Submission For The Record of Mr. Carl Blake, National Legislative Director Paralyzed Veterans of America
Chairman Runyan, Ranking Member Titus, and members of the Subcommittee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to offer our views on the Department of Veterans Affairs (VA) use of the 100 percent temporary total disability rating. First, we must emphasize that this type of rating is rarely used for the veterans that PVA serves through our national service staff. When we file claims on behalf of our members—veterans with spinal cord injury or disorder—and other catastrophically disabled veterans, their final decision generally is a permanent and total rating.
That being said, temporary total disability ratings serve an important and practical purpose for many veterans. The determination for temporary total disability ratings are governed by the provisions of 38 C.F.R. § 4.29, Ratings for service-connected disabilities requiring hospital treatment or observation, and 38 C.F.R. § 4.30, Convalescent ratings. Temporary increases to VA disability ratings in accordance with the provisions of Paragraphs 29 and 30 are simple adjustments to running compensation awards that can be accomplished by employees with a minimum of training. Temporary increases to compensation Paragraph 29 are determined by the verified dates of hospitalization. Meanwhile, adjustments under the provisions of Paragraph 30 are established by rating action based on available medical information. In each case, the dates of entitlement are clearly indicated, and with only a small amount of attention to detail, there should be no significant errors.
In January 2011, the VA Office of the Inspector General (OIG) published a report entitled “Veterans Benefits Administration, Audit of 100 Percent Disability Evaluations” (Report #:
09-03359-71, January 24, 2011). In that report, the OIG examined approximately 181,000 veterans claims rated with a total disability. Of that number, approximately 11,800 (reported as 43 percent of 27,500 claims that were determined to have errors) of those claims were for temporary total disability that the OIG determined contained errors. OIG concluded that this had led to overpayments of nearly $943 million with a potential overpayment of approximately $1.1 billion in the next five years. Unfortunately, the OIG report fails to address the cost of the loss of benefits when veterans with total disabilities were underpaid.
PVA has also reviewed the findings of the recent report “Inspection of the VA Regional Office (VARO), Anchorage, Alaska (Report #: 12-02089-60, January 3, 2013) from the VA Office of the Inspector General (OIG). In the report, the OIG concluded that the Anchorage VARO lacked effective controls and accuracy in processing some disability claims. Specifically, 50 percent of the 30 temporary total disability evaluations reviewed were inaccurate. The OIG attributed these errors to staff that did not establish controls to monitor proposed reductions, or schedule future medical reexaminations as required to determine whether to continue these evaluations.
The remaining errors identified in the Anchorage report for processing temporary total disability evaluations involved Veterans Service Center staff not:
· Scheduling routine future medical reexaminations as required,
· Requesting the necessary medical examination, and
· Timely scheduling hearings for veterans to present evidence in response to proposals to reduce their benefits.
PVA is especially troubled by the fact that these findings are not substantially different from those included in the OIG report from January 2011.
Unfortunately, the overriding concern emphasized by the OIG in both reports is the increased risk of paying unnecessary compensation benefits. In the most egregious case outlined in the Anchorage report, the VARO staff did not schedule a medical reexamination to evaluate a veteran’s breast cancer. However, VA medical records showed the veteran had completed treatment, which should have resulted in a reduction in benefits. Because a follow-up medical reexamination was not scheduled, VA continued processing monthly benefits for temporary total disability and ultimately overpaid the veteran $96,135 over a period of 5 years and 11 months. The report from January 2011 outlined occurrences that were far worse than that scenario.
PVA is concerned that this issue is being framed as wasteful spending on the part of VA. While we do not dispute the findings of the OIG report regarding overpayment of compensation under the rules for temporary total disability ratings, we believe the Committee should similarly examine the VA’s failure to provide these benefits in a timely manner or decisions to not grant the maximum entitlement. Too often, an individual can wait for months while convalescing to receive the increase to his or her compensation for temporary total disability. This delay in payment of benefits can put a serious financial strain on a veteran who might be unable to work during that convalescence period. In fact, the OIG identified a case where the VARO staff did not grant a veteran entitlement to an additional special monthly benefit based on evaluations of multiple disabilities, as required. As a result, VA underpaid the veteran a total of $19,220 over a period of 5 years and 1 month.
Documentation of major discrepancies in determinations for temporary total disability indicates that much larger problems apparently exist in training and evaluation. The discovery of such fundamental and egregious errors that have been ongoing for a ten year period can only be construed as an indictment of a failed training program and failed management practices. If VA employees cannot successfully perform the most basic claims processing functions, what should we expect when they engage the more complex aspects?
First line supervisors must be capable of evaluating the skills and needs of their subordinates, but responsibility cannot stop there. Mid-level and higher management also must bear part of the responsibility. From our perspective, we see front line VA employees that are beaten down by their supervisors under the guise of quality control. STAR reviews, and similar measures, are constantly in pursuit of errors in an effort to improve overall quality. Unfortunately, the result all too often is an intensified focus on the process, and not the outcome.
Mr. Chairman, we would like to thank you once again for allowing us to address this issue. We hope that by highlighting this issue, VA will make meaningful reforms to ensure that errors are corrected, that appropriate steps are taken when processing temporary total disability claims, and that veterans receive the correct benefits in a timely manner.
PVA would be pleased to take any questions for the record.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the following information is provided regarding federal grants and contracts.
Fiscal Year 2013
No federal grants or contracts received.
Fiscal Year 2012
No federal grants or contracts received.
Fiscal Year 2011
Court of Appeals for Veterans Claims, administered by the Legal Services Corporation — National Veterans Legal Services Program— $262,787.