Apr112013
Hearing Transcript on The State of the Veterans Benefits Administration.
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THE STATE OF THE VETERANS BENEFITS ADMINISTRATION
HEARING BEFORE THE SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION JUNE 15, 2010 SERIAL No. 111-85 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
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
June 15, 2010
The State of the Veterans Benefits Administration
OPENING STATEMENTS
Chairman John J. Hall
Prepared statement of Chairman Hall
Hon. Doug Lamborn, Ranking Republican Member
Prepared statement of Congressman Lamborn
Hon. Deborah L. Halvorson
WITNESSES
Advisory Committee on Disability Compensation, Lieutenant General Ronald R. Blanck, USA (Ret.), D.O., Member
Prepared statement of General Blanck
U.S. Department of Veterans Affairs, Michael Walcoff, Acting Under Secretary for Benefits, Veterans Benefits Administration
Prepared statement of Mr. Walcoff
American Federation of Government Employees, AFL-CIO, and AFGE Veterans Affairs Council, Molly M. Ames, Rating Veterans Service Representative, Veterans Benefits Administration Regional Office, San Diego, CA
Prepared statement of Ms. Ames
American Legion, Ian C. de Planque, Deputy Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. de Planque
Disabled American Veterans, Joseph A. Violante, National Legislative Director
Prepared statement of Mr. Violante
Federal Bar Association, Carol Wild Scott, Chairman, Veterans Law Section
Prepared statement of Ms. Scott
National Organization of Veterans' Advocates, Inc., Richard Paul Cohen, Executive Director
Prepared statement of Mr. Cohen
Veterans for Common Sense, Paul Sullivan, Executive Director
Prepared statement of Mr. Sullivan
MATERIAL SUBMITTED FOR THE RECORD
THE STATE OF THE VETERANS BENEFITS ADMINISTRATION
Tuesday, June 15, 2010
U. S. House of Representatives,
Subcommittee on Disability Assistance and Memorial Affairs,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:05 p.m., in Room 340, Cannon House Office Building, Hon. John J. Hall [Chairman of the Subcommittee] presiding.
Present: Representatives Hall, Halvorson, Donnelly, Lamborn, and Bilbray.
OPENING STATEMENT OF CHAIRMAN HALL
Mr. HALL. Good afternoon. Would everybody, to begin our meeting, please rise for the Pledge of Allegiance.
[Pledge of Allegiance.]
Thank you. And welcome to the House Committee on Veterans' Affairs, the Subcommittee on Disability Assistance and Memorial Affairs.
Our hearing today is on the state of the Veterans Benefits Administration (VBA). I welcome everybody and look forward to hearing from our panels. This hearing represents the seventh hearing that we have held this year, and the 15th for the 111th Congress, which we have conducted relating to problems plaguing the disability claims processing system. So oversight has been vigorous with significant activity on this front from stakeholders across the board.
The system is still, however, in dire need of continuing reform. Today, there are over 546,000 compensation and pension (C&P) claims awaiting final processing, with a total inventory or backlog of over 1 million claims and appeals within the VBA pending a decision. VBA employs over 13,000 personnel in its compensation and pension operation, and this figure represents a staffing increase of 32 percent since Democrats became the majority party in 2007 in Congress.
However, as we stated in the past, the problems plaguing VBA are not just workforce issues; they are leadership methodology, cultural and technology issues. That is why we passed the Veterans Benefits Modernization Act, H.R. 5892, which was included almost in its totality in Public Law 110-389. As many of you in this room recall, with your help P.L. 110-389 established a guided roadmap for VA to get us to where we are today—encouraged by the reform efforts that VA is making, but cautious to make sure that we are doing everything we can to help VA make those meaningful reformations of its claims processing system.
There has been major progress since the passage of Public Law 110-389. For instance, very recently, today the VA adopted a shortened claims filing form as well as other easy forms like the fully developed claims forms for both compensation and pension claims. The inclusion of a checklist will increase compensation requests. You, the VA, have heeded the call of Congress as outlined in Public Law 110-389, and I applaud you, as I am sure other Members of this Subcommittee do, for your efforts to bring this to fruition.
VA also has a number of claims processing related pilots underway, and I applaud your activity and proactivity in this area. I would like to caution, however, that we want to avoid action for the sake of action. We are committed to ensuring that the 30-plus ongoing pilots translate to real change for our veterans and for our survivors who are still languishing in the backlog.
I think most stakeholders believe that a comprehensive overhaul is still in order, and I am encouraged that we seem to be on the right path to get there. We seem to have the right leader for this monumental task in Secretary Shinseki, who has both the vision and commitment, in my opinion, to get us to a more veteran-centered 21st Century system claims processing system.
We all know about the myriad of problems plaguing the VBA's current system; the lack of adequate training; a 30- to 40-percent error rate; a paper-based system; still an overemphasis on quality and underemphasis on quantity—or, I am sorry, an overemphasis on quantity over quality without putting enough emphasis on accountability, consistency, or accuracy.
As I have said many times, and I know that many of you agree, as does Secretary Shinseki, we want a system that gets it right the first time, one that renders decisions in which our veterans and stakeholders can have 100 percent confidence.
