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41–370 2008

EXAMINING THE BACKLOG AND THE 

U.S. DEPARTMENT OF VETERANS AFFAIRS’ 

CLAIMS PROCESSING SYSTEM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND 

MEMORIAL AFFAIRS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

FEBRUARY 14, 2008 

Serial No. 110–70 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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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 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

VACANT 

Malcom A. Shorter, Staff Director 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS 

JOHN J. HALL, New York, Chairman 

CIRO D. RODRIGUEZ, Texas 

PHIL HARE, Illinois 

SHELLEY BERKLEY, Nevada 

DOUG LAMBORN, Colorado, Ranking 

MICHAEL R. TURNER, Ohio 

GUS M. BILIRAKIS, Florida 

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. 

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C O N T E N T S 

February 14, 2008 

Page 

Examining the Backlog and the U.S. Department of Veterans’ Affairs Claims 

Processing System ................................................................................................ 1 

OPENING STATEMENTS 

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

Prepared statement of Chairman Hall ........................................................... 56 

Hon. Doug Lamborn, Ranking Republican Member ............................................. 4 

Prepared statement of Congressman Lamborn .............................................. 57 

WITNESSES 

U.S. Government Accountability Office, Daniel Bertoni, Director, Education, 

Workforce, and Income Security ......................................................................... 9 

Prepared statement of Mr. Bertoni ................................................................. 65 

U.S. Department of Veterans Affairs, Michael Walcoff, Deputy Under Secretary for Benefits, Veterans Benefits Administration ..................................... 41 

Prepared statement of Mr. Walcoff ................................................................. 109 

American Federation of Government Employees, AFL–CIO, J. David Cox, 

R.N., National Secretary-Treasurer .................................................................... 18 

Prepared statement of Mr. Cox ....................................................................... 80 

American Legion, Steve Smithson, Deputy Director, Veterans Affairs and 

Rehabilitation Commission ................................................................................. 33 

Prepared statement of Mr. Smithson .............................................................. 96 

Center for Naval Analyses (CNA) Corporation, Alexandria, VA, Joyce 

McMahon, Ph.D., Managing Director, Center for Health Research and Policy .......................................................................................................................... 5 

Prepared statement of Ms. McMahon ............................................................. 58 

Disabled American Veterans, Adrian Atizado, Assistant National Legislative 

Director ................................................................................................................. 30 

Prepared statement of Mr. Atizado ................................................................. 89 

Erspamer, Gordon P., Senior Counsel, Morrison and Foerster, Walnut Creek, 

CA .......................................................................................................................... 20 

Prepared statement of Mr. Erspamer ............................................................. 83 

Institute of Medicine, The National Academies, Michael McGeary, Senior 

Program Officer and Study Director, Committee on Medical Evaluation 

of Veterans for Disability Benefits, Board on Military and Veterans Health . 7 

Prepared statement of Mr. McGeary .............................................................. 63 

National Organization of Veterans’ Advocates, Inc., Richard Paul Cohen, Executive Director .................................................................................................... 15 

Prepared statement of Mr. Cohen ................................................................... 73 

National Veterans Legal Services Program, Ronald B. Abrams, Joint Executive Director .......................................................................................................... 17 

Prepared statement of Mr. Abrams ................................................................ 76 

Veterans for Common Sense, Paul Sullivan, Executive Director ........................ 31 

Prepared statement of Mr. Sullivan ............................................................... 94 

Veterans of Foreign Wars of the United States, Gerald T. Manar, Deputy 

Director, National Veterans Service ................................................................... 34 

Prepared statement of Mr. Manar .................................................................. 101 

Wounded Warrior Project, John Roberts, National Service Director .................. 36 

Prepared statement of Mr. Roberts ................................................................. 107 

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iv 

SUBMISSIONS FOR THE RECORD 

Bilmes, Linda J., Professor, Kennedy School of Government, Harvard University, Cambridge, MA, statement ......................................................................... 112 

Priessman, Master Sergeant Kurt, USAF (Ret.), Vernon, TX, statement .......... 116 

MATERIAL SUBMITTED FOR THE RECORD 

‘‘Wounded Vets, Broken System,’’ CQ Weekly, April 30, 2007, by Patrick 

Yoest and Rebecca Adams ................................................................................... 119 

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(1) 

EXAMINING THE BACKLOG AND THE 

U.S. DEPARTMENT OF VETERANS AFFAIRS’ 

CLAIMS PROCESSING SYSTEM 

THURSDAY, FEBRUARY 14, 2008 

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 2:15 p.m., in Room 

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

of the Subcommittee] presiding. 

Present: Representatives Hall and Lamborn. 

OPENING STATEMENT OF CHAIRMAN HALL 

Mr. HALL. Please forgive the delay. Once again, thank you all for 

being here. The Committee on Veterans’ Affairs, Subcommittee on 

Disability Assistance and Memorial Affairs, hearing on examining 

the U.S. Department of Veterans Affairs’ (VA’s) claims processing 

system will come to order. 

Would everyone please rise for the Pledge of Allegiance. 

[Pledge of Allegiance.] 

Mr. HALL. Thank you. 

Today we are here to examine the VA’s claims processing systems and its attendant disability claims backlog. There are many 

areas to explore when trying to determine why the disability claims 

backlog has reached the point of unmanageability and why this is 

the second time in a 7 year time period that we have reached this 

crisis point. 

From 2002 to 2007, the disability claims backlog has risen from 

about 250,000 to nearly 650,000. During the same time period, the 

Veterans Benefits Administration (VBA) consistently missed its 

performance targets on nearly all compensation and pension (C&P) 

claims processing fronts. 

These failures engender many questions about the complexity of 

the system the VA has created and the model upon which it is 

built. 

One of my leading questions concerns the effectiveness of the 

Claims Processing Improvement (CPI) model regards its suitability 

to establish meaningful accountability parameters to eliminate the 

claims backlog and accurately process claims. Thus far, none of the 

VA’s own benchmarks have improved since the CPI implementation and I find this fact disturbing. 

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Moreover, it seems as if the failure is not necessarily with the 

system itself, but with the execution of the processes that are supposed to be reinforced with transparent and highly visible accountability measures to make it work. 

As outlined by the 2001 report of the VA Claims Processing Task 

Force led by Daniel L. Cooper, now VA Under Secretary for Benefits, ‘‘Accountability includes not only the proposition that a leader 

is responsible for the actions of the group, but also is accountable 

for the results of those actions or inactions. This single attribute 

is the most serious deficiency in the VBA organization.’’ 

At the time, Mr. Cooper was referring to VBA’s then failed 

claims processing system, SDN. I think many of those who testify 

today will concur that these same observations could apply both to 

today’s VBA organization and its claims processing system model, 

CPI. 

One can only wonder where the accountability is in a work credit 

system whose only meaningful measure is productivity and where 

quality seems to be an afterthought. 

Only about 2 percent of all claims are checked for quality and 

one in ten claims is processed incorrectly. This error rate is unacceptable and indicates that VA needs to improve its training regimens to ensure uniformity across Regional Offices (ROs) and that 

highly qualified individuals are processing and adjudicating claims. 

Further, I ask why bonuses are consistently paid to managers at 

both the Regional and Central offices while claims languish. I want 

VA management to adopt this principle: Be accountable for the 

backlog, do not pay yourselves anything extra until the veterans 

are paid. 

I know that VA contends that all of its inventory is not backlogged, but try selling these semantics to veterans waiting 183 days 

and longer for decisions on their claims. 

From the Subcommittee’s standpoint, based on the VA’s current 

performance, most of the disability claims in its inventory are eventually going to become a part of those claims pending longer than 

VA’s target of 145 days for claims processing. Hence, they will become part of the backlog. 

Moreover, the Subcommittee does not consider as progress an increase in the time needed to process a claim from 177 days in 2006 

to 183 days in 2007 accompanied by an increase in the VBA’s target performance days for processing claims from 125 days up to 145 

days during the same time period. 

It is interesting that moving the goal from 125 days to 145 days 

is actually a greater increase than the increase in the backlog from 

177 to 183 days. 

VA should not conceive of moving its targets to compensate for 

its poor performance. I am confounded by these actions and would 

like an explanation and so would our veterans. 

I am encouraged that some of the numbers from VA’s fiscal year 

2009 budget indicated a 19 percent increase in VBA information 

technology (IT) funding to support efforts to move to a paperless 

claims environment and increased funding for VETSNET. While 

technological improvements alone will not solve the backlog problem, they are clearly critical to the solution. 

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I am also anxious to see the results of IBM’s study of the VBA’s 

business processes involved with adjudicating a claim. This type of 

review is long overdue. 

I am also encouraged to see that VA is requesting more money 

to add 703 full-time employees (FTE), yet I am aware that you 

have been unable to maximize the performance of the record number of 3,100 FTEs that this Congress ensured you received during 

the last two funding cycles. 

Let us be very clear. This is not just a people problem and adding more people to a broken system cannot be the only answer to 

vanquishing the claims backlog and improving processing times. To 

date, this single-minded approach has proven unsuccessful. 

I think the major faulty premise in this system is that the VA 

behaves as if it is only accountable to meet the numerical targets 

it sets and that Congress tacitly approves. But I want to reinforce 

to you that you are actually supposed to be accountable to the veteran who has borne the battle, to his widow, and to his orphan. 

I believe we need to refocus and refine our Nation’s claims processing system to make it accountable to producing better outcomes 

for our veterans, their families, and survivors. 

I thank the witnesses on the first three panels for their thoughtful, solution-oriented testimonies. I hear the frustration in your 

statements and I look forward to working with you and with the 

Ranking Member and other Members of this Committee on ways 

to implement the workable solutions many of you offer. 

I know that the backlog has taken on a life of its own. However, 

it is not bigger than the collective will we will devote to eliminating 

it and to honing a claims processing system that is veteran-focused, 

not process-focused. 

Last, I know that VA cannot be pleased with its current disability claims processing performance and I look forward to hearing 

VBA’s strategic plan for addressing these concerns. 

Secretary Peake has highlighted this issue as one of his top priorities and I hope VA sees Congress as a friend and not a foe in 

helping to correct the shortfalls in the disability claims processing 

system. 

I believe that just as the Veterans Health Administration (VHA) 

experienced a revolutionary transformation, it is well time to think 

of devoting the same type of resources into transforming the VBA. 

It is time for a paradigm shift. 

Our veterans deserve the benefit of our collective resources to ensure that this process is a world-class, 21st century model that reflects their priceless sacrifice for our Nation. 

And I would ask that the article from CQ Weekly entitled 

‘‘Wounded Vets, Broken System,’’ April 30, 2007, issue be entered 

into the record without objection. Without hearing any, so ordered. 

[The prepared statement of Chairman Hall appears on p. 56, and 

the article referenced, ‘‘Wounded Vets, Broken System,’’ CQ Weekly, April 30, 2007, by Patrick Yoest and Rebecca Adams, appears 

on p. 119.] 

Mr. HALL. Thank you very much. I would yield now to Ranking 

Member Lamborn for his opening statement. 

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OPENING STATEMENT OF HON. DOUG LAMBORN 

Mr. LAMBORN. Thank you, Mr. Chairman, for yielding. I look forward to hearing our witnesses’ testimony on how we might address 

the challenges and opportunities facing VA’s compensation and 

pension service. 

In fiscal year 2007, compensation and pension service commonly 

referred to as C&P performed more than 838,000 rating decisions. 

C&P also performed nearly 582,000 claims actions that did not require rating decisions. 

Yet, despite this tremendous volume of work accomplished, C&P 

finds itself behind in its struggle to overcome the steady accumulation of claims awaiting action. An array of reasons contributes to 

this frustrating trend and our witnesses outlined a number of them 

in their written statements. 

Foremost among them will be that VA place more emphasis on 

accuracy and less on speed. Rating decisions must be done right 

the first time. I wholeheartedly agree. 

But as much as we may ponder and discuss solutions to the multitude of underlying problems, I think we all realize that the time 

has arrived for a reasonable, yet fundamentally different approach 

to the problem. If we continue to merely tread water, we are going 

to sink. 

As my Subcommittee colleagues are aware, I have long been an 

advocate for major reform with regard to the use of information 

technology. I am heartened to know that they concur with my perspective that it is well past time for VA to embrace IT as a remedy 

to an outdated paper-based system. VA should be on the forefront 

of technology in the disability benefits arena and I believe it can 

be. 

Not too long ago, VA’s healthcare system was so poor, it was the 

subject of derision in movies such as Born on The Fourth of July. 

Now, though, VA healthcare is the subject of emulation among a 

number of high-quality medical models. 

I believe that VA can make a similar improvement on the benefits side of the Department. We must be open to considering new 

ideas, especially in the area of IT, and not be bound by narrow 

paradigms. 

I invite the Members of the Subcommittee, the veterans groups, 

and others to offer suggestions that will improve the process for 

our future veterans. 

Thank you, Mr. Chairman, and I yield back. 

[The prepared statement of Congressman Lamborn appears on 

p. 57.] 

Mr. HALL. Thank you, Congressman Lamborn. 

I would like to welcome all of our panelists testifying before the 

Subcommittee today and remind our panelists that your complete 

written statements have been made part of the hearing record. 

Please limit your remarks so that we may have sufficient time 

for follow-up questions once everyone has had the opportunity to 

testify. 

Joining us on our first panel is Ms. Joyce McMahon, Managing 

Director, Center for Health Research and Policy, CNA Corporation; 

Mr. Michael McGeary, Senior Program Officer and Study Director 

for the Committee on Medical Evaluation of the Veterans for Diswwoods2 on PRODPC68 with HEARING

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ability Benefits, Board on Military and Veterans Health of the Institute of Medicine; and Mr. Daniel Bertoni, Director of Education, 

Workforce, and Income Security of the U.S. Government Accountability Office (GAO). 

If the panelists would come to the table, please. We welcome you. 

And, Ms. McMahon you are recognized for 5 minutes. 

STATEMENTS OF JOYCE MCMAHON, PH.D., MANAGING DIRECTOR, CENTER FOR HEALTH RESEARCH AND POLICY, CENTER FOR NAVAL ANALYSES (CNA) CORPORATION, ALEXANDRIA, VA; MICHAEL MCGEARY, SENIOR PROGRAM OFFICER 

AND STUDY DIRECTOR, COMMITTEE ON MEDICAL EVALUATION OF VETERANS FOR DISABILITY BENEFITS, BOARD ON 

MILITARY AND VETERANS HEALTH, INSTITUTE OF MEDICINE, THE NATIONAL ACADEMIES; AND DANIEL BERTONI, 

DIRECTOR, EDUCATION, WORKFORCE, AND INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

STATEMENT OF JOYCE MCMAHON, PH.D. 

Ms. MCMAHON. Thank you. 

Chairman Hall, Representative Lamborn, distinguished Members, I appreciate the opportunity to testify before the House Subcommittee on Disability Assistance and Memorial Affairs today on 

the subject of the VA’s claims processing system. 

The testimony I am giving is based on findings and our final report for the Veterans’ Disability Benefits Commission (VDBC). In 

the written testimony I have provided, there is a website link that 

can provide a full copy of that report. 

I am going to summarize from the testimony that we have that 

is pertinent to the topic of examining the backlog and the VA’s 

claims processing system. 

In particular, there were two parts of our study that relate to 

these issues. We did an evaluation that compared the VA Disability 

Compensation Program to other Federal disability programs, looking at the claims process. 

We also conducted surveys of both raters and Veterans Service 

Organizations (VSOs) to determine how they felt about the rating 

process and their ability to work with the claims system. 

I am first going to mention briefly some of the comparisons we 

did across the other Federal disability programs. We looked at Social Security disability income, the Supplemental Security Income, 

workers’ compensation, the disability retirement under the Federal 

employee system, and U.S. Department of Defense’s (DoD’s) disability evaluation system. 

Our strategy was to look at literature reviews, reports from GAO, 

congressional testimony, Office of Inspector General (OIG) reports, 

and interviews with various officials at all of these programs. 

We found two difficulties in terms of making these comparisons, 

the first of which is there is generally a lack of formal evaluation 

of the effectiveness of specific practices for the non-VA programs. 

That limited our ability to make direct head-to-head comparisons 

of methods. 

In addition, there are different goals and structures and procedures and claims requirements across the programs. In particular, 

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the VA system has a great deal of complexity required for the evaluation process, more complexity than may be required for some of 

these other programs. 

To be specific, there is a requirement that the VA disability be 

a service-connected disability, and multiple VA disabilities are examined. Each disability has to be assessed for a degree of disability 

to determine an overall disability compensation that is appropriate 

for the individual. 

In particular, the age of claim is an important issue, because the 

initial disabling event may have occurred years prior to the claim 

being filed, meaning that the documentation that is provided is old 

and may have to be requested from DoD. The evidence may have 

to be resurrected, from old files. So the evidence that is needed to 

apply to the claim may not, in fact, be very current and this adds 

to the problem of resolving claims quickly. 

We looked at several metrics including timeliness, accuracy, consistency, training issues, and staff turnover. The one that was the 

most striking was the timeliness issue, in that the VA claims process takes a much longer time to complete than is the case for the 

other programs. 

In part, this may be due to the complex issues that the VA has 

to deal with in terms of the determination process, but we think 

that one suggestion that was offered by GAO has tremendous 

merit. GAO suggested that the VA should look at desegregating the 

process of the claim so that it can be determined which stages of 

the claims process contribute most to the total processing time. 

In other words, we do not know why it takes as many days as 

it does. We do not know enough about where the bottlenecks occur. 

Is it a problem with retrieving old paperwork? Is it getting input 

from DoD? Is it based on the issue of trying to do medical and clinical assessments? So we think it would be very helpful to look at 

that process more closely. 

I would like to turn now to the discussion of the rating officials, 

both the VBA rating officials and the accredited Veteran Service 

Officers in terms of the surveys that we did. These are the firstline people that deal with the claims processing, either doing the 

claims processing or assisting individuals with the claims processing. 

We prepared surveys for each group that were related as parallel 

as possible so we could ask pretty much the same questions from 

both groups of people and get their separate opinions. We focused 

on the challenges in the benefits determination and claims rating 

process and the raters’ perspectives on their performance. 

We asked raters to identify their three top challenges, for example, what kind of training they had that they thought made them 

very effective, what kind of resources were good to help them make 

the claims decisions, what types of claims were most difficult to 

process, and what resources would help them do a better job. 

In general, the finding was that the overall determination process is difficult to use and, in particular, the VSOs reported that 

most veterans and survivors find it difficult to understand the determination process, difficult to navigate through the steps, and 

difficult to provide the needed evidence. 

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Both raters and VSOs agree that veterans have unrealistic expectations about the process and I think that means unrealistic in 

terms of what they can do to help the veterans get through the 

claims process more quickly. That is how the raters perceived it. 

Particular things that we found from these surveys include the 

following: more clinical input would be helpful, especially from physicians and mental health professionals. The claims processes are 

viewed as being complex and getting more complex over time. And 

obviously, the more complex the condition that has to be considered, the more time it takes to do an accurate job on getting that 

done. 

Some types of disabilities were identified as being more difficult 

to assess than others. In particular, rating mental claims is considered to be much more problematic than rating physical condition 

claims. Again, in particular, Post Traumatic Stress Disorder 

(PTSD) was singled out as requiring more judgment and subjectivity and being much more difficult and time consuming compared 

to physical claims. Both groups agreed. 

Mr. HALL. Could you summarize, please? 

Ms. MCMAHON. Yes, I can. 

Among physical disabilities, neurological, musculoskeletal and 

sense organs were more difficult than the other physical disabilities 

to rate. It is not just a matter of training, but years of experience 

on the job that makes raters more confident. And, in particular, 

both the raters and VSOs believed that the claims rating process 

generally arrives at the fair and right decisions for veterans. 

Thank you. 

[The prepared statement of Ms. McMahon appears on p. 58.] 

Mr. HALL. Thank you very much, and to remind all of our witnesses, your full statements have been entered into the record. 

Mr. McGeary, you are now recognized for 5 minutes. 

STATEMENT OF MICHAEL MCGEARY 

Mr. MCGEARY. Good afternoon, Mr. Chairman, Members of the 

Committee. 

As the Chairman indicated, I was the Staff Director for the Institute of Medicine’s Committee on Medical Evaluation of Veterans 

for Disability Benefits, which produced the report called, ‘‘A 21st 

Century System for Evaluating Veterans for Disability Benefits,’’ 

last June. The Committee was established at the request of the 

Veterans’ Disability Benefits Commission and it was funded by VA. 

In this report, the Committee assessed the medical criteria and 

processes used by VA to determine the degree of disability of service-connected veterans. The Committee did not, however, assess the 

nonmedical aspects of the claims process. So the report does not address all the factors that might affect the timeliness of decisions on 

claims. 

The Committee did not, for example, evaluate the adequacy of 

staffing nor the capacity of VA’s management information systems. 

Rather, the main focus of the report is on the medical criteria VA 

uses to assess degree of disability, which are embodied in the VA’s 

schedule for rating disability. 

Dr. Lonnie Bristow, the Chairman of the Committee, is scheduled to testify before you on the rating schedule on February 26. 

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I am here today to review the part of the report in Chapter 5 which 

focuses on the two steps in the claims process that are medically 

based, namely, the medical examination step and the rating step. 

My written testimony contains statistics on timeliness, accuracy, 

and consistency of decisions in recent years, which I will not repeat 

here other than to note that, despite improvements of the time it 

takes to resolve claims, it is long and the number of pending claims 

is still large. 

The Committee made several recommendations to improve the 

medical examination process and several more to improve the rating process. These recommendations were primarily aimed at improving the quality of the medical evidence and rating decisions 

rather than speeding the claims process. But two of the Committee’s recommendations promise to get faster as well as better decisions. 

First, VA has developed standardized online protocols or templates for documenting the most common disability examinations. 

VA has conducted studies which indicate that examinations using 

these templates are not only higher in quality, but reported more 

quickly, 7 to 17 days more quickly than traditional transcribed reports. 

However, the Committee noted that the use of these templates 

is voluntary and the rate of use is low, although growing. And the 

Committee recommends, therefore, that the use of the templates be 

made mandatory. 

Second—— 

Mr. HALL. Excuse me, Mr. McGeary. I am going to ask you, if 

you would, to pause right there and take a quick recess while we 

run across the street and vote and come back again. 

Mr. MCGEARY. Yes, sir. 

[Recess.] 

Mr. HALL. The hearing of the Subcommittee is back in session. 

Please continue Mr. McGeary. 

Mr. MCGEARY. Okay. Second, the Committee found that raters 

should have quicker access to medical expertise. And you just 

heard from Ms. McMahon that the raters report the need for more 

medical information to use. 

The raters are not medical professionals. If they have a question 

about the meaning of a test result or if the evidence is inconclusive, 

they have to refer the case back to the C&P examiners in the Veterans Health Administration, which adds time or, to save time, 

they can determine a rating based on incomplete information, 

which is obviously not desirable. 

The Committee recommends, therefore, that VA have medical 

consultants readily available to the raters in the Regional Offices. 

This does not mean having a medical consultant in every Regional 

Office, because with modern communications technology, VBA medical consultants could be in a national or in Regional centers. 

This recommendation that VBA have its own medical consultants 

would require congressional action because the U.S. Court of Appeals for Veterans Claims has barred the participation of physicians in adjudicating claims. 

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The Committee believes that the Court’s decision was based on 

a misunderstanding of the role of physicians in adjudication, which 

is different from the role of a treating physician. 

All other major disability programs, for example, Social Security, 

DoD’s disability evaluation process, ‘‘The Federal Employee Compensation Act’’ Program, Civil Service Disability Retirement Program, either have physicians participating in the adjudication decision or have medical experts readily available to review and discuss claims with the lay disability raters. 

So the Committee concluded that adoption of these recommendations, that the templates be made mandatory, and that VBA have 

medical consultants for raters, would, among other results, possibly 

improve the timeliness of the decisions. 

And this concludes my remarks. Thank you for the opportunity 

to testify, and I would be happy to address any questions. 

[The prepared statement of Mr. McGeary appears on p. 63.] 

STATEMENT OF DANIEL BERTONI 

Mr. BERTONI. Good afternoon. I am pleased to participate in this 

discussion of the Department of Veterans Affairs’ disability claims 

process. Last year, VA provided $36 billion in benefits to nearly four million recipients. For years, VA’s disability program has been plagued 

by untimely processes, large backlogs, and error-prone decisions. It 

will be further strained as more Operation Iraqi Freedom (OIF) 

and Operation Enduring Freedom (OEF) veterans seek benefits in 

the coming years. 

In 2003, we at GAO designated VA’s disability program high risk 

because it was based on outmoded concepts and continued to experience management and operational problems. Since that time, we 

have issued numerous reports with recommendations for change. 

Today I will briefly highlight three areas, service delivery challenges facing VA, actions taken to improve performance, and areas 

where fundamental reform is needed. 

In summary, VA continues to experience service delivery challenges. Over the past 4 years, pending ratings-related claims increased over 50 percent to nearly 400,000. Claims pending longer 

than 6 months have more than doubled to over 100,000. 

The time required to resolve appeals is also problematic with a 

current average processing time of almost 700 days. And VA also 

faces challenges ensuring that its decisions are accurate and consistent. 

VA has taken steps to expedite and improve claims processing 

such as increasing staff overtime, using retired staff to provide 

training and claims assistance, shifting workloads to offices with 

excess capacity, and establishing special teams to prioritize claims 

for aged veterans as well as returning OIF and OEF veterans. 

VA’s 2009 budget funds nearly 11,000 claims processing staff, an 

increase of 2,600 positions, with 32 percent over fiscal year 2007. 

While VA acknowledges some temporary declines in productivity 

until new staff are trained and gain experience, it expects productivity to ultimately increase. 

Despite these assertions, we are concerned that incorporating a 

large number of new staff into the claims process will likely 

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present substantial human capital challenges relative to hiring, 

training, and deployment of new personnel. 

And even if staffing levels increase, other actions are needed to 

improve productivity. To that end, VA has continued to expand the 

number of benefits delivery at discharge (BDD) sites where servicemembers can apply for benefits prior to discharge and receive expedited claims processing. 

To improve decisional accuracy and consistency, VA has begun to 

enhance its quality assurance processes and develop baseline data 

to monitor decisional variances, especially for PTSD and other 

brain injury claims. 

Finally, to address longstanding systemic weaknesses, VA and 

the Department of Defense are piloting a joint disability evaluation 

system whereby VA performs a single medical exam, rates the disabilities of active-duty servicemembers. This pilot intends to 

streamline the confusing dual DoD and VA disability systems and 

ultimately expedite claims processing. 

Despite VA’s efforts, several factors may impede progress. Claims 

have increased steadily from about 579,000 at the start of this decade to 838,000 last year. And VA predicts that the current war will 

place a further strain on operations. 

Court decisions are requiring VA to assist veterans in developing 

claims. They have also expanded workloads. Increased outreach 

and additional laws and regulations creating new presumptions of 

service-connected disabilities have added to the volume of claims. 

Caseload complexity has also increased as more veterans claim 

multiple disabilities. Thus, continuing to explore new ways to work 

smarter and more efficiently is essential to increasing VA’s productivity. 

Going forward, significant program improvements may lie in 

more fundamental reform. We have noted that VA’s programs do 

not reflect the current state of science, medicine, technology, and 

the national economy, which has moved away from manufacturing 

jobs to service and knowledge-based employment. Thus, VA’s rating 

criteria and support services have lagged behind modern concepts 

of disability and early intervention. 

The Veterans’ Disability Benefits Commission has recommended 

that VA’s entire rating schedule be updated starting with PTSD, 

Traumatic Brain Injury (TBI), and other signature disabilities of 

the current war. 

The Dole-Shalala Commission also noted that the current schedule does not sufficiently acknowledge injuries that are new or for 

which diagnostic criteria are changing rapidly. This is an area of 

concern to us also. 

Finally, we reported that VA’s field structure may impede efficient operations. Despite limited ad hoc efforts to consolidate some 

processes and workloads at VA’s 57 offices, claims processing remains unchanged and continues to experience large performance 

variations. 

VA must take a more strategic approach to determining the appropriate structure and division of labor among its field locations. 

In conclusion, reexamining claims processing challenges and implementing viable solutions for reform is difficult. However, recent 

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studies have laid the groundwork to help VA better align its programs with modern concepts of disability. 

It is imperative that VA thoughtfully assess the range of options 

and their potential effects and continue to look for other reforms 

to further improve its disability programs into the 21st century. 

This concludes my statement. I am happy to answer any questions that you may have. Thank you. 

[The prepared statement of Mr. Bertoni appears on p. 65.] 

Mr. HALL. Ladies and gentlemen, thank you for your attention. 

We are in the middle of a stack of votes. There are five votes remaining, 5-minute votes supposedly. Each one is 5 nominally. So 

you are still talking about somewhere in the neighborhood of probably 40 minutes or so. 

I apologize. I cannot control the vote schedule. But I will be back 

and hopefully the Ranking Member will be back as well and we 

will proceed. Thank you for your patience. You are excused again. 

I am officially putting this hearing in recess. 

[Recess.] 

Mr. HALL. The hearing of the Subcommittee is back in session. 

There is a privileged motion being discussed on the floor right now 

that could take anywhere from 1 to 50 minutes or so. I am not sure 

what is going to happen. We are going to try to move as much as 

we can through the business at hand today. 

So let me ask some questions of our first panelists. And thank 

you for your patience. 

Ms. McMahon, it seems that the bulk of the time, 111 days, according to the VDBC, is taken during the development stage of 

claims processing, most of which involves acquisition of medical 

records and a medical examination of a veteran by the VA or its 

contractor. 

Your report to the VDBC also highlights how raters indicated 

that obtaining needed evidence and the insufficiency of medical examinations was a serious challenge given the time constraints. 

During your analysis and comparison of disability programs, did 

you find that these programs allow the admission of independent 

outside examinations and, if not, how does it work in the other disability systems? 

Ms. MCMAHON. Well, I think that it does allow an independent 

examination. Although when we talked to the raters, they indicated that they would appreciate more of that evidence to help 

them make their decisions. They did not think they received 

enough of that information. 

So they have pointed out they wanted more information from clinicians, outside physicians, medical rehabilitation people, and material of this nature to help them with the decision process and 

that was a lack in the overall process. 

We are not in a position at CNA, as we are not clinicians, to 

make recommendations regarding the specific processes that these 

VA raters do or the other programs do with regard to how they 

take in their medical evidence. That is a little bit beyond my purview. 

Mr. HALL. Okay. Thank you. 

In your testimony, you mentioned that your survey results indicated that many raters and VSOs see claims with mental disorder 

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problems or issues, especially PTSD, as requiring more judgment 

and subjectivity than claims of physical conditions. 

We know from previous hearings before the Subcommittee that 

there is a tremendous variance between ROs on these claims. 

Do you have recommendations for improving the consistency of 

the outcomes for veterans filing these types of claims and how do 

you think we can make these determinations less subjective? 

Ms. MCMAHON. One way to make it less subjective would be to 

rely more on medical testimony. I would say again not as a medical 

person myself, this is basically what I have been told, that one way 

to do this would be to have an actual one-on-one assessment medically that would lay out the characteristics of the person’s case and 

make a medical recommendation. This is time consuming but it 

would probably be something that would be helpful. 

The issue of consistency across ROs can be dealt with, but it also 

takes the process further away from the individual person. For example, suppose you consolidated certain types of claims into a specified office. Perhaps it might be that all of the PTSD claims would 

go to a certain office with raters that were specializing in PTSD 

claims. You would probably get more consistency. But then you are 

taking the claim away from the individual Regional Office and from 

the individual veteran that is talking directly to a claims representative. 

So you have a problem in the sense that you can try to specialize 

some types of claims, perhaps not just PTSD, but neurological 

claims also, so they are reviewed by certain types of raters, but 

then you may move away from the process of dealing with claims 

in an individual RO to some extent. 

Mr. HALL. Thank you. 

Mr. McGeary, would you please elaborate on your recommendation that VA should implement mandatory use of interactive online 

versions of the VA examination worksheets? How does this process 

work now and how could this change affect the processing times for 

rating claims? 

Mr. MCGEARY. VA first started working on the medical exams in 

the mid-1990s and they developed standard worksheets. They 

worked up a large number, I think 50 plus worksheets for the most 

common conditions, for clinicians to use in conducting the C&P 

exams and in reporting them. 

And then they went the next step, which is to develop them into 

an on-line interactive system. The idea here was that the template 

would indicate what information was needed. It would provide 

standardized input, structured and so forth, and would also make 

sure that everything that was needed would be answered. 

And they have been working on developing these templates. They 

are, I believe at this point, rolled out nationally, but they are not 

mandatory yet. The Committee thought that they should make 

them mandatory because VA’s own studies show that it improves 

the quality of the exam, at least in terms of making sure that the 

information that is asked for is provided and that it is also faster. 

I believe the average time for a Regional Office to get an examination report is about 30 to 35 days. And they found that using 

some of these templates would save 7 to 17 days. That was a couwwoods2 on PRODPC68 with HEARING

13 

ple of years ago. I am not sure whether they have looked at this 

lately. 

That is why I highlighted this particular recommendation as 

something that would presumably result in better medical evidence 

and also shorten the turnaround for doing the exams. 

Mr. HALL. Thank you. 

Can you provide more detail on your recommendation that raters 

should have better access to medical expertise, such as having 

medical consultants in a National or Regional Office which raters 

would be able to confer with on the tough cases? 

Currently it does not happen with most ROs, but I believe it 

used to be the case that doctors or medical experts were available 

to raters for medical advice. 

Mr. MCGEARY. Yes, sir. In the 1920s, when VA started the compensation program, they had rating boards and there would be a 

medical person on the board. They also would have a vocational 

person and a legal person. 

When you fast forward to when the U.S. Court of Appeals for 

Veterans Claims was established, the court began to issue cases in 

which they were putting a pretty high standard on using doctors 

in these decisions. So basically, VA dropped having physicians on 

the rating boards and at the VBA as well. 

We looked at the other disability programs as CNA did and 

found that VA is unique in this regard, that the other programs either have medical advisors or they actually have physician adjudicators. 

[Mr. McGreary subsequently provided the following information:] 

The Committee’s recommendation that VBA have medical consultants for 

raters should reduce the number of times a case must be returned to the 

Veterans Health Administration and thus save time spent deciding these 

cases. 

Mr. HALL. Thank you, Mr. McGeary. 

Mr. Bertoni, in your written testimony, you note that the VA continues to fall short on its quality assurance program to assess rating accuracy. In fact, by VA’s own numbers, one out of every ten 

cases is adjudicated incorrectly. Many of today’s witnesses will testify that it may even be higher than that, closer to three in ten. 

Would you please describe your observations of the VA’s Systematic Technical Accuracy and Review Program (STAR) and provide 

any thoughts on how it might be improved? 

Mr. BERTONI. Certainly. We have not done an in-depth analysis 

of the STAR system for some time. I guess the bottom line was that 

our concern with STAR was that the level and depth of their sampling perhaps at times has been insufficient to generalize and to 

sort of drill down into the root causes of some of the issues for the 

inconsistencies and inaccuracies. 

To rectify that, I think you really need to look at sampling methodology, your approach, whether you are actually sampling enough 

cases and your methodology for doing that is going to give you a 

reasonable assurance that this is or is not a true soft spot or bottleneck in the system or quality assurance issue. And that has been 

our concern with the STAR system. 

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Mr. HALL. You also mentioned that VA may need to look at more 

fundamental reforms for improving its disability program in the 

long term. 

Do you have any specific closing thoughts on that matter? 

For instance, we will hear later today from the VA about its IT 

improvements and plans, something that Congressman Lamborn 

and I have been advocating. 

Could you comment on what role you think technology might 

play and whether it is the panacea? 

Mr. BERTONI. Absolutely. You know, technology is not the panacea, but it can make everyone’s life more pleasant and result in 

more accurate and more consistent decisions. 

I think before you talk about technology, I think you really need 

to, as I always say, to follow the process, to really understand the 

weak points, the bottlenecks, the parts of the process that really do 

call for reengineering. 

Once you have done your due diligence and done that analysis, 

then you should write the system requirements that you need to 

write and build your systems around the new reengineered, more 

efficient system. And at the end of the day, you will end up with 

a more effective process. 

I think what happens so many times at Federal programs, and 

we have seen it before, is agencies will take existing manual or inefficient processes and just embalm them into the new technology. 

And what you have is new technology that are simply built around 

faulty processes and techniques. 

So that is the issue. You really need to look at reengineering the 

process, defining the system you want to use for that process, and 

building a system around it. 

Mr. HALL. Thank you. 

You highlight in your testimony how the complexity of claims is 

adding significantly to the challenges that the VA is facing in getting rid of its claims backlog and in decreasing processing times. 

In fact, VA reported that the number of cases with eight or more 

disabilities increased from 21,800 to 58,500 between the years of 

2000 and 2007. 

Given your familiarity with the VA and its team and workflow 

concept instituted under CPI, would you say that its claims processing model is equipped to or flexible enough to handle this dynamic of claims complexity given that the claims processing times 

and the backlog have worsened? 

Mr. BERTONI. I probably cannot talk specifically as to whether 

the current model would be sufficient or not. We have not done the 

drill or done the analysis on the claims processing model that we 

probably should do in the near future. 

I was just talking to someone on your staff earlier that it is probably a good time for us to go in and do a top-to-bottom review of 

the claims processing structure to get a sense of where the soft 

spots are, where the problems are and have a better sense of that. 

But in terms of the multiple impairments, I think in general, any 

time you have increasing complexity in a case, you want to make 

sure you have the most streamlined, efficient, effective process in 

place that is going to allow you to address that. 

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Complexity is not going to go away. We have an aging beneficiary cohort. We have people coming in with some very complex 

impairments, especially the OIF/OEF veterans coming in with 

some TBI and other serious brain injuries, that and many other 

body systems are going to be affected. 

So I think I do not know exactly whether the current system is 

equipped to handle those impairments. But to the extent that it is 

not, it could be problematic and we would need to go in and really 

look at that and we have not. 

Mr. HALL. Thank you, Mr. Bertoni, Mr. McGeary, Dr. McMahon. 

Thank you for your patience. Your spoken testimony was entered 

into the record as well as your written testimony. Minority Counsel 

will enter questions for the record. With our gratitude for your patience, you are now excused. 

I have votes once again on the floor, so I am going to run across 

the street and come back. And this hearing will be in recess until 

then. 

[No questions were submitted.] 

[Recess.] 

Mr. HALL. The Subcommittee is reconvened and is called to 

order. Thank you again for your patience. Welcome to our second 

panel, Richard Cohen, Executive Director of the National Organization of Veterans’ Advocates, Inc. (NOVA); Ronald Abrams, the Joint 

Executive Director, National Veterans Legal Services Program 

(NVLSP); J. David Cox, National Secretary-Treasurer, the American Federation of Government Employees (AFGE); and Gordon 

Erspamer; is that correct? 

Mr. ERSPAMER. Erspamer. 

Mr. HALL. Erspamer, thank you, Claims Attorney from California. 

Your full statements, as usual, are entered in the record and you 

will each be recognized for 5 minutes starting with Mr. Cohen. 

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

INC.; RONALD B. ABRAMS, JOINT EXECUTIVE DIRECTOR, NATIONAL VETERANS LEGAL SERVICES PROGRAM; J. DAVID 

COX, R.N., NATIONAL SECRETARY-TREASURER, AMERICAN 

FEDERATION OF GOVERNMENT EMPLOYEES, AFL–CIO; AND 

GORDON P. ERSPAMER, SENIOR COUNSEL, MORRISON AND 

FOERSTER, WALNUT CREEK, CA 

STATEMENT OF RICHARD PAUL COHEN 

Mr. COHEN. Thank you, Chairman Hall and Members of the 

Committee. 

I will not belabor what we all know about the VA’s shortcomings 

in claims processing except to say that this Committee needs to 

keep in mind the devastating effects on real people because we are 

not really talking about inventory and we are not talking about 

production standards. We are talking about veterans and their 

families, veterans who die without their benefits or live impoverished, lose their homes or their vehicles. 

Now that we are at war in two theaters, we know that there is 

a flood of injured veterans who are going to be turning to the VA 

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for the benefits they deserve and now almost 7 years after the 

Claims Processing Task Force report in October 2001, we still have 

an unconscionable backlog of over more than a half a million 

claims, with decision delays of greater than 3 years and in many 

cases greater than 5 years. 

The main reason for this is VA funding which is too low leading 

to inadequate staffing and inadequate training. It is time that we, 

as a country, recognize that the VA’s funding is a cost of war and 

we need to adequately fund the VA so they have adequate staff and 

adequate training. 

We were told how complex the system is. It is a complex system, 

but the VA training has been less than 10 or about 10 hours a 

year. Their raters consistently demonstrate lack of knowledge and 

training. They have a staff of about 14,000 who are handling 1.4 

million claims and these people still do not know how to apply the 

VA law when it applies to presumptions, and when it applies to the 

benefit of the doubt. 

The VA is proud to tell you about an accuracy rate of over 80 

percent. I am here to tell you that is an internal number which has 

no reality in the real world and if you look at the numbers of the 

BVA decisions, the number of reversals and remands, because the 

case was not adequately developed or was decided wrongly, you 

will see that the accuracy rate is below 20 percent. 

This accuracy rate is more than just an academic exercise. It directly leads to more appeals which leads to more backlogs. If the 

VA could decide the cases correctly the first time, it would not have 

the cases coming back and we would not have hamster-wheel justice that everyone is talking about. 

Instead of fixating on delays and on accuracy, the VA has decided to institute their extraordinary award rule, in 2007, which 

puts a chilling effect upon raters who now know that, if they state 

that the veteran was incorrectly denied benefits for a long time, 

that claim will be reviewed in a Central Office in Washington, D.C. 

Not only does it put a chilling effect on the raters causing them 

not to make the right decision, but it in effect punishes veterans 

who are finally able to convince raters, with further review and 

after further delays, that the decision was wrong initially and they 

are entitled to more money. 

This is a big mistake by the VA. This rule has resulted in, apparently, at least 500 claims in a 4-month period of 2007 being reviewed. 

The production standards are improper. There is no way that 

someone can make three to five decisions each day. It takes longer 

than that to review the file and to make a proper decision. And the 

raters have said in a survey that they cannot keep up with those 

production standards. 

In addition, the VA has maliciously refused to adjudicate Agent 

Orange claims of Blue Water vets that the Haas decision said veterans were entitled to. There is also a movement afoot, that members of NOVA have been seeing to deny PTSD benefits to combat 

vets. 

Finally, the Veterans Claims Assistance Act (VCAA) is a mistake 

as applied. Congress needs to tell the VA that they should give 

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claim-specific information to the veterans so they can know how to 

handle their case. 

Thank you. 

[The prepared statement of Mr. Cohen appears on p. 73.] 

Mr. HALL. Thank you, Mr. Cohen. 

Mr. Abrams, you are now recognized for 5 minutes. 

STATEMENT OF RONALD B. ABRAMS 

Mr. ABRAMS. Thank you, Mr. Chairman, Councils. 

I have several things to say and it is always enjoyable for me to 

talk about the VA claims process. 

In 1987 as a VA employee, I was asked to testify, and I recommend to the Committee that you get a copy of serial number 

100–4 where they analyzed pretty much what you are analyzing 

today and you will see many of the same comments talking about 

what is wrong with the VA system. That is about 21 years ago. 

Unfortunately, not much has changed. The VA obviously needs 

more and better people to adjudicate claims. The system is complicated and they could use people who get paid at a higher rate 

if they are accountable for their work. 

And, of course, unless work is measured rationally and people 

are evaluated based on a system that considers the needs of veterans and not the bureaucracy, things will not change. I say that 

again. You can go to a paperless system. You can introduce doctors 

to give medical opinions. But if the workers in the VA system are 

going to be promoted and given bonuses on productivity by moving 

a claims file from desk A to desk B, because that is how they internally measure, you are not going to make major changes in this 

system. 

Please encourage the VA to measure work from the point of view 

of the claimant, not the bureaucracy. As part of my job in the VA, 

I worked in and was in charge of quality. And one of the things 

that we learned how to do was to look at it from the point of view 

of the claimant. The claimant just gets letters from the VA. 

Have any of you ever looked at a statement of the case? There 

is usually about 8 pages to 14 pages of complete boiler-plate. Some 

statutes and regulations that are quoted are relevant. Others are 

not. Then there is a short paragraph as to why the claim was denied. 

VCAA letters, as Richard said, are not claim specific. They are 

just generalized. They give no real help to veterans. We need to fix 

that. 

In order to test this system, NVLSP took on a few test cases, 

hard cases, cases where medical opinions were necessary, where 

lay evidence was necessary. We made two basic assumptions, that 

working with the VA was not worth our time and that we knew 

the system as well as they did and we would go out and get all the 

evidence necessary. We would get the doctors to evaluate the claimants based on our knowledge of the rating schedule. 

It took us about 8 months to get all that evidence. It took the 

VA 1 week to grant benefits at the hundred-percent rate. I say that 

to you because it is not important to veterans how quickly the VA 

makes the initial rating or decision. It is important in the overall 

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scheme how quickly they come to a fair conclusion in the claim. 

That is the key measure. 

The VA adjudication system is rife with premature denials based 

on inadequate development, and failures to recognize important 

issues. All of that is driven by the need for production. This is not 

just based on my time working for the VA, which I did for many 

years. It is based on over 40 recent quality reviews conducted for 

the American Legion. All of these reviews are available to you. I 

know that Mr. Smithson of the Legion is testifying in the next 

panel. 

As far as doctors being available, it is a good thing if doctors are 

available to give medical advice to raters, but we certainly would 

not be happy if they were voting on their own medical opinions. 

Also, all of those opinions should be in writing and freely available to the veteran so that he or she could obtain evidence to rebut 

them because we have found in our experience that you can rebut 

very effectively VA medical opinions. Why? Garbage in, garbage 

out. The VA, in many cases, does not ask the right questions to its 

doctors and based on that, they get misleading medical opinions. 

If I had more time, I would go into that in detail. Possibly you 

will want to ask me about that. 

Thank you very much, and I will be happy to take any questions. 

[The prepared statement of Mr. Abrams appears on p. 76.] 

Mr. HALL. Thank you, Mr. Abrams. 

Mr. Cox, you are now recognized. 

STATEMENT OF J. DAVID COX, R.N. 

Mr. COX. Chairman Hall, thank you for the opportunity to share 

the views of the American Federation of Government Employees on 

a very urgent matter of the growing claims backlog. 

As the sole representative of VBA employees who process these 

disability claims, AFGE knows firsthand about the hardships to 

our veterans from the backlog of 650,000 pending claims. This is 

a disservice to veterans and unacceptable to AFGE members, including the many veterans and service-connected veterans who 

work at VBA. 

We want to assist you in any way we can to address this crisis. 

