our first panel, the 

Managing Director, Institute for Public Research, CNA. 

Your full statement is entered in the record, sir and you are now 

recognized. 

STATEMENT OF ERIC CHRISTENSEN, MANAGING DIRECTOR 

OF HEALTH RESEARCH POLICY, INSTITUTE FOR PUBLIC RESEARCH, CNA 

Mr. CHRISTENSEN. Thank you, Mr. Chairman, distinguished 

Members. I appreciate the opportunity to testify before you today 

on the subject of VBA’s work credit and work management systems. 


anorris on DSK5R6SHH1PROD with HEARING
4 

As you said, I am Eric Christensen, Managing Director of Health 

Research and Policy at CNA. CNA is a non-profit firm that provides independent objective analysis to various government agencies. 

CNA conducted its analysis of the work credit and work measurement systems between March and September of 2009. We interviewed over 100 VBA employees at six regional offices (ROs) to understand the issues, complexities, and incentives associated with 

these systems. We note that VBA works in a challenging environment. The number of compensation claims submitted each year increased by 53 percent between fiscal years 1999 and 2008. At the 

same time, the complexity of claims has also increased. 

There are three principal concerns about the current employee 

work credit system: one, that it emphasizes quantity over quality; 

two, that production standards are not based on a careful analysis 

of the task performed; and, three, that work credits and production 

standards do not reflect changes in claim complexity and additional 

duties imposed by legislation. 

Our study confirmed that employees perceive that quantity is 

emphasized over quality, as well as confirmed the other two concerns. 

To address these concerns, we recommended that VBA redefine 

the work credits so that work credits account for claim characteristics that are correlated with the amount of work required. For example, accounting for the number of issues and types of medical 

conditions would likely be important to accurately reflect the work 

credits on a claim. 

Further, we recommended that VA consider two options or 

frameworks when redefining work credits. The first is to give work 

credits for only the following broad groups: one, initiating development; two, making a claim ready to rate; three, deciding an award; 

and, four, authorizing the award. This was the recommendation of 

a VA work group. At the time of our report, VA was preparing to 

pilot test this approach at multiple sites. 

The second option is to base work credits on a comprehensive, 

detailed list of all individual activities that employees perform. 

As for quality, we recommended that VA conduct more quality 

reviews to better communicate quality as a priority. Similarly, we 

recommended that, on internal quality reviews, VA consider deviations from official procedures for claiming work credits as errors 

rather than as comments. Further, we recommended that there 

would be work credit deductions for actions with errors. 

Turning to VBA’s work management system, the concern is that 

quality and accountability are lacking, because many different people are involved in processing each claim under the Claims Process 

Improvement, or CPI, Model. 

Note that the CPI Model is not VBA’s first effort to manage 

claims processing by dividing it into separate stages and passing 

a claim through a series of people. In the 1990s, VBA used a similar model called the unit model. In the late 1990s, there was an 

effort to address these challenges of the unit model. These challenges were lack of individual accountability and an emphasis on 

quantity over quality. The solution was a case management model 

in which each case was handled by one veterans service representVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
5 

ative (VSR) and one rater. VBA used this model until it adopted 

the CPI model in response to concerns about problems with timeliness. 

At the time of our report, VBA was conducting a pilot study in 

the Little Rock regional office. The key element to this pilot is processing claims that contain predetermination, rating, and post-determination functions while maintaining the current specialization 

of VSRs under the CPI model. This model appears to have the potential to improve quality compared to the CPI model, especially if 

it creates a greater sense of accountability. Consequently, we recommended that VA waits to see the results of this pilot before investigating other alternatives to the CPI model. 

Thank you for allowing me to testify. I would be happy to answer 

any questions you may have. 

[The prepared statement of Mr. Christensen appears on p. 31.] 

Mr. HALL. Thank you, Mr. Christensen. 

We will just ask you a couple of questions before we break for 

votes; and if we have any more, we will submit them to you in writing. 

But in surveying stakeholders concerning the VBA’s employee 

work credit system, the central issues, as you noted, indicate that 

you are able to determine, first, that the system emphasizes quantity over quality, that production standards are not based on a 

careful analysis of the tasks performed, and that work credits and 

production standards do not reflect the changes in complexity of 

claims and in Congressional mandates. What would you recommend to address these issues? 

Mr. CHRISTENSEN. As I mentioned, what we recommend—the 

issue is there are very broad categories with which credits are 

given. So, for example, a claim with zero to seven issues would receive the same work credits if it was one issue or seven. There is 

a difference in work credits if the claim has eight issues or more 

compared to something that has less than that. Those are relatively broad categories. We would recommend that narrower variations be given in work credits. 

We also recommend that work credits be contingent upon the 

type of medical condition. There is some variation of work credits, 

for example, if a veteran has post-traumatic stress disorder 

(PTSD), but, otherwise, there is really no recognition of type of 

medical condition. You speak with people at the VA and the people 

who rate the claims, obviously, a hearing case is much simpler and 

probably over credited compared to some other types of claims such 

as one with traumatic brain injury (TBI). So we think that considering those things in the work credits would be important. 

As I mentioned a couple of options, there are two really kind of 

philosophical approaches you can take for credits. One is giving a 

credit for each individual action that raters perform, and the other 

is basing credits more on broad categories of moving a claim past 

key milestones in the process. It is kind of a different philosophical 

approach to do so. There are advantages and disadvantages to each 

of those, but those are things that we recommend in terms of production. 

The other recommendations of quality are really to create signals 

to rating personnel that quality is important. 


anorris on DSK5R6SHH1PROD with HEARING
6 

Mr. HALL. Thank you. 

And can you give us any insight into why the VA has been unable to release the study which was done by CNA, which I believe 

you said was completed in September? 

Mr. CHRISTENSEN. We completed it in September and delivered 

it to VBA per our contract. I cannot speak for VA in terms of why 

they have not provided it to you. 

Mr. HALL. Mr. Christensen, the last question I have is, there are 

two, as you said, seemingly opposite philosophies that may be able 

to be followed at the same time. The question is, in your opinion, 

is it possible to provide a partial work credit or a positive employee 

evaluation for a claims processor who begins the flow of compensation dollars to a veteran for an undisputed part of his or her claim 

while at the same time doing what many stakeholders, many veterans groups are suggesting, which is to not give the complete 

work credit until the appeals process or appeals time period has expired and the final resolution of the claim is done? So that I guess 

the question is, can you speed up the front end while at the same 

time holding up the back end to make sure that the quality is 

there? 

Mr. CHRISTENSEN. That is not something we looked at specifically. Obviously, you can give work credits however the system is 

designed and chooses to do so. But that is not something we specifically study. 

Mr. HALL. Okay. Thank you very much, sir. We will send you 

some more questions in writing. 

For now, this Subcommittee will recess until after votes; and I 

ask the rest of your patience, please. 

[Recess.] 

Mr. HALL. The Subcommittee on Disability Assistance and Memorial Affairs will resume our hearing. Thank you all for your patience. 

We welcome our Panel 2: Richard Paul Cohen, Executive Director of National Organization of Veterans’ Advocates (NOVA), Inc.; 

Mr. Ronald B. Abrams, Joint Executive Director of National Veterans Legal Service Programs (NVLSP); James D. Wear, Assistant 

Director, National Veterans Service, Veterans of Foreign Wars of 

the United States (VFW); John Wilson, the Assistant National Legislative Director of Disabled American Veterans (DAV); Ian C. de 

Planque, Deputy Director, Veterans Affairs and Rehabilitation 

Commission, the American Legion; and Jimmy F. Sims, Jr., Rating 

Veterans Service Representative (RVSR) from the Winston Salem 

Regional Office of the Veteran Benefits Administration and Shop 

Steward for Local 1738, on behalf of the American Federation of 

Government Employees (AFGE) . 

Gentlemen, thank you so much for waiting and for the testimony 

you are going to give and have given. 

You know the routine by now. Your full written statement is already made a part of the record, so you each will have 5 minutes, 

starting with Mr. Cohen. 


anorris on DSK5R6SHH1PROD with HEARING
7 

STATEMENTS OF RICHARD PAUL COHEN, EXECUTIVE DIRECTOR, NATIONAL ORGANIZATION OF VETERANS’ ADVOCATES, 

INC.; RONALD B. ABRAMS, JOINT EXECUTIVE DIRECTOR, NATIONAL VETERANS LEGAL SERVICES PROGRAM; JAMES D. 

WEAR, ASSISTANT DIRECTOR, NATIONAL VETERANS SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; 

JOHN L. WILSON, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; IAN C. DE 

PLANQUE, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; AND 

JIMMY F. SIMS, JR., RATING VETERANS SERVICE REPRESENTATIVE, WINSTON-SALEM, NC, REGIONAL OFFICE, 

VETERANS BENEFITS ADMINISTRATION, AND SHOP STEWARD, LOCAL 1738, AMERICAN FEDERATION OF GOVERNMENT 

EMPLOYEES (AFL–CIO), AND AFGE NATIONAL VETERANS AFFAIRS COUNCIL 

STATEMENT OF RICHARD PAUL COHEN 

Mr. COHEN. Thank you, Chairman Hall, for allowing NOVA to 

submit its comments regarding the claims allocation process. 

It is no secret that we agree with you that the system is not 

working well. We have testified in great detail on other occasions 

about the backlogs, the errors in the ratings, and the hamster 

wheel phenomenon. There is a fundamental problem not with the 

individual employees in the trenches who want to do the right 

thing. There is a problem with the bureaucracy, with the organization. 

We all know that the VA has problems acting. A case in point, 

is Public Law 110–389, which required a report on the work credit 

system. The report is not out. The VA has not issued the required 

regulations on substitutions in the case where a veteran dies when 

the claim is pending. The new Agent Orange presumption regulations were not put out as proposed regulations until there was a 

lawsuit compelling it. 

The VA just is ineffective. It reminds us of trying to correct the 

course of the Titanic. There seems to be a disconnect between what 

the Secretary says, what the management says, and what is actually going on in the regional offices. 

A case in point is the testimony that you will hear later on from 

the VA stating that the VA has never emphasized production over 

quality. Yet, we had a 2005 report from the Office of Inspector General (OIG) showing that the work credit system did emphasize production over quality and inhibited the ability of VA employees to 

do quality decision-making. And, in fact, CNA just testified, and 

their written testimony says, that their research indicates that 

work credit system inhibits quality. 

So what the VA needs is a total course correction in terms of supervision, and in terms of management. 

We have a system where the VA claims to be looking for quality 

decision-making, yet they do not know what their actual error rate 

is. In their reports, the VA indicates an error rate around 80 percent. But if you do the math and figure out how many claims are 

denied, how many are abandoned, the remainder that go to the 

Board of Veterans’ Appeals (BVA), and how many are confirmed by 


anorris on DSK5R6SHH1PROD with HEARING
8 

the BVA, you will find out that the error rate is probably as high 

as what they say their accuracy is. Their error rate is about 80 percent if you trace the cases to the BVA and then to the court. So 

what the VA needs to do is to develop a method for analyzing 

whether they are doing correct decisions. They need to get it right 

the first time. 

Congress’ role is a watchdog. It can’t micromanage the VA but 

has to encourage them to change the whole system. The pod approach—where a team takes credit for the end result—is the way 

to go, where the credit is not for productivity on an individual basis 

but is on reaching the correct decision by the pod, by the group. 

That would solve the problem. 

The other thing is that the VA is never going to get a handle on 

this backlog until they start looking at the crisis on a triage basis. 

What they need to do is look at those cases which are easy grants. 

The claim by a combat veteran who has a Purple Heart for benefits 

based on PTSD needs no further development. That should be a 

grant. Don’t waste time on it. There are harder claims with harder 

medicine, and harder laws. Those, the VA should spend time on. 

They have not been effective in working claims like a true business, but that is what they need to do. They need to bring in business experts to help them do this and, as AFGE has said, true time 

and motion studies are needed to try to figure out how to save time 

on what VA’s employees do. 

But the bottom line here is NOVA and the veterans who our 

members represent are not that interested in work credits. I know 

the employees are. I know the VA is. Everyone should be more interested in quality decision-making from the outset. 

Thank you. 

[The prepared statement of Mr. Cohen appears on p. 38.] 

Mr. HALL. Thank you, Mr. Cohen. 

Mr. Abrams. 

STATEMENT OF RONALD B. ABRAMS 

Mr. ABRAMS. Thank you, Mr. Chairman. 

I would first like to say that when I listened to the earlier testimony I think that you should be cautioned that it is not a one-way 

street. Claims are filed, and people are represented. And when we 

get involved in a case, we try to file the claim as early as we can 

so a veteran can get the earliest possible effective date. 

But that doesn’t mean we are going to let the VA adjudicate that 

claim in 30, 90, or even 180 days. Sometimes it takes us, with all 

the time that we have to spend on a case, 6 to 8 months to get 

proper medical opinions; and the VA has to wait until we get that. 

So it is just not up to the VA to do things in a certain time. 

The advocates are also going to submit evidence, and we are 

going to take our time to get the right evidence. Therefore, if you 

have a system that stops the clock for the VA when an advocate 

says, look, we are going out and getting several medical opinions, 

that would be a good thing. It is not the VA’s fault that we are taking our time, and that would encourage them to let us do that. 

As you know, veterans cannot shop where they are going to get 

their VA benefits. They are stuck with the VA. Other people who 

are shopping for televisions, for cars, if they don’t like the quality 


anorris on DSK5R6SHH1PROD with HEARING
9 

of a certain brand can buy some other brand. Vets have to go to 

the VA. And I want to stress that proper attention by VA managers 

to protect the fairness of the process is counterintuitive to them because it affects the statistics upon which they are evaluated. 

For example, control of claims, checking to see where the claim 

is, slows managers and workers down. If they have to review unnecessarily delayed claims, it takes time and energy to do that. You 

take people off of production. Development, even Systematic Technical Accuracy Review (STAR) shows that is the biggest error; and, 

as a result of improper development, claims are just churned. You 

get on the hamster wheel, and we have talked about that over and 

over again. 

It takes time to carefully analyze a case and recognize all the important issues. As you know, the VA has been doing it wrong for 

many years. As a result, when a rater gets the case in the regional 

office, they have to review the entire file if they are going to do the 

right job, and they might have to correct errors all the way back 

30, 40 years ago. This needs to be acknowledged and built into the 

work credit system. 

There is always tension between quality and quantity, and the 

VA has to establish a natural balance. And what we would like the 

VA to do is first change its work measurement system so it reflects 

the needs of the claimants rather than the needs of the people 

working in the VA. Let them adjust to what really needs to be done 

correctly. 

Second, we should have an independent quality check, one from 

outside of VBA. That way you are not going to have pressure not 

to find errors, and I think that would help a great deal. 

Thank you very much. 

[The prepared statement of Mr. Abrams appears on p. 40.] 

Mr. HALL. Thank you, Mr. Abrams. 

Mr. Wear. 

STATEMENT OF JAMES D. WEAR 

Mr. WEAR. Chairman Hall and Members of the Subcommittee, on 

behalf of the 2.1 million members of the Veterans of Foreign Wars 

of the United States and our auxiliaries, I would like to thank you 

for the opportunity to be here today to share our concerns and 

thoughts regarding VBA’s work credit and management systems. 

The VFW’s chief concern today is a very real perception that VA 

puts more emphasis on the number of claims that are processed 

than the accuracy of those claims. This is validated by the over 1.1 

million claims for compensation, pension, education, and appeals 

pending, as reported by the VBA in its weekly Monday Morning 

Report, as well as many VA OIG reports. 

Secretary Shinseki’s goal of rating all claims with a 98-percent 

accuracy in under 125 days is very laudable, But the VFW would 

be ecstatic if the VA could reach the 98-percent accuracy goal with 

even the current average wait time of 165 days. 

The VFW has developed five immediate actions that we believe 

will improve VBA’s quality now: 

First, the VA management team must focus on changing the culture in VBA to award quality over production. VBA must incorporate quality and accountability into its self-imposed work credit 


anorris on DSK5R6SHH1PROD with HEARING
10 

measurement system. VBA must determine which employees get it 

right and which employees get it wrong. VBA must hold every employee and manager accountable. VBA needs to know who is making the errors in order to train the employees accordingly. VBA 

must provide incentives to employees and managers so that they 

continuously look for ways to improve quality. The employees and 

managers must know that quality is the most important aspect of 

their job. VBA’s new slogan could be ‘‘Do It Right the First Time.’’ 

Second, require two signatures on all awards and ratings prepared by new employees and/or employees with low quality until 

sustained improvement is shown. A second signature will help to 

ensure a more experienced set of eyes have reviewed the work of 

less-experienced employees. Also, it gives managers more opportunities to train on those errors as soon as they are discovered. 

Third, require employees and managers to prepare partial rating 

decisions whenever possible to give the veteran immediate financial 

assistance and access to VA medical care. This will aid veterans 

and foster good public relations among veterans. VA must emphasize giving work grade credit for partial ratings to incentivize employees to make this extra effort. 

Fourth, publicize VSRs and rating VSRs who have demonstrated 

consistently outstanding quality. Morale is a large part of motivating employees to work towards organizational goals. 

Lastly, VA should share with their claimants the average wait 

time to process their type of claim in either an e-mail or in the initial development letter. This would let the veteran know up front 

about how long he might have to wait. 

The VFW supports a fully integrated system, one that allows VA 

to operate in a paperless environment as much as possible. We 

urge Congress to use its oversight authority to ensure VA successfully transforms from a paper-centric to paperless environment. 

The VA must enter the 21st Century, which is only achievable with 

the support and careful attention of this Committee. 

This concludes my remarks. I would be happy to address any 

questions you or your Committee may have. 

Thank you. 

[The prepared statement of Mr. Wear appears on p. 43.] 

Mr. HALL. Thank you. 

Mr. Wilson. 

STATEMENT OF JOHN L. WILSON 

Mr. WILSON. Mr. Chairman, Members of the Subcommittee. I am 

pleased to have this opportunity to appear before you on behalf of 

the Disabled American Veterans to address the efforts of the Veterans Benefits Administration to properly balance quality and 

quantity in the work credit and work management programs. 

Too often, VBA has attempted to manage its ever-increasing 

workload emphasizing production to the detriment of accuracy. 

DAV is as concerned as the Committee about the large and growing claims inventory, or backlog, the VBA is managing. The problem is not the backlog. Nor is it the root cause of the problem. 

Rather it is the symptom. It is akin to an individual having a fever. 

While one can take an Aspirin to reduce the fever, the underlying 

condition, the cause of fever must be treated. Otherwise, it will reVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
11 

turn. The patient’s condition may worsen. So, too, it is with the 

claims backlog and the process. The underlying condition is a broken claims processing system that leaves too many veterans waiting too long for rating decisions that are too often wrong. 

Until we address the lack of quality, accuracy, and consistency— 

the root cause of the backlog—then no matter how quickly claims 

are processed the problem will remain and the backlog will return. 

We, therefore, believe that the best and only approach is to take 

one that emphasizes quality at every stage of production. To 

achieve this outcome, it is essential that we examine the system of 

incentives and accountability for employees, management, and 

leadership. 

We have heard Secretary Shinseki says that he intends to break 

the back of the backlog this year. The only way any such success 

will be measured at present is through VBA’s Monday Morning 

Workload Reports, which contain measures of production, not accuracy or quality. 

Similarly, looking at VBA’s dashboard, which provides current 

performance statistics for each VA regional office, the measure’s report primarily relates to pending work inventory and production 

times, not quality. 

With the directive from leadership to break the back of the backlog, it is not surprising that the RO management focuses heavily 

on production, rather than accuracy or quality. Given leadership’s 

and management’s focus on production, it is also not surprising 

that VSRs and RVSRs feel tremendous pressure to meet production 

goals. 

