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Witness Testimony of Mr. James O. Richman, Director – Claims Representation and Counseling, Texas Veterans Commission

Good Morning, Chairman Runyan, Ranking Member McNerney, and Members of the Subcommittee.  My name is Jim Richman and I have the privilege of serving as the Director of Claims Representation and Counseling at the Texas Veterans Commission.  As the Chairman mentioned, I have been with the agency for over 25 years.  I am a veteran myself and come from a family where military service was expected, as is the case with countless families across this nation and across the great State of Texas.  My father and uncles were members of the greatest generation and participated in some of the toughest combat in WWII.  By the grace of God, they all came home and they taught me to be a part of something bigger than myself.  I instill that virtue in my Claims Counselors, all of whom are veterans, many of them disabled veterans.  Serving the veterans of Texas, their families and survivors is not only our mission, it is our duty, as veterans serving fellow veterans.

This morning, I will provide you with the details of Texas’ State Strike Force and Fully Developed Claims Team Initiative, provide an update, one month in to the initiative, and highlight some keys to successful implementation.

In his remarks, Chairman Cantu outlined the gravity of the situation for us in Texas, that in the years from 2010 to 2012, the total pending caseload of claims has doubled and the number claims pending longer than 125 days, backlogged, has quadrupled.  I will only emphasize that the end of combat operations in Iraq, a decreased military presence in Afghanistan, and force shaping measures announced by the Department of Defense in January 2012 are expected to greatly increase the demand and need for these services.  This influx, coupled with the increasing demand of an aging population of WWII, Korea, Vietnam, and Gulf War I Era veterans threatens to compound the workload of a system already operating beyond capacity. 

As I am confident that this Subcommittee has received prior testimony from the U.S. Department of Veterans Affairs (VA) and others regarding the overwhelming backlog of claims and the unacceptable current timelines of 18-24 months associated with claims processing, I will not belabor the point any further.  What I will add is that this situation exists, despite the fact that, in Texas, the VA is full of dedicated, hard-working people who are trying to do the right thing for the veterans they serve.  The problem is the complexity of the process. 

The information that follows is how we propose to assist the VA in Texas with regard to reducing the backlog and improving processing timeliness of current claims.

DETAILS OF THE INITIATIVE

The concept for the State Strike Force and Fully Developed Claims Teams was developed as the result of best practices and lessons learned from two previous cooperative projects with the VA in Texas.  The first, in 2008, was the Development Assistance Pilot Project (DAPP) wherein the VA Central Office requested a TVC team to conduct claims development parallel to a team from the VA. In the final analysis of this project, development of the claims processed by the TVC Claims Counselors was accomplished in 10.73 days compared to the VA’s 131 days.  At the time, VA Undersecretary for Benefits Patrick Dunn commended the results and the VA Office of Field Operations provided all of its regional offices with a copy of the final report, and encouraged them to implement the best practices identified by the project. 

The second, the Claims Processing Assistance Teams (CPAT), Chairman Cantu covered in his remarks.  CPAT was a state project, funded by the Governor’s Office from November 2009 to July 2011.  Twelve (12) TVC Claims Counselors targeted specific areas within the claims process, doing all development needed on the individual claims and working directly with the claimants in identifying and acquiring necessary evidence.  By the end of the project, TVC had handed back to the VA 17,325 cases ready for decision or award action.

As soon as the direction came this past July from the Governor Rick Perry, Lieutenant Governor David Dewhurst, and House Speaker Joe Straus to reinstate a form of this initiative, we began building two separate teams.

STATE STRIKE FORCE TEAMS

First, there are two (2) State Strike Force Teams, each consisting of eight (8) members located at each of the two VA Regional Offices in Texas (Houston and Waco).  The purpose is to assist the VA by accomplishing all necessary development on cases that have been pending for over 125 days (backlogged) and return to the VA ready for decision.  These teams will review cases and not only determine what development needs to be done, but to actually accomplish that development utilizing best practices identified in previous projects, which include: 

•          Utilizing every resource available (telephone, email, fax, family members, and mail as a last resort) to contact the veteran, clarify or get additional information on his or her claim.

•          Contacting private physicians, hospitals or any other party or entity that has information to give the Veteran the highest possibility of a favorable decision on the claim.

•          Expediting claims and appeals through submission of waivers, as appropriate.

•          Contacting claimants with Decision Review Officer (DRO) hearing requests.

•          Contacting claimants with Board of Veteran Appeals (BVA) partial grants for resolution of appeal.

•          Identifying inadequate exams. 

•          In our review, if we find “directed development” or things that have been overlooked or not finalized, we will make recommendations regarding what is needed.