The Veteran Service Representatives or VSRs and rating specialists who develop and rate cases are an extremely valuable resource 

and a source of guidance to this problem. 

I was a registered nurse at the VA for 23 years. I acquired most 

of the skills I needed from nursing school. In contrast, VBA claims 

processing skills are learned entirely on the job. No one understands better than a VBA claims processor how to fix the VBA 

claims process. 

Sadly, our input is no longer welcomed by management. At the 

national level, we are left out of groups addressing claims process 

improvement, training, performance standards, or skill certification. At the local level, management refuses to consider suggestions made by employees. These days, VBA management wants one 

thing from its workforce, make the numbers. 

AFGE and the VSOs who represent the frontline users of this 

process are the critical eyes and ears on the ground that can identify and oversee VBA reform. 

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Therefore, we urge Congress to establish a joint VSO/AFGE Advisory Committee to focus on the claims process. As long as VBA 

production standards continue to be driven by politics rather than 

methodology, all attempts to improve the claims process and employee training will be undermined. 

And very often, these standards are set by managers with little 

or no claims processing experience. As a result, critical on-the-job 

training is cut short by managers anxious to put employees back 

in the assembly line. Make no mistake, these training gaps do contribute to the backlog. We must stop rewarding Regional Office Directors for quantity above all else. Claims accuracy and effective 

training should also be a part of their performance measures. 

We concur with The Independent Budget recommendation to give 

more accountability to the Compensation and Pension Service Director for the performance of the Regional Office Directors. 

We also need a lot more accountability when it comes to implementing claims process reforms. When the claims process improvement initiative was implemented in 2002, it was supposed to provide a uniform national model for all Regional Offices. Instead, 6 

years later, we have 57 varieties in 57 different offices. 

The first step in any reform process should be a time-motion 

study of the staffing needed to process different types of claims. To 

date, VBA has made minimal attempts to gather this critical data. 

We urge you to proceed cautiously with artificial intelligence. In 

its current stage of development, it cannot begin to replace the 

ability of an experienced employee to identify and analyze all the 

relevant evidence in each veteran’s record. In contrast, a paperless 

record system is within our technological reach and long overdue. 

Centralization is no panacea for fixing the claims process. VBA 

has centralized its 57 call centers down to nine and is planning to 

centralize the fiduciary program. Yet, things are only getting 

worse. Centralization increases the distance between the veteran 

and the employees serving them. 

Veterans and taxpayers deserve a real cost benefit analysis of 

the impact of centralization on claims accuracy and timeliness and 

access for veterans. 

AFGE also supports The Independent Budget recommendation to 

complete the phase-in of VETSNET, but we urge VBA to make 

good on its promise to address glitches in VETSNET that are also 

slowing down the claims processing such as requiring employees to 

input the same veteran information multiple times. Employees 

should be able to submit reports of VETSNET’s problems and other 

insights about the claims process to an online suggestion box that 

is taken seriously by management. 

Finally, AFGE is concerned that the claims process improvement 

pendulum has swung too far turning the claims process into an assembly line. There are many benefits when employees work the entire claim from the application to the appeal, including eliminating 

the extra time required for another employee to have to relearn the 

same claim. 

Our members really feel the loss of weekly case management 

meetings that used to give them the opportunity to discuss challenging claims, changes in the laws, and best practices. 

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We look forward to working with Chairman Hall and the other 

Members of the Committee to improve this process and to serve 

American veterans. 

[The prepared statement of Mr. Cox appears on p. 80.] 

Mr. HALL. Thank you, Mr. Cox. 

Mr. Erspamer. 

STATEMENT OF GORDON P. ERSPAMER 

Mr. ERSPAMER. Thank you, Chairman Hall. I really appreciate 

the opportunity to be here today to deliver what I think is probably 

somewhat of a unique perspective amongst all the panelists you are 

going to hear from. 

I want to attack this problem, and I will accept Mr. Abrams’ 

framing of the definition, that of the basic fairness of procedures, 

from a different standpoint. 

I pose the question, what do you suppose is the most institutionalized form of discrimination in statutes and regulations today? 

I would suggest to you that it is our veterans in that suspect classification because veterans are the victims of the most institutionalized versions of discrimination. 

What do I mean by that? I am referring to basic procedural 

rights rooted in the due process clause of our Constitution. 

First of all, veterans have at the Regional Office level no right 

to a lawyer, at least no right to pay a lawyer. They have no right 

to subpoena documents. The VA has that right, but rarely uses it. 

The veteran has no right to compel the attendance of witnesses, no 

right to issue subpoenas to VA doctors, for example, who may have 

critical evidence in support of or in contravention of a claim. 

Most often, it is the case that the veteran’s treating physician is 

a VA physician. Yet, the veteran cannot call that doctor to testify 

at a hearing to support his claim. 

There is also no discovery. The veteran gets no discovery at any 

stage of the system. For example, if the veteran has been the subject of some misconduct by the VA or there is some critical evidence 

that is within the VA’s control or the control of another governmental agency, the veteran gets no discovery. 

And then when you add to it the defects that are built into the 

structure of the Court of Appeals for Veterans Claims, I think you 

have a system that does not comport with the basic requirements 

of due process. 

And with respect to the court, I will mention one thing, but there 

are a number of problems, and that is a problem that has been referred to many times by former Chief Judge Nebeker of the Court 

of Appeals for Veterans Claims, and that is the court has no power 

to force Regional Offices to obey its decisions. They violate the decisions with impunity repeatedly over and over again. 

If any of you have ever read the Myth of Sisyphus, there is a solitary figure that climbs a hill, rolls a rock up a hill only to see it 

come down again. I would liken the VA system to that because 

each veteran must roll that rock up the hill. Even if there are a 

hundred thousand other veterans with the same claim, each has to 

go the entire mile and push that rock up that hill in order to get 

a relief. 

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There have to be improvements in the procedures and that is 

why I have proposed a Veterans Bill of Rights. And I have attached 

it to my testimony and I will go through it briefly in a moment. 

But there is a second aspect to this institutional discrimination 

against veterans and one that the Committee is probably not even 

aware of, and that is the limitations on the rights of veterans to 

ever go into court. The Veterans Court is purely a paper record appeal. All other citizens of this country have the right to go into 

court and I mean the Article 3 courts, the Federal District Courts. 

And when you look at the positions the Veterans Administration 

over the years has taken in cases involving veterans, it is deplorable. They take the position, for example, in recent litigation that 

we filed, Morrison and Foerster, on behalf of veterans, that veterans have no entitlement to medical care, notwithstanding the efforts of Congress to create the 2 year statute for medical care 

under the ‘‘Dignity for Wounded Warriors Act.’’ 

According to the VA, there is no ability to enforce those rights 

at all in Federal Court because the veterans lack a property interest in the benefits, because there is no entitlement to benefits, because medical care is completely at the discretion of the VA. We 

decide what care you get, when you get it, and how you get it, and 

no one else can question us. 

Those are very, very basic problems with the system and I think 

the Congress needs to do something about this by passing legislation that says, look, veterans, you do have a basic property right 

under the Fifth amendment and the receipt of disability and death 

compensation, veterans, yes, you do have an entitlement. 

When you are a disabled veteran who has served our country and 

been wounded in Iraq or Afghanistan or heaven help us died there, 

you have a right to those benefits and you have the rights that all 

other citizens in this country, to have access to the courts and 

meaningful access at a meaningful time in a meaningful way. And 

that is the basic tenant of due process. 

And I would be happy to take questions, but I would just close 

with just an observation. There are many myths that have been 

circulating about the VA process for many, many years. I have 

been in the thick of it for a long time. I have seen it from the inside. I have seen it from the perspective of litigation against the 

Veterans Administration. And I can tell you that these are myths. 

You need to find some way to get beyond the myths and find out 

what is really happening and we need to bring the country around 

to where everyone is working for the veteran. The veterans need 

it now more than ever. 

Thank you. 

[The prepared statement of Mr. Erspamer appears on p. 83.] 

Mr. HALL. Thank you, Mr. Erspamer and to the rest of our second panel. 

First of all, I had an opportunity this morning at the breakfast 

with the Secretary of the Army and Chief of Staff and numerous 

other brass to speak with them about some of these issues and possible solutions we are talking about. And the Surgeon General and 

I were speaking about hopefully what will soon be an electronic 

handshake or handoff of information from DoD to VA. 

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Also, when I was in Landstuhl, Germany, on my way back from 

Iraq in October, I visited with our returning soldiers and also with 

the staff and the Commander who assured me that in December, 

2 months ago, we would be able to start handing off the onion, as 

he called it, that is being created of electronic records. 

We have come far from having a description of the wound written or the injury written with magic marker on the forehead of the 

soldier as he is put in the helicopter a few years ago. Now I am 

told of having an electronic record that travels from the battlefield, 

has another layer added in the helicopter, has another layer added 

at Balad describing the treatment, the medications, et cetera, in 

the plane to Germany, another layer in the hospital in Landstuhl, 

and then the entire electronic record coming back here to the 

United States to Walter Reed or Bethesda or wherever the service 

man or woman is returning to for further treatment. 

I am not under any illusion about this except for the fact that 

I am being told that this is beginning to happen. And this panel 

is not perhaps as in tune to that aspect of the solution as some of 

the other panels that we have heard from and that we will hear 

from. 

But I would start with you, Mr. Cohen. How much of a difference 

would it make in your opinion if a veteran’s claim could start with 

a report from DoD that states what they have observed and diagnosed, what the condition of the returning soldier or veteran is as 

they enter VA’s care? 

Mr. COHEN. It sounds wonderful on paper. However, the reality 

is that we are hearing horror stories of servicemembers who have 

breakdowns in Iraq, go for medical treatment, and are then told to 

sign off on a paper saying they have a preexisting personality disorder which then becomes the kernel of this onion, so to speak, and 

follows them into the VA system. 

And when they file their claim for Post Traumatic Stress Disorder and anxiety, they are told, no, this is a noncompensating preexisting medical condition which you had when you entered service 

even though it does not appear on your induction physical. There 

is some danger of that and that concerns me very much. 

Mr. HALL. Any idea what percentage of those kinds of inaccuracies or misdiagnoses we are looking at? 

Mr. COHEN. No. I do not have any numbers on that, but I have 

seen some information, which seems to indicate that there is a certain percentage of the people, maybe as high as a quarter of the 

diagnoses coming out as personality disorders even though there is 

no preexisting condition noted in an induction physical. And that 

concerns me very much about the VA then accepting diagnoses put 

in by the DoD. 

Mr. HALL. Or as Mr. Abrams put it, garbage in, garbage out. 

Mr. COHEN. Yes. 

Mr. HALL. Only done electronically. 

Mr. Erspamer, could you please describe for us with a little more 

detail your recommendation that VA scrap its paper-based system 

and develop a system that allows information to be shared between 

the VHA and VBA? 

Mr. ERSPAMER. Yeah. I think it has been covered in some of the 

other testimony. I think the VA needs to gradually move, and you 

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cannot do it in one day, but to a paperless system where all the 

claims files, all the medical information on the medical side and on 

the VBA side are all shared, where simultaneous users can share 

that file at the same time. It is all imaged on a computer, somewhere where they can all get access to a database. 

I cannot believe in today’s world that we do not have that already because the paper record system for reasons I have explained 

in my testimony just creates enormous problems. We have to tackle 

the problem and maybe we do it a year at a time. We work back 

a year at a time every year. We move back in time until we get 

them all on a computer system. And I think that is absolutely essential. 

Mr. HALL. You indicate in your testimony that you think the 

abandonment of claims could be as high as 99 percent. 

Mr. ERSPAMER. Yes. 

Mr. HALL. How did you arrive at that figure? 

Mr. ERSPAMER. Well, in the prior litigation we did, which is mentioned in my testimony, we actually got discovery from the VA on 

the claim abandonment rate. And that is the number. It is somewhat dated. It has been more than 10 years old. That was the rate 

that existed back then. And so I am using that as a basis for going 

forward. And whether it is 90 percent, 95 percent, or 99 percent, 

it is way too high. 

The bottom line is a lot of those claims that are abandoned are 

valid claims and they only get abandoned because the veteran does 

not have a lawyer and he gets very frustrated in trying to deal 

with a very complicated system that is totally baffling. 

Mr. HALL. How many claims were you talking about at that 

point? 

Mr. ERSPAMER. I do not remember the exact number at that 

time. But it would probably be, I would guess, would be around 

half of what it is today in terms of total number of claims. 

The big thing you need to understand is that the problems and 

the most important issue is the Regional Office level because most 

claims never get beyond the Regional Office level. They do not get 

to the appellate stage. The claims are abandoned for one reason or 

another at the Regional Office level and they die there. 

And what I am suggesting to you is they do not die because the 

claims are bad or they are invalid. They die because lack of access 

to counsel and because of the individual veterans get frustrated 

and give up. And I know that to be the case. I have seen many examples of it in my own experience. 

Mr. HALL. Thank you. 

Mr. Cox, it seems that the main flaw with the CPI model of 

claims processing is the lack of accountability. You highlight this 

problem in your testimony on pages three and four when you say 

that VBA is not held accountable for the quality and consistency 

of training at each RO nor the quality or accuracy of its completed 

work. 

Could you elaborate on that statement? 

Mr. COX. Yes, sir. VBA is very numbers driven. Every day, it is 

produce your numbers. You have to get out the number of claims. 

There is the performance standards, those type things. 

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We do not believe that there is the focus on the quality of work. 

I have heard other people give testimony today about the number 

of claims someone is expected to produce versus the quality of the 

work product that they produce in the end. 

And each Regional Office again has different processes with 

training. You need people to do the work, so you cut the training 

program short. We need you back on your job. We cannot let you 

go for training today to give people the necessary skills. 

And, again, the big issue with people that do the work in VBA, 

they do not come with ready set skills for those jobs. They come 

with skills, but it is all on-the-job learning. Doctors, nurses, lawyers, whoever, come with skills by basic education to do that type 

work. But in VBA, it is all on-the-job learning. Hire someone to 

work in VBA today, they are going to be seasoned and ready to 

produce work at a good level maybe 2 to 3 years from now. 

Mr. HALL. Thank you. 

And would you please enlighten us more about the current use 

of IT in claims processing at VBA? For instance, the RBA2000, 

BDN, VETSNET, how do these systems work together? What limitations or benefits do they pose for VBA employees? 

Mr. COX. In my discussions with the employees who work at 

VBA, the way these programs work and the boxes come open on 

the computer. And, you know, I am not a computer guru, sir. But 

the boxes come open or they enter information. It does not automatically update and populate the other fields in the system. If 

they are entering data into one box, then when the next box comes 

up, they have to enter the same data again. 

And the way work flows in the development of claims and reviewing the claims that, again, they have to come all the way out 

of one area to go into another area where if the system was more 

integrated, they could immediately move from one spot to the 

other. 

Mr. HALL. So the lack of integration for development and adjudication of claims is part of the problem? 

Mr. COX. Yes, sir. 

Mr. HALL. Could you further explain why you think the VA’s current IT artificial intelligence efforts to move to a paperless environment are not the silver bullet for fixing the claims processing system and how long do you think those plans will take to impact 

claims processing in the short term and the long term? What do 

you think the effect will be? Is the current system capable of accepting artificial intelligence (AI) improvements without other process improvements? 

Mr. COX. Again, I think there are things that you can do that 

would improve the processing of claims with the information technology. You can never replace the human element and how the 

claims are reviewed and understanding the data and those type 

things. 

AFGE supports the paperless record. In VHA where I worked for 

many years, while we are the world leader in the paperless record 

and the electronic record and to be able to have that in VBA, these 

claims examiners would not be constantly sitting down now writing 

a letter to someone chasing down this record or that record. It 

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could all be there electronically very quickly. But I think you cannot develop a system that will take away the human element, sir. 

Mr. HALL. Thank you. 

Mr. Abrams, you commented on the obtuseness or the obscurity 

of VCAA letters to veterans and how unhelpful they are or how difficult they are for the lay person to understand. 

Mr. ABRAMS. Yes. 

Mr. HALL. Do you have more specific suggestions or—— 

Mr. ABRAMS. Well, we would like them to be claim specific. One 

of the problems is a veteran might file enough evidence to clearly 

prove one of the three elements of service connection and what he 

really needs to submit is evidence on element three, but he has got 

one and two at least started. 

The VA letter will not really get into that. He will go out and 

he will go and repeat and spend his money and his time in some 

cases trying to reprove something that should have been conceded. 

Part of that is the way the VA has set up how its Regional Offices work. They have divided these groups of adjudicators into 

teams and the people who are making the final decision are not the 

people who are developing the claim. So the people developing the 

claim are leery of conceding certain factual predicates. 

That also impacts on examinations. Too many times we have 

seen a VA examination go to a doctor for PTSD where the veteran 

has a Combat Infantryman’s Badge and the doctor looks at it and 

is not told to concede the fact that the veteran was in combat and 

that if he alleges a stressor linked to combat to concede that the 

stressor occurred. 

So the doctor looks at the records and goes I do not see any 

stressor. I cannot diagnose PTSD. So the vet is told you do not 

have PTSD. And he spends his money to go to a private doctor to 

diagnose PTSD when really the issue was stressor and the VA 

made an error in not telling the doctor to concede the fact that he 

was exposed to combat and suffered a stressor. 

These are the kind of things that need to be fixed. But, again, 

I stress unless you change the work measurement system, all of 

these are minor cures. The major cure is to get the VA to do it 

right in the first instance. 

Mr. HALL. Thank you. 

We, my office, had a 60-year-old claim, 84-year-old veteran, 

Navy, World War II, who had been misdiagnosed for 60 years. Just 

a couple months ago we got him a PTSD rating of 100 percent, 

which he deserved all along after having two ships blown out from 

under him in the Pacific. 

Mr. ABRAMS. Mazeltov. 

Mr. HALL. Well, thank you. But, you know, I am glad he lived 

to see it. 

I want to thank you. You have all been very helpful and very patient. 

And starting with Mr. Cohen and then anybody else who wants 

to comment on this last question, would you elaborate on what you 

mean when you say VA should focus more on accuracy and not 

speed? 

It seems to be a theme that has been mentioned by all of our witnesses in processing claims. Since the VA denies that this is the 

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basis for determining production standards, speed that is, describe 

how VA should change this result and focus on quality, not quantity. 

Mr. COHEN. Well, the OIG report, which interviewed people who 

were involved in ratings leaves us with the conclusion that, in fact, 

speed is the criteria that people who work for the VA live or die 

by in terms of their awards and their bonuses. 

Now, at the same time, that same evaluation by OIG revealed 

that 50 percent of the people who were doing the ratings said the 

speed criteria prohibits them from adequately developing the claim 

before they decide it and from deciding it correctly. 

We know that in order to decide a claim correctly, you have to 

decide whether this particular claim should be service connected, 

whether the impairment should be service connected, the proper 

rating, and the proper effective date. All these things are decisions 

that have to be made right. If they are not made right in the beginning, what we end up with is the 190 days in the Regional Office 

system and then you get a denial. And then 90 percent of them are 

abandoned. 

I know that is true because in the 15 years that I have been representing veterans, I have yet to find a case where a veteran came 

to me with a claim that had not already been filed and abandoned. 

So at the time they are ready to go into court, they may have 

filed this claim twice or three times and abandoned it each time 

after they got their initial denial. 

But when someone continues on it, then they are facing another 

2 years in the Board of Veterans Appeals and it probably, because 

it was not developed properly, will come back again to haunt the 

VA and increase their backlog. 

If they took the time to develop it properly and to decide it properly, then they would not face the same claim again. But this requires adequate training because this is a complex area of the law. 

And our experience shows that the people who are doing the ratings do not have an adequate understanding of the rules and regulation they are supposed to rate it under. They are not keeping up 

with the court decisions. So they are not really able to effectively 

and accurately decide a claim. 

Mr. ERSPAMER. May I just add one more point to that, Mr. Chairman? Back in the 1980s when I was doing the Norris case and taking discovery in that case, which went to the United States Supreme Court, the issue of incentive compensation system in the VA 

was a central issue in that case. It is the same system today. Some 

bells and whistles have been changed, but it is fundamentally the 

same system. 

The problem is if you create a financial incentive with the adjudicators that conflicts with doing the case right, that is a system 

that is bound to fail. You cannot pit the financial interest of the 

rater or the adjudicator against the interest of the veteran. 

It is a system that is flawed in the inception and it has never 

been changed. It needs to be changed. And I think that is one thing 

all of the people on this panel probably agree with. That system 

has severe problems and they have been endemic for many, many 

years. No one has ever paid any attention to it. 

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You know, there were two attorneys at the BVA who were indicted for doctoring and removing records from claim files in order 

to create an immediate basis for a remand decision, a quick remand decision about 10 years ago that involved thousands of 

claims. 

And that illustrates the depth of the problem and it is still there 

even though there have not been any recent indictments. The problems are still there. 

Mr. HALL. Mr. Cox, would you care to add anything to that? 

Mr. ABRAMS. I do, too. 

Mr. COX. I think I would add to it from the medical perspective. 

Who would you want to do your cardiac bypass, the physician who 

can turn out the most and make the most money in the day or the 

one that can turn out your surgery with the best outcome and with 

the least complications and the best survival rate? 

And I agree with my colleagues. Do the claim properly first out, 

get it right, get that veteran what they deserve, so that they do 

have that good life thereafter and are taken care of. 

Mr. HALL. Thank you. 

Mr. Abrams, last word. 

Mr. ABRAMS. Well, I want to answer you with a story. We had 

a case where a veteran filed a claim for a bilateral leg condition. 

The VA did not have his service medical records. But in its eagerness to adjudicate the claim, the VA wrote him a letter and asked 

for continuity of symptomatology. The veteran did not answer within 60 days and his claim was denied and it went away. 

I was working for the VA at the time. I picked the case up on 

quality review. After the claim had been put back in the file bank, 

the veteran’s service records came in. They showed that the veteran lost both his legs due to machine gun fire. I called the veteran. I said why did you not submit evidence. And he said how can 

I prove continuity of symptomatology when I do not have my legs 

anymore. The man was entitled in today’s dollars to over $3,000 a month. 

Now, we quickly fixed it and got him his money, but that was simply the Regional Office trying to do something quickly to get work 

credit and it impacts—— 

Mr. HALL. Mazeltov. 

Mr. ABRAMS. Thank you. 

But I want to read you what I wrote in 1987 talking about 

Gordie Erspamer and his lawsuit. I was working for the VA at the 

time. I was their legal advisor. And I said if Mr. Erspamer can 

show that our system pits the financial interest of adjudication officers, which today are service center managers, against the fair and 

reasonable treatment of our claimants, he would well be on his way 

to proving the VA does have an unfair, adversarial claims adjudication system. 

It is clear that the people in this panel all say that there is too 

much emphasis on productivity, not on quality. And in our solutions, we have to be reasonable. The VA needs more people to do 

this. But if they are going to get the people, let us make them accountable for doing the claims correctly at first. 

Independent quality review, a different work measurement system, and all the other improvements will help. And that will 

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change this system. The VA will have to be brought kicking and 

screaming into this, but it will work. 

Mr. HALL. Minority Counsel has a couple of questions. 

Mr. LAWRENCE. Thank you, Mr. Chairman. 

On behalf of the Ranking Member, Mr. Erspamer. 

Mr. ERSPAMER. Yes. 

Mr. LAWRENCE. You stated that 99 percent of the claims at the 

Regional Office are abandoned. Could you elaborate on where you 

arrived at those numbers? Do you mean that if a claim is denied 

and somebody does not appeal the decision, is that what you consider an abandoned claim? 

Mr. ERSPAMER. It would include that circumstance. And I think 

I explained this in part in my first answer, but I think Mr. Cohen, 

I believe, gave a further explanation. 

Most claims, the veteran starts out representing himself, files a 

claim, gets a denial decision. If he does not appeal within a certain 

period of time, it lapses and that claim is deemed abandoned. 

Most often, veterans try a second time at the Regional Office or 

a third time or a fourth time or a fifth time. Eventually they may 

try to get some help somewhere along that process. 

And with each abandonment, the effective date, he loses the effective date unless he can show CUE, clear and unmistakable 

error. So the problem is you get the same claim over and over and 

over again. The veteran often abandons it. 

And the statistics I gave you, the 99 percent as I indicated earlier, came from discovery in the Norris litigation. And that is a 

dated figure, but it is probably roughly what it is today. I do not 

know any reason why it would change. 

But if you look at the number of claims filed, you will see that 

the same veteran files a claim over and over and over and over 

again. It is not efficient for the system either. 

Mr. LAWRENCE. Well, let me ask this. 

Mr. ERSPAMER. Yeah. 

Mr. LAWRENCE. If somebody opens a claim for, say myopia, that 

is not service connectable by statute and they do not appeal that 

decision that would then be considered an abandoned claim by the 

standard that you apply? 

Mr. ERSPAMER. Well, no. The standard I would apply assumes 

that we do not really know whether a particular claim is abandoned because it is a bad claim or it is a good claim, where the veteran does not have a lawyer or whatever. We do not know the answer to that question. 

Some abandoned claims are abandoned because perhaps the veteran thinks it is not a very good claim. I do not start from the 

proposition of assuming that veterans file false claims or invalid 

claims. There probably are a few of them. 

But, yes, in that 99 percent, probably are some claims that are 

abandoned because they are without merit. I would agree with that 

part of your assumption in your question. 

But I can tell you very many times from having studied many 

claim files in litigation that many abandonments are abandonments of valid claims and they are abandoned because a veteran 

does not know what to do. He does not know how to appeal or he 

lets the time run. That is a very common occurrence. 

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And if you looked at the appeal dispositions, you will see that 

many dispositions on appeal are by summary dispositions because 

the veteran has not complied with the statutory time requirement. 

It is just too bad because a lot of deserving veterans lose out. 

Mr. LAWRENCE. Thank you, sir. 

I will be interested in the VA’s response, what their take on that 

is. 

And for, Mr. Cohen, you said the VA’s accuracy rate is 80 percent, that it is actually more like 20 percent. And could you elaborate more on how you arrived at that? 

Mr. COHEN. Yes. If you look at the report of the chairman of the 

Board of Veterans Appeals and you look at the number of merit decisions where the Board decides either that they are reversing the 

decision of the Regional Office or that the claim was inadequately 

developed and sent back for redevelopment and you calculate out 

adding those two together, you will find out that it is over 80 percent of the claims either have to be sent back because the Regional 

Office did not do its job, made a rating without an adequate record, 

or outright denied it improperly. 

A lot of the cases that we see that get reversed by the Board involve things like presumptions, benefit of the doubt, and my own 

personal favorite is lack of clear evidence of aggravation. The VA 

is very fond of saying, well, you had a condition before you came 

into service and it should not be service connected because the 

change in your condition was not aggravated by service. 

The burden is on the VA to show it was not clearly aggravated 

by service and what we usually have is we usually have the veteran’s doctor saying I believe that it was aggravated by service, the 

VA doctor saying, oh, it was not aggravated by service. So you have 

one piece of evidence on one side, one piece of evidence on the other 

side. Obviously you cannot make a decision which way it goes. 

The standard should say there is no clear evidence of lack of aggravation and the veteran wins. That is not the way the Regional 

Office does it. Frequently the Board will have to correct them on 

that. 

Mr. LAWRENCE. All right, sir. Thank you. 

Thank you, Mr. Chairman. 

Mr. HALL. Thank you. 

Thank you to our panel. You have been most helpful and we will 

do our best to take all the information we are gathering and make 

some progress on these very important issues. You are now excused. 

And we would ask our third panel to come join us at the table, 

the witness table, Adrian Atizado; Assistant National Legislative 

Director of Disabled American Veterans (DAV); Paul Sullivan, the 

Executive Director, Veterans for Common Sense (VCS); Steve 

Smithson, Deputy Director of Veterans Affairs and Rehabilitation 

Commission, the American Legion; Gerald Manar, Deputy Director, 

National Veterans Service, the Veterans of Foreign Wars of the 

United States (VFW); and John Roberts, National Service Director 

of the Wounded Warrior Project (WWP). 

Thank you, gentlemen, for your patience as well. As usual, your 

full written statements are entered in the record. And you will each 

be recognized for 5 minutes starting with Mr. Atizado. 

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STATEMENTS OF ADRIAN ATIZADO, ASSISTANT NATIONAL 

LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; 

PAUL SULLIVAN, EXECUTIVE DIRECTOR, VETERANS FOR 

COMMON SENSE; STEVE SMITHSON, DEPUTY DIRECTOR, 

VETERANS AFFAIRS AND REHABILITATION COMMISSION, 

AMERICAN LEGION; GERALD T. MANAR, DEPUTY DIRECTOR, 

NATIONAL VETERANS SERVICE, VETERANS OF FOREIGN 

WARS OF THE UNITED STATES; AND JOHN ROBERTS, NATIONAL SERVICE DIRECTOR, WOUNDED WARRIOR PROJECT 

STATEMENT OF ADRIAN ATIZADO 

Mr. ATIZADO. Thank you, Mr. Chairman. 

Mr. Chairman, Members of the Subcommittee, I am pleased to 

have this opportunity to appear before you on behalf of the DAV 

to address the Department of Veterans Affairs disability claims 

backlog and claims processing system. 

Mr. Chairman, it is evident that the claims backlog is growing 

and it is doing so successively each year. The complexity of the 

workload has grown as veterans are claiming greater numbers of 

disabilities and the nature of such disabilities are ever more sophisticated. 

At the current rate, we can reasonably expect VA’s caseload to 

pass 1 million claims at the current rate. However, if the most recent trend in increased staffing is sustained and recommendations 

that the DAV and The Independent Budget are utilized in conjunction, we believe VA can gain control of the growing claims backlog. 

In addition to the mismatch of VBA staffing and workload, the 

DAV has maintained and has been confirmed, as mentioned in previous panels, by the VA’s Office of Inspector General’s survey that 

VA should invest more in training its adjudicators and that such 

training should have a higher priority. 

The DAV has consistently stated that quality is the key to timeliness. Higher quality has a multiplier effect that reduces duplicative 

work and stems the flow of additional claims to an already overburdened system. 

With additional tools through training, the DAV also believes VA 

should hold its adjudicators accountable for higher standards of accuracy. In fact, the VA acknowledged in 2000 that management 

needed tools to monitor individual performance. This led to the 

Systematic Individual Performance Assessment or SIPA Program. 

Unfortunately, due to inadequate resources, the VA abandoned 

this initiative in 2002 and proficiency is now apparently subjectively assessed by supervisors based on their day-to-day perceptions of employee performance. 

We submit to you, Mr. Chairman, that without any standard 

quality assurance review on the individual level, we do not believe 

optimum quality can be expected nor achieved. 

DAV believes various oversight and policy changes should be concurrently implemented to reduce VA’s claims backlog while also improving services to VA’s clientele. 

For example, numerous developmental procedures in the VA’s 

claims process collectively add to the enormous backlog of cases. 

However, some of those developmental procedures are arbitrarily 

abused causing overdevelopment of a pending claim. 

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Specifically the VA consistently refuses to render decisions in 

cases where the claimant has submitted a private medical examination and opinion until such time as VA has had its own medical 

examination and opinion obtained. We believe such egregious behavior should be curbed, Mr. Chairman. 

In light of the known hardships of prosecuting claims based on 

combat injuries and the type of warfare currently waged in Iraq 

and Afghanistan, the DAV believes Congress should also amend 

section 1154(b) of Title 38. This would clarify what type of military 

service would be treated as having engaged in combat. 

The DAV urges Congress to consider defining a veteran when engaged in combat as one who during active service served in a combat zone for purposes of section 112 of the Internal Revenue Code 

of 1986 or predecessor provision of law. 

Mr. Chairman, this concludes my oral testimony. We hope the 

Subcommittee will review these recommendations and those in my 

written testimony for inclusion in your legislative plans. 

Again, thank you for the opportunity, and I would be happy to 

answer questions you may have. 

[The prepared statement of Mr. Atizado appears on p. 89.] 

Mr. HALL. Thank you, sir. 

We will now recognize Mr. Sullivan for 5 minutes. 

STATEMENT OF PAUL SULLIVAN 

Mr. SULLIVAN. I would like to thank Chairman Hall and Members of the Subcommittee for inviting Veterans for Common Sense 

to offer solutions on eliminating the enormous backlog of 650,000 

claims at VA Regional Offices. 

First, as a friend and former aide to the late Congressman Tom 

Lantos, I just wanted to recognize his great service on behalf of 

veterans, civil liberties, and human rights. I am sad to see him 

have passed away. 

In addition, since today is Valentine’s Day and it is hospitalized 

veterans day, I would hope we would also keep hospitalized veterans in our thoughts today. 

VCS wants to start off by thanking the VBA Regional Office employees who are here in this hearing room. Veterans for Common 

Sense wants to help the VBA employees help our veterans. 

Now, regarding VBA’s massive claims backlog, a failure to address this claims catastrophe has needlessly increased suffering 

among our returning veterans. 

According to published government and news reports, the number of broken homes, unemployed veterans, drug and alcohol abuse, 

homelessness, and even suicide are all rising, problems that are expected to worsen unless VBA resolves the claims backlog. 

VCS believes we must focus on two priorities. The first is veterans must come first and the second is veterans’ claims must be 

decided accurately within 30 days. 

There are two ways to bring reform to VA. The first is an overhaul approach in the long term and the second is an incremental 

approach in the short term. There have been lots of incremental 

approaches, a lot of them great ones suggested here. 

VCS supports the Veterans’ Disability Benefits Commission report. We also support the recommendations by Harvard Professor 

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Linda Bilmes, the recommendations made by Gordon Erspamer 

from Morrison and Foerster, the veterans groups, AFGE, NOVA, 

and the NVLSP. Now, those are all long-term solutions. 

Now, in the short term, there are two quick things that Congress 

can do. One would be to pass a law that would simplify and expedite claims processing at Regional Offices. This would allow VA 

employees to automatically approve claims for TBI and PTSD. This 

means fewer errors and faster benefits for the hundreds of thousands of veterans expected to file TBI and PTSD claims after serving in Iraq and Afghanistan. 

This change is needed because the military does not document all 

bomb blasts and all combat events, thus making it hard for VA to 

verify and to process TBI and PTSD claims. 

Our proposal would establish that a deployment to the war zones 

means VBA concedes there was a concussive blast or psychological 

stressor sufficient to cause the TBI or PTSD. 

Another short-term solution for VBA is enforcing accountability. 

Almost everyone up here has mentioned accountability. 

In 2001, the current Under Secretary for Benefits was fully informed about all of VBA’s vast problems while leading the Claims 

Processing Task Force. While in office, he should have planned for 

expanding VBA when the President started the Afghanistan and 

Iraq wars. 

He should have been aware of briefings given by me to some of 

his top aides about the claims crisis exacerbated by a flood of 

claims from veterans. This serious problem of Iraq and Afghanistan 

war veterans was first reported on the front page of the Wall 

Street Journal in 2003. 

VCS believes that Congress should hold the entire Administration, VBA, VA, Office of Management and Budget (OMB), and the 

White House accountable for systemic leadership failures to assist 

our disabled veterans. If we change the laws, but we do not change 

the leadership that is failing to implement the laws, we are still 

going to be crashing VA over and over again. 

For these reasons, VCS believes that the current Under Secretary for Benefits should step down and be replaced with a nonpartisan career official loyal to veterans, not the White House and 

not the OMB. 

In conclusion, Veterans for Common Sense believes VA, VBA, 

congressional leaders, and others should work closely with VBA 

employees, academics, VSOs, and advocates to find common-sense 

solutions. The first, of course, is to change the law for presumptions of PTSD and TBI. 

To finish, as General Omar Bradley said, we are dealing with 

veterans, not procedures, with their problems, not ours. VCS asks 

if Congress cannot fix this problem, then who will? 

Thank you, Mr. Chairman. I will be glad to answer any questions. 

[The prepared statement of Mr. Sullivan appears on p. 94.] 

Mr. HALL. Thank you, Mr. Sullivan. 

Mr. Smithson, you are now recognized. 

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STATEMENT OF STEVE SMITHSON 

Mr. SMITHSON. Good afternoon, Mr. Chairman. Thank you for 

this opportunity to present the American Legion’s views on the VA 

claims backlog and the claims processing system. 

As of February 9th, 2008, there were more than 657,000 total 

claims pending in the Veterans Benefits Administration, more than 

402,000 of which were rating cases. There has been a steady increase in VA’s pending claim backlog since the end of fiscal year 

2004 when there were more than 320,000 rating cases pending. 

The majority of the claims processed by the VBA’s 57 Regional 

Offices involve multiple issues that are legally and medically complex and time consuming to adjudicate. Providing quality decisions 

in a timely manner has been and will continue to be one of the 

VA’s most difficult challenges. 

Inadequate staffing levels, inadequate continuing education, and 

pressure to make quick decisions resulting in an overall decrease 

in quality work has been a consistent complaint among Regional 

Office employees interviewed by American Legion staff during Regional Office quality checks. 

It is an extreme disservice to veterans, not to mention unrealistic 

to expect VA to continue to process an ever-increasing workload 

while maintaining quality and timeliness with the current staff levels. 

Despite the recent hiring initiatives, Regional Offices will clearly 

need more personnel given current and projected future workload 

demands. 

Since 1996, the American Legion, in conjunction with the National Veterans Legal Services Program, has conducted quality review site visits at more than 40 Regional Offices with the purposes 

of assessing overall operation. 

Our quality review team visits a Regional Office for 1 week and 

conducts informal interviews with both VA and Veteran Service Organization staff. The team also reviews a random sample of approximately 30 to 40 recently adjudicated American Legion represented claims. We find errors in approximately 20 to 30 percent 

of the cases we have reviewed. 

The most common errors include inadequate claim development 

leading to premature adjudication of claim, failure to consider reasonably inferred claims based on evidence of record, ratings based 

on inadequate VA examinations, and under-evaluation of disability, 

especially mental conditions. 

In our opinion, these errors are a direct reflection of VA’s emphasis of quantity over quality of work and validate our concern that 

emphasis on production continues to be a driving force in most VA 

Regional Offices, often taking priority over such things as training 

and quality assurance. This frequently results in premature adjudications, improper denials of benefits, and inconsistent decisions. 

Unfortunately, VA’s end product work measurement system as 

discussed in detail in my written statement creates a built-in incentive to take shortcuts so that the work credit can be taken. This 

system in effect rewards Regional Offices for the gross amount of 

work they report, not whether the work is done accurately or correctly, often resulting in many claims being prematurely denied. 

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Last, I would like to direct your attention to some nonlegislative 

remedies VA could use to help address its current unmanageable 

backlog. Several recommendations are discussed in detail in my 

written statement. 

In closing, the best way to help veteran claimants is to fix the 

entire VA claims adjudication system. Piecemeal solutions do not 

work and should be avoided. The VA work measurement system 

should be changed so that VA Regional Offices are rewarded for 

good work and suffer a penalty when consistent bad decisions are 

made. 

Managers, rating specialists, and Board of Veterans’ Appeals 

(BVA) law judges and attorneys should be awarded for prompt, 

careful work and they should also be held accountable when they 

make bad decisions. American veterans seeking VA disability benefits deserve better treatment than what they are currently getting 

from VA. 

Mr. Chairman, that concludes my statement. I would be happy 

to answer any questions you may have. 

[The prepared statement of Mr. Smithson appears on p. 96.] 

Mr. HALL. Thank you, Mr. Smithson. 

And, Mr. Manar, is that the correct pronunciation of your name? 

Mr. MANAR. That’s correct. Thank you. 

STATEMENT OF GERALD T. MANAR 

Mr. MANAR. Chairman Hall, thank you for this opportunity to 

present the views of the 2.4 million veterans and auxiliaries of the 

Veterans of Foreign Wars of the United States on the VA claims 

processing system. 

My written testimony discusses at length many events over the 

last 30 years which have changed the world in which claims are 

adjudicated. Annual legislation, staffing limitations, implementing 

and modifying regulations, changes in leadership, mismanagement, 

failed oversight, and court decisions are just a few of the reasons 

why the backlog at VA stands perilously close to 900,000 compensation, education, and appeal cases. 

We hope that you consider our testimony as you ponder what, if 

anything, you can do or should do in the coming weeks and months 

to help the VA better serve veterans. 

This hearing today focuses on the claims processing system. Invariably when looking at the process, it is easy enough to ask VA 

why do you do it that way. Why does it take, for instance, so long 

to develop a claim when the insurance industry can decide a claim 

in a matter of days? 

The answer lies in the unique set of rights afforded veterans by 

a grateful Nation in recognition of their service to our country. The 

insurance industry requires the insured to provide the information 

it needs to pay a claim. If the insured does not provide the information in a timely manner, the claim does not get paid. 

The VA on the other hand is required by law to try and obtain 

nongovernmental information not just once, but twice, before the 

burden shifts to veterans. And the VA must spend whatever time 

is necessary in its efforts to get governmental records. The VA 

must either receive government records or be told that they do not 

exist. 

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The point here is that VA operates by a very different veteranfriendly set of rules which imposes burdens on the government that 

are not faced by private industry. As a consequence, any comparison between VA and private industry is like comparing apples to, 

say, canines. They are not in the same genus, species, class, or 

family. 

We believe that there is no quick fix to fixing the problems in 

VBA. There is only the opportunity for steady and deliberate improvement. 

Again, we are convinced that there is no magic bullet. Any single 

plan that makes the claims processing system simple and easy will 

make things only marginally simpler and easier on the VA and will 

occur at the expense of the rights and benefits of at least some veterans, dependents, and survivors. Any such plan is simply unacceptable. 

There are a number of things that can be done to improve service 

and maximize efficiencies. The claims processing improvement 

model dictates the physical structure of claims processing teams 

within a Regional Office Service Center. It imposes uniform structure, staffing, and duties on Regional Office management. They deviate from the model at their peril. It has been in place for over 

5 years and it has known limitations and problems. 

Two years ago, a group of supervisors and managers were asked 

to study the CPI model and make recommendations for its improvement. Although they spent months diligently working on the 

task and reportedly made at least several significant recommendations, their report has never been finalized and the changes they 

suggested have not been implemented. 

Since it is our view that the claims processing improvement 

model has significant problems and limitations, we recommend 

that an impartial third party critique its strengths and weaknesses 

and recommend changes that will improve the structure through 

which claims are processed. 

We discuss in our written testimony the current VBA policy of 

denying replacement staff to offices which are not performing well. 

In our view, VA either needs to adequately address the problems 

in those offices or shift the claims processing to other offices since 

veterans in those jurisdictions are the ones who suffer the most 

from extended delays and poor quality. 

We have offered other suggestions and observations in our testimony on the VCAA, how to encourage ready-to-rate cases, informal 

claims, the use of computer technology, and how to migrate claims 

processing to an all electronic environment. We hope that you find 

them to be informative and useful. 

In the end, it is our belief that VBA has difficulty effectively 

dealing with change. They appear to react to change rather than 

anticipate it. They need to learn how to better manage change to 

minimize its impact on employees and veterans. 

In our view, VA needs to change its corporate attitude and work 

toward adjusting to change, managing change, and accommodating 

the challenges that come with change. If they can do that, if they 

accomplish that, then we are certain that veterans can be and will 

be better served than they are today. 

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The programs are sound. The protections afforded veterans’ 

rights are justified and necessary. We caution, however, against 

any radical action that changes veterans’ programs for the sole 

purpose of solving the backlog and timeliness problems. 

The VFW does not support proposals by Professor Linda Bilmes 

nor the Dole-Shalala Commission recommendations concerning the 

compensation program. 

Thank you for this opportunity to testify before you today. I will 

be happy to respond to any questions you may have. 

[The prepared statement of Mr. Manar appears on p. 101.] 

Mr. HALL. Thank you, Mr. Manar. 

Mr. Roberts. 

STATEMENT OF JOHN ROBERTS 

Mr. ROBERTS. Thank you, Mr. Chairman, distinguished Members 

of the Committee. 

Our written testimony is on record, so I will highlight a few 

items. 

I would like to start off with agreeing with some of the comments 

made by Mr. Abrams on the second panel. I have a unique experience. Prior to my position with the Wounded Warrior Project, I was 

a supervisor with VBA. 

I agree until you change the current measurement system for 

production, you are going to continue to have a problem. When you 

put employees into a position where they have to worry about their 

job and not the veteran, you are going to have a problem. It becomes an ‘‘us’’ versus ‘‘them’’ type situation. 

Currently I disagree with some of the comments made earlier on 

other panels. I believe quality is an issue for VA because I have 

seen more employees in trouble for quality issues than I have production. 

So as a supervisor, I would do a random selection of cases per 

employee per month. And this was computer generated. It had no 

influence on whether I liked the employer or not. The computer 

generated what I was going to review and what I was not going 

to review. Therefore, their employee never knew what was going to 

be taking a look at for their quality issues. So some of the issues 

I agree with. Some I disagree with. 

Now, clearly the Wounded Warrior Project deals strictly with 

only the OIF/OEF generation of veterans. However, all these problems, they affect all generations of veterans. 

Therefore, everybody that has come before you today does have 

their own ideas, their own recommendations. However, there is no 

easy fix. That has been said several times. There is no silver bullet. 

We do recommend any advancement on technology be researched. However, that is not going to be a quick fix or solution 

to the problem. 

The VA does have in its authority to award what is called a 

prestabilization rating to the newly injured, which this would allow 

VA to get money in the hands of the servicemen being discharged 

from service as soon as possible and then they can go back and look 

at the other issues. 

As a National Service Director, I have traveled from military facilities across the country. On one visit to Camp Lejeune, I witwwoods2 on PRODPC68 with HEARING

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nessed what I considered a one-stop shopping. They actually had 

a fully functional team within Camp Lejeune which consisted of a 

supervisor, a rating specialist, veterans service representatives. 

Each one of them, they had medical professionals there to conduct 

exams. The file never had to leave Camp Lejeune. It was done 

right there, which I question sometimes why it is not done at all 

the major military facilities. 

I understand BDD is in place. But if you can put people at all 

the major military facilities, it seems like it would cut down on 

some of the shuffling files back to other locations. 

Now, complying with the recommendation of the Veterans’ Disability Benefits Commission to incorporate medical expertise into 

the rating process, by necessity, VA disability compensation claims 

are being rated by individuals who lack medical experience. As a 

result, if more explanation is needed on a particular exam, a further delay is created when the file is required to be sent back to 

the examiner for clarification. 

To remedy this, WWP agrees with the VDBC recommendation 

that VA raters should have ready access to qualified healthcare experts who could provide advice on medical and psychological issues 

that arise during the rating process. 

Currently, right now I do know when I was a supervisor that VA 

gave limited access to VBA employees to access VHA records outside their area of jurisdiction. This is an easy fix, I believe, if you 

give more VBA access to other VHA facilities. That is something 

that could be easily done. 

