Claims Processing Improvement Act of 2013

Bill: 113-s-928
Sponsor: full_name: Sen. Sanders, Bernard [I-VT]
Introduced: 2013-05-09
Policy area: Armed Forces and National Security
Subjects: Administrative remedies

Advisory bodies

Asia

Conflicts and wars

Congressional oversight

Department of Veterans Affairs

Disability and paralysis

Executive agency funding and structure

Federal-Indian relations

Government employee pay, benefits, personnel management

Government information and archives

Government studies and investigations

Health information and medical records

Health personnel

Intergovernmental relations

Judicial review and appeals

Marriage and family status

Medical tests and diagnostic methods

Mental health

Military education and training

Philippines

Separation, divorce, custody, support

State and local government operations

Veterans' education, employment, rehabilitation

Veterans' medical care

Veterans' pensions and compensation
Latest action: action_date: 2013-06-12
text: Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 113-111.

Summaries:
action_date: 2013-05-09
action_desc: Introduced in Senate
text: <p>Claims Processing Improvement Act of 2013 - Directs the Secretary of Veterans Affairs (VA) to establish: (1) a working group to assess and develop recommendations for improving the employee work credit and work management systems of the Veterans Benefits Administration, and (2) a task force to assess the retention and training of claims processors and adjudicators employed by the VA and other federal departments and agencies.</p> <p>Requires the Secretary, in providing assistance to a VA benefits claimant, to make no fewer than two attempts to obtain needed records from another federal department or agency, and to notify the claimant of the inability to obtain all of the records sought. Requires a record sought before the adjudication of a claim but received after such adjudication to be considered part of the original record.</p> <p>Authorizes the Secretary to recognize representatives of Indian tribes in the preparation, presentation, and prosecution of VA claims.</p> <p>Directs the Secretary to: (1) carry out a pilot program of including the participation of local governments and tribal organizations in improving the quality of disability compensation claims submitted to the VA, and (2) report quarterly through 2015 to the congressional veterans committees on the backlog of submitted claims.</p> <p>Changes from one year to 180 days the filing period of a notice of disagreement to a decision on a claim, after which appellate review will be initiated. Allows the Secretary to waive such deadline for good cause shown, as long as such notice is filed within 186 days after the original deadline.</p> <p>Revises the manner of appearance (in person, through picture and voice transmission, etc.) and appropriate location of a hearing before the Board of Veterans' Appeals.</p> <p>Authorizes the Secretary to disclose VA patient medical records, as appropriate under an appeal, to the Supreme Court, a U.S. Court of Appeals, or the U.S. Court of Appeals for Veterans Claims.</p> <p>Extends: (1) VA authority to operate a regional office in the Republic of the Philippines, (2) the period for the scheduling of VA medical exams for veterans receiving temporary disability ratings due to severe mental disorders, (3) the marriage delimiting date for surviving spouses of Persian Gulf War veterans to qualify for a VA death pension, and (4) the temporary authority for the performance of VA medical disability examinations by contract physicians.</p> <p>Requires a report from the Secretary to the veterans committees on: (1) the furnishing of general and specialty medical examinations by the VA for purposes of adjudicating benefits claims, and (2) progress of the VA's acceptable clinical evidence initiative in reducing the necessity for in-person disability examinations and other efforts to comply with requirements concerning the acceptance of reports of private physicians.</p>