Currently we are not there, but as they say in the self-help world, we are looking for progress, not perfection. None of us expect to get to perfection instantly, but we are, however, seeking progress. We are not here to blame anyone for where we are today. The claims backlog has been a decades-old problem that is coming to a head mostly because we are engaged currently in two wars, for which there was little planning for the veterans of those wars at the same time that our older veterans are aging and need more care.
We want to focus on solutions. I expect to get a comprehensive update on where the VA is today, what it plans to do to meet its 2015 claims transformation target with its new Veterans Benefits Management and Veterans Relationship Manager Systems. We also want to know if and how these two systems interface with the Virtual Lifetime Electronic Records (VLER) Initiative announced by the President.
Lastly, we look forward to hearing about the state of the VA's efforts to bring aboard a permanent Under Secretary for Benefits.
I think we all have the same goal, which is to ensure that we have a world-class 21st Century claims processing system that helps our veterans, their families, and their survivors secure the benefits they deserve and that they have earned, without delay.
With that, I look forward to the insightful testimony of our witnesses. I now will recognize Ranking Member Lamborn for his opening statement.
[The prepared statement of Chairman Hall appears in the Appendix.]
OPENING STATEMENT OF CONGRESSMAN LAMBORN
Mr. LAMBORN. Thank you, Mr. Chairman. It has been about a year since we first convened as a Subcommittee to discuss VA's ongoing struggle to overcome the backlog of disability claims. Multiple hearings have been devoted to this topic and to the underlying need for VA to improve the timeliness and accuracy of its adjudication process.
Now, anyone who has followed this Subcommittee's hearings over the past several years knows that I have long advocated for better use of information technology as a partial remedy to VA's problems. I am pleased that the virtual regional office (RO) concept I introduced in 2007 to modernize the claims process is being included in the Veterans Benefits Management System (VBMS). I hope that it and other integral parts of the VBMS will establish the framework needed to transform VA into a 21st-Century benefits system.
I look forward to hearing from our VA panel this afternoon for an update on the status of the pilot programs that are underway. And I would like to know how long will it be before they are implemented and how soon will they have a positive impact.
While I understand that diligence is required when a foundation's pillars are being set, it is imperative that VA continues its progress with the utmost sense of urgency. Veterans are suffering as a result of the ever-increasing inventory of claims, and this is simply unacceptable. There was no hesitation on their part when it came to serving our Nation in a time of need, and they should not have to wait months and years to receive compensation for the injuries they incurred during service.
Thank you, Mr. Chairman. And I yield back.
[The prepared statement of Congressman. Lamborn appears in the Appendix.]
Mr. HALL. Thank you Mr. Lamborn.
I would remind all panelists that your complete written statements have been made a part of the hearing record. Please—oh, I am sorry, Mrs. Halvorson, would you like to make a statement?
OPENING STATEMENT OF HON. DEBORAH L. HALVORSON
Mrs. HALVORSON. Sure. Thank you, Mr. Chairman.
I would like to just thank and congratulate you on the intense meetings that we have had over the backlog. This is the number one complaint I get every time I go back home. I have a Veterans Advisory Committee that we get together, and once we get on the backlog issue we never get off of it. I think that it is true that this is a part of a bigger problem, and we need to continue to focus on it. We have to remember that it is not about activity, it is about results. We don't want to confuse the two. So just throwing more people after a broken system is not what we want to do. I am looking forward to continuing the effort. This is our mission and we have to see it through.
Mr. HALL. Thank you, Mrs. Halvorson.
Panelists, please remember that your written statements have been made a part of the hearing record so you can limit your remarks so that we may have sufficient time to follow up with questions.
Will today's first panel please come and join us at the witness table. Dr. Ronald Blanck, a Member of the Advisory Committee on Disability Compensation at the U.S. Department of Veterans Affairs; Carol Wild Scott, Veterans Law Section (VLSL) of the Federal Bar Association; Joseph Violante, National Legislative Director of Disabled American Veterans (DAV); and Ian de Planque, Assistant Director, Veterans Affairs Rehabilitation Commission, the American Legion. Thank you all for joining us again, and welcome.
Mr. Blanck, you are now recognized.
STATEMENTS OF LIEUTENANT GENERAL RONALD R. BLANCK, USA (RET.), D.O., MEMBER, ADVISORY COMMITTEE ON DISABILITY COMPENSATION; CAROL WILD SCOTT, CHAIRMAN, VETERANS LAW SECTION, FEDERAL BAR ASSOCIATION; JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; AND IAN C. DE PLANQUE, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION
STATEMENT OF LIEUTENANT GENERAL RONALD R. BLANCK, USA (RET.), D.O.
Dr. BLANCK. Thank you very much, Mr. Chairman. I would just like to summarize a few points from my witness statement.
First of all, to note that I am here representing our Chairman, General Scott, who is farming in Texas and could not leave, and so he asked if I would represent him and the Committee. And it is a pleasure.
You know what our Committee does. Our charter is in the statement. We have now met 19 times over a close to 2-year period, and forwarded an interim report with recommendations to the Secretary that addressed our efforts in July of 2009. We received a response from the Secretary in February of 2010, and if those copies aren't available, I do have them for you. The first you were provided; the second you may not have seen. And we are in the process of preparing a draft report for the Secretary and for Congress, as required, which will be available in October of this year, that will summarize the work that we have done, the recommendations we have, and the progress the VA has made.