Most of our recommendations are very simple. I am very familiar 

with the CPI process. We are not advocating the removal of it as 

this would cause even more problems than you have now. However, 

we are in favor of allowing Regional Offices the flexibility to adjust 

their current system they have in place to utilize the strengths of 

their employees. 

Each office has employees that are better at one thing or another. If you allow people to adjust the current system, the current 

CPI system, they may have better processes in place they could use 

at their own office. Not every system works for every office across 

the country. 

Currently ROs are graded on the number of claims they complete 

each month. Because cases can be complex, there are different 

times in development process based on the complexity of the claim. 

However, you could take one with PTSD, brain injury, and an amputation. But if you go ahead and grant the amputation, you get 

money in the veteran’s hands. You can go back at a later time and 

finish out the other issues that are more complex. 

As I said, our written testimony is on record. Therefore, we welcome any questions you may have. Thank you. 

[The prepared statement of Mr. Roberts appears on p. 107.] 

Mr. HALL. Thank you, Mr. Roberts. 

Mr. Roberts, for the generation of veterans that the Wounded 

Warrior Project serves, a lot seems to hinge on getting accurate information from DoD. 

There seems to be an effort underway to get medical records to 

the VHA, but does that also benefit the VBA in the same way? Is 

there something missing in this records transfer process? 

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Mr. ROBERTS. Well, right now it is. You know, in my recent testimony last month when I came in, there is a problem now. You have 

National Guard, you have Reservists, and then you have regular 

active-duty servicemen deploying and at any given time, they are 

redeploying on numerous occasions. 

When they redeploy, the records go with them. When they come 

back, they refile a claim and you have to start the process all over 

again. Unfortunately, you have the record management centers 

that are receiving these records, DD 214s. 

There are so many different factors that play into why it takes 

so long to get a claim finished that if the records came straight 

from DoD into wherever that veteran is going to be located, if it 

is at the military facility where you staff personnel to rate the 

claims right there before they even leave to go to their home of 

record, yeah, that would be an easy transfer. You take them from 

one location, one building to another building. It would benefit 

VBA in that aspect. 

Mr. HALL. Thank you. 

Mr. Smithson, you mentioned that the American Legion does 

quality reviews, so I am sure you are familiar with the CPI model 

of claims process that VA employees. 

We have heard during our last hearing on artificial intelligence 

a description of how six teams of people handle one claim. 

What is your opinion or your observations about that process and 

should we keep it or go back to a case management model or somewhere in between? 

Mr. SMITHSON. Well, when we go out and do our quality review 

visits, we talk to people. We talk to both the VSOs and the VA personnel, both managers and the front-line people. And we have 

heard a consistent theme of problems or complaints about the CPI 

model. 

The first one is basically it is an assembly line mentality. Under 

the old case management system, there was more of a pride in 

ownership. Now it is an assembly line. You move it on. 

There also tends to be, I do not know whether it is intentional 

or it is just a product of the system, but we have heard that there 

tends to be discouragement of communication between, say, developers and raters. You know, the developers do the development. 

They move it on to the raters. There is not any interaction in the 

process. 

One case in point, and we have heard this from both raters and 

developers, rating veterans service representatives (RVSRs) and 

veterans service representatives (VSRs), is the examination request 

process. The VSR has to write up that exam request for the doctor. 

They put the information they want from the doctor, medical opinion, that type of thing, and oftentimes they are not properly trained 

to write it up. They are not the one rating the claim, but they are 

the one having to write it up for the rater to come back and then 

look at. 

And so we have heard from both the VSRs and the person who 

actually rates the claim that there needs to be more communication 

in that process, possibly letting the rater be involved in that process of doing the exam request versus the developer. So that has 

been a problem. 

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And also we have also heard the rotation of employees tends to 

cause problems as well. And we also learned during our visits that 

some offices do certain parts of the CPI and some offices tend to 

ignore certain portions. 

So I do not know if the whole thing should be scrapped, but it 

definitely needs to be examined because both the managers and the 

people that actually have to implement it, the frontline workers, 

have concerns. 

Mr. HALL. Thank you. 

Mr. Manar, you stated in your written testimony that VA leadership has experimented with different claims processing models and 

configurations of work activities. 

Can you give us more details as to what sort of experiments 

these were or how long the VA has been experimenting with these 

claims processing models and did any of them have potential that 

you thought was worthy of following up on? 

Mr. MANAR. In the context in which you use it, experiment probably is too strong a word. I was thinking over the course of my career with the VA. I started with the VA at a moment in time when 

they were just moving into the units and section concept. 

As the adjudication officer out in Los Angeles, I was charged 

with incorporating the case management concept and to bringing 

it into fruition. And then finally I finished up my career at the 

Washington Regional Office under the CPI model. 

So I have had an opportunity to experience it all and each model 

has its own pluses and minuses. I am convinced, however, that 

there are significant flaws in the CPI model. It is only marginally 

less flawed than the case management system. 

It could be it is just because I grew up in it and I was most comfortable with it, but I think that the unit and section concept approach offered the greatest flexibility while still allowing a relatively small group of people to focus on and manage a particular 

batch or digit range of the cases in front of them. It seemed to me 

that there was greater accountability under the unit and section 

concept than more currently. 

The CPI model has so many flaws and problems that it is difficult to describe in a short period. So that is it. If I could wave 

a magic wand, I think we would go back about 10 years and try 

and do it the old-fashion way, which seemed to process claims pretty efficiently and quickly. And I think quality, if not any better, 

was certainly no worse than it is today. 

Mr. HALL. Thank you. 

Mr. Sullivan, did you want to comment on that same question? 

Mr. SULLIVAN. No. 

Mr. HALL. No? Okay. Well, in that case, Mr. Sullivan, could you 

provide any information on why National Guard and Reserves are 

nearly three times as likely to have their claims denied? 

Mr. SULLIVAN. Mr. Chairman, I wish I could give you a thorough 

answer. What we have done at Veterans for Common Sense is identified the problem. 

About a year ago when we analyzed the claim activity of Iraq 

and Afghanistan war veterans, we identified that Guard and Reserve were about twice as likely to have their claim denied than 

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active-duty soldiers. And now that rate is almost three times as 

high, fourteen percent versus 5 percent. 

What we would like to know is, is it because of a lack of outreach? Is it a lack of the records being unable to be found? Is it 

a lack of redeployment? We do not know. 

What we would like to do is ask that it be investigated to find 

out what it could be. But it is a significant problem because it 

seems to be getting worse. 

Mr. HALL. That is a powerful piece of information. Colonel Norton, one of our witnesses in a hearing recently said, his slogan that 

stuck in my head was ‘‘same service, same battlefield, same benefits.’’ And he was talking about educational benefits in that particular hearing, but I would say, you know, that the same should 

go for all of the benefits, and disability included. 

Mr. SULLIVAN. Mr. Chairman, some of it may eventually be addressed if, for example, benefits delivery at discharge was forward 

deployed at National Guard and Reserve armories and demobilization sites. Again, there are a lot of reasons why this might be happening. 

I think what we should try to do here is to find out what are the 

facts, what is going behind it, and then to try to find some solutions. But BDD, expanding that more thoroughly for National 

Guard and Reserve, it does not currently exist for them, may be 

part of the answer to solving it. 

Mr. HALL. Thank you. 

Mr. Atizado, you mentioned quality in your statement as a key 

issue. So could you tell us more about what you envision as a better approach for the VA? How can individual managers and employees be more accountable and is there a better approach than 

the STAR Program? 

Mr. ATIZADO. Thank you, Mr. Chairman. 

The STAR Program has a number of limitations and one of 

which is it does not allow for any kind of root cause analysis, any 

kind of trend analysis. And it is only limited to the Regional Office 

level, not down to the section or individual level. 

As I had mentioned in my testimony, the SIPA Program which 

was created and eventually abandoned in 2002, we were hopeful 

that would actually get funded the following year or any subsequent fiscal year, but unfortunately that has not. 

The reason we believe that a more individualized quality review 

or quality assurance program should be in place is simply because 

if you do not know what the problem is, how can you propose a solution to it? And if we cannot somehow show where the issue is, 

whether it is a single individual or a group of individuals or a particular process, you know, the DAV comes from the position that 

adjudicators and rating specialists and developers are all inherently in the job to do service for veterans. The problem we see is 

that the workload is dragging that away from them. 

Our relationship with the adjudicators hinges on their attitude. 

If they are open for debate or a discussion to assist the veteran, 

it makes the quality of the claim and the decision of the claim more 

in favor of the veterans, particularly if the evidence supports that. 

Unfortunately, as my colleagues have mentioned, they are getting beat down by the requirements to produce rather than produce 

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good work. And we believe that some kind of tool, whether it be 

the SIPA Program or some other standardized quality review instrument, be utilized or should be utilized to achieve the quality we 

are looking for. 

Mr. HALL. Thank you. 

The Minority Counsel will submit the Ranking Member’s question for the record. 

[No questions were submitted.] 

Mr. HALL. You have all been most helpful and patient and I 

thank you all. This panel is now excused. 

And we would ask our fourth panel to join us, Michael Walcoff, 

Deputy Under Secretary for Benefits, U.S. Department of Veterans 

Affairs; Diana Rubens, Associate Deputy Under Secretary for Field 

Operations of the Veterans Benefits Administration; Bradley G. 

Mayes, Director of Compensation and Pension Service, Veterans 

Benefits Administration of the U.S. Department of Veterans Affairs. 

Thank you also for your patience. Had we known, we would have 

called this meeting to start at four o’clock instead of two o’clock. 

But at any rate, thank you for being here. And, of course, your 

statement is entered in the record as written, so feel free to highlight or shorten it or whatever you choose. 

Mr. Walcoff. 

STATEMENT OF MICHAEL WALCOFF, DEPUTY UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY DIANA RUBENS, ASSOCIATE DEPUTY UNDER 

SECRETARY FOR FIELD OPERATIONS, VETERANS BENEFITS 

ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND BRADLEY G. MAYES, DIRECTOR, COMPENSATION 

AND PENSION SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Mr. WALCOFF. Mr. Chairman, thank you. 

Mr. Chairman, Members of the Subcommittee, thank you for providing me the opportunity to appear before you today to discuss the 

Veterans Benefits Administration’s claims inventory and claims 

processing system. 

I am pleased to be accompanied by Ms. Diana Rubens, VBA’s Associate Deputy Under Secretary for Field Operations, and Mr. Brad 

Mayes, VBA’s Director of Compensation and Pension Service. 

My testimony will focus on two efforts we currently have in 

progress to improve claims processing, our aggressive hiring initiative, and an independent study of the claims process conducted by 

IBM Global Business Systems. 

Before I begin discussing our efforts to improve the claims process, I would like to talk about the inventory and productivity. 

As of January 31st, 2008, VBA’s pending inventory was 397,077 

claims. And I want to stop here because I want to talk about some 

of the other numbers that have been kind of mentioned in previous 

testimony. 

There were several people, Mr. Cohen, I believe, mentioned 

650,000. He also talked about 177 days in the same paragraph that 

he talked about 650,000. And I would tell you that I believe that 

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is a little unfair in that the 177 days is how long it takes us to do 

our rating claims which is the 397,000. If you throw in our nonrating claims which gets it to 650,000, our timeliness is about 130 

days. So if we are going to use the 650, then let us use the 130 

in terms of timeliness. 

And I believe that Mr. Manar threw in education claims to take 

the number up around 800,000. And our timeliness on education 

claims, especially supplementals, is approximately 12 days. So that 

would really bring our timeliness down. But I do not think that 

would be an accurate reflection of what we are here for today. 

Basically I believe the 397,000 number are the group of cases 

that we are really talking about at this hearing and the timeliness 

for that is about 180 days. 

There are numerous factors that contribute to that number. The 

two primary ones being the increase in the number of claims filed 

and the increased complexity of those claims. The numbers of veterans filing initial disability compensation claims and claims for increased benefits has increased every year since fiscal year 2000. 

In fiscal year 2007, we received 838,141 rating-related claims 

compared to 578,000 in fiscal year 2000, a 45-percent increase. This 

high level of claims activity is expected to continue over the next 

years due to claims from Operation Iraqi Freedom and Operation 

Enduring Freedom veterans, the addition of type two diabetes as 

an Agent Orange presumptive disability, more beneficiaries on the 

rolls with resulting additional claims for increased benefits, and 

improved expanded outreach to active-duty servicemembers, Guard 

and Reserves, survivors, and veterans of earlier conflicts. 

VBA’s inventory has remained at approximately the 400,000 

level for the last year. During that time, VBA has become much 

more productive, over 21 percent more productive compared to 2 

years ago. 

If you look at the current fiscal year alone, our production is already up 13 percent compared to fiscal year 2007. In fiscal year 

2008, we expect to make decisions on over 878,000 claims and in 

2009, that number goes to 942,000. Our increased productivity will 

eventually have a significant positive impact on our inventory. 

VBA is continually seeking new ways to decrease the pending inventory of disability claims and shorten the time veterans must 

wait for their decisions. Key to our success will be ongoing longterm effort to enhance and upgrade our claims processing system 

through integration of today’s technology. 

In the near term, we have two initiatives that I want to highlight. In fiscal year 2007, we implemented an aggressive nationwide hiring initiative. More than 1,800 new employees have been 

added since January of 2007 and our hiring plan will add an unprecedented 3,100 additional employees by the end of this fiscal 

year. 

To enhance rapid integration into the veterans claims process, 

we have modified our employee training program to focus on initial 

training on specific claims processing functions. This will allow new 

employees to become more productive earlier in their training and 

at the same time allow our more experienced employees to focus on 

the more complex and time-consuming claims. 

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By more effectively utilizing both newly hired employees and experienced claims processors, we expect to reduce the pending inventory and improve claims processing in 2008. 

From October 2007 until January 2008, the IBM Global Business 

Services conducted a detailed review of our business process involved with adjudicating a claim beginning with the application receipt and ending with notification to the claimant. 

To date, IBM has provided VBA with a gap analysis which identifies the gaps between VBA’s current process and IBM’s envisioned process. The gap analysis also includes short-term and longterm recommendations to help VBA improve its processes. 

Overall, IBM’s recommendations validate areas for efficiency 

gains already identified internally. Both the short-term and longterm recommendations made by IBM focus on the phases of the 

claims process and special activities under VBA’s control. 

The short-term recommendations are incremental enhancements 

VBA can make to the existing business process to realize benefits 

and efficiency in productivity in the near term. 

Because our current claims process is heavily reliant on paper 

and the movement of paper claims folders, the greater efficiencies 

will be gained as a result of IBM’s longer term recommendations 

to move to an electronic paperless environment. 

Managing work flow, monitoring performance, and tracking the 

number of claims processed are critical to maintaining processing 

efficiencies. The average number of medical disabilities or condition 

claimed on an original application is increasing. 

To further enhance our ability to monitor performance, the study 

recommends the creation of a performance measurement system focused on tracking the number of medical disabilities or issues 

claimed. 

VBA agrees with the idea of adding an issue-based performance 

measurement system to our current reporting system. This system 

will provide us with a better understanding of our workload and 

productivity. However, at the same time, VBA must ensure that 

our claims processors stay veteran focused. 

To achieve large-scale improvements, VBA must make a fundamental shift in how we process C&P claims. 

All of the study’s long-term recommendations focus on IT enhancements that will allow VBA to move into a paperless environment, one where work can be managed electronically and automation can reduce manual activities, thereby freeing resources for 

more value-added decisionmaking. 

IBM believes that one of the first steps for VBA in this transition 

is to enhance the current veteran’s online application or VONAPP. 

VBA is currently coordinating with VA’s Office of Information and 

Technology to resolve all data and privacy and security concerns 

surrounding the use of an electronic signature. 

In addition, we are working through VA’s General Counsel to resolve any regulatory issues regarding the need for a wet signature. 

Using the virtual VA application, VBA has also initiated two 

pilot efforts to test our ability to shift to a paperless environment 

and to test the utility of imaging technology. Through these pilots, 

we continue to refine our business process and identify necessary 

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44 

enhancements that will allow us to expand the use of imaging technology. 

We are also leveraging the lessons learned from the imaging accomplishments in our Insurance, Education, and Loan Guaranty 

programs. 

As VBA transitions to paperless processing, claimants’ access to 

information will expand. The study team recommends the creation 

of a secure web portal so that claimants can access claim information and request transactions online. 

Currently, claimants may check the status of their claim by calling a toll-free number or by visiting a Regional Office or through 

a Veteran Service Organization. VBA has a secure web portal 

called the Veterans Information Portal. The primary external users 

of this portal are lenders and appraisers who are assisting veterans 

in the Loan Guaranty Program. Through this portal, external users 

can access web-enabled computer applications. 

Currently there are no disability compensation business applications available to external users through the portal. But efforts are 

underway as the President’s Commission on Care for America’s Returning Wounded Warriors also recommended that VA and DoD 

develop an interactive web portal. 

In conclusion, we believe that the independent study by IBM 

validates our current course of action to improve claims processing 

timeliness, particularly with regard to information technology. Despite ongoing challenges, VBA continues to develop new strategies 

to improve claims processing and reduce the time veterans must 

wait for decisions. 

Mr. Chairman, this concludes my testimony. I would be happy to 

respond to any questions that you may have. 

[The prepared statement of Mr. Walcoff appears on p. 109.] 

Mr. HALL. Thank you, Mr. Walcoff. 

When do you expect that the Subcommittee could see the IBM 

report? 

Mr. WALCOFF. I think Monday is the official day that we get it 

and I will be glad to give you whatever we get on Monday. 

Mr. HALL. That is great. Thank you. I am looking forward to 

that. 

Congratulations on your new position. 

Mr. WALCOFF. Thank you, sir. 

Mr. HALL. And as former chief person for field operations prior 

to elevation to this position, I am sure your experience will serve 

our veterans well. 

Could you please describe the current claims processing system 

model used by the VBA called CPI and the current number of days 

that each step in the process uses? 

Mr. WALCOFF. The CPI model is a process where the teams are 

divided by particular functions within the claims process. We have 

a function called triage where employees will look at mail when it 

comes in. They put it under control and they make a determination 

as to whether work can be done quickly, immediately, or whether 

it has to go through a longer process of development before a decision is made. 

Assuming that the work does have to be developed, it is then 

passed on to the predetermination team which is responsible for 

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developing the claim. That includes sending out VCAA letters. It 

includes going out for medical evidence. It sometimes includes 

going out for service medical records or service treatment records. 

It sometimes means going out for private medical evidence. It could 

be going to Joint Services Records Research Center (JSRRC) to get 

stressor information on a PTSD claim. 

There are all kinds of different types of development that has to 

be done and this is the process that takes the longest in developing 

for that evidence waiting for the evidence to come back. And I will 

give you some timeframes in a minute. 

The third process after the case has been developed is to certify 

it as ready to rate and it is then sent to the rating board where 

a rating specialist will rate the case. 

Once the case is rated, it goes to a fourth team called the postdetermination team where it is gapped, meaning it is printed out 

on a piece of paper and it is authorized. The award is actually paid 

in the post-determination team. 

That would be the typical claim that you would have. There is 

another team called the appeals team that would only get involved 

in cases where a veteran has appealed the decision. So that is the 

basic process. 

The average time it takes to work a claim, and I am going to do 

this off my memory, so I might be off a couple days, but it will give 

you a little bit of an idea. It takes us about 8 to 10 days to put 

the case under control and do that triage process that we talked 

about. 

It then gets sent to the pre-determination team. It takes them 

about 30 days to begin the development of the case. And there is 

an area that we can improve in. From the time it goes to triage 

to pre-D on average, we need to quicken the time that it will take 

for a VSR to begin the development on that case. 

The development itself does not really take that long, but waiting 

for the evidence to come back is what really takes long. That takes 

right now about 63 days for all the evidence to come back from the 

various places. And there are a lot of reasons for that. 

Under VCAA, we have to give a certain amount of time for a provider to respond. And under certain types of conditions, if he does 

not respond in 60 days, we give another 30 days for them to respond. So that is why it takes so long on this particular process. 

When all the evidence comes in, it actually moves fairly quickly 

from there. The rating specialist, it goes into the rating team and 

it takes about somewhere, I would say, between 14 and 20 days for 

the rating team to be finished with the case. 

It then goes to the post team and it takes there, I would say, 

about 15 days for it to go through that process. So that is 30 and 

60 is 90 and 30 is 120. Depending on the case and how long that 

part takes where we have to develop evidence, it takes you to 

around 170 days. 

Mr. HALL. Thank you. 

And is this an effective model in your opinion and, if so, why has 

the VA backlog increased almost threefold since its implementation 

along with a notable rise in processing times? 

Mr. WALCOFF. Well, there are several answers to that. First in 

terms of whether it is an effective model, I will compare it to the 

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model that it replaced which is what we called the BPR model. It 

was a model that was developed by Joe Thompson who was a 

former Under Secretary. And it involved a situation where an employee would not pass the case from one person to another. They 

would be responsible for all the elements involved in a case. 

And I will tell you that when I came into Washington in the Associate Deputy Under Secretary role, I was brought in by Joe 

Thompson who was Under Secretary at the time and was a supporter of that model at that time. 

But what we found was that our work had become so complex 

and so difficult that our VSRs were having a lot of trouble being 

able to master all aspects of what a VSR does and at the same 

time, having to do all the different aspects of VSR work on any 

given day. 

And the reason the CPI model was adopted was the idea that by 

specializing in a particular function, an employee could learn it, 

could get comfortable with it, and get good at it. And that is the 

basic philosophy behind the CPI model. 

Now, why has our inventory gone up so much? Well, I can give 

you a couple reasons. One was we got down to 253,000 at the end 

of fiscal year 2003. And on September 23rd of that year, there was 

a court decision called PVA versus Principi, I guess it was at the 

time. Yes. And that decision said that we could not deny any issue 

of a claim until it had been pending a year. Within 3 months, because of that court decision, our inventory went from 253,000 to 

354,000. 

It was finally remedied by legislation passed by Congress. But by 

that time, we had already gone up 101,000 claims. So that is part 

of why we are in the shape we are in. 

In addition to that, our receipts have continued to go up. We 

went through a period when we were in a hiring freeze. So while 

we had receipts going up, while we were losing experienced employees, we were not hiring for about 18 months. Now that is a 

while ago and we have been hiring now for about 2 years. But we 

are still paying to a certain extent for that period where we did not 

hire. 

But I believe that with the hiring we are doing now, with the 

training we are doing, and I think with the total number of employees that we are going to have available to us, we will bring the 

backlog down. 

Mr. HALL. And the loss of experience is slow to be made up when 

you are bringing new people on board. So that is understandable. 

I am curious that witnesses here have taken issue with the 

VBA’s work credit system which is used to measure the productivity of your employees. I know that you disagree. I think that you 

disagree that the system sacrifices quantity over quality. 

But who is accountable for the accuracy of a veteran’s claim and 

the decisions made in adjudicating it? For instance, if an RVSR 

makes an error in making a rating or a VSR commits an error in 

the development resulting in an avoidable remand, are there any 

actions taken? 

Mr. WALCOFF. Well, who is responsible? I would say that the employee is responsible for the part of the claim that they did. 

wwoods2 on PRODPC68 with HEARING

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And I will tell you that I do disagree with a lot of the statements 

that were made on previous panels, statements that in effect said 

that all VBA cares about is productivity and that we do not measure quality at the individual level. 

STAR does not measure quality at the individual level. I agree 

with what the DAV rep said about that. And the reason for that 

is that STAR is a quality assurance program. It is not a quality 

control program. It is not meant to measure quality at the individual level. 

We do have measures in place tied in with the individual performance standards of all VSRs and all rating specialists that require that five cases a month be reviewed for each employee. And 

what is reviewed is the part of the work that they were responsible 

for. 

So if it is a VSR who was on the pre D team, the work they did 

in developing the claim would be what would be reviewed. If you 

are a rating specialist, then the rating would be the part of the 

case that would be reviewed. That is a part of our performance 

standards. 

I thought Mr. Roberts made a point as somebody who was a supervisor that he has actually seen more employees be put under 

performance reviews for quality than he saw for productivity. So I 

think that certainly proves by a very neutral witness the fact that 

we do have a quality program. 

Mr. HALL. Although it is not abnormal to realign targets as realities change, in your testimony, you talked of the addition of 1,800 

employees since January 2007. Yet, during the same time, VA has 

moved its claims processing target from 125 days in 2007 to 145 

days for 2008. 

Could you explain why? 

Mr. WALCOFF. The change was made because 125 days we felt 

was not realistic. And to put a goal out there that we just did not 

feel there was any way we were going to make we felt was, and 

I guess I will use the word, in some way intellectually at least dishonest. 

And the 145 days, I was asked by counsel whether that was a 

goal that I really felt was realistic and I absolutely believe it is. I 

do not know whether we will make it or not, but I honestly believe 

that with all the staffing we are getting that we should be able to 

make 145 days. And that is why we put that out as our goal. 

Mr. HALL. Well, certainly we have to get there before we get to 

125. 

Mr. WALCOFF. We do. We do. And certainly, sir, strategically, 

and I think we talked about this a little bit at the hearing that we 

had in New York, strategically I would like to see us get to 125 

days and I have not given up on that. But I think that in terms 

of, you know, the years that we are talking about, 2009, 145 is 

more realistic. 

Mr. HALL. During this same time period as former Director of 

Field Operations, can you tell us how many Regional Office Directors received a bonus? 

Mr. WALCOFF. I do not know the number off the top of my head. 

I would say that it is probably half. I would say it is probably about 

wwoods2 on PRODPC68 with HEARING

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50 percent. That is not an exact number, but I would say that is 

in the ballpark. 

Mr. HALL. And in your previous position, you also received a 

bonus. Can you look at that with some objectivity? With the current and historical performance of VBA in processing claims, what 

do you think of that? In your new position, are you expecting or 

are you eligible for receiving a bonus and what would that depend 

on? 

Mr. WALCOFF. I am not going to offer a personal comment on 

whether my bonus was justified. I would suggest that you talk to 

the two people that rated me, Ron Aument and Admiral Cooper. 

In the position that I am in right now, I am eligible for a bonus. 

Whether I get one is going to be up to Admiral Cooper and the Secretary. 

Mr. HALL. Fair enough. 

As a long-time employee with the VA who has occupied several 

positions of leadership with the VBA, could you explain the seemingly sudden shift in priorities at the VBA to information technology improvements? 

While I am happy to see VA make affirmative moves in this direction to help increase the efficiency in processing claims for our 

veterans, I have to say I am not convinced, nor were a number of 

our witnesses, that the shift is a panacea for all that ails the system. 

Mr. WALCOFF. It is not a panacea. I definitely agree with that. 

I mean that if I am giving the impression that by going paperless, 

the day after we go paperless, our timeliness will immediately improve by, you know, 50 percent, that certainly is not true and I am 

not saying that our quality will automatically improve or anything 

else. 

But I think it is a tool. I think it will give us a lot more flexibility 

in terms of how we handle the work. You know, there has been a 

lot of discussion. We always hear discussion about consistency and 

our quality. 

And I can tell you that right now there has been suggestions, for 

instance, just to give you an example on how this could help us, 

there have been suggestions about PTSD claims. You get inconsistency from office to office. Why do you not just have all PTSD claims 

processed at a particular office? 

Well, on the surface, that sounds like, that might be a good idea. 

That way, you have all people in one building doing them. You can, 

centralize your training. You can make sure everybody is doing it 

the same way, that sort of a thing. 

Well, the problem is that most PTSD claims are along with several other issues so that you have a claims folder with the PTSD 

information in there along with the information about, say, five or 

six other issues. You really cannot pull out certain pieces of the 

paper and send them to another office and then leave the paper 

that is left to the office where the claim was filed. 

If we went to an electronic system, it would be very, very simple 

to have a particular office have access to the part of the file that 

deals with PTSD while at the same time, the home office could 

have access to the rest of the file at the same time. 

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That is a great example to me of how going to a paperless system 

will absolutely help us in terms of our flexibility and allow us to 

do some things that we cannot do today. 

Mr. HALL. Well, it would seem to me that is true and also all offices could have access to the same information—— 

Mr. WALCOFF. That is right. 

Mr. HALL [continuing]. At the same time. One of our earlier 

hearings was on artificial intelligence and some of our witnesses 

were suggesting from their academic or private-sector experience 

that a system could be set up, which would process 80 to 90 percent of the claims or the portions of claims that were brought by 

veterans because there would be definitive either presumptive 

causes or definitive medical records that would establish a clear, 

visible, undeniable aspect of that claim and leave the 10 or 20 percent that were more difficult to be handled by the human part of 

the process that you described before. 

Do you think that is at all realistic and what would your comments be about that? 

Mr. WALCOFF. I am going to make a comment and then I am 

going to ask Brad to comment. 

If you remember when I talked about how long it takes to do different parts of the claim, the actual rating of the claim really does 

not take that long. What really takes a long time is the part of the 

development, the deciding what evidence is needed and then having to wait for all that evidence to come back. 

Having an expert system or I call it an expert system which you 

are referring to, to help on the rating aspects of it, I think that the 

way I understand expert systems, it could help us on the quality 

aspect because everybody would be sent down the same path answering the same questions as they work through a claim which 

would, I think, provide for more consistency. 

But I am not sure that it would save that much time because 

that part of the process does not take that much time to begin 

with. 

What do you think, Brad? 

Mr. MAYES. Well, I agree with that, Mr. Chairman. Two comments. First of all, we are pretty effective once we gather all of the 

information and evidence needed to make a decision. We are pretty 

effective at making the decision. We are doing it 13, 15 days, something in that neighborhood. 

Second of all, the algorithms that would be needed to evaluate 

evidence and the probative value of that evidence in some cases 

would be, I think, very complex. 

And, thirdly, the third point that I would make is that is the fundamental decision and obligates the U.S. Government to that veteran. I would think that where we are making that critical obligation, that commitment, that we would want to have a person involved in that decision-making process. 

Rather, I would like to see us, if we are going to look at this type 

of technology, let us leverage that technology up front in the process, taking information from an application, using that technology 

to see if there is basic entitlement. Does the claimant have status 

to file the claim in the first place? Are they a veteran? Use that 

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technology up front and help in this process, the development process, which takes more time. 

So I would suggest that probably more bang for our buck if it 

could be achieved in the front part of the process as opposed to that 

part of the process where we are already doing it timely and also 

we are making that critical obligation. 

Mr. HALL. There are a number of Members, I would say most if 

not all of the Subcommittee, who feel strongly that we should find 

a way to start providing disability benefits, at least partial benefits 

to our veterans as soon as possible, if not immediately upon filing 

a claim. There must be a way for this to be done, even as other 

aspects of the claim are still adjudicated. 

And I realize that we do not want to make this more complicated 

and more expensive and we are running the risk of doing both. But 

at the same time, the hardest thing for us as individual Members 

of Congress in our districts when we deal with cases that come 

through our door there or as Members of the Committee or the 

Subcommittee is to justify 125 days, 145, 180, whatever it is, before 

some money starts to flow and some part of the claim is recognized. 

I just wanted to ask if rating a claim actually is not the part that 

takes the longest, why are there over 800 cases ready to rate in 

Baltimore and close to 1,000 in Philadelphia? 

Mr. WALCOFF. You know, I do not know. I would have to look to 

see what the ratio is in terms of rating specialists to VSRs. I do 

not know whether they have been instructed to concentrate on development with the idea that the area Director is planning on 

brokering some of those cases out. If you want, I can get back to 

you on that. 

[The following was subsequently received from Mr. Walcoff:] 

At the end of May 2008, there were 733 claims awaiting a rating decision 

in Baltimore and 392 awaiting a decision in Philadelphia. The national average processing time is 15 days from the time a claim is determined to be 

ready to be rated until the rating is completed. During this period, the Rating Veterans Service Representative (RVSR) reviews all evidence in the 

claims file, ensures that VA has met its duties to notify and assist, and 

makes a determination related to service connection, degree of disability, 

and effective date. Additionally, the decision time includes any required second-signature reviews by senior RVSRs. At the Philadelphia Regional Office, the decision time is 8.2 days, while this process currently takes 20.6 

days in Baltimore. 

To assist the Baltimore office in providing more timely claims decisions, 

additional staffing has been authorized, and cases are being brokered from 

Baltimore to other regional offices with capacity to assist in rating these 

claims. Baltimore has hired 51 employees since January 2007. This fiscal 

year through May, Baltimore brokered over 1,500 claims to other regional 

offices for rating. 

Mr. HALL. Sure. That would be great. I understand there are 

similar numbers in some of the other ROs. 

Mr. WALCOFF. Sir, there are some offices that have been, based 

on a lot of different factors, and, Diana, you may want to comment 

on this, instructed to put all of their resources toward development 

with the idea that we have capacity maybe in the rating area in 

another office. 

And we want to try to get them as much as possible where they 

have trained rating specialists. So we might tell an office to conwwoods2 on PRODPC68 with HEARING

51 

centrate on getting these cases ready to rate and we will get them 

rated for you. 

Mr. HALL. So each office does not have trained rating specialists? 

Mr. WALCOFF. Well, it depends. I mean, certainly every office has 

trained rating specialists. Do they have enough depends on several 

things. 

It could be that they have recently had losses where it is taking 

a while to get the replacements trained so that they are temporarily in a situation where they do not have enough. 

It could be that their receipts are up more in a particular area 

than they are nationwide which is causing a shortage in a given 

area. There are a lot of different reasons why that might be. 

Mr. HALL. On a visit to Landstuhl, Germany, I was informed 

that efforts are underway to have the medical records for OIF/OEF 

soldiers leaving the medical facility available in an electronic format upon arrival on American soil. 

How accurate is that or how close to that are we and what are 

VA’s efforts and the status currently of efforts to have access to 

these records and to establish the level of disability or injury? 

Mr. WALCOFF. You want to take that? 

Mr. MAYES. Sure. That is one of the lines of action that is underway right now with the Senior Oversight Committee. I know that 

Dr. Tibbits from VA’s OI&T staff has been working with some individuals over at DoD at a high level. 

I do not know the exact status of the electronic transfer of those 

types of records. But I am aware that there are some records apparently that are available in the personnel file that we can actually access right now. But it is very limited. 

Ideally, we have the entire service treatment record available online. I mean, that is the ultimate goal and I know that is what the 

line of action team is pursuing. 

Mr. HALL. Does the IBM report address this in particular? 

Mr. WALCOFF. Not really. They did not get into the whole idea 

of electronic records in our relationship with DoD. It is not covered. 

Mr. HALL. Can any of you tell us how compatible or incompatible 

the DoD and VA systems are from a computer software standpoint? 

How close are we to being able to actually transfer that information? 

Mr. WALCOFF. I cannot answer the question. I do not know. I 

know that we are working with DoD on several different levels to 

try to be able to share records. But in terms of the medical records 

themselves. I do not know the answer. 

Mr. HALL. Mr. Cohen, I believe it was, on one of the other panels, 

was talking about inaccuracies or misdiagnoses in the DoD side 

and his concern about them being transferred to VA and being 

used as a starting point for whatever follows. 

Do you have any opinion as to the accuracy of what you are getting from DoD? 

Mr. MAYES. I do not think we would necessarily question, for example, a diagnosis by a medical care provider if it is in the service 

treatment records. But I can speak to the fact pattern that Mr. 

Cohen talked about. He mentioned that service personnel were 

being diagnosed with personality disorder and being put out of the 

military. 

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As long as they do not have a disqualifying separation, they file 

a claim with us and there is evidence of a neuropsychiatric disorder, whether or not there was a diagnosis of personality disorder 

or not, then we will go ahead and develop that claim. We will pursue that claim. 

And in many cases, I should not say many, I am aware of cases 

where there was a personality disorder that was referenced on the 

DD–214 and, yet, we got a diagnosis of a condition that is subject 

to compensation and have awarded disability benefits in those 

cases. 

So the point here is that we will treat that claim just like any 

other claim as long as there is no barred benefits and we will adjudicate it. We will develop for the evidence and in some cases, order 

an exam if appropriate and pay benefits if appropriate. 

Mr. HALL. That is good to hear. I am still curious if there is a 

percentage. But do you want to hazard a guess? 

Mr. MAYES. I do not have data that I am aware of that would 

show how many service personnel put out for personality disorder 

where we have seen those diagnoses. 

Mr. HALL. I mean, we have heard about it, but it is anecdotal 

and hard to quantify from my point of view in any way. But it is 

a concern, especially if we are thinking that, as some people have 

suggested to the Subcommittee or to the full Committee, that the 

parallel in the health maintenance organization/private sector 

world would be a diagnosis of a doctor. 

I go into an emergency room or go in to see my doctor and he 

takes an X-ray, says I have a broken leg, whatever. Either he or 

I file with the insurance company and that starts, you know, the 

claim out. And if we could rely on the medical records transferred 

from DoD and have that peg or at least approximate the level of 

disability that we are going to be looking at so that it sort of starts 

the process up. 

The question is, how reliable that is and what would trigger a 

reexamination being necessary? Could that be done on a random 

basis? 

I mean, you can never remove the human component completely. 

But we are hoping that the electronic and the AI aspect of this is 

going to help us reduce those parts of claims and those claims 

which are obviously valid and not have your people spending time 

on things that theoretically could be simple enough that they would 

be rated or processed by electronic means. It is being done in other 

areas of government and apparently successfully. 

The American Legion testified today about the brokering of 

claims which involve transferring claims from the Regional Office 

of jurisdiction to another Regional Office to adjudicate the claim, 

usually from a poor-performing RO to a high-performing RO. Apparently this brokering concept was instituted around the time of 

implementation of the CPI model. The Legion believes that this 

was intended to be a short-term solution as VBA does not have a 

tool in place to measure the quality of brokered work. 

Could you explain for the Subcommittee how and why VBA brokers its claims? Is this a resources, training, or management problem? Are these claims being checked for quality and how does the 

brokering figure into the strategic plan for processing claims? 

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Mr. WALCOFF. I can definitely do that since I was very involved 

in the decision to start the extensive brokering that we do. 

It really does not have anything to do with the CPI model per 

se. You have heard testimony and I think, you know that we do 

have variation in terms of performance from office to office around 

the country. 

I wish I could tell you that all 57 of our offices were performing 

very, very well—equally well. But the fact is that for a lot of different reasons, we have some offices that have more of a backlog 

than other offices do. 

In addition to that, we have organizations called Resource Centers that were set up back in 2000, 2001. The purpose of them 

being set up originally was to work the diabetes claims that were 

going to be coming in when the new presumptive was passed. For 

a lot of reasons, that is not what they were used for. 

But we have started using them or started using them back 

around 2002 to handle the work that was backing up at some of 

our stations that were not doing as well. 

And the philosophy is that, and I will use an example, sir, of 

your home office of New York, that if a veteran lives in the southern part of New York in New York Regional Office that he should 

not have to wait an extra 80 to 100 days, let us say, to get that 

case done because he happens to live in New York where if I move 

that case to Salt Lake City or Milwaukee, I can get the case probably turned around in 30 days. 

And that is the basic philosophy. The fact is we do not have, in 

my view, New York veterans or Utah veterans. We have veterans 

of this country and they all deserve to get their case worked as 

quickly and as accurately as possible. 

And if we can find a way to keep that case from sitting some 

place and get it moved and get it worked, we are going to do that. 

And that is really the basic philosophy behind brokering. 

Now, the answer to the other part of it, I know it was mentioned 

in here by somebody that we do not do quality checks on the brokered cases and that is not true. 

Brad, you might want to talk about that. 

Mr. MAYES. Yeah. We are now including the brokered work as 

part of our Systematic Technical Accuracy and Review Program or 

the STAR Program. So I believe there was a limitation at one point 

in attributing those cases to the Regional Office that actually did 

the work, but we are incorporating brokered work into those reviews. 

Mr. HALL. CPI was supposed to eliminate the inconsistencies in 

ROs, so—— 

Mr. MAYES. Well, okay. Let me—— 

Mr. HALL [continuing]. Was that the idea? 

Mr. MAYES. What he was talking about, the quote that I guess 

that somebody read out of Admiral Cooper’s task force, what he 

was referring to had to do with the fact that when he came in, he 

found that every office was processing work in a different way. 

We would put a policy out from Central Office. The C&P Service 

would put a policy out and we found that there were offices that 

were deciding, yeah, that is a good policy. I am going to do that 

policy. And then there were other offices that said, you know, I do 

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not agree with that. I am just going to ignore it. And then there 

were other offices that said, well, I am going to do it, but I am only 

going to half do it because Joe Thompson is going to be gone soon 

anyway, so, you know, it will all go away. 

And Admiral Cooper felt, based on his background of being in the 

Navy for 33 years that that was an unworkable system. Once the 

headquarters’ organization puts a policy out, everybody has to follow it. You cannot have the people in the field making a decision 

as to whether they like that policy or not and deciding whether to 

apply it or not. 

We would put IT applications out and offices would make their 

own decisions as to whether they were going to use them or not. 

So, therefore, it really became difficult as you would try something 

new to see whether it would work in a given place because a given 

place was not necessarily the same as three other places. 

And that is what he meant in terms of consistency, that the offices need to be structured the same, meaning they all should be 

under the CPI model, and that everybody should follow the policies 

that are decided. There will be time for discussion, that type of a 

thing. But once a decision is made, everybody does what they are 

told to do. And that is what he meant by consistency. 

Mr. HALL. You will be happy to know this is my last question, 

Mr. Walcoff. 

Mr. WALCOFF. That is fine. 

Mr. HALL. It has been mentioned several times before the Subcommittee that providing a prestabilization rate, as outlined in title 

38, as well as possibly expanding the Benefits Delivery at Discharge Program would help provide many veterans who are waiting 

for the adjudication of claims. 

Could you give us your thoughts on these ideas? 

Mr. WALCOFF. I think one of the things that we have discussed 

actually fairly recently that we are concerned about is that I do not 

think our people in the field are making proper use of the pre-stabilization ratings. 

Just in looking at the numbers that we see, it appears like there 

should be more of them and that is one of the things that I am 

going to talk to Diana about working with the service to see what 

we need to do to find out why stations are not using pre-stabilization ratings. 

Now, one thing I will tell you, sir, is that on the seriously injured 

cases, there is an assumption that if on a given case it took us, say, 

150 days to process the case, that means that the veterans did not 

receive anything for 150 days. 

In most of those cases where the condition that is actually the 

most serious, let us say it is an individual with an amputation, 

that amputation, that leg amputation should be able to be rated 

based on the service treatment records from Walter Reed. 

Now, that does not mean we can take the end product on the 

case because maybe he also filed for a hearing loss and for a back 

condition or whatever. But the way our process, the way our procedures are laid out, the Regional Office is supposed to pay for the 

amputation, get that money out to the individual, and then develop 

for everything else. That is the procedure that we have so that in 

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a situation like that, the veteran would not have to wait the 150 

days. 

Mr. HALL. Is that happening to your knowledge? 

Mr. WALCOFF. I believe it is happening, but I will tell you that 

anecdotally, I have heard some people complain to me that because 

you do not get credit for the case, you know, when you put the 40 

percent out for the leg that stations are holding off on doing that 

until they can do the whole case. 

And I will tell you that I tell them and I have told Brad in terms 

of his STAR reviews that that is one of the things I want them 

looking at. And if we find any cases where they are doing that, I 

want to know about it because that is absolutely contrary to the 

policy we put out and it is contrary to doing the right thing. 

Mr. HALL. Well, thank you for expressing that sentiment and for 

passing it on to your employees. I think this Subcommittee would 

agree wholeheartedly with that approach. 

And thank you for testifying. Thank you for being here. Thank 

you for waiting so long, Mr. Walcoff, Ms. Rubens, Mr. Mayes. We 

may have other questions that we will submit in writing to you. 

And thank you for the work that you do and have a good evening. 

The Minority will submit questions on behalf of the Ranking 

Member and the record will stay open for 5 days. 

[No questions were submitted.] 

Mr. HALL. Okay. I just wanted to thank you again for your work 

on behalf of our Nation’s veterans and thank everyone who testified. Some of you from the beginning are still here. We look forward to working with all of you on those important issues involved 

with improving the claims process system. 

This hearing now stands adjourned. 

[Whereupon, at 6:25 p.m., the Subcommittee was adjourned.] 

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A P P E N D I X 

Prepared Statement of Hon. John J. Hall, Chairman, 

Subcommittee on Disability Assistance and Memorial Affairs 

Today we are here to examine the VA’s claims processing system and its attendant disability claims backlog. 

There are many areas to explore when trying to determine why the disability 

claims backlog has reached the point of unmanageability and why this is the second 

time in a seven-year time period that we’ve reached this crisis point. 

From 2002–2007, the disability claims backlog has risen from about 250,000 to 

nearly 650,000. During the same period, the VBA consistently missed its performance targets on nearly all compensation and pension claims processing fronts. 

These failures engender many questions about the complexity of the system VA 

has created and the model upon which it is built. One of my leading questions concerns the effectiveness of the Claims Processing Improvement (CPI) model and its 

suitability to establish meaningful accountability parameters to eliminate the claims 

backlog and accurately process claims. Thus far, none of VA’s own benchmarks have 

improved since its implementation, and I find this fact disturbing. 

Moreover, it seems as if the failure is not necessarily with the system itself but 

with the failed execution of the processes that are supposed to be reinforced with 

transparent and highly visible accountability measures to make it work. 

As outlined by the 2001 VA Claims Processing Taskforce Report, led by Daniel 

L. Cooper, now VA Under Secretary for Benefits Cooper, ‘‘accountability includes not 

only the proposition that a leader is responsible for the actions of the group but also 

is accountable for the results of those actions or inactions. This single attribute is 

the most serious deficiency in the VBA organization.’’ At the time, Dan Cooper was 

referring to VBA’s then-failed claims processing system, SDN. I think many of those 

who testify today will concur that these same observations could apply both to today’s VBA organization and its claims processing system. 

One can only wonder, where is the accountability in a work credit system whose 

only meaningful measure is productivity and where quality seems to be an afterthought. One where only about 2% of all claims are checked for quality and 1 in 

10 claims is processed incorrectly. 

This error rate is unacceptable and indicates that VA needs to improve its training regimens to ensure uniformity across ROs and that highly qualified individuals 

are processing and adjudicating claims. 

Further, I ask why are bonuses consistently paid to managers at both the Regional and Central Offices while claims languish. I want VA management to adopt 

this principle—be accountable for the backlog, don’t pay yourselves anything extra 

until the veterans are paid. 

I know VA contends that all of its inventory is not backlogged, but try selling 

these semantics to veterans waiting 183 days and longer for decisions on their 

claims. From the Committee’s standpoint based on the VA’s current performance, 

most of the disability claims in its inventory are eventually going to become a part 

of those claims pending longer than VA’s target of 145 days for claims processing. 

Hence, part of the backlog. 

Moreover, the Committee does not consider an increase in processing times from 

177 days in 2006 to 183 days in 2007, accompanied by an increase in VBA’s target 

performance days for processing claims from 125 days to 145 days during the same 

time period as progress and neither do our veterans. VA should not conceive of moving its performance targets to compensate for its poor performance. I am confounded 

by these actions and would like an explanation—so would our veterans. 