tv_txt: II 113th CONGRESS 1st Session S. 928 IN THE SENATE OF THE UNITED STATES May 9, 2013 Mr. Sanders introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL To amend title 38, United States Code, to improve the processing of claims for compensation under laws administered by the Secretary of Veterans Affairs, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Claims Processing Improvement Act of 2013 . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. TITLE I—Agency of original jurisdiction Sec. 101. Establishment of working group to improve employee work credit and work management systems of Veterans Benefits Administration. Sec. 102. Establishment of task force on retention and training of Department of Veterans Affairs claims processors and adjudicators. Sec. 103. Streamlining non-Department of Veterans Affairs Federal records requests. Sec. 104. Recognition of representatives of Indian tribes in the preparation, presentation, and prosecution of claims under laws administered by the Secretary of Veterans Affairs. Sec. 105. Pilot program on participation of local and tribal governments in improving quality of claims for disability compensation submitted to Department of Veterans Affairs. Sec. 106. Quarterly reports on progress of Department of Veterans Affairs in eliminating backlog of claims for compensation that have not been adjudicated. TITLE II—Board of Veterans' Appeals and Court of Appeals for Veterans Claims Sec. 201. Modification of filing period for notice of disagreement to initiate appellate review of decisions of Department of Veterans Affairs. Sec. 202. Determination of manner of appearance for hearings before Board of Veterans' Appeals. Sec. 203. Disclosure of certain medical records in appellate proceedings in certain courts. TITLE III—Other matters Sec. 301. Extension of authority for operations of Manila Department of Veterans Affairs Regional Office. Sec. 302. Extended period for scheduling of medical exams for veterans receiving temporary disability ratings for severe mental disorder. Sec. 303. Extension of marriage delimiting date for surviving spouses of Persian Gulf War veterans to qualify for death pension. Sec. 304. Making effective date provision consistent with provision for benefits eligibility of a veteran's child based upon termination of remarriage by annulment. Sec. 305. Extension of temporary authority for performance of medical disabilities examinations by contract physicians. I Agency of original jurisdiction 101. Establishment of working group to improve employee work credit and work management systems of Veterans Benefits Administration (a) In general Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a working group to assess and develop recommendations for the improvement of the employee work credit and work management systems of the Veterans Benefits Administration. (b) Composition The working group shall be composed of the following: (1) The Secretary or the Secretary's designee. (2) Individuals selected by the Secretary from among employees of the Department of Veterans Affairs who— (A) handle claims for compensation and pension benefits; and (B) are recommended to the Secretary by a labor organization for purposes of this section. (3) Not fewer than three individuals selected by the Secretary to represent different organizations recognized by the Secretary for the representation of veterans under section 5902 of title 38, United States Code. (c) Duties The duties of the working group are as follows: (1) To assess and develop recommendations for the improvement of the employee work credit and work management systems of the Veterans Benefits Administration. (2) To develop a data based methodology to be used in revising the employee work credit system of the Department and a schedule by which revisions to such system should be made. (3) To assess and develop recommendations for improvement of the resource allocation model of the Veterans Benefits Administration. (d) Review and incorporation of findings from prior study In carrying out its duties under subsection (c), the working group shall review the findings and conclusions of the Secretary regarding previous studies of the employee work credit and work management systems of the Veterans Benefits Administration. (e) Reports (1) Interim report Not later than 180 days after the date of the establishment of the working group, the working group shall submit to Congress a report on the progress of the working group. (2) Final report Not later than one year after the date of the establishment of the working group, the working group shall submit to Congress the methodology and schedule developed under subsection (c)(2). (f) Implementation of methodology and schedule After submitting the report under subsection (e), the Secretary shall take such actions as may be necessary to apply the methodology developed under subsection (c)(2) and apply such methodology according to the schedule developed under such subsection. 102. Establishment of task force on retention and training of Department of Veterans Affairs claims processors and adjudicators (a) Establishment The Secretary of Veterans Affairs shall establish a task force to assess retention and training of claims processors and adjudicators that are employed by the Department of Veterans Affairs and other Federal agencies and departments. (b) Composition The task force shall be composed of the following: (1) The Secretary of Veterans Affairs. (2) The Director of the Office of Personnel Management. (3) The Commissioner of Social Security. (4) An individual selected by the Secretary of Veterans Affairs who represents an organization recognized by the Secretary for the representation of veterans under section 5902 of title 38, United States Code. (5) Such other individuals selected by the Secretary who represent such other organizations and institutions as the Secretary considers appropriate. (c) Duration The task force established under subsection (a) shall terminate not later than two years after the date on which the task force is establish under such subsection. (d) Duties The duties of the task force are as follows: (1) To identify key skills required by claims processors and