Our focus of course is in three areas. It is methodology for reviewing and updating the Veterans Administration Schedule for Rating Disabilities (VASRD); that is, the VA schedule for rating disabilities, because that is central to everything. And that if it is done properly, it will in and of itself reduce the backlog, reduce the appeals that add to the backlog and all of that.
We are also looking at the transitioning of the servicemember from military to the VA.
And finally, disability compensation for noneconomic loss, often referred to though not in any legislation that I have seen, as quality of life, which is now not very much a part of compensation.
Where we are in the VASRD, of course, is that we have seen progress. The VA is taking this very, very seriously. And I have to acknowledge that standards for the diagnosis and evaluation of traumatic brain injury (TBI) have been established. There has been progress in reviewing the entire mental disability category, because the mental health disability seems to be the most problematic, given the difficulty of measuring it, and it matches least well with other disability of other body systems.
Preliminary steps are also underway to review the musculoskeletal and the endocrine systems. Again, we are convinced that reviewing these body systems and updating the VASRD will pay great dividends.
We have proposed a level of permanent staffing for both the VBA—the Veterans Benefit Administration—and the VHA—the Veterans Health Administration—to ensure that all 15 body systems are reviewed and updated as necessary in a timely way, a minimum of three per year so that all 15 would be reviewed in a 5-year period on a recurring basis.
We have also proposed a priority among body systems that takes into account which are at greatest risk of inappropriate evaluations; problem prone, relative number of veterans and veterans' payments associated.
The Secretary's response to all of our recommendations has been timely. The Secretary and his staff concur in general with most of our recommendations at least; however, he does not commit the—the agency has not committed to specific management procedures, staffing, or timeline for review and update. And in our full report in October, we will comment on this and see if we can work more closely and get some of the detail we feel is necessary. Now, the VA is working on these; we just don't have some of those details.
We have also proposed a detailed procedure for review and updating the VASRD, which I have available. We believe that there will be two studies necessary as the rating, schedule for rating disabilities is reviewed. One is to validate the horizontal and vertical equity in the tables of disability, and the second is looking at the vocational rehabilitation program.
We continue to review the quality-of-life issue using special monthly compensation (SMC) as a model. We are looking at transition issues, and I believe we are progressing on a broad front. The Committee has had excellent access to the Secretary, to the staff. We are very pleased with our working relationships with the VA and other organizations.
That concludes my report, and I stand ready to take questions. Thank you very much.
[The prepared statement of Dr. Blanck appears in the Appendix.]
Mr. HALL. Thank you, sir.
And, Ms. Scott, you are now recognized.
Ms. SCOTT. Thank you. Good afternoon Chairman Hall, Ranking Member Lamborn and Members of the Subcommittee.
I am pleased to provide this testimony on behalf of the Veterans Law Section of the Federal Bar Association. Indeed, the backlog is more symptomatic of a process out of control. For too many decades it has operated as if only the subordinate persons were in charge, each with an individual regional command operating day to day as the individual circumstances may dictate. This Secretary, more than any of his immediate predecessors, has the leadership skills to meet the challenge and at the same time gain the trust he must have from at least the two communities of the veterans and the VA itself.
We continue to urge very serious consideration of the pod process of processing claims. Dividing the processors into discreet teams that incorporate all of the individual skills provides an opportunity for mentoring, on-the-job training, and provides also opportunity to develop specific areas.
This is something that we would suggest they look at; that some teams within this process specialize in the things that seem to provide the greatest problems in training and continuing education—herbicide exposure, post-traumatic stress disorder (PTSD) and mental disabilities and neurological issues, TBIs. These are complex, involving many body systems, and people who are attuned and trained specifically in those areas would facilitate those claims.
We also continue to encourage VBA to enhance the position of decision review officer as an immediate supervisory personnel over the claims processing teams within the pod structure, tested and certified, at least to pass the agent's exam; in this position would exercise quality review over the decisions for adequacy of development, as well as accuracy of decision making.
We also recommend that this modality include a full-time training coordinator in each regional office monitoring on-site training needs and requirements, setting curricula consistent with those universal to the agency and ensuring that instruction and questions and answers are available to every employee.
We also renew our encouragement of a treating physician rule. Regardless of whether treatment has been by VHA or private providers, nexus opinion and questions of the level of disability or the extent of impairment should be addressed to those providers. The traditional concept that a VHA physician is incompetent to provide a nexus opinion because the treating physician is inherently biased is inherently absurd.
VLS continues to urge legislative amendment of 38 U.S.C. section 5904(c) to expand the availability of fee-based representation to veterans filing the initial claim with the VA. The regulations governing fee-based practice before the agency are the most restrictive of any Federal agency. Regardless of extensive self-regulation in State and Federal Court rules of ethic and conduct, the VA continues to regard attorneys with an unwarranted mistrust. The demographic has changed. Today's veteran has fought a highly technological war. This is the best-educated army in history. Men and women who have fought and survived significant horrors of today's battlefield deserve the dignity of determining for themselves whether they wish to represent themselves, be represented by an organizational veterans service organization (VSO), or retain professional counsel. This generation of veterans, like Vietnam veterans before them, has founded their own veterans organizations to address the issues inherent and the conflicts they experience. Just as the Vietnam veterans, they support fee-based representation before the agency, beginning at the point at which the claim is filed.