FULLY DEVELOPED CLAIMS TEAMS

The Fully Developed Claims Teams were the critical missing piece of our previous projects to assist the VA with reducing the backlog of claims.  While the State Strike Force Teams are attacking cases already caught in the backlog, the Fully Developed Claims Teams will work on the front end of the process to ensure that qualifying new cases being filed by TVC Claims Counselors (an average of 500 claims and appeals per day) are filed in a fully-developed status.  They will work with the TVC field counselors and Veterans County Service Officers (VCSO’s) to assist them in making every claim possible a fully developed claim, and work with the VA Regional Offices to expedite their ratings.

There are two (2) Fully Developed Claims Teams of five (5) members in each of the two VA Regional Offices in Texas (Houston and Waco).  The five Fully Developed Claims Team members inside the VA Regional Offices will be working with our TVC field staff to:

•          Provide additional training, resources, and assistance in properly preparing fully developed claims prior to submission. 

•          Utilize “Informal Claims” whenever necessary to insure the Veterans date of claim is protected.

•          Review incoming claims to identify those which could be made fully developed claims. 

•          Review existing claims and determining if they could be “re-filed” as fully developed claims.

There are an additional eight (8) Fully Developed Claims Team members in the field will be utilized to augment the staff of field office locations that have the highest daily volumes of veteran clientele, thereby allowing the counselors in those offices to have more time to develop the claims they file, ensuring they meet the threshold of fully developed. 

UPDATE

Within days of state leaders’ authorization of the teams, we posted the positions and began hiring.  As of September 1, we filled all 34 positions created as a result of the initiative.  Those hires include personnel with significant VA claims experience, including former and retired TVC and VA professionals with a total combined experience with the VA claims process of over 700 years. 

During this initial period, lead TVC and VA personnel have been working together to create the Standard Operating Procedures (SOP).  I would like to point out that VA Area Director, Beth McCoy, Houston Regional Office Director, Pritz Navaratnasingam, Waco Regional Office Director, John Limpose, and their staffs have completely bought in to what we can accomplish with this endeavor.  Both VA Regional Offices have provided TVC with the additional space, computers, training materials and support we need to make this a truly successful endeavor.  We have already devised workflow and workload tracking because we must be able to track all of our production from both teams.  The VA has provided us with specific people and/or locations to receive the files, use of the “Covers” computer program to track our work, and to locations to deliver our work.  Of course, everything we do is subject to adjustments and improvements as we progress into the project.

As of Monday, September 17, members of the State Strike Force Teams have reviewed 2,525 case files of backlogged claims, identifying and executing all required additional development.  They have already delivered 852 claims to the VA, fully developed and ready to rate.

KEYS TO SUCCESS

Based on experience gleaned from previous projects and with Texas’ State Strike Force and Fully Developed Claims Teams initiative, there are several essential elements required for the successful implementation of these, or like, initiatives.

  1. Complete support from the VA Regional Offices involved.

No state level initiative can succeed without the complete support of the VA Regional Offices involved, in particular the Regional Office Directors.  The need for additional workspace, computers, training materials, and access to VA systems and applications, necessitates the need for a solid working relationship between the state agency and VA personnel.  VA Regional Office Directors need to direct their entire staff to recognize the experience of the team members and be accepting of their suggestions when devising workflow and workload tracking.  As with any cooperative effort, transparency and feedback from both parties regarding the effectiveness of efforts is critical to refining processes and procedures. 

2.      The individuals hired to staff such an initiative must be experienced with the VA claims process.

Based on our previous experience with the projects referenced, an experienced workforce is critical to the success of a project like this.   

  1. Any initiative should utilize identified best practices for claims development.

As previously discussed, our prior cooperative projects (DAPP and CPAT) have identified best practices for claims development.  The effective implementation of these practices has demonstrated that they can drastically reduce the time required to get claims through the development process to a rating decision.

  1. Dedicated funding to support the initiative for a set period of time in order to realize meaningful reduction in the backlog of claims.

The value of federal funding such initiatives is obvious.  The specific situation faced by the particular state veteran agency or VA Regional Office will dictate the funding requirement and length of time such funding would be required in order to affect reduction in the claims backlog.  In Texas, state leaders have currently authorized $1.5 million in state funds for the State Strike Force and Fully Developed Claims Teams initiative for one fiscal year.  TVC’s goal for this initiative, for this single year, is to reduce the backlog of claims in Texas by 17,000 claims. 

CLOSING

In closing, I would like to thank the Subcommittee for the opportunity to share this information with you today.  State leaders have provided TVC with the opportunity to make a tangible difference in the lives of veterans of the state of Texas.  TVC has demonstrated the capability to have a positive impact on this issue twice before.  With the support of this Subcommittee and federal funding, we believe that Texas and other states have the capability to successfully replicate and implement similar initiatives.  Like those famous Texans who drew a line in the sand at the Alamo, Governor Rick Perry, Lieutenant Governor David Dewhurst, and House Speaker Joe Straus have drawn a line in the sand regarding the backlog of claims in Texas to say “No More”.  The Texas Veterans Commission is making a difference now, because the veterans we serve already did.