adjudicators to perform the duties of claims processors and adjudicators in the various claims processing and adjudication positions throughout the Federal Government. (2) To identify reasons for employee attrition from claims processing positions. (3) Not later than one year after the date of the establishment of the task force, to develop a Government-wide strategic and operational plan for promoting employment of veterans in claims processing positions in the Federal Government. (4) To coordinate with educational institutions to develop training and programs of education for members of the Armed Forces to prepare such members for employment in claims processing and adjudication positions in the Federal Government. (5) To identify and coordinate offices of the Department of Defense and the Department of Veterans Affairs located throughout the United States to provide information about, and promotion of, available claims processing positions to members of the Armed Forces transitioning to civilian life and to veterans with disabilities. (6) To establish performance measures to assess the plan developed under paragraph (3), to assess the implementation of such plan, and revise such plan as the task force considers appropriate. (7) To establish performance measures to evaluate the effectiveness of the task force. (e) Reports (1) Submittal of plan Not later than one year after the date of the establishment of the task force, the Secretary of Veterans Affairs shall submit to Congress a report on the plan developed by the task force under subsection (d)(3). (2) Assessment of implementation Not later than 120 days after the termination of the task force, the Secretary shall submit to Congress a report that assesses the implementation of the plan developed by the task force under subsection (d)(3). 103. Streamlining non-Department of Veterans Affairs Federal records requests (a) In general Paragraph (2) of section 5103A(c) of title 38, United States Code, is amended to read as follows: (2) (A) Whenever the Secretary attempts to obtain records from a Federal department or agency, other than the Department, under this subsection, the Secretary shall make not fewer than two attempts to obtain the records, unless the records are obtained or the response to the first request makes evident that a second request for such records would be futile. (B) The notification requirements under subsection (b)(2) of this section shall apply if the Secretary is unable to obtain all of the records sought from a Federal department or agency other than the Department. . (b) Subsequent attainment of records Such section is further amended by adding at the end the following new paragraph: (3) If, after adjudicating a claim for a benefit under a law administered by the Secretary, the Secretary receives a record relevant to such claim (or associates with the file for such claim a record) that the Secretary requested from a Federal department or agency before the adjudication, the record received (or associated) shall be deemed to have been in the file for such claim as of the date of the original filing of the claim for such benefit. . (c) Effective date The amendments made by this section shall take effect on the date that is 180 days after the date of the enactment of this Act and shall apply with respect to any claim that— (1) is filed on or after the date that is 180 days after the date of the enactment of this Act; or (2) was filed before the date of the enactment of this Act and was not final as of such date. 104. Recognition of representatives of Indian tribes in the preparation, presentation, and prosecution of claims under laws administered by the Secretary of Veterans Affairs Section 5902(a)(1) of title 38, United States Code, is amended by inserting Indian tribes (as defined in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 450b )) after Foreign Wars, . 105. Pilot program on participation of local and tribal governments in improving quality of claims for disability compensation submitted to Department of Veterans Affairs (a) Pilot program required The Secretary of Veterans Affairs shall carry out a pilot program to assess the feasibility and advisability of entering into memorandums of understanding with local governments and tribal organizations— (1) to improve the quality of claims submitted to the Secretary for compensation under chapter 11 and pension under chapter 15 of title 38, United States Code; and (2) to provide assistance to veterans who may be eligible for such compensation or pension in submitting such claims. (b) Minimum number of participating tribal organizations In carrying out the pilot program required by subsection (a), the Secretary shall enter into memorandums of understanding with at least— (1) two tribal organizations; and (2) 10 State or local governments. (c) Tribal organization defined In this section, the term tribal organization has the meaning given that term in section 3765 of title 38, United States Code. 106. Quarterly reports on progress of Department of Veterans Affairs in eliminating backlog of claims for compensation that have not been adjudicated (a) In general Not later than 90 days after the date of the enactment of this Act and not less frequently than quarterly thereafter through calendar year 2015, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the backlog of claims filed with the Department of Veterans Affairs for compensation that have not been adjudicated by the Department. (b) Contents Each report submitted under subsection (a) shall include the following: (1) For each month through calendar year 2015, a projection of the following: (A) The number of claims completed. (B) The number of claims received. (C) The number of claims backlogged at the end of the month. (D) The number of claims pending at the end of the month. (E) A description of the status of the implementation of initiatives carried out by the Secretary to address the backlog. (2) For each quarter through calendar year 2015, a projection of the average accuracy of disability determinations for compensation claims that require a disability rating (or disability decision). (3) For each month during the most recently completed