I am encouraged by some of the numbers from VA’s FY 2009 Budget that indicates a 19% increase in VBA IT funding to support efforts to move to a paperless 

claims environment and increased funding for VETSNET. While technological improvements alone won’t solve the backlog problem they are clearly critical to the sowwoods2 on PRODPC68 with HEARING

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lution. I am also anxious to see the results of IBM’s study of the VBA’s business 

processes involved with adjudicating a claim. This type of review is long overdue. 

I am also encouraged to see that VA is requesting more money to add 703 FTEs; 

yet I am aware that you have been unable to maximize the performance of the 

record number of 3100 FTEs that this Congress ensured that you receive during the 

last two funding cycles. 

Let’s be very clear, this is not just a people problem and adding more people to 

a broken system cannot be the only answer to vanquishing the claims backlog and 

improving processing times. To date, this single-minded approach has proven unsuccessful at best. 

I think the major faulty premise in this system is that the VA behaves as if it 

is only accountable to meet the numerical targets it sets and Congress tacitly approves. 

But, I want to reinforce that you are actually supposed to be accountable to the 

veteran who has borne the battle and to his widow and his orphan. I believe we 

need to refocus and refine our Nation’s claims processing system to make it accountable to producing better outcomes for our veterans, their families and survivors. 

I thank the witnesses on the first three panels for their thoughtful, solution-oriented testimonies. I hear the frustration in your statements and I look forward to 

working on ways to implement the workable solutions many of you offer. 

I know that the backlog has taken on a life of its own. However, it is not bigger 

than the collective will we devote to eliminating it and to honing a claims processing 

system that is veteran-focused, not process-focused. 

Last, I know that VA cannot be pleased with its current disability claims processing performance, and I look forward to hearing VBA’s strategic plan for addressing these serious concerns. Secretary Peake has highlighted this issue as one of his 

top priorities and I hope the VA sees Congress as a friend and not a foe in helping 

to correct the shortfalls in its disability claims processing system. 

I believe that just like the VHA experienced a revolutionary transformation, it is 

well-time to think of devoting the same type of resources into transforming the 

VBA. It is time for a paradigm shift. 

Our veterans deserve the benefit of our collective resources to ensure that this 

process becomes a world-class, 21st century model that reflects their priceless sacrifice to our Nation. 

f 

Prepared Statement of Hon. Doug Lamborn, Ranking Republican Member, 

Subcommittee on Disability Assistance and Memorial Affairs 

Thank you Mr. Chairman for yielding. 

I look forward to hearing our witnesses’ testimony on how we might address the 

challenges and opportunities facing VA’s Compensation and Pension Service. 

In fiscal year 2007, Compensation and Pension Service, commonly referred to as 

C&P, performed more than 838 thousand rating decisions. 

C&P also performed nearly 582 thousand claims actions that did require rating 

decisions. 

Yet, despite the tremendous volume of work accomplished, C&P finds itself behind 

in its struggle to overcome the steady accumulation of claims awaiting action. 

An array of reasons contributes to this frustrating trend, and our witnesses outlined a number of them in their written statements. 

Foremost among them will be that VA place more emphasis on accuracy and less 

on alacrity, rating decisions must be done right the first time. 

I wholeheartedly agree . . . 

But as much as we may ponder and discuss solutions to the multitude of underlying problems, I think we all recognize that the time has arrived for a reasonable, 

yet fundamentally different approach to the problem. 

If we continue to merely tread water, we are going to sink. 

As my Subcommittee colleagues are aware, I have long been an advocate for 

major reform with regard to the use of information technology. 

I am heartened to know that they concur with my perspective that it is well past 

time for VA to embrace IT as a remedy to an outdated paper based system. 

VA should be on the forefront of technology in the disability benefits arena, and 

I believe it can be. 

Not too long ago, VA’s healthcare system was so poor it was the subject of derision 

in movies such as ‘‘Born on the 4th of July.’’ 

Now, VA healthcare is the subject of emulation among a number of high-quality 

medical models. 

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I believe VA can make a similar ascension on the benefits side of the Department. 

We must be open to considering new ideas, especially in the area of IT, and not 

be bound by narrow paradigms. 

I invite the members of the Subcommittee, the veterans groups, and others to 

offer suggestions that will improve the process for our future veterans. 

Thank you, Mr. Chairman. I yield back. 

f 

Prepared Statement of Joyce McMahon, Ph.D., Managing Director, 

Center for Health Research and Policy, 

Center for Naval Analyses (CNA) Corporation, Alexandria, VA 

Chairman Hall, Representative Lamborn, distinguished members, I appreciate the 

opportunity to testify before the House Subcommittee on Disability Assistance and 

Memorial Affairs of the House Committee on Veterans’ Affairs today on the subject 

of the VA’s Claims Processing System. This testimony is based on the findings reported in Final Report for the Veterans’ Disability Benefits Commission: Compensation, Survey Results, and Selected Topics, by Eric Christensen, Joyce McMahon, 

Elizabeth Schaefer, Ted Jaditz, and Dan Harris, of the CNA Corporation (CNA). Details on the specific findings discussed here can be found in the report, which is 

available at http://www.cna.org/domestic/healthcare/. The report also includes reference sources. 

The Veterans’ Disability Benefits Commission (the Commission) asked CNA to 

help assess the appropriateness of the benefits that the Department of Veterans Affairs (VA) provides to veterans and their survivors for disabilities and deaths attributable to military service. Specifically, the Commission was charged with examining 

the standards for determining whether a disability or death of a veteran should be 

compensated and the appropriateness of benefit levels. The overall focus of our effort was to provide analyses to the Commission regarding the appropriateness of the 

current benefits program for compensating for loss of average earnings and degradation of quality of life resulting from service-connected disabilities for veterans. We 

also evaluated the impact of VA compensation for the economic well-being of survivors and assessed the quality of life of both service-disabled veterans and survivors. 

We also explored other issues for the Commission and documented those results. 

Pertinent to this testimony is that we were asked to: 

• Compare the VA disability compensation program to other disability programs. 

• Conduct surveys of raters and Veterans Service Officers (VSOs) with regard to 

how they perceive the processes of rating claims and assisting applicants. 

First we will discuss how we compared the VA disability compensation program 

to other disability programs with respect to the ratings process. We will then summarize the primary relevant findings based on conducting surveys of raters and 

VSOs. 

Comparing the disability ratings process across disability programs 

The Commission asked us to compare VA’s program with other federal disability 

compensation programs in order to determine whether there are any useful practices that VA could adopt to improve its own operations. Our first task was to identify the major criticisms of operations in the VA disability program. We reviewed 

a variety of publicly available sources that discussed problems with VA performance, including reports from the Government Accountability Office (GAO), reports 

from the VA Office of the Inspector General (OIG), and congressional testimony. 

Next we spoke with the relevant VA staff to get the most current information on 

the areas being criticized. We interviewed people in the Veterans Benefits Administration’s (VBA’s) Compensation and Pension Service, VBA’s Office of Employee Development and Training, the Board of Veterans’ Appeals, and the Office of the General Counsel. We discussed specific aspects of VA operations that were identified as 

problematic and the approaches that the other disability programs take in those 

areas. Our focus was limited to federal programs paying monetary benefits to disabled individuals, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) under the Social Security Administration (SSA), 

Workers’ Compensation under the Federal Employees’ Compensation Act (FECA), 

disability retirement for federal employees under the Federal Employee Retirement 

System (FERS) and the Civil Service Retirement System (CSRS), and DoD’s Disability Evaluation System (DES). 

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We found that there were no formal evaluations of the effectiveness of specific 

practices in other programs in the areas identified as problematic for VA. We decided to first determine whether a program used a practice different from VA’s and 

then to consider whether the other program’s practice might be an improvement 

over VA’s. We consulted a variety of sources, including GAO reports, congressional 

testimony, and personal interviews. We spoke with staff in various offices in the Social Security Administration, the Department of Labor, the Office of Personnel Management, and DoD. 

Differences noted across disability compensation programs 

There are many differences across the disability programs in terms of purpose, 

administrative processes, eligibility, benefits, and size. These differences may limit 

the potential applicability for VA of lessons from the other programs. For example, 

each disability program has different administrative processes for filing claims and 

making appeals. The various disability compensation programs also have different 

criteria for determining eligibility and benefit levels, and different purposes of the 

monetary compensation, varying from partial or full replacement of earnings to an 

income supplement, or even to compensation for a shortened career. 

The purpose of the VA program is to compensate disabled veterans for earnings 

lost due to their disability, although there is no mechanism for calculating individual-specific earnings losses (except for cases of Individual Unemployability (IU)). 

A disability is defined as either an injury or a disease that resulted from service 

or as a pre-existing injury or disease that was aggravated by service. A veteran can 

have multiple disabilities, each of which is assigned a rating reflecting its severity. 

The combination of the disability ratings for all disabilities determines a veteran’s 

level of compensation. 

The amount and type of information needed for each program are important determinants of how difficult and time-consuming it is to process and resolve a claim. 

For example, the VA, FECA, and DES programs all require that a disability be a 

consequence of an individual’s job in order to be eligible for compensation. The connection between employment and disability is straightforward to demonstrate sometimes, but not always, especially for VA cases in which the injury or disability may 

have occurred many years previously, and may require providing extensive documentation. Although in general the VA program does not require a decision about 

how much the disability affects a particular veteran’s employment and earnings (except for IU cases), it does require raters to determine the extent and nature of multiple disabilities. 

Measures of performance 

For any disability compensation program, three important measures of performance in claims processing are timeliness, accuracy, and consistency. In addition, we 

consider issues involving training, productivity standards, and staff turnover. 

Timeliness 

Beginning with timeliness, we note that the time required to decide and resolve 

a claim depends on how complex the design of the program is. For example, although the VA program does not need to know a claimant’s earnings history, it does 

need to determine service connection and severity for each disability, and each claim 

can have multiple disabilities. 

Compared to the other disability programs, VA performance in terms of timeliness 

is poor. The average time for VA to complete a claim (without appeals) in FY2006 

was 177 days. In comparison, the average for SSDI was 88 days in FY2006, and 

OPM staff reported that the FERS/CSRS average is currently 38 days. In general, 

the FECA and DES programs also reported shorter times to adjudication than the 

VA average. 

Because of the differences across programs in the work required to process a 

claim, it is difficult to say whether VA’s timeliness problems are due to the complex 

nature of its disability decisions, staffing shortages, low productivity, or some other 

factors. To know how best to address its problems with timeliness, it would be useful for VA first to disaggregate that 177-day average so that it understands what 

stages of the claims process are contributing most to the total processing time. 

With respect to specific strategies to improve timeliness, VA already does make 

use of ‘‘Tiger Teams’’ to deal with cases that are designated as high priority at any 

given time, such as very longstanding cases or cases where the veteran is very old 

or terminally ill. Because the success of those teams comes from the fact that they 

are made up of the most experienced staff, unfortunately the Tiger Team approach 

is not something that VA can replicate on a larger scale (i.e., there are not enough 

experienced employees to staff a large number of Tiger Teams). VA might also learn 

from SSA’s new Quick Disability Determination (QDD) process, which involves 

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using a predictive model to identify cases with a relatively high probability of being 

granted benefits and then trying to act on those cases within 20 days. 

Accuracy 

Accuracy is another major dimension of the quality of claims processing. VA’s accuracy rate in 2006 was 88 percent. Accuracy is based on whether all issues in the 

claim were addressed, whether the claim was developed in compliance with the Veterans Claims Assistance Act, and whether the rating decision, effective date, and 

payment date were correct. VA’s accuracy is below the overall accuracy rate for 

SSDI, which is 96 percent, but the difference is not large. However, when comparing 

accuracy one should remember that the programs have different requirements for 

processing a claim. In particular, the fact that VA has to rate the severity of a disability creates more potential for error than the yes-or-no disability decision that is 

required for SSDI. 

We were unable to obtain overall accuracy rates for the other programs. However, 

in comparing other programs’ practices with VA’s, the only practice that is substantively different from VA’s is SSA’s practice of focusing on the most error-prone 

type of cases. Incorporating this element could be worthwhile for the VA because 

it would result in a disproportionately large gain in accuracy for any given increase 

in the number of reviews. 

Consistency 

Measuring consistency in disability programs is difficult, and none of the programs currently has a measure of consistency of the level that GAO recommends 

for that task, including the use of multivariate analysis to examine disability decisions while controlling for various factors, and in depth independent review of statistically selected case files. Although VA has studied recommendations to improve 

consistency, the lack of consistency evaluations across programs makes it impossible 

to compare consistency. 

Possible ways to improve consistency might include standardizing training for raters, improving standardization of medical examinations, and consolidating the rating process into fewer locations. In addition, it is worth noting that there have been 

criticisms of SSA regarding consistency, which in part may be due to the task of 

determining medical eligibility, which involves considerable subjectivity. 

Physical consolidation is also a way to reduce inconsistency in disability programs, and it is an approach that is already being considered by VA. VA disability 

compensation claims are currently processed in 57 Regional Offices (ROs), and GAO 

has recommended that VA consolidate some of its disability compensation operations as one way to improve claim processing quality and reduce variation across 

regional offices. VA reports that it does in fact have plans to consolidate some of 

its disability claims processing in the future, based in part on past successes in consolidating some other areas of operations. However, this may create less in-person 

access for some veterans. 

SSA has a similar regional variation to that observed for the VA. The other programs face fewer consolidation issues or concerns, because they are much smaller 

programs and have fewer offices and locations for processing claims. 

We also considered a variety of other issues that were identified as potential problems for the VA. We considered the claim that the VA emphasizes quantity over 

quality in performance evaluations of individual employees, which might lead to 

hasty decisions that would in turn lead to appeals and more backlogs. However, an 

emphasis on productivity has been identified as having the potential to negatively 

affect accuracy in SSA as well. The tension caused by quantity standards, even if 

accompanied by quality standards, appears to be an issue for the other disability 

compensation programs as well as for VA. 

Training Issues 

VA has also received criticisms in the area of staff training. However, examination 

of the other disability programs shows that VA certainly is not lagging behind in 

its training efforts. None of the other programs seems to have any formal evaluation 

of their training either. VBA has also recently focused on increasing the standardization of training. It is worth noting that no other disability program has VA’s level 

of standardization. 

Staff Turnover 

For the VA program, high staff turnover is viewed as creating a problem for the 

quality of claims processing by lowering the overall level of expertise. By comparison, it is not clear that the one-year attrition rate for VA disability examiners differs from the rate for all new federal employees. However, minimizing turnover is 

especially important for VA because of the lengthy training time required for claims 

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processing. GAO has recommended that it might be useful for the VA to take steps 

to quantify the reasons that raters resign. In any event, VA is not the only disability 

program facing the problem of high staff turnover, which has been identified as a 

particularly difficult issue for SSA. The other disability compensation programs reported similar staff turnover concerns. 

Summary of comparisons across programs 

Except for the very important issue of timeliness, VA does not appear to be underperforming in comparison with other disability programs. Recent training improvements seem promising for improving VA timeliness in the long term, but effects will 

not be seen for a while. Some of VA’s problems with timeliness could be the result 

of a complex program design, with multiple disabilities per claim, the need to determine service connection (sometimes many years after separation), and the need to 

assign a disability rating to each disability. For VA to develop a focused strategy 

to improve timeliness, it first needs to determine the stages of the claims process 

that are contributing most to the total elapsed time required to complete a claim. 

Raters and VSOs survey results 

With regard to the benefits determination process, the Commission asked us to 

gather information by conducting surveys of VBA rating officials and accredited veterans service officers (VSOs) of National Veterans Service Organizations (NVSOs). 

The intent was to gather insights from those who work most closely with the benefits determination and claims rating process. Through consultation with the Commission, we constructed separate (but largely parallel) surveys for raters and VSOs. 

We focused on the challenges in implementing the laws and regulations related to 

the benefits determination and claims rating process and perspectives on how the 

process and rating schedule perform. 

Survey content 

The surveys explored issues involving training, proficiency on the job, and resource availability and usage. Respondents were asked about what they considered 

to be their top three job challenges. They were also asked about how they decided 

or established specific criteria related to a claim, how smoothly the rating process 

went, the perceived capabilities of the various participants in the process, which 

types of claims were most difficult to process, and what resources would improve 

the claims process. 

Assessment 

The overall assessment indicated that the benefits determination process is difficult to use by some categories of raters. Many VSOs find it difficult to assist in 

the benefits determination process. In addition, VSOs report that most veterans and 

survivors find it difficult to understand the determination process and difficult to 

navigate through the required steps and provide the required evidence. Most raters 

and VSOs agreed that veterans have unrealistic expectations of the claims process 

and benefits. 

Raters and VSOs noted that additional clinical input would be useful, especially 

from physicians and mental health professionals. Raters felt that the complexity of 

claims is rising over time, and that additional resources and time to process claims 

would help. Some raters felt that they were not adequately trained or that they 

lacked enough experience. They viewed rating mental disorder claims as more problematic than processing physical condition claims. They viewed mental claims, especially PTSD, as requiring more judgment and subjectivity and as being more difficult and time-consuming compared to physical claims. Many raters indicated that 

the criteria for IU are too broad and that more specific decision criteria or evidence 

would help in deciding IU claims. 

Specific findings 

The findings identify several problematic issues related to the benefits determination process that bear on the challenges inherent in implementing, assisting, and 

navigating the claims process, including: 

• Both raters and VSOs identify additional clinical input on rating teams as potentially useful, especially from physicians of appropriate specialties and from 

mental health professionals. VSOs identify rehabilitation specialists and medical records specialists as other potentially useful sources of input. • There is a relatively wide range of perceived training adequacy, perceived proficiency in knowledge, skills and abilities (KSAs), KSAs relevant to the performance of the rater’s role, and years of rating experience among rating officials 

that appears to be related to raters’ ability to implement the process and their 

ease at rating and otherwise deciding claims. Raters who feel less well-trained 

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or less proficient and those who have fewer years of rating experience generally 

find the process more problematic. 

• Raters’ perceptions regarding their training adequacy and their KSA proficiency 

are both somewhat related to their perceptions of the availability of the resources they need to decide a claim such as computer system support, information and evidence, time, and administrative/managerial and clerical support. As 

perceived training adequacy and KSA proficiency increase, so does perceived resource availability. 

• In many respects, rating or otherwise deciding mental disorder claims is generally more problematic than rating or deciding physical condition claims. Both 

raters and VSOs see claims with mental disorder issues, especially PTSD, as 

requiring more judgment and subjectivity than claims with physical condition 

issues. Raters and VSOs also indicate that it is less likely that mental disorder 

issue claims rated by different raters at the same VA Regional Office would receive similar ratings. Raters and VSOs also both indicate that deciding the various criteria of a claim is more problematic for mental disorder than for physical 

condition claims. 

• A significant majority of raters indicate that more specific decision criteria or 

more specific evidence regarding individual unemployability (IU) would be helpful and that the criteria for IU are too broad. 

• Rating physical conditions in several body systems or subsystems also appears 

problematic. Raters identified neurological and convulsive disorders, musculoskeletal disorders (especially involving muscles), and disorders of special sense 

organs (especially eyes), along with mental disorders (especially PTSD), as the 

most difficult to rate, the most difficult to apply the Rating Schedule to, and 

the most time consuming to rate. 

• Time to rate or otherwise decide a disability claim is a scarce resource and a 

major challenge for raters; it is also a challenge for VSOs and their veteran and 

survivor clients to get claims decided in a timely manner. Time appears to be 

most challenging when raters are deciding complex claims, and raters report 

that they see claims getting more complex over time. 

• A large majority of raters reported that they had insufficient time to rate or 

otherwise decide a claim, and both raters and VSOs reported that there was too 

much emphasis on speed relative to accuracy. 

• Obtaining needed evidence, especially given the challenge and scarcity of time 

and the insufficiency of many medical examinations (in particular from private 

examiners, according to raters) is a challenge in its own right. 

• Separately rating the impact of a disability on quality of life and lost earnings 

capacity was not supported by a majority of either raters or VSOs. The use of 

computerized decision support technology was not supported by raters; however, 

raters reported that the use of standardized assessment tools and more specific 

criteria for rating and deciding mental health issues—especially PTSD—would 

be useful. 

• The process is difficult for most veterans and survivors to understand and navigate. Assisting clients to understand the process and the evidence needed for 

it is a major challenge for VSOs. A majority of VSOs further report that they 

disagree that the process is satisfactory to most of their clients. A majority of 

both raters and VSOs indicate that they believe veterans have unrealistic expectations of the claims process and the benefits they should receive. 

• Overall, most raters and VSOs report that they believe that the claims rating 

process generally arrives at a fair and right decision for veterans. Further, in 

general, raters and VSOs assessed the performance of their VSOs (and each 

other) as good; however, most raters reported that they believe VSOs inappropriately coach their clients. 

Summary of survey findings for raters and VSOs 

The purpose of these surveys was to provide the Commission with insights and 

perspectives from those on the frontlines of the benefits determination process— 

VBA rating officials who rate and otherwise decide disability claims, and VSOs who 

assist veterans and their survivors to prepare, present, and prosecute disability 

claims. The findings presented in the previous section portray a picture of a benefits 

determination process that is difficult to use by some categories of raters, difficult 

to assist by many VSOs, and difficult to navigate or understand by most veterans 

and survivors. 

In summary, these survey results and findings highlight some specific issues that 

reflect challenges inherent in the benefits determination process. Addressing these 

challenges may assist in improving the overall VA rating process. 

f 

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Prepared Statement of Michael McGeary, Senior Program Officer and 

Study Director, Committee on Medical Evaluation of Veterans for 

Disability Benefits, Board on Military and Veterans Health, 

Institute of Medicine, The National Academies 

Good morning, Mr. Chairman and members of the Committee. My name is Michael McGeary. I am a Senior Program Officer of the Institute of Medicine (IOM) 

and served as the staff Director of the IOM’s Committee on Medical Evaluation of 

Veterans for Disability Benefits. Established in 1970 under the charter of the National Academy of Sciences, the IOM provides independent, objective advice to the 

Nation on improving health. 

The Committee on Medical Evaluation of Veterans for Disability Benefits (the 

Committee) was established at the request of the Veterans’ Disability Benefits Commission and funded by the Department of Veterans Affairs (VA). 

In its June 2007 report, A 21st Century System for Evaluating Veterans for Disability Benefits, the Committee assessed the medical criteria and processes used by 

VA to determine the degree of disability of service-connected veterans. The Committee did not, however, assess nonmedical aspects of the VA disability claims process and therefore the report does not address all factors that might affect the timeliness of decisions on claims. The Committee did not, for example, evaluate the adequacy of staffing levels or the performance of management information systems. 

Chapter 4 of the report focuses on the medical criteria VA uses to assess degree 

of disability, which are embodied in the VA’s Schedule for Rating Disabilities. Dr. 

Lonnie Bristow, who chaired the Committee, is scheduled to testify before you on 

the Rating Schedule on February 26. Chapter 5 of the report, which I am here to 

review today, focuses on the medical examination and disability rating parts of the 

claims process. Chapter 5 includes background information on the organization of 

the claims process and some statistics on workload trends and the timeliness and 

accuracy of decisions, which I will summarize briefly. 

Disability Claims Workload—Veterans Benefits Administration (VBA) 

Between 2000 and 2006, the annual number of claims from veterans for disability 

compensation increased by 56 percent (from 420,000 to 650,000). VA was able to decide 630,000 claims in 2006, almost as many as were filed, but the backlog of pending claims increased. At the end of 2006, 378,000 claims were pending, 83,000 of 

them for more than six months. 

Disability Claims Workload—Board of Veterans Appeals (BVA) 

Between 2000 and 2006, the annual number of formal appeals filed on VA Form 

9 increased by 42 percent (from 33,000 to 46,000). Although there were fewer Veterans Law Judges (VLJs) in 2006 than in 2000, the annual number of completed 

decisions grew, but not enough to keep the backlog of cases pending at BVA from 

doubling from 20,000 to 40,000. This did not include about 130,000 appeals being 

reconsidered at the regional office level, either before going to BVA or on remand 

from BVA. 

Timeliness of Disability Decisions—VBA 

The average elapsed time from the date the claim requiring a disability decision 

is received to the date it is decided at the regional office level was 177 days in 2006, 

up from 166 days in 2004 but down from 223 days in 2002. 

Timeliness of Appeals Decisions—VBA and BVA 

The average number of days to resolve appeals by VBA and BVA was 657 days 

in 2006, more than the 529 days it took in 2004 but less than the 731 days it took 

in 2002. 

Accuracy 

VBA and BVA each review a sample of decisions for quality assurance purposes. 

In 2006, 88 percent of rating-related cases met VBA’s accuracy standard, compared 

with 80 percent in 2002. BVA’s rate of deficiency-free decisions was 93 percent in 

2006, compared with 88 percent in 2002. 

Consistency 

VA does not assess consistency of decisionmaking on a regular basis. There are 

indications of substantial variability in decisionmaking from state to state, for example, in the average number of disabilities per veterans; average combined degree 

(or severity) of disability; average rating level for each of the 14 body systems; percentage of veterans service connected for PTSD, for ratings of 100 percent, and for 

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individual unemployability; and in the percentage of appeals in which the appellant 

is successful. 

IOM Committee Recommendations for Improving the Medical Examination 

Process 

The medical aspects of the claims process that the Committee looked at were, 

first, the medical examination process and, second, the disability rating process. 

Applicants for disability compensation are asked to provide their medical records 

and, under the duty-to-assist law, VBA helps them obtain those records, especially 

their service medical records. In nearly every case, VBA has applicants undergo a 

compensation and pension, or C&P, examination performed by a Veterans Health 

Administration (VHA) or contractor clinician. The reports of these C&P examinations become part of the medical evidence that VBA’s raters use to evaluate the degree of disability of the veteran and to assign a rating between 0 percent and 100 

percent in 10 percent increments. The rating level in turn determines the amount 

of compensation the applicant will receive. 

The Committee found that VBA and VHA have improved the quality and timeliness of medical examinations greatly in the last 10 years but made three recommendations for further improvements. First, VA has developed standardized examination worksheets for more than 70 common conditions, to increase completeness and consistency of examination reports. VA does not, however, have a regular 

process for updating the worksheets. Most were developed a decade ago, and the 

Committee found some outdated tests and procedures. The Committee recommended, therefore, that VA implement a process for periodic updating of the disability examination of the worksheets, which should be part of, or closely linked to 

the process for updating the Rating Schedule recommended by the Committee, with 

input from an expert advisory Committee, also recommended in the report. 

Second, VA has developed interactive online versions of the examination worksheets, which result in quicker and higher quality reports than dictated reports. VA 

has not made use of the online templates mandatory, and the Committee recommended that VA make them mandatory. 

Third, the Committee found that VA’s quality review of the examination process 

was more procedural than substantive, measuring whether a requested item is included in the report, not whether the item is accurate. The Committee recommended 

that VA establish a regular assessment of the substantive quality and consistency, 

or inter-rater reliability of examinations and, if the assessment finds problems, to 

address them, for example by revising the templates or adjusting the training program. 

IOM Committee Recommendations for Improving the Rating Process 

After the information needed to adjudicate a claim is collected, including the C&P 

examination report, the veteran’s file is given to a nonmedical rater, who compares 

the information in the file with the criteria in the Rating Schedule to determine the 

rating level. The Committee offered three recommendations for improving the rating 

process. 

First, the Committee found that accuracy rate of rating decisions has increased 

steadily since VA introduced a quality review program in 1998, from an accuracy 

rate of 64 percent to 88 percent in 2006. The sample size is small, however, only 

enough to determine the overall accuracy rate of regional offices, not the accuracy 

of decisions at the body system or diagnostic code level. GAO and VA’s Office of Inspector General have noted indicators of variability in decision outcomes and urged 

VA to identify disabilities subject to a great deal of decisions variability, understand 

the reasons for the variability, and act to reduce the variability where possible. The 

Committee recommended that VBA periodically assess inter-rate reliability at the 

diagnostic code level and study the accuracy and validity of ratings. For example, 

VBA could have a sample of claims rated by two or more raters and analyze the 

degree of consistency in the ratings given. It could sample ratings given for a particular diagnostic code across field offices to analyze inter-rater and inter-office differences. 

Second, the Committee found that raters should have better access to medical expertise. The raters are not medical professionals. If they have a question about the 

meaning of a test result or if the evidence is inconclusive or incomplete, they have 

to refer the case back to VHA, which adds time, or make a decision based on incomplete information, which affects accuracy. The Committee recommends that VBA 

have medical consultants available to raters in the regional offices. With modern 

communications technology, VBA medical consultants could be in a national or in 

regional centers. 

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At one time, there were physicians on the rating boards, but the U.S. Court of 

Appeals for Veterans Claims barred the participation of physicians in rating decisions. The Committee believes that the court’s decision was based on a misunderstanding of the role of physicians in adjudication, which is different from the role 

of treating physicians. All other major disability programs, such as Social Security’s, 

DoD’s disability evaluation process, and the Federal Employee Compensation Act 

program and civil service disability retirement programs, either have physicians or 

other appropriate clinicians involved in the adjudication decision or have medical 

experts readily available to review and discuss claims with lay disability raters. 

The third recommendation regarding the rating process is to develop and mandate 

uniform training and certification programs across all regional offices with standardized objectives and outcomes. At the time of the report, VA was well along in 

developing a training and certification program for C&P medical examiners, which 

was due to be deployed in the current fiscal year, 2008. VBA had implemented a 

certification program for its veterans service representatives but, although plans 

were being made, no such certification program existed for raters. The Committee 

recommended that VBA develop a training program for raters, using advanced techniques, and evaluate the program rigorously. 

Conclusion 

The June 2007 report of the Committee on Medical Evaluation of Veterans for 

Disability Benefits recommended further improvements in VA’s medical examination and rating processes. These recommendations were aimed at improving the 

quality of medical evaluation and rating processes in terms of accuracy and consistency rather than at increasing the timeliness of decisions. However, several of the 

recommendations promise to improve timeliness. The recommendation to mandate 

the use of online medical examination templates, should speed the completion of examination reports, and the recommendation to provide raters with access to medical 

consultants, should reduce the need to refer case files to VHA for medical opinions. 

This concludes my remarks. Thank you for the opportunity to testify. I would be 

happy to address any questions the Subcommittee might have. 

f 

Prepared Statement of Daniel Bertoni, Director, Education, Workforce, and 

Income Security, U.S. Government Accountability Office 

Veterans’ Disability Benefits: Claims Processing Challenges Persist, while 

VA Continues to Take Steps to Address Them 

GAO Highlights 

Why GAO Did This Study 

The Subcommittee on Disability Assistance and Memorial Affairs, House Veterans’ Affairs Committee, asked GAO to present its views on the Department of Veterans Affairs’ (VA) disability claims process. This statement discusses (1) claims 

processing challenges VA faces, (2) steps VA is taking to address these challenges, 

and (3) opportunities for more fundamental reform. 

GAO has reported and testified on this subject on numerous occasions. GAO’s 

work has addressed VA’s efforts to improve the timeliness and accuracy of decisions 

on claims, VA’s efforts to reduce pending claims levels, and concerns about 

decisional consistency. This testimony is based on a body of past work, updated as 

appropriate to reflect the current workload and initiatives. 

What GAO Found 

Despite taking steps to improve its disability claims process, VA continues to face 

challenges, specifically in reducing the number of claims pending, speeding up the 

process of deciding claims, and improving accuracy and consistency of decisions 

across regional offices. For example, between fiscal years 2003 and 2007, the inventory of claims awaiting a decision by VA grew by more than 50 percent to a total 

of about 392,000, and the average number of days claims were pending increased 

by 3 weeks to 132 days. Further, GAO and VA’s Inspector General have identified 

concerns about the consistency of decisions across regional offices. Factors affecting 

VA’s claims-processing performance may include increases in the number and complexity of claims being filed and the potential impacts of laws and court decisions. 

VA continues to take steps to help improve claims-processing performance, including requesting funding for additional staff. The President’s fiscal year 2009 budget 

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1 Rating-related claims are primarily original claims for disability compensation and pension 

benefits, and reopened claims. For example, veterans may file reopened claims if they believe 

their service-connected conditions have worsened. 

request funds an increase of more than 2,600 additional full-time equivalent employees over fiscal year 2007 levels to process claims. 

Beyond the steps VA is taking to address its claims processing challenges, opportunities for significant performance improvement may lie in more fundamental reform of VA’s disability compensation program. Such reforms could include reexamining program design such as updating the disability criteria to reflect the current 

state of science, medicine, technology, and labor market conditions. It could also include examining the structure and division of labor among field offices. Recent studies conducted by presidential and congressionally appointed commissions have recommended some fundamental changes, including updating VA’s rating schedule, 

which provides the basis for decisions about eligibility for benefits. 

Mr. Chairman and Members of the Committee: 

I am pleased to have the opportunity to comment on the claims-processing challenges and opportunities facing the Department of Veterans Affairs’ (VA) disability 

compensation and pension programs. Through these programs, VA provided about 

$37.5 billion in cash disability benefits to more than 3.6 million veterans and their 

survivors in fiscal year 2007. For years, the claims process has been the subject of 

concern and attention by VA, Congress, and veterans service organizations, due in 

large part to long waits for decisions and large numbers of claims pending a decision. Further, we and VA’s Inspector General have identified concerns about the 

consistency of decisions across regional offices. These concerns have continued and 

been magnified as veterans of the conflicts in Iraq and Afghanistan, and survivors 

of servicemembers who have died in those conflicts face similar issues as they seek 

VA disability benefits. In January 2003, we designated modernizing VA and other 

federal disability programs as a high-risk area, because of these service delivery 

challenges, and because our work over the past decade has found that these programs are based on outmoded concepts from the past. More recently, the President 

and Congress established commissions to study VA’s disability compensation system. 

You asked us to discuss our views on VA’s disability claims process. Specifically, 

my statement today addresses (1) claims processing challenges VA faces, (2) steps 

VA is taking to address these challenges and (3) opportunities for more fundamental 

reform. My statement draws on a number of prior GAO reports and testimonies that 

were conducted in accordance with generally accepted government auditing standards. (See related GAO products.) We updated information as appropriate to reflect 

the current status of VA claims processing workload and initiatives. 

In summary, despite taking steps to improve its processing of disability claims, 

VA continues to face challenges, specifically in speeding up the process of deciding 

claims, reducing the number of claims pending, and improving the accuracy and 

consistency of decisions across regional offices. For example, between fiscal years 

2003 and 2007, the inventory of claims awaiting a decision grew by more than 50 

percent to a total of about 392,000, in part because of increased filing of claims, including those filed by veterans of the Iraq and Afghanistan conflicts and from VA’s 

increased outreach to veterans.1 During the same period, the average number of 

days these claims were pending increased by 21 days, to an average of 132 days. 

Further, we and VA’s Inspector General have identified concerns about the consistency of decisions across regional offices. Some of the factors affecting VA’s claims 

processing performance may include increases in the number and complexity of 

claims being filed such as those for Post Traumatic Stress Disorder (PTSD), reopening of existing claims, and the potential impacts of laws and court decisions. VA has 

taken a number of steps to help improve claims processing performance, including 

requesting funding for additional staff, establishing ‘‘tiger teams’’ to help process 

certain claims, and expediting the processing of claims filed by veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The President’s 

fiscal year 2009 budget request funds an increase of over 2,600 full-time equivalent 

employees from actual fiscal year 2007 levels to process compensation claims. While 

the infusion of a large number of staff has the potential of increasing VA’s claims 

processing capacity, quickly absorbing these many staff will likely present human 

capital challenges for VA such as how to develop, train, and deploy them. 

Beyond the steps VA is taking, opportunities for significant performance improvement may lie in more fundamental reform of VA’s disability compensation program. 

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2 38 U.S.C. § 1115 provides for payment of additional benefits for qualifying dependents of veterans whose disability is rated not less than 30 percent. 3 Veterans qualify for pensions for non-service connected disability if they have low income, 

served in a period of war, and are permanently and totally disabled for reasons not service-connected (or are aged 65 or older). 38 U.S.C. § 1521 and 38 U.S.C. § 1513. 4 Appeals from the Board of Veterans Appeals go to the U.S. Court of Appeals for Veterans 

Claims, and finally to the U.S. Court of Appeals for the Federal Circuit, under certain circumstances. 

This would include reexamining program design as well as the structure and division of labor among field offices. For example, after more than a decade of research, 

we have found that VA’s and other federal disability programs have not been updated to reflect the current state of science, medicine, technology, and labor market 

conditions. More specifically, VA’s rating schedule, upon which disability decisions 

are made, is based primarily on estimates made in 1945 about the effect of serviceconnected impairments on the average individual’s ability to perform jobs requiring 

manual labor. We and at least two recent commissions—the President’s Commission 

on Care for America’s Returning Wounded Warriors, commonly referred to as the 

Dole-Shalala Commission, and the Veterans’ Disability Benefits Commission—appointed to study VA’s disability compensation system, have recommended updating 

VA’s rating schedule, among other fundamental reforms. 

Background 

VA pays monthly disability compensation benefits to veterans with service-connected disabilities (injuries or diseases incurred or aggravated while on active military duty) according to the severity of the disability. VA also pays additional compensation for some dependents—spouses, children, and parents—of veterans.2 VA’s 

pension program pays monthly benefits based on financial need to certain wartime 

veterans or their survivors.3

When a veteran submits a claim to any of the Veterans Benefits Administration’s 

(VBA) 57 regional offices, a veterans service representative is responsible for obtaining the relevant evidence to evaluate the claim. Such evidence includes veterans’ 

military service records, medical examinations, and treatment records from VA medical facilities and private medical service providers. Once a claim has all the necessary evidence, a rating specialist evaluates the claim and determines whether the 

claimant is eligible for benefits. If the veteran is eligible for disability compensation, 

the rating specialist assigns a percentage rating based on degree of disability. A veteran who disagrees with the regional office’s decision can appeal to VA’s Board of 

Veterans’ Appeals and then to U.S. federal courts.4

VA Continues to Face Challenges in Improving Its Claims Processing 

VA continues to experience significant service delivery challenges—large pending 

workloads, lengthy processing times, and inaccurate and inconsistent decisions. A 

number of factors contribute to these challenges, such as an increase in the numbers 

and complexity of the claims veterans are filing and the effects of recent laws and 

court decisions. These factors have eroded some of the earlier gains VA made in reducing claims backlogs. For example, VA made progress in fiscal years 2002 and 

2003 reducing the size and age of its pending claims inventory, but it has lost 

ground since then. 

VA’s inventory of claims awaiting a decision and their average time pending has 

increased significantly in the last 4 years, in part because of an increase in the 

number of claims received. The number of pending claims increased by more than 

50 percent from the end of fiscal year 2003 to the end of fiscal year 2007 to about 

392,000. During the same period, the number of claims pending longer than 6 

months more than doubled from about 47,000 to about 101,000 (see figure 1). 

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Figure 1—Rating-Related Claims Pending at End of Period, Fiscal Years 

2000–2007 

Source: VA data. 

Similarly, while VA reduced the average number of days claims were pending 

from a high of 182 days at the end of fiscal year 2001 to 111 days at the end of 

fiscal year 2003, the average age of pending claims crept back up to 132 days by 

the end of fiscal year 2007, as shown in figure 2. 

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Figure 2—Average Days Pending for VA Compensation and Pension RatingRelated Claims, Fiscal Years 2000–2007 

Source: VA data. 

A number of factors are contributing to this increase in VA’s inventory of pending 

claims, and their average time pending. First, there has been a steady increase in 

the number of claims filed—including those filed by veterans of the Iraq and Afghanistan conflicts—from about 579,000 in fiscal year 2000 to about 838,000 in fiscal year 2007, an increase of about 45 percent. VA projects claims receipts to increase to about 872,000 in fiscal year 2009 and cautions that ongoing hostilities in 

Iraq and Afghanistan, and the Global War on Terror in general, may further increase its workload. VA also attributes increased claims receipts to its efforts to increase outreach to veterans and servicemembers. For example, VA reports that in 

fiscal year 2006, it provided benefits briefings to about 393,000 separating servicemembers, up from about 210,000 in fiscal year 2003. VA has also noted that the 

number of veterans receiving compensation has increased by about a half million 

from fiscal years 2000 to 2007. VA anticipates the number of reopened claims will 

increase as compensation recipients—many of whom suffer from chronic progressive 

disabilities such as diabetes, mental illness, and cardiovascular disabilities—reopen 

claims for increased benefits as they age and their conditions worsen. 

Another factor affecting processing times is the complexity of cases, in both terms 

of numbers and types of disabilities veterans are claiming. According to VA, some 

veterans are citing more disabilities in their claims than in the past and these 

claims can take longer to complete because each disability needs to be evaluated 

separately. VA reported that the number of cases with eight or more disabilities 

claimed increased by 168 percent—from about 21,800 to about 58,500—from 2000 

to 2007. Additionally, VA notes that it is receiving claims for new and complex disabilities related to combat and deployments overseas, including those based on environmental and infectious disease risks and Traumatic Brain Injuries. Further, VA 

reports receiving increasing numbers of claims for compensation for PTSD, which 

is generally more difficult to evaluate, in part because of the evidence required to 

link the disorder to a particular event. According to VA, from 1999 through 2007, 

the number of veterans receiving compensation benefits for PTSD increased from 

120,000 to nearly 300,000. 

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5 Veterans Benefits Improvement Act of 2004, Pub. L. No.108–454; Veterans Benefits Act of 

2003, Pub. L. No. 108–183; Veterans Claims Assistance Act of 2000, Pub. L. No. 106–475. 6See e.g., Moody v. Principi, 360 F.3d. 1306 (Fed. Cir. 2004); Szemraj v. Principi, 357 F.3d 

1370 (Fed. Cir. 2004); Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 

1339 (Fed. Cir. 2003). 7For example, the Agent Orange Act 1991, Pub. L. No. 102–4, broadens the presumption of 

exposure to herbicides in Vietnam. See also, 38 C.F.R. § 3.309 (diseases subject to a presumptive 

service connection). 8 National Defense Authorization Act for Fiscal Year 2004, Pub. L. No. 108–136, Div. A. tit 

VI, § 641, amending 10 U.S.C. § 1414. 9See GAO, Veterans’ Benefits: More Transparency Needed to Improve Oversight of VBA’s 

Compensation and Pension Staffing Levels, GAO–05–47 (Washington, D.C.: Nov. 15, 2004). 

Further, a number of statutes 5 and court decisions 6 related to VA’s disability 

claims process have affected VA’s ability to process claims in a timely manner. For 

example, VA stated that the Veterans Claims Assistance Act of 2000 significantly 

increased the length and complexity of claims development by adding more steps to 

the process and lengthening the time it takes to develop and decide a claim. VA also 

notes that legislation and VA regulations have expanded benefit entitlement, adding 

to the volume of claims. In recent years, statutes have created new presumptions 

of service-connected disabilities for many Vietnam veterans and former prisoners of 

war.7 Also, VA expects additional claims receipts following enactment of legislation 

that allows certain military retirees to receive both military retirement pay and VA 

disability compensation.8

VA Continues to Take Steps to Improve Claims Processing 

VA is taking several steps to improve claims processing. Some near-term initiatives include the increased use of overtime and use of retired VA employees to provide training and to assist in processing claims. VA reported it currently employs 

70 rehired annuitants. VA expects these annuitants to complete 23,000 rating decisions in 2008. VA has also used other initiatives such as brokering claims between 

offices to help manage its claims inventory and establishing special teams to assist 

in the processing of claims. For example, VA established teams to process disability 

claims for veterans 70 years and older and for expediting claims of OIF and OEF 

veterans. In 2007, VA announced an initiative to provide priority processing of disability claims for all OIF and OEF veterans’, including active duty, National Guard, 

and reservists. 

In VA’s fiscal year 2009 budget justification, an increase in claims processing staff 

was identified as essential to reducing the pending claims inventory and improving 

timeliness. The fiscal year 2009 request would fund 10,998 full-time equivalent employees working on compensation and pension claims, and represents an increase 

of about 2,600 positions, or 32 percent over fiscal year 2007. In keeping with our 

prior recommendation, VA’s budget justification provides information on actual and 

planned productivity, in terms of claims decided per full-time equivalent employee. 

While VA expects a temporary decline in productivity in fiscal year 2008 as new 

staff are trained and become more experienced, it expects productivity to increase 

in the longer term. VA is modifying its centralized training program to focus newly 

hired employees on processing burial and dependency claims. VA reports this will 

allow them to become productive more quickly, while enabling more experienced 

staff to focus on disability claims processing. However, incorporating the large number of new employees into the disability claims process will likely present human 

capital challenges for VA. For example, VA would have to adequately train them. 

For staff who decide claims, it is estimated that this could take 1 to 2 years. VA 

would also have to determine where these staff should be deployed. 

Even as staffing levels increase, however, VA acknowledges that it still must take 

other actions to improve productivity.9 For example, VA added more locations where 

servicemembers can initiate the VA disability claims process up to 180 days prior 

to separating from the service. VA reports that these locations, known as Benefits 

Delivery at Discharge sites, now total 140. The goal of the program is to provide 

benefits within 60 days following discharge. In addition, VA also plans to pilot 

paperless Benefits Delivery at Discharge, where servicemembers’ disability claim 

applications, service medical records, and other evidence would be captured electronically prior to discharge. VA expects this new process will reduce the time needed to gather evidence for deciding claims. GAO currently has work underway looking at the Benefits Delivery at Discharge program. 

Another step to improve claims processing is a pilot program by VA and the Department of Defense (DoD) in which VA completes disability ratings for servicemembers who have been found unfit for duty due to disability by the military services. The goal of the pilot program is to deliver faster and more consistent disability 

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10GAO, Veterans’ Benefits: Quality Assurance for Disability Claims and Appeals Processing 

Can Be Further Improved, GAO–02–806 (Washington, D.C.: Aug. 16, 2002); and Veterans Benefits: VA Needs Plan for Assessing Consistency of Decisions, GAO–05–99 (Washington, D.C.: Nov. 

19, 2004). 11GAO, High Risk Series: An Update, GAO–03–119 (Washington, D.C.: Jan. 2003). 12GAO, SSA and VA Disability Programs: Re-examination of Disability Criteria Needed to 

Help Ensure Program Integrity, GAO–02–597 (Washington D.C.: Aug. 9, 2002). 

evaluations and compensation to servicemembers and veterans. Because VA rates 

disabilities while the servicemember is still in the military service, disability benefits can be awarded soon after the servicemember is discharged. GAO is currently 

studying this pilot. 