The Veterans Law Section does not support other provisions of the Secretary's proposed legislation, including the imposition in sections 202 and 203 of jurisdictional time limits appeal within the agency. This is a somewhat cynical effort to eradicate the backlog by making it extremely difficult for a generation of veterans to perfect their claims and meet shortened filing deadlines, when over half of them are diagnosed with TBI, post-traumatic stress disorder (PTSD), or other mental disorders, all of which impair their ability to organize and respond to those deadlines.
Neither do we support the proposal in section 206 that the board no longer be required to render decisions in which factual determinations are supported by adequate reasons and bases, but only that they be plausible. In conclusion, the Veterans Law Section thanks the Subcommittee for the opportunity and urges that it is the responsibility of all of us to ensure that the quality of life is met as humanly, as much as humanly possible.
With now over 1 million pending claims, it matters not who represents whom or on whose shoulders the blame properly lies. The job must be done, and rather than ensure that each recommendation for revision or reform is nibbled into oblivion by the ducks of turf protection, it is time to recognize, as the cartoon strip character Pogo once did, we have met the enemy and he is us.
Thank you for the opportunity to present these views on behalf of the Veterans Law Section of the Federal Bar Association. I will be happy to respond to any questions.
[The prepared statement of Ms. Scott appears in the Appendix.]
Mr. HALL. Thank you, Ms. Scott. You have given us the quote of the day so far, "the ducks of turf protection."
Mr. Violante?
STATEMENT OF JOSEPH A. VIOLANTE
Mr. VIOLANTE. Mr. Chairman, Members of the Subcommittee, thank you for holding today's important hearing on the state of the Veterans Benefits Administration. DAV has comprehensive recommendations on all their programs in our annual legislative agenda as well as in The Independent Budget, and we recommend those publications to the Subcommittee.
Mr. Chairman, as you know, thousands of disabled veterans today face unacceptable delays and unjustified denials of their applications for VA benefits. As of June 5th, there were about 550,000 pending claims for compensation and pension awaiting rating decisions. Almost 200,000 of these claims were waiting over 125 days. Worst, by VBA's own measurement, the accuracy of disability compensation rating decisions for the past year was just 83 percent, continuing a downward trend.
However, despite these problems there are some reasons to be optimistic about VBA's prospects for improvement. Recently both VA and VBA leadership have acknowledged longstanding problems and looked for new solutions. VBA has over three-dozen new initiatives underway that may help transform the archaic paper-based claims processing system to a modern information technology (IT) centrist process. We believe VBA is headed down the right path; however, they will not succeed without effective leadership internally and strong oversight externally.
Mr. Chairman, VBA must remain focused on getting claims decided right the first time, not just on reducing the backlog. After all, the backlog is not the problem, nor is it the cause of the problem, it is a symptom. Lowering the backlog does not guarantee that veterans will get all the benefits they have earned in a timely manner.
To be successful, VBA must engage in a true partnership with VSOs. Last year, DAV alone helped a quarter of a million veterans and their families free of charge in their claims for VA benefits.
DAV and other VSOs are not just interested observers in this process, we are active and essential components of the system itself. VBA must solicit and incorporate our input at the beginning of their transformation efforts, not just update us during implementation.
VBA has launched dozens of new pilot programs at regional offices, almost entirely without input from VSOs, either nationally or locally. We believe this is a mistake for a number of reasons. Not only do VSOs bring vast experience and expertise about claims processing, but we hold power of attorney for hundreds of thousands of veterans and their families. When we help veterans prepare and submit claims, VBA spends less time and resources developing and adjudicating them. We urge VBA to integrate us into their planning for new initiatives from the beginning.
Mr. Chairman, as VBA pilot programs have been rolled out, we have found some areas of concern in their implementation. For example, VBA recently rolled out the Fully Developed Claim, FDC, Program. And while we support this program, it requires changes to fully protect veterans rights. Unlike the normal claim process, under the FDC Program a veteran cannot file an informal claim. As a result, veterans have to choose between a quicker decision under FDC or an earlier effective date under the regular process. We have discussed this issue with VBA, and Congressman Joe Donnelley is prepared to introduce the legislation. We urge this Subcommittee to work with him to fix the problem.
Most important to VBA's reform and modernization is the ongoing development of a new IT system, particularly the Veterans Benefits Management System, or VBMS. The final VBMS must have comprehensive and realtime quality control and must utilize intelligence of modern IT systems, which must include rule-based decision support. We are concerned that in a rush to meet self-imposed deadlines for rolling out VBMS, programmers may be under pressure to cut corners. We urge this Subcommittee to continue its aggressive oversight of VBA's IT projects.
Mr. Chairman, in assessing the state of VBA, we do want to recognize the important steps that have been taken by VA, however, we firmly believe that VBA cannot be completely successful unless they truly seek a mutually beneficial partnership with the VSOs.
Mr. Chairman, I want to commend you and this Subcommittee for all that you have done to help reform VBA in the claims processing system. I would be pleased to answer any questions. Thank you.
[The prepared statement of Mr. Violante appears in the Appendix.]
Mrs. HALVORSON. [Presiding.] Mr. de Planque, you are next. You are recognized for 5 minutes.