While accuracy has been and remains one of the performance 

standards that must be met by employees, we are concerned that 

the work credit system creates incentives for them to favor production over accuracy. Performance standards are the most important 

factor in determining the incentives for employees. If performance 

standards directly or indirectly reward production over quality and 

accuracy, we must expect employees to work first towards production goals. 

The new performance standards have streamlined the measures 

of production for VSRs from what had been 63 categories of rated 

work activities to five production categories, now called outputs. 

Essentially, VSR will receive one output credit for completing each 

stage of the work process. We have been told that the old work 

credit system created opportunities for gaming the system, such as 

delaying requests for routine future exams in order to get additional work credits later. However, we are now concerned that the 

new streamlined system of measuring only outputs may inadvertently create incentives for cutting corners, since more complex 

cases get no more credit than simple cases. 

We know that VBA has increased the accuracy standard for 

VSRs, and we certainly agree that accuracy even by the national 

STAR measures remains too low. However, it is not clear how raising the standard in and of itself will result in increased accuracy. 

We also remain concerned about how reliable the employee reviews will be for measuring quality. We have testified previously 

that coach reviews of five cases per month are not accomplished 

100 percent of the time; and, in many cases, coaches do not have 


anorris on DSK5R6SHH1PROD with HEARING
12 

sufficient time to comprehensively review each case. Consequently, 

we do not have confidence that employees performing below or 

above standard will be consistently measured. 

We are also concerned about these local quality reviews being 

different from station to station. We continue to note that VBA 

does not have a unified system for aggregating and analyzing results of both coaches’ reviews and STAR reviews to provide trend 

analysis for quality control, improvements, and new training instrument development. 

Under the new VSR standards, time limits are established by 

each RO based on end-of-year station targets. We recognize cycle 

times will vary from station to station but question whether it is 

a reasonable expectation to have employees at different stations 

being held to different standards for the same work. 

We also have questions about whether cycle times, which include 

wait periods and work volume, are the most reasonable measure 

for holding VSRs accountable, since it is out of their control. For 

example, is the cycle time for average days awaiting evidence a fair 

measure, since the admission of evidence by the claimant is not 

under the control of the VSR? 

VSRs will also now be held accountable for meeting the training 

standard. We question whether this should be a management accountability standard more than an employee standard, since training is critical to keeping staff informed of the ever-revolving nature 

of claims, whether it is new presumptive service conditions, 

changes in public law, or recent court cases. 

Given some reports, we have heard from the field about management pressuring employees to cut back from time for training to 

production goals. How is management being held accountable for 

training being implemented at the regional office level? 

That concludes my testimony. I would be happy to answer any 

questions you may have. 

[The prepared statement of Mr. Wilson appears on p. 45.] 

Mr. HALL. Thank you very much. 

And, Mr. de Planque, you are now recognized. 

STATEMENT OF IAN C. DE PLANQUE 

Mr. DE PLANQUE. Thank you, Mr. Chairman. I appreciate the opportunity to express the views of the American Legion on the importance of accuracy in the veterans benefits system. 

Before discussing the problem of accuracy in depth, a little bit of 

perspective is necessary to illustrate why this is such an important 

component of the VA claims adjudication. 

According to most optimistic numbers—and these are VA’s public 

statistics and not those suspected by OIG audit, which are believed 

to be much lower—VA is operating at approximately 87 percent accuracy rate, or 13 percent error rate. 

This year alone, VA expects to receive and process nearly 

200,000 claims solely related to the three new presumptive Agent 

Orange conditions. Statistically, we can thus expect that 26,000 of 

those claims will be processed in error. Twenty-six thousand veterans will have their claims improperly handled. That figure represents nearly half of the names on the Vietnam Wall in Washington, DC. 


anorris on DSK5R6SHH1PROD with HEARING
13 

Every claim is a life affected. Every claim is more than one life, 

because veterans have families and loved ones. Veterans have husbands. They have wives. They have children. 

We are told VA will process as many as 1 million claims a year 

within the next year or two. One must remember that at least 1 

percent of inaccuracy represents 10,000 veterans’ claims. VA has to 

do better, clearly. 

The inaccuracy of the system contributes to the massive lack of 

trust in the VA by the veterans’ community. When veterans cease 

to trust the system by which their country returns the promise to 

them, there must be great concern. VA has to stop asking the veterans of America to trust them, that they will be treated properly, 

and VA is now in a position to re-earn that trust. 

Rather than repeating the number of things that we all have 

been saying here, not just in this session but for many, many years 

now, I want to touch on something that Mr. Christensen’s report 

listed this morning. Because we, like you, have not had been an opportunity to see this report until this time. 

One of the things that was stated is there were two surveys on 

the perceptions of quality and quantity and considerations of which 

is more important and that both surveys had found that the quantity of claims process was believed to be more important, and it 

said something which is very interesting. It states, this is an important finding, because, even if that perception is incorrect, at 

least some employees who have that perception will probably 

change the way they process claims in order to do what they think 

their supervisors want. Perception is reality. If VA employees think 

that numbers are what is important, that is what they will work 

to; and they have nothing to look to that is there to show them that 

accuracy is the same thing. 

We mentioned the daily reports that VA makes, their Monday 

Morning Workload Reports. They list the number of claims and 

how long they have been pending. They don’t list how accurate the 

regional offices are performing. You can find those statistics, but 

you really have to start digging for them. 

Transparency gets mentioned a lot in Washington right now. If 

VA wants to start re-earning that trust from the veteran community, they need to be a lot more transparent. They need to put 

those numbers up and say this is what we are staking our reputation on. Our reputation is on the accuracy; and if we can’t see that, 

if the veterans can’t see that, if the employees working in those offices can’t see that that is what VA is putting their priorities to, 

then they are not going to believe that that is the case. They are 

going to believe that it is still continuing to be driven by the numbers. 

There are ways that they can help do that. Obviously, it takes 

more time to process a claim effectively; and VA doesn’t want to 

lose ground with the number of claims that they have pending 

right now. Putting an experienced claims examiner at the beginning of the process to do triage is going to help the VA if they can 

have someone who can take these cases and say, this is ready to 

rate. This doesn’t need as much development. 


anorris on DSK5R6SHH1PROD with HEARING
14 

It was mentioned earlier a hearing loss case doesn’t require near 

as much work as a TBI case. Put them to the people who can do 

the work best. 

We have mentioned that hiring all of the VA employees is going 

to take a while to show dividends because of the training times 

that are involved. Less-experienced employees can handle simpler 

claims, such as hearing loss. The other ones can be directed to 

other employees who are more competent and more capable of 

doing them right. 

So if you do better triage at the beginning, if you direct the cases 

better, you will be able to do them on time and have the time you 

need to do the ones that take more time. 

Making time for training. Making training a priority is also going 

to show those employees that this is the priority. We are okay with 

you setting aside some time from those numbers to make sure you 

understand that it is right, and we are going to take the time to 

pay attention to what you are doing and get it right. 

There are a number of other solutions, and I would be happy to 

answer any more questions on those, but we would like to state on 

behalf of the millions of veterans of the American Legion but also 

the millions and millions of veterans in America, VA needs to earn 

this trust back, and they need to do that by showing that accuracy 

is their most important priority. 

Thank you. 

[The prepared statement of Mr. de Planque appears on p. 48.] 

Mr. HALL. Thank you, Mr. de Planque. 

Mr. Sims. 

STATEMENT OF JIMMY F. SIMS, JR. 

Mr. SIMS. Thank you, Chairman Hall. Appreciate the opportunity 

to testify today on behalf of AFGE and the VA Council. 

In my position as a RVSR and a union steward who has represented numerous employees, I have seen firsthand the impact of 

VBA’s work credit and management system. These systems have 

placed the VBA on the precipice at a great risk of falling behind 

on our mission to provide service to the veterans and their dependents. The performance standards under these work management 

systems established by the VBA do not provide adequate work 

credit for many of the critical steps involved in the claims process. 

The new VSR standards that were issued last month provide no 

credit for supplemental development such as requesting additional 

evidence and have reduced the work credits from over 60 categories 

to only 5. Denying work credits for critical tasks will slow down the 

process and decrease quality. 

The standards also force employees to make daily choices between quality and quantity by including timeliness as a critical element. Many delays, such as awaiting records from the U.S. Department of Defense (DoD) or from private physicians, are outside of 

the control of the employee and, as such, employees should not be 

held accountable for these delays. 

The implementation of the new VSR standards included a prohibition on variation from the national standards, although current 

RVSR standards do not. Local VA ROs may arbitrarily increase the 

production standard, which results in disparity based on geoVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00018 Fmt 6633 Sfmt 6633 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
15 

graphic location. An RVSR in Seattle may be required to produce 

31 percent more daily work than an RVSR in Winston Salem. Variations in local standards are taking their toll on morale and accelerating attrition of senior RVSRs with valuable experience. I fear 

that the new RVSR standards being developed will continue the 

systemic problem. 

Trainees are also being subjected to these unrealistic standards 

and working conditions during their initial period of on-the-job 

training. The minute they hit the floor, they have only 90 days to 

hit the standard. During this training phase, the receive no time 

allowance or credit for making corrections to their work. These 

VBA production standards result in a waste of taxpayer dollars 

through termination of large number of probationary employees 

who fail to meet these arbitrary standards during training. 

Under the current work credit management system, employees 

find themselves in a catch 22. If they focus on quality of work, the 

quantity may fall behind. If they focus on quantity of work, their 

quality may fall below. Either situation results in the risk of demotion or termination. 

Because of the inverse relationship of quality and quantity, many 

employees find themselves being forced to work off-the-clock to 

meet their production and quality standard. By doing this, they 

risk disciplinary action for violating VA directives and Federal 

wage and hour laws. 

One critical element for an effective work credit management 

system is a scientific time-motion study that accurately measures 

the process. VBA has conducted no more than a minimal attempt 

at this. Without an effective analysis of the process, there can be 

no improvement. 

President Obama’s executive order on labor management is intended to include the employees and their representatives in development of policies before they are implemented. Unfortunately, 

VBA is woefully behind in establishing effective partnership. Frontline employees and other stakeholder have ideas to improve the 

claims process. We are the subject matter experts and wish management would acknowledge and include us in the establishment of 

the policies. 

In closing, AFGE urges you to mandate completion of the scientific study of the claims process for VBA to include stakeholders 

in the policy development and to end the local variations in the 

RVSR production standards. 

Thank you for this time you have allowed me to provide this insight. 

[The prepared statement of Mr. Sims appears on p. 51.] 

Mr. HALL. Thank you, Mr. Sims. 

I will start with you, sir, Mr. Sims, and ask you if you could 

elaborate on your suggestions for VBA so that Rating Veterans 

Service Representatives, RVSRs, can more accurately rate claims 

at a pace that allows the VA to meet its goals of timely delivering 

of benefits to veterans and their families. 

Mr. SIMS. One of the primary concerns for the RVSRs in the field 

is the training that is being provided. Currently, training is done 

through a computerized system which is on an independent basis, 

which gives no feedback from a subject matter expert on the issues 


anorris on DSK5R6SHH1PROD with HEARING
16 

for which they are training. This lack of proper training is resulting in a delay in the RVSR being able to process the claim due to 

lack of knowledge. 

It also is impacting the overall process of meeting the requirements for the VA. Because as the RVSRs are being slowed down 

in their process of rating the claims due to lack of proper knowledge, it reduces or it increases a backlog of the claims that we are 

trying to produce. 

Mr. HALL. Can you suggest any specific reforms to the work credit system that would reward claims processors for spending sufficient time developing and adjudicating claims? Is there some way 

to get around this inverse relationship you talked about between 

quality and quantity? 

Mr. SIMS. The only way that is actually going to be effective is 

for the time that is required for each element of the claims process 

to be considered in the work crediting system. Currently, that is 

not the case. 

An RVSR may get a case which contains three issues that may 

be incredibly complex and requires hours of review of the evidence 

in rendering the decision. But that time frame that is required to 

conduct the proper rating is not considered under the production 

standards. We are required to maintain a certain level of productivity without consideration of the amount of time that is involved 

in each individual rating. So in order to adjust the production 

standards properly, there would have to be an adequate time management study done, which indicates the necessary time frame for 

each individual step in the process. 

Mr. HALL. Do you have a comment on I believe it was Mr. 

Abrams’ suggestion that the clock be stopped at the VA for a particular claim if the claim is being developed and documents or medical evidence is being produced by the veteran or representative of 

the veteran and that is not within the VA’s control? 

Mr. SIMS. Unfortunately, currently, the receipt of evidence from 

a third party is strictly based on that third party’s willingness to 

provide the evidence in a timely fashion. Regulations stipulate that 

certain providers such as the Department of Defense, Social Security, those agencies were required to continue to request that evidence until it is received. Therefore, the time delay that is associated with that process is outside the control of the individual RVSR 

or VSR. So, currently, the new standards are holding the employee 

accountable for that process of which they have no control. 

If the VA was to consider a time delay in the processing of a 

claim to allow for that third party to develop the evidence that they 

wish to submit, then at that point it becomes an issue of timeliness 

over the overall process, which Congress has indicated that needs 

to be adjusted. 

So the current concept of delaying or stopping the clock to allow 

for additional evidence to come in may be beneficial on one aspect 

for the claimant, but then again it will end up in greater delays 

for the claimant and result in a greater delay in the claims processing overall. 

Mr. HALL. Right. And it may be that the VA person who was trying to get the information from Social Security or from DoD or 

whatever will feel less pressure to harass the other branch of govVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
17 

ernment into coming up with—I understand you are saying we 

don’t want to make the time longer, but at the same time we 

want—I think we are looking for ways to emphasize, as we have 

been saying, quality without having the RVSRs or any VA personnel feel that their evaluation of their work will be more negative if they take the time to get it right, and that may be out of 

their control due to these certain factors. 

Mr. Cohen, this question could be for you but also for everybody 

else on the panel. Could you briefly state if you feel the reforms 

of the claims process that focus primarily on timeliness and speed 

of claims will be effective? Do you think that veterans should be 

and are willing to accept a slightly longer adjudication process if 

it results in a more accurate claims decision the first time? 

Mr. COHEN. I think that veterans and their representatives 

would accept a longer time period if it was correct the first time 

around. 

One of the things, though, that we need to consider is the biggest 

delay in processing a claim is in development, is in getting the 

exams. If the VA were to make it clear to the treating physicians 

who work for the VA that they are permitted to provide opinions, 

if they have them, about whether conditions are service-connected 

or the degree of disability, that might eliminate the need for Compensation and Pension (C&P) exams. 

In addition, if 5125 were amended to be mandatory to accept an 

adequate exam, one that is adequate for rating purposes, then, 

again, additional medical development could be eliminated. 

The biggest part of the time delay is in obtaining these C&P 

exams. If we can do anything to shortcut that time, the total process will be much shorter. 

Mr. HALL. Mr. Abrams. 

Mr. ABRAMS. I think any veteran would rather obtain benefits in 

8 months than be promptly denied in 3 months. That doesn’t seem 

to be worthy of any more discussion. The idea is to try to get the 

veteran the benefit as quickly as possible correctly. 

Mr. HALL. General agreement on that, or would anybody else like 

to comment? 

Mr. WILSON. I would like to say that we—I would like to see a 

case take the current 160 days to get done correctly rather than 90 

days to get done quickly but incorrectly. The excessive amount of 

churn you will have in the appellate process is not acceptable to 

us; and, given the current situation, moving towards speedier decisions without proper development is going to lead to just that. 

Mr. DE PLANQUE. I would just like to add, in terms of perspective 

for this, when you have a rush to judgment, if they are just going 

to blitz through quickly and get them done in a short period of 

time, it has to be appealed. And when we talk about the backlog 

and when we talk about veterans waiting years and years to get 

their claims, that is not an initial claim. If a veteran is waiting 

years and years and years to get their claim, that is a claim that 

is on appeal; and it had to be appealed because there were problems made at the lower level. 

The problem is that mistakes at the RO don’t take a minute to 

correct. They take years to correct. Because it has to go out to the 

Board of Veterans’ Appeals, sometimes the courts, because things 


anorris on DSK5R6SHH1PROD with HEARING
18 

weren’t done right the first time; and that is why waiting a little 

bit longer, waiting a couple months more to get it done right the 

first time, I don’t think any veteran would argue with that. 

Mr. SIMS. If I can add the insight from the employees’ perspective on this process. 

For myself as a rating specialist, the greatest problem that I face 

is inadequate development. Currently, under the current work 

management system, the employees are pressured to get the claims 

to us on the rating board as quickly as possible so that we can get 

a decision out within the 125 days that the Secretary has stated 

that we would do. 

Unfortunately, oftentimes these claims are not developed appropriately and evidence is missing, which is intricate to the rating decision. That is why the appellate process is the way it is, is because 

the development process is being rushed. If the process was slowed 

down and allowed to be developed appropriately, the veteran and 

the claimant on the other end would get the decision correctly the 

first time; and that would alleviate a lot of the appellate process. 

Mr. HALL. Thank you, Mr. Sims. 

And I would ask starting with you perhaps to comment on the 

pod concept and the triage concepts that were mentioned by a number of our panelists, Mr. Cohen in particular. But what do you 

think about those two approaches? 

Mr. SIMS. I have personally been involved in a pod situation in 

which the VSR and the RVSR were paired in a project that we had 

at the regional office. It resulted in an extensive amount of knowledge being transferred between the RVSR and the VSR on both 

sides of the equation, and we found that the quality of our team 

at that point was 100 percent and the production was increased by 

an overall 30 percent. This was in a decision review process that 

we conducted. 

As for the triage phase, there are a number of claims that come 

through that I see on a daily basis that there is no basis for the 

additional development to have been conducted. The decision could 

have been rendered when the claim was received. Unfortunately, 

because there is not an adequate triage system in place, those decisions are delayed and thus increasing the overall inventory. 

Mr. HALL. Mr. de Planque? 

Mr. DE PLANQUE. I think with both of those systems—certainly 

in a pod system, being able to see the entire picture, being able to 

immediately communicate back and forth—— 

Mr. Sims commented not too long ago that development—inadequate development is one of the biggest problems they face, the 

ability to communicate back and forth and say I am here trying to 

rate this case but we don’t have the development that we need and 

this needs to get done at that level. That level of communications 

can only help the claims process. 

In terms of the triage system, you can’t indicate the importance 

of that enough. When VA got caught with the shredding scandal 

and 10s of thousands of documents were being shredded, they took 

it seriously; and they put a GS–12 in every office whose only job 

now is to control what documents are being shredded. That was a 

way of sending a message that the document destruction is important. 


anorris on DSK5R6SHH1PROD with HEARING
19 

If they took a high-level employee in every regional office with 

the job of making sure this is right, looking at the accuracy, making sure this is directed to the right place, that is another way of 

sending a signal. 

We talked about sending signals so the employees have a perception of what truly is most important: getting the work to the right 

places and getting the work done right. That is another way that 

they can indicate that. 

Mr. HALL. Mr. Wilson. 

Mr. WILSON. I think the pods and the pilots that VBA has implemented are important to consider. There are lessons to be learned 

from them. I think we will see that as we continue with the pilot 

programs and see what the final reports have from them. 

The triage, putting an experienced person in the beginning of a 

particular process to have them as a gatekeeper to make sure the 

right decisions are being made by those less-experienced personnel, 

and pushing ready-to-rate claims to raters, is an excellent approach, which is one that should be adopted as soon as possible at 

each VA regional office. 

Mr. HALL. Mr. Wear? 

Mr. WEAR. I think the pod system and the triage, I think those 

are all good ways to make sure that the claim is complete as early 

in the process as possible. We have all talked about how long it 

takes—the longer development takes, the more time it takes to 

reach a final decision on a case—and the people don’t see it. I think 

the better we can get the right information to the VA as quickly 

as possible and have somebody look at it is critical. 

If we could rearrange who we put where so we could put maybe 

a GS–12 or somebody right up front to do triage, I think that would 

be really critical to looking at what they have got and where it 

needs to go but also working with service organizations to say, can 

you get me this or get me that? Or they can have people call. 