In addition to challenges with managing pending claims inventories and deciding 

claims in a timely manner, VA acknowledges that regional office decisional accuracy 

needs further improvement. VA reports that it improved the accuracy of decisions 

on rating-related compensation claims from 80 percent in fiscal year 2002 to 88 percent in fiscal year 2007. However, this figure remains short of its current strategic 

goal of 98 percent. In March 2007, VA stated it had established an aggressive quality assurance program to assess rating, authorization, and fiduciary program accuracy. Additionally, VA plans to begin routine quarterly monitoring of compensation 

and pension cases by diagnostic code and to expand quality review staff to complete 

additional reviews. 

VA also continues to face questions about its ability to ensure that veterans receive consistent decisions across regional offices. We have identified the need for VA 

to systematically address this issue to achieve acceptable levels of variation.10 VA’s 

Inspector General has studied one indicator of possible inconsistency, which is a 

wide variation in average payments per veteran from state to state. In May 2005, 

the Inspector General reported that variation in rating decisions was more likely to 

occur for some disabilities like PTSD than for others, where much of the information 

needed to make a determination is susceptible to interpretation and judgment. To 

improve decision consistency, VA conducted a pilot project to monitor consistency of 

rating-related claims decisions. VA also conducted a consistency review of Post 

Traumatic Stress Disorder claims. Finally, VA deployed 58 computerized exam templates for each type of compensation and pension exam to each Veterans Health Administration compensation and pension exam site to improve the quality of medical 

exams used to make rating decisions. 

Opportunities for Improvement May Lie in More Fundamental Reform 

While VA is taking actions to address its claims processing challenges, there are 

opportunities for more fundamental program reform such as reexamining program 

design and the structure and division of labor among field offices. 

After more than a decade of research, we have determined that federal disability 

programs, including VA’s disability program, are in urgent need of attention and 

transformation and placed modernizing federal disability programs on our high-risk 

list in January 2003.11 Specifically, our research showed that the disability programs administered by VA and the Social Security Administration (SSA) lag behind 

the scientific advances and economic and social changes that have redefined the relationship between impairments and work. For instance, advances in medicine and 

technology have reduced the severity of some medical conditions and have allowed 

individuals to live with greater independence and function in work settings. Moreover, the nature of work has changed in recent decades as the national economy has 

moved away from manufacturing-based jobs to service- and knowledge-based employment. At the same time, impairments such as Traumatic Brain Injury have become more prevalent. Yet VA’s and SSA’s disability programs remain mired in concepts from the past—particularly the concept that impairment equates to an inability to work—and as such, we found that these programs are poorly positioned to 

provide meaningful and timely support for Americans with disabilities. We currently 

are assessing the challenges VA faces in providing vocational rehabilitation and employment services to current beneficiaries as well as the large number of servicemembers returning from the OIF and OEF conflicts in need of such services. 

In prior work, we recommended that VA use its annual performance plan to delineate strategies for and progress in periodically updating labor market data used in 

its disability determination process.12 We also recommended that VA study and report to Congress on the effects that a comprehensive consideration of medical treatment and assistive technologies would have on its disability programs’ eligibility criteria and benefits package. This study would include estimates of the effects on the 

size, cost, and management of VA’s disability programs and other relevant VA prowwoods2 on PRODPC68 with HEARING

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13 National Defense Authorization Act for Fiscal Year 2004. 14 VBA also provides dependency and indemnity compensation to survivors of certain deceased 

disability compensation beneficiaries. 38 U.S.C. §§ 1541,1542. 15GAO, Veterans’ Benefits: Further Changes in VBA’s Field Office Structure Could Help Improve Disability Claims Processing. GAO–06–149 (Washington, D.C.: Dec. 9, 2005). 

grams and would identify any legislative actions needed to initiate and fund such 

changes. 

In its October 2007 report, the Veterans’ Disability Benefits Commission 

(VDBC)—established by Congress in 2003 to study the appropriateness of VA disability benefits 13—also pointed out that VA’s eligibility criteria were outdated and 

recommended that the VA Rating Schedule be reviewed and updated. The commission further recommended the schedule be reviewed and updated on a frequent 

basis and that first priority be given to revising the mental health and neurological 

body systems to expeditiously address Post Traumatic Stress Disorder, other mental 

disorders, and Traumatic Brain Injury. 

In its July 2007 report, the Dole-Shalala Commission also recommended updating 

VA’s rating schedule. The commission reported that VA’s rating schedule is outdated and does not include diagnostic criteria for injuries that are new or for which 

diagnostic criteria are changing rapidly, such as Traumatic Brain Injury. Further, 

the commission pointed out that VA’s rating schedule fails to acknowledge the disabling impact of conditions such as PTSD, and the effect medical advances have on 

the prognosis for certain conditions such as serious burns and amputations. 

VA is in the process of addressing some of our and the commission’s concerns. For 

example, VA is modifying the rating schedule to provide detailed and updated criteria for evaluating Traumatic Brain Injury and the potential effect of medical advances on certain conditions. In January 2008, VA announced that it had contracted 

for a study of the appropriate level of compensation for any loss of earnings capacity 

caused by service-incurred or service aggravated conditions. 

In addition to program design, VA’s regional office claims processing structure 

may be disadvantageous to efficient operations. VBA and others who have studied 

claims processing have suggested that consolidating claims processing into fewer regional offices could help improve claims-processing efficiency and save overhead 

costs. We noted in December 2005 that VA had made piecemeal changes to its 

claims-processing field structure. For example, VA consolidated decisionmaking on 

certain claims—Benefits Delivery at Discharge claims, which are generally original 

claims for disability compensation—at two regional offices (Salt Lake City, Utah and 

Winston-Salem, North Carolina). VA also consolidated in-service dependency and indemnity compensation claims at the Philadelphia regional office. These claims are 

filed by survivors of servicemembers who die while in military service.14 VA consolidated these claims as part of its efforts to provide expedited service to survivors, 

including servicemembers who died in Operations Iraqi Freedom and Enduring 

Freedom. Despite these initiatives, VA has not changed its basic field structure for 

processing disability claims at 57 regional offices, which have large variations in 

performance. Unless more comprehensive and strategic changes are made to its field 

structure, VBA is likely to miss opportunities to substantially improve productivity, 

especially in the face of future workload increases. We have recommended that VA 

undertake a comprehensive review of its field structure for processing disability 

compensation and pension claims.15 Undertaking such a review is especially critical, 

since VA will need to determine how and where to deploy the 2,600 new staff that 

may be coming on board between fiscal years 2007 to 2009 to address its claims 

processing challenges. 

In conclusion, reexamining claims-processing challenges and finding viable solutions are daunting tasks. While VA has taken a number of steps to improve its disability claims process, challenges persist. Opportunities may lie in more fundamental reform. A number of recent studies by commissions, GAO, and others have 

laid the groundwork and made many recommendations for addressing current workload challenges and redesigning the current program to better align it with modern 

concepts of disability and support services. However, as we move forward, it is imperative that VA adequately assess its options for improving its disability compensation program and their potential effects. It is also important that VA continue to 

look for other fundamental reforms that may be needed to improve its disability program for the longer term. 

Mr. Chairman, this concludes my remarks. I would be happy to answer any questions that you or other members of the subcommittee may have. 

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GAO Contact and Acknowledgments 

For further information, please contact Daniel Bertoni at (202) 512–7215 or 

Bertonid@gao.gov. Also contributing to this statement were Shelia Drake, Martin 

Scire, Kate van Gelder, and Rachael Valliere. 

Related GAO Products 

DoD and VA: Preliminary Observations on Efforts to Improve Healthcare and Disability Evaluations for Returning Servicemembers. GAO–07–1256T. Washington, 

D.C.: September 26, 2007. 

Veterans’ Disability Benefits: Processing of Claims Continues to Present Challenges. GAO–07–562T. Washington, D.C.: March 13, 2007. 

Veterans’ Disability Benefits: Long-Standing Claims Processing Problems Persist. 

GAO–07–512T. Washington, D.C.: March 7, 2007. 

High Risk Series: An Update. GAO–07–310. Washington, D.C.: January 31, 2007. 

Veterans’ Disability Benefits: VA Can Improve Its Procedures for Obtaining Military Service Records. GAO–07–98. Washington, D.C.: December 12, 2006. 

Veterans’ Benefits: Further Changes in VBA’s Field Office Structure Could Help 

Improve Disability Claims Processing. GAO–06–149. Washington, D.C.: December 9, 

2005. 

Veterans’ Disability Benefits: Claims Processing Challenges and Opportunities for 

Improvements. GAO–06–283T. Washington, D.C.: December 7, 2005. 

Veterans’ Disability Benefits: Improved Transparency Needed to Facilitate Oversight of VBA’s Compensation and Pension Staffing Levels. GAO–06–225T. Washington, D.C.: November 3, 2005. 

VA Benefits: Other Programs May Provide Lessons for Improving Individual 

Unemployability Assessments. GAO–06–207T. Washington, D.C.: October 27, 2005. 

Veterans’ Disability Benefits: Claims Processing Problems Persist and Major Performance Improvements May Be Difficult. GAO–05–749T. Washington, DC.: May 26, 

2005. 

VA Disability Benefits: Board of Veterans’ Appeals Has Made Improvements in 

Quality Assurance, but Challenges Remain for VA in Assuring Consistency. GAO– 

05–655T. Washington, D.C.: May 5, 2005. 

Veterans Benefits: VA Needs Plan for Assessing Consistency of Decisions. GAO–05– 

99. Washington, D.C.: November 19, 2004. 

Veterans’ Benefits: More Transparency Needed to Improve Oversight of VBA’s Compensation and Pension Staffing Levels. GAO–05–47. Washington, D.C.: November 

15, 2004. 

Veterans’ Benefits: Improvements Needed in the Reporting and Use of Data on the 

Accuracy of Disability Claims Decisions. GAO–03–1045. Washington, D.C.: September 30, 2003. 

Department of Veterans Affairs: Key Management Challenges in Health and Disability Programs. GAO–03–756T. Washington, D.C.: May 8, 2003. 

Veterans Benefits Administration: Better Collection and Analysis of Attrition Data 

Needed to Enhance Workforce Planning. GAO–03–491. Washington, D.C.: April 28, 

2003. 

Veterans’ Benefits: Claims Processing Timeliness Performance Measures Could Be 

Improved. GAO–03–282. Washington, D.C.: December 19, 2002. 

Veterans’ Benefits: Quality Assurance for Disability Claims and Appeals Processing Can Be Further Improved. GAO–02–806. Washington, D.C.: August 16, 2002. 

Veterans’ Benefits: VBA’s Efforts to Implement the Veterans Claims Assistance Act 

Need Further Monitoring. GAO–02–412. Washington, D.C.: July 1, 2002. 

Veterans’ Benefits: Despite Recent Improvements, Meeting Claims Processing Goals 

Will Be Challenging. GAO–02–645T. Washington, D.C.: April 26, 2002. 

Veterans Benefits Administration: Problems and Challenges Facing Disability 

Claims Processing. GAO/T–HEHS/AIMD–00–146. Washington, D.C.: May 18, 2000. 

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’’) on the issues surrounding the VA’s disability 

claims process at the Regional Office level, including what measures can be taken 

to improve its effectiveness in lessening the 600,000 plus claims backlog, and solutions for improving the VA claims process system in general. 

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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’’), and on remand before the VA. 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 fifteen-year experience representing 

claimants at all stages of the veteran’s benefits system from the VA Regional Offices 

to the Board of Veterans Appeals to the CAVC as well as before the Federal Circuit. 

OBSERVATIONS 

Throughout 2007, top VA officials such as former Secretary James Nicholson and 

Daniel Cooper, VA’s Veterans Benefits Administration Director, informed Congress 

about the backlog and excessive delays veterans are facing when filing a claim for 

VA benefits. Unfortunately, it is NOVA’s conclusion that 2008 has brought little to 

no change in the following six major problem areas causing or contributing to the 

VA’s inability to process a veteran’s claim in a timely fashion. All of these problems 

require immediate attention and action in order for our Nation’s veterans to see any 

real improvement in a system upon which they rely for benefits and assistance. 

I. Backlog 

In 2006, the backlog of claims for VA benefits, has skyrocketed to over 654,000 

claims. See, Report Veterans Disability Benefits Commission, October 2007, p. 305. 

At the same time, the VA received some 800,000 new claims in 2006, making it 

nearly impossible for VA staff to effectively address the 654,000 backlogged claims 

waiting to be processed and decided. 

II. Processing Time 

When a veteran submits a new claim for VA benefits, he or she must currently 

wait an average of 177 days—almost six months—before getting the first decision. 

This six-month processing time consists primarily of the VA obtaining evidence, usually with the veteran’s assistance. And, not surprisingly, when the VA does finally 

issue a decision, it is not always favorable. When a veteran appeals an adverse decision, the processing time for a claim on appeal is astronomical. On average, the time 

from receipt of the notice of disagreement, which begins the appeal, until the 

issuance of a Board of Veterans’ Appeals (‘‘BVA’’) decision is 971 days. Office of the 

Secretary, Department of Veterans Affairs, ‘‘Strategic Plan for Employees’’, July 

2007, P 14; Reports of the Chairman of the Board of Veterans’ Appeals, Fiscal Year 

2006, p. 16. Simply stated, because of the problems identified herein, a veteran 

must wait more than three years (177 days for the initial processing of a new client plus 971 days for appeal to be ultimately adjudicated) to finally get a favorable 

decision from the BVA granting him or her VA benefits and compensation. Those 

veterans whose claims are not granted by the BVA must wait 2 more years for a 

decision by the CAVC. 

Compounding the processing time even more is the well-intentioned Veterans 

Claims Assistance Act of 2000. The VCAA’s intended purpose was to better inform 

the veteran about the information and evidence needed to support his or her claim. 

However, the reality is that the veteran now receives a multi-page form letter, 

which results in a deluge of confusing correspondence between the VA and the veteran. 

III. Insufficient Staffing 

As of April 30, 2007, the VBA had 12,684 employees processing veteran’s claims. 

Department of Veterans Affairs, ‘‘Fact Sheet’’ July 2007, P. 6. In September 2007, 

former VA Secretary Nicholson reported that 1,100 new staff had been hired in an 

effort to reduce the 177 days it takes the VA to issue the first decision on a new 

claim. Even with these new hires, the staffing at local VA regional offices is woefully 

inadequate as the numbers make clear: some 13,784 VBA employees are being 

tasked with processing and deciding over 1.4 million new and backlogged claims. 

IV. Insufficient Training 

In 2006, the VA’s Office of Inspector General conducted a survey of Rating Veterans Service Representatives (‘‘raters’’) and Decision Review Officers (‘‘DROs’’). The 

results of the survey, revealed that within the last year they had received 10 hours 

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or less of formal classroom instruction on rating policies and procedures. Department of Veterans Affairs Office of Inspector General, ‘‘Review of State Variances in 

VA Disability Compensation Payments’’, May 19, 2005, p. 58. Given that the VA is 

the second largest government agency with 57 regional offices and over 12,000 staff 

throughout the country, 10 hours of training cannot possibly suffice to keep all of 

the VA’s local offices and staff in step with all the policies and procedures directly 

affecting veterans’ claims. 

V. Inappropriate Production Standards 

Raters and DROs are held to production standards of completing decisions in 

three to five cases per day which are tied to awards and bonuses, and which adversely affect the quality of their work and the accuracy of their decisions. Nearly 

half (47%) of those surveyed said it was difficult or very difficult to meet their daily 

production standards. Forty-nine percent stated that they had difficulty meeting 

their production standards without sacrificing quality. And 57% stated they have 

difficulty meeting their production standards if they ensure that they have sufficient 

evidence for each rating and thoroughly review the evidence. Department of Veterans Affairs Office of Inspector General, ‘‘Review of State Variances in VA Disability Compensation Payments’’, May 19, 2005, pp. 60, 61. These adjudicators are 

supposed to make decisions based on the evidence in the veteran’s claims folder, 

which can be anywhere from a couple of hundred to several thousand pages of 

records. But, by forcing VA adjudicators to make three to five decisions per day, the decisionmaker is forced to make rush decisions, oftentimes without genuinely 

reviewing the veteran’s entire claims file. 

VI. Inaccurate and Inconsistent Decision Making 

Calculations derived from the Reports of the Chairman of the Board of Veterans’ 

Appeals reveal an accuracy rate in disability benefit decisions by the VA of less than 

20%, rather than the 88% accuracy rate reported by the VA in 2006. See, Institute 

of Medicine ‘‘A 21st-century System for Evaluating Veterans for Disability Benefits’’ 

Pp. 180,181; Reports of the chairman of the board of Veterans’ Appeals, Fiscal Year 

2006, p. 19. http://www.va.gov/Vetapp/ChairRpt/BVA2006AR.pdf. Inaccurate rating 

decisions result in inappropriate denials and lower awards than are warranted, and 

also in more appeals. 

Providing support for anecdotal complaints that veterans regularly have to appeal 

partially favorable Regional Office decisions ( usually due to a lower rating being 

assigned than the veteran’s disability warrants) the VA’s Office of the Inspector 

General’s 2006 survey, revealed that 52.4% of Regional Office raters believed it was 

somewhat likely or very likely that two or more different ratings ( one resulting in 

more compensation for the veteran) for the same medical condition could be supported. Department of Veterans Affairs Office of Inspector General, ‘‘Review of State 

Variances in VA Disability Compensation Payments’’, May 19, 2005, p. 59. In addition, veterans’ advocates are now reporting incidents of VA rating officers and examiners ignoring the diagnostic criteria contained in the Diagnostic and Statistical 

Manual of Mental Disorders, published by the American Psychiatric Association. 

Giving more weight to their personal biases than the diagnostic criteria, VA raters 

and examiners are denying PTSD claims submitted by combat veterans, falsely concluding that the veteran’s combat stressor was insufficient for a diagnosis of PTSD. 

RECOMMENDATIONS 

I. Staffing 

Quite simply, all VA regional offices need more staff to process and decide the 

new and backlogged claims. NOVA recommends that increased funding be provided 

to the Veterans Benefits Administration, specifically targeted toward hiring more 

staff, raters and DROs. Only by increasing the number of VA employees who have 

the responsibility for processing claims can the speed of claims processing be increased without sacrificing the accuracy of the decisions. 

II. Training 

In addition to hiring more staff, the staff must be regularly and effectively 

trained. NOVA therefore recommends that increased funding be specifically directed 

toward providing semiannual training in VA law and medicine to VA raters, DRO’s, 

Regional Office staff and to clinicians who conduct psychological evaluations and 

compensation and pension exams. This training should provide emphasis on the significance of the duty to assist and notify veterans, the VA’s regulations regarding 

the benefit of the doubt, and how to rate difficult medical conditions such as psychological impairments, TBI, pain, impairments caused by Agent Orange exposure, and 

Gulf War Illness. It should be noted that the Veterans’ Disability Benefits Commiswwoods2 on PRODPC68 with HEARING

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sion recommended increasing VA staff and adequate education and training in order 

‘‘to achieve a manageable claims backlog’’. Veterans’ Disability Benefits Commission, 

‘‘Honoring the Call to Duty: Veterans Disability Benefits in the 21st Century’’, October 2007, pp. 394, 395, recommendations 9.1, 9.3, 9.5. Similarly, the VA’s Office of 

Inspector General recognized the need for ongoing training and reevaluation of 

human resources to ‘‘ensure that the VBA field organization is adequately staffed 

and equipped to meet mission requirements’’. Department of Veterans Affairs Office 

of Inspector General, ‘‘Review of State Variances in VA Disability Compensation 

Payments’’, May 19, 2005, xi, recommendation 6. 

Finally, this training needs to include some meaningful way for VA adjudicators 

to review precedential opinions from the U.S. Court of Appeals for Veterans Claims 

and apply them where relevant. Given the current caseload of claims to decide, VA 

adjudicators cannot be expected, on their own, to keep up with the Court’s jurisprudence. There should be a system in place for key Court cases to be disseminated 

among VA adjudicators so they can start following and applying Veterans Court 

precedent in a timely and efficient manner. Consistent training sessions would help 

VA adjudicators better understand the implications and meaning behind important 

Veterans Court decisions, and help them implement the Court’s case law in their 

own rating decisions. 

III. Concentrate on Accuracy Not Just Speed When Deciding VA Claims 

Although every claimant wants a speedy decision, and the old saw reminds us 

that ‘‘justice delayed is justice denied’’, an overly hasty and erroneous decision is 

not beneficial to the veteran or to the VA, which will have to deal with the eventual 

appeal. In the long run, the time spent to provide an accurate and just rating will 

most certainly reduce the VA’s backlog by eliminating ‘‘hamster wheel’’ repeated reviews of the same claim, which occurs when a veteran is forced to appeal a hastily 

made erroneous decision. By encouraging VA adjudicators to make quality decisions 

(as opposed to meeting a quota of decisions per day), they will take the time to review the veteran’s entire claims folder and apply relevant VA law, regulations and 

case law. 

IV. Require the VA to Maintain Statistics on the Regional Office Denial Rate 

Without statistics on the VARO’s denial rate it is impossible to determine how 

many veterans and other claimants abandon their claims rather than proceeding 

with an appeal. Denial rates broken down by type of claim would also provide an 

insight into the examiner’s and rater’s experiences in dealing with different claims. 

V. Enact Legislation to Enhance the VCAA 

Currently, the VA has interpreted the VCAA in such a manner as to deprive veterans and other claimants of meaningful and helpful claims specific information. Instead, the VA provides generic information which is not helpful because it fails to 

inform the veteran of what evidence is necessary to prove entitlement to benefits. 

The result is that is not until many years later, following multiple decisions and 

multiple remands, does the veteran finally understand the VA’s perception of the 

shortcomings in the evidentiary development of the claim. The propensity of the VA 

to withhold claims specific information contributes to ‘‘hamster wheel’’ litigation and 

to the VA’s increased caseload. 

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 27 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 

claimants before the Board of Veterans’ Appeals 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’ Apwwoods2 on PRODPC68 with HEARING

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peals 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. 

According to the VA Monday Morning Workload reports, in early January 2006 

there were 532,228 total claims pending adjudication at the VA regional offices 

(VAROs). In early January 2007 there were 603,104 total claims pending adjudication at the VA regional offices (ROs). In early January 2008 there were 647,478 

total claims pending adjudication at the VA regional offices (ROs). These VA statistics reveal that there are now 115,250 more claims pending adjudication at the ROs 

in 2008 than there were in 2006. This is an increase of over 21 percent in just two 

years. If this trend continues the VA ROs will have over 947,000 backlogged claims 

in just four years. NVLSP believes that the current size of the backlog is obviously 

unacceptable and allowing that unacceptable number to grow by 200,000 cases in 

just four years would be insulting to veterans. 

Why Is There Such a Large Backlog? 

In the opinion of NVLSP, the major cause of the VA claims adjudication backlog 

is a VA work credit system that prevents the fair adjudication of many claims for 

VA benefits generating extra work for the VA and major problem for claimants. 

Also, the inadequate quality of many VA adjudications and the inadequate number 

of trained adjudicators contribute to the size of the backlog. 

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 has had a major impact on the adjudication of claims for veterans benefits. 

Each year, after a complicated process involving the executive branch and Congress, the VA is given its budget. The budget can be defined as the resources available to the Secretary of Veterans Affairs to be used to accomplish the mission of 

the VA. Managers at different levels within the VA are then given their allocation 

from the overall VA budget. This allocation is determined by the workload and performance of the various VA components. For example, the money budgeted to a particular VARO determines how many workers can be hired or fired, how equipment 

is maintained, and what new equipment can be purchased. 

Claims received in VARO are described as ‘‘pending issues.’’ These claims are assigned an ‘‘end product code,’’ alternatively described by the VA as a unit of work. 

When final action is taken on a pending claim, or pending issue, the regional office 

(and eventually the VA) receives a credit. 

End products are assigned values based on the average number of work hours it 

takes an employee or group of employees to complete all action necessary for that 

type of claim. Each end product code has a different value. For example, VA managers receive more credit for work completed on an original claim than they do for 

adjusting the income of a current pension beneficiary. No matter how much work 

the VARO does on an individual claim, however, it receives as credit only the value 

that is provided for the end product code assigned to that particular type of pending 

claim. Therefore, VA managers receive the same credit whether or not the claim is 

granted or denied or whether the particular claim takes the VARO one day or two 

years to decide. 

VA manuals describe the end product system as a ‘‘management tool’’ and indicate 

that its measure should not be used to evaluate individual performance. As is the 

case with many management information systems, however, the measurement system tends to drive what and whom it measures, rather than the converse. VA managers are evaluated by how many end products they produce, how quickly they can 

take credit for end products, how many employees they need to produce these end 

products, and lastly, the quality of the work in the office they manage. Because it 

is in the best interest of the VA managers to complete as many cases as quickly 

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as they can, the interests of VA managers in many cases stands in opposition to 

the interests of claimants for VA 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 final 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 2007, over 56 percent of all appeals decided by the BVA were reversed or remanded and over 63 percent of CAVC decisions on the merits were reversed, or remanded. Some VAROs are 

worse than others. Over 60 percent of the appeals from the New York RO and over 

62 percent of the appeals from the St. Petersburg, Florida RO were reversed or remanded by the BVA. 

Based on the experience of NVLSP (over 10 years of quality reviews, in conjunction with The American Legion, of approximately 40 different VAROs combined with 

extensive NVLSP representation before the CAVC), most of the most egregious VA 

errors are a result of premature adjudications. For example, many errors identified 

by the Legion/NVLSP quality review teams 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 want to emphasize that most premature VA adjudications are caused by ROs 

seeking work credit. If the claimant should appeal, the RO can earn another work 

credit for work to process the appeal. The VA manager gets to claim unearned work 

credits and to show an erroneously low time period to adjudicate these claims. That 

would help the manager earn a promotion and a bonus for such ‘‘productive’’ work. 

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/NVLSP 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 for over 30 years. My experience tells me that unless the system is corrected most 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 problems 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. 

NVLSP believes that the quality of VARO adjudications is much worse than what 

is reported by the VA. A relatively independent review of the quality of adjudications performed by the VAROs are the remand and reversal statistics produced by 

decisions issued by the Board of Veterans’ Appeals (BVA or Board). BVA statistics 

provided by the Veterans Appeals Control and Locator System (VACOLS) for FY 07 

reveal that Board decided over 40,000 appeals. The Board granted additional benefits in 21.12 percent of the appeals and remanded 35.36 percent of these appeals 

back to the VAROs. Therefore, 56.48 percent of the VARO decisions that were appealed and decided by the BVA were either reversed or remanded. This 56.48 perwwoods2 on PRODPC68 with HEARING

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cent statistic could be considered an error rate. Even if we were to assume that the 

VARO did not err in 20 percent of these cases because the Board granted additional 

benefits or remanded due to new evidence added at the Board level, an error rate 

as high as 36 percent (56.48 minus 20) is not acceptable and is flatly inconsistent 

with the low error rate produced by the VA Star Reports (which claims that the 

VAROs maintain close to a 90 percent ‘‘accuracy rate’’). 

The news gets worse. The BVA, in its rush to make final decisions and to avoid 

remands quite often prematurely denies claims that should have been remanded. Of 

course, the error was originally committed by the VARO, not the BVA. In September 

2007, my fellow Joint Executive Director, Bart Stichman, testified that ‘‘[f]or more 

than a decade, the Court’s [Court of Appeals for Veterans Claims (Court or CAVC)] 

annual report card of the BVA’s performance has been remarkably consistent. The 

12 annual report cards issued over the last 12 years yields the following startling 

fact: of the 16,550 Board decisions that the Court individually assessed over that 

period (that is, from FY 1995 to FY 2006), the Court set aside a whopping 77.7% 

of them (that is, 12,866 individual Board decisions). In each of these 12,866 cases, 

the Court set aside the Board decision and either remanded the claim to the Board 

for further proceedings or ordered the Board to award the benefits it had previously 

denied. In the overwhelming majority of these 12,866 cases, the Court took this action because it concluded that the Board decision contained one or more specific 

legal errors that prejudiced the rights of the VA claimant to a proper decision. By 

any reasonable measure, the Court’s annual report card on the Board’s performance 

has consistently been an ‘‘F.’’ 

How should a veteran seeking VA disability benefits feel? The Board of Veterans’ 

Appeals reverses or remands over 50 percent of all VARO adjudications and the 

CAVC sets aside over 77 percent of the Board decisions that deny benefits. These 

numbers do not inspire confidence in the quality of VA adjudications. 

Overall, the results of the Legion/NVLSP quality reviews have been discomforting. 

The American Legion/NVLSP team usually spends a week in a VARO reviewing the 

quality of recently adjudicated claims where The American Legion represented the 

veteran. The results of these quality reviews reveal that in many instances claims 

are improperly denied or benefits are not paid at the proper rate because the RO 

was more concerned about claiming work credit and reducing the VARO backlog 

than taking the time to develop and analyze the claim properly. 

For example, many of the VAROs had problems with claims for service connection 

for mental conditions (especially Post Traumatic Stress Disorder) and problems evaluating the severity of mental disabilities. In too many instances, claims for total disability based on individual unemployability were improperly denied and in more 

than a few instances we determined that claims for increase in evaluation to 60% 

or 70% were hard to obtain because such a rating could require the VARO to consider entitlement to a total disability rating due to individual unemployability 

(TDIU) and the VARO adjudicator did not want to have to take the time to deal 

with a claim for TDIU. Also, we have discovered that too many VA examinations 

are inadequate because the VARO did not explain what facts the VA physician 

should accept as true in making his or her medical opinion. The team generally reviews between 25 to 40 cases and finds errors in about 20 to 30 percent of these 

cases. This is a much higher rate than the ‘‘accuracy rate’’ reported by VA on its 

Star Report. 

Potential Solutions 

The VA needs to acknowledge the complexity of its claims adjudication system 

and hire a reasonable number of adjudicators to work these claims. The grade levels 

of VA raters and Decision Review Officers should be raised and these federal employees should be held accountable for the quality of their work product. The Congress needs to provide the funding for the additional adjudicators, and the VA would 

have to be willing to submit to an independent quality review to validate the quality 

of the work. The additional adjudicators should help 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 work measurement system has to be overhauled. HR 3047 which, in section 2 would change when VA regional offices (VAROs) can claim work credit, is a 

good bill that would accomplish this goal. 

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 

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by real people. Their goal should not be just prompt adjudication; the goal should 

be a timely, accurate and fair adjudication. 

Thank you for permitting NVLSP to testify on such an important issue. 

f 

Prepared Statement of J. David Cox, R.N., National Secretary-Treasurer, 

American Federation of Government Employees, AFL–CIO 

Dear Chairman and Members of the Subcommittee: 

The American Federation of Government Employees, AFL–CIO, which represents 

more than 600,000 federal employees who serve the American people across the Nation and around the world, including roughly 160,000 employees in the Department 

of Veterans Affairs (VA), is honored to testify today regarding the Veterans Benefits 

Administration (VBA) claims processing system and the current claims backlog. 

The current backlog and waiting times for pending claims are unprecedented and 

unacceptable. Our veterans served our country when they were needed. It is imperative that we serve them when they are in need. 

AFGE is the sole employee representative of Veterans Service Representatives 

(VSRs), Rating Specialists (RVSRs), Decision Review Officers (DROs) and other VBA 

employees. A large number of these employees are veterans, and many are service 

connected themselves. (We hope that VBA will increase its hiring of preference eligibles to ensure that the valuable perspective of the veteran remains part of the 

claims process, but that is a subject for another hearing.) Therefore, AFGE is in a 

unique position to convey the sense of mounting pressure, frustration and demoralization at the frontlines in the face of this backlog. 

AFGE is also in a unique position to identify approaches to improving the quality 

and timeliness of the process. The input of the VBA workforce is essential to any 

claims reform process because the skills of a VBA claims processor are unique. Unlike skills such as medical care and information technology that are largely transferable from one workplace to another, VBA claims processing is learned entirely on 

the job. Consequently, the employees who have been developing and rating cases for 

much of their career are extremely valuable sources of guidance. 

Sadly, the VA does not recognize what these employees have to offer. In recent 

years, management has increasingly excluded AFGE from national level efforts to 

improve the claims process, VSR Certification testing and training. At the local 

level, our members report that they are regularly rebuffed by management when 

they attempt to make suggestions for process improvement. These days, management wants one thing, and only one thing from the VBA workforce: produce claims 

as fast as possible. 

Employee representatives and veterans’ service organizations (VSO) are the eyes 

and ears on the ground, and we engage in a regular dialogue about different reform 

approaches. Both are key stakeholders who should be included in VBA policy setting 

groups. 

Recommendation: Congress should establish a Joint VSO–AFGE Advisory 

Committee to make recommendations on needed improvements to the 

claims process, and related issues of training, skills certification and production standards. 

The unrelenting pressure ‘‘to make the numbers’’ starts at the top with VA Central Office (VACO) where individual station goals are set. The RO Director’s performance is measured by the total number of claims produced, not the quality of 

completed work or quality of the training provided to the employees who perform 

the work. As a result, new employees lose critical on-the-job training because supervisors who are trying to meet their own production goals assign cases to them before 

they are fully trained. Similarly, managers frequently cut short training for experienced employees who rely on continuing education to become familiar with the 

steady stream of new laws, court cases, and benefits programs that directly impact 

claims determinations. It is also common for rating specialists who have recently 

been promoted from VSR positions to have their critical on-the-job training interrupted so they can perform VSR duties. All these training gaps contribute to the 

backlog. 

Issuing new mandates without accountability leaves the VBA with just that: more 

mandates. VBA is not held accountable for the quality and consistency of training 

at each RO. VBA’s national training program operates more as a guideline, rather 

than a requirement to follow a mandatory curriculum and training schedule. VBA 

now mandates training, and proudly points out that each RO is required to provide 

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employees with 80 hours of training per year. However, VBA never explained how 

it determined that 80 hours, not more, not less, was adequate. 

Recommendation: The Joint VSO–AFGE Advisory Committee should oversee the VBA training process and make recommendations to Congress 

about ways to improve current training programs. Training and accuracy 

of claims determinations should be included in management performance 

measures. 

Persistent problems with the VSR Skills Certification test also adversely impact 

VBA’s ability to reduce the claims backlog. Pursuant to an agreement between VBA 

and AFGE, qualified GS–10 VSRs who pass a skills certification test can receive a 

noncompetitive promotion to a GS–11. Contrary to assurances from VBA and the 

terms of our agreement, the training is not always sufficiently aligned with the 

scope of the exam, and trainers are often confused about which training materials 

are relevant to the test. In addition, extremely low passage rates (that also raise 

questions about the test’s validity) are demoralizing to competent VSRs with years 

of experience. At the same time, management refuses to provide employees with 

useful feedback on the questions they missed. 

AFGE was not allowed to collaborate in the process of refining the test and working out test administration problems. We were also denied access to raw test data 

to help address low passage rates. 

Recommendation: Congress should require VBA to release to AFGE complete demographics on skill certification test results. VSRs should be provided with adequate feedback on their test scores to allow them to 

strengthen their understanding of all relevant concepts. 

Our members desperately want to reduce the backlog, and when a new proposal 

to accomplish that emerges, they feel a sense of renewed hope. Yet time and again, 

those proposals fall victim to the same forces: poor implementation, lack of accountability and inadequate training. 

AFGE initially worked with VBA on the development of the Claims Process Improvement Initiative (CPI) Model, and reached an agreement on the recommendations of the CPI Task Force. Even though VBA has since made a number of revisions to the CPI model, such as centralizing the Public Contact Unit, employee representatives were excluded from recent Task Force meetings. When CPI was implemented in 2002, it was supposed to provide a uniform national model for all ROs. 

Instead, six years later, we have ‘‘57 varieties’’, that is, 57 different ways of applying 

the CPI model to the claims process. The Program Director for the Compensation 

and Pension (C&P) Service is not being held accountable for consistent implementation of this model. 

Similarly, VBA welcomes each new set of Government Accountability Office (GAO) 

recommendations, but fails to implement them. Again, accountability is the key. 

Recommendation: AFGE supports the recommendation in the veterans’ 

2008 Independent Budget (IB) to hold the Compensation and Disability 

Program Director more accountable for the performance of RO directors, 

including the quality and consistency of training provided to claims processors. 

VBA claims process reform adds new meaning to the familiar quote, ‘‘Those who 

don’t know history are destined to repeat it.’’ Before Congress embarks on a search 

for a new approach to improving this process, we urge you to consider the reasons 

why previous attempts to reform the claims process have failed. 

We see a renewed interest is using Artificial Intelligence (AI) to expedite the 

claims process. AI may have some utility in helping a veteran file a claim, but our 

members see much less utility in AI’s ability to help a VSR or RVSR work a claim. 

Certainly in its current stage of development, AI is not advanced enough to replace 

the individual experience-based judgment of a VSR or Rating Specialist who is 

adept at ‘‘reading between the lines’’ of a claimant’s record. 

VBA also mandates production standards, but we fear they are based more on politics and bonuses rather than the requirements of the many complex, multiple 

claims being filed by veterans at the current time. Again, mandates without accountability or scientific basis will not bring about meaningful claims process reform. One member explains flawed production standards as follows: ‘‘Like an engine, 

when an employee is run too long at too high an RPM without fresh oil, it will inevitably begin to perform poorly and eventually quit.’’ 

Currently, VBA managers, many of whom have not adjudicated a claim for many 

years (or never), define performance solely in terms of inventory and days pending 

completion of a decision. In addition, employees and their representatives are never 

invited to participate on teams that develop employee performance standards. 

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Production standards and staffing should be based on scientific methodology, not 

politics. VBA has never done a time-motion study of the claims process, to determine how many hours are required to process claims of different categories and 

complexity. This should be the first step in any reform process. 

AFGE is aware of only one extremely limited attempt 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. Again, with input from VSOs and employee representatives, the findings of a more meaningful study can be used to establish and 

regularly update production standards and set appropriate staffing. 

Recommendation: VBA should conduct a scientific time-motion study of 

the resources and skills required to do the current mix of increasingly complex claims. 

We also caution the Subcommittee about further centralization of VBA functions. 

VBA regularly touts centralization as synonymous with management efficiencies. In 

addition to extensive centralization of VBA functions outside of Compensation and 

Pensions (C&P), VBA has centralized its 57 Call Centers down to 9 centers in operation today, and is planning to centralize the Fiduciary Program. Yet, VBA has 

never been held accountable for proving that centralization improved its operations. 

Centralization puts a greater distance between the veteran and the claims process. 

The taxpayer and the veteran deserve a careful assessment of the costs and benefits 

of centralization before we centralize more functions or continue centralized operations already in place. 

Recommendation: The impact of centralization on VBA functions should 

be assessed and compared with alternative, more decentralized approaches 

to delivering services. 

Our members have identified a number of specific fixes for expediting and improving the claims adjudication process. However, AFGE continues to have great difficulty in obtaining information from management, and as noted, is increasingly left 

out of key policy setting groups. Therefore, this list is somewhat limited. 

Vetsnet: Problems Remain 

Although VBA started to phase in the Vetsnet program to replace the Benefits 

Delivery Network (BDN) nearly 20 years ago, significant glitches remain. For example, there remains a redundancy in the process of inputting information, more specifically, employees have to have multiple applications open at the same time and 

enter duplicative information because these programs do not ‘‘talk to one another.’’ 

It would be more efficient if the system automatically made the updates when employees enter new veteran information. VBA made a commitment to address this defect but has not done so to date. 

Recommendation: AFGE supports the recommendation of the 2008 veterans’ Independent Budget to complete the phase-in of Vetsnet. VBA should 

be required to consult with the Joint VSO–AFGE Advisory Committee on 

a regular basis to identify future problems that emerge as the transition 

from BDN to Vetsnet proceeds. VBA should develop an online ‘‘suggestion 

box’’ to which employees can submit reports of problems associated with 

Vetsnet. 

‘‘Benefits Delivery and Discharge’’ Authority 

VBA already has the authority under current regulations to award benefits for 

one year payable immediately upon discharge from active duty. Known as Benefits 

Delivery at Discharge (BDD), this allows VBA to give seriously injured new veterans 

immediate compensation during their recovery through a 50% or 100% rating. Their 

claims are reevaluated a year later to see if their conditions have worsened or improved. 

Recommendation: VBA should expand the use of Benefits Delivery and 

Discharge authority to expedite processing of appropriate claims. 

Paperless Records: AFGE also supports the recommendation of the 2008 Independent Budget to further develop and enhance a paperless records system. VBA 

employees already have limited access to electronic medical records from VA medical centers, which enables them to conduct an effective online search for needed 

medical evidence. However, military records are still only available in hard copy. As 

VBA moves toward an electronic records system, we urge them to take steps to enwwoods2 on PRODPC68 with HEARING

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sure that these files are readable and that the system has a strong online search 

capability so evidence can be efficiently located. 

Recommendation: The Subcommittee should move toward a fully 

paperless records system, and should examine similar efforts already in 

place for VBA education claims for lessons learned. 

Assembly lines and widgets: the wrong approach to veterans’ disability 

claims 

In the words of another member, CPI takes an assembly line approach to claim 

processing, i.e. CPI divides up the tasks, so that one employee installs the headlights, another the tires. Whereas in the past, employees did everything from taking 

the claim to issuing the final decision, now, once the employee ‘‘installs the headlights’’, he or she has no knowledge of or investment in the outcome of the claim. 

When a case is remanded from the Board of Veterans Appeals or the courts, a new 

employee has to learn the claim all over again. The same employee should handle 

a claim at all stages. 

Another practice from the past that should be revived are regular (usually weekly) 

meetings among claims adjudication staff to review new cases, changes in the law 

and share best practices, This practice seems to have disappeared along with the 

case management approach that CPI replaced. 

Recommendation: VBA and the Joint VSO–AFGE Advisory Committee 

should reexamine the case management model to determine whether some 

of its features should be brought back to the claims process, including regular case meetings in each RO and having the same employee handle cases 

from application to appeal. 

We look forward to working with Chairman Hall and members of the Subcommittee to identifying approaches to improving the VBA claims process and ensuring that VBA considers regular input from employees, their representatives, and 

the veterans’ community. Thank you. 

f 

Prepared Statement of Gordon P. Erspamer, Senior Counsel, 

Morrison and Foerster, Walnut Creek, CA 

. . . Law has reached its finest moments when it has freed man from the unlimited 

discretion of some ruler, some civil or military official, some bureaucrat. Where discretion is absolute, man has always suffered. At times it has been his property that 

has been invaded; at times, his privacy; at times, his liberty of movement; at times, 

his freedom of thought; at times, his life. Absolute discretion is a ruthless master. 

It is more destructive of freedom than any of man’s other inventions. 

Justice William O. Douglas in United States v. Wunderlich, 342 U.S. 98, 101 

(1951). 

A. Personal Background: 

1. I have been representing individual veterans on service-connected disability 

and death and disability compensation claims and appeals for over 25 years, 

all on a pro bono basis. I also acted as counsel for my mother and late father 

in the first case ever argued in the newly created Court of Veterans Appeals, 

since renamed the Court of Appeals for Veterans Claims (‘‘CAVC’’). See 

Erspamer v. Derwinski, 1 Vet. App. 3 (1990). In addition, I have represented 

veterans’ organizations and veterans in two major constitutional actions 

against the DVA (‘‘VA’’), each of which Morrison & Foerster has also handled 

pro bono, including the following: 

a. National Association of Radiation Survivors, et al. v. Walters, Administrator of Veterans Affairs, et al., 589 F. Supp. 1302 (N.D. Cal. 1984); 473 

U.S. 305 (1985); 111 F.R.D. 595 (N.D. Cal. 1986); 111 F.R.D. 543 (N.D. Cal. 

1987); 782 F. Supp. 1392 (N.D. Cal. 1992); 994 F.2d 583 (1992); and 

b. Veterans for Common Sense, et al. v. James B. Peake, M.D., Secretary of 

the Department of Veterans Affairs, et al., USDC–N. Cal. Case No. 07– 

3758–SC (filed July 23, 2007). See www.veteransptsdclassaction.org (reproducing copies of complaint and other major pleadings and decisions). 

B. Major Regional Office Problems: 

1. The Hollowness of the VA’s Motto: ‘‘For Him That Hath Borne the 

Battle . . .’’ The VA’s motto is not only inscribed outside its headquarters 

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here in Washington, D.C., but it also is widely publicized elsewhere. The inconsistency between the VA’s motto and the positions or actions it adopts in 

court in cases brought by veterans is steeped in irony. Instead of seeking to 

extol the contributions made by veterans and recognize veterans’ rights, in 

my experience the opposite has been true. For example, the VA argues that 

disabled veterans do not possess an enforceable ‘‘entitlement’’ to any medical 

care, that all veterans’ benefits are ‘‘mere gratuities,’’ that the Secretary has 

total discretion whether or not to provide medical care, that veterans lack 

a 5th amendment property interest in the receipt of disability or death compensation, or that the VA is insulated from court challenges by sovereign immunity, the outdated doctrine that ‘‘The King Can Do No Wrong.’’ Given its 

stated mission, it is telling that the VA actually labors to urge courts to minimize or restrict the scope of veterans’ rights. 

2. Perpetuation of Myths: A series of characterizations about the adjudication process have received wide circulation for many years. For example, 

Congress has frequently been told that the VA process is ‘‘non-adversarial,’’ 

that lawyers are unnecessary, and that the VA’s procedures are ‘‘informal.’’ 

In my opinion, these characterizations have always been myths, but they are 

even more mythical in today’s world. The Federal Circuit itself has recognized that the claims process has become adversarial. See Bailey v. West, 160 

F.3d 1360, 1365 (Fed. Cir. 1998) (‘‘[S]ince the [VJRA] . . . it appears that 

the system has changed from a nonadversarial, ex parte, paternalistic system 

for adjudicating claims, to ones in which veterans . . . must satisfy formal 

legal requirements, often without the benefits of legal counsel, before they 

are entitled to administrative and judicial review.’’) As to informality, all too 

often it has been an opportunity for the VA to take shortcuts without the 

veteran’s knowledge or to ‘‘streamline,’’ and by that I mean ignore, the procedural rights of veterans. 

3. Absence of Single Assignment of Claims: One fundamental regional office problem is that the VA does not assign a person or persons to handle 

a particular veteran’s claim from ‘‘cradle to grave.’’ Instead, the Service Center Manager (formerly called ‘‘Adjudication Officer’’) of each office is listed 

on correspondence, and the actual decision-makers remain anonymous. Thus, 

the veteran never has a specific name to contact, and no VA employee builds 

experience or expertise on a claim. There also is no accountability and no 

incentive for the employees to develop and decide the case correctly. 

4. Antiquated Hard Copy System: Congress should order the VA to scrap its 

antiquated hard copy claim file system and replace it with an up-to-date 

database where claim file information can be shared by users at both the 

VHA and VBA. The hard copy system leads to delays, lost or misplaced files 

and enables misconduct to occur without any remedy or detection. And Congress should force the VA to give a veteran web access to his claim file. 

