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Witness Testimony of The Honorable Allison A. Hickey, Under Secretary for Benefits, Veterans Benefits Administration U.S. Department of Veterans Affairs

Chairman Miller, Ranking Member Michaud, and Committee Members, thank you for providing me the opportunity to discuss the Department of Veterans Affairs’ (VA) special initiative to address the oldest compensation claims in our inventory.  The first step of this initiative was launched on April 19, 2013.  I directed all regional offices (RO) to process within 60 days all rating claims pending for over 2 years.  Once those claims are completed, we will focus on rating those claims that have been pending for more than 1 year.  This initiative will accelerate the receipt of benefits for those Veterans who have waited for a decision for the longest period of time as part of VA’s overall strategy to eliminate the claims backlog in 2015.  For the purposes of this testimony, I will address the 2-year old claim plan that is currently underway in all ROs.  I am accompanied today by Diana Rubens, Deputy Under Secretary for Field Operations. 

 

Implementation Plan

Effective April 19, 2013, and after valuable input from our Veterans Service Organization (VSO) partners, VA began making “provisional” decisions on the oldest claims in the inventory.  This adjudication allows eligible Veterans to begin collecting disability compensation benefits immediately based on the evidence of record, allowing many Veterans who have waited the longest to more quickly begin collecting compensation benefits.  In all cases, VA will ensure that the Veteran’s applicable service treatment and personnel records are available for review in connection with the claim.  We will further ensure that VA medical examinations or opinions are in the record if they are necessary to decide the claim.  All Veterans Benefits Administration (VBA) claims processing personnel have been fully trained on how to process these claims and are eager to expedite benefits for those Veterans who have waited the longest.

To ensure fairness, Veterans will be permitted to submit additional evidence or request that VA obtain additional evidence for a full year following the provisional rating, before VA issues a final decision.  This 1-year “safety net” provides Veterans the opportunity to identify or obtain additional evidence that may change the provisional rating, particularly with respect to the disability evaluation level assigned.  If VA receives additional evidence within the 1 year following the provisional rating that substantiates an increased evaluation, VA will pay the increased compensation back to the original date of claim.  Following the year-long period of time for the submission of additional evidence, VA will issue a final decision to the Veteran, and include information should the Veteran decide to appeal the decision.  The Veteran will then have the standard year to appeal the decision. 

Throughout this initiative, VA will render final, rather than provisional, decisions on claims where all available evidence is of record or when the rating assigned for each claimed issue already provides the highest level of disability compensation allowed under our laws and regulations.  Also, Veterans may request to receive a final decision with appeal rights, rather than a provisional decision, before the 1-year provisional period ends. 

VBA’s plan is to complete claims pending 2 years or longer within 60 days and claims pending 1 year or longer within 6 months.  VA will continue to prioritize Veterans who are most in need.

  • We have been, and will continue to prioritize claims for homeless Veterans, the terminally ill, former Prisoners of War, and Medal of Honor recipients.  About 3,000 to 5,000 Veterans per month in this category are receiving expedited claims processing.  We will also continue to prioritize Fully Developed Claims (FDC), which are critical to eliminating the claims backlog. 
  • Veterans who are facing financial hardship are also prioritized and tracked specifically by VA ROs.  VA can assign that status based on the case, or Veterans can self-identify—either when filing or by alerting VA after the claim has been filed.  VSOs can also alert VA to prioritize cases for financial hardship on behalf of Veterans they represent.
  • For wounded, ill, and injured Servicemembers separating from the military for medical reasons, there is an Integrated Disability Evaluation System (IDES) to ensure a “warm handoff” between the Departments of Defense (DoD) and VA.  For this system, VA dedicates staff solely to process claims for this priority population.  VA completes IDES claims in less than half the normal processing time.

This initiative will not affect Veterans who have already received a decision on their claim and have filed an appeal.

 

Content and Basis of Provisional Ratings

When making a provisional decision, VA will grant or deny the claim based on the evidence of record; however, provisional decisions will not be made on claims where the following evidence is absent from the claims record:

  • Service treatment records (STR) for original claims;
  • VA medical records;
  • Any evidence needed to establish Veteran status and/or pertinent service dates, if available evidence is not otherwise sufficient; or
  • VA examinations, if such exams are pending at the time the case is reviewed or if exams are necessary to make a decision on the claim.

 

If required Federal records outside of STRs have not yet been received, VA will issue a provisional decision and request the Federal records.  VA will review any new evidence received as a result of this request and issue a final decision on the claim.  If the claimant has additional relevant evidence pertaining to the claim, he or she is given 1 year from the date of the provisional decision to provide it to VA or to request VA’s assistance in obtaining it.  Upon receipt of any new evidence, VA may render a final decision and provide appeal rights.

VBA notified the Veterans Health Administration (VHA) of this initiative, and the 2 administrations have worked together to identify existing examination requests for claims over 2 years old.  Future examination requests on these claims will identify the specific priority, and ROs are working closely with their VHA partners to ensure timely examinations.  Nationwide, VHA’s average processing time for returning completed exams has remained at 30 days or less since August 2011.  As ROs will only be working the oldest claims and certain identified special-issue categories, existing non-priority examination requests will be quickly worked through the system so we can concentrate on these oldest claims.

The contracted disability examination providers have also been notified of VBA’s initiative to expedite certain examination requests.  Specifically, all 2-year-old claims pending contract examinations were identified, and contact was made with the vendors to ensure prioritization.  We do not anticipate that this will affect the scheduling of other pending examinations.

DoD has also collaborated with VBA in this initiative, granting additional access accounts to RO personnel that allow us to directly access DoD’s Armed Forces Health Longitudinal Technology Application to search for additional medical evidence, if needed.  In addition, for several months now, a number of DoD personnel have been co-located at VBA headquarters to assist in locating service medical records needed to support pending claims. 

 

Reporting Metrics

As a result of this initiative, metrics used to track benefits claims will experience significant fluctuations.  By eliminating the oldest claims from the inventory, VA lowers the average days pending for claims in the overall inventory.  VA is aware that this focus on taking care of those Veterans who have been waiting the longest will also cause the measure for average days to complete (ADC) a claim to rise significantly in the near term.  Over time, as VA clears out this backlog of oldest claims and increases processing of new claims electronically, we expect the ADC measure to significantly improve.  As of May 14, there were about 28,800 claims over 2 years old and 206,822 over 1 year.

 

Summary

VA is launching this initiative to expedite claims decisions for Veterans who have waited the longest.  We will also continue to prioritize claims from Veterans who are homeless, terminally ill, former Prisoners of War, and Medal of Honor recipients, those facing financial hardship and our most seriously injured, in addition to processing claims that are fully developed.  Today, we have rated 62,000 FDCs in 111 days, on average – demonstrating how critical the FDC initiative is to resolution of the claims backlog.  Our VSO partners are fully supportive of using FDC and recognize the increased efficiency, quality, and productivity that result.

We must eliminate the claims backlog; the President has made that very clear.  That is why VA is launching this initiative to expedite claims decisions for those Veterans who have waited the longest - we owe them a decision.  This concludes my testimony.  I would be happy to address any questions or comments from Chairman Miller or the Committee Members.