quarter, the following: (A) The number of claims completed. (B) The number of claims received. (C) The number of claims backlogged at the end of the month. (D) The number of claims pending at the end of the month. (E) A description of the status of the implementation of initiatives carried out by the Secretary to address the backlog. (4) For the most recently completed quarter, an assessment of the accuracy of disability determinations for compensation claims that require a disability rating (or disability decision). (c) Availability to public The Secretary shall make each report submitted under subsection (a) available to the public. (d) Definitions In this section: (1) Backlogged The term backlogged , with respect to a claim for compensation received by the Secretary, means a claim that has been pending for more than 125 days. (2) Pending The term pending , with respect to a claim for compensation received by the Secretary, means a claim that has not been adjudicated by the Secretary. II Board of Veterans' Appeals and Court of Appeals for Veterans Claims 201. Modification of filing period for notice of disagreement to initiate appellate review of decisions of Department of Veterans Affairs (a) Filing of notice of disagreement by claimants (1) In general Paragraph (1) of section 7105(b) of title 38, United States Code, is amended— (A) by striking one year and inserting 180 days in the first sentence; and (B) by striking one-year and inserting 180-day in the third sentence. (2) Electronic filing Such paragraph is further amended by inserting or transmitted by electronic means after postmarked . (3) Good cause exception for untimely filing of notices of disagreement Such section 7105(b) is amended by adding at the end the following new paragraph: (3) (A) A notice of disagreement not filed within the time prescribed by paragraph (1) shall be treated by the Secretary as timely filed if— (i) the Secretary determines that the claimant, legal guardian, or other accredited representative, attorney, or authorized agent filing the notice had good cause for the lack of filing within such time; and (ii) the notice of disagreement is filed not later than 186 days after the period prescribed by paragraph (1). (B) For purposes of this paragraph, good cause shall include the following: (i) Circumstances relating to any physical, mental, educational, or linguistic limitation of the claimant, legal guardian, representative, attorney, or authorized agent concerned (including lack of facility with the English language). (ii) Circumstances relating to significant delay in the delivery of the initial decision or of the notice of disagreement because of natural disaster or factors relating to geographic location. (iii) A change in financial circumstances, including the payment of medical expenses or other changes in income or net worth that are considered in determining eligibility for benefits and services on an annualized basis for purposes of needs-based benefits under chapters 13, 15, and 17 of this title. . (b) Application by Department for review on appeal Section 7106 of such title is amended in the first sentence by striking one-year period described in section 7105 and inserting period described in section 7105(b)(1) . (c) Effective date The amendments made by this section shall apply with respect to claims for compensation and benefits under laws administered by the Secretary of Veterans Affairs filed with the Secretary after the date of the enactment of this Act. 202. Determination of manner of appearance for hearings before Board of Veterans' Appeals (a) In general Section 7107 of title 38, United States Code, is amended— (1) by redesignating subsection (f) as subsection (g); (2) in subsection (a)(1), by striking in subsection (f) and inserting in subsection (g) ; and (3) by striking subsections (d) and (e) and inserting the following new subsections: (d) (1) Except as provided in paragraph (2), a hearing before the Board shall be conducted through picture and voice transmission, by electronic or other means, in such a manner that the appellant is not present in the same location as the members of the Board during the hearing. (2) (A) A hearing before the Board shall be conducted in person upon the request of an appellant. (B) In the absence of a request under subparagraph (A), a hearing before the Board may also be conducted in person as the Board considers appropriate. (e) (1) In a case in which a hearing before the Board is to be held as described in subsection (d)(1), the Secretary shall provide suitable facilities and equipment to the Board or other components of the Department to enable an appellant located at an appropriate facility within the area served by a regional office to participate as so described. (2) Any hearing conducted as described in subsection (d)(1) shall be conducted in the same manner as, and shall be considered the equivalent of, a personal hearing. (f) (1) In a case in which a hearing before the Board is to be held as described in subsection (d)(2), the appellant may request that the hearing be held at the principal location of the Board or at a facility of the Department located within the area served by a regional office of the Department. (2) A hearing to be held within an area served by a regional office of the Department shall (except as provided in paragraph (3)) be scheduled to be held in accordance with the place of the case on the docket under subsection (a) relative to other cases on the docket for which hearings are scheduled to be held within that area. (3) A hearing to be held within an area served by a regional office of the Department may, for cause shown, be advanced on motion for an earlier hearing. Any such motion shall set forth succinctly the grounds upon which the motion is based. Such a motion may be granted only— (A) if the case involves interpretation of law of general application affecting other claims; (B) if the appellant is seriously ill or is under severe financial hardship; or (C) for other sufficient cause shown. . (b) Effective date The amendments made by subsection (a) shall apply with respect to cases received by the Board of Veterans' Appeals pursuant to notices of disagreement