5. Time/Delay, Abandonment of Claims: Delay has become an endemic feature of the VA adjudication system for decades, raising the venerated principle of jurisprudence that ‘‘Justice delayed is justice denied,’’ as reflected in 

the following table, prepared in July 2007: 

Stage Time Source 

1) Initial Decision 196 days* (Department of Veterans Affairs FY 

2006 Performance and Accountability 

Report (2006) at 213) 

2) BVA Appeal 971 days BVA Chairman’s Report at 16 

3) CAVC Appeal 1286 days: 120 days 

(notice of appeal) + 254 

days (docketing, briefing) 

+ 912 days (judicial 

consideration) 

38 U.S.C. § 7266; Ct. Vet. App. R. 

4(c), 10(a), 10(b), 11(a)(2), 31(a)(1), 

31(a)(2), 31(a)(3); Testimony of Robert 

Chisholm 1

4) Federal Circuit 317 days Review of Federal Circuit docket 

sheets re veterans’ appeals from 

CAVC 2

5) U.S. Supreme Court 386 days Review of Supreme Court docket 

sheets for 2005 term 3

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Stage Time Source 

TOTAL: 3,156 days (8.65 years) 

*Accuracy is questionable. 

1Past-President of National Organization of Veterans Advocates (Robert V. Chisholm, Statement Before the 

House Subcommittee on Disability Assistance and Memorial Affairs of the House Committee on Veterans’ Affairs (May 22, 2007)). 2Derived from hand review of all veteran appeals in Federal Circuit from October 1, 2005 to September 30, 

2006 that resulted in decisions on the merits. 3Derived from hand review of all signed Supreme Court decisions issued in the 2005 Term. 

The number of claims pending at regional offices in recent years has accelerated rapidly, and the huge backlog is now reaching crisis proportions, as 

shown on the graph attached as Exhibit A. Shockingly, there is no deadline 

for the VA to act on claims or to prepare documents needed for an appeal 

such as a ‘‘Statement of the Case’’; ironically, the only deadlines apply to 

the veteran, who is often unrepresented. As a result, veterans frequently 

trip up at the regional office level, resulting in a summary denial of a claim 

or appeal as reflected in the high percentage of appeals to the BVA and 

CAVC that are summarily denied on jurisdictional defect grounds, including 

failure to comply with time deadlines or legal doctrines such as waiver and 

subsumption. The VA benefits from delays because some of the veterans die 

while their claim is pending, and survivors often do not pursue the claim 

further, and the VA does not award interest on any retroactive award, which 

is calculated at the historical rates, not current rates that reflect inflation. 

The claim abandonment rate at the regional office level is also very high, 

perhaps as high as 99%. Thus, the appeal system is irrelevant for the vast 

majority of veterans because their claims never get that far. In my opinion, 

many of the abandoned claims likely have at least some merit, and many 

veterans give up out of frustration. The VA’s timeliness measures are unreliable because it often manipulates the numbers, e.g., by calculating from the 

wrong date or by artificially truncating a regional office decision into a number of parts to make the delay numbers look more palatable. For example, 

the timeliness of medical care is calculated as the time between a request 

for an appointment and the date the appointment date is given, not the date 

the appointment occurs, which may stretch months in the future. Congress 

needs to set minimum times for complete action at the regional office level 

in the absence of which a claim would be provisionally granted. And it also 

needs to take a hard look at the BVA and the CAVC, which are experiencing 

unprecedented delays that only will get worse with time. See Exh. B. 

6. Excessive Remands—The Recycling or ‘‘Hamster Wheel’’ Problem: If 

the VA makes a mistake at the regional office level, however egregious, no 

consequences attach to it. Instead, the claim is ‘‘remanded’’ and the innocent 

party—the veteran—has to wait several years for the BVA or CAVC to order 

the VA to correct the mistake and start all over at the regional office. Thus, 

it is the veteran that suffers. The error rates reflected in the disposition of 

the appeals of VA regional offices are startlingly high, as reflected on the 

chart attached as Exhibit B. 

7. Incentive Compensation System: The design of the VA’s incentive compensation system is to give adjudicators a financial incentive to ‘‘game’’ the 

system at the veteran’s expense. For example, shredding a medical examination report or another key piece of evidence can make a denial or remand 

decision easy to write. The incentive compensation system operates under a 

‘‘piece work’’ basis, making it more important to find ways to accomplish a 

task quickly rather than correctly. Two BVA attorneys were indicted several 

years ago for doing exactly this in hundreds or potentially thousands of 

cases, and both plead guilty (Jill Rygwalski and Lawrence Gottfried). The 

VA must do more to detect and correct internal abuses that have plagued 

the agency for many years. I would recommend that incentive compensation 

for adjudicators and caregivers be primarily based on the results of veteran 

satisfaction surveys. 

8. Need for Veterans Civil Rights Legislation—a ‘‘Veterans Bill of 

Rights:’’ The veteran is procedurally handicapped at the regional office level 

by statutory or regulatory restrictions on his or her civil and procedural 

rights. Unlike all other citizens, the veteran cannot retain a lawyer at his 

own expense, leaving him or her vulnerable to sharp practices, procedural 

missteps or abandonment. The veteran cannot subpoena any VA employees 

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to testify (e.g., the VA’s own doctor who concluded he was disabled or the 

anonymous medical person on the adjudication side who says he is not), and 

the veteran cannot subpoena documents or other witnesses to testify at a 

hearing (in most cases). Our veterans deserve more than a watered-down 

version of mass justice. The regional office stage is crucial because that is 

where the record is developed and upon which the appeal depends. I also believe that it was a serious error for Congress to set up an Article I court to 

hear veterans appeals, the limited powers of which play a key role in circumscribing veterans’ civil rights. It is time for Congress to restore the civil 

rights of veterans by passing a veterans’ Bill of Rights. See Exh. C. 

9. Remedies for Denial of Healthcare: One of the greatest weaknesses in 

the veterans’ benefits system at the regional level is that no meaningful or 

timely remedies exist for a veteran who is denied health care—no form, no 

established procedure. Instead, the veteran’s complaint is handled under an 

informal VHA ‘‘directive’’ that does not have the force of law. Thus, everything is left to fiat, and the veterans has no enforceable rights and no timely 

recourse. The delays inherent in the informal procedure also make it ineffective. This is contributing to the suicide epidemic amongst returning OIF/ 

OEF veterans, amongst other frustrations that veterans experience. 

10. Inability of Veterans Court to Enforce its Decisions at the Regional 

Office Level/Need for Expansion of Powers of Veterans Court: One of 

the most serious defects in the VA system is the CAVC’s inability to force 

regional offices to obey the rule of law. As former Chief Judge Frank 

Nebeker of the CAVC pointed out in his ‘‘State of the Court’’ speeches, the 

CAVC’s inability to force the regional offices to follow its decisions means 

that the regional offices can violate the CAVC’s decisions with impunity. The 

CAVC also needs to be given the power to issue injunctions against the VA 

and to order relief under the Declaratory Judgments Act. In addition, the 

Court should be ordered to adopt a class action procedure whereby relief can 

be extended beyond the individual veteran to encompass similarly situated 

veterans. Finally, the lack of discovery at any stage of the adjudication process has to be addressed, as it hampers veterans’ ability to develop facts to 

support a claim and/or to challenge adverse evidence, and prevents the veteran from discovering misconduct. 

11. The Unofficial Regulation Problem: For many years the VA has adopted 

rules by way of ‘‘fast letters,’’ directives or other unofficial means on important issues that in effect may dictate the result in an individual case or entire category of cases. Put differently, these unofficial rules prescribe substantive standards which properly should have been the subject of rulemaking, and an opportunity for judicial review. This practice completely circumvents the judicial review process set up by Congress. Most recently, the 

VA has set up a special review procedure at the Central Office for ‘‘extraordinary awards’’ made by regional offices that involves extra layers of review 

and delay and which discourages adjudicators from making retroactive 

awards. History is rife with similar examples, such as the ‘‘second signature’’ 

requirement for PTSD grants (but not denials), the directive not to infer 

claims based upon individual unemployability, the ‘‘courtesy sign-off’’ system 

which defeated the whole purpose of having a three-member decision-making 

team, and a host of others. 

12. Absence of Guaranteed VA Budget and Chronic Underfunding: The 

VA has been chronically underfunded for years. Pentagon Undersecretary for 

Personnel and Readiness David Chu’s interview in the Wall Street Journal 

on Jan. 25, 2005 is very revealing as to what has been driving the VA budget constriction—a desire to spend more money on armaments and less money 

on personnel. The VA’s chronic underfunding creates a compulsion to ration 

healthcare and disability payments, and contributes to lengthy delays as 

well as to the hiring of marginally qualified workers or medical professionals. 

13. Upgrade Quality of Personnel and Leadership: The VA needs to upgrade the quality of its hiring. My understanding is that many VA rating 

specialists have only a high school education and lack any medical training—meaning that unqualified persons are deciding the fates of our veterans. This may help explain the high error rate and the great frustration 

felt by our veterans. At the same time, reports have continued to surface 

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erans. The VA’s management problems are immense and so deeply entrenched that they warrant the hiring of a capable crisis management or 

turnaround Executive to either head the agency or recommend how to address the huge problems that it faces. Sinecures or political appointments do 

no one any good. 

C. Conclusion 

One litmus test for the VA’s performance that is within the experience of each 

of you is the frequency with which you receive complaints from your constituents. 

If the number of phone calls and e-mails I receive from veterans is any indication, 

the dissatisfaction levels are very high. I leave you with one final quote from 

Marlow v. West, and ask you to consider whether this is the type of experience you 

want to subject our veterans to: 

Although the dispositive law is all too clear, we are constrained to comment on Mrs. Marlow’s 12 year effort to get her veteran father’s full benefits before he died. The record is replete with examples of VA’s disingenuous refusal to acknowledge the specific nature of the claim for benefits 

under section 1114(o) and to deny what is manifestly obvious in the record 

and was clearly articulated in Mrs. Marlow’s communications to VA. See, 

e.g., R. at 38–42, 182–202. VA ultimately corrected Mr. Mokal’s ratings 

from the time of his discharge, but only after it was too late, as a matter 

of law, to pay him. R. at 336–38. This is a case that gives credence to those 

who don’t believe that VA is committed to the spirit expressed in the words 

of General Omar Bradley, the Administrator of Veterans Affairs from 1945 

to 1947: ‘‘We are dealing with veterans, not procedures; with their problems, not ours.’’ 

Marlow v. West, Decision No. 98–113 (CAVC 1999). 

Exhibit A 

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Exhibit B 

Exhibit C 

THE VETERANS BILL OF RIGHTS 

Preamble: It is the intent of Congress to honor the service and personal sacrifices of veterans and their families by ensuring that they have fair and timely access to all the benefits to which they are entitled, including death and disability 

compensation, medical care, educational assistance, job training, housing and pensions (‘‘VA Benefits’’). To this end, 

1. Congress recognizes that all veterans have and have always had a Fifth 

amendment property interest in the receipt of all VA Benefits. 

2. Veterans shall have an unfettered access to retain attorneys at their own expense, and the Fee Prohibition in 38 U.S.C. § 5904(c)(l) shall be abolished. 

3. Veterans should have full rights to judicial review in Article III courts, and the 

Court of Appeals for Veterans Claims should be abolished, with a transition 

plan for implementation. 

4. Veterans shall have the right to subpoena documents or records from all federal agencies, and all federal agencies shall treat veterans’ document or record 

requests expeditiously and shall produce all responsive documents within 60 

days. 

5. Veterans shall have the right to call any VA employees as witnesses at any 

regional office hearings related to veterans’ benefits, including treating physicians or other medical personnel and anyone else who has made any determination in connection with a claim. 

6. Congress shall take all necessary measures to insure that the VA delivers on 

its commitments to provide healthcare to veterans, and the VA’s practice of denying care to veterans it classifies as having a low priority is disapproved. 

7. The VA shall adopt remedies and procedures to timely address cases of alleged 

denial of or unreasonable delays in providing healthcare, including notice, an 

opportunity to call witnesses, and a hearing to any veteran contesting such denial, as well as an expedited procedure in cases of emergency. 

8. The VA shall award interest at the federal rate on all retroactive awards of 

any form of death or disability compensation or pension. 

9. Congress shall guarantee and appropriate all funds necessary to provide all 

veterans benefits in accordance with the VA’s budgets. 

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1 39,885 claims in FY 2004; 37,832 in FY 2005; 40,074 in FY 2006; and 37,370 in FY 2007. 

2Fiscal Year 2008 Budget Submission, Volume II, National Cemetery Administration, Benefits 

Programs, and Departmental Administration, Benefits Summary, Department of Veterans Affairs, Pg. 6A–2 (Retrieved Feb. 2, 2008, from <http://www.va.gov/budget/summary/index.htm>). 

Prepared Statement of Adrian Atizado, 

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 Department of Veterans Affairs’ 

(VA) disability claims backlog and claims processing system. 

To improve administration of VA’s benefits programs, the DAV recommends Congress provide the Veterans Benefits Administration (VBA) with enough staffing to 

support a long-term strategy for improvement in claims processing and reduction of 

the claims backlog. Through recommendations contained in VA’s budget submission 

and the Independent Budget for fiscal year (FY) 2009, to include recent appropriations, the VA may soon have the appropriate staffing, if utilized in conjunction with 

the recommendations herein, to finally begin to gain control of the growing claims 

backlog. Therefore, this testimony primarily focuses on policy initiatives to manage 

the increase in new claims and reduce the out-of-control claims backlog. In total, 

if Congress accepts our recommendations, the VA will be better positioned to serve 

all disabled veterans and their families. 

Claims Backlog 

Mr. Chairman, the claims’ backlog is unquestionably growing. Rather than making headway and overcoming the protracted delays in the disposition of its claims, 

VA continues to lose ground on its claims backlog. According to VA’s weekly workload report, as of January 26, 2008, there were 816,211 pending compensation and 

pension (C&P) claims, which include appeals. Putting this number into perspective, 

at the end of 2004, 2005, 2006, and 2007, the total number of pending claims was 

620,926; 680,432; 752,211; and 809,707 respectively. Therefore, in the three years 

from the end of 2004 to the end of 2007, the total number of pending C&P claims 

rose by 188,781 for an average of 62,929 additional pending claims per year. The 

VA’s pending claims rose by 6,504 just from the end of 2007 to January 26, 2008— 

less than one month. At this rate, VA’s caseload will pass one million claims in 

three years. With the wars in Iraq and Afghanistan still raging, together with the 

mass exodus from military service that usually occurs following cessation of combat 

operations, new and re-opened claims received by the VA are more likely to increase 

than decrease. A caseload topping one million claims will truly be a demoralizing 

moment for America—the time to act is now. 

New claims per year continue to increase from one year to the next. For example, 

VBA received 771,115 new rating claims in FY 2004 and 838,141 new claims in FY 

2007, equaling an average increase of 16,756 additional claims per year. During this 

same period, the VA received a total of 155,164 new beneficiaries that had never 

before been on VA rolls through the Benefits Delivery at Discharge (BDD) claims 

process. At this rate, 1 the average number of new BDD claims per year is 38,791 

for a total of 232,746 new claims through the BDD process by the end of FY 2009. 

These figures do not include service members filing claims through either the military’s physical disability evaluation systems, or those discharging via end-of-service 

contracts who then come to the VA on their own to files claims after discharge. 

The significance of these new beneficiaries is that large portions of VA’s workload 

increase via new claims each year are re-opened claims rather than claims from veterans who have never filed for VA benefits. Therefore, the increase in brand new 

beneficiaries into the system will inevitably increase further the number of reopened claims, ultimately causing the total number of claims received by the VA 

each year to continue growing, contrary to VA’s FY 2008 budget estimate. VA’s 2009 

budget submission reveals the VA added 277,000 beneficiaries to its C&P rolls in 

2007, which further proves this point. 

The complexity of the workload has also continued to grow. Veterans are claiming 

greater numbers of disabilities and the nature of disabilities such as Post Traumatic 

Stress Disorder (PTSD), complex combat injuries, diabetes and related conditions, 

and environmental diseases are becoming increasingly more complex. For example, 

the number of cases with eight or more disabilities increased 135 percent from 

21,814 in 2000 to 51,260 in 2006.2 Such complex cases will only further slow down 

VBA’s claims process. 

We have maintained the VA should invest more in training adjudicators and that 

it should hold them accountable for higher standards of accuracy. Nearly half of 

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3Department of Veterans Affairs Office of Inspector General, Rep. No. 05–00765–137, Review 

of State Variances in VA Disability Compensation Payments 61 (May 19, 2005). 4See M21–4, Ch. 3. 5See I.d. at 3.3 

VBA adjudicators responding to survey questions from VA’s Office of Inspector General admitted that many claims are decided without adequate record development. 

(The Board of Veterans’ Appeals (Board) and the Court of Appeals for Veterans 

Claims’ (Court’s) remand rate clearly demonstrate this.) The Inspector General saw 

an incongruity between their objectives of making legally correct and factually substantiated decisions, with management objectives of maximizing output to meet production standards and reduce backlogs. Nearly half of those surveyed reported that 

it is generally, or very difficult, to meet production standards without compromising 

quality. Fifty-seven percent reported difficulty meeting production standards while 

attempting to ensure they have sufficient evidence for rating each case and thoroughly reviewing the evidence. Most attributed the VA’s inability to make timely 

and high quality decisions to insufficient staff. In addition, they indicated that adjudicator training had not been a high priority in VBA. 

We have consistently stated that quality is the key to timeliness. Timeliness follows from quality because omissions in record development, failure to afford due 

process, and erroneous decisions require duplicative work, which add to the load of 

an already overburdened system. Quality is achieved with adequate resources to 

perform comprehensive and ongoing training, to devote sufficient time to each case, 

and to impose and enforce quality standards through effective quality assurance 

methods and accountability mechanisms. The VA has simply not had the resources 

necessary to achieve the level of quality required to avoid unacceptable error rates, 

increased numbers of appeals, and the consequent overload that causes backlogs 

and delays in claims dispositions. Having said that, we realize the FY 2009 budget 

submission provides a significant increase in staffing for VBA. 

However, additional resources are not the solitary answer to the claims backlog. 

One of the most essential resources is experienced and knowledgeable personnel devoted to training. More management devotion to training and quality requires a 

break from the status quo of production goals above all else. In a 2005 report from 

VA’s Office of Inspector General, VBA employees were quoted as stating: ‘‘Although 

management wants to meet quality goals, they are much more concerned with quantity. An RVSR is much more likely to be disciplined for failure to meet production 

standards than for failing to meet quality standards;’’ and that ‘‘there is a lot of 

pressure to make your production standard. In fact, your performance standard centers around production and a lot of awards are based on it. Those who don’t produce 

could miss out on individual bonuses, etc.’’ 3

In addition to basing awards on production, the DAV strongly believes that quality should be awarded at least on parity with productions. However, in order for this 

to occur, VBA must implement stronger accountability measures for quality assurance. VA’s quality assurance tool for compensation and pension claims is the Systematic 

Technical Accuracy Review (STAR) program. Under the STAR program, the VA reviews a sampling of decisions from regional offices and bases its national accuracy 

measures on the percentage with errors that affect entitlement, benefit amount, and 

effective date. Notwithstanding other elements of concern over this program, if 

STAR were being used effectively, we question why the VA did not detect the substantial variations in average annual compensation payments from state to state 

brought to light by the news media and thereafter investigated by the VA Office of 

Inspector General in 2005. 

Inconsistency is a sign of arbitrariness in decisionmaking, uneven, or overall insufficient understanding of governing criteria or rules for decisions or rules that are 

vague or overly broad to allow them to be applied according to the prevailing 

mindset of a particular group of decision makers. Obviously, the VA must detect inconsistencies before the cause or causes can be determined and remedied. 

Simply put, there is a gap in quality assurance for purposes of individual accountability for quality decision making. In the STAR program, a sample is drawn each 

month from a regional office workload divided between rating, authorization, and 

fiduciary end products. For example, a monthly sample of ‘‘rating’’ related cases generally requires a STAR review of ‘‘10’’ rating-related end products.4 Therefore, one 

can easily distinguish the significant importance placed on productivity over and 

above the priority placed on accuracy. Reviewing 10 rating-related cases per month 

for a large size regional office, 5 an office that would easily employ more than three 

times that number of raters, is undeniable evidence of a total void in individual accountability. If an average size regional office produced only 1000 decisions per 

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month, which we feel is quite conservative, the STAR program would only review 

a tenth of one percent of the total cases decided by that regional office. Those figures leave no room for trend analysis, much less personal accountability. 

To complement its STAR program for allegedly measuring quality at the national 

level, the VA announced in the year 2000 a new initiative for quality review at the 

individual level. Acknowledging that management needed tools to monitor individual performance, the VA created the ‘‘Systematic Individual Performance Assessment’’ (SIPA) program. Under this program, the VA would review an annual sample 

of 100 decisions for each adjudicator to identify individual deficiencies, ensure maintenance of skills, promote accuracy and consistency of claims adjudication, and restore credibility to the system. The reviewers would perform related administrative 

functions, such as providing feedback on reviews, maintaining reports, and playing 

a role in employee development and ongoing training. Unfortunately, the VA abandoned this initiative during 2002, and proficiency is now apparently subjectively assessed by supervisors based on their day-to-day perceptions of employee performance. Without any actual systematic review of samples of an individual adjudicator’s 

decisions, deficiencies are more likely to go undetected and uncorrected. We understand that the culprit behind abandonment of SIPA was inadequate resources. 

Without any quality assurance review on the individual level, the VA is unlikely to 

impose effective accountability down to the individual adjudicator level, where it 

must go if optimum quality is expected. 

We believe today’s VA workforce is conscientious and desires to make the best 

claims decisions possible, but it needs the time, training, and tools to do so, and the 

tools include a source of direct feedback from individualized quality reviews. Without such oversight, under qualified, poorly trained VBA employees repeat the same 

mistakes, which lead to repeated appeals on the same issue, and that result in the 

VA recycling the same cases over and over, further adding to the backlog. 

There is no proverbial silver bullet to solving VA’s challenges. Various policy 

changes can and should be implemented that will collectively have a positive impact 

on reducing VA’s claims backlog while also improving services to VA’s clientele. The 

DAV believes the following policy changes will have such an impact. 

Overdevelopment of Claims 

Numerous developmental procedures in the VA claims’ process collectively add to 

the enormous backlog of cases. While many of these procedures are mandatory, they 

are often over utilized. This unnecessarily delays claims for months—when this occurs in, or leads to, the appeals process, claims are delayed for many years. There 

is no single answer to solving the claims backlog. Therefore, in addition to staffing 

increases, Congress and the VA must attack the problem using alternative methods, 

particularly when those alternative methods are parallel with the intent of the law, 

work to save departmental resources, and protect the rights of disabled veterans. 

For example, rather than making timely decisions on C&P claims when evidence 

development may be complete, the VA routinely continues to develop claims. These 

actions lend validity to many veterans’ accusations that whenever the VA would 

rather not grant a claimed benefit, the VA intentionally overdevelops cases to obtain 

evidence against the claim. Despite these accusations, a lack of adequate training 

is just as likely the cause of such overdevelopment. 

Such actions result in numerous appeals, followed by needless remands from the 

Board and/or the Court. In many of these cases, the evidence of record supports a 

favorable decision on the appellant’s behalf yet the appeal is remanded nonetheless. 

These unjustified remands usually do nothing but perpetuate the hamster-wheel 

reputation of veterans law. Numerous cases exemplify this scenario; a list can be 

provided upon request. 

Essentially, the VA requests unnecessary medical opinions in cases where the 

claimant has already submitted one or more medical opinions that are adequate for 

rating purposes. VA claimants desiring to secure their own medical evidence, including a fully informed medical opinion, are entitled by law to do so. If a claimant does 

secure an adequate medical opinion, there is no need in practicality or in law for 

the VA to seek its own opinion. Congress enacted title 38, United States Code, section 5125 for the express purpose of eliminating the former 38 Code of Federal Regulations, section 3.157(b)(2) requirement that a private physician’s medical examination report be verified by an official VA examination report prior to an award of VA 

benefits. Section 5125 states: 

For purposes of establishing any claim for benefits under chapter 11 or 15 

of this title, a report of a medical examination administered by a private 

physician that is provided by a claimant in support of a claim for benefits 

under that chapter may be accepted without a requirement for confirmation 

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istration if the report is sufficiently complete to be adequate for the purpose 

of adjudicating such claim. [Emphasis added] 

Therefore, Congress codified section 5125 to eliminate unnecessary delays in the 

adjudication of claims and to avoid costs associated with unnecessary medical examinations. Notwithstanding the elimination of title 38, Code of Federal Regulations, section 3.157, and the enactment of title 38 United States Code section 5125, 

the VA consistently refuses to render decisions in cases wherein the claimant secures a private medical examination and medical opinion until a VA medical examination and medical opinion are obtained. Such actions are an abuse of discretion, 

which delay decisions and prompt needless appeals. When claimants submit private 

medical evidence that is adequate for rating purposes, Congress should mandate the 

VA must decide the case based on such evidence rather than delaying the claim by 

arbitrarily and unnecessarily requesting additional medical examinations and opinions from the agency. Such enactment will preserve VA’s manpower and budgetary 

resources; help reduce the claims backlog and prevent needless appeals; and most 

importantly, better serve disabled veterans and their families. 

Standard for Determining Combat Veteran Status 

Title 38, United States Code, section 1154(b) requires the VA to accept lay or 

other evidence as sufficient proof of service connection of a disease or injury if a veteran alleges that disease or injury occurred in or was aggravated during combat. 

While the VA recognizes the receipt of certain medals as proof of combat, only a 

fraction of those who participate in combat receive a qualifying medal. Further, military personnel records usually do not document actual combat experiences. As a result, veterans who suffer a disease or injury resulting from combat are forced to provide evidence that may not exist or wait a year or more while the VA conducts research to determine whether a veteran’s unit engaged in combat. 

Congress should amend title 38, United States Code, section 1154(b) to clarify 

military service as treatable service in which a member is considered to have engaged in combat for purposes of determining combat-veteran status. Such clarification would properly allow for utilization of nonofficial evidence as proof of in-service 

occurrence for service connection of combat-related diseases or injuries. 

This type of legislation would remove a barrier to the fair adjudication of claims 

for disabilities incurred or aggravated by military service in combat zone. Under existing law, veterans who can establish that they ‘‘engaged in combat’’ are not required to produce official military records to support their claim for disabilities related to such service. This legislation would not alter the law’s current requirement 

that a veteran confirm a disability through official diagnosis. Further, it would not 

alter the requirement that a veteran show a nexus between a claimed disability and 

military service. The only alteration from current law would be a relaxed standard 

of proof, consistent with Congress’ original intent, required to establish a veteran 

as one who engaged in combat. This relaxed standard of proof would then only apply 

to those who serve in a combat zone. 

Many veterans disabled by their service in Iraq and Afghanistan, and those who 

served in earlier conflicts are unable to benefit from liberalizing evidentiary requirements found in the current version of section 1154(b). This results because of difficulty, even impossibility, in proving personal participation in combat by official 

military documents. 

Impositions put forth by VA General Counsel opinion 12–99 require veterans to 

establish by official military records or decorations that they ‘‘personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality.’’ Oversight visits by Congressional staff to VA regional 

offices found claims denied under this policy because those who served in combat 

zones were not able to produce official military documentation of their personal participation in combat via engagement with the enemy. The only possible resolution 

to this problem without amending section 1154(b) is for the military to record the 

names and personal actions of every single soldier, sailor, airman, and Marine involved in every single event—large or small—that constitutes combat and/or engagement with the enemy on every single battlefield. Such recordkeeping is impossible. 

Numerous veterans have been and continue to be harmed by this defect in the 

law. In numerous cases, extensive delays in claims processing occur while VA adjudicators attempt to obtain official military documents showing participation in combat: documents that may never be located. 

The Senate noted in 1941, in the report on the original bill that the absence of 

an official record of care or treatment in many of such cases is explained by the conditions surrounding the service of combat veterans. Congress emphasized that the 

establishment of records for non-combat veterans was a simple matter compared to 

the combat veteran—either the veteran carried on despite his disability to avoid 

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6 38 U.S.C.A, § 7252(a) (West 2002) (‘‘The Court of Appeals for Veterans Claim shall have exclusive jurisdiction to review decisions of the Board of Veterans’ Appeals. The Secretary may 

not seek review of any such decision.’’) 

having a record made lest he or she be separated from his or her organization or, 

as in many cases, the records themselves were lost. Likewise, many records are simply never generated. 

Congress should clarify its intent by amending title 38, United States Code, section 1154(b), with respect to defining a veteran who engaged in combat for all purposes under title 38, as a veteran who during active service served in a combat zone 

for purposes of section 112 of the Internal Revenue Code of 1986 or a predecessor 

provision of law. 

Other Factors Affecting the Backlog 

In addition to the backlog of claims originating at the local regional office, the 

Board and the Court add substantially to the claims backlog by needlessly and frequently remanding numerous cases on appeal. In many of these appeals, the evidence of record fully supports a favorable decision on the appellant’s behalf, yet the 

appeal is remanded nonetheless. These unjustified remands deprive the appellant, 

usually for many additional years, to benefits awardable based on facts already of 

record. 

The greatest challenge facing the Court is identical to the VA—the backlog of 

cases. The Court has shown a reluctance to reverse errors committed by the Board. 

Rather than addressing an allegation of error raised by an appellant, the Court has 

a propensity to vacate and remand cases to the Board based on an allegation of 

error made by the VA’s counsel for the first time on appeal, such as an inadequate 

statement of reasons or bases in a Board decision. Another example occurs when 

the VA argues, again for the first time on appeal, for remand by the Court because 

the VA failed in its duty to assist the claimant in developing the claim notwithstanding an express finding by the Board that all development is complete and 

where the appellant accepts, and does not challenge such finding by the Board. Such 

actions are particularly noteworthy because the VA has no legal authority to appeal 

a Board decision to the Court.6

Consequently, the Court will generally decline to review alleged errors raised by 

an appellant that actually serve as the basis of the appeal. Instead, the court remands the remaining alleged errors on the basis that an appellant is free to present 

those errors to the Board even though an appellant may have already done so, leading to the possibility of the Board repeating the same mistakes on remand that it 

had previously. Such remands leave errors properly raised to the Court unresolved; 

reopen the appeal to unnecessary development and further delay; overburden an already backlogged system; exemplify far too restrictive judicial restraint; and inevitably require an appellant to invest many more months and perhaps years of his 

or her life in order to receive a decision that the court should have rendered on initial appeal. As a result, an unnecessarily high number of cases are appealed to the 

Court for the second, third, or fourth time. 

In addition to postponing decisions and prolonging the appeal process, the Court’s 

reluctance to reverse Board decisions provides an incentive for the VA to avoid admitting error and settling appeals before they reach the Court. By merely ignoring 

arguments concerning legal errors rather than resolving them at the earliest stage 

in the process, the VA contributes to the backlog by allowing a greater number of 

cases to go before the Court. If the Court would reverse decisions more frequently, 

the VA would be discouraged from standing firm on decisions that are likely to be 

overturned or settled late in the process. 

To remedy this unacceptable situation, Congress should amend title 38, United 

States Code section 7261 to require the Court on a de novo basis, to: (1) decide all 

relevant questions of law; (2) interpret constitutional, statutory, and regulatory provisions; and (3) determine the meaning or applicability of the terms of an action of 

the Secretary. The Court’s jurisdiction should also be amended to require it to decide all assignments of error properly presented by an appellant. 

Conclusion 

We hope the Committee will review these recommendations and give them consideration for inclusion in your legislative plans. 

Mr. Chairman, thank you for inviting DAV to testify before you today. 

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Prepared Statement of Paul Sullivan, Executive Director, 

Veterans for Common Sense 

I would like to thank Chairman John Hall and members of the subcommittee for 

inviting Veterans for Common Sense to offer testimony regarding regional office solutions to eliminate the enormous backlog of 650,000 claims at the Veterans Benefits Administration. VCS is a non-profit organization based in Washington, DC, 

founded in 2002, providing advocacy for service members and veterans. 

At a recent VCS meeting with veterans, one Iraq war combat veteran asked us, 

‘‘What would a smooth running VBA regional office look like?’’ We said it should 

be where veterans come first and where claims are decided accurately within 30 

days. 

VCS fully supports the superb recommendations already made by Harvard Professor Linda Bilmes, Morrison & Foerster’s Gordon Erspamer, and the Veterans Disability Benefits Commission. In addition, we recognize the tremendous efforts by 

VBA rank-and-file staff, many of whom are veterans, for their work assisting veterans every day. 

Backlog Causes 

VCS believes there are five major reasons why VBA remains foundering in an 

ocean of incomplete claims, doubling from 325,000 claims in 2002 to 650,000 claims 

today. Veterans now wait more than six months for an answer from VBA. Most of 

the reasons are beyond the control of rank-and-file VBA employees working at regional offices: 

1. Staffing: VBA lacks the money to hire enough staff to handle the increased 

volume or to adequately train existing staff to make accurate, complete and 

timely decisions. 

2. Process: VBA’s complex and adversarial rules, VBA’s 26-page claim form, and 

VBA’s lack of due process make deciding claims unreasonably complicated. 

3. Volume: More claims—with an increase of 17 percent more issues per claim 

over the past six years—keep flooding into VBA, such as Vietnam War veterans seeking benefits for Agent Orange poisoning and PTSD, as well as other 

veterans seeking a financial safety net due to a weak economy. 

4. The Iraq and Afghanistan Wars: The two wars generated 245,000 unanticipated VBA claims—again, with more issues per claim—with high rates of traumatic brain injury (TBI), post traumatic stress disorder (PTSD), and hearing 

loss. 

5. Poor Leadership: VBA’s political leadership lacked the vision to become 

proactive and resolve VBA’s severe claims crisis. 

When combined, these five factors created a perfect storm at VBA. Compounded 

by institutional inertia and draconian budget restrictions from the Office of Management and Budget and the White House, the result is a catastrophic failure where 

the backlog and the length of time to process claims continues to grow. Now hundreds of thousands of veterans go without disability payments and access to VA 

medical care because VBA remains rudderless, sinking, and far out to sea in a raging hurricane. 

Future Challenges 

Here are four significant additional challenges VBA faces: 

1. The VBA capacity crisis is expected to worsen in the foreseeable future, as VA 

expects to process nearly one million new and re-opened claims next year. 

2. VA regional offices received 245,000 unanticipated disability claims, yet 16 percent, or 39,000 veterans, are still waiting, on average six months, for a VA 

claim decision. 

3. DoD already reports 68,000 non-fatal battlefield casualties from the two wars, 

and VA expects to treat 333,000 veteran patients during 2009, most of whom 

can be expected to file VBA disability claims, based on the activity of Gulf War 

veterans. 

4. Veterans who served in the National Guard and Reserves are nearly three 

times as likely to have their claim denied than veterans from regular Active 

Duty (14% v. 5%). VCS believes this discrepancy warrants an investigation by 

VA, the Department of Justice, and Congress because last year the difference 

was only two times as likely. 

Solutions 

VBA should use two avenues to fix problems: an incremental approach and an 

overhaul approach. VBA must make immediate reforms while keeping its eyes fowwoods2 on PRODPC68 with HEARING

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cused on creating a robust system where VA can, in fact, produce prompt, complete, 

and accurate VA disability claim decisions with 30 days. In the long-term, VCS suggests using the recommendations provided by the Veterans Disability Benefits Commission as a blueprint for the start of a desperately needed overhaul of VA, especially VBA. 

In the short term, in addition to recommendations made by Bilmes, Erspamer, 

and the VDBC, we ask Congress to change the law and thus provide VBA regional 

office employees the tools to put our veterans first: 

1. Automatically approve disability claims for TBI. Congress should pass 

legislation to automatically approve disability benefits for deployed veterans 

who are diagnosed with TBI. Such a law would simplify and expedite claims 

processing at regional offices. According to the Defense and Veterans Brain Injury Center at Walter Reed Army Medical Center, up to 20 percent of Iraq and 

Afghanistan war veterans are at risk for TBI due to roadside bomb blasts. One 

VA physician estimates up to 30 percent, or between 320,000 and 500,000 TBI 

cases. However, the military does not document all bomb blasts, thus making 

it hard for VA to verify and to process TBI claims. This new law would establish that a deployment to the Iraq and Afghanistan war zones means VBA concedes there was a concussive blast incident strong enough to cause the TBI, 

unless there is evidence to the contrary. Coupled with this recommendation is 

a requirement for mandatory full funding for VA to provide proper TBI screening for all 1.6 million of our service members sent to war zones since September 11, 2001. 

2. Automatically approve disability claims for PTSD. In July 2007, VCS 

asked Congress to pass legislation designed to automatically approve disability 

claims for veterans who are diagnosed with PTSD. VCS believes such a law 

would simplify and expedite claims processing at regional offices. Estimates 

range from 20 percent to 36 percent for Iraq and Afghanistan war veterans returning home with PTSD, or between 320,000 and 600,000 PTSD cases. In a 

July 2004 Army study, the military documented 93 percent of soldiers and 97 

percent of Marines experienced ‘‘being shot at or receiving small arms fire,’’ indicating that nearly all soldiers are now involved in combat. Congress should 

investigate why VA diagnosed 56,246 veterans with PTSD, yet approved only 

34,138 PTSD disability claims, or only 61 percent. Are the 22,000+ claims 

pending, denied, or under appeal? Do veterans receiving free VHA healthcare 

know about VBA? A major problem facing veterans and regional office staff is 

the military’s lack of records for all combat engagements. PTSD claims should 

be automatically approved with the understanding that deployment to Iraq and 

Afghanistan means VBA concedes there was at least one stressor sufficient 

enough to cause PTSD, unless there is evidence to the contrary. 

3. Expand Benefits Delivery at Discharge. One of VBA’s biggest hurdles at 

regional offices is obtaining military service and medical records. With a complete forward deployment of VBA staff at military bases, including all National 

Guard and Reserve armory and demobilization sites, VBA would have immediate and full access to records before they are shipped off to storage, misplaced, or destroyed. Congress should change the law so that all service members can file claims while still in the military. Currently, this is not available 

at all military installations, and is noticeably absent for our Reserve and National Guard. Congress should require any VBA employee stationed at a military facility to be trained and authorized to assist with both military and VA 

healthcare and claims paperwork. Coupled with this suggestion is the need for 

DoD to comply with 38 U.S.C. section 5106 and provide military service records 

and military medical records to VA and to the veteran at discharge and for 

VHA to automatically enroll all new service members upon enlistment. 

4. Hold VBA Accountable. In the end, VCS believes there must be accountability at VBA. At present, VCS is aware of only a very small number of VBA 

employees who have faced adverse consequences for incomplete, incorrect, negligent, or criminal activities involving veterans’ claims. VCS asks Congress to 

request statistics from VBA that show the number of VBA employees who 

faced personnel actions (counseling, reprimands, demotion, transfer, or termination) as a result of a poor performance evaluation associated with developing 

or approving claims—and this should include all VBA staff, from rating specialists to supervisors to Executives. 

VCS believes accountability for VBA must rest with the highest official at VBA, 

the Under Secretary for Benefits, Daniel Cooper. After six years, he provided only 

small incremental changes rather than both incremental change and a massive 

overhaul. Congress must hold the entire Administration—VBA, VA, OMB, and the 

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White House—accountable for this systemic failure to assist our disabled veterans, 

lest this problem continue indefinitely even if a new Under Secretary were confirmed. 

Here is a chronology showing the Under Secretary was fully aware of VBA’s crisis 

before he became Under Secretary, yet he failed to deliver for our veterans: 

• In early 2001, then-Secretary Anthony Principi recognized challenges at VBA, 

and he created the ‘‘Claims Processing Task Force,’’ naming Cooper to lead it, 

even though he had no experience with VA. He was a retired Navy Vice Admiral who served on the Board of Directors for Exelon, a nuclear power company, 

and USAA, an insurance and banking company. • In October 2001, Cooper issued his Task Force report, which made dozens of 

thoughtful incremental recommendations, including holding VBA employees accountable. In November 2001, the full Committee held a hearing to discuss the 

work of the Task Force. After 9/11 and after the invasion of Afghanistan, Cooper told the full Committee, ‘‘In my opinion, today, there are enough resources 

in VBA to do the job that has to be done’’ (page 16). • In December 2001, with more troops pouring into Afghanistan and with plans 

on the table to invade Iraq, Cooper provided additional written answers to the 

full Committee’s questions about staffing resources. Cooper wrote, ‘‘At the hearing, I specifically stated that new resources (i.e., FTE) should not be provided’’ 

(page 166). Given that there were hundreds of thousands of claims from half 

of our Gulf War conflict veterans, why did he not plan for nor act on the needs 

of a new generation of war veterans when he became Under Secretary in 2002? 

Conclusion 

A failure to address VBA’s claims catastrophe has needlessly increased suffering 

among our veterans and their families. According to published government and 

news reports, the number of broken homes, unemployed veterans, drug and alcohol 

abuse, suicides, and homelessness all rose—problems expected to worsen without 

immediate action to resolve VBA’s claims crisis. VCS believes VA, VBA, and Congressional leaders should work closely with VBA employees and advocates to find 

solutions. VCS respectfully requests our ethics complaint against the Under Secretary for Benefits sent to DoJ on September 4, 2007, be entered into the hearing 

record. 

f 

Prepared Statement of Steve Smithson, Deputy Director, 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

Thank you for giving The American Legion the opportunity to present its views 

on the Department of Veterans Affairs (VA) backlog and VA’s claims processing system. 

Claims Backlog & Staffing 

In Fiscal Year (FY) 2007, more than 2.8 million veterans received disability compensation benefits. Providing quality decisions in a timely manner has been, and 

will continue to be, one of the VA’s most difficult challenges. A majority of the 

claims processed by the Veterans Benefits Administration’s (VBA) 57 regional offices 

involve multiple issues that are legally and medically complex and time consuming 

to adjudicate. 

As of February 2, 2008, there were 653,595 claims pending in VBA, 400,386 of 

which are rating cases. There has been a steady increase in VA’s pending claim 

backlog since the end of FY 2004 when there were 321,458 rating cases pending. 

At the end of FY 2007, there were more than 391,000 rating cases pending in the 

VBA system, up approximately 14,000 from FY 2006. Of these, more than 100,000 

(25.7 percent) were pending for more than 180 days. Including non-rating claims 

pending, the total compensation and pension claims backlog was more than 627,000, 

with 26.5 percent of these claims pending more that 180 days. There were also more 

than 164,000 appeals pending at VA regional offices, with more than 142,000 requiring some type of further adjudicative action. At the end of FY 2007, the average 

number of days to complete a claim from date of receipt (182.5 days) was up 5.4 

days from FY 2006. 

Inadequate staffing levels, inadequate continuing education, and pressure to make 

quick decisions, resulting in an overall decrease in quality of work, has been a consistent complaint among regional office employees interviewed by The American Legion staff during regional office quality checks. It is an extreme disservice to vetwwoods2 on PRODPC68 with HEARING

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erans, not to mention unrealistic, to expect VA to continue to process an ever increasing workload, while maintaining quality and timeliness, with the current staff 

levels. The current wartime situation provides an excellent opportunity for VA to 

actively seek out returning veterans from Operations Enduring Freedom and Iraqi 

Freedom, especially those with service-connected disabilities, for employment opportunities within VBA. Despite the recent hiring initiatives, regional offices will clearly need more personnel given current and projected future workload demands. 

However, VBA must be required to provide better justification for the resources 

VBA says are needed to carry out its mission and, in particular, how VBA intends 

to improve the level of adjudicator training, job competency, and quality assurance. 

Each of these topics will be discussed in greater detail below. 

Production vs. Quality 

Since 1996, The American Legion, in conjunction with the National Veterans 

Legal Services Program (NVLSP), has conducted quality review site visits at more 

than 40 regional offices for the purpose of assessing overall operation. This Quality 

Review Team visits a regional office for a week and conducts informal interviews 

with both VA and veterans service organization (VSO) staff. The Quality Review 

Team then reviews a random sample of approximately 30–40 recently adjudicated 

American Legion-represented claims. The Team finds errors in approximately 20– 

30 percent of cases reviewed. 

The most common errors include the following: 

• Inadequate claim development leading to premature adjudication of claim; 

• Failure to consider reasonably inferred claims based on evidence of record; 

• Rating based on inadequate VA examination; and/or 

• Under evaluation of disability (especially mental conditions). 

These errors are a direct reflection of VA’s emphasis of quantity over quality of 

work. This seems to validate The American Legion’s concerns that emphasis on production continues to be a driving force in most VA regional offices, often taking priority over such things as training and quality assurance. Clearly, this frequently results in premature adjudications, improper denials of benefits and inconsistent decisions. 

Training 

Proper mandatory training is a key factor in the quality of VA regional office rating decisions. The Board of Veterans’ Appeals (BVA) combined remand and reversal 

rate (56 percent) of regional office decisions for FY 2007 is a direct reflection of the 

lack of importance placed on training by the VA regional offices. Our quality review 

site visits have revealed that, at many regional offices, there have been too few experienced supervisors that could provide trainee adjudicators proper mentoring and 

quality assurance. In addition, at many stations, ongoing training for the new hires, 

as well as the more experienced staff, would be postponed or suspended, so as to 

focus maximum effort on production. 

Despite the assurances of the Under Secretary for Benefits that training of personnel is a top priority within VBA, the inconsistency in VBA’s training approach 

and in its implementation needs to be thoroughly reviewed and addressed by upper 

management within the VBA. In the experience of The American Legion, the lack 

of proper training and oversight adversely impacts all areas of VBA. Each of VBA’s 

57 regional offices appear to have different approaches to training and also differ 

in the importance placed on training. According to a May 2005 report from the VA 

Office of the Inspector General (VAOIG), based on a survey of rating veterans service representatives (RVSRs) and decision review offices (DROs), the respondents expressed positive opinions regarding the quality of their training, but the overall response indicated that training did not receive high priority. 

The information obtained in the VAOIG’s survey is consistent with what The 

American Legion has found in talking to service center staff during our quality review site visits. Some stations have regular formalized or structured training programs, while others have training programs that are best described as more informal and sporadic. Some stations have well established and structured training for 

new employees, but ongoing training for experienced staff is very limited. 

The VAOIG also recommended that a scientific study be conducted to further examine the variances in disability payments. VA subsequently contracted the Institute for Defense Analyses (IDA) to conduct the study. IDA released its report in 

2007. IDA noted that although VBA provides centralized training modules for training purposes, many regional offices supplement this training with material developed locally. IDA also noted that many rating specialists interviewed stated that 

they received ‘‘on-the-job’’ training from senior raters and identified these individwwoods2 on PRODPC68 with HEARING

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uals as the biggest influence on their rating styles. IDA suggested that a ‘‘stronger 

mechanism’’ would reduce the potential for persistent differences among regional offices in ratings and ensure that raters VA-wide are receiving the same training. IDA 

further recommended that raters be given standardized test cases, reflecting the 

most likely areas of variation, as part of an ongoing training process. 