All that is going to help get everything focused as early as possible, and that will lead to a better decision quicker. 

Mr. HALL. Mr. Abrams? 

Mr. ABRAMS. We like the pod concept. We don’t like what they 

have now. Several years ago, we went to one of the regional offices 

with the American Legion to do a quality check, and a friend of 

mine from my days at the VA called me aside. He was on the rating board, and he complained forever about the inadequate development. 

Mr. ABRAMS. He called it widget production. People are disassociated with the final result when they are isolated and only have 

one part of the claim to do. It is much better to do it the other way. 

Mr. HALL. Mr. Cohen, anything to add? 

Mr. COHEN. Yes. I just wanted to add something about the 

triage. The indication that triage is needed can be seen by the 

number of combat veterans who have Purple Hearts or have significant heavy combat who apply for benefits based on PTSD and 

are denied, that either the VA wants more development on their 

stressor or doesn’t believe the adequacy of their stressor or doesn’t 

believe that the horrific conditions that they experienced in combat 

were sufficient to cause the PTSD. Those should be no-brainers and 

should just run right through the system. 


anorris on DSK5R6SHH1PROD with HEARING
20 

It is appalling that some of these people get denied and then 

have to go through the appellate system and may wait a year and 

a half to get the benefits that should be so obvious. 

Mr. HALL. Thank you. 

Mr. Abrams, you said that 60 percent of the claims appealed to 

VBA are remanded or overturned, and the most common problem 

they report is premature adjudication of claims and lack of development. Do you think the VA has resorted to using the BVA and the 

U.S. Court of Appeals for Veterans Claims as a de facto quality 

control process? 

Mr. ABRAMS. Yes. We have been told by VA employees who are 

frustrated, that what the VA says is, Let them appeal. Let the BVA 

decide this. 

And it is a good way to take the case off their backlog, put it into 

appellate process, and move it up. This is not the first time that 

this has happened. 

During the 1970s, when the vets were coming back from the 

Vietnam war or Vietnam conflict, I started working at the VA. And 

when I walked in, I saw case files piled to the ceiling in the Philadelphia office, and the managers would run up and down the aisles 

yelling, ‘‘Make a final decision.’’ 

You were pressured to take what evidence you had and try to 

make a final determination. And most of the time it had to be a 

denial, because you didn’t have the evidence that would support a 

grant. 

Mr. HALL. And Mr. de Planque, regarding the Monday Morning 

Reports you spoke about, do you believe that the VA could produce 

analogous reports to show the accuracy on a weekly basis of the 

claims system? Could this lead to an increased accountability and 

focus the attention of VA personnel on quality as a basis for their 

evaluation and for reforming the system? 

Mr. DE PLANQUE. Actually, I think if they are reporting on quality on a daily basis, it would show that it is important. And I think 

that it would help. It is like having your grades posted on the wall 

at school. You know, when they have their workloads posted, this 

is how many cases they have, this is how many cases they have 

pending over this number of days, there has to be a pressure at 

that point to move those cases along so we are not the lowest or 

we are not the ones who are looking that way. 

If they were having their accuracy ratings posted at the same 

time, that is going to create an analogous pressure to—I want to 

be in the top of accuracy. I want to be able to point to our regional 

office and say we are in the tops in VA in accuracy. 

If you talk to VA employees, as we do when the American Legion 

works with NVLSP and does quality review visits, they want to be 

proud of the place where they work. And so if you have something 

that is publicly posted that this office is doing this level of quality, 

there then becomes an incentive to make sure that you are reaching the top numbers, that you are achieving, and that you are not 

falling behind of those levels. 

At the same time, it gives the veterans groups, it gives the veterans themselves, independent of groups, an ability to look at that 

and say, All right, this is how I restore my confidence in VA, because I see where they are going and I see it is a priority to them 


anorris on DSK5R6SHH1PROD with HEARING
21 

because they are posting their numbers and showing pride in what 

they are doing. 

Mr. HALL. Well, thank you, Mr. de Planque. And thank you all. 

We have more questions for you. I have more questions for you, 

but I will submit them in writing so that we can move on to our 

next panel. Thank you for your patience and for your continuing 

work on behalf of our veterans. 

Mr. HALL. And panel two is now excused, and we will have a 

changing of the guard and invite our last panel, Diana M. Rubens, 

Associate Deputy Under Secretary for Field Operations at the Veterans Benefits Administration, U.S. Department of Veterans Affairs, accompanied by Jason McClellan, Director of the Central 

Area Office of VBA, U.S. Department of Veterans Affairs, to join 

us at the table. 

Thank you again for your being here, for your testimony, and for 

your patience with the schedule across the street. As usual, your 

full written statement is entered in the record. 

And, Ms. Rubens, you are now recognized for 5 minutes. 

STATEMENT OF DIANA M. RUBENS, ASSOCIATE DEPUTY 

UNDER SECRETARY FOR FIELD OPERATIONS, VETERANS 

BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY JASON McCLELLAN, DIRECTOR, CENTRAL AREA OFFICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Ms. RUBENS. Thank you, Mr. Chairman. Thank you for providing 

me the opportunity to appear before you today to discuss the work 

credit and management systems study and the way we think that 

those things relate to accountability, accuracy, and compensation 

and pension claims processing. 

We acknowledge the concerns of our stakeholders and our veterans regarding the current work credit system and perceived emphasis on quantity over quality. But I want to make it clear that 

VBA does not emphasize quantity over quality. 

Secretary Shinseki has set a goal for VBA to process disability 

claims at a rate sufficient to ensure all veterans have their response within 125 days. But that is only a successful effort if we 

also achieve the goal that he has established for us of a 98-percent 

quality rate. 

As the Subcommittee is fully aware, Public Law 110–389 required the Secretary to initiate a study of the effectiveness of 

VBA’s employee work credit and work management systems to 

evaluate a more effective means of improving disability claims 

processing performance. 

I apologize for the late delivery, as we experienced delays in both 

the initiation of that study and the completion of that concurrence 

process. I do anticipate that it will be delivered shortly, and am 

happy to be available for any questions you have upon your review 

of that study. 

[The Report was received by the Committee.] 

The Center for Naval Analyses recommendations closely align 

with VBA’s current initiatives to better link individuals’ performance with completion of decisions for veterans. VBA has both longand short-term strategies underway to reduce the backlog of claims 


anorris on DSK5R6SHH1PROD with HEARING
22 

while improving quality, even as the complexity and the numbers 

increase. We continue to hire aggressively, with the strategy being 

to make good selections, provide full training, establish expectations, provide feedback, and hold ourselves accountable. 

As it pertains to quality, I have also asked the area offices to increase their oversight of regional offices with quality that doesn’t 

measure up to par. While this is just a starting point, we need to 

work all together to raise that to that 98-percent quality. 

We talked a little bit about the new performance standards that 

were developed in concert with our national Labor partners at 

AFGE, our veterans service representatives, that address recommendations since made by CNA. 

While our local performance standards have always included a 

quality element, the new standards further align individual targets 

with national targets and require that local reviews that are being 

done use that same checklist used by our national star review 

team. These new standards give work credit only for work done 

that moves the claim to the next stage of the process, as we feel 

that aligns most closely with veterans’ desire to actually get a decision in their claim. 

We are nearing the 30-day mark of the implementation of those 

new standards, and will be working with our labor partners to review how that implementation has gone in terms of outcomes as we 

look at that first 30 days, and then over the coming months to 

share that information with them to ensure we are getting closer 

to the right standard and measuring the right things to help us get 

the job done for veterans. 

The CNA study also looked at the current work management 

study, referred to as the Claim Process Improvement Model, which 

emphasized employee task specialization. VBA has been engaged 

for some time in several pilots to evaluate the alternatives to the 

CPI model; most notably, the pilot in Little Rock, Arkansas, which 

used Lean Six Sigma analysis techniques. That pilot will complete 

shortly, and we anticipate having a final report. Additionally, we 

have pilots underway in both our Pittsburgh Regional Office and 

our Providence Regional Office to look at the process and technology respectively. 

Recognizing that there are many approaches to improve our process, we have gathered ideas from as many arenas as possible, to 

include opportunities such as our Innovation Initiative competition, 

engaging in the roundtable held by Chairman Filner, and in 

March, VBA leadership met to generate ideas with the focus on 

reaching that 125-day processing at a 98-percent quality level. We 

have also engaged our VSO partners in a one-day session to get 

their input directly, and similarly are working to schedule one with 

our Labor partners from AFGE early in June. 

VBA does not believe there is going to be one silver bullet to 

solve the problems of the backlog, but it will be a combination of 

people, process, and technology that will enable us to meet the Secretary’s goal of no claims over 125 days at a 98-percent quality 

level. 

That concludes my statement. I would be happy to answer any 

questions you may have. 

Mr. HALL. Thank you, Ms. Rubens. 


anorris on DSK5R6SHH1PROD with HEARING
23 

[The prepared statement of Ms. Rubens appears on p. 53.] 

Mr. HALL. First of all, could you please explain what has delayed 

the transmission of the report outlined in Public Law 110–389. And 

when you said ‘‘shortly,’’ what does that mean? When will we receive that report? 

Ms. RUBENS. Yes, sir. I will tell you that this study was one of 

11 required in Public Law 110–389. As we work to get the studies 

all engaged, it took us longer than it should have. It was an inexcusable delay. That was enacted in October. It took us until March; 

you heard Mr. Christensen say we engaged them in March. So that 

was an inexcusable delay. 

As I understand it, and as I followed up in the last couple of days 

trying to ascertain just where it is, the concurrence process, 

through VBA, VA, and working with OMB, is closer to the end of 

that process than at the beginning. And we have engaged in some 

ongoing discussions to ensure that everybody that is looking at it, 

if you will, outside of VBA, recognizes that we are late. 

Mr. HALL. Well, if the report was done in September, are you 

changing the report? Is it being modified? Or are you just reading 

it before we get to read it? 

Ms. RUBENS. I will tell you that I think we were reading it before 

you get to read it. And the concurrence process over the course of 

October, November, and December was painfully protracted. It 

wasn’t so much that we are editing or changing, I think, as making 

sure that we understand and, unfortunately, not staying on top of 

the concurrence process to move it along. 

Mr. HALL. Well, I would appreciate receiving it within what I 

would consider to be a reasonable time, like the next week. I see 

no reason why a report that was paid for by the taxpayers, that 

was required by this Congress and by this Committee, and was 

completed last September by an outside contractor, should be sitting somewhere at VA, and for no good reason that I have been 

told, other than it being reviewed and concurred upon—whatever 

that may mean—has not yet been shared with us. And I think it 

is time. 

Ms. RUBENS. Yes, sir. 

Mr. HALL. Concerning that VBA Management System, the CPI 

model, today’s witnesses have testified that while specialization of 

the process improves quality and timeliness on the one hand, the 

moving of claims across teams also reduces quality and timeliness. 

I know that VA is working on at least four pilots pertaining to 

transforming its claims processing system into a 21st Century entity looking at other business reorganization efforts in the process. 

Could you elaborate on these pilots by explaining how they fit 

into the larger mission of greater accountability, accuracy, and consistency and outcomes? 

Ms. RUBENS. Yes, sir. The Little Rock pilot that I think you alluded to and the last panel addressed in terms of the pod concept, 

and quite frankly the triage effort, are both things that are part 

of that Little Rock pilot. And some of the things that we have seen 

have preliminarily shown us that triage function up front, where 

you get the claims started in the right direction with the right folks 

as quickly as possible, absolutely will result in a quicker, more 

timely outcome for the veteran. 


anorris on DSK5R6SHH1PROD with HEARING
24 

But additionally, that close proximity of the VSRs and the rating 

VSRs we found, in fact, does encourage the cooperation, the learning, the cross-talk in an effort to ensure the VSRs are requesting 

the right evidence, the right information that that rating specialist 

will need to make that final decision. 

As I said, that study concludes shortly. We anticipate to have a 

report. We have begun some preliminary discussions about—and 

how and what do we do with this on the national level to ensure 

that we take the best parts of it to increase our consistency, our 

quality, and improve timeliness as well. 

The pilot in Pittsburgh is, if you will, a case management development process where we have begun on a small scale to engage 

the veteran on a more personal level early in the process, so that 

when we receive a claim we will make a phone call and talk to that 

veteran about the contentions, the issues that they have claimed. 

Do we understand them? Are we searching for the right evidence? 

Are there other pieces of evidence that might be there that he perhaps forgot or overlooked on his application? 

When we send out that VCA letter that informs the veteran of 

what steps we have taken, what steps might help to move that 

claim along, it gives us an opportunity, quite frankly, to better explain what is a very lengthy letter, so that we can ensure the veteran understands; and that at various points during the processing 

of that claim, as we get evidence or have not received evidence, 

whether it is from the veteran or perhaps a third-party private 

medical care provider, we are able to apprise the veteran of the 

progress that we have made, what help we might use to get that 

evidence in an effort to help veterans better understand what we 

need and move that claim along, ensuring that we have all the evidence to make the best decision possible. 

Mr. HALL. Well, thank you, Ms. Rubens. And you heard the previous panel talk about the pods and triage, which seemed to be a 

fairly popular and somewhat successful approach. At least you are 

speaking positively of it. 

There have been cases in research projects that were done by the 

Centers for Disease Control and Prevention, I believe, or the National Institutes of Health where, in the middle of a study—if I remember correctly, I think it was hormone replacement therapy 

(HRT) for women—in the middle of the study, they realized that 

the evidence was so overwhelming that they stopped the rest of the 

study and said, Let’s all do this. Let’s recommend that women stop 

taking these HRTs because there is risk to their health caused by 

that. 

I can think of some others in terms of various pharmaceuticals 

that were being investigated, where the researchers themselves 

thought that it was so clear what the outcome was going to be that 

they stopped the study and said—for instance, Celebrex I can think 

of as one that was found to be a health risk for most of the patients 

who were taking it, and so doctors were advised immediately to 

stop prescribing, it except in particular situations. 

But my question is, is there a point at which you would take this 

pod concept and/or the triage concept and just say, okay, let’s just 

do it at every RO? Do we have to wait? Is there a long time necessary to do this if it seems to be working? 


anorris on DSK5R6SHH1PROD with HEARING
25 

Ms. RUBENS. No, sir. There is not a long time necessary. In fact, 

the area directors and the office field operation have been working 

with Compensation and Pension Service to draft the guidance that 

says here is how to put that mail processing, that triage piece, up 

front right now. So that while we haven’t received the final report 

on this study, we are already taking that piece of it and saying 

here is that guidance. Here is how we put it together. 

If I may, additionally, some of the early success that we have 

seen in Pittsburgh insofar as that telephone contact with veterans, 

we have also required already some phone calls up front with the 

veteran to make sure that, when that VCA letter has gone out, did 

you understand it? It is rather complex. Let us make sure you get 

it. We are working on the right issues, as well as mandating followup at intervals for claims that are pending so that we can apprise 

the veterans of the progress that we are making on their claims. 

Mr. HALL. Well, that is encouraging. My next question actually 

was going to be of phone calls, because the study Mr. Christensen 

testified about apparently found that work credits do not accurately 

reflect the effort involved in various actions. Like telephone calls. 

VBA employees surveyed noted that phone calls to claimants, as 

you just said, are the most direct or quickest way to resolve claims. 

Calls are seldom made, because the current work credit system 

does not award credit for a phone call. So are we seeing steps? Is 

VBA taking steps to change that, to award work credits for phone 

contacts? 

Ms. RUBENS. As part of the new VSR standards, the work credit 

currently is going to be given out for establishing the claim, beginning the development of the claim, getting that claim ready to rate, 

so that all the evidence has been gathered, as well as inputting the 

final decision and authorizing the claims. So there really only could 

be four steps that will get us credit. 

As we did the study on the new VSR standards—and we had 10 

stations participate in the study to evaluate how would this work 

for a VSR—over 1,300 VSRs participated in gathering the information. And some of the feedback that we got was the encouragement 

of folks to pick up the phone and make a call in an effort to get 

that ready for decision so that claim is now ready and that credit 

could be garnered. 

The challenge of the complexity of the claims will, I think, show 

itself as we work to do the reviews of what does the data show, 

now that we have implemented it nationally, at the 30-day, 60-day, 

90-day mark? And we sit down and look at that with our AFGE 

Labor partners to say, is it working the way we thought it would? 

Mr. HALL. Thank you. As of May 1 of this year, there are over 

8,700 compensation claims pending before the New York RO, nearly half of which have been waiting for over 125 days. 

What can you tell my New York area veterans and those in other 

Congressional districts about the work that is being done to reform 

the system so that the staff—both line staff and managers alike— 

focus on improving quality and still get the benefits to the veteran 

in a timely manner? 

Ms. RUBENS. Yes, sir. Specifically to New York, as you know, we 

have got a new management team in the New York Regional Office. I am very excited about their innovative approach, their colVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
26 

laboration that they have taken on their own already with the local 

medical centers to ensure that we get timely and accurate exams 

upon which to make decisions. And so the efforts there with the 

new management team I think will begin to, if you will, bear fruit 

as they help the employees better manage the work in innovative 

ways that we have developed locally. 

At the national level, I mentioned some of the things that we 

have done to generate ideas, whether it is internally, whether it is 

through the roundtable that Chairman Filner hosted, whether it is 

our National Innovation Initiative. And we are working to put together an overarching approach to improve nationwide some of the 

things that I heard of concern here. 

Interim ratings is one of the things that I have heard discussed 

in terms of if there are three or four issues on a claim and we can 

process one and need to develop further information on the other. 

We are reinforcing the use of interim ratings. It starts getting 

money flowing to the veteran and starts getting them access to 

health care, and ensures that they are in, if you will, our system 

and getting work done. 

We are also looking at how do we segment claims. I heard some 

discussion from some of the panel members about those one-issue 

claims that might move more quickly, whether it is that hearing 

loss claim or perhaps just one single issue, and are currently piloting, in a couple of offices, how will that work. About 26 percent of 

our work is a single-issue claim. And if we can move those along 

more quickly, will we allow ourselves a better focus, if you will, on 

those more complex claims, whether it is a complex issue or whether it is a number of issues. 

I talked a little bit about the proactive phone development. We 

have heard some concerns about whether or not we are 

incentivizing and rewarding employees. I will tell you that as we 

reward employees, quality is always a part of the requirement for 

a reward to be given. But it is also about that—I will call it ‘‘less 

tangible monetary award,’’ and it is that recognition of who your 

performers are and making sure that we are recognizing them for 

that effort. 

One of the initiatives that we are developing and in which the 

Secretary is interested in supporting is, if you will, a Who’s Who 

in VBA for VSRs and ratings specialists that will allow us to recognize, quarterly, the top 25 in each of those categories, and, at the 

annual level, with recognition from the Secretary, in an effort to 

have people continue to stay jazzed and focused on ‘‘We have got 

to get this job done.’’ 

I would be remiss if I didn’t mention some of the efforts that we 

are making in both the technology, if you will, the VBMS, the Veterans Benefits Management System. We are standing up an organization that brings VBA end-users, if you will, field users and the 

Office of Information and Technology organization together to be 

focused on this project that will grow from the virtual regional office pilot that was just completed in Baltimore, allowing us to 

change and pursue actively the electronic claims processing system. 

Mr. HALL. Well, thank you for all that. I am especially happy to 

hear that you are moving toward more streamlined granting of 

claims or approval of claims in clear-cut cases like hearing loss. 


anorris on DSK5R6SHH1PROD with HEARING
27 

Although I am a little bit disappointed that in 2008, Congress 

passed a law unanimously, that was signed by President Bush, 

that said the Secretary shall issue this partial claims rating. 