STATEMENT OF IAN C. DE PLANQUE
Mr. DE PLANQUE. Thank you. Good afternoon, Members of the Subcommittee. On behalf of the American Legion I would like to thank you for the opportunity to provide testimony today.
The VA is obviously in a very difficult position, but they have come forward and spoken of their problems. And the first step towards the solution is to admit that you have a problem. The recent aggressive stance taken by Secretary Shinseki of breaking the back of the backlog in this year and reducing the claims to a 98 percent claims rate and no claim over 125 days is admirable and aggressive and will be incredibly difficult to implement. It is an encouraging sign, but we cannot fully credit that sign as a movement forward without seeing the results as they come forward.
One of the key components that has been a problem for VA is assessing the quality figure. The 98 percent is an admirable target; however, as was recently noted, 83 percent was the rate that VA is assessing themselves for last year, which is down 4 percent from the previous year, 87 percent. The Office of the Inspector General (OIG) even stated that that was 10 percent higher than their internal figures. And when the American Legion had done claims visits and quality review visits to regional offices, we found that the number is actually closer to 60 to 70 percent accuracy rate.
Why is this important? Because when you are processing 1 million claims, 1 percent of error is 10,000 veterans. It is completely unacceptable. And VA must take steps to ensure that the quality is the driving force towards driving down their backlog. Approximately 50 percent of the cases that go before the Board of Veterans' Appeals (BVA)are remanded back, sent back into the system because they weren't done right the first time. This is a recursive loop that only keeps these claims in the system and will not reduce the backlog. Getting the claim done right the first time removes it from the backlog.
VA has instituted a number of pilots which are very promising and are very helpful; however, without proper involvement from the ground floor with the service organizations, we have questions about the success of those pilots. Some of them, they have been very generous with the access, and we have been out to see their pilots in Little Rock and Providence and Pittsburgh recently, and have seen some very good signs.
In Baltimore, where they were piloting a very important virtual regional office, despite mentioning in the Roundtable of this committee the importance of that program, they still were not able to get the VSOs or Congress involved in seeing these programs. We need to be involved while they are happening.
With the recent programs in Pittsburgh, they are experimenting with things that have long been mentioned by the service committees creating templates for private physicians to alleviate some of the load on VA physicians and help get those exams done faster, providing public contact with the veterans to call and follow up to the notoriously confusing Veterans Claims Assistance Act (VCAA) letters.
These are great steps forward and the initial indications are that the interaction with the veterans are leading to a better understanding of the claims process. The veteran service organizations have stepped forward and asked to be involved and asked to help with the contact with the veterans and facilitate this communication. And VA is slow to include us in the process.
We are very heartened by the steps they are taking and that they are reaching out. We are having more meetings with VA to discuss the situation, to discuss the problems from an earlier stage in the development. But without full inclusion, the end users of the system, both VA and the VSOs and the veterans who use the system, won't have the full share of development in that system, and it will lead to a faulty system.
It is difficult to give the VA a grade on the state of the VA at this point, other than incomplete at this time, because there are so many pilots that are in a state of flux that are going forward.
The VBMS system shows tremendous promise. It is the first time that we are beginning to see where these pilots are leading into, and that it will be a truly integrated IT system that will actually capitalize on those electronic developments and use it to move the claims process forward to be more accurate, to be more timely, and to be more helpful. However, until we have seen these things implemented, it is difficult to see what the end result would be.
We are optimistic, and we commend the Secretary and the Administration for the hard work that they are doing and for the open hands that they are putting out to the service organizations, but we are also mindful and cognizant of the fact that we have heard promises from VA in the past and they have not always followed through. And the promise to the American veterans is what is important.
We thank you for the opportunity to comment, and we will be happy to answer any questions.
[The prepared statement of Mr. de Planque appears in the Appendix.]
Mrs. HALVORSON. Thank you, Mr. de Planque.
Before we ask questions I have a few of my own. So you are encouraged by the fact that you have heard that the VA wants to listen, they are including some new practices, and that they are going to reach out to work with you. Because you say that you want to get this done right the first time, which I think we all agree with, what do you do when the doctor doesn't provide what they need to, because we agree, we want this done right the first time, but we are worried that the doctor doesn't reply in a timely manner and they only have so many days to do it. We are trying to figure out how to get the doctor to reply more promptly. What would you suggest?
Mr. DE PLANQUE. Are you speaking of putting some kind of restriction or pressures on the private doctors? Because the plus side of the templates that they are working on developing for private physicians is that they are very explicit about the information that is needed. VA examinations, compensation pension examinations, are different than what a normal practicing physician might do to treat a veteran, and therefore, they sometimes require different information.
And so from a template standpoint, it is specifically asking for the information, so you are not going to have an inadequate exam returned that they don't have the information they need. As far as the timeliness factor of how you can pressure private physicians to respond to them on time, if it is a private physician, that would be an issue between the veteran and their physician.
Mrs. HALVORSON. Thank you. Mr. Lamborn, do you have any questions?
Mr. LAMBORN. Thank you, Madam Chairman.
Just briefly. Dr. Blanck, can you tell us a little bit more about the Advisory Committee's work on the quality of life, and when can we expect the full extent of the findings to be made public?
