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Paralyzed Veterans of America

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 situation faced by thousands of veterans awaiting decisions on their appeals for veterans’ benefits.  This issue has been challenging the Department of Veterans Affairs (VA) for years and PVA appreciates you conducting this hearing to try and find answers.  However, answers without action is meaningless.

With much of the discussion focusing on the VA disability claims backlog and the litany of initiatives launched by the Veterans Benefits Administration (VBA) to address it, very little attention has been placed on the appeals process.  However, the downstream effects of the backlog, which now sits at over 613,000 claims, fall to the jurisdiction of the Board of Veterans Appeals where nearly 43,000 appeals now await adjudication. For veterans who had endured the wait associated with backlogged claims, many face a new waiting game that will last 251 days on average once those claims become appeals.  The current remand rate now sits at 46 percent, which means nearly half of appeals are returned to VBA due to error or incompleteness.  This also means those appeals will spend an average of 251 days in the process plus the time it takes to fulfill a remand order.  This can take months or even years in some cases.

PVA has identified a number of reasons for the appeals backlog. Chief among them is the number of appeals that have to be sent back, or remanded, to VBA for additional development.  Inadequate medical exams, inadequate reasons and bases, and inadequate notice of examination are a few of the most common reasons for remand.  When an appeal is remanded, it returns to the jurisdiction of VBA through the Appeals Management Center (AMC), a separate entity where assigned VBA staff are tasked to remedy flaws in claims development identified by the Board.  It is at the AMC where many remanded appeals idle on a procedural “hamster wheel” due to a failure to comply with the remand order, an automatic basis for continued remand.  In some cases, AMC will simply reiterate the rationale of a medical opinion without applying legal analysis or render a decision without complying with the Board’s remand directives thus unnecessarily extending the process.

However, the Board and appellants are also culpable to an extent.  Both the Board and VBA share a predilection for wrongly favoring VA exams over most others and will require one before rendering a decision, even when private medical evidence or treatment notes from an appellant’s treating VA physician is sufficient.  This is an issue PVA has testified about on multiple occasions.  Not only does this slow the claim or appeal of the individual veteran, it further slows the claims process when unnecessary resources are used to seek medical information VA already has.  In addition, it increases VA costs and diverts them from serving other veterans who need exams.

Veterans also share responsibility when many appeals arrive at the Board with little to no merit.  A disability claim that gets denied by VBA should not automatically become an appeal simply based on the claimant’s disagreement with the decision.  When a claimant either files an appeal on his own behalf or compels an accredited representative to do so with no legal basis for appealing, this clogs the process and draws resources away from legitimate appeals.  PVA has taken steps to reduce these frivolous appeals by having claimants sign waivers when taking power of attorney.  In addition, PVA has an attorney serve as Director of the PVA National Appeals Office which allows our organization to better evaluate the merits of an unfavorable VA decision before proceeding with an appeal.
There may be many avenues to improve the appeals process for claims.  PVA offers the following recommendations for improvement:
•    In order to reduce remands, the Board should order VA medical exams only when necessary and give appropriate weight to private medical evidence and treatments records from treating VA physicians.

•    Granting the Board settlement authority, similar to that allowed by the Veterans’ Court, will eliminate the need for time consuming additional development in cases where the appellant, an accredited representative, and the Board can agree to a resolution based on existing evidence of record.

•    Review examination scheduling procedures to reduce the number of remands related to inadequate notice.

•    Review AMC procedures and quality review as part of the VBA’s 21st transformation effort, to include the implementation of new technologies where applicable.

Without improvements in the appeals process, PVA does not believe VA will be able to meet the Secretary’s deadline of 2015 to end the claims backlog that has damaged both VA’s credibility and damaged, and continues to damage, the lives of many disabled veterans.

Mr. Chairman, we would like to thank you once again for allowing us to address this issue.  We hope that by continuing to seek the answers on claims delays, VA will make meaningful reforms to ensure these claims are completed in a timely manner.

PVA would be pleased to take any questions for the record.