Changed the language from ‘‘may’’ to ‘‘shall,’’ indicating the clear 

intent of Congress that when there is an undisputed severe disability—which I think hearing loss might fall under—or a loss of 

limb or a paralysis or blindness, or any number of other things that 

are clearly service-connected and are not in dispute—notwithstanding the possibility that there may be many other facets of 

claims that need further development or adjudication—that the 

Secretary shall award an immediate partial rating so that money 

starts flowing to the veteran. That was passed unanimously and 

signed by the previous President. And 2 years later, I am surprised 

that we are talking about being partway on the road to getting that 

done. I would hope that we would have been there already. 

In your written testimony, you state, Ms. Rubens, quote: VBA 

does not and never has emphasized the quantity of claims completed over the quality of our decisions. Unquote. 

While this may be VBA’s stated policy, I think the testimony of 

other witnesses here demonstrates pretty clearly that that is not 

actually true in practice, to say nothing of the roughly 25 percent 

error rate nationally that the VA Office of Inspector General reported to this Subcommittee in March at our hearing on the STAR 

process in light of the staggering rates of claims that are remanded 

or overturned by the Board of Veterans’ Appeals and the U.S. 

Court of Appeals for Veterans Claims. 

The message that I would like the VA to take from this hearing 

is that speed cannot be the sole aim of reforming the claims system 

or else the same problems will continue to plague veterans. Timeliness will be a byproduct of an efficient and accurate claims processing system. 

So I would just hope that you can reassure me that VBA has 

some idea how to effectively live up to the quality commitment, 

while at the same time providing speed when it is appropriate, as 

in the case of the undisputed severe cases that you were speaking 

about, which I was mentioning also. 

And I am also curious whether claims processors can be or are 

being incentivized in a way to achieve both of these goals—the accuracy, but also the credit for compensation—flowing to veterans as 

soon as possible when that part of their claim is not in dispute. 

I also and the Committee needs to better understand the ways 

in which VBA is emphasizing quality on a par with quantity. And 

we would like to be reassured that the courts—that the appeals 

levels are not being used as a backstop, and that hopefully by 

triage and pod approaches, we may achieve a higher accuracy rating the first time around. 

I am sure these are all goals of yours, too. I know you have a 

lot on your plate. I know that the VA has a lot of cases and an increasing number of claims. Nobody thinks that you have an easy 

job or that the Secretary has an easy job, or that anybody who 

works at the VA has an easy job. But we are in a position to hopefully provide you with resources to do what you need to do, and all 

branches at the VA to do what needs to be done for our veterans, 

but, at the same time, fulfilling our Congressional role of oversight. 


anorris on DSK5R6SHH1PROD with HEARING
28 

And to that end, seeing the report, which you have, would be 

good, and at least having the knowledge that the law that was 

passed in 2008 and signed into law is actually being implemented. 

And hopefully that, as was requested then, that claims processors 

and raters are being credited and rewarded and that their evaluations are getting more positive. Not only are they making more accurate decisions but they are, when they can, speeding the delivery 

of compensation to the veterans. Because for a veteran who is 

sleeping under a bridge, or for a veteran who is having suicidal 

thoughts or family problems or bankruptcy issues or adjustment, 

family adjustment problems, all the things that we all know are 

happening, time is important. And one of the ways we can help is 

by easing the financial difficulties, especially in this difficult financial time that the country is going through. 

So I am not telling you anything you don’t already know, but I 

would appreciate your getting back to us. You can do it in writing, 

if you would like, because I have a plane to catch and you have 

probably heard enough by now. But if you would like to take a couple minutes to answer, Ms. Rubens, I would be happy to let you 

do that and then we will submit some more questions to you in 

writing. 

Ms. RUBENS. Thank you. I do want to just—I didn’t mean to insinuate, to say that we hadn’t been doing partial ratings all along. 

I will tell you, though, that we have seen the opportunity to allow 

us to achieve, if you will, one more piece of that vision that the Secretary has; and that is, how do we make sure that we are being 

the best advocates for veterans that we can? And that is to make 

sure that not only are we using them when they come up, but that 

we are actively pursuing them, that we are actively encouraging 

our VSRs and ratings specialists that, as quickly as they can—even 

if it is only partial—that they are ensuring that they are starting 

that flow of money, for the reasons that you stated in terms of the 

challenge of a transition, the challenge of the economy and homelessness, that we need to make sure that we are getting the message across. We know we are a source of help for them, and that 

is what we are here for. 

I will tell you that I do not believe that we are using the appeals 

process, if you will, as a backstop. We see about a 12 to 13 percent 

appeal rate. We don’t think that is good. We know we need to improve that. But it is also one of the measures that we look at regularly from the standpoint of appeals, remands, by individual regional office as you look at quality, and make sure that that is part 

of the feedback that we give not only to our directors but to our 

service center managers and our employees who are doing the job 

on a day-to-day basis. 

We recognize that it is possible to be both timely and have a high 

degree of quality. We do have offices that have managed to achieve 

those goals. And part of what we have to do is invest in stealing 

those good ideas and making sure that they are being implemented 

in other places; that we are requiring them, and that we are holding ourselves accountable to meeting that same level of service, 

which really does pair those two things—a timely decision, made 

in a quality way. 


anorris on DSK5R6SHH1PROD with HEARING
29 

Mr. HALL. Well, that is the last word, and thank you very much 

for it. Thank you for your testimony and for your commitment to 

working with us to improve the quality of processing veterans 

claims. 

And I will just state that all Members have 5 legislative days to 

revise and extend their remarks. 

We thank all our witnesses on our three panels today for staying 

this afternoon. We value your insight and opinions and your work 

on behalf of our veterans. This hearing stands adjourned. 

[Whereupon, at 5:03 p.m., the Subcommittee was adjourned.] 


anorris on DSK5R6SHH1PROD with HEARING
(30) 

A P P E N D I X 

Prepared Statement of Hon. John J. Hall, Chairman, 

Subcommittee on Disability Assistance and Memorial Affairs 

Good Afternoon. 

Would everyone please rise for the Pledge of Allegiance? 

Flags are located at the front and back of the room. 

Ladies and gentlemen, I welcome you to today’s hearing entitled ‘‘Quality vs. 

Quantity: Examining the Veterans Benefits Administration’s Employee Work Credit 

and Management Systems.’’ 

The purpose of the hearing is to examine how VBA’s employee work credit system 

and its Claims Processing Improvement (CPI) work management system model may 

contribute to diminished quality, accountability and accuracy in compensation and 

pension claims. Today’s hearing continues this Subcommittee’s efforts to analyze 

various elements of the compensation and pension claims process over the 111th 

Congress, and marks the fifth oversight examination this year focused on ensuring 

that our veterans and survivors properly receive their benefits. It is our collective 

quest to vanquish VBA’s backlog of claims and appeals, which currently exceeds one 

million. 

We also intended for today’s hearing to provide an opportunity to examine a congressionally-mandated report on the VBA’s work credit and management systems 

outlined in legislation that I developed and sponsored during the 110th Congress, 

the Veterans Disability Benefits Claims Modernization Act of 2008, H.R. 5892, (codified in P.L. 110–389). The goal of this legislation, among other things, was to provide VBA with a valuable roadmap to assess and improve its work credit and management systems to produce better claims outcomes for our veterans. 

The deadline for this report was October 31, 2009 and I note that we have yet 

to receive it. However, VA has authorized its independent research contractor that 

was retained to complete this report, the Center for Naval Analyses (CNA), to testify before us today concerning a summary of the report’s findings and recommendations. VA advised the Subcommittee that the report is still under review by the 

agency and OMB, and that it should be transmitted to Congress soon. We look forward to hearing today when this report will be ready and submitted to Congress, 

and getting a better understanding of why it has not yet been delivered. 

Since 2007, the VBA has added over 7,100 claims processing personnel and Congress has funded these requests. Yet the backlog still climbs. This is not to say that 

adding additional workforce has not been beneficial. Had Congress not provided 

these new claims processors, the backlog might have been even worse than it is 

today, given the exponential growth in claims receipts. As the VA itself acknowledged at Chairman Filner’s Claims roundtable in March, this is a sign of a broken 

system. The mounting claims backlog is a symptom that can not be addressed until 

the VA truly refocuses itself on adjudicating claims correctly the first time. We need 

to continue to look at the system with fresh eyes and determine how a new outlook 

can help VA fix its claims processing system and get the claims backlog under control. 

In convening today’s hearing, the Subcommittee seeks to further explore how the 

VBA’s work credit incentives and flawed CPI model may be significantly contributing to delays and errors in the claims process. It is my hope that in continuing 

to examine this issue, we will be able to help veterans secure the benefits they deserve and prevent them from suffering further injury as a result of delays in receiving disability benefits. That is why I want to revisit the issue of partial, provisional 

and temporary ratings. I believe that if VA increases the use of this authority and 

also awards a credit to claims processing personnel who use it. This will go a long 

way in making sure that many more veterans can begin to receive their benefits 

more promptly. I would like VA to address this issue when it testifies. 

Today we will also hear from Veterans Service Organization and Veterans Advocacy Groups who will explain their vision for how the VA should address the probVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00034 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
31 

lem with VBA claims processing. From them, I hope to gain a better understanding 

of the underlying issues that led to such an unmanageable claims backlog at VBA, 

and if they believe that VA is directing its efforts in the right direction to address 

the issue. Specifically, I would like to know if you agree with VBA’s assertion that 

it emphasizes quality on par with quantity and timeliness. 

I look forward to the testimony of our witnesses and insightful comments and 

questions from my colleagues on the Subcommittee. I now recognize Ranking Member Lamborn for his opening statement. 

f 

Prepared Statement of Hon. Doug Lamborn, Ranking Republican Member, 

Subcommittee on Disability Assistance and Memorial Affairs 

Thank you Mr. Chairman, 

I look forward to this afternoon’s hearing on VA’s work credit system. 

The purpose of this discussion is to ascertain whether proper performance measures are in place to effectively gauge both efficiency and accuracy of work. 

A system that rewards work credits based on production alone undermines quality, and as we all know, poor quality work has ramifications throughout the entire 

system that have contributed to the backlog of claims. 

At the same time, there is also clearly a need for VA to maintain a high level 

of efficiency so that veterans can begin receiving compensation in a timely manner. 

Where does the proper balance lie? 

True quality means being effective and efficient, the key to achieving this balance 

lies in how employees are rewarded for the work they accomplish. 

For too long, it appears that VA has placed too high an incentive on production— 

but it is simply counterproductive to strive for high numbers if the work has to be 

revisited at a later time. 

Yet it would be equally detrimental to veterans if there was an overemphasis on 

quality and the average handle time was off the charts. 

This Subcommittee passed legislation during the last session to obtain a study of 

the effectiveness of the VA’s employee work credit and work management system. 

From this, we hope VA will be able to develop a more effective means of improving its claims processing performance. 

I look forward to working with my colleagues and Department officials to delve 

into this issue and hopefully identify how the work credit system can help 

incentivize the proper balance between quantity and quality. 

I want to thank the witnesses for their participation and their testimony, and I 

look forward to our discussion today. 

Mr. Chairman, I yield back. 

f 

Prepared Statement of Eric Christensen, Managing Director of Health 

Research Policy, Institute for Public Research, CNA 

In response to Section 226 of Public Law 110–389, the Veterans’ Benefits Improvement Act of 2008, the Department of Veterans Affairs (VA) asked CNA to 

study the effectiveness of its current employee work credit system and the work 

management system. Beyond these principal areas of study, we considered other 

topics including the use of information technology (IT) applications, methods of reducing the time required to obtain outside information, processing of claims that are 

ready to rate upon submittal, processing of claims from severely injured (SI) and 

very severely injured (VSI) veterans, and an assessment of best practices in claims 

processing. CNA conducted this analysis between March and September 2009. 

Due to the nature of our study questions and the short timeline for this project, 

the most appropriate methodology was qualitative data analysis. Our primary 

source of data was information collected from interviews on site visits to six Regional Offices (ROs) selected by the Veterans Benefits Administration (VBA). On 

these site visits we spoke with employees in a wide variety of roles in order to obtain as complete a picture as possible within the time constraints of the study. We 

took detailed notes from each interview and reviewed them to identify common 

themes among the responses. In total we spoke with 41 frontline employees, 49 

managers, and 11 other employees. We supplemented the information from our site 

visits with background information from congressional hearings, formal evaluations 

from a variety of sources (such as the Government Accountability Office (GAO), VA’s 


anorris on DSK5R6SHH1PROD with HEARING
32 

1 U.S. Government Accountability Office. Veterans’ Disability Benefits: Preliminary Findings 

on Claims Processing Trends and Improvement Efforts. Testimony of Daniel Bertoni before the 

Committee on Veterans’ Affairs, U.S. Senate, 20 July 2009, GAO–09–910T. 2 Ibid. 

3 U.S. Department of Veterans Affairs, Office of the Inspector General. Review of State 

Variances in VA Disability Compensation Payments. Report No. 05–00765–137. May 2005. 4D. Harris. Findings from Raters and VSOs Surveys, May 2007 (D0015934.A2). 

Office of Inspector General (OIG), and internal VBA projects), conversations with 

VBA subject matter experts, and summarized VBA administrative data. 

Background 

VBA faces multiple challenges in processing claims including large increases in 

the number of claims submitted and the increasing complexity of these claims. The 

increase in the number of claims submitted is striking. For example, VA received 

about 719,000 compensation claims in FY 2008. This is a 53 percent increase from 

FY 1999.1 Reasons often cited for the increase are the return of veterans from Global War on Terror deployments and the expansion of benefit entitlements, such as 

new presumptions of service connection. As for the complexity of claims, GAO reported that in FY 2006, 11 percent of claims that VA decided included 8 or more 

issues. By FY 2008, this proportion increased to 16 percent.2 We note these statistics to illustrate the challenging and dynamic environment in which VBA works to 

process claims. 

The work management system that VBA uses is the Claims Process Improvement 

Model or CPI model. The CPI model is an organizational model that promotes specialization as a way to improve quality and timeliness. The model has separate 

claims processing teams to perform functions in each of the following areas: public 

contact, triage, pre-determination, rating, post-determination, and appeal. In this 

model the triage team reviews and routes mail, enters basic claim information into 

the computerized workload management system, and performs some simple claims 

processing actions. From triage, claims move to the pre-determination team, which 

primarily gathers the information necessary to rate each claim. Once a claim is 

ready to rate, the rating team decides whether a veteran’s medical conditions are 

connected to military service and if so, what the degree of disability is according to 

the VASRD (Department of Veterans Affairs Schedule for Rating Disabilities). Next 

the post-determination team processes (i.e., authorizes) awards and notifies claimants of the decisions made on their claims. Outside of this process, the appeals team 

handles claims for which claimants disagree with the award decision and decided 

to appeal it and the public contact team conducts personal interviews and responds 

to phone inquiries. 

Veterans Service Representatives (VSRs), Rating VSRs (RVSRs), and Decision Review Officers (DROs) are VBA employees that work on the various teams in the CPI 

model. These employees are all subject to minimum work credit standards. They 

earn work credits by performing certain claims processing actions, each of which is 

assigned a specific number of credits meant to reflect the time required to complete 

the action. Employees’ ability to meet the work credit standards is one of the elements considered in their annual performance evaluations. 

Note that VBA asked CNA to study its work credit and work management systems to see how they could be improved. While there are positive aspects to these 

systems, our charter was to look for areas of improvement; hence, we report on 

areas for improvement only. Therefore, one should not conclude that no part of these 

models works well because we focused on areas for improvement only. 

Work credit system 

Findings 

Stakeholders’ main concerns about the current employee work credit system are 

(1) that it emphasizes quantity over quality, (2) that production standards are not 

based on a careful analysis of the tasks performed, and (3) that work credits and 

production standards do not reflect changes in claim complexity and additional duties imposed by legislation. 

Two recent surveys found strong evidence that VBA claims-processing employees 

perceive that quantity is considered more important than quality. The first was a 

survey of RVSRs and DROs conducted by VA’s OIG during March and April 2005.3

CNA conducted the second survey of rating officials and Veterans Service Organization (VSO) representatives for the Veterans’ Disability Benefits Commission during 

December 2006 and January 2007.4 Both surveys found very strong evidence that 

rating officials perceive that quantity is considered more important than quality. 

This is an important finding because even if that perception is incorrect, at least 


anorris on DSK5R6SHH1PROD with HEARING
33 

some employees who have that perception will probably change the way they process claims in order to do what they think their supervisors want. 

From our analysis in this study, the perception that the quantity of work receives 

more emphasis than the quality of work was common. The overwhelming theme 

from frontline employees was that the production standards are difficult to meet, 

whereas concerns about struggling to meet the quality standards were rare. We 

infer from this that a moderate increase in the number of quality reviews per employee would better communicate to employees that VBA values both production 

and accuracy. In addition, some interview respondents reported that they feel the 

current number of reviews is too low to be representative of their work, which certainly implies that some employees would even welcome an increase in the number 

of quality reviews. 

VBA has undertaken several of its own efforts to consider ways to improve the 

work credit system. One of these efforts was a time-motion study intended to provide information for updating the work credit values. A more fundamental change 

that VBA is investigating is re-defining all the actions for which employees receive 

credit in order to better align them with the overall goal of completing claims. In 

particular, VA established a VSR Performance Standards Workgroup that recommended that VSRs receive work credit for only the following four types of actions: 

(1) initiating development, (2) making a claim ready to rate, (3) deciding an award, 

and (4) authorizing the award. At the time of our report, VA was preparing to pilot 

test this approach at multiple ROs. 

Prior to developing this approach, the VSR Performance Standards Workgroup 

conducted a survey of frontline employees and managers. It included questions on 

perceived weaknesses in the current work credit system, and the responses echoed 

what we heard through our evaluation. The most commonly reported problems were 

that the performance standards are outdated, there are inconsistencies across teams 

and ROs in the rules for claiming credits, deductible time is subjective, the standards are stagnant, the current system rewards churning of work, and piecemeal development is the only way to meet the performance standards. 

Based on information from our site visits, we found that employees generally feel 

that the work credit values in the current work credit system do not accurately reflect the amount of time required for each action. In particular, each action is too 

broadly defined to account for the large degree of variation in complexity across 

claims. The perceived inaccuracy of the work credits combined with the requirement 

to meet minimum work credit standards and the perceived emphasis on quantity 

over quality result in some unintended consequences for the way in which claims 

are processed. 

One of the most basic questions to consider about the employee work credit system concerns the actual work credit values. Both frontline employees and managers 

were overwhelmingly in agreement that the work credits assigned to each individual 

action do not always accurately reflect how much time is needed to perform that 

action for each claim. Respondents reported multiple ways in which the work credit 

values are not accurate. Some actions receive too much credit for the average claim, 

some actions receive too little credit for the average claim, and some actions receive 

no credit at all. 

There is tremendous variation in the complexity of claims, and based on information from our site visit interviews, the actions in the work credit system are not defined at a level of detail to reflect that variation. This implies that even if the work 

credit for an action is accurate on average for claims worked over an extended period of time, there’s no assurance to the employees that the work credit they receive 

for that action on any particular claim reflects the actual amount of time required 

to be spent. 

The two factors that respondents reported as the main determinants of the difficulty of processing a claim were the number of issues and the types of medical conditions. For some actions, the current system allows extra work credit for claims 

with eight or more issues and for claims with certain medical conditions that are 

difficult to adjudicate (e.g., post-traumatic stress disorder). However, there is still 

a lot of variation that is not taken into account. There was general agreement that 

the number of issues on a claim is not adequately addressed by the work credits 

system. In particular, the ranges for the number of issues (1 to 7 issues and 8 or 

more issues) are too broad, and performing an action for a claim with 7 issues 

should receive more credit than for a claim with 1 issue. 

There was also agreement that the particular medical condition or conditions on 

a claim have a big effect on how much time a claim requires. For example, respondents reported that actions on claims for hearing loss are typically relatively straightforward and might even be over-credited, whereas actions on claims with complex 

medical conditions (such as traumatic brain injury) might merit additional credit. 


anorris on DSK5R6SHH1PROD with HEARING
34 

Some respondents indicated that one of the reasons they believe that work credits 

do not accurately reflect the effort involved in various actions is that the system has 

not been revised to account for changes in the types of claims submitted. They specifically cited increases in the number and complexity of issues. 