Mr. BLANCK. We will have a report on that issue in our October full report. We are still in the throes of a lot of discussion. We are using the special compensation program as kind of a model, which takes the most severely injured servicemember, and even if because of whatever disability they have or whatever wound or injury they have, it only reaches a certain level of disability, they get additional compensation because of what that injury is. Bilateral amputations, for example, is one of the things. We think there is a place for this, but we think it will be relatively limited to those very severely injured. But anyway, that will be covered in our October report.
Mr. LAMBORN. Thank you. I yield back.
Mrs. HALVORSON. Thank you. Mr. Bilbray?
Mr. BILBRAY. Thank you, Madam Chair. I apologize for missing the first part of your testimony. I just had a death in the family, I am the executor of the will, and you know how that is. I think the oldest in the family should always do it.
One of the things that I see inherent to our challenges here is the response time. And in the private sector one of the things that they have been able to do in 20 years is to really use technology. And I know we keep bringing this up as if it is the silver bullet, but if I can remind you of the success that we see almost in every community—some people may not like it—of Sam Walton figuring out how to use data processing, bar coding, using smart technology to not only get a job done, but do it very cost effectively and build an empire—he built an empire basically off of knowing what inventory he had or didn't have, and knew where it was and how to manage it.
I see that in a lot of ways as being essential if we are actually going to keep our promise to our veterans. Where are they, who are they, what do they need? And if you see the parallel, if Sam Walton could tell us where, you know, a commodity—and I won't even say the commodity because somebody will say I am comparing this to a veteran—but could tell you where the toothbrush was anywhere in his empire, doggone it, we should be able to tell the veteran where they are in the process and we should know where they are in the process.
And so I think that in all fairness, we haven't been aggressive enough at looking at what do we need as tools to do the job that we are promising the veterans we will do down the line. And I think there is a lot of this base technology that is not being done. And I have seen it again and again. And I will just say we have been working a decade, trying to work out medical records, electronic medical records, and it seems like people look at this in isolation. But the fact is that technology, just as much as Sam Walton could know that you bought a toothbrush in Cleveland, he knows that he has to get a new replacement toothbrush shipped at the moment the purchase was made. As soon as somebody swiped that bar code, that information was out there and everybody knew it.
The challenge that we have, Mr. Chairman, can we be as responsive to our veterans as Sam Walton was to his clientele? And that is—I would just ask you right there, that technology—let me just add into it. The bar code I see for our veterans is not just a number or a name; it may be biometrics, it may be that technology of going that far. But let me just open that up, just throw that one in the middle of the court, and in the spirit of the World Cup you can kick that ball around.
Mr. BLANCK. Well, I will take a shot at it first, if I may. I have been heavily involved in health IT. I was the Army Surgeon General, retired in 2000, and of course worked on those issues then, did it at a university, and now in this committee. And kudos to the VA for the work they have done, particularly in VHA, on their electronic medical record. I think it stands as a model in the integration that is going on with that of the military, gets at what you are trying to say. But the whole organization needs to have that automation put in place.
My little piece is on the Advisory Board for Disability Compensation, so we are looking at the rating schedule for disabilities. And I spoke of the need to revise, update, and all of that. And the whole point of all of that is not to keep up with everything, it is also to standardize. How do you standardize so that the private mission, the VA physician, the military physician, all use the same automated form for the disability evaluation? And that has been a specific recommendation of ours that I know the VA is taking seriously, the VBA specifically, and it needs to be linked in then with that military and VHA health record; all of this centered around not records, but around the veteran. And the bar coding, and whatever measures you use there, is part of what will allow all of that to happen in a very standardized and efficient way as information is transported, as opposed to the old medical records you carry around in a wagon because they are so voluminous.
Mr. BILBRAY. To give you an example, let's say we talked about this. You can imagine the fact that although when someone files a claim or thinks they qualify, we should be able to have the capability, just as much as Sam Walton, to be able to go back and say on this date he received this and this, bam, bam, bam, we know exactly who it is. We are not asking the veteran to go back and find his file, have somebody dig it up. It should be able to be retrieved and should be able to be reviewed very quickly.
I have seen the extraordinary difference that the Internal Revenue Service (IRS) has done by going to electronic filing, the effectiveness, the efficiency, the cost effectiveness, and how much more user-friendly it was than shoveling papers around. I yield back, Mr. Chairman.
Mr. HALL. [Presiding.] Thank you, Mr. Bilbray. Mrs. Halvorson?
Mrs. HALVORSON. No.
Mr. HALL. Dr. Blanck, you mentioned in your remarks that the Secretary agreed with the Commission's recommendations, and in some areas differed. Can you remember, account for us, some of the various differences?
Mr. BLANCK. Well, some of the areas in which, it wasn't so much that he differed but had to have legal review, had to look at the practicality of the recommendations. I do have a copy of his response with me, which I would be pleased to share with you.
[The information was supplied to Mr. Hall and will be retained in the Committee files.]
Mr. HALL. Thank you. The Advisory Committee researched that a new rating schedule should address the inconsistencies in mental versus physical disabilities, and also differences in age in onset of the disabilities. How would this change assist the VA in assessing and processing TBI, military sexual trauma (MST), PTSD and other complex injury claims?
Mr. BLANCK. Well, the problem with the VA we all have is in both being able to adequately and accurately assess and measure the TBI or psychological disorder to begin with, and then to assess its effect, because it changes day to day on earnings over a lifetime in which the disability might be based. The VA is coming up with some very innovative ways of trying to do that, using biomarkers, for example, magnetic resonance imaging, or computed tomography scans of the brain, volume studies of the brain, that kind of thing, to try to measure that.