We are appreciative of the importance the Under Secretary for Benefits has 

placed on training of VBA personnel. We are also aware of the centralized training 

program that has been implemented; however, a national training standard/requirement, in addition to the centralized training conducted by Compensation and Pension (C&P) Service, for regional office personnel is also needed. Consistent and 

standardized training at each regional office must take place for all personnel—experienced and new hires alike. The American Legion believes it is crucial that such 

a program be implemented and closely monitored for compliance by the Under Secretary for Benefits. Management in stations, not in compliance with such training 

requirements, must be held accountable; otherwise, any national or centralized 

training effort will not be successful. 

Additionally, The American Legion believes it is essential to proper training that 

information (reasons for remand or reversal) from BVA decisions, DRO decisions 

and errors noted in National STAR and other internal quality reviews be tracked 

and examined for patterns. This information should then be used in mandatory formal training to ensure that common errors and other discrepancies occurring in regional office rating decisions are not repeated. This information should also be used 

for remedial training purposes when patterns of errors are identified for specific individuals. Although such data is currently being collected and disseminated to the 

regional offices, it appears that consistent utilization of this data in regular formalized and specific training is lacking. 

The American Legion must stress that unless regional offices (both managers and 

individual adjudicators) learn from their mistakes and take corrective action, the VA 

will continue to have a high rate of improperly adjudicated claims, which result in 

a consistently high appeals rate and subsequent high BVA remand/reversal rate. 

Performance Standards 

Performance standards of adjudicators and rating specialists are centered on productivity as measured by work credits, known as ‘‘End Products.’’ Both veterans 

service representatives (VSR) and RVSRs have minimum national productivity requirements that must be met each day. Some stations also set their own standards, 

based on their claims backlog and other station specific requirements that are over 

and above the national requirement. Despite the fact that VBA’s policy of ‘‘production first’’ has resulted in many more veterans getting faster action on their claims, 

the downside has been that tens of thousands of cases are prematurely and arbitrarily denied. Approximately 65 percent of VA raters and DROs surveyed by the 

VAOIG, in conjunction with its May 2005 report, admitted that they did not have 

enough time to provide timely and quality decisions. In fact, 57 percent indicated 

that they had difficulty meeting production standards if they took time to adequately develop claims and thoroughly review the evidence before making a decision. These findings are consistent with what our Quality Review Team has reported from interviews with regional office service center staff. 

Unfortunately, the End Product work measurement system essentially pits the interests of the claimant against the needs of VA managers. The conflict is created 

because the regional offices have a vested interest in adjudicating as many claims 

as possible in the shortest amount of time. Awards and bonuses are often centered 

on production rather than outcomes. This creates a built-in incentive to take shortcuts so that the End Product can be taken. The system, in effect, rewards regional 

offices for the gross amount of work they report, not whether the work is done accurately or correctly, often resulting in many claims being prematurely adjudicated. 

These problems are caused by inadequate development, failure to routinely identify 

all relevant issues and claims and/or ratings based on inadequate examinations. 

Even the VAOIG acknowledged that because the VA often does not take the time 

to obtain all relevant evidence and information, there is a good chance that these 

claims are not properly adjudicated. 

Such errors, however, are often overshadowed by the desire of VA managers to 

claim quick End Product credit. The result has been a traditionally high remand 

rate by BVA and the Court of Appeals for Veterans Claims (CAVC). The American 

Legion believes that VBA management is reluctant to establish a rigorous quality 

assurance program to avoid exposing the longstanding history of the manipulation 

of workload data and policies that contribute to poor quality decisionmaking and the 

high volume of appeals. VBA’s quality-related problems and the fact that little or 

no action is being taken to prevent or discourage the taking of premature End Prodwwoods2 on PRODPC68 with HEARING

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ucts have been longstanding issues for The American Legion. The current work 

measurement systems, and corresponding performance standards, are used to promote bureaucratic interests of regional office management and VBA rather than 

protecting and advancing the rights of veterans. The End Product work measurement system, as managed by the VA, does not encourage regional office managers 

to ensure that adjudicators do the ‘‘right thing’’ for veterans the first time. For example, denying a claim three or four times in the course of a year before granting 

the benefit sought allows for a total of FIVE End Product work credits to be counted 

for this one case, rather than promptly granting the benefit and taking only one 

work credit. 

In the view of The American Legion, the need for a substantial change in VBA’s 

work measurement system is long overdue. A more accurate work measurement system would help to ensure better service to veterans. Ultimately, this would require 

the establishment of a work measurement system that does not allow work credit 

to be taken until the decision in the claim becomes final, meaning that no further 

action is permitted by statute whether because the claimant has failed to initiate 

a timely appeal or because the BVA rendered a final decision. We are pleased that 

legislation (H.R. 3047) introduced in 2007 would mandate such overdue changes to 

VA’s work credit system. We are hopeful that, if enacted, this legislation, which 

would change the underlying incentive by rewarding quality of work rather than 

quantity, will increase the number of accurate decisions as well as claimant satisfaction and, in doing so, reduce the overall number of appeals. 

Proficiency/Competency 

C&P Service conducted an open book (pilot) job skill certification test for VSRs 

several years ago in which the pass rate was extremely low (approximately 23 percent). Even more alarming than the low-test scores was the fact that those who took 

the test had several years of experience in the position and were considered to be 

proficient. 

C&P Service subsequently finalized its VSR proficiency test and conducted tests 

in May and August 2006. Employees participating in the testing underwent 20 

hours of training prior to taking the test. Although the pass rate (about 42 percent) 

for these tests was much higher than the pilot test, it is still very low and can hardly be considered acceptable. C&P Service did not conduct any tests in FY 2007. 

The American Legion applauds the new testing program as a step in the right 

direction, but we still have concerns. Although successful completion of the test will 

be required for promotion or assignment to a rating board, it is not mandatory as 

a condition of employment in that position and is completely optional. C&P Service 

is in the process of developing a test for RVSRs and DROs, but a timeline for completion or implementation has not yet been determined. Unfortunately, like the VSR 

test, the test for RVSRs and DROs will not be mandatory as a condition of employment. 

The ultimate goal of proficiency or competency testing should be to ensure that 

an individual in any given position is competent, proficient, and otherwise qualified 

to perform the duties required of that position. This goal will not be achieved if testing is not mandatory, or is not provided for all levels or for all positions, and remedial training or other corrective action is not required for those who do not successfully pass the test. Although this concept may not be embraced by some, the ultimate goal is to have qualified and competent staff who will provide the best service 

possible for veterans and their families. 

Immediate (Non-legislative) Remedies to reduce Claims Backlog 

Greater emphasis should be placed on conducting triage to identify and expedite 

claims that are substantially complete (very little or no development needs to be 

completed in order to rate the claim) at the time they are submitted. Then compensation & pension exams should be ordered as soon as possible in cases where 

the only development that is needed in order to rate the claim is an exam. Although 

there are mandatory notification requirements under the VCAA, VA can streamline 

its waiver process in those cases where the claim is substantially complete and or 

veterans do not have any additional evidence to submit. This would allow VA to proceed with the adjudication process in a timely manner without having to wait for 

the expiration of the time period for a veteran to submit additional evidence or otherwise respond to the VCAA letter. 

The aforementioned process should also be applied in claims with multiple issues 

in order to provide claimants with access to VA healthcare and compensation, while 

VA continues to work those issues that are more complex or require significant development. Issues that are substantially complete and essentially ‘‘ready to rate’’ at 

time of submission should be so identified and expedited in order to avoid delay that 

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would result if adjudication was put off until all issues were ready to rate. Issues 

that are more complex or require significant development should be deferred for rating upon completion of required development. 

VA often receives claims that contain evidence sufficient to establish service connection and also sufficient medical evidence to properly rate the current severity of 

the condition under the applicable diagnostic code. In most, if not all of these cases, 

VA, as matter of routine, schedules an exam even though it has sufficient evidence 

to not only establish service connection, but also sufficient evidence to properly rate 

the condition under the applicable rating criteria. 

Perfect examples of this are claims of entitlement to service connection for type 

II diabetes based on the Vietnam Agent Orange (herbicide) presumption. If a veteran diagnosed with type II diabetes meets the Vietnam service requirements, exposure to herbicides is conceded and entitlement to service connection is automatically 

established, if the condition developed to a degree of 10 percent or more disabling 

during the applicable presumptive period and rebuttal of service connection, in accordance with 38 C.F.R. § 3.307, was not accomplished. In type II diabetes cases, 

the treatment notes (either private or VA) more often than not contain sufficient 

medical information to properly rate the current severity of the condition under the 

VA Schedule for Rating Disabilities, negating the necessity of a VA examination. 

Unfortunately, the routine scheduling of (unnecessary) examinations in cases such 

as this where there is sufficient evidence of record to establish service connection 

and to properly rate the condition can result in one to three month delays in adjudicating the claim. The American Legion, therefore, recommends establishing specially 

trained triage teams to identify such claims. 

VA could also explore another option that involves cases where there is sufficient 

evidence to establish service connection, but an exam is needed to accurately rate 

the current severity of the condition. In these cases, VA could grant service connection, establish a baseline evaluation based on the medical evidence of record, and 

then go back later and conduct an exam to establish current severity of the condition. Such a process would quickly establish service connection and, as a result, VA 

healthcare eligibility, and generally provide the claimant with payments in a 

timelier manner. 

Brokered Claims 

In an effort to help balance its claims backlog across regional offices, VBA established a ‘‘brokering’’ program where it transfers claims from the regional office of 

jurisdiction to another regional office to be adjudicated. The idea behind brokering 

cases is to provide assistance to regional offices with large backlogs by having another regional office rate a specified number of its claims each month. Regional office employees and VSOs located at regional offices that broker work to other offices 

have consistently voiced concern about the quality of the brokered work, to our 

Quality Review Team during site visits. There seems to be a common consensus 

among VA and VSO employees, interviewed by the Team, that regional offices working brokered claims do not have a vested interest in the brokered claim as it is not 

under their permanent jurisdiction nor will they have to deal with subsequent appeals. The frequency of errors found in brokered cases reviewed during The American Legion quality review site visits supports this concern. 

Unfortunately, although VBA does not have a mechanism in place to monitor the 

quality of brokered work, VBA management continues to tout this program as an 

effective case management tool. Although this program may be a necessary shortterm solution for regional offices unable to effectively manage current workloads, it 

does not address the staffing and other resource deficiencies that resulted in the 

need for work to be brokered in the first place. VBA management should not continue to rely on brokering as permanent solution to addressing its claims backlog, 

but should focus on ensuring that its regional offices have adequate staffing, training, and other resources in order to properly manage their own workloads and eliminate the need for brokering all together. 

Conclusion 

The best way to help veteran claimants is to fix the entire VA claims adjudication 

system. Piecemeal solutions do not work and should be avoided. The VA work measurement system should be changed so that VA regional offices are rewarded for good 

work and suffer a penalty when consistent bad decisions are made. Managers, rating specialists and BVA law judges and attorneys should be rewarded for prompt 

careful work and they should also be penalized when they make bad decisions. 

American veterans seeking VA disability benefits deserve better treatment than 

what they are currently getting from VA. 

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Thank you again, Mr. Chairman, for allowing The American Legion to present 

comments on these important matters. As always, The American Legion welcomes 

the opportunity to work closely with you and your colleagues to reach solutions to 

the problems discussed here today that are in the best interest of America’s veterans and their families. 

f 

Prepared Statement of Gerald T. Manar, Deputy Director, 

National Veterans Service, Veterans of Foreign Wars of the United States 

CHAIRMAN HALL, RANKING MEMBER LAMBORN AND MEMBERS OF THE 

SUBCOMMITTEE: 

Thank you for this opportunity to present the views of the 2.4 million veterans 

and auxiliaries of Veterans of Foreign Wars of the United States on the VA claims 

processing system. 

An increasingly complex world 

During my 30 year career with the Department of Veterans Affairs I was fortunate to meet, and in some cases, work with many of the highest leaders in what 

is now the Veterans Benefits Administration (VBA). During one such meeting several of these Executives spent a few minutes reminiscing about the days when they 

were young claims examiners in the 1950’s and ‘60’s. They laughed about a disability pension program so simple that they were able to memorize the monthly benefit rates paid based on the breakdown of income received by veterans. Under that 

program it was only necessary to compute income within a band, or a range, of income. Income within that band was paid a single rate. 

That simple program was replaced by what is now called section 306 Pension; 

that, in turn, was replaced in 1979 by the ‘‘Improved Pension’’ Program. The Improved Pension Program requires detailed reporting by claimants, verified through 

matching programs with Social Security and the Internal Revenue Service. The pension benefit is adjusted up or down for every single dollar of countable income. It 

is a program so precise that discovery of an extra $10 of income will lessen the pension by that amount while payment of an extra $10 for medical expenses may increase it. 

There are many positive and negative aspects to the Improved Pension Program. 

However, it is undisputable that it is not easy to understand and is certainly not 

‘‘simple’’ to administer. 

In truth, I am not aware of any program administered by VA that is simpler or 

easier to administer today than it was 30 years ago. 

When I started working for the VA in 1974 there were three education programs: 

Chapter 34, the GI Bill, Chapter 31, vocational rehabilitation, and Chapter 35, for 

certain dependents and survivors of veterans who either died from or were totally 

disabled by service connected disabilities. Today, in addition to Chapters 31 and 35, 

there are separate programs for active duty and Guard and Reserve members. Better for veterans? Yes. Simpler and easier to administer? No. 

Congress created the Court of Veterans Appeals, now the Court of Appeals for 

Veterans Claims (CAVC), in 1988 to provide veterans and other claimants an independent review of VA decisions concerning their entitlement to benefits. In the 20 

years since its creation, the Court has issued thousands of opinions affirming the 

decisions of the Board of Veterans Appeals (BVA). During the same period, however, 

the CAVC has issued many other decisions which clarified, corrected or redefined 

VA’s interpretation of the law governing compensation, pension and education benefits. These decisions, in turn, forced VA to rework its policies and procedures to conform to these new interpretations of the law. In some instances, VA has had to rework thousands of cases to ensure compliance with court decisions. 

Few can dispute that veterans and other claimants have benefited from the improved understanding of the legal requirements surrounding the development and 

decisionmaking process within VA. However, no one anticipated the impact court decisions have had in making the work more complex. And, as we have seen, increased 

complexity extends the time it takes to resolve claims and increases the opportunity 

for error. Better for veterans? Yes. Simple and easy to administer? No. 

It is not just changes to the law and judicial review that have delayed VA decisionmaking. Until the last few years, staffing at VA experienced a decade’s long roller coaster ride that trended ever downward. As an Adjudication Officer in Los Angeles from 1986 to 1996, I can report to you that we suffered through long periods 

of hiring freezes and delayed budgets. Our annual attrition rate during that period 

averaged 15 percent and to be forced to wait a year or more before being able to 

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hire anyone was disastrous to the orderly maintenance of a workforce capable of 

processing of claims. Further, when we were able to hire, we were rarely permitted 

to recruit to fill all our needs. 

We soldiered on through those staffing draughts, always trying new ways to motivate and encourage our employees to produce more. Although we had our successes, 

long periods of overtime that tend to exhaust employees, reduced flexibility due to 

staffing losses and an inability to timely fill critical vacancies resulted in gradually 

increasing backlogs. Sadly, it also led to an increase in errors: mistakes that cost 

veterans and the government alike. 

VA leadership experimented with different claims processing models and configurations of work activities. While always well intentioned, these experiments generally failed either because they didn’t translate well from private industry or 

through poor execution. Each failed business model caused VBA to fall further and 

further behind. 

I mention all these things because they are not ancient history. There has been 

no break in the last 10 years where the VA was problem free and operating on all 

cylinders. The problems of the past continue to echo down to the present. While the 

infusion of much needed staffing over the last few years is welcome, it takes years 

to properly bring those new employees to accomplish quality work at journeyman 

levels of production. 

Axioms—self evident truths 

There is no quick fix to VBA; there is only the opportunity for steady and deliberate improvement. 

There is no magic bullet. Any single plan to make the claims processing system 

simple and easy will make things only marginally simpler and easier on the VA bureaucracy and will occur at the expense of the rights and benefits of at least some 

veterans, dependents and survivors. Any such plan is simply unacceptable. 

Perhaps it is time to recognize that the world has changed. There has been a silent paradigm shift over the last 30 years. If for no other reason than judicial review, the Veterans Claims Assistance Act and the budgetary environment which exists today, it may be time to acknowledge that VA cannot be staffed at such levels 

as will allow it to produce quality decisions in the same timeframe that earlier generations of dedicated government workers achieved. 

The converse of this may be to acknowledge that the better production and timeliness levels achieved in the 1950’s and ’60’s may very well have been accomplished 

because there was less attention paid to procedural rights and that the VA may 

have exhibited a cavalier attitude when it came to interpreting the law and its own 

regulations. 

It pains me to say this, but whether you agree with either view of history, the 

initial point remains: the world in which VA operates has changed and it may no 

longer be realistic to expect accurate benefit decisions in a short period of time. 

If we concede for the sake of argument that the first three observations are accurate, there are still things that can be done to improve production, reduce backlogs 

(although perhaps not at the rate we would like to see) and ensure claims are completed with quality. 

During my career with the VA I made a conscious decision to avoid membership 

in any veteran’s service organization. I felt that I needed to be totally objective and 

free from even the appearance of a conflict of interest. However, I was well aware 

of the good things service officers were able to accomplish for veterans and their 

families. That is why I did not hesitate to extend my service to veterans by joining 

with the VFW. 

One of the things that has bothered me since coming to work for the VFW is that 

the general public, when it thinks of veterans service organizations at all, thinks 

of us as always having our hand out, always asking more and more for veterans. 

It is the perception that we are ungrateful beggars that bothers me the most. 

We stand here speaking for our nearly 2 million veteran members. More than 

that, we, and the others at this table, speak for all veterans who don’t have a working knowledge of the laws found in the U.S. Code or the rules set out in the Code 

of Federal Regulations. We are both advocates and lobbyists; we are proud to speak 

for all those men and women who, through the years, offered up themselves, sometimes at great risk of injury or death, so that you and I have the freedom to speak 

our minds in this public forum. 

We ask for nothing but that which these men and women deserve to help make 

them whole from the physical and mental injuries they suffered during their military service. 

We come today not with our hands out but with real tangible ideas for improving 

timeliness of processing claims without harming veterans in the process. Some of 

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the suggestions offered below were first put forward to the Veterans Disability Benefits Commission in April 2007. Others arise from the experiences of those who 

serve veterans, both in and out of government. These suggestions alone will not 

have a major impact on the backlog. However, if presenting them spurs additional 

ideas, then perhaps they will all, cumulatively, make the improvements necessary 

to achieve quality decisions within a reasonable time. 

Starving regional offices 

One of VBA’s current policies is to replace lost staffing in regional offices according to their ability to process claims. Specifically, the more productive an office is, 

the more staff they receive. While this policy may encourage management at an 

underperforming office in the short run, over time it magnifies the deficiencies at 

the underperforming office, resulting in disproportionate backlogs and extended 

delays for the veterans served by that office. 

This policy has existed for at least the last five years. While VBA attempts to 

compensate by shifting, or ‘‘brokering’’, work to other offices, this does not solve the 

problems at the underperforming offices. Further, while brokering cases is an excellent temporary measure to deal with workload fluctuations, it has become routine 

for some offices. Continuous brokering of work takes on the trappings of a game 

called ‘‘Whack-a-Mole’’ at the county fair: as soon as you push down workload at 

one location, it rises dramatically in another. 

In our view, the policy of starving certain offices is counterproductive, both for 

employees and the veterans they serve. If VBA is unable to provide those offices 

with the leadership, resources and training to make them productive, then it needs 

to develop the corporate, institutional and political courage to change the mission 

of those offices to something other than claims processing. 

Rotation of Veteran Service Representatives 

The current claims processing system requires the periodic rotation of Veteran 

Service Representative (VSR’s) from team to team. While this facilitates personal 

development and ensures that a cadre of employees exist who have experience in 

all aspects of claims processing, it means that teams lose their most knowledgeable 

members at the very moment they become the most effective and productive. If the 

current claims processing model is the most efficient, and I am not convinced that 

it is, then VBA management needs to reexamine this policy and determine how it 

can be better adjusted to ensure that the needs of veterans, employees and the organization are best met. 

We urge the VA to reexamine the way it staffs its’ Triage Team. It is our belief 

that this part of the organization would benefit most from having a stable workforce 

made up of clerks (similar to the correspondence and development clerks employed 

by VA in the past) rather than the higher paid and more versatile VSR. Utilization 

of more clerks at this level would reduce at least one rotation of VSR’s. 

Focus on quality; get it right the first time 

We believe that the greatest benefits can be found by fixing the front end of the 

claims operation. Most court decisions today focus on procedural problems stemming 

from notice to claimants and development, or failures to properly develop evidence. 

The VCAA was created because VA would sometimes take shortcuts in the claims 

development period, failing to give claimants adequate notice of what they needed 

to produce to prove their claims. However, as we have seen since its passage, it is 

quite possible to become bogged down in the notice requirements while attempting 

to dot every ‘‘i’’ and cross every ‘‘t’’. 

We support the VCAA because we believe it helps level the playing field for veterans. The VA has the expert knowledge of what is required in order to grant or 

increase benefits to veterans. They are required to pass that knowledge on so that 

claimants know, too, and can focus their energies in obtaining the necessary evidence to perfect their claim. 

However, this is not rocket science. If a veteran claims service connection for the 

residuals of a knee injury, the VA can tell her that she needs to show that she has 

a disability of the knee now, that she injured the knee in service or something that 

happened in service caused a knee problem and to provide VA with medical evidence that shows the current problem to be related to the event in service. These 

are the same three things that have always been required to prove service connection. 

The requirements for obtaining an increase in benefits are equally finite: a claimant must show that their service-connected disability has worsened sufficiently to 

obtain a higher evaluation. In order to obtain an increase for that knee problem, 

the veteran must show the existence of arthritis in the joint which limits motion 

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or pain, or limitation of extension or flexion by certain amounts, or instability in 

the joint. 

Again, this is not rocket science. Software can be developed that allows a VSR 

in a Pre-Determination team to simply answer a question on a computer screen concerning whether the claim is for service-connection or an increase and what the 

claimed condition is. Now, as you suspect, the computer can generate paragraph 

after paragraph explaining what is required and if the veteran is claiming 12 conditions then the letter can become quite long. However, if the object is to ensure that 

claimants have the information necessary to perfect their claims then it can be done 

with properly programmed computers. Further, these software programs can be 

made available to claimants in a simple, easily accessed, public website. Any curious 

veteran could enter the website, answer a series of simple questions and receive detailed information on what is needed to obtain the benefit. 

Veterans Claims Assistance Act 

It has been said that a journey of a thousand miles begins with a single step. In 

a like fashion, the journey from filing an initial claim to receipt of a final decision 

by the VA begins with the determination by VA as to whether a ‘‘substantially complete claim’’ has been submitted by a claimant. Once VA receives a substantially 

complete claim it is required by law to begin a rigorous ritual of notification and 

action which are designed to help claimants obtain either sufficient evidence to 

allow VA to grant their claim or all pertinent evidence which will allow VA to deny 

the benefits sought. 

Background 

The rules governing VA’s duty to assist were spelled out by Congress in the Veterans Claims Assistance Act of 2000 (VCAA). This law overturned a Court of Appeals for Veterans Claims ruling in Morton v. West, 12 Vet. App. 477 (1999) which 

held that individuals had to submit a ‘‘well grounded’’ claim before VA was required 

to help them obtain evidence necessary to prove their claim. In application, a well 

grounded claim proved to be harder to achieve than previously required by VA. 

With the VCAA, Congress substantially lowered the evidentiary standard claimants had to meet before VA was required to help them gather evidence. The Veterans of Foreign Wars (VFW) believes that the VCAA was necessary to restore the 

status quo ante. In doing this, Congress spelled out in great detail the actions VA 

must take to help claimants with their claims. 

Following passage of the VCAA, VA diligently (some would say bureaucratically) 

attempted to comply with both the substance and spirit of the legislation. In doing 

so, VA crafted and refined procedures and correspondence designed to comply with 

the law. Legal challenges required significant changes and one required VA to send 

letters to hundreds of thousands of individuals who had claims pending before VA. 

These legislative and judicial efforts to ensure that VA does everything possible 

for claimants to help them develop claims, while well intentioned, has led to a process that is legalistic, fragmented and more intended to make cases appeal proof 

than it is to adequately inform claimants of the information they need to move forward with their claims. Review of a single VCAA letter will leave even lawyers 

shaking their heads in an attempt to understand what it is VA needs to complete 

processing of a claim. 

On the surface, the legal requirements seem simple enough: tell the claimant 

what evidence is contained in her file; tell her what evidence is needed to complete 

the claim; tell her that VA will help her obtain certain evidence if she provides the 

names and addresses of facilities and doctors who provided treatment related to the 

claim; and tell her that VA will obtain service medical records, pertinent VA health 

records and any necessary records held by the Federal government. 

What makes this difficult is that individuals often want service connection or 

higher evaluations for more than one condition. At a time when the average new 

claim contains 8 or 9 conditions, and some as many as 20 or more, spelling out a 

simple and clear explanation as to how claimants can obtain an earlier decision 

from VA is difficult. 

We believe that this effort, if done properly, will go a long way to taking the confusion out of the VCAA notice letters. Such clarity will help claimants provide all 

the evidence needed by VA to decide their claims. 

We would suggest, however, that those who have brought us the current stable 

of lengthy and confusing development letters are likely to be the same people who 

revise them. Consequently, we believe that VA should extensively use focus groups 

to ensure that the new letters are understandable and readable to the average person while complying with the law. 

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We believe that additional things can be done to allow knowledgeable claimants 

to move more quickly through the duty to assist morass: 

Waiver of the VCAA notice and 60 day waiting period 

Currently, VA is required to send a VCAA notice to everyone who has submitted 

a ‘‘reasonably complete’’ claim. There are times, however, when knowledgeable 

claimants, or claimants represented by competent advocates, submit everything necessary for VA to adjudicate their claim. Under current law and practice, however, 

VA is required to not only review the claim for completeness but also undertake development as required by law. The VA does this even if the claimant specifically 

states, in writing, that the claim is complete, that there is no additional evidence 

available and requests a waiver of VCAA development. This creates additional and 

unneeded work on VA regional office personnel and delays the adjudication of the 

claim by at least 60 days. 

What we propose is that Congress amend the duty to assist provisions of the law 

to allow a knowledgeable wavier of duty to assist development. What we envision 

is a form which requires positive or negative answers to specific questions which, 

in the end, demonstrates that the claimant knows what the law requires VA to do, 

what evidence is needed by VA and consciously waives the VCAA notice and 60 day 

waiting period. 

For example, the waiver form could include questions like: 

• Have you been treated since service for any of your claimed disabilities? (yes/ 

no) 

• If you were treated since service, have you submitted all private medical evidence that shows treatment for your claimed disabilities? (yes/no) 

• Have you furnished VA with the names, addresses and dates of treatment, if 

any, of all records held by the Federal government (not just VA)? (yes/no) 

• Do you understand that by requesting this waiver VA will make no further efforts to identify or develop treatment records not currently held by VA? (yes/ 

no) 

• Do you understand that by requesting this waiver VA will make no further efforts to identify or develop records not currently held by the Federal government? (yes/no) 

• Do you understand that while you may submit additional evidence while your 

claim is being processed, your waiver relieves VA of the legal requirement to 

help you obtain evidence that you tell it about? (yes/no) 

While VA would still have to develop those claims where the form was not utilized 

or not correctly completed, it would still be able to move a significant number of 

claims to the next level, reducing their workload and hastening the completion of 

some of its work. 

VA would still be responsible for developing government held records and obtaining required physical examinations. However, the elimination of the 60 day waiting 

period should prove extremely helpful. 

Require VA to encourage ready to rate cases 

Many VA regional office service center managers encourage veteran service organizations to bring them ‘‘ready to rate’’ cases. While this practice works well in some 

offices, it is rarely utilized in others. This practice encourages service officers to 

bring complete and ready to rate claims to a designated person who ensures that 

routine development is bypassed and claim adjudication is expedited. 

We believe that this practice should be encouraged since it reduces the workload 

on VA staff and ensures that the backlog is not unnecessarily increased. We recommend the creation of a nation-wide initiative which formalizes this practice. 

To ensure that this practice actually works, VA should require that regional office 

personnel, managers and veteran service officers are adequately trained to recognize 

a properly developed claim and understand that receipt of such a claim triggers actions which ensure prompt adjudication. 

We believe that VA should give no preferential treatment to any case which, upon 

review, is found not to be ready to rate. This is necessary to ensure that partially 

developed cases receive no preferential treatment, thereby slowing completion of 

claims already in process. 

However, one of the purposes of this program is to educate veteran service officers 

as to the evidence needed to produce a ready to rate case. We suggest that VA could 

do this by offering service officers an opportunity to complete development in a case 

found not ready to rate by telling them exactly what evidence is missing and giving 

them 10 working days to produce it. 

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The case could be considered ready to rate if the service officer is able to provide 

the necessary evidence. Failure to timely complete the claim would simply mean 

that the case would receive no preference and be worked under current procedures. 

Informal claims 

An informal claim is any communication from a claimant indicating intent to 

apply for one or more benefits from VA. (38 C.F.R. 3.155) If no formal claim has 

been received, VA writes the claimant and describes what is necessary to submit 

a substantially complete claim. The claimant has one year from the date of the VA 

letter to submit a completed application (e.g., VA Form 21–526). However, VA establishes no control and takes no further action. If the requested information is received within the year, the date of receipt of the informal claim becomes the date 

of claim. If the information sought is received after the one year period expires, the 

date of claim is the date of receipt of the additional material. 

However, if a formal claim for benefits was previously received by VA, than an 

informal claim is considered simply a claim for benefits. (38 CFR 3.155(c); 3.160) 

In this case, VA establishes a computer control and begins the development required 

by the VCAA. 

This rule discourages knowledgeable claimants and advocates from submitting 

complete or ready to rate claims to VA. Any delay in submitting a claim to reopen 

or a claim for an increase could negatively effect the date of claim which is the date 

from which benefits, if granted, are payable. 

What we propose is that Congress change the law to allow the submission of an 

informal claim for the purpose of establishing an effective date. Under such a law, 

knowledgeable claimants and advocates could submit an informal claim at any time. 

VA would be required to acknowledge receipt of the claim and the claimant would 

be told what is necessary to perfect the claim. In this situation, the claimant would 

have a year in which to either submit evidence necessary to perfect his/her claim 

or request the assistance of VA to develop the claim. In the later situation, VA’s 

duty to assist would be triggered and it would begin development required by the 

VCAA. 

However, this change allows knowledgeable claimants and advocates to relieve VA 

of the burden of developing every claim. To the extent that the claimant or advocate 

is successful in obtaining evidence, it lessens the workload on VA and hastens the 

claim through VA once it is received by VA. 

This suggestion, if adopted, will not necessarily lessen the amount of time it takes 

for an individual or advocate to develop the claim and the VA to reach a decision. 

However, it encourages certain claimants and advocates to undertake development 

prior to submitting a claim and to the extent that it reduces the workload on VA 

personnel it will allow all claims to move more swiftly through the process. 

Artificial Intelligence 

In our view there is computer programming and ‘‘artificial intelligence’’. Nearly 

everything touted as ‘‘artificial intelligence’’ is really just computer programmers 

giving answers to a very large number of yes/no questions. There is, however, ample 

opportunity to use computers to decide certain evaluations based on established 

findings. Evaluations for service connected visual impairment or hearing loss, largely based on loss of visual acuity, fields of vision or decibel loss, could be easily assigned by computers. We encourage VA to utilize properly programmed computers 

to apply regulations to discrete data to arrive at concrete evaluations. This will 

allow rating specialists more time to work on decisions requiring judgment and experience. 

All Electronic Record 

Currently the VA has several thousand all electronic claims files primarily located 

in the Winston-Salem regional office. These cases are largely Benefits Delivery at 

Discharge cases. It is our understanding that VA continues to process a number of 

these cases. 

These electronic claims files offer VA a unique opportunity to create a separate 

office to handle all electronic claims. We suggest creation of a completely separate 

office, rather than the continued integration of electronic claims processing into the 

everyday flow of work, because it provides VA with the opportunity to experiment 

and create an environment unencumbered by paper files. Imagine if you will, two 

Rating VSR’s located in separate sections of a building reviewing the claims file and 

making decisions on different elements of a claim simultaneously. The efficiencies 

that such a system creates could be significant. 

VA rightfully believes that scanning its millions of existing files would be cost prohibitive. We agree. However, VA receives thousands of requests each year for copies 

of claims files. Right now, each file is photocopied and sent to the claimant. What 

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we propose is that each office be equipped with scanners so that, instead of 

photocopying the file, it is scanned. The claimant still receives a paper copy of the 

file. At the same time, VA also has an electronic record. We suggest that this electronic file can be transferred to the office handling all electronic files. VA can experiment with the most appropriate work procedures at this office and, when it has 

grown sufficiently, a second office can be created. 

Eventually, most claims will be electronic and VA can then begin converting RO’s 

into public contact offices. 

These suggestions, ideas and recommendations will not, in and of themselves, 

solve the backlog, timeliness and quality issues impacting VA today. However, if 

adoption of these and similar proposals each result in some improvement, we believe 

the cumulative effect will be sufficient to achieve reductions in workload and improvements in quality and service to veterans, their families and survivors. 

We appreciate the opportunity to present our views to you today and we welcome 

any questions you may have. 

f 

Prepared Statement of John Roberts, National Service Director, 

Wounded Warrior Project 

Mr. Chairman, Ranking Member Lamborn, distinguished Members of the Committee, thank you for the opportunity to testify before you today regarding the use 

of technology in the Department of Veterans Affairs claims process. My name is 

John Roberts, and I am the National Service Director for the Wounded Warrior 

Project (WWP), a non-profit, non-partisan organization dedicated to assisting the 

men and women of the United States Armed Forces who have been injured during 

the current conflicts around the world. As a result of our direct, daily contact with 

these wounded warriors, we have a unique perspective on their needs and the obstacles they face as they attempt to transition and reintegrate into their communities. 

In addition to my experience with WWP, I am a service-connected veteran, a 

former veterans service officer, and was most recently a supervisor with the Houston VA Regional Office where I reviewed claims and became familiar with a number 

of significant deficiencies within the system. 

In the words of one of our Founding Fathers and Patriot, George Washington ‘‘The 

willingness with which our young people are likely to serve in any war, no matter 

how justified, shall be directly proportional as to how they perceive the veterans of 

earlier wars were treated and appreciated by their Nation’’. 

Clearly with a backlog of over 600,000 claims currently pending within the VA 

claims system, the perception of veterans of all generations is that we are not meeting that goal. 

As I mentioned in my previous testimony, the current model of the VBA claims 

processing system has a total of six separate teams and often, but not always, includes another team that is dedicated to processing only the OIF/OEF cases. The 

six separate teams handle the incoming evidence, maintain the outdated file cabinet 

system, develop all claims for service connected disability, conduct interviews, assign ratings, generate notification letters, and maintain all pending appeals submitted by the claimants. 

Files must be hand carried to each of the teams, and any member of these teams 

has access to the records at any given time. Obviously, this is time consuming, and 

if any documents are lost or misplaced, the burden then falls to the veteran to replace the missing evidence or claims. 

In order to increase efficiency and get compensation and benefits into the hands 

of our Nations veterans, WWP recommends the following steps: 

1. Capitalize on advanced technology to replace the antiquated paper 

system currently being utilized. The Veterans Health Administration 

(VHA) has already moved to an electronic system, yet VBA is still dependent 

on a paper based system which results in the loss of vital medical evidence, folders and files. However, this process is likely to take time to implement and other 

measures must be implemented simultaneously. 

2. The VA must use its current authority to award ‘‘pre-stabilization ratings’’ to those who are injured. Under Title 38 the VA can already give a 

pre-stabilization rating while a final rating is developed. This step would get 

cash in the hands of our veterans quickly without having to first complete the 

entire ratings process. Unfortunately, this is a severely underutilized authority, 

resulting in delays of months or even years in compensation for injured veterans. 

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3. The VA must have a fully functional ratings board at the major Military Treatment Facilities. As the National Service Director for WWP, I travel 

the country visiting the military facilities that care for and treat the newest generation of combat wounded. On one visit to Camp Lejeune, I witnessed a one 

stop shopping system. VBA had in place a supervisor, Rating Veterans Service 

Representatives (RVSR) to rate the claims and Veterans Service Representatives 

to develop and finalize disability claims. To this end, VBA and the Department 

of Defense are currently working on a pilot program at Walter Reed enabling 

VBA to perform the task of rating the disabilities received during active duty 

for the servicemen pending medical board proceedings. This step will help to resolve the issue of claims files being sent across the country for processing and 

reduce waiting times and lost files and, if successful, should be replicated across 

the country as soon as possible. 

4. Comply with the recommendation of the Veterans Disability Benefits 

Commission (VDBC) to incorporate medical expertise into the ratings 

process. By necessity, VA disability compensation claims are being rated by individuals who lack medical experience. As a result, if more explanation is needed on a particular exam, a further delay is created when the file is required to 

be sent back to the examiner for clarification. To remedy this situation, WWP 

agrees with the VDBC recommendation that ‘‘VA raters should have ready access to qualified healthcare experts who can provide advice on medical and psychological issues that arise during the rating process (e.g., interpreting evidence or assessing the need for additional examinations or VA diagnostic 

tests).’’ 

5. Allow the Regional Offices consistent access to files across the country. 

Currently, VBA allows only limited electronic access to VHA medical records in 

areas outside their jurisdiction. What this means that if a veteran received 

treatment in New York and now resides in California, the past method was to 

send a hard copy paper request to the VA Medical Center and wait for a response. Although there have been improvements by allowing limited personnel 

to have nationwide access, this is a situation that could be easily resolved by 

allowing more VBA personnel to have this access. The concept of one VA should 

not be limited to specific personnel. 

6. Keep files within one ratings team. WWP is not advocating for the removal 

of the current CPI processing system. However, we are in favor of allowing Regional Offices the flexibility to adjust the current system in order to utilize the 

strengths of their employees to better serve the veterans waiting on a decision 

to their claim. 

7. Collect statistics on partially finalized ratings as well as those files 

that are complete. Currently, RO’s are ‘‘graded,’’ if you will, on the number 

of claims that are complete. Because cases can be extraordinarily complex, they 

take significant time to develop. However, parts of that file can be reviewed 

quickly. For example a claim that includes Post Traumatic Stress Disorder, a 

brain injury and an amputation is very complex, but the amputation itself can 

be rated quickly. If partial ratings were more widely awarded while the complete file is developed, again, the result would be compensation in the hands of 

our injured veterans. 

Finally, as we discuss and implement any changes to the system, it is important 

to remember that each of the 600,000 pending claims represents a veteran, a dependant or survivor and not just a file containing documents and medical evidence. 

Although changing the current system will be difficult and time consuming, it is imperative that this happen to ensure that past generations and future generations 

of veterans receive the highest quality of service this country can offer. The current 

system is not sufficient to carry the VA into the future and now is the time for bold 

initiatives that will serve for generations to come. 

Again, thank you for the opportunity to testify today, and I look forward to answering any questions you may have. 

f 

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Prepared Statement of Michael Walcoff, 

Deputy Under Secretary for Benefits, 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) claims inventory and claims processing system. I am pleased to be accompanied by Ms. Diana Rubens, VBA’s Associate Deputy Under Secretary for Field Operations and Mr. Brad Mayes, VBA’s Director of Compensation and Pension Service. 

Today, my testimony will focus on two efforts we currently have in progress to 

improve claims processing: our aggressive hiring initiative and an independent 

study of the claims process conducted by IBM Global Business Services. 

Inventory 

Before I begin discussing our efforts to improve claims processing, I would like 

to talk about our inventory and productivity. As of January 31, 2008, VBA’s pending 

inventory was 397,077. There are numerous factors that contribute to that number, 

the two primary ones being the increase in the number of claims filed and the increased complexity of those claims. The number of veterans filing initial disability 

compensation claims and claims for increased benefits has increased every year 

since FY 2000. In FY07, we received a total of 838,141 rating-related claims, compared to 578,773 in FY 2000, an increase of forty-five percent. This high level of 

claims activity is expected to continue over the next few years due to claims from 

Operation Iraqi Freedom and Operation Enduring Freedom veterans; the addition 

of type II diabetes as an Agent Orange presumptive disability; more beneficiaries 

on the rolls with resulting additional claims for increased benefits; and improved 

and expanded outreach to active-duty servicemembers, guard and reserve personnel, 

survivors, and veterans of earlier conflicts. 

VBA has maintained the inventory at the 400,000 level for the last year due, in 

large part, to the productivity of our employees. In fact, VBA is 21 percent more 

productive now compared to two years ago. If you look at the current fiscal year 

alone, production is already up almost 13 percent compared to FY07. In FY08, we 

expect to make decisions on over 878,000 claims and in FY09, we expect that number to increase to over 942,000 claims. Our increased productivity will have a significant positive impact on our inventory. 

The term ‘‘backlog’’ is frequently used when discussing VBA inventory, but it is 

not universally understood. Oftentimes you will hear that VBA has a ‘‘backlog’’ of 

approximately 400,000 claims. As stated earlier, 397,077 is the current number of 

disability claims that are pending determination. This inventory includes all claims, 

whether pending a few days or a few months. ‘‘Backlog’’ is actually the current inventory minus the normal running inventory if we are meeting our timeliness goals. 

For example, in FY 2008, we expect to receive 854,000 claims, or 71,000 claims per 

month. Achievement of our strategic target of 145 processing days would result in 

a consistent running inventory of approximately 339,000 claims at any given time. 

That means with an inventory of 400,000, 61,000 claims should be considered ‘‘backlog.’’ 

VBA is continually seeking new ways to decrease the pending inventory of disability claims and shorten the time veterans must wait for decisions on their claims. 

Key to our success will be our ongoing longer term effort to enhance and upgrade 

our claims processing systems through integration of today’s technology. In the near 

term, we have two initiatives that I would like to highlight here today. 

Hiring Initiative and Training 

In FY 2007, we implemented an aggressive nationwide hiring initiative to provide 

more timely decisions. More than 1,800 new employees have been added since January 2007. VBA’s hiring plan will add an unprecedented total of 3,100 additional employees by the end of this fiscal year. We are also conducting ongoing recruitment 

to replace staffing losses due to normal attrition. 

To enhance rapid integration into the claims production process, we modified our 

new employee training program to focus initial training on specific claims processing 

functions. This will allow new employees to become productive earlier in their training program and, at the same time, allow our more experienced employees to focus 

on the more complex and time-consuming claims. By more effectively utilizing both 

newly hired employees and experienced claims processors, we expect to reduce the 

pending claims inventory and improve claims processing timeliness in FY 2008. 

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Independent Study of the Claims Process 

Adding more decisionmakers is only one part of VBA’s strategy to further improve 

claims processing. Throughout the last few years, VBA has implemented a variety 

of initiatives aimed at better managing the disability claims workload and improving benefits processing. Some of the initiatives include implementation of a consistent organizational structure across regional offices, establishment of an aggressive quality assurance program, centralization and standardization of training, and 

consolidation of specialized processing operations. VBA continues to develop new initiatives and strategies aimed at addressing the challenges posed by the number of 

claims received, the greater number of disabilities veterans now claim, the increasing complexity of the disabilities claimed, and the changes in law and processes. 

Because of the increasing and changing workload and workforce and VBA’s desire 

to ensure the most effective methods of organizing work and maximizing resources 

are in place, we sought help from the private sector. In September 2007, VBA contracted with IBM Global Business Services to analyze our current business processes and provide recommendations to further improve our operational efficiency 

and consistency. 

From October 2007 through January 2008, IBM conducted a detailed review of 

the business processes involved with adjudicating a claim, beginning with application receipt and ending with notification to the claimant. To date, IBM has provided 

VBA with a gap analysis, which identifies the gaps between VBA’s current process 

and IBM’s envisioned process. The gap analysis also includes short-term and longterm recommendations to help VBA improve its processes. Overall, IBM’s recommendations validate areas for efficiency gains already identified internally. 

Both the short-term and long-term recommendations made by IBM focus on the 

phases of the claims process and specific activities under VBA’s control. The shortterm recommendations are incremental enhancements VBA can make to the existing business processes to realize benefits in efficiency and productivity in the near 

term. Because our current claims process is heavily reliant on paper and the movement of paper claims folders, the greatest efficiencies will be gained as a result of 

IBM’s longer term recommendations to move to an electronic, paperless environment. 

Recommendations 

Managing workflow, monitoring performance, and tracking the number of claims 

processed are critical to maintaining processing efficiencies. The average number of 

medical disabilities or conditions claimed on original applications is increasing. To 

further enhance our ability to monitor performance, the study team recommends the 

creation of a performance measurement system focused on tracking the number of 

medical disabilities or issues claimed. IBM believes that this issue-based performance measurement system, in conjunction with the existing claim-based performance measurement system, will result in a more accurate and detailed measure of 

productivity and workload. Under the current claim-based performance measurement system, a regional office is given the same credit for completing a claim with 

one issue as a claim with forty issues. The study team believes that measuring work 

output by both number of claims and number of issues at an organizational level 

is a more accurate assessment of a regional office’s productivity. In addition, an 

issue-based performance measurement at an individual level will provide more specificity in the activities of staff and result in increased accountability overall. 

VBA agrees with the idea of adding an issue-based performance measurement 

system to our current reporting structure. This system will provide us with a better 

understanding of our workload and productivity. However, VBA must ensure that 

our claims processors stay veteran-focused. Consequently, we must continue to pay 

benefits on specific issues as soon as possible, but remain cognizant that a claim 

is not complete until all issues have been resolved. 

When analyzing our claims process, the study team noted that a bottleneck occurs 

during the time VBA waits for a response to our Veterans Claims Assistance Act 

(VCAA) letter. Upon receipt of a claim for benefits, claims processors must carefully 

analyze all issues claimed and determine what evidence is necessary to substantiate 

the claim. Under VCAA, claims processors must also provide a letter to the claimant 

detailing the evidence required and which party (VA or the claimant) is responsible 

for obtaining the evidence. Under statute (38 U.S.C. 5103), claimants have one year 

from the date of the VCAA notification to submit any requested evidence. However, 

VA may make a decision on the claim prior to the one-year expiration. Current VBA 

procedures allow 60 days for a claimant to respond to a request for evidence before 

VBA makes a decision. 