Based on information from our site visits, one unfortunate effect of the current 

work credit values is that VSRs tend not to use phone calls to veterans to expedite 

development because there are generally no separate work credits for those phone 

calls during the development phase, even though sometimes a phone call is the most 

direct way to resolve a question. Some of the VSRs who do make use of phone calls 

said they have learned to work around the absence of work credits. They do this 

by following up a phone call (for which they receive no credit) with a letter (for 

which they do receive credit), even for cases where they feel the letter isn’t necessary. Thus, the lack of work credits for phone calls slows development down both 

by discouraging some VSRs from using a potentially good source of information and 

by causing others to perform an unnecessary activity (writing a follow-up letter) in 

order to get the work credits that they need. 

We also heard about some examples of churning or piecemeal development of 

claims such as spreading development over multiple days to classify them as separate actions and therefore be able to claim multiple credits. However, we do not 

know exactly how frequent or rare piecemeal development is. We observed that most 

frontline employees are genuinely concerned with serving veterans and their families and that these types of activities are simply responses to the production pressures that many employees feel. 

Figure 1 shows the distribution of the average number of work credits claimed 

per completed claim for all the ROs. If all ROs were processing the same set of cases 

in the same way, and if all employees were claiming the same work credits for the 

same actions, then we would expect minimal variation across ROs. Instead, we 

found that the average number of work credits per claim at each RO ranged from 

5.2 to 17.7, with substantial variation within that range. These results do not account for average differences in the types of cases across ROs, and those differences 

certainly could explain some of the differences in work credits per claim. However, 

the sizable magnitude of variation raises questions. 

Figure 1. RO’s average work credits per claim 

The existence of unintended consequences such as rushed actions and piecemeal 

development, have negative effects on both the quality and timeliness of claims 

processing. The first step toward eliminating them should be a pilot to develop a 

set of actions and associated work credits that accurately reflect, and are perceived 

to accurately reflect, the time required to perform each action at a targeted level 

of quality. Those work credit values can then be combined with information on exVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00038 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING57021a.001
35 

pected caseload to determine the staff required to process that caseload at that quality level. Because these changes will not be quick to implement, VBA should determine what the trade-off between quality and quantity is under current resource constraints and then explicitly decide on which levels of quality and quantity best contribute to accomplishing VA’s mission. 

Recommendations 

To address both the issues of work credit values and increasing the perceived emphasis on quality, we recommend conducting a pilot test of the effectiveness of taking the following steps, in the order indicated: 

1. Develop a list of actions defined so that there is little variation across claims 

in the time required to perform the action. This will probably require accounting for the number of issues and the specific medical conditions involved. 

2. Determine the time that is required (i.e., the work credits) to perform each action at a certain average level of quality. This will require incorporating the 

fact that employees with different levels of experience (i.e., different GS levels) 

will need different amounts of time to achieve the same average level of quality. 

3. Communicate information to employees about the methodology used in developing the new work credits. The goal is for employees to understand that the 

work credits accurately reflect the time that should be required for each action. 

In addition, they should understand how accuracy of claims processing was explicitly incorporated into the development of the work credits and thus how important quality is to VBA. 

4. Set the daily work credit performance standards for each individual employee 

to match the number of available work hours per day. Since the work credits 

from step #2 above will have been developed to equal the time required for 

each action, setting daily standards to match the time available ensures that 

employees should not perceive a need to rush. This recommendation is for 

staff’s ease of understanding work credit values. 

5. Set the RO production standards so that they can be attained when employees 

are working at the work credit standards from step #4 above. (This contrasts 

with what we heard about the current RO standards, which apparently cannot 

be met if all frontline employees are working only at their minimum work credit standards.) 

6. Develop mathematical models to predict how the number and complexity of 

claims translate into the number of employees needed to complete those claims. 

Then, apply the model to the predicted caseload to calculate the number of employees needed in the future to handle that caseload. Plan to increase or decrease the number of claims processing employees accordingly. 

7. Conduct ongoing analysis and revisions of the actions, work credit values, and 

number of employees needed. The ongoing analysis is required to account for 

the fact that there are continuing changes in the complexity of claims, in the 

legal requirements about what must be done for each claim, and in IT system 

capabilities. 

We consider the following options for redefining actions (step 1) as only two examples among the numerous possible alternative approaches. 

One option is to base the detailed list of actions on the four main types of actions 

proposed by the VSR Performance Standards Workgroup, which are initiating development, making a claim ready to rate, deciding an award, and authorizing the 

award. Within each of those four types of actions, the work credit values would vary 

to account for differences in complexity of claims by number of issues, types of medical conditions, and any other factors found to be good predictors of how much time 

the action requires. 

One advantage of this approach would be that employees could focus more on the 

actual performance of actions rather than spending time recording a lot of separate 

smaller actions. Another advantage would be that employees would have a lot of incentive to perform only those activities that make a definite contribution to completing the claim. A disadvantage of this approach would be that work credits would 

be ‘‘lumpy,’’ by which we mean they would be relatively large but there would be 

only a few points in processing a claim at which work credits could be claimed. This 

could be a problem if there were a day or even a week in which a VSR was in the 

middle of intensive development activities for a large number of claims, but by 

chance none of the claims became ready to rate during that day or week because 

the external parties from whom supporting information had been requested were 

not responding. In that case, the VSR would earn zero credits for that time period. 


anorris on DSK5R6SHH1PROD with HEARING
36 

A second option is to base the detailed list of actions on a comprehensive list of 

all the individual activities that employees perform in the process of doing their 

jobs. The main advantage and disadvantage of this option would be directly opposite 

to those described in the first example above. Specifically, the disadvantages would 

be that not all actions make a direct contribution to completing the claim and that 

the frontline employees would need to spend time recording each of their many separate actions in ASPEN (Automated Standardized Performance Elements Nationwide). However, the advantage would be that this approach would produce detailed 

records on each frontline employee’s specific activities, which would provide both 

frontline employees and managers with very precise information on exactly how 

much work the employees have done for any given time period and therefore how 

well they are on track to meet the month’s minimum work credit standards. 

In addition to the seven recommended steps, we also have the following individual 

recommendations for actions that would contribute to the effectiveness of the work 

credit system: 

• As discussed earlier, conducting more quality reviews would better communicate to staff that quality is a priority for VBA. 

• If the RO internal quality reviews counted deviations from official procedures 

for claiming work credits as errors (instead of just as ‘‘comments’’), then that 

would improve adherence to procedures, thereby improving quality. 

• If there were work credit deductions for actions on which there were errors, 

then that would improve quality. 

• In the long term, if VETSNET could be modified so that it captures work credits 

automatically as a claim moves through the stages of processing, then that 

would save time for employees in recording their work credits, and it would ensure that work credits are logged more accurately and consistently across staff 

and ROs. 

Work management system (CPI Model) 

VBA’s current work management system is the Claims Process Improvement 

Model. The CPI model is not VBA’s first attempt to manage the claims process by 

dividing it into separate stages and passing a claim along to a different person at 

each stage. In the 1990s, VBA was using a similar model called the ‘‘unit model.’’ 

That model resembled the CPI model in that employees were specialized so that the 

various functions of claims processing (e.g., development, rating, authorization) were 

performed by different people. The main difference between the unit model and the 

CPI model was that employees were not organized into teams in which everyone on 

the team performed the same function. Instead, each team consisted of employees 

who performed different functions so that they collectively covered all the necessary 

claims processing functions. 

In the late 1990s, there was a business process reengineering (BPR) effort in 

which a VBA guidance team analyzed the key challenges facing claims processing. 

Among those challenges were a lack of individual accountability and an emphasis 

on quantity of work over quality. The team’s solution was a ‘‘case management 

model’’ in which each claim was handled by only one VSR and a rater who made 

the rating decision. VBA used this model until it adopted the CPI model in response 

to concerns about problems with timeliness. 

It’s not difficult to see the cyclical pattern of recurring concerns that led to switching between two basic types of approaches (more vs. less employee specialization), 

each of which has different advantages and disadvantages. The key question then 

is which approach has stronger advantages than disadvantages, and based on our 

synthesis of information that we obtained from our site visits, the answer is not 

straightforward. 

The main motivation for studying the CPI model is the concern that quality and 

accountability are lacking because many different people are involved in processing 

each claim. Our analysis finds that two of the main distinguishing features of the 

CPI model, i.e., the specialization of VSRs and the fact that claims are passed 

through a series of specialized teams, have both advantages and disadvantages for 

the quality and timeliness of claims processing. In particular, VSR specialization improves quality and timeliness (compared to a model with less specialization but 

more continuity in the staff who work on each claim), but the movement of claims 

across teams reduces quality and timeliness. The issue is to determine whether the 

improvements outweigh the disadvantages. Thus, the net effect of the CPI model is 

unclear, which means that before making any changes to its approach to claims 


anorris on DSK5R6SHH1PROD with HEARING
37 

5 Booz Allen Hamilton. Veterans Benefits Administration Compensation and Pension Claims 

Development Cycle Study. Final Report. 5 June 2009. 

processing, VBA should conduct a pilot study to confirm that those changes will actually produce the desired net improvements. 

At the time of our report, VBA was already conducting a pilot study to test an 

alternative to the CPI model that, based on its design, appears to have the potential 

to improve both quality and timeliness. Consequently, we recommend that VBA 

wait for the results of that study before deciding whether it would be worthwhile 

to investigate other alternatives. 

Specifically, VA was conducting a pilot study in the Little Rock RO, and one of 

its main elements is testing the use of claims processing teams (called ‘‘pods’’) that 

contain pre-determination, rating, and post-determination functions. One of the expected benefits of organizing employees into pods is ‘‘improved quality resulting 

from more rapid identification and resolution of errors within the team (i.e., errors 

will be detected much closer to the point of occurrence)’’.5 This approach also retains 

the current specialization of VSRs. Thus, the current pilot study is testing a model 

that appears to have reasonable potential to improve quality compared to the CPI 

model, especially if organizing employees into pods creates a greater sense of accountability than in the CPI model’s function-based teams. Consequently, we do not 

see any reason to pilot test another approach (e.g., the hypothetical one we consider 

above) unless the results of the current pilot show that the use of pods does not 

result in claims processing outcomes any better than ose obtained under the CPI 

model. 

It is also important for all stakeholders to consider the possibility that different 

work management systems might ultimately produce similar outcomes. On our site 

visits, we heard from a number of managers who thought that the specific claim 

processing model is less important than managers’ abilities in implementing it. This 

line of thinking suggests that only limited improvements could be obtained from 

changing the approach to claims processing. VA should certainly be using the approach that will best produce the quality and timeliness results it wants. However, 

other factors, such as certain IT improvements, could easily have much more impact 

than changes to the claims processing approach. 

Other study topics 

In the area of IT use, VA has been proceeding with its efforts to increase the use 

of paperless processing, and that strategy seems to have the most long run potential 

for improving timeliness and quality. VA has investigated the possibility of using 

rules-based applications for the rating decision, but the subjective nature of many 

of the current VASRD criteria would make implementation of that approach extremely challenging. 

Timely development of claims is essential to the timely completion of claims, and 

VBA could improve development time by encouraging more use of telephone contacts to obtain information from claimants and third-party organizations. The best 

way to encourage this would be to provide appropriate work credit for phone development. Currently, some employees who use phone contacts for development report 

that they also follow up with a letter that’s not always necessary because sending 

the letter is what enables them to claim sufficient work credits to meet their minimum performance standards. 

On the topic of claims that are ready to rate at the time they’re submitted, we 

found that there are no standard practices across ROs for handling those claims. 

There is currently a pilot study to determine the potential for a program in which 

‘‘fully developed claims’’ receive expedited treatment, and depending on the results 

of that pilot, it is possible that VA will establish such a program at all ROs. If it 

does, then it seems likely that any special procedures that ROs have developed for 

ready-to-rate claims would be superseded by the program for fully developed claims. 

Another category of claims that we were asked to address is claims from SI and 

VSI veterans. The practice reported to be effective in ensuring that those claims are 

processed promptly is to designate specific individuals to be responsible for following 

those claims extremely closely through all phases of processing. 

Until recently, VBA did not formally assess or disseminate best practices for 

claims processing. Instead, managers tended to learn about practices at other ROs 

through informal contacts. We heard from managers that they would like more access to information on alternative approaches that other ROs have found to be successful, but because of the many differences among ROs, the managers would prefer 

that any practice reported to work well at one RO be presented as a suggestion 

rather than as a requirement. In July 2009, VBA issued a standard operating proceVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00041 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
38 

dure for identifying best practices and disseminating them on their Quality Assurance Web site. So, in the future, it should be easier for managers at ROs to access 

information regarding best practices. 

f 

Prepared Statement of Richard Paul Cohen, Executive Director, 

National Organization of Veterans’ Advocates, Inc. 

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: 

Thank you for the opportunity to present the views of the National Organization 

of Veterans’ Advocates, Inc (‘‘NOVA’’) concerning the Veterans Benefits Administration Employee Work Credit and Management Systems. 

NOVA is a not-for-profit § 501(c)(6) educational organization incorporated in 1993. 

Its primary purpose and mission is dedicated to train and assist attorneys and nonattorney practitioners who represent veterans, surviving spouses, and dependents 

before the Department of Veterans Affairs (‘‘VA’’), the Court of Appeals for Veterans 

Claims (‘‘CAVC’’), the United States Court of Appeals for the Federal Circuit (‘‘Federal Circuit’’). 

NOVA has written many amicus briefs on behalf of claimants before the CAVC 

and the Federal Circuit. The CAVC recognized NOVA’s work on behalf of veterans 

when it awarded the Hart T. Mankin Distinguished Service Award to NOVA in 

2000. The positions stated in this testimony have been approved by NOVA’s Board 

of Directors and represent the shared experiences of NOVA’s members as well as 

my own eighteen-year experience representing claimants before the Veterans Benefits Administration (‘‘VBA’’). 

P.L. 110–389 

In October 2008 Congress passed S. 3023, enacted as P.L. 110–389, and titled the 

‘‘Veterans’ Benefits Improvement Act of 2008’’ (‘‘the VBIA 2008’’ or ‘‘Act’’). 

Among the reports which the Act required the VA to submit to Congress, before 

the end of 2009, is a report on a study conducted on the effectiveness of the current 

VBA employee work credit and work management systems. Act, section 226. 

VA COMPLIANCE WITH P.L. 110–389 

As of the date this testimony was submitted, NOVA has not seen a copy of the 

VA’s required report to Congress. Moreover, as of May 1, 2010, the VA’s required 

report had not been submitted to Congress. 

THE WORK CREDIT SYSTEM 

For many years NOVA’s members have noticed large numbers of inaccurate compensation and pension decisions which we attributed, in part, to lack of effective 

training of VA employees and to their cursory review of claims folders. 

One of the first published studies to confirm that the VA’s present work credit 

system prevents accurate decision-making was the May 19, 2005 report from the VA 

Office of Inspector General, ‘‘Review of State Variances in VA Disability Compensation Payments’’, Report No. 05–00765–137 (‘‘the Report’’). According to the IG, the 

VBA’s national production standards which must be equaled or exceeded by each 

Regional Office (‘‘VARO’’) include, for journeyman Rating Veterans Service Representatives (‘‘RSVRs’’), 3 to 5 weighted cases per day, based on the type of claim 

and the number of claimed disabilities or issues rated; from 3 to 7 weighted cases 

per day for those working from home; and from 3 to 4 weighted cases per day for 

Decision Review Officers (‘‘DROs’’). Report, page 60. 

Sixty-five percent of those VA employees who responded to the IG’s questions 

(questionnaires were sent to 1,992 rating specialists and DROs) reported insufficient 

staff to insure timely and quality service. More troubling is the report by 57 percent 

of those responding that it is difficult to meet production standards if they adequately develop claims and thoroughly review the evidence before issuing rating decisions. And, 41 percent of those responding estimated that 30 percent or more of 

the claims were not ready to rate when presented for rating. Report, pages viii, 58, 

60. 

An additional indictment of the work credit system is contained in the June 5, 

2009, Booz Allen Hamilton Final Report, ‘‘Veterans Benefits Administration Compensation and Pension Claims Development Cycle Study’’ (‘‘Booz Allen Report’’) 

which noted that, although the work credit system ties employee performance standards to the system, the work credit system ‘‘does not measure individual contribuVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00042 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
39 

tion to VARO production goals . . . [and] does not track the number of claims made 

ready to rate or the amount of time a VSR needs to prepare a claim for rating.’’ 

Booz Allen Report, pages 16, 17. Furthermore, the work credit system is processed 

utilizing software known as the Access Standardized Performance Elements Nationwide (‘‘ASPEN’’), an automated database maintained on the VBA’s information technology system, which relies upon self reporting of specific actions taken during the 

processing of a claim, for example, .5 credits for conducting follow-up work on a 

claim already in development, but 1.5 credits for sending a VCAA notification letter. 

Booz Allen Report, pages 5, 16. More specifically, in 2010, Veterans Service Representatives (‘‘VSRs’’) received 1.25 credits for issuing a Veterans Claims Assistance 

Act (‘‘VCAA’’) notification letter to a veteran claiming 1 to 7 disabilities and 1.5 

credits if the veteran claimed 8 or more disabilities. September 23, 2009, Report 

from the VA Office of Inspector General, ‘‘Audit of VA Regional Office Claims Processing Exceeding 365 Days’’ Report 08–03156–227, page iv. 

The American Federation of Government Employees, AFL–CIO, has stated that 

work credits are not properly assigned for the various tasks necessary for processing 

a claim which causes VBA employees ‘‘to short cut those tasks that are undervalued, 

such as additional case development.’’ Statement of John McCray, AFGE, February 

3, 2010, before the House Subcommittee on Disability Assistance and Memorial Affairs, page 5. Additionally the work credit system has led to a hostile work environment in which additional stress is imposed by ‘‘arbitrary increases in production requirements.’’ Statement of John McCray, AFGE, February 3, 2010, before the House 

Subcommittee on Disability Assistance and Memorial Affairs, page 2. The result of 

the VA’s periodic increases in required production standards has been ‘‘a dramatic 

drop in both accuracy and station production. . . .’’ id., page 2. 

ACCURACY 

The STAR Program 

Accuracy in VBA decision-making is reported in and is measured by STAR, Statistical Technical Accuracy Review, which requires reviewers, who are VBA employees, 

to review for accuracy a statistical sample of cases worked by each regional office. 

According to the 2005 IG report, the VBA’s error rate was 13 percent in 2004. Report, page 55. 

There is presently no 100 percent reliable way to assess the VBA accuracy rate 

because there are no available statistics on the number of incorrect rating decisions 

which are not appealed, nor on the number of partially correct rating decisions, containing incorrect effective dates or disability percentages, which are not appealed. 

Rather than rely on the VBA’s misleading published accuracy rates, one commentator suggests that review of the claims which are appealed to the BVA is more informative. Benjamin W. Wright, The Potential Repercussions of Denying Disabled 

Veterans the Freedom to Hire an Attorney, 19 FCBJ 433, 440 (2009). 

Statistics from the Board of Veterans Appeals for FY 2007, suggest a VBA error 

rate over four times as large as that reported by the VBA for those decisions which 

were appealed to the BVA. Thus, in 2004 it took on average 937 days, or 21⁄2 years 

from initial appeal, or Notice of Disagreement, to final Board decision, see Report 

Chairman of Board of Veterans Appeals, FY 2004, page 8, http://www.bva.va.gov/ 

docs/Chairmans_Annual_Rpts/BVA2004AR.pdf. 