A lot of these things still have to be validated, but that is part of the process of putting this into place. I was able to attend a conference sponsored by the VBA on mental health, that whole area, but specifically looking at psychological injuries—PTSD, for example, post-traumatic stress disorder, and traumatic brain injury—where a lot of these injuries were discussed. I think progress was made, and the VA, I believe, has been very, very aggressive in trying to measure as best they can and come up with ways to accurately and reproducibly assess a veteran and come up with the disabilities.
Mr. HALL. Thank you, Doctor.
Ms. Scott, some stakeholders have suggested that veterans benefits administration claims processors have been over-relying on the appeals process as ways of catching and cleaning up their errors. What are your thoughts on this? Do you think that happens? Is that an accurate assessment?
Ms. SCOTT. I think that when it happens, at least according to most of the audits and the studies that have come out in the last couple of years, that to a great extent part of it is the way they measure the work product, work credits. And another is that they would rather pass along a difficult issue and let somebody else up the line worry about it.
And I also think that a great deal has to do with training. There doesn't seem to be, from the reports on training, that there is any kind of standardization. The academy should be the focal point of the training for the entire agency. It should be the one thing with a director of training agencywide so that you have centralized—again, we emphasize vertical accountability for the training from the bottom up. That is why we recommended that you put—that they put training directors or coordinators in every regional office. That would provide a mechanism for ensuring that we don't have repeats of one office having one level of training and within that office the one-size-fits-all, so that some people are bored silly and the other ones simply aren't getting what they need.
Mr. HALL. I realize the treatment with the idea of a full-time trainer in each RO and regularly scheduled instruction and question-and-answer opportunities for all the employees at that RO—I mean, especially as new rules come down, as they did today, or new paper applications come out, as they did today.
Ms. SCOTT. Well, part of that is the medical issues with which we are now involved are so complex and they affect the quality of life to such an extent that evaluating these issues needs to have the kind of training that is basically what a paramedic gets. They need to know what those body systems are, how they work, and why they work the way they do. Because we are not just dealing with muscles and bones, we are dealing with complex issues; and having those training coordinators there that are themselves properly trained so that the error is not instructed and becomes cocooned in the agency is vitally important, which is why we said that.
Mr. BILBRAY. It sounds like another project for our medics.
Mr. HALL. That is good. We don't have enough of them to worry about.
Mr. Violante, if I may ask you, the American Legion and some other stakeholders suggest transferring the job of quality control assurance from within the VBA to an independent third party. It has been suggested such a move would ensure partiality and follow-up to ensure compliance. What is VBA's position on this proposal?
Mr. VIOLANTE. Well, we certainly believe in quality control, and we don't believe there is any. Whether it is internal or external, we don't have a position but it needs to be there at each step of the process.
In answer to your other question to Ms. Scott, I mean there is no incentive to do these cases right the first time. There is no accountability. And the incentive is to continue to put these cases out, whether they are right or wrong. And so the importance of quality review is essential to getting this done right the first time. And again, whether it is internal or external, we would just like to see some type of quality review at every step of the phase.
Mr. HALL. Thank you.
And Mr. de Planque, your testimony mentioned the Secretary's goal of transforming the VBA by 2015 to the point where the claims backlog can essentially be eliminated, and claims can be processed within 125 days at a 98 percent accuracy rate.
Do you think these are realistic goals, and what resources would be needed to help the Secretary achieve those goals if they can be had?
Mr. DE PLANQUE. In terms of whether or not they are realistic goals, that is a very, very difficult question. Is it achievable? America put a man on the Moon in a decade. If we are going to devote the resources and set something out as a mission, there is nothing that we can't accomplish.
Now, whether or not those goals are possible, that is going to take—it is going to take a paradigm shift within VA. It is going to take a complete culture shift.
To mention the idea of passing along the errors, we talked to people in the regional offices, and we do education for our service officers on recent court decisions and how those affect VA adjudication of cases. And our service officers very often will take these court cases to the VA and say, But in this court case they found that this applies, and so you can apply it there. And they are told by VA employees in regional offices, "We don't deal with court cases, that is what the Board deals with."
Well, no, that is not what it deals with, it gets dealt with at the ground level. Now, VA's central offices put out the message that that is something that they want to change, but until that changes on the ground level they are not going to be able to achieve that level. And what they need to do is they need to transform the mind-set. And that is a top-down leadership and that is leadership all the way through. And whether or not they are saying that is the case, it needs to get through to the employees.
This was mentioned by people in the employee's union, regardless of what they are saying, what is the perception among the employees? What do they believe is where the pressure for their job is coming from? As long as the employees believe that moving the cases is the most important thing to them, then they are not going to work towards the accuracy. When the employees believe that the accuracy is equally important, then they will be working on that and they can achieve a goal where they are at 98 percent accuracy and where they are getting the cases done on time. But that takes a culture shift and that takes deep-rooted traditions to be shifted.
Mr. BILBRAY. Mr. Chairman.
Mr. HALL. Mr. Bilbray?
