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Paralyzed Veterans of America

Paralyzed Veterans of America

Chairman Miller, Ranking Member Michaud, and members of the Committee, Paralyzed Veterans of America (PVA) appreciates the opportunity to submit a statement for the record concerning the Department of Veterans Affairs’ (VA) performance with processing claims.  We are particularly pleased to see the focus you have placed on VA’s plans for employee training, accountability, and workload management to improve disability claims processing.  This issue deserves a great deal of oversight as the number of veterans waiting on ratings decisions continues to grow.  
Historically the Veterans Benefits Administration (VBA) was funded based on workload demands and staffing budgets were predicated based on the perceived need to provide quality service to veterans.  The number of authorized Full-Time Equivalent Employees (FTEE) was based on anticipated workload and could also include additional services that were deemed to be of value to veterans.  The allocation of resources, as funded by Congress, was based on the need to provide adequate and timely services.  As this paradigm shifted to a more capricious budgetary process which formulated  FTEE requirements based on available funding rather than workload demands, the dynamics of claims processing became  inextricably intertwined with issues unrelated to the quality of service.   

The clamor that then accompanied the steadily increasing backlog in the number of claims quickly garnered the attention of Congress, and the previously esoteric internal affairs of the VA quickly became the object of external review.  As the pressure on VA increased to reduce the backlog of pending claims, employees were strongly encouraged to maximize their productivity.   The short term dividends achieved in part by reduced training time were followed by long term losses fostered by lack of expertise.  As the error rate climbed, a new clamor loomed; this time to improve quality.
By this point the VA was forced to defend a situation that it did not have sole responsibility in creating.  Every oversight hearing conducted by Congress or other government agencies has basically centered on finding fault, as if success could be equated with determining why something failed.  This then fostered a culture in VA of “it's OK if something failed, as long as it's not my fault.”
The VA felt increasing pressure from Congress to demonstrate improvements in the overall accuracy of claims processing.  This pressure elicited responses from VA top leadership from the Secretary on down. The cry from veterans’ service organizations merely echoed the universal agreement that change was essential. While no one disagreed on the requirement for accuracy, there were other components that entered into the equation.  

We live in a highly sophisticated world of technology where ubiquitous sources of statistical data lead us to conclusions that are not always reinforced by logic.  Errors are often evaluated by the scale on which they deviate from the established process.   While the traditional process can have great value, it cannot summarily dismiss the value of applied logic and common sense.   VA employees who know their jobs well should not live in fear of being punished for exercising judgment in the processing of VA claims.  The adjudication of VA claims must not be limited by the application of algorithmic technolologies.  If this were the case, we would not need a Board of Veterans’ Appeals or the Court of Appeals for Veterans Claims.  

While the Department of Veterans’ Affairs has made great progress in streamlining their overall system of claims processing, they have overemphasized the role of technology and have underestimated the capacity of individual innovation.  Technology is a tool that offers great advantage to a competent work force.  It is not a substitute for qualified employees.   While VA is paving the way for the future with their implementation of the Veterans Benefits Management System (VBMS), they are missing the opportunity to empower their people by fostering and recognizing creativity.  

We have to ask how VA Regional Offices like Baltimore and Oakland were allowed to get to the point where any semblance of quality workmanship was difficult to recognize?  Could it be that people in these geographic areas are less qualified?   While this question is obviously rhetorical, it does lend credence to the probability that the likely root cause of the problem can be traced to poor management.  

First line supervisors are responsible to evaluate those working under their direction and to take whatever corrective action is deemed necessary to achieve an acceptable level of employee performance.  This responsibility continues up the supervisory chain and ultimately rests with the Director of a Regional Office.  All employees are challenged to do the best they can with the resources that are available to them.  When forced to work in an environment that is far from ideal, innovation and empowerment become more important than ever.

We would offer an example of a situation PVA is currently facing.  PVA is handling the claim of a veteran for amyotrophic lateral sclerosis (ALS) where the veteran had deteriorated rapidly and was rated as R-2, which is the highest possible VA rating.  The rating was completed in January and as of this writing, has not been promulgated.  After numerous inquiries, PVA’s Benefits staff was told that since the retroactive payment was in excess of $25,000, a third signature was required, and that there was no one in the office that week that could authorize this payment.  While this determination was made by a very senior level employee who was “following the rules,” we would argue that the delay was needless.  The obvious purpose of the $25,000 rule is to prevent costly errors that could easily occur in large retroactive benefits payments.  In this case, however, the veteran’s R-2 rating resulted in a $5,000 monthly increase for the previous six month period.  Simple math shows that the veteran should receive $30,000 as a retroactive payment.  There really isn’t any potential vulnerability in this instance and the high level supervisor in question could have considered the intent of the audit procedure and assumed the risk of taking an appropriate action under the circumstances.

Generally speaking, procedures are set in place for a reason, but the application of common sense must somehow be facilitated.  Employees must be trained and empowered to follow the intent of established practices. The Hippocratic Oath, “Do no harm,” should be valued as much by VBA as it is by VHA.  Quality cannot be determined by an overlay approach of the process   

The bottom line is that VA was forced to react to mounting criticism of poor quality and they ultimately relied too heavily on the rules rather than on results.  The only resolution that we see to this issue is a more objective measure of quality that focuses on results more than procedural issues.  VA employees should be recognized for creativity and innovation on how they comply with the intent of the law.  Quality reviews should include a focus on claims processing which objectively evaluates how a claim was processed from start to finish as opposed to reliance only on incremental reviews of each of the multiple components of the process.

Paralyzed Veterans of America appreciates the Committee’s continued concern with the massive problem that the VA faces in getting claims decisions done in a timely manner while ensuring that they are done right the first time.  With the Committee’s diligent oversight and the VA’s willingness to change, we believe VBA can achieve Secretary Shinseki’s goal of eliminating the claims backlog.

Thank you again for the opportunity to submit a statement for the record.  We would be happy to take any questions.