Review of the Chairman’s Annual Report for FY 2007, page 20, http:// 

www.bva.va.gov/docs/Chairmans_Annual_Rpts/BVA2007AR.pdf which would be expected to contain decisions on appeals from those VBA decisions appealed in 2004, 

shows that, in 2007, 41 percent of the appeals to the BVA were denied, leaving 59 

percent which were reversed or remanded because of errors by the VBA, not the 13 

percent error rate which was reported in STAR. 

The Use of ASPEN 

Another information technology system utilized by VBA to track performance of 

VSRs, RVSRs, and DROs, is the Access Standardized Performance Elements Nationwide (‘‘ASPEN’’). Booz Allen Report, page 5. Problems with this system include that 

it reflects a random internal review by a Super Senior VSR who pulls the file, reviews the case, logs the result in ASPEN and returns the file. Not only might the 

internal reviewer’s judgment be questionable, but the delay in providing feedback 

can be as long as six weeks. The procedure discourages employees from revealing 

problems, and does not emphasize problem-solving and root-cause analysis. Booz 

Allen Report, page 18. 


anorris on DSK5R6SHH1PROD with HEARING
40 

1March 17, 2010, Report from the VA Office of Inspector General, ‘‘Audit of VA’s Efforts To 

Provide Timely Compensation and Pension Medical Examinations’’ Report 09–02135–107, pages 

i, 11; September 23, 2009, Report from the VA Office of Inspector General, ‘‘Audit of VA Regional Office Claims Processing Exceeding 365 Days’’ Report 08–03156–227, pages iii, 4, 8, 9; 

Booz Allen Report, page 12. 

MANAGEMENT 

Because the VBA changed the claim processing model from the unified team case 

management approach to the Claims Processing Improvement (‘‘CPI’’) model, utilizing six separate teams, and separating pre-determination (development) from rating and post-determination and appeals, ‘‘work moves in large batches to the next 

step before it is actually needed . . . claims spend time waiting in queues between 

process operations . . . [and there is] overlapping, redundant, and sometimes unnecessary work activities.’’ Standardized step-by-step instructions are not provided. 

Team members lack immediate and unambiguous feedback because limited visual 

management cues are provided. Additionally, employees are ‘‘not sure how the quality of their work impacts the next step in the process, or how their work contributes 

to the quality of the final product.’’ Booz Allen Report, pages 3, 13, 14, 18. 

Not only does the use of the CPI model cause delays, but the present system, 

which requires the assignment of work to a VSR utilizing a system based on the 

last two digits of a Veteran’s claim number, leads to short term ‘‘backlogs and 

delays by not routing work to available VSRs,’’ Booz Allen Report, page 14. 

A further inefficiency is caused by VBA’s use of supervising managers who are 

not adequately trained. Statement of John McCray, AFGE, February 3, 2010, before 

the House Subcommittee on Disability Assistance and Memorial Affairs, page 3. 

NOVA’S SUGGESTIONS 

Booz Allen’s Cycle Study highlights systemic problems of delays, inefficiencies and 

inaccuracies present in and created by the VBA’s claims adjudication process which 

are well known to those who practice in this field and are consistent with the findings contained in the 2005 report by the VA Office of Inspector General concerning 

the effect of the work credit system on inducing VA employees to prematurely and 

inaccurately rate claims. 

NOVA supports the Booz Allen recommendation to return to a pod team approach 

and to encourage VA employees to take the time necessary to process a claim correctly the first time. Further, rather than utilizing the present obstructing work 

credit system, VA employees should be evaluated on the correctness and completeness of their actions to advance the efficient, timely and accurate resolution of the 

claim. Because most of the delay in processing claims involves development, particularly waiting for and obtaining C&P exams, 1 NOVA also suggests that 38 U.S.C. 

§ 5125(a) be amended to require the VA to forego obtaining an additional exam 

where the record already contains an exam sufficient for rating purposes which 

would result in a grant of the benefit requested. 

Additionally, NOVA recommends the creation of independent quality control 

teams to monitor accuracy and efficiency and to provide the additional service of 

conducting on the job training by reviewing claims folders with VSRs, RVSRs, and 

DROs. Obviously, suitable training is a crucial component of a system designed to 

make the correct decision the first time. More time and resources need to be devoted 

to ensuring that all VA employees who handle claims are adequately trained to do 

their job in an accurate and timely manner. 

f 

Prepared Statement of Ronald B. Abrams, Joint Executive Director, 

National Veterans Legal Services Program 

Mr. Chairman and Members of the Committee: 

I am pleased to have the opportunity to submit this testimony on behalf of the 

National Veterans Legal Services Program (NVLSP). NVLSP is a nonprofit veterans 

service organization founded in 1980 that has been assisting veterans and their advocates for 30 years. We publish numerous advocacy materials, recruit and train 

volunteer attorneys, train service officers from such veterans service organizations 

as The American Legion and Military Order of the Purple Heart in veterans benefits 

law, and conduct quality reviews of the VA regional offices on behalf of The American Legion. NVLSP also represents veterans and their families on claims for veterans benefits before VA, the U.S. Court of Appeals for Veterans Claims (CAVC), 

and other federal courts. Since its founding, NVLSP has represented over 1,000 


anorris on DSK5R6SHH1PROD with HEARING
41 

claimants before the Department of Veterans Affairs (VA) and the Court of Appeals 

for Veterans Claims (CAVC). NVLSP is one of the four veterans service organizations that comprise the Veterans Consortium Pro Bono Program, which recruits and 

trains volunteer lawyers to represent veterans who have appealed a Board of Veterans’ Appeals decision to the CAVC without a representative. In addition to its activities with the Pro Bono Program, NVLSP has trained thousands of veterans service officers and lawyers in veterans benefits law, and has written educational publications that thousands of veterans advocates regularly use as practice tools to assist 

them in their representation of VA claimants. 

NVLSP has been asked to testify about the quality vs. quantity tension that exists 

in almost every production system—in the production of televisions, in the production of automobiles and in the production of decisions on claims for VA disability 

benefits. Television and automobile companies would like to produce as many products as quickly as they can; however their need for production is tempered by their 

certain knowledge that if they produce automobiles or televisions that have lousy 

quality people will not buy their products because consumers seeking televisions or 

automobiles have other choices. But veterans seeking VA disability benefits can only 

turn to the VA. They are stuck with the quality of the product the VA produces. 

As you know, there is always tension between quantity and quality. In fact, faced 

with a growing backlog caused by a surge of claims from OIF and OEF veterans 

and with the compounded impact of many years of premature adjudications that 

forced claimants to appeal or file reopened or repeat claims, the issue of quantity 

vs. quality has gained increased importance. Unfair, premature denials cause unnecessary appeals and years of delay before deserving veterans obtain justly earned 

benefits. Adjudicating many claims quickly does no good if many of these adjudications are premature and many deserving veterans are unfairly denied. 

The most important and pervasive problem facing veterans seeking VA disability 

benefits is the eagerness of some VAROs to adjudicate claims before all necessary 

evidence has been obtained. For example, some VAROs prematurely deny claims 

based on inadequate VA examinations. In some cases, even where the VA examiner 

clearly fails to respond to a specific question asked by the RO, the examination report is not returned as inadequate. Instead, the claim is adjudicated and denied on 

the basis of the inadequate report. In other instances, claims are denied before all 

service medical records are received. Other claims are sometimes denied before the 

veteran has a fair opportunity to submit independent medical evidence. These alltoo-frequent cases of premature denial result from an over-emphasis on timeliness 

and a lack of accountability. 

It is clear to NVLSP that the way the VA evaluates its adjudicators and the way 

the VA awards work credit encourages sloppy adjudication resulting in premature, 

unfair denials. Therefore, the first thing stakeholders and those who manage the 

VA need to do is to admit there is a real and very serious problem with the quality 

of VA adjudications. NVLSP believes that the problems within the VA claims adjudication system are so serious that band aids (such as: paper-free or electronic 

claims processing, and a return to the team adjudication approach) will not be 

enough to fix the problem. 

NVLSP has learned that the Veterans Benefits Administration is considering 

changing how its raters and adjudicators are evaluated, and we eagerly anticipate 

reviewing these changes once they are final. We, however, advise the Veterans Benefits Administration not to simply make cosmetic changes to the quality, timeliness 

and output (production) standards for VSRs and RVSRs and expect significant improvement. For example, increasing the quality or accuracy standard from 83 percent to 85 percent for a GS–9 adjudicator could be considered just a superficial 

change because the current crop of GS–9 adjudicators are having trouble meeting 

the current 83 percent accuracy rate goal. Unless VBA changes the current system, 

a system that rewards VA managers for premature denials, there will be no substantive change in the quality of work performed by the VA regional offices. 

In the opinion of NVLSP, the current VA employee and work management systems reflect a system that was created to serve the needs of the bureaucracy rather 

than the needs of the veteran. Veterans do not care about the VA need for: work 

credit; for productivity statistics; and for timeliness statistics. From the point of 

view of a veteran claimant it is just one claim even if the VARO improperly adjudicated his claim five times and the BVA remanded it three times over the course 

of 10 years. The primary goal of VBA should be to provide the best service to veterans. It makes sense that the VA work measurement system should reflect and 

support that goal. What is easiest for the VA bureaucracy is not necessarily best 

for veterans. 

NVLSP suggests that final work credit should not be awarded until the appellate 

period expires or when the BVA makes a final decision. That would encourage the 


anorris on DSK5R6SHH1PROD with HEARING
42 

VAROs to completely and correctly adjudicate claims at the earliest possible time. 

It would also incentivize VA managers to encourage their adjudicators to ‘‘do the 

claim right the first time’’ because a correct, complete adjudication would be in the 

best interest of the VA manager. 

Therefore, NVLSP suggests that the VA restructure its work credit and work 

management systems to reflect the needs of its veteran claimants and then restructure its bureaucracy so that veterans can be best served. The VA needs to balance 

its competing needs for timeliness and production with the need to provide quality 

service to its claimants. 

I. The Unfair VA Work Measurement System 

The current VA work credit system prevents the fair adjudication of many claims 

for VA benefits. The current VA work credit system needs to be overhauled because 

it rewards VA managers and adjudicators who claim multiple and quick work credit 

without complying with the statutory duties to assist claimants obtain evidence that 

would substantiate their claims and notify claimants of what evidence would substantiate their claims. 

No matter how much the average VA employee wants to help the client population, the VA decision-making culture, fueled by the VA work measurement system, 

penalizes many VA adjudicators for doing a good job. The VA has created a work 

measurement system for deciding critically important claims that is driven by 

weighty incentives to decide claims quickly. How the VA measures its work and 

evaluates the performance of its employees continues to have a major impact on the 

adjudication of claims for veterans benefits. 

Responsibilities of VA managers that protect the fairness of the adjudicatory process—such as ‘‘control’’ of claims, supervisory review of unnecessarily delayed claims, 

thorough development of the evidence needed to decide a claim properly, recognition 

of all of the issues involved, provision of adequate notice, documentation that notice 

was given, and careful quality review—all adversely affect the productivity and 

timeliness statistics (that is, how many decisions on claims are made within a particular period of time) for the VA manager. Consequently, proper attention by VA 

managers to their legal obligations very often adversely affects the statistics upon 

which their performance is rated. 

II. The Impact of Judicial Review 

The VA claims processing (or claims adjudication) system has been exposed by judicial review. To say there is a crisis in VA claims adjudication is an understatement. Statistics from the Board of Veterans’ Appeals (BVA) and the U.S. Court of 

Appeals for Veterans Claims (CAVC) show that nationally, for FY 2009, over 60 percent of all VA regional office appeals reviewed by the BVA were reversed or remanded and over 80 percent of CAVC decisions on the merits reversed, or remanded 

BVA decisions. Please note that for FY 2008 the CAVC reversed and remanded only 

63 percent of all merits decisions. 

Based on the experience of NVLSP (over 12 years of quality reviews, in conjunction with The American Legion, of over 40 different VA regional offices combined 

with extensive NVLSP representation before the CAVC), the most egregious VA errors are a result of premature adjudications. For example, many errors identified 

by Legion quality reviews reveal that VA adjudicators failed to even try to satisfy 

its statutory duty to assist the claimant by obtaining the evidence needed to substantiate the claim, and incorrectly accepted and prematurely denied claims based 

on inadequate evidence (especially inadequate VA medical examinations). 

I have been told by a variety of VARO officials that because of pressure to produce 

end products and reduce backlogs, they intentionally encourage the premature adjudication of claims. This statement is based on my experience as a VA employee, and 

based on my experience as a member of the Legion quality review team. 

Fixing the VA work credit system is a topic that is near and dear to my heart. 

I have been involved in various aspects of veterans law (working for the VA and 

then NVLSP) for about 35 years. My experience tells me that unless the system is 

corrected most well-meaning attempts to improve VA claims adjudication will not 

be successful because the driving force in VA adjudication will continue to be claiming quick work credit. 

III. The Inadequate Quality of VA Adjudications Is a Major Influence on the 

Size of the Backlog 

It is clear that the quality of VA adjudications is not satisfactory and is a major 

contributor to the size of the backlog. Because many claims are improperly denied, 

because many VA adjudicators are inadequately trained, because many VA regional 

offices are improperly managed, because many VA regional offices are inadequately 

staffed, and because VA Central Office management has not acted to fix these probVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00046 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
43 

lems in any meaningful way, many veterans and other claimants for VA benefits 

have to file unnecessary appeals, wait several years for a BVA remand, and wait 

for the VA to obtain evidence that should have been requested during the original 

adjudication of the claim. These appeals clog the system and create unneeded work 

for the VA. Of course, it would have been better for the VARO to do the work correctly the first time. 

The VA is now receiving many claims submitted by OIF and OEF veterans. These 

claims will obviously increase the backlog and increase VA workload. Dealing with 

this wave of claims will become especially daunting if many of these claims are improperly denied in an effort to artificially decrease the backlog and improve VA 

managers’ timeliness and productivity statistics. This makes it even more important 

that the VA adjudication system be improved now. 

Potential Solutions 

The VA work measurement system has to be overhauled. H.R. 3047 which, in Section 2 would change when VA regional offices (VAROs) can claim work credit, was 

a good bill that would have accomplished this goal. NVLSP looks forward to reviewing the overdue VA report that was mandated by P.L. 110–389. 

The VA needs to acknowledge the complexity of its claims adjudication system 

and continue to increase the number of adjudicators to work these claims. The following suggestions should be considered: 

• The VA should be required to submit to an independent quality review to validate the quality of work performed in the individual VA regional offices. • The grade levels of VA raters and Decision Review Officers should be raised and 

these employees should be held accountable for the quality of their work. • Even though additional adjudicators have been hired, Congress needs to continue to provide additional funding for more adjudicators if the workload requires more adjudicators. The additional adjudicators, once properly trained, 

should help prevent the VAROs from brokering cases (sending cases from one 

VARO with too much work to another VARO). In the opinion of NVLSP, brokered cases are less accurately adjudicated than most cases and cause continuing problems for the originating VARO. • The VA should consider going back to the ‘‘team’’ concept in the VAROs. • Adjudicating from electronic records is a laudable goal if complete records can 

be obtained and if the database permits logical searches. • Finally, the adjudication culture at the VAROs needs to be changed. Many VA 

managers act like they are producing widgets rather than adjudicating claims 

filed by real people. Their goal should not be just prompt adjudication; the goal 

should be a timely, accurate and fair adjudication—which in the long run is the 

fastest way to finally adjudicate claims. 

I want to stress that NVLSP is not demanding perfection from VA managers and 

adjudicators. NVLSP, however, feels that unless the VA changes the way it counts 

its work, there will be no significant improvement. 

Thank you. 

f 

Prepared Statement of James D. Wear, Assistant Director, National 

Veterans Service, Veterans of Foreign Wars of the United States 

MR. CHAIRMAN, RANKING MEMBER LAMBORN, AND MEMBERS OF THE 

COMMITTEE: 

On behalf of the 2.1 million men and women of the Veterans of Foreign Wars of 

the U.S. (VFW) and our Auxiliaries, we appreciate the opportunity to present our 

views before you today. The Veterans Benefits Administration’s (VBA) work credit 

and management systems deserve careful review by Congress. The VFW applauds 

this Subcommittee for using its oversight authority to examine the incentives within 

VBA that pit ‘‘Quality vs. Quantity.’’ 

Further, the VFW compliments Secretary Shinseki’s leadership team for VA’s 

Open Government Plan. We fully support all efforts to transform VA into a peoplecentric, results-driven, forward-looking organization. We welcome every opportunity 

to work with Secretary Shinseki to encourage a transparent, participatory and collaborative VA that places veterans and their survivors at the center of every decision. 

The VFW’s chief concern today is the very real perception that VA puts more emphasis on the number of claims that are processed than the accuracy of those 

claims. This is validated by VA’s own measures in the ‘‘Monday Morning Report,’’ 


anorris on DSK5R6SHH1PROD with HEARING
44 

as well as by many VA Office of Inspector General (IG) reports. Secretary Shinseki’s 

goal of rating all claims with 98-percent accuracy in under 125 days is extremely 

laudable, but the VFW would be ecstatic if VA could just reach the 98-percent goal 

with the current average wait time of 165 days. 

Workload & Management Systems 

Claims submitted to VA are tracked by the assignment of a discreet identifier 

called an ‘‘end product.’’ VBA’s work management and measurement systems have 

various subsystems to track the age of each pending end product, to track the various development and rating actions taken in end products, and the number of end 

products completed. VBA’s work management system tracks all computer actions 

taken on pending claims by service center employees. 

In our view, the major focus for VA must be on management systems reform and 

fostering a culture change in VBA. As indicated above, VBA has management and 

work measurement systems that have been in place with only minimum changes for 

decades. There is a systematic review of the basis used for these management and 

work measurement systems being conducted, but the results have not yet been released. 

Quality Measurement 

The current system employed by the Department of Veterans Affairs, Systematic 

Technical Accuracy Review (STAR), to analyze and determine accuracy in promulgated claims decisions was created and deployed in 1997. The system determines 

accuracy by using analytic statistics over the previous 12 months. This is identified 

as a ‘‘rolling 12’’ since each current month that is added results in dropping the oldest month. When STAR was first used, the accuracy rate was 64 percent and is currently 83 percent. Although there has been an increase in overall accuracy, it is far 

from an acceptable standard. 

The system is based on a random selection of promulgated decisions (rating, authorization and fiduciary) under specific rating indicators or ‘‘end products.’’ Therefore, not every decision of a claim is subject to the review. Cases are requested from 

each regional office based on size. It is very difficult to obtain a reliable sample size. 

A truly representative sample for the larger offices would require many additional 

reviewers. The current sample size for the ‘‘National Average’’ in rating decisions 

is 13,199 cases for 57 regional offices for the past 12 months. The current sample 

size for the ‘‘National Average’’ in authorization decisions is 8,251 cases for 57 regional offices for the past 12 months. 

The system is based on the concept that a decision is either entirely correct or 

entirely wrong. No longer are there classifications of errors from mere procedural 

to substantial. Once an error is called and the regional office notified, there is a 

time period (usually 60 days) in which the regional office may request reconsideration of the error. It is their responsibility to ‘‘make the case’’ that the decision was 

not incorrect. Since an error can be reversed within a period of time, the accuracy 

rate reflects a period of time that is 3 months delayed. In other words, the report 

issued in early February covers decisions ending in November 2009. This time delay 

affects the validation of the numbers. 

The group of employees, considered to be staff of the Compensation and Pension 

Service in VA Central Office, is located in a separate facility in Nashville, Tennessee. Each expert consultant is tasked with a ‘‘second look’’ at cases with identified errors to insure corrective action is completed based on the error. This is assigned on a rotating basis as ‘‘other duties as assigned’’ and not their primary priority. 

There are some deficiencies in this analysis of completed claims. Since it is a random selection of certain types of actions, it is only those identified actions that determine the error or accuracy rate. For example, a claim is identified for review 

based on a completed action in April 2009. That action is completed according to 

current policies and regulations. However, the consultant discovers an erroneous action taken in January 2006. The consultant has the responsibility to identify that 

error and direct corrective action under a ‘‘comment’’ rather than a formal error call. 

