Mr. Sherman Gillums, Jr.
To achieve real success, the Veterans Benefits Administration must focus on creating a veterans’ benefits claims processing system designed to “get each claim done right the first time.”
· A system based upon modern, paperless information technology.
· Workflow systems focused on quality, accuracy, efficiency and accountability.
· Must be capable of continuous improvement.
The VBA has undertaken over 40 initiatives and pilot programs to address the claims backlog and reform the claims process simultaneously.
· PVA understands the need to explore new ideas.
· There are so many initiatives and pilots currently in process, that the defined outcome, if any, is obscured.
VA's Veterans Benefits Management System (VBMS) initiative pioneered the development of a paperless claims IT solution to improve future business process and integrate with Veteran Relationship Management and Virtual Lifetime Electronic Record.
· Its success to date is qualified by the reality that the system is designed to handle simpler cases than those PVA typically sees.
· None of the 484 cases processed through VBMS in Providence have been this type.
· Approximately 10 of 239 processed through Salt Lake City have been.
· The new system remains untested in our view.
· While PVA may have criticisms of the VBMS, we believe it does offer hope and is ready for wider implementation, but VA needs to present a good plan for VBMS.
The success of VBMS will greatly depend on rules-based systems.
· These systems treat all veterans the same.
· They can be flawed by imperfect rulemaking and application.
· Does not have the human interaction to fully understand the circumstances of a specific injury.
All of these initiatives are driven by statistics and very resource intensive.
· PVA appreciates VA's effort to aggressively tackle the backlog
· Cannot lose sight of the simple virtue of having well trained people do quality work.
Historically, due to the nature of our catastrophically disabled membership, PVA has been the subject matter expert for claims involving multiple injuries or conditions.
· PVA has enjoyed the privilege of providing VA with help in field studies and advice on processes.
· PVA looks forward to continuing to make valuable contributions.
Chairman Miller, Ranking Member Filner, and members of the Committee. Paralyzed Veterans of America (PVA) is pleased to present our views on Reclaiming the Veterans Benefits Process and the best methods of effectively serving our veterans, with particular emphasis on the Veterans Benefits Management System (VBMS). PVA thanks the Committee and the Department of Veterans Affairs (VA) for the opportunity to contribute to the discussion on the best way to promote timeliness and quality improvement in the VA claims adjudication process. We remain cautiously optimistic about the 21st century VA transformation plan moving forward and hope the transparency and collegiality enjoyed between VA and the VSO community as of late will continue.
To achieve real success, the Veterans Benefits Administration (VBA) must focus on creating a veterans’ benefits claims processing system designed to “get each claim done right the first time.” This goal cannot be over emphasized. This system needs to be based upon modern, paperless information technology (IT) and workflow systems focused on quality, accuracy, efficiency and accountability and must be capable of continuous improvement. VBA must evolve its corporate culture to focus on information gathering, systems analysis, identification of problems, creative solutions and rapid adjustments. If VBA stresses quality control and training, and continues to receive sufficient resources, timeliness will improve and production will increase and then and only then can the backlog be reduced and eventually eliminated.
The VBA has undertaken a number of initiatives and pilot programs to address the claims backlog and reform the claims process simultaneously, which seems to be the typical Washington response to a problem: “do a study” or “create a pilot.” While PVA understands the need to explore new ideas, there are so many initiatives and pilots currently in process, that the defined outcome, if any, is obscured. PVA believes VA’s effort would be well served by deciding on what is going to work and simply get it working. If the system is adaptable to changes and new information, it would allow for necessary adjustments to be implemented more rapidly. We expect progress, not perfection. If perfection is VA’s ultimate goal with all these initiatives, we may get neither.
Specifically, we note that VA has presented over 40 initiatives as components of its transformation plan, spanning all aspects of the claims adjudication process. This signals a commendable effort on VA's part to comprehensively confront issues that have long plagued its systems and processes. However, the success of this litany of initiatives depends heavily on whether the VA Regional Offices are properly staffed and resourced, training is adequate, and the cost-benefit analyses are thorough and honest. PVA remains concerned about whether VBA will successfully extract and then integrate the best practices from so many ongoing initiatives, while simultaneously meeting the Secretary’s ambitious goal of “breaking the back of the backlog” in the foreseeable future. One could argue that so many initiatives launched at once illustrates a lack of focus and a “whack-a-mole” approach to problem solving that presents the illusion of progress with little return on investment. Given the enormous pressure to reduce the backlog, we are also concerned that there could be a bias towards process improvements that result in greater production over those that lead to greater quality and accuracy. We urge the Committee to continue oversight, as with this hearing today, of the VBA’s myriad ongoing pilots and initiatives to ensure that best practices are adopted and integrated into a cohesive new claims process and that each pilot or initiative is judged first and foremost on its ability to help VA get claims “done right the first time.” Once pilots are found to be inefficient or fail to support improvements, those pilots need to end immediately.