To help streamline this evidence-gathering process, IBM recommends we simplify 

the VCAA letter and also reduce the evidence-gathering time period from 60 days 

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to 30 days. The current VCAA letters are lengthy and contain complex legal language that many claimants find difficult to understand. Additionally, the VCAA letters include a waiver that allows the claimants to certify that they have no additional evidence and waive the 60-day evidence-gathering time period. IBM believes 

that if the letter were simpler to understand, the likelihood of a veteran responding 

to the VCAA letter with either additional evidence or waiver of the 60 day period 

would increase. 

VBA agrees that a simplified VCAA letter will reduce confusion and misunderstanding by the veteran. In fact, VBA is currently working closely with the VA’s Office General Counsel to revise and simplify the letter. However, we must ensure 

that any new language also meets legal requirements. We anticipate these revisions 

will be completed by August 2008. VBA has also considered a reduced time period 

for evidence gathering and agree that it would have measurable results in improving claims processing timeliness. 

To achieve large-scale improvements in efficiency and productivity, however, VBA 

must make a fundamental shift in how we process compensation and pension 

claims. All of the study’s long-term recommendations focus on information technology enhancements that will allow VBA to move into a paperless environment. 

Where work can be managed electronically and automation can reduce manual activities freeing up resources for more value-added decisionmaking. Eliminating manual processes is also necessary to greatly improve VBA’s timeliness. IBM believes 

that one of the critical first steps for VBA to transition is to enhance the current 

Veterans Online Application (VONAPP). 

Because VONAPP is not integrated with our IT systems, claims processors must 

manually enter data provided in the online applications into our claims processing 

systems. Additionally, VBA does not currently have the capability or the authority 

to use e-signature and e-authentication. With these two features, claimants would 

no longer have to submit a ‘‘wet’’ signature in addition to their online application 

before benefits can be paid. Once e-signature and e-authentication elements are in 

place, VBA can create direct data feeds into our IT applications, thereby streamlining the data entry process. 

Enhancing VONAPP is a critical step in moving to a paperless environment. VBA 

is currently coordinating with VA’s Office of Information and Technology to resolve 

all data privacy and security concerns. In addition, we are working through VA’s 

Office of General Counsel to resolve any regulatory issues regarding the need for 

a ‘‘wet’’ signature. Following approval and verification of security, implementation 

is expected to begin in FY 2009. 

Another key element in a paperless environment is electronic workflow management, which would reduce our reliance on the physical movement of a claims folder 

to trigger the next step in the claims process. Work would automatically flow between claims processors as each activity is completed. Management would be able 

to allocate resources electronically based on individuals’ workloads and available 

hours. Additionally, claims processing work would no longer be limited to a specific 

regional office. Work could be transferred instantaneously to any one of our regional 

offices, allowing for improved balance of our workload and increased utilization of 

resources nationwide. 

Electronic workload management will only be successful if completed in conjunction with an electronic content management system (ECM). The disability claims 

process is very paper-based and requires a vast amount of space to store all of the 

associated documentation. In the study team’s envisioned paperless environment, 

ECM is integrated with business applications via an Electronic Folder (eFolder). 

The ECM system would pull relevant data from the corporate database to populate 

the eFolder. The biggest challenge and expense for VBA to convert to electronic content management is the scanning of paper records. 

VBA has initiated two pilot efforts to test our ability to shift to a paperless environment and to test the utility of imaging technology. The Virtual VA application 

is being used for both pilot programs. Through the pilot programs, we continue to 

refine our business processes and identify necessary enhancements that will allow 

us to expand the use of imaging technology. We are also leveraging the lessons 

learned and the imaging accomplishments in our Insurance, Education, and Loan 

Guaranty programs. 

As VBA transitions to paperless processing, claimants’ access to information will 

expand. The study team recommends the creation of a secure web portal so that 

claimants can access claim information and request transactions online. Currently, 

claimants may check the status of their claim by calling the toll-free number, by 

visiting a regional office, or through their veterans service organization. 

The study team believes that creation of a secure web portal will reduce telephone 

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edge of the claims process. In addition to claim status, the team recommended the 

secure web portal contain functionality to allow online claim submission with e-signature, updates to contact information, review of prior and current benefits, online 

help, and frequently asked questions. 

VBA has a secure web portal called the Veterans Information Portal (VIP). The 

primary external users of VIP are lenders and appraisers who are assisting veterans 

in the Loan Guaranty Program. Through VIP, external users can access web-enabled computer applications. Currently, there are no disability compensation business applications available to external users through VIP, but efforts are underway 

as the President’s Commission on Care for America’s Returning Wounded Warriors 

also recommended that VA and DoD develop an interactive web portal. 

Conclusion 

We believe that the independent study by IBM validates our current course of action to improve claims processing timeliness, particularly with regard to information 

technology. Despite ongoing challenges, VBA continues to develop new strategies to 

improve claims processing and reduce the time veterans must wait for decisions. 

Mr. Chairman, this concludes my testimony. I will be happy to respond to any 

questions that you or other members of the Subcommittee have. 

f 

Statement of Linda J. Bilmes, Professor, 

Kennedy School of Government, Harvard University, Cambridge, MA 

Thank you for inviting me to testify before this Committee today. I am Professor 

Linda Bilmes, lecturer in public policy, at the Kennedy School of Government at 

Harvard University. This year I have given testimony regarding veterans issues on 

three previous occasions: on October 24, 2007 (before the House Committee on the 

Budget); on May 23, 2007, before the House Veterans Affairs Committee Claims 

Roundtable; and on March 13th, 2007 before this Subcommittee. I would like to 

enter copies of all three of these previous statements into the record. 

Today I will discuss some of my recent research and resulting recommendations 

on how to improve the disability claim process. The purpose of these recommendations is to: (a) reduce the backlog of pending disability claims; (b) process new 

claims more quickly; and (c) to reduce the rate of error and inconsistency among 

claims. 

I will very quickly review the context of this discussion, which I am sure is familiar to members of this subcommittee. First, the Veterans Benefits Administration 

(VBA) currently has a backlog of 400,000 pending claims and another 200,000 

claims that are somewhere in the adjudication process. This backlog has nearly doubled since 2001. Second, VBA expects to receive an additional 800,000 to 1,000,000 

new claims during the next year. To date, 230,000 veterans from the Iraq and Afghanistan conflicts have filed claims, but the majority of claims for that conflict 

have yet to be submitted. My own projections, based on estimates from the first Gulf 

War, predict that a total of 791,000 veterans from the Iraq/Afghan wars will eventually seek disability benefits. However, many veterans’ organizations have suggested 

that my estimates are too conservative, considering the length of deployment and 

the number of 2nd and 3rd deployments into this theatre. It may well be that the 

number of eventual claims is far higher. 

Third, the VBA currently requires an average of 6 months to process a claim. 

Fourth, for a variety of reasons that I will address in a minute, there is a high level 

of variation in outcomes in different regions. This undoubtedly contributes to the 

fact that veterans appeal some 12–14% of decisions. These claims then take an average of 2 years to resolve, and consume a disproportionate amount of staff time and 

attention from the VBA during the protracted period. 

The solutions that have generally been put forward until now fall into what I call 

the ‘‘typically governmental’’ trap of throwing more people, money and overall resources at the issue without doing the restructuring work that is needed to fix the 

root of the problem. VBA may need more resources—but not simply to ‘‘do the 

wrong thing’’ faster; but rather to change direction and to ‘‘do the thing right’’. This 

will require VBA to simplify its process, to change the way initial claims are developed, and to shift presumption more in favor of the veteran. 

One way to analyze this is to compare the process for handling medical claims 

used by the medical insurance industry to the process used in the VBA. The medical 

insurance industry handles 30 million claims per year, and pays 98% of them within 

60 days. The process is very simple. After the patient receives a medical service 

from the provider, the provider prepares and submits a claim to the insurance comwwoods2 on PRODPC68 with HEARING

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pany, usually within 30 days. The insurer then pays, denies or pends the claim, in 

57% of cases within 7 days, and in 98% of cases within 30 days. Therefore the overwhelming majority of medical providers are reimbursed within 69 days. When the 

insurer ‘‘pends’’ a questionable claim, the process takes an additional 10 days, during which the insurer typically contacts the provider by e-mail or telephone. In 3% 

of denied cases the provider or the patient appeals the decision. Most appeals are 

resolved within 30 days. Many medical insurers also perform a random audit of a 

small number of claims. 

A diagram of the basic process flow is shown as Chart 1. 

Chart 1—Private Sector Health Insurance Claims Process 

There are several characteristics of the private medical insurance claim process 

that enable it to be highly efficient. First, the claim is prepared by a healthcare provider—not the patient. Hospitals and physician practices employ staff who have experience in preparing such claims. The ‘‘claim’’ typically consists of a short form (2– 

3 pages), attached to diagnostic reports. Therefore the vast majority of claims that 

are submitted for payment to the insurance company are ‘‘clean claims’’. This is, of 

course, a major point of difference from the VBA system, where veterans prepare 

their own claims to a large extent, and may obtain advice from state and local governments, VSOs, VBA officials, websites family or friends. The result is that a high 

proportion of the initial claims submitted by veterans are not ‘‘clean’’, so a great 

deal of the delay is caused by the need to get the form filled out properly, with the 

required documentation. This is particularly complicated when the veteran has received treatment from multiple providers (for example, been treated at Landstuhl, 

Walter Reed, and VA medical clinics). 

Second, it is important to note that most states require by law that the medical 

insurance industry pay the providers within 30–60 days of receiving the claim—with 

financial penalties for non-compliance. In the VBA, there is no ‘‘penalty’’ for delays. 

Third, the claims process described above is generally for a single patient transaction, such as a doctor visit, hospital procedure or diagnostic test. So from the perspective of the healthcare provider, the consequences of overpaying are limited. The 

insurer can tradeoff between the possibility of overpaying for an x-ray (or reimbursing the doctor for an x-ray that was not really necessary) vs. the alternative—a protracted wrangle over a small claim. It is not in the financial interest of medical insurers to contest any but the largest, most obviously flawed claims. 

By contrast the VBA process is dealing not with short one-off transactions but 

with making a decision on service-connectivity that may affect the lifetime of benefits for a veteran. Thus it is instructive to examine how the private medical insurers 

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tion and other claims which require outlays over a long stretch of time. Surprisingly, the system for deciding such claims is similar to the one used for small ticket 

items. Some insurance companies will require a higher standard of evidence for 

long-term care (such as the opinion of 2 specialists), but the actual process is the 

same. 

Accordingly, the medical insurance industry uses the same philosophical approach 

to claims processing that the IRS uses for taxes: it handles most transactions with 

minimal processing, and investigates (audits) a small subset of the total, focusing 

on large or unusual claims. The expectation is that the majority of claims received 

are approximately correct, because making them perfect would cause unacceptable 

delays in reimbursing medical providers. 

The VBA system is based on a different philosophy, which is to require the veteran to produce detailed medical documentation for every disabling condition he or 

she claims. Many VBA employees work hard to assist the veteran in putting together the package—but the underlying idea is still that the veteran needs to compile a dossier to prove that his medical problems stem from his military service. The 

process is more akin to a student applying to college, who is required to assemble 

a whole package of materials before his application is even considered. 

The VBA process is also structured to be cumbersome and inefficient. (See Chart 

2). It involves applying to one of 57 regional offices, where a number of different 

staff members handle the claim, in terms of reviewing it, requesting additional documentation, checking that documentation, sending out formal notifications to the 

veteran of the status of his application, consolidating and evaluating the evidence 

from many different sources, and ultimately making a decision whether a veteran’s 

health problems are service-connected or not, and assigning a percentage rating. 

Chart 2—VBA Claims Process 

It is not surprising, given that thousands of veterans with no experience in filing 

claims are doing the initial claims, and the complexity of the 26-page form, that 

most claims require a substantial work-up at the regional office. Most of the elapsed 

time in the 6-month process is spent trying to prepare a ‘‘clean’’ claim that the VBA 

can adjudicate. 

VBA has developed a large and bureaucratic structure for handling these claims. 

(See Chart 3) 

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Chart 3—VBA Structure for Claims Approval 

It is also not surprising, given this process, that the regional offices produce highly varying, inconsistent results. The recent National Institute of Medicine study 

found significant variance in processing time, compensation, and appeal rates. (See 

Chart 4) A number of GAO reports have reached the same conclusion. 

Chart 4—NIM Study Inconsistencies Identified (sample) 

Days to process claim 99 (Salt Lake City) 277 (Honolulu) 

Percent of veterans receiving compensation 6.9% 19.2% 

Average compensation $7,000 (Illinois) $12,000 (New Mexico) 

Percent Individually unemployable Maryland 3.3% New Mexico 20.1% 

Number of claims appealed 22% 65% (highest region) 

Proposals for Reform 

The question is: considering that veterans returning from Iraq and Afghanistan 

have already served at least 15 months in the field, with 35% of them having served 

two or more tours of duty, would it not make more sense to simply accept their word 

that any medical problems detected at discharge are a result of their service? Additionally, since 90% of disability compensation claims are ultimately approved by 

VBA (following this protracted process), at least in part, would it not make sense 

to follow the private sector model and to automatically approve a standard minimum benefit within 30 days? 

However, to implement this kind of common sense approach would require certain 

changes in the structure of the claims process. First, every veteran must have an 

exit medical examination at (or prior to) discharge. Any medical problems (physical 

or mental) identified at that examination should then be automatically assumed to 

be service-related. The system from that point should mirror the private system. 

The VBA needs to work with VHA to create a one-step online system for the medical 

provider to record findings from this clinical evaluation, and personnel need to be 

provided and trained to enter this information into the centralized system. 

Veterans returning from a war zone should then be automatically entitled to receive a base level of benefits corresponding to the clinical evidence. Current benefits 

scales should be revised and simplified to provide for four common sense categories: 

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not disabled; mild, moderate and severe disability. The healthcare provider who 

evaluates the veteran should make this initial assessment. 

All returning veterans should be presumed to have acquired the medical conditions during military service. This should be provided within 30 days. 

This system should be designed to provide basic benefits for a period of two years 

only. Within that time, veterans with serious injuries should be fast tracked to a 

full evaluation of benefits. All other veterans should have a choice of whether their 

cases need to be re-examined or not. If veterans disability rating is adjusted downward during a subsequent evaluation; their monthly stipend should be lowered accordingly, but they should not be liable to repay their excess benefit. However if the 

benefit is found to be too low, they should be eligible for retroactive pay. In addition, 

the VBA should audit a sample of cases in order to deter fraud. 

Clearly there are many implications of restructuring the claims system along 

these lines, including a partial retraining and redeployment of claims analysts, and 

a possible reorganization of the regional offices. But I believe that moving in this 

direction would dramatically simplify the process, lower the rate of inconsistency, 

and most importantly enable returning veterans to be compensated for disabilities 

quickly and without much bureaucracy. 

f 

Statement of Master Sergeant Kurt Priessman, 

USAF (Ret.), Vernon, TX 

Discussion and recommendations from Veterans and Widows on the subject discussed by the VAC Subcommittee in expediting claims: 

Veterans need help now before we all die, not after continued promises of implementation of electronic medical records using extremely difficult interfaces, artificial 

intelligence with query language too few are able to utilize, and often delayed 

progress stretching into not months but years. The Department of Veterans Affairs 

has done nothing to correct this problem, and continues to promulgate anti-Veteran 

rules to delay, stall, and deny while it fights Court cases, which rather than reduce 

claims has exacerbated the backlog. The Courts gave the Department wide latitude 

to stay Haas, which it has thoroughly abused. Congress must take bold action 

NOW to mandate ways to catch up. 

Congress can help to substantially reduce this backlog by mandating the following: 

Claim Triage Process 

A civilian fellow with Veterans Affairs (VA) experience recently testified before 

your subcommittee, and concluded that simple claims should not be part of the complex process that is time consuming and creates delays in presumptive approval 

that at most require a brief evaluation and decision. 

Triage should be performed on all claims. Any presumptive disease claims 

should go to a team that only does presumptive disorders. This requires the 

verification of ‘‘three data points’’ only, with emphasis on giving the ‘‘Congressional 

mandated’’ benefit of the doubt concerning presumption, service connection, and 

precedence to establish compensation rates. 

Examples: Stage four presumptive cancers are automatically 100% by VA rating 

rules. The Veteran is either going to die or is going to seek treatment for the cancers. Cancer treatment alone is enough to disable someone from working. 

In some disorders such as presumed diabetes, it is not the level of created disability but the level of treatment that is required to determine the disability rating. 

Only the verification of data is required with no C&P. In this case, the validation 

of four data points and the level of treatment are required. Obvious secondary conditions from the records could be included if there is a straightforward connection to 

the primary disability. C&Ps to determine levels of disability and other more complicated residuals can then be accomplished and compensated based on the results. 

Getting the Veteran and his family the needed financial support in a timely 

manner should be the most important aspect. This also entitles the Veteran 

to many benefits from their respective States that is continually being delayed. 

This process also would allow those claims that are contentious to get the full attention, fact-finding, and ‘‘speed of resolution’’ they deserve, also contributing to the 

reduction in the backlog of claims. 

Congress must not allow the Department of Veterans Affairs special legal 

privileges. Congress must hold the Department to the same legal standards 

non-governmental entities and citizens are. The Department ignores evidence 

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presented by Veterans as unverified, impugns the veracity of honorable Veterans, 

calls every case unique by denying case precedence, and refuses to assist Veterans 

in accordance with law. 

If the Court of Circuit Appeals honors a Veteran’s statement in support of a claim 

that he loaded herbicides in Udorn, or similarly a declassified report or other evidence confirms use, and the claim is awarded, then the Department must approve 

all claims for Udorn for similar circumstances. Each case is not unique. It makes 

no sense to have two Veterans serving side by side to have dissimilar results with 

one claim approved and the other denied for the same disorder within the adjudication and BVA justice system. Congress provided administrative adjudication powers 

to a department of the Executive Branch, not authority to act with judicial prejudice. 

The triage process looks at similar periods of service, military occupations, duty stations, diseases, Court decisions and then rules in favor of the Veteran. The data 

fields necessary to search like citations and decisions already exist. 

Example: Esophageal cancers are very prevalent in Vietnam Veterans with herbicide exposures, yet the Department ‘‘of Veterans Affairs denies esophageal cancers 

as a presumptive disorder, and then is overruled by BVA and CAVC. These claims 

take years. 

Once the BVA or CAVC has approved the claim for one, then all such like claims 

should be approved. Through use of ‘‘artificial intelligence,’’ the Department can create rule-based criteria for all esophageal cancers. The rules then approve claims for 

widows and Veterans based on legal precedence and not necessarily subjective nexus 

with herbicides, particularly when data outside the DVA and IOM indicates this 

should be presumptive to tactical herbicides. We do not need to prosecute the same 

case 100,000 times rather than define approval criteria and approve the same 

100,000 cases. 

Congress must mandate that cases with decisions overturned by the BVA 

and the Court of Appeals for Veterans Claims (CAVC) set legal precedence 

and the Department of Veterans Affairs must decide favorably in like cases. 

Congress must mandate that spouses and families of Veterans who die 

prior to adjudication of their claims are legally and legitimately no different from the deceased Veteran and the Veteran’s claim is ‘‘in perpetuity’’ 

until settled. There is no other system in the world that treats the legal rights of 

the claimant’s descendents as different from the claimant. At the DVA if the Veteran dies before his claim is approved, the claim is then dead as well. This is a direct conflict of interest and leads to a bias not to perform in a timely manner. The 

widow then must reenter the claim again and submit for DIC, a process that creates 

catastrophic financial hardship of potentially many years for what should be a simple validation of beneficiary information and the immediate prioritization to ‘‘the 

head of the line’’ for deciding the claim. 

These suggestions should result in the reduction of massive numbers of claims, 

associated costs, and delays of six to eighteen months or longer which cause financial hardship on the Veteran and his family or widow for presumptive disorders and 

like-claims. The Department of Veterans Affairs should approve these claims 

through a brief evaluation and decision process. Additionally, there is little risk of 

abuse as these changes are in accordance with law as established by Congress, and 

the Courts. 

To further reduce claims backlog Congress should amend the law for Veterans 

who served in the toxic chemical swill on the Korean DMZ. Congress identified the 

period from 1967 to 1971 for civilian contractors that worked ‘‘on or near the Korean 

DMZ’’ with presumptive disorders while the DoD and DVA only recognize a short 

period of time for spraying, which nullifies and discounts the laws of chemistry and 

the half-life of dioxins. This span is nearly four times that of the span for Veterans. 

We find this total disparity between Civilian versus Veterans an injustice and an 

unjustifiable issue. The DVA must stop denying those claims, and accept them as 

compensable. 

A group of 14 engineers that served along the Korean DMZ petitioned Congress 

and indicated they sprayed this toxic swill from 1967 to 1971 on the DMZ and at 

Camp Casey. Many of these engineers have the same presumptive disorders already 

established for herbicide association and in some cases, there are two automatic presumptive cancer disorders leaving the DMZ with a diagnosis of pustular acne, a 

hallmark of dioxin exposures. Yet, the VA still denies claims based upon the denial 

of the laws of chemistry and the very narrow inclusive dates of which Congress 

itself is in disagreement with regarding civilian contractors. 

Many Korean DMZ and herbicide sprayings claims from documented locations 

should be presumptive and not held and denied for nefarious reasons and then appealed just creating more and more backlog. It is imperative that Congress remembers that our own government causes most of the mortality and morbidity issues. 

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Congress must mandate the same inclusive dates that it has established 

for civilians and the inclusive dates our Veterans and declassified DoD documents indicate herbicide spraying occurred. The DVA must reverse and 

approve denied claims based only on erroneous DoD inclusive dates. 

Congress must mandate immediate release and inclusion of locations documented and released to the public rather than permitting the Departments, who are in possession of them, not to acknowledge them and update 

the list maintained by the DVA. 

Next, there is the Blue Water Navy exposure issue. Congress must get involved in this issue before all these seamen are dead and the DVA denies 

their widows DIC payments. 

Congress leaves the Veterans and their expert witnesses no forum from which to 

present their own scientific and medical evidence. Congress must make this decision and not abdicate its authority to the DOD, DVA, or IOM, who cannot 

deny conflicts of interest and insertion of biases into final reports. Many 

Veterans would welcome the opportunity to debate the IOM and DVA in the halls 

of Congress utilizing some common sense and scientific data but Congress has not 

afforded Veterans that opportunity. Congress must include in legislation the 

formation of a Veteran/Citizen’s Committee that reports these conflicts of 

interest and recommends resolution in favor of Veterans to the Congress 

for issues previously presented only by the DVA and the contracted IOM, 

both of whom have numerous conflicts of interest, as does the DOD. 

If the Congress implements all of these recommendations, there would not be 

delays of years to reduce the backlog of claims. These risk associated with the validity of these recommendations is negligible. Congress and the Nation can be certain 

that Veterans are asking only for earned benefits and promises kept. 

Many scientists as well as Veterans believe that the way dioxins work in the 

body’s cells, any cancer or immune system dysfunction is an expected outcome. The 

data is there in many studies including, the opinion of a sitting member of Congress, a medical doctor, who under oath, has concluded before the BVA that esophageal cancers are associated. 

Our personal beliefs, based on scientific data and biological plausibility is that all 

cancers, endocrine and immune system disturbances in homoeostasis are associated 

with herbicides. A quantitative risk analysis based on the top four-dioxin studies results in the SMR delta for all cancers and specific cancers as very slight. Additionally, the Ranch Hand Study, the government’s gold standard used in denial, now 

admits it missed a twofold increase in all cancers after spending $140 million dollars, which was ignored by the Air Force chairperson. 

We have estimated a reduction of at least 200,000 claims within 6 months by 

using ‘‘artificial intelligence’’ from BV NCA VC databases and the recommend 

changes noted herein. Congress provided the Department of Veterans Affairs funding already that doubled the number of employees in the Veterans Court and the 

result has been a 50% reduction in claims output, obviously a poor investment. 

The time for Congressional action is NOW. We respectfully request you include 

these suggestions in new legislation, or at worst in the Department of Veterans Affairs 2009 Budget Request. 

Thank you in advance, 

Kurt Priessman, MSgt, USAF (Ret), B.A., M.B.A. 

The Bottom Line http://tmai18.spaces.live.com 

U–Tapao RTNAB, 71–72 

Korat RTAFB, 72–73 

Kadena AB, Okinawa, Japan 73–76 

Kunsan AB, Korea 77–78 

Clark AB, 78 

Taegu AB, 78–80 

Author: Herbicides Use in (The Relationship to the ROE and Use in and) 

Proud Father of SSgt Michael G. Priessman, USAF 

Kuwait 93–94 

Bahrain 95–96 

Korea 03–04 

Kyrgyzstan 04–05 

Kadena 04–06 

Baghdad 06 

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(1) Grassroots Veterans, widows, and Veterans organizations now question the 

Congressional wisdom of placing veteran judicial functions under the direct control 

of our Executive Branch of Government. There is a groundswell of veterans that believe individuals in the government should be held criminally liable for their decisions and efforts to hide the truth. The impact of class action suits to overturn the 

Feres Doctrine and potential Rico Act suits will deluge the Courts of Appeals of the 

Federal Circuit if action is not taken. 

(2) The Executive Branch judiciary function has taken liberty to freely weight evidence and scientific facts in its own behalf. The Executive Branch in the performance of judiciary functions pronounces before the claimants case is brought what is 

and what is not valid, accepts invalid Executive Branch controlled studies with 

flawed results from which to base administrative and judicial decisions. Veterans 

believe these studies are invalid based on federal departmental and agency influence and directions not to associate mortality and morbidity damages to Veterans 

and their offspring for government causations. Veterans also believe that the continuing mortality and morbidity rates are caused by the Departments of Defense 

and Veterans Affairs, both part of the Executive Branch. 

(3) Our beliefs are based on the common sense notion that it is nonsensical to provide the Executive Branch a process where judicial decisions permit the same 

branch of government to adjudicate and rule in its own favor when they are the defendants. With the usage of the Feres Doctrine and the processes described, there 

can be no doubt in the proliferation of collusion rather than the prosecution of the 

government for collusion. 

f 

Wounded Vets Face Broken System 

CQ WEEKLY—COVER STORY 

April 30, 2007—Page 1256 

By Patrick Yoest and Rebecca Adams, CQ Staff 

The downtown Washington offices of Disabled American Veterans hummed with 

activity on a recent weekday as four staff counselors helped ex-servicemembers 

navigate the bureaucracy of the Department of Veterans Affairs. 

James Mack, a stern-looking veteran of the first Gulf War, welcomed recent returnees from the conflicts in Iraq and Afghanistan by handing them copies of VA 

Form 21–526—a two-sided, 13-page application for benefits—then tearing out the 

first four pages of fine-print instructions. 

‘‘For folks who just want to know what they’re entitled to, that’s a little bit too 

much information,’’ said Mack, who patiently guided some veterans through questions about service-related injuries and the care they received, and signed others up 

for a biweekly class on veterans’ benefits that he teaches Monday nights. It is fully 

subscribed until July. 

Elsewhere in the office, workers tracked the progress of hundreds of appeals filed 

by veterans in response to VA denials, stepping around piles of inch-thick files detailing the particulars of each case that threatened to inundate their cubicles. 

Phones constantly rang with big and small requests. One frantic ex-servicemember 

could not find the room in VA headquarters where he was supposed to participate 

in a teleconference about his appeal. By the time Mack sorted out the matter and 

provided directions, the hearing had been postponed. Mack then spent an hour rescheduling the hearing and briefing the veteran on what to expect. 

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FILING CLAIMS: Adam Kave, 23, who was discharged from the Air Force after serving in 

Iraq, Kuwait and Uzbekistan, recently sought help from the Disabled American Veterans to file 

a claim for VA compensation for a personality disorder. 

(CQ PHOTOS / SCOTT J. FERRELL) 

Disabled veterans of the Iraq War already have braved insurgent attacks and the 

threat of improvised explosive devices. But few are prepared for the nerve-wracking 

experience of dealing with the VA system. The government is trying to hack away 

at a backlog of more than 405,500 disability claims while marshaling more injured 

soldiers through its bureaucracy. It now takes an average of 177 days for a disabled 

soldier to get a VA claim processed—nearly double the 89.5-day wait civilians face 

in a private health-insurance system widely acknowledged to be underperforming. 

And with recent revelations about neglect of care at the Army’s flagship Walter 

Reed Medical Center, the political pressure is mounting for the government to improve its performance. 

But there aren’t many signs that the crush is dissipating at critical junctures like 

the Disabled American Veterans office and similar facilities run by nearly a dozen 

veterans’ service groups. Academic experts and veterans’ advocates say the VA is 

facing unprecedented stresses due to the conflicts in Iraq and Afghanistan and is 

ill-equipped to handle an influx of returning soldiers that would come from any 

troop withdrawal in Iraq. 

Beyond the paperwork hassles and delays, there are serious gaps in medical care, 

especially for treating Traumatic Brain Injuries and psychological problems that 

have arisen from extended deployments and stressful ground warfare, according to 

health professionals and veterans’ groups. 

‘‘We have not paid careful enough attention, or devoted sufficient resources, to 

planning for how to take care of these men and women who have served the nation,’’ 

said Linda Bilmes, a lecturer in public policy at Harvard University’s John F. Kennedy School of Government who has studied the long-term costs of caring for veterans. 

Congress, rattled by the problems at Walter Reed and public concern over returning servicemembers, is pledging to spend considerably more on veterans’ programs. 

The House’s 2008 budget resolution would increase the budget for VA healthcare 

and claims processing by $6.6 billion over 2007 levels. Congress in February included $3.6 billion for veterans’ programs in a budget package to fund much of the 

government for the remainder of the fiscal year. A supplemental spending bill 

cleared April 26 would give the department $1.8 billion more. 

But experts such as Bilmes warn that the extra money will do little good unless 

Congress and the VA fix deep-rooted problems in the way the government processes 

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disability claims, screens veterans for health problems and handles appeals for denied benefits. These problems will loom over Congress for the rest of the session as 

the House and Senate debate the direction of the war and how to provide for what 

a bipartisan majority have come to call ‘‘wounded warriors.’’ 

‘‘All of the things we’re seeing—the problems at Walter Reed, people getting lost 

in the process—can all relate back to the fact that the VA and the Department of 

Defense did not plan for a long war and the impacts of that,’’ said Democratic Senator Patty Murray of Washington, a member of the chamber’s Veterans’ Affairs 

Committee and the Appropriations subcommittee that oversees the VA. ‘‘If I was sitting in the VA, I’d be in the president’s face all the time, saying we have to deal 

with these huge issues and I want resources to educate people.’’ 

The Bush administration says it is addressing the most serious concerns. An 

interagency task force headed by VA Secretary Jim Nicholson released recommendations April 24 that include adding case managers to help guide troops and their 

families through the system and improving the process for handing off medical 

records when an active-duty soldier is discharged and enters the VA’s network. 

‘‘The federal government must be responsive and efficient in delivering our benefits and services to these heroes,’’ Nicholson said in announcing the recommendations. ‘‘They should not have to fight bureaucratic red tape for benefits earned by 

their courageous service.’’ 

Some of the problems are due to the unique nature of the Iraq and Afghanistan 

conflicts. Better battlefield care has allowed more servicemembers to survive roadside bombs, suicide attacks, rocket-propelled grenades and other incidents that probably would have killed soldiers in past conflicts. But many are returning home with 

complicated, sometimes catastrophic wounds that require much more elaborate 

treatment and rehabilitation. 

The government has not prepared itself for such demands. Harvard’s Bilmes notes 

that while the VA has steadfastly maintained that it can cope, the agency ran out 

of money to provide health care for the past two years and had to submit emergency 

budget requests to Congress for $2 billion in fiscal 2006 and $1 billion in 2005. A 

Government Accountability Office analysis of the shortfalls concluded that the VA 

was basing its cost projections on 2002 data that was generated before the war in 

Iraq began. 

Flawed Claims Process 

The concern about the VA goes beyond just how it calculates costs to how efficiently it provides veterans with their benefits. Experts are particularly worried 

about the claims process that returning soldiers must confront to qualify for disability payments—a system that has been widely criticized for delays and excessive 

bureaucracy. 

Servicemembers file claims in one of 57 regional offices belonging to the Veterans 

Benefits Administration, a branch of the VA that assesses service-related injuries 

on a sliding scale from 0 percent to 100 percent in 10 percent increments. Veterans 

must submit to medical evaluations for each condition they are claiming. If a claim 

is rejected, the veteran can appeal to a VA board that renders a decision or sends 

the case back to the regional office. 

Government audits have uncovered fundamental flaws in the process. The GAO 

last March reported that even though medical problems that veterans report are becoming more complex—including those based on environmental risks, infectious diseases and brain injuries—the VA’s criteria for disability decisions continue to be 

based on estimates made in 1945 about how service-connected impairments could 

affect the average individual’s ability to perform manual labor. 

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LENDING A HAND: Mack of the Disabled American Veterans, with paperwork from hundreds of appeals of denied claims, helps returning veterans from Iraq and Afghanistan navigate 

the VA’s bureaucracy. 

(CQ PHOTOS/SCOTT J. FERRELL) 

The GAO also found that the Veterans Benefits Administration has to wait a year 

or longer to obtain military records to verify some claims of Post Traumatic Stress 

Disorder. Auditors suggested that the VA try using an electronic library of medical 

records instead of submitting requests to the Army and Joint Services Records Research Center. The VA responded that it would study the matter. 

Piecemeal efforts to streamline claims processing in the regional offices have left 

big disparities in service, with significant delays in some cities. The advocacy group 

Amvets found that 63 percent of claims filed at the VA’s Washington, D.C., office 

took six months or longer to resolve. By contrast, 7 percent or fewer claims filed 

in offices in Providence, R.I., Fargo, N.D. and Boise, Idaho, took that long. 

The VA’s reliance on medical checkups to verify claims is adding to the bureaucratic headaches by lengthening waiting times at VA medical centers around the 

country and delaying some patients from getting access to specialists. ‘‘People are 

just clamoring to get VA medical treatment in order to be able to get into the VA 

disability benefits ladder,’’ Bilmes said. 

She expects the situation to worsen, projecting that the VA will receive roughly 

400,000 new claims from servicemembers returning from Iraq and Afghanistan over 

the next two years. Many will be submitted after the veterans exhaust the two free 

years of medical care the VA provides upon discharge. ‘‘The main stress is yet to 

come,’’ Bilmes said. ‘‘There will be a huge increase in the number of claims.’’ 

The claims process also does not treat every returning servicemember equally. Active-duty soldiers have a better chance of getting claims evaluated promptly and approved than reservists and members of the National Guard. That is because activeduty soldiers often have the option of having their condition reviewed earlier by the 

VA before they are discharged from service. Reservists and guardsmen typically cannot get a ruling because they are discharged much faster. The result is that some 

ex-servicemembers start collecting their disability payments later. 

‘‘They typically don’t remain in place long enough for us to go ahead and make 

the arrangements for the necessary medical exams and the other steps needed . . . 

to give them the same types of service we give the active-duty members,’’ said Ron 

Aument, the VA’s deputy undersecretary for benefits. 

Data the VA released in February confirmed that active-duty servicemembers are 

nearly twice as likely as reservists to have claims approved. 

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‘‘The result is devastating and scandalous,’’ said Paul Sullivan, Executive Director 

of Veterans for Common Sense and a former project manager at the Veterans Benefits Administration. ‘‘The VA should immediately and aggressively investigate this 

problem and then correct it.’’ 

Congress tried to address claim denials last year by including language in a VA 

authorization bill allowing claimants to retain attorneys to represent them at some 

stages of the appeals process. But VA officials and veterans’ groups have said the 

addition of attorneys has made the claims process more adversarial, encouraging 

claimants to file more, and more complicated, appeals. Veterans’ groups predict additional delays as the system gets increasingly clogged. 

‘‘You have an entire system that’s been designed around the notion of being a nonadversarial process,’’ Aument said. ‘‘You are now bringing attorneys into the process 

whose very training is to be a zealous advocate and actually conduct themselves in 

many cases in an adversarial manner on behalf of their clients.’’ 

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Nicholson, in announcing improvements April 24, attributed some of the backlog 

in the system to the VA’s improved outreach to the veterans’ community, which 

made some ex-servicemembers aware of benefits and, in turn, encouraged more 

claims. 

‘‘We’re challenged really because we’re . . . a victim, maybe is the best way to 

say it, of our own success,’’ Nicholson said. ‘‘The result of that is that while we are 

working diligently, the time it’s taking is too long.’’ 

The VA and Congress propose solving many of the problems by hiring more claims 

processors. The agency, in its fiscal 2008 budget request, requested 450 processors 

to help cut through red tape. Congress will probably authorize money in this year’s 

supplemental spending measure, and again in 2008 spending bills. VA officials say 

the additional staff will help the agency reach a goal of shortening the time it takes 

veterans to get a ruling on initial claims to 125 days, although Aument said that 

this may not be realized until fiscal 2009 at earliest. 

However, some veterans’ groups predict that extra staff at claims centers could 

increase waiting times even more. That is because it takes two to three years for 

senior staff to train claims processors. Meanwhile, some longtime processors are expected to retire, with the net effect being a shortage of experienced personnel available to process the veterans’ paperwork. 

‘‘They’re going to have to pull some of their best people off to train’’ the new hires, 

said Dennis Cullinan, Legislative Director of the Veterans of Foreign Wars. ‘‘Things 

are going to get worse for a while rather than better.’’ 

Shifting the Burden 

Some in Congress, such as House Veterans’ Affairs Chairman Bob Filner of California, have embraced a new approach proposed by Bilmes in which the government 

would assume that all claims are valid, then audit a fraction at some later date. 

That would effectively shift the burden of proving a claim was valid from the veteran to the government. 

‘‘I do favor the principle of shifting the burden,’’ Filner said in an interview, adding that the VA ‘‘had enough time to deal with this, and they have refused.’’ 

VA officials have stated publicly that they are concerned that the extra auditing 

of claims will sap the agency’s resources. The department this spring announced its 

opposition to a bill by Indiana Democratic Rep. Joe Donnelly, a member of the Veterans’ Affairs panel, that would essentially implement the system Bilmes proposes, 

citing projections that the change would cost an extra $173 billion over 10 years. 

Groups such as Disabled American Veterans, which for decades have guided returning servicemembers through the claims process, also believe the change would 

unwisely divert VA funding for the sake of shaking up the present system. Carl 

Blake, Legislative Director of the Paralyzed Veterans of America, even suggests that 

blanket approval of all claims would encourage fraud and abuse. 

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‘‘We believe if Congress lowers this threshold . . . the results would be an overwhelming number of claims filed for compensation,’’ Blake said. 

But opinion within the VA could be shifting on the issue. While Aument testified 

against Donnelly’s legislation and said in an interview that such a proposal probably 

would cause ‘‘serious unintended consequences,’’ VA Secretary Nicholson has made 

statements to the contrary. In an interview April 24, he said he is considering the 

possibility of creating a pilot program modeled on Bilmes’ proposal, and has discussed the matter with the White House Office of Management and Budget. 

Bilmes said that during a recent meeting with her, Nicholson ‘‘definitely was intrigued at the concept of changing the presumption.’’ 

But even if the VA gets behind such a change, the prospect of offering blanket 

approval of claims would face tough scrutiny in the Senate. 

‘‘There are serious procedural questions, but far more importantly, the cost implications suggest this has little chance of enactment,’’ said a Senate Democratic aide. 

Another change proposed by Bilmes would streamline the VA’s 10-point disability 

rating system and create four classifications: none, low, medium and high. Bilmes 

believes the change would cut down on the number of appeals in the system. 

Some lawmakers, such as New York Democratic Rep. John Hall, who also serves 

on the House Veterans’ Affairs Committee, would provide financial assistance to veterans whose claims were languishing by providing a $500 monthly benefit to those 

whose appeals were not taken up within 180 days. 

But such proposals face stiff opposition in the Senate, where lawmakers from both 

parties are worried about the extra costs and inclined to wait for the recommendations of a congressionally mandated 13-member commission convened to study the 

VA’s disability benefits programs. 

Senator Larry E. Craig of Idaho, the ranking Republican on the Senate Veterans’ 

Affairs Committee, says he hopes the commission ‘‘will provide the foundation for 

the types of fundamental changes that may be needed to ensure lasting improvement to the disability compensation system’’ and possibly lead to a bipartisan reform package. ‘‘The system as currently structured cannot provide veterans with 

timely, accurate and consistent decisions on their claims,’’ Craig said. 

Gaps in Medical Care 

In contrast to the troubled claims process, the VA’s medical system has received 

widespread praise from politicians and veterans’ groups for the way it treats more 

than 5 million veterans annually. The network’s well-regarded rehabilitation services have become vital for many of the recent returnees from Iraq, who suffer from 

head trauma, spinal injuries, amputations, blindness or deafness. 

But experts contend that the system is ill-equipped to cope with increased caseloads because the VA has regularly underestimated the cost of care, workloads and 

the length of waiting lists. Harvard’s Bilmes noted that the VA’s fiscal 2006 request 

for emergency funding included $677 million to cover an unexpected 2 percent increase in the number of patients, another $600 million to correct inaccurate estimates of long-term care costs and $400 million more for an unexpected 1.2 percent 

increase in per-patient costs. 

Some professional organizations and veterans’ groups are particularly concerned 

about the VA’s ability to treat mental health and brain disorders—including traumatic brain injuries and behavioral problems such as post traumatic stress disorder, 

depression and substance abuse—that are fast becoming the war’s signature medical issues. 

Frances M. Murphy, the VA’s deputy undersecretary for health policy coordination, stoked fears last year when she told a presidential commission on mental 

health that some VA clinics do not provide mental health or substance abuse care, 

and that in other locations, ‘‘waiting lists render that care virtually inaccessible.’’ 

The remarks triggered a huge flap in which Murray and other congressional Democrats questioned whether Nicholson was giving returning veterans the services they 

need. 

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MORE OVERSIGHT: Murray says Democrats will dictate change if the VA doesn’t act 

promptly. 

(GETTY IMAGES/CHIP SOMODEVILLA) 

The American Psychological Association reported in February that the armed 

forces and veterans’ systems both suffer a shortage of qualified specialists, noting 

that the VA employs 1,839 psychologists to serve some 24.3 million veterans. Veterans’ groups contend that the shortage has meant some returning servicemembers—especially National Guard members and reservists—are subjected to perfunctory screenings lasting only several minutes that are geared toward treating 

easily apparent physical disabilities. 

‘‘Funding for the VA was based more on hope than projectable data,’’ said Paul 

Rieckhoff, Executive Director of the advocacy group Iraq and Afghanistan Veterans 

of America. ‘‘They hoped people wouldn’t have casualties, wouldn’t have brain injuries. The reality is those things happened. There was an absurd lack of planning.’’ 

The VA has disputed the psychological association’s study, saying the findings 

were flawed because the group did not contact the department for information about 

VA programs, staffing data and other information. 

However, veterans’ groups and experts contend that staffing shortages within the 

military medical establishment hinder the ability to diagnose mental health problems in the field, before servicemembers return home. The American Psychological 

Association says the number of active-duty psychologists has been slipping in recent 

years because of heavy caseloads, job stress and declining morale. And only 10 to 

20 percent have been trained to counsel soldiers suffering from post-traumatic stress 

disorder. 

Harvard’s Bilmes says the cumulative effect of these gaps in care is that veterans 

are at higher risk of unemployment, homelessness, family violence, crime, alcoholism and drug abuse—problems that will impose societal and financial burdens 

on states and localities. 

VA officials say they are addressing shortcomings in their system by beginning 

to screen discharged servicemembers for traumatic brain injuries as soon as they 

are admitted into the veterans system. The department also will hire 100 new patient advocates to travel to medical facilities and help wounded servicemembers and 

their families cut through bureaucratic red tape and obtain information about disability compensation and options for rehabilitation. And the department is asking 

Congress for money to expand a network of 21 ‘‘polytrauma’’ centers across the 

country so that veterans who live in outlying areas can have better access to facilities that can simultaneously treat injuries to more than one body part. 

The task force recommendations that Nicholson issued April 24 call for making 

VA and military medical records systems interoperable sometime between mid-2008 

and January 2009. 

‘‘VA has worked hard to improve the transition process for our deserving servicemen and women. Yet we are not satisfied that we have achieved all that is possible,’’ VA Undersecretary for Benefits Daniel Cooper told a joint hearing of the Senate Armed Services and Veterans’ Affairs Committees April 12. 

Helping ‘Wounded Warriors’ 

While Congress has always supported the principle of improving veterans’ healthcare, the disclosure of problems at Walter Reed Army Medical Center has inspired 

more detailed proposals that address kinks in the system. 

After the Walter Reed disclosure, the House in late March overwhelmingly passed 

a plan to improve the coordination of VA and military health services by adding 

caseworkers and counselors to the military’s medical system. The plan also required 

the Pentagon and VA to better coordinate the transfer of servicemembers between 

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the two bureaucracies. The changes would cost at least $300 million over the next 

five years, according to the Congressional Budget Office. 

There is no identical companion legislation in the Senate yet. An effort by Democrats Barack Obama of Illinois and Claire McCaskill of Missouri to add caseworkers 

and mental health counselors to military hospitals and provide money for the military to develop a system allowing soldiers to submit medical paperwork over the 

Internet was defeated by Republicans during a debate on a war spending bill in late 

March. The Bush administration says it prefers that Congress wait until a presidentially appointed commission studying problems in the military’s medical system 

issues a report, due by July 31. The commission is headed by former Republican 

Senator Bob Dole and Donna Shalala, former Secretary of Health and Human Services in the Clinton administration. 

House members and senators also are trying to confront the problems by earmarking more money in spending bills. The 2007 supplemental spending bill, for example, designated $100 million for mental health services, another $30 million for 

a new polytrauma center and $20 million to improve services at ‘‘Vet Centers’’—a 

network of more than 200 storefront centers the VA operates around the country 

where veterans and their families can receive counseling. 

Beyond such narrow remedies, VA officials and medical researchers are trying to 

gain a better understanding of the new types of injuries veterans are bringing home. 

With as many as one in five soldiers projected to suffer mild Traumatic Brain Injuries, researchers at the W.G. Hefner Medical Center in North Carolina are collaborating with scientists at the Massachusetts Institute of Technology to establish how 

the force of an explosion affects brain cells and their ability to communicate with 

one another. The answers could yield clues about whether veterans with brain injuries are more susceptible to the effects of alcohol or certain medicines, and help VA 

screeners differentiate between physical brain injuries and stress-related disorders. 

Murray, a leading Democratic voice on veterans’ issues, gives the administration 

some credit for recognizing the scope of the problems and taking constructive steps. 

But she says the VA needs to be a much more vocal advocate for veterans’ needs, 

especially in the area of healthcare. 

She predicts that unless there is more initiative, the Democratic Congress will impose more oversight when it draws up fiscal 2008 spending bills and takes up a defense authorization bill later this year. 

Æ 

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