That action must be completed, but does not figure into the overall accuracy rate. 

There is one big deficiency to this system that constantly presents a major problem to VA. No one learns from their mistakes. The STAR system was designed to 

enhance training and knowledge. Each regional office is treated as an individual office and not part of a larger quality control system. It is true that the VA ‘‘intranet’’ 

has links for regional staff to review the number and type of errors being called but 

there is no mandatory training of personnel. Identification of an error without a 

clear instruction or resolution is of no value. Each individual rating or authorization 

decision maker very rarely is counseled on their individual quality. Therefore, they 


anorris on DSK5R6SHH1PROD with HEARING
45 

believe that they were not responsible for any mistake. The overall accuracy rate 

may be part of the performance standards for managers and directors, but an individual employee is graded on a ‘‘pass/fail’’ standard. VA willingly admits that production is ‘‘job one.’’ Training is the first casualty in the war of the pending backlogs. The nature of the work has become extremely complicated and training should 

be absolutely required for all decision makers. Regular and serious training will not 

only stop the slide, but will actually enhance individual skills. The training in an 

open and serious environment will also benefit all VA staff who interacts with veterans. All such training efforts should be thoroughly documented for all interested 

parties. 

Suggestions for Improvement 

Quality must be incentivized as the primary component of all VA workload and 

management systems. The current systems are self-imposed VA models that do not 

have incentives built in to reward accuracy or to correct poor decision-making. The 

VA must consider the individual training needs of each employee and each regional 

office in all future work-credit systems. VA leadership must be able to quickly and 

accurately identify the items that need additional training on the local level. 

The current VA nationwide accuracy rate is 83 percent, which ranges from 92 percent at the best Regional Office in Des Moines to a 67 percent worst in Baltimore. 

All of which still fails to achieve Secretary Shinseki’s 98-percent accuracy goal. 

The VFW previously suggested that ratings quality could be improved by instituting a two-signature review on every claim before the rating decision is finalized. 

The management at the Baltimore Regional Office recently decided to start doing 

two-signature reviews on all actions, ratings and authorization. We will be watching 

carefully to see if this practice improves their accuracy rate. 

The VFW strongly supports partial rating decisions, thus allowing a veteran immediate financial assistance and access to medical care, while promoting the further 

development of the complete claim. However, VA must grant work credit for partial 

decisions to incentivize VA employees to utilize this practice. With the advent of an 

electronic claim, individual issues will be more easily tracked. Most claims are comprised of multiple conditions/issues. Currently, a claim cannot be counted as a completed end product until all claimed conditions have been addressed. Further, veterans cannot be paid until a condition or issue is granted. With the tracking of individual issues, both work-credit and compensation may be awarded as the claim undergoes further development and is finally completed. 

VBA leadership needs to reward quality and accuracy. VA must examine each 

process and decision point and reengineer them to reduce the opportunity for error. 

Make each decision more difficult to get wrong and errors will be reduced. Regional 

Offices and individuals with high quality and/or accuracy ratings should be rewarded for their work. The VA management team should focus on changing the culture in VBA so that quality rules, without exception. VBA should emphasize processing an issue correctly the first time. 

Finally, VA collects timeliness data to monitor the ability of every office to complete claims within certain pre-established goals. The VFW believes VA should 

share this information with new claimants via e-mail or letter. Just as many commercial service centers inform telephone callers that ‘‘your call will be answered in 

3 minutes,’’ it should be just as easy for VA to use real-time information on how 

long it normally takes to process original compensation claims from, for example, 

Montgomery, Alabama, which would be 250 days. While that is far too long to process a claim in any world, the veteran would still be knowledgeable of the average 

length of the wait. 

Mr. Chairman, this concludes my testimony. I would be happy to address any 

questions you or your committee may have. Thank you. 

f 

Prepared Statement of John L. Wilson, Assistant National Legislative 

Director, Disabled American Veterans 

Mr. Chairman and Members of the Subcommittee: 

I am pleased to have this opportunity to appear before you on behalf of the Disabled American Veterans (DAV) to address the efforts of the Veterans Benefits Administration (VBA) to properly balance quality and quantity in their work credit 

and work management programs. Too often, VBA has attempted to manage an ever 

increasing workload by emphasizing production to the detriment of accuracy. We 

commend this Subcommittee and Congressman Hall for holding today’s hearing 


anorris on DSK5R6SHH1PROD with HEARING
46 

which focuses on this very important issue and how VBA’s work credit and management systems impact the claims backlog. 

Let me note at the outset that in preparing for today’s testimony, we lacked some 

information that could have better informed our testimony. Specifically, I am referring to the report on the work credit and work management system required by Section 226 of Public Law 110–389, Veterans’ Benefits Improvement Act of 2008, which 

was due to Congress over 6 months ago. It is our understanding that the Center 

for Naval Analysis (CNA) presented this report to VBA last November, but that it 

has remained at the Department of Veterans Affairs (VA) for their review and concurrence. In addition, VBA has just recently implemented new performance standards for 

Veterans Service Representatives (VSRs) that significantly change the work credit 

system for employees performing triage, development and post-development work on 

claims for benefits. We understand that new performance standards for Rating Veterans Service Representatives (RVSRs) are also due to be released shortly. We look 

forward to hearing VBA’s explanation for how these new standards were developed, 

how they will be implemented, and what effect they will have on both the quantity 

and quality of work produced by VSRs and RVSRs. 

Mr. Chairman, like you, DAV remains concerned about the large and growing 

claims inventory, or backlog, that VBA is managing. However, we caution the Subcommittee that the backlog is not the problem, nor the root cause of the problem; 

rather it is a symptom. It is akin to an individual having a fever. While one can 

take aspirin to reduce the fever, unless the underlying condition that caused the 

fever is treated, the fever may return and the patient’s condition may worsen. So 

too it is with the claims backlog. The underlying condition is a broken claims processing system that leaves too many veterans waiting too long for rating decisions 

that are too often wrong. Until we address the root problems within that system 

that resulted in the backlog—lack of quality, accuracy and consistency—no matter 

how quickly claims are processed, the problems will remain and the backlog will return. 

For this reason, we believe that the best and only approach that will work is one 

that emphasizes quality at every stage of production. To achieve this outcome, it is 

essential that we examine the system of incentives and accountability for employees, 

management and leadership. 

Mr. Chairman, I am sure you and other members of this Subcommittee have 

heard Secretary Shinseki say that he intends to ‘‘break the back of the backlog this 

year.’’ The way this will be measured is through VBA’s Monday Morning Workload 

Reports which contain measures of production, but not accuracy or quality. Since 

this is the only set of numbers that consistently makes its way into the consciousness of Congress and the media, it is not surprising that the backlog has become 

the focus of each, and thus VBA’s leadership has a great incentive to reduce the 

backlog, which logically leads to an emphasis on production. However, producing 

more inaccurate decisions will not reduce the backlog; it will increase it and further 

clog the appellate process. 

Similarly, looking at VBA’s Dashboard, which provides the current performance 

statistics for each VA Regional Office (VARO), the measures reported are primarily 

related to pending work inventory and production times. There are few measures 

of accuracy included in the Dashboard reports, and those are based upon 12-month 

rolling averages from national STAR reviews. Improvements to these quality measures would take many months to show up, whereas changes in production would 

be more easily influenced by management decisions about resource and work allocation. Given the directive from leadership to ‘‘break the back of the backlog,’’ it is 

not surprising that VARO management focuses heavily on production, rather than 

accuracy or quality. 

Given leadership and management’s focus on production, it is not surprising that 

employees—VSRs and RVSRs—feel tremendous pressure to meet production goals. 

While accuracy has been and remains one of the performance standards that must 

be met by employees, there is reason to believe that the work credit system creates 

incentives for them to favor production over accuracy. 

Performance standards are the most important factor in determining the incentives for employees. If the standards either directly or indirectly reward production 

over quality and accuracy, we must expect employees to work first toward production goals. Although we have not heard VBA’s explanation of the new performance 

standards, nor seen the CNA study on the work credit system, we were able to get 

a copy of the new VSR performance standards and offer the following observations 

and concerns about this significant change. 

The new performance standards have streamlined the measures of production for 

VSRs from what had been 63 categories of weighted work activities to five producVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00050 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
47 

tion categories now called ‘‘outputs.’’ Essentially, a VSR will receive one ‘‘output’’ 

credit for completing each stage of the work process: initial rating development, initial nonrating development, ready for decision, process award/decision and authorize 

award. It appears that this system is designed to emphasize moving claims quickly 

towards completion by eliminating the piecemeal work credits that were based upon 

each activity related to development that was completed. 

The new system provides no work credit for Congressional inquiries, Freedom of 

Information Act requests or conducting personal interviews. It also appears to eliminate work credit for appeals related activities, such as supplemental statements of 

case (SSOC). 

We have been told that the old work credit system created opportunities for ‘‘gaming’’ the system, such as delaying requests for routine future exams, in order to gain 

additional work credits. However, we are now concerned that the new streamlined 

system of measuring only ‘‘outputs’’ may inadvertently create incentives for cutting 

corners, since more complex cases get no more credit than simple cases. 

In addition to output, there are three other ‘‘Critical Elements’’ in the new VSR 

performance standards: Quality, Timeliness, and Training. We certainly agree that 

each of these are essential to improving the benefit claims processing system; however, we do have questions about how these new standards will produce more accurate and timely claims. 

We note that VBA has increased the accuracy standard for VSRs and we certainly 

agree that accuracy, even by the national STAR measures, remains too low. However, it is not clear how raising the standard in and of itself will result in increased 

accuracy. We also remain concerned about how reliable the employee reviews will 

be for measuring quality. We have testified previously that coach reviews of five 

cases per month are not accomplished 100 percent of the time, and in many cases 

coaches do not have sufficient time to comprehensively review each case. As a consequence, we do not have confidence that employees performing below or above 

standard will be consistently measured. Employees in need of extra training and individualized mentoring may not get the attention they need to become more effective. We are also concerned that these local quality reviews may be significantly different from station to station. 

We continue to note that VBA does not have a unified system for aggregating and 

analyzing the results of both the coach reviews and the STAR reviews in order to 

provide trend analysis for both quality control improvements and for development 

of new training instruments. 

Under the new VSR performance standards, ‘‘Timeliness’’ will be established locally by each VARO based upon end of year station targets. While we recognize that 

cycle times vary from station to station due to workload and inventory, we question 

whether it is reasonable to have employees at different stations being held to different standards for the same work. We also have questions about whether cycle 

times, which include wait periods and work volume, are the most reasonable measure for holding VSRs accountable. For example, is the cycle time for average days 

awaiting evidence a fair measure since the submission of evidence is not in the control of the VSR? 

VSRs will also now be held accountable for meeting the ‘‘Training’’ standard. We 

question whether this should be a management accountability standard more than 

an employee standard, since training is critical to keeping staff informed of the 

evolving nature of claims, whether it is new presumptive service conditions, changes 

in public law or recent Court cases. Given some reports we have heard from the 

field about management pressuring employees to cut back on time for training to 

meet production goals, how is management held accountable for training being properly implemented? 

Mr. Chairman, we congratulate you and the Subcommittee for holding today’s 

hearing raising the critical issue of quality. We will continue to work with you and 

others to help create a culture at VBA that measures and rewards the quality and 

accuracy of results, not just quantity, and provides sufficient training of VA’s management and workforce in order to achieve this outcome. 

That concludes my testimony and I would be happy to answer any questions the 

Subcommittee may have. 

f 


anorris on DSK5R6SHH1PROD with HEARING
48 

Prepared Statement of Ian C. de Planque, Deputy Director, 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

I appreciate this opportunity to express the views of The American Legion on the 

importance of accuracy in the veterans’ benefits system. The Department of Veterans Affairs (VA) has maintained, as stated by Acting Undersecretary for Benefits 

Michael Walcoff in a January 3, 2010 appearance on CBS’s 60 Minutes, that: ‘‘We 

stress over and over again to our employees that quality is our number one indicator, 

that that’s absolutely a requirement for successful performance.’’ However, even cursory examination of actual operations shows that a far greater emphasis falls on the 

quantity of claims processed than the accuracy with which those claims are processed. VA Secretary Shinseki has recently set forth a bold goal of elevating the accuracy rate to 98-percent, while slashing the time of processing those claims to a state 

in which no claim would remain in the system unfinished for more than 125 days. 

In short, VA means to eliminate the backlog while eliminating error. If such a thing 

is possible, it would obviously be of great benefit to the veterans of America; however, if such a plan has any chance of being effective, it must start with the quality 

component. Otherwise there is little hope of providing real benefits to veterans. 

Quality is essential because of the sheer scale of the matter. By VA’s own admission, in 2010 and 2011 and beyond, they will be processing in excess of a million 

claims a year. With volume such as this, even an error rate of 1 percent represents 

10,000 claims incorrectly processed. Recently, VA’s most optimistic accuracy projection was 87 percent. This number was challenged by the VA Office of the Inspector 

General (VAOIG) as being highly optimistic and at least 10 percent higher than the 

actual figure. However, even relying on this inflated number, when one small component of the upcoming claims challenge is examined, the impact is potentially staggering. VA expects approximately 200,000 veterans with Ischemic Heart Disease to 

file claims under the new regulations regarding Agent Orange in 2010. Going by the 

optimistic error rate of 13 percent, this still means 26,000 of those veterans will 

have their claims improperly processed. 

Errors at VA impact thousands of veterans every year. A veteran who struggles 

to earn an income because of a service-connected disability, an error that denies 

service-connection for that disability can be the difference between getting by and 

becoming one of the over 100,000 homeless veterans in America today. Errors affect 

lives. It is essential that the removal of errors from the system be the highest priority of reform. 

Testimony from the American Federation of Government Employees (AFGE) representatives before this Subcommittee, as well as comments during personal interviews conducted during American Legion Quality Review visits to Regional Offices, 

has spoken of the overarching pressure to ‘‘make the numbers for the week’’. VA 

employees are charged to complete a minimum of 3.5 claims per day, often more 

in some Regional Offices. This pressure leads to the conundrum faced by a VA rater 

at one Regional Office who, during the interview process of an American Legion 

Quality Review, gestured to a claims file five inches thick and stated, ‘‘That’s one 

of my fellow veterans there. I have less than two hours to go through that claim. 

How am I giving that guy justice?’’ The employees want to get the job done right. 

VA employees want to take pride in their work and be accurate. They want to help 

veterans. However, the pressures brought about by volume are making it increasingly difficult for those employees to do so. 

To resolve the issue, VA will have to go through a several step process, yet none 

of these steps are insurmountable. VA must begin by making quality the foundation 

upon which all else is based. They can make better use of triage techniques to help 

manage the time constraints that quality demands. Finally, VA must commit to accuracy as a greater measure of success than quantity of claims processed. 

VA is in the process of testing multiple pilots across the country to determine the 

most effective operating procedures in their Regional Offices. Whether it is the 

‘‘Lean Six Sigma’’ pilot in Little Rock, the electronic office pilot in Providence or one 

of the many others, these pilots all have the same aim—to improve how VA operates 

and to create a better system. However, even in these efforts, the goal is increased 

speed in processing as the ‘‘Prime Directive.’’ Clearly, VA is interested in transforming the office environment and thus there is no better time to ensure that this 

transformation is built upon a solid foundation—accuracy. 

Quality takes time. It takes time to do something right. However, when something 

is done properly in a repetitive manner, speed will derive from the smoothness. Familiarity breeds speed. When an employee develops speed due to quality and effectiveness, they are developing speed with the proper procedure. As the system currently works, there are errors rampant within the processing system. This is comVerDate Nov 24 2008 02:07 Dec 10, 2010 Jkt 057021 PO 00000 Frm 00052 Fmt 6604 Sfmt 6621 I:\VA\57021.XXX GPO1 PsN: 57021

anorris on DSK5R6SHH1PROD with HEARING
49 

pounded by tremendous pressure placed on VA by veterans’ and military service organizations; private citizens; the media; and Congress to eliminate the backlog. Perhaps the focus should be on quality the first time and not the backlog itself. New 

tools, such as electronic office measures to operate in a paperless environment, are 

touted as the solution to increase timeliness. However, unless the transformation of 

the operating environment is fundamentally changed to an environment based on 

quality, VA will only be processing mistake-ridden claims . . . faster. 

Ingrained in military training is a well-known maxim that ‘‘if you do something 

right, the speed will follow.’’ It is the principle of crawl, walk, run. Take the time 

to learn the procedure right the first time, each successive time that the task is performed, speed can and will be increased. The important difference is that proficiency 

and speed will be increased under a proper operational model. 

VA has increased hiring due to additional monies provided by Congress. As the 

existing workforce is being displaced through retirement, VA is in a position to, 

through training of the new employees, create a core group that will be the foundation of VA going forward through the 21st Century. 

Taking the time to do claims correctly and inculcate this mindset of attention to 

detail will, in fact, temporarily increase the existing backlog. Some of this process 

may require a more sympathetic eye towards a slower pace of reduction. Most veterans could agree that a little longer time for a claim, if it is done properly, is a 

small sacrifice to pay for a system that will be better and better for many years 

to come. A little more patience is required for a job done right. If your choices are 

swift, but shoddy work vs. deliberate, but accurate work, many would vote for accuracy every time. Errors take years, not hours, to correct. 

Still, there can be improvements in the overall system that will help create the 

necessary time to get the job right. In a more efficient system, time can be better 

allocated to get the right amount of time to the claims that demand additional time. 

With a better system of triage, simple claims which require little or no development 

can be fast-tracked, allowing for a greater portion of time to be allotted to those 

claims that justifiably demand more intricate attention. VA can identify claims, 

such as presumptive disorders, submitted with private medical evidence. These 

claims can be granted immediately with an interim rating, allowing for the lion’s 

share of development time to be undertaken after veterans are integrated into the 

system and receiving their earned benefits, such as health care for their condition. 

A simple claim seeking an increased rating for hearing loss, which should require 

little development, can be performed in short order. If VA seeks to maintain their 

present rate of three to four claims a day per employee, triaging claims to account 

for simple claims that can be accomplished relatively quickly will provide more time 

for those claims that have more issues or are more complex. In this manner, the 

overall numbers should continue to be relatively the same, or even improve, if a 

more efficient system of directing claims to where they can be processed most effectively can be implemented. 

All of this will be in vain, however, if VA continues to track success primarily by 

the number of claims processed. VA regularly reports the number of claims processed and the number of claims pending in their Monday morning workload reports. 

These reports are silent as to the accuracy of claims being processed in the offices 

and in the VA overall. This is a clear indication of what matters. Human nature 

dictates that employees will work to the acceptable standards put forth by management. If management stresses numbers, then numbers are what employees will 

strive to accomplish. If management stresses accuracy and judges employees based 

on accuracy, then the incentive to cut corners will disappear, and employees will exercise more caution to ensure they aren’t falling behind in accuracy. 

Similarly, if management is judged on the volume that their office produces, and 

little attention is paid to the quality of work, managers will respond with greater 

emphasis on volume to their employees. Currently, there is a single component devoted to accuracy rate in management evaluation, the greater emphasis is on performance, and thus, whether management receives bonuses is based on the volume 

of claims moved through the office. As long as this state of affairs persists, then 

quantity is what will be produced, often at the expense of quality. 

The American Legion has long supported a change in the manner in which VA 

counts their production. The American Legion continues to advocate for a system 

that is based on quality determined by the final adjudication of the claim. This is 

based on a belief that the current emphasis on numbers creates an atmosphere of 

substandard quality and cutting corners, and that, as much as any other factor, contributes to claims remaining in the system for long periods of time, thus leading to 

the backlog of claims VA is currently operating under. 