Mr. BILBRAY. There was a statement just made, and I think we really need to jump on this, is the perception by any Federal employee; but the perception that the court's rulings don't determine how we operate, is that the way? We are basically saying we are not—that isn't going to determine our procedure. If the courts rule this way, we don't—
Mr. DE PLANQUE. Well, and that is, to be clear, that is the kind of reaction that you can get from an employee. It is not what VA is directing from their central office. They are not telling people the courts don't matter, but that is the reality of a day-to-day interaction in many cases.
Mr. BILBRAY. I think our attitude ought to be if the President and the Congress have to live by these court rulings, doggone it, all of us in government, even the Executive Branch, have to recognize this is part of the separation of powers. And it just concerns me if that is an attitude of our Federal employees, of any Federal employee, that what the courts rule doesn't—you know, I am not going to recognize or I am not going to let it affect my operations. I think maybe there is a measure of concern here we have that people think they are above the law, because that is what the courts are; they are defining what the law is, and I think it is a serious concern.
Mr. HALL. Thank you, Mr. Bilbray. You are absolutely correct. And Mr. de Planque, thank you for bringing it up and voicing that observation, because we will make a note to ask the undersecretary about it when we get to our third panel.
We just had a series of three votes called and, I am sorry, we always seem to get interrupted like this. But I want to thank the members of this panel for their testimony, and if we have any further questions we will send them to you in writing.
And I will now excuse you for the rest of the day, ask for patience on the part of Panels 2 and 3. We will be back as quickly as we can from this series of votes, and the Subcommittee stands in recess.
[Recess.]
Mr. HALL. The Subcommittee will return to order.
I would now ask our second panel of speakers to join us at the witness table, including Richard Paul Cohen, Executive Director of the National Organization for Veterans' Advocates (NOVA); Molly M. Ames, Rating Veterans Service Representative (RVSR), San Diego, California, Office 377, on behalf of the American Federation of Government Employees (AFGE); and Paul Sullivan, Executive Director for Veterans for Common Sense (VCS).
Welcome.
Mr. Sullivan will be with us shortly.
Mr. Cohen, you are recognized. And, of course, your full statement has been entered into the record, so feel free to give a 5-minute summary.
STATEMENTS OF RICHARD PAUL COHEN, EXECUTIVE DIRECTOR, NATIONAL ORGANIZATION OF VETERANS' ADVOCATES, INC.; MOLLY M. AMES, RATING VETERANS SERVICE REPRESENTATIVE, VETERANS BENEFITS ADMINISTRATION REGIONAL OFFICE, SAN DIEGO, CA, ON BEHALF OF AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES, AFL-CIO, AND AFGE VETERANS AFFAIRS COUNCIL; AND PAUL SULLIVAN, EXECUTIVE DIRECTOR, VETERANS FOR COMMON SENSE
STATEMENT OF RICHARD PAUL COHEN
Mr. COHEN. Thank you, Chairman Hall, and thank you to the Subcommittee for the opportunity for the National Organization of Veterans' Advocates to participate in this hearing.
We have testified previously, on many occasions, about all the problems that the Veterans Benefits Administration has in adjudicating claims, all of which have been previously stated by this Committee and by the participants here.
The biggest problem, however, has always been the culture of the VA and the perception among veterans and among those who work in the VA that the primary responsibility of the VA is to rout out fraudulent claims, move claims along, and generally to not be veteran-friendly, even though the Secretary of the VA, Secretary Shinseki, has for almost 6 months been going around the country talking about not only pilot projects but his vision for changing the culture of the VA.
And we were very optimistic after hearing about the pilot projects and about the attempt to change the culture. But, very recently, we became aware of a memo and proposed legislation sent out by the Secretary on May 26, 2010. I hold it in my hand here.
When you read through this proposal, and if you are someone who works in the veterans adjudication system, it is very apparent that the VA has now concluded that it cannot effectively decide the vast number of appeals that are out there. So the VA has decided to take itself out of the appellate system.
And the way VA proposes to do this at the front end, it is to cut in half—or it wishes to have legislation to cut in half the time for a veteran to appeal—cut it from a year to 6 months, even though the VA knows we are dealing with veterans now who have traumatic brain injury and PTSD who can't comply with time limits. They want to cut that time limit.
They want to, for the first time, make the time to appeal to the Board of Veterans' Appeals jurisdictional. It has never been jurisdictional. It has always been subject to equitable tolling where a veteran misses the time limit. The VA says, this is not a problem because claims are simple. They say this in the request for legislation. Yet, when the VA complains about its inability to get it right the first time, the VA says claims are so complex.
At the same time that the VA says that appeals are so simple that it will not hurt veterans to cut the appeal time and make the time to file jurisdictional, what they are attempting to do in this legislation is to make the appeal process more restrictive. They want to require a specific type of appeal to the VBA, a certain type of form, and, when it is not complied with, they want the appeal to be dismissed.
At the back end of the appeals, the VA has realized that it is having trouble making good decisions. We know this because, of the decisions that the court makes, 70 percent of the merits decisions conclude that the BVA's decision was not substantially justified, which results in a court award of Equal Access to Justice Act (EAJA) fees at 70 percent of the merits decisions conclude that the BVA's decision was not substantially justified, which results in a court award of EAJA fees.
The VA says, "That has cost us $13 million. We need to do something about that." What the VA proposes is to change the rules for EAJA fees only with re
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