submitted on or after the date of the enactment of this Act. 203. Disclosure of certain medical records in appellate proceedings in certain courts Section 7332(b)(2) of title 38, United States Code, is amended— (1) by redesignating subparagraphs (E) through (G) as subparagraphs (F) through (H), respectively; and (2) by inserting after subparagraph (D) the following new subparagraph (E): (E) To the Supreme Court of the United States, the United States Court of Appeals for the Federal Circuit, or the United States Court of Appeals for Veterans Claims, and all parties of record, in a case that is appealed to such court and such records are included in the record on appeal. Upon disclosure of such records, the court concerned shall impose appropriate safeguards against unauthorized disclosure that are consistent with the provisions of section 7268 of this title. . III Other matters 301. Extension of authority for operations of Manila Department of Veterans Affairs Regional Office Section 315(b) of title 38, United States Code, is amended by striking December 31, 2013 and inserting December 31, 2014 . 302. Extended period for scheduling of medical exams for veterans receiving temporary disability ratings for severe mental disorder Section 1156(a)(3) of title 38, United States Code, is amended by striking six months and inserting 540 days . 303. Extension of marriage delimiting date for surviving spouses of Persian Gulf War veterans to qualify for death pension Section 1541(f)(1)(E) of title 38, United States Code, is amended by striking January 1, 2011 and inserting the date that is 10 years and one day after the date on which the Persian Gulf War was terminated, as prescribed by Presidential proclamation or by law . 304. Making effective date provision consistent with provision for benefits eligibility of a veteran's child based upon termination of remarriage by annulment Section 5110(l) of title 38, United States Code, is amended by striking , or of an award or increase of benefits based on recognition of a child upon termination of the child's marriage by death or divorce, . 305. Extension of temporary authority for performance of medical disabilities examinations by contract physicians (a) In general Section 704(c) of the Veterans Benefits Act of 2003 ( Public Law 108–183 ; 38 U.S.C. 5101 note) is amended by striking December 31, 2013 and inserting December 31, 2014 . (b) Report on disability medical examinations furnished by Department of Veterans Affairs (1) In general Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the furnishing of general medical and specialty medical examinations by the Department of Veterans Affairs for purposes of adjudicating claims for benefits under laws administered by the Secretary. (2) Contents The report submitted under paragraph (1) shall include the following: (A) The number of general medical examinations furnished by the Department during the period of fiscal years 2009 through 2012 for purposes of adjudicating claims for benefits under laws administered by the Secretary. (B) The number of general medical examinations furnished by the Department during the period of fiscal years 2009 through 2012 for purposes of adjudicating a claim in which a comprehensive joint examination was conducted, but for which no disability relating to a joint, bone, or muscle had been asserted as an issue in the claim. (C) The number of specialty medical examinations furnished by the Department during the period of fiscal years 2009 through 2012 for purposes of adjudicating a claim. (D) The number of specialty medical examinations furnished by the Department during the period of fiscal years 2009 through 2012 for purposes of adjudicating a claim in which one or more joint examinations were conducted. (E) A summary (including citations of) any medical and scientific studies which provide a scientific basis for determining that three repetitions is adequate to determine the effect of repetitive use on functional impairments. (F) The names of all examination reports, including general medical examinations and Disability Benefits Questionnaires, used for evaluation of compensation and pension disability claims which require measurement of repeated ranges of motion testing and the number of examinations requiring such measurements which were conducted in fiscal year 2012. (G) The average amount of time taken by an individual conducting a medical examination to perform the three repetitions. (H) A discussion of whether there are more efficient and effective scientifically reliable methods of testing for functional loss on repetitive use of an extremity other than the three time repetition currently used by the Department. (I) Recommendations as to the continuation of the practice of measuring functional impairment by using three repetitions during the examination as a criteria for evaluating the effect of repetitive motion on functional impairment with supporting rationale. (c) Report on progress of Acceptable Clinical Evidence initiative (1) In general Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the progress of the Acceptable Clinical Evidence initiative of the Department of Veterans Affairs in reducing the necessity for in-person disability examinations and other efforts to comply with the provisions of section 5125 of title 38, United States Code. (2) Contents The report required by paragraph (1) shall include the following: (A) The number of claims eligible for the Acceptable Clinical Evidence initiative during the period beginning on the date of the initiation of the initiative and ending on the date of the enactment of this Act, disaggregated by fiscal year. (B) The total number of claims eligible for the Acceptable Clinical Evidence initiative that required a medical examiner of the Department to supplement the evidence with information obtained during a telephone interview with a claimant. (C) Information on any other initiatives or efforts of the Department to further encourage the use of private medical evidence and reliance upon reports of a medical examination administered by a private physician if the report is sufficiently complete to be adequate for the purposes of adjudicating a claim.