The American Legion believes that the backlog is not the problem. The backlog 

is merely a symptom of the problem. Much as an infection in the body leads to a 


anorris on DSK5R6SHH1PROD with HEARING
50 

fever, the infection of poor quality work in VA leads to the backlog. If you treat the 

infection, the fever will reduce. If you improve the quality of decision-making in VA, 

the backlog will diminish. 

The media is full of reports of veterans who fight years and years in the VA system for benefits they are entitled to receive. The constant refrain from frustrated 

veterans is that VA is delaying and denying and waiting for them to die. A veteran’s 

claim is not an initial claim, if it is languishing in the system for multiple years. 

VA’s average processing time for an initial claim hovers around 6 months. While 

many of these initial claims can exceed a year, multiyear claims are almost exclusively claims that have been appealed through the higher levels of VA’s adjudication 

system. 

When a claim is reviewed by the Board of Veterans Appeals (BVA) many years 

after the initial claim has been filed and appealed and made its way to Washington, 

DC, that claim is commonly remanded or returned to address simple procedural errors that were made at the Regional Office. Many of these claims are won once the 

proper procedure has been followed. The end result is that a veteran with a legitimate claim has waited now for three to 4 years or more to be granted a claim that 

would have been won in the Regional Office had the Regional Office only done its 

duty properly the first time. 

To understand the scale of the appeals problem, it is again important to consider 

the numbers involved. If VA is processing approximately one million claims a year, 

and approximately 10–15 percent of veterans are appealing these claims simply because of poor decision-making and failure to adhere to the required procedures, then 

approximately 100,000—150,000 cases are being recycled into the system every 

year. These are hundreds of thousands of claims that would not be a part of the 

backlog had VA done the job properly when given the first opportunity to do so. 

It is this cycle which must stop if the backlog is ever to be cured. By minimizing, 

or better yet eliminating errors at the Regional Office level, the number of appeals 

and thus the number of claims destined to languish many years in the system will 

be massively diminished. This is the goal VA must strive for. 

VA’s frequency of error has created a gulf of distrust between this Federal agency 

created to help veterans and the community of veterans that they have been directed to serve. Veteran confidence in the VA’s ability to correctly process their 

claim is very low. However, this trust is not lost, merely damaged, and with diligent 

effort on the part of VA it can be restored. In the 1970s the Veterans’ Health Administration faced a similar lack of confidence in their ability to serve the veterans’ 

population. A major overhaul was required to regain the public trust. 

The American Legion monitors the VA health care system through our annual 

System Worth Saving reports. What has been shown is a renewed confidence in VA 

health care. Many veterans speak proudly of the care they receive through VA and 

the quality of that care. Patient satisfaction is among the very best in the entire 

health care industry, public and private. There are still problems within that system, and there is always much work to be done. However, the example of this transformation and VHA’s ability to regain some measure of trust within the veterans’ 

community is indicative that it is not too late for the Veterans’ Benefits Administration (VBA) to similarly embark on a great campaign to regain the trust of the veterans that they serve. 

The present administration of VA under Secretary Shinseki has set bold expectations and shown promising signs. The candor with which they admit to the grave 

flaws within the system and the necessity of change is both refreshing and admirable. Whether or not the reality of this transformation within VA will conform to 

this mission statement remains to be seen. VA has recently announced changes to 

their internal work credit system. Information on exactly what these changes constitute is currently slim, yet hopefully will be revealed in the near future. Whether 

these changes will be real changes with a chance to positively support an emphasis 

on quality or simply window-dressing covering a continued emphasis on pure volume remains to be seen. 

With the positive mission laid out by Secretary Shinseki, perhaps a situation of 

distrust may be moved to one of ‘‘trust, but verify’’. There is, to be sure, a great 

deal of damage that has been done to the state of trust by an ongoing culture of 

volume over accuracy. When veterans look to the system designed to support them, 

they too often experience only a cold, unfeeling bureaucracy that treats them as a 

number and pays little attention to getting their claim done ‘‘right’’. If a mistake 

is made, then what are the consequences? Veterans do not see consequences for errors, but experience the dramatic impact on their life and well being. This must 

change. 

VA stands on the brink of a major transformational effort. There is no better time 

than the present to rebuild this system on a bedrock of quality and accuracy. There 


anorris on DSK5R6SHH1PROD with HEARING
51 

is no better time to repair the lost trust with the veterans’ community. A demonstrable dedication to quality above all else would go a long way towards doing so. 

The American Legion stands ready to answer any questions of this Subcommittee 

and thanks you again for this opportunity to provide testimony on behalf of our 

members. 

f 

Prepared Statement of Jimmy F. Sims, Jr., Rating Veterans Service 

Representative, Winston-Salem, NC, Regional Office, 

Veterans Benefits Administration, and Shop Steward, Local 1738, 

American Federation of Government Employees (AFL–CIO), and 

AFGE National Veterans Affairs Council 

Chairman Hall, Ranking Member Lamborn and Members of the Subcommittee: 

Thank you for the opportunity to share the perspective of the American Federation of Government Employees (AFGE) and the National Veterans Affairs Council 

(VA Council), the exclusive representatives of Compensation and Pension Service 

(C&P) employees of the Veterans Benefits Administration (VBA), regarding the critical need to overhaul the current work credit and work management systems. 

The work credit system is the essential building block for managing work and 

evaluating performance. This system must be developed on the basis of valid empirical data; VBA must, with no preconceptions, identify how much an employee can 

reasonably be expected to do with an acceptable level of accuracy, and use that data 

to project the number of employees it needs to process its inventory. 

The studies that form the basis of work credit systems are widely used in industry 

to increase productivity and known by terms such as ‘‘business efficiency’’ or ‘‘time 

and motion’’ studies. AFGE and the VA Council are aware of only one extremely 

limited attempt by VBA to conduct a study along these lines but it failed to produce 

any useful findings. Management placed a software program on a sampling of employees’ computers in an undetermined number of ROs, with no explanation of how 

they selected the sample. The data was collected by a program appearing on the 

screen every few hours to ask what the employee was doing. The program did not 

differentiate between employees working on a single claim and multiple claims, 

thereby leading VBA to continue to create flawed work credit and work management systems based on incomplete data retrieved. 

A study of VBA’s work credit and work management systems was mandated by 

P.L.110–389, but we fear that when completed by the contractor, this long overdue 

study will not produce adequate data. It is very troubling that once again, VBA did 

not solicit input from employee representatives. 

The performance standards that comprise the work management system are only 

as good as the underlying work credit system. Pursuant to an agreement between 

VBA and AFGE and the VA Council, national performance standards to boost VSR 

productivity were put in place in 1997, and were later revised in 2003, again in 

2005, and most recently this spring. 

AFGE and the VA Council have long taken the position that VBA is contractually 

barred from raising local production standards above the national standards. VBA’s 

insistence on allowing ROs to set their own local standards has led to harmful inconsistencies and low morale. For example, a RVSR assigned to the Seattle Regional 

Office may be required to produce 5.25 weighted cases per day, where a RVSR assigned to the Winston Salem Regional Office may be required to produce 4.0 weighted cases. Consequently, RVSRs in Seattle have to complete 6 single weighted action 

cases, while RVSRs in Winston-Salem only have to complete 4 cases, to meet the 

local standard. 

The underlying problem is that production standards for VSRs and RVSRs appear 

to be based more on politics and bonuses rather than on the goal of processing today’s complex claims in an accurate and complete manner. VBA managers, many 

of whom have not adjudicated a claim for many years (or never), define performance 

largely in terms of inventory and days pending completion of a decision. Our members working on the front lines report that when they meet RO production goals, 

they have been ‘‘rewarded’’ with arbitrary increases in production standards for the 

following year. 

VBA has not adjusted individual employee production standards to reflect the increasing sophistication of our claimants, the complexity of claims and continued 

changes stipulated by regulation. Employees are subjected to arbitrary and unreasonable production standards that lead to inefficient and incomplete claims development. As a result, issues are missed, evidence is ignored, and decisions are rushed. 


anorris on DSK5R6SHH1PROD with HEARING
52 

All of this results in poor service to our claimants and is contrary to the VA’s mission. 

The current standards discourage complete and accurate claims development by 

denying employees credit for completing work on essential tasks. The following are 

some of the many examples of essential work that VSRs and RVSRs perform for 

which they receive zero credit: (We can provide more examples at your request) 

1. VSRs receive zero credit for Triage and Public Contact work because the new 

VSR Performance Standards only allow credit based on 5 criteria (instead of 

60); 

2. RVSRs get zero credit for additional development directed or completion of VA 

examination requests, even though both may require multiple hours of production time to complete; 

3. Under the previous standards, VSR would receive full credit for all tasks (‘‘End 

Products (EP)’’). Under the current VSR standards, employees can receive zero 

credit for work completed. For example, a VSR on the Post-determination 

team receives a rating to promulgate a reopened claim (EP 020), and the veteran requests to add a dependent (EP 130). In addition, VBA proposes to reduce the rating of one of the veteran’s service-connected disabilities (EP 600). 

The employee would only receive credit for the 020, while completing the other 

actions for zero work credit. 

4. VSRs get zero credit for any supplemental development, i.e. all aspects of the 

claim following initial development actions at the time the claim is established. 

The only other credit is applied at the time the claim is established as Ready 

for Decision. For example, RVSRs may send the case back to ‘‘cut’’ (request) 

the correct exam. (This is occurring more frequently because VSRs are being 

asked to write opinion exams and perform other complex work without adequate training, thus causing more requests for the wrong exams). In this case, 

the VSR is forced to remove any prior credit taken, and must complete the directed development with zero credit given. 

5. In order to provide medical release forms to all treating physicians, VSRs may 

spend up to an hour—with zero credit—duplicating individual release forms, 

because veterans often erroneously list all their providers on a single form. 

6. VSRs and RVSRs get zero credit for the mandatory work of reviewing the 

claims folder, which may take as long as two to four hours to complete. 

Other Concerns 

The current work credit system fails to adequately measure the work of VBA personnel who have been assigned collateral duties (in addition to adjudication duties), 

e.g. Homeless Veteran Coordinator and Seriously Disabled Veteran Coordinator. 

These employees are especially impacted by management’s continual change in priorities to meet new Central Office mandates. 

Similarly, employees assigned to outreach duties during the work day do not receive adjustments in their work credit for time away from production. 

New VSRs and RVSRs still undergoing training are held to unrealistic standards 

and penalized for having to correct prior work, regardless of how much time this 

takes away from production. Corrections are not considered in the evaluation of performance. 

Summary 

The current work credit system has created a tremendously stressful, demoralizing, assembly-line work environment that is hurting VBA retention of experienced employees and contributing to attrition among new hires. The current system 

also takes a heavy toll on training, resulting in the termination of many employees 

within the first year. The ultimate harm falls upon the veterans, who are deprived 

of a full, fair, and timely consideration of their claims, and a growing backlog. 

Therefore, AFGE and the VA Council urge the Subcommittee to mandate a scientific time-motion study of the resources and skills required to do the current mix 

of increasingly complex claims. Both VSOs and employee representatives should 

have formalized, ongoing roles in the design, implementation and updating of the 

new work credit and work management systems, as well as staffing decisions based 

on these measures. Thank you. 

f 


anorris on DSK5R6SHH1PROD with HEARING
53 

Prepared Statement of Diana M. Rubens, Associate Deputy Under 

Secretary for Field Operations, Veterans Benefits Administration, 

U.S. Department of Veterans Affairs 

Mr. Chairman and Members of the Subcommittee, thank you for providing me the 

opportunity to appear before you today to discuss the Veterans Benefits Administration’s (VBA) work credit and work management systems as they relate to quality, 

accountability, and accuracy in compensation and pension claims processing. I am 

happy to be accompanied by Jason McClellan, Director of the Veterans Benefit Administration’s (VBA) Central Area Office. VBA acknowledges the concerns of our 

Veterans, stakeholders, and the general public regarding our current work credit 

system and the perceived emphasis of quantity rather than quality; however, VBA 

does not and never has emphasized the quantity of claims completed over the quality of our decisions. 

Under the leadership of Secretary Shinseki, the vision of VBA and that of the entire Department is to be an advocate for Veterans, not an adversary. Secretary 

Shinseki’s guidance to VBA and all of VA is clear: to transform VA into a 21st Century organization and to ensure that we provide timely access to benefits and high 

quality care to our Veterans over their lifetimes, from the day they take their oaths 

of allegiance until the day they are laid to rest. One of the Secretary’s key objectives 

is to eliminate the disability claims backlog by 2015 while creating a new claims 

processing system that is more timely and accurate. The Secretary set a goal for 

VBA to process disability claims at a rate sufficient to avoid any Veteran waiting 

more than 125 days for a quality review and decision. It will take all of VA, as well 

as the help of Congress, Veterans Service Organizations, and other stakeholders to 

achieve this goal. A crucial component of achieving this goal is a well-trained, wellmanaged, and well-resourced workforce that has the tools and systems in place to 

tackle the complex work of disability claims processing. The President’s 2011 budget 

fully supports our progress with a 27 percent increase in VBA funding over the current year. 

As the Subcommittee is well aware, under Section 226 of Public Law 110–389, 

Congress required the Secretary to initiate a study of the effectiveness of the VBA’s 

employee work credit and work management systems to evaluate more effective 

means of improving disability claims processing performance. A report to Congress 

on that study was due on October 31, 2009. I want to apologize to the Subcommittee 

for this late report, which we expect to deliver in the near future. 

Under a contract with the VBA, the Center for Naval Analyses (CNA) conducted 

this study and produced the report titled, Qualitative Analysis of VBA Employee 

Work Credit and Work Management Systems. The CNA report was primarily a qualitative analysis of employee interviews, and the recommendations provided focus on 

improving the employee work credit system by establishing specific standards with 

clearly defined actions and time allotments that support quality work. The CNA recommendations closely align with VBA’s current initiatives to better link performance with the completion of decisions for Veterans and lessen emphasis on discrete 

work actions within the claims processing lifecycle. 

I want to emphasize that VBA strives to ensure that compensation and pension 

benefits are provided in a timely, accurate, and consistent manner. As our workload 

continues to grow, we are committed to increasing the consistency and accuracy of 

our decisions while completing an anticipated record 1,000,000 claims in fiscal year 

2010. 

Regional Office (RO) performance varies as the result of several factors including 

workforce experience, local economic and employment environment, and staff turnover. VBA aggressively monitors RO performance and develops specific action plans 

to address areas for improvement. Leadership within the Compensation and Pension 

Service as well as Area Directors oversee RO performance through monitoring and 

site visits. Lessons learned and specific examples of ‘‘best practices’’ from these visits are provided to assist ROs in enhancing their performance. 

As VBA’s workload continues to increase, maintaining balance between the quality and quantity of claims completed remains a priority. VBA experienced a 14.1 

percent increase in annual claims received in 2009, and we project increases of 13.1 

percent and 11.3 percent in 2010 and 2011, respectively. In addition, on October 13, 

2009, Secretary Shinseki announced his decision to establish presumptions of service-connection for Vietnam Veterans with three specific illnesses based on the latest 

evidence of an association with exposure to herbicides including Agent Orange. To 

respond to this expected growth in claims receipts, Secretary Shinseki announced 

an aggressive new initiative in March, 2010 to solicit private-sector input on a proposed ‘‘fast track’’ Veterans’ claims process for these new claims related to Agent 

Orange exposure during the Vietnam War. We are seeking automated solutions for 


anorris on DSK5R6SHH1PROD with HEARING
54 

the parts of the claims process that take the longest amount of time but do not involve actual adjudication or award of benefits. VA believes these parts of the process 

can be collected in a more streamlined and accurate way. With this new approach, 

VA expects to shorten the time it takes to gather evidence, which now takes on average over 90 days. Once the claim is fully developed and all pertinent information 

is gathered, VA will be able to more quickly decide the claim. 

VBA has both short-term and long-term strategies underway to reduce the backlog of disability claims while improving the quality of our output, even as those 

claims increase in number and complexity. VBA continues to aggressively hire 

claims processing staff across the Nation. Recognizing that it takes approximately 

2 years for a new employee to become fully trained in claims processing, ROs are 

encouraged to implement mentoring programs and provide new claims processing 

employees with timely feedback from trainers, reviewers, and supervisors. Area offices are increasing their oversight of ROs whose national rating-related claims 

quality is below 85 percent. In addition, quality factors heavily into VBA’s threetiered incentive compensation program which provides meaningful incentives to ROs 

that achieve a 90 percent or higher accuracy rate for the fiscal year. As mentioned 

earlier, an expanded workforce, improved training and leadership are a part of the 

toolkit we are bringing together with new technology and business systems solutions 

to tackle the disability claims backlog. No single part of this approach can solve the 

disability claims backlog alone. It must be a concerted approach, throughout the entire VA, to bring every tool to bear on this important priority. 

Completing an independent VBA effort begun in 2009, we recently revised the 

Veterans Service Representative (VSR) performance standards in ways that address 

recommendations since made by CNA. VBA performance standards have always included a quality element for claims processors to ensure correct information is disseminated and accurate decisions are provided on all claims administered by the 

VA. 

The newly revised VSR performance standards further align individual employee 

performance targets with national targets and require local quality reviews to be 

based on the same criteria as the national quality assurance reviews. In developing 

these new standards, VBA formed a workgroup of subject matter experts from all 

levels of the organization, including RO Directors, Veterans Service Center managers, and first-line supervisors, as well as employees from the Compensation and 

Pension Service and the Office of Field Operations in VBA Headquarters. A VSR 

also participated in the workgroup as the representative for VBA’s labor partner, 

the American Federation of Government Employees. 

VBA implemented the revised performance plan for VSRs nationwide on April 12, 

2010. The revised plan aligns the specific quality and production elements with the 

national targets, allowing performance credit only for those actions that advance a 

claim to the next stage of a claim’s life cycle. A similar initiative is currently underway for the Rating Veterans Service Representative and Decision Review Officer 

performance plans. 

VBA is actively pursuing additional initiatives to reach our strategic goals of 

eliminating the backlog of disability claims while achieving a 98-percent quality 

level. We established pilot initiatives to improve claims processing and services to 

Veterans at the Little Rock, Providence, and Pittsburgh ROs. These pilots are actively exploring process and policy simplification and technology improvements to 

enable VBA to reach our goal of providing world-class service to our Veterans. The 

CNA study also looked at the current VA work management system, referred to as 

the Claims Process Improvement Model, which emphasized employee task specialization. In support of the pilot in the Little Rock RO, VA has engaged Booz, Allen, 

and Hamilton to assist with evaluating the current claims process using lean six 

sigma analysis techniques. 

This past fall, VA employees and co-located Veterans Service Organizations submitted more than 3,000 ideas as part of a VA Innovation Initiative competition with 

the stated purpose of finding the best ideas to improve the claims process. Ten winners were announced; after further analysis, eight were determined to be viable solutions. We are working with the ROs that submitted these initiatives to refine 

costs, timelines, and resource requirements for implementation. 

In addition, VBA Leadership met for a week in March to begin to develop a comprehensive plan that will focus on eight lines of action for change in VBA in order 

to achieve the Secretary’s goal of eliminating the disability claims backlog by 2015. 

These lines of action include: leadership and culture, performance management, resource capacity and footprint, process design, claims segmentation, Veteran partnership, legislative and regulatory framework, and technology. 

Developing and implementing these technological and procedural initiatives will 

reduce the time required to obtain information from outside sources, simplify the 


anorris on DSK5R6SHH1PROD with HEARING
55 

claims adjudication process, and increase accountability for claims decisions. These 

changes will help us achieve our goals of eliminating the disability claims backlog, 

reducing the pending inventory, fielding a sustainable processing system where significant inventories do not develop, and most importantly, providing all Veterans 

with accurate, timely, and consistent decisions on their disability claims. 

Mr. Chairman, this concludes my statement. I would be happy to respond to any 

questions from you or other Members of the Subcommittee. 

Æ 


anorris on DSK5R6SHH1PROD with HEARING