Without question, PVA supports any effort to make the claims adjudication process more efficient, and we are optimistic that many of these initiatives will ultimately prove their worth. However, our first duty is to ensure the real needs of every veteran we serve remain the central focus, not abstract statistics and novel business processes that satisfy VA leadership’s idealistic aims yet miss the mark when viewed in the difficult, hard-hitting reality many of our members live within. The bottom line is we must remain sober in our assessment of whether we have done enough to fix the problems we face, no matter how deep our desire is to be encouraged by slight successes.
With this in mind, I will discuss the most notable VA initiatives, including VBMS, Nehmer claims, Disability Benefits Questionnaires (DBQ), rules-based calculators, Integration Labs, and the Fully Developed Claims pilot and their impacts as reported by our field staff and the veterans we serve. We offer these assessments with the hope that our criticisms and compliments alike are received with equal appreciation.
VA's most anticipated initiative, the Veterans Benefits Management System (VBMS), pioneered the development of a paperless claims IT solution to improve future business process and integrate with Veteran Relationship Management and Virtual Lifetime Electronic Record. It was intended to enable more efficient claims process flow to reduce cycle time through the elimination of paper claims and to support process changes like segmentation of complex claims and auto-adjudication. VA launched the pilot in two locations: Providence, Rhode Island and Salt Lake City, Utah. Conceptually, the VBMS could be the answer to adjudicating claims quicker and more accurately; however, this is yet to be determined. Its success to date is qualified by the reality that the system is designed to handle simpler cases than those PVA typically sees. Many of our cases entail seeking benefits for veterans with catastrophic injury or disease, which often triggers entitlement to a range of monetary and ancillary benefits. None of the 484 cases processed through VBMS in Providence have been this type, and approximately 10 of 239 processed through Salt Lake City have been. Thus the new system remains untested in our view. Incidentally, we have found that not using VBMS is preferred by our service officers as they believe the current process of handcarrying these claims through works best as they most often result in a 2-3 day turnaround. This may explain why we have seen very few of our cases processed through VBMS, making it difficult to ascertain its efficacy. PVA believes it will prove valuable as a utilitarian measure to reduce the sheer number of simpler claims, but ineffective in its current form for more complex claims. This is critical to note when touting the success of VBMS and considering its expansion.
While PVA may have criticisms of the VBMS, we believe it does offer hope and is ready for wider implementation. That said, VA has not completely stated what the expectations are for the VBMS. It was originally going to be an on-line digital storage system for records. It has now morphed into something different. What is the end goal? PVA does not know, and we wonder if VA knows. A good plan is like a roadmap, with a final destination and the best ways to get there identified. VA needs to present a good plan for VBMS.
The success of VBMS will greatly depend on the process design changes, like rules-based processes, and supportive technologies like Special Monthly Compensation (SMC) calculators, that undergird this new system. The problem with rules-based systems is they treat all veterans the same and can be flawed by imperfect rulemaking and application. This is the challenge for a rules-based computer system; it does not have the human interaction to fully understand the circumstances of a specific injury. The numerous issues often faced by veterans with catastrophic injuries create a complex set of outcomes that cannot be easily reconciled by logic-based systems that cannot appreciate nuance in disability assessments. Rules-based systems are composed of a series of algorithms that determine the outcomes of the inputs. Depending on who designs the rules for the algorithms, very different outcomes are possible with calculators historically failing to compute the right ratings for persons with multiple issues. PVA believes VA cannot simply create a “Turbo Tax” for claims processing. Whereas something as simple as hearing loss can easily be identified on a graph or chart, the impact of bladder conditions, susceptibility to skin ulcers, and need for regular aid and attendance must be more closely examined to determine the extent of the problem. If it has not been already done, PVA recommends taking older previously adjudicated ratings and testing them against the outcomes achieved using rules-based calculators in order to determine their true accuracy.
In the area of the Agent Orange Nehmer claims processing initiatives, it sought to quickly reduce the backlog in claims for disability or death caused by herbicide exposure during the Vietnam War era. The plan provided for the consolidation of these cases from around the country to thirteen Resource and Day-One Brokering Centers. This was an important step toward making Vietnam veterans whole after decades of neglect, apathy, and even disrespect where their needs were concerned. To its credit, VA did a remarkable job in tackling this issue head on and clearing these cases from the claims backlog. Our field staff reported that many of these claims were timely and accurately adjudicated. The question that remains, however, is whether diverting an arguably inordinate amount of resources on these cases was worth the cost of under-resourcing other areas. Many VA employees who worked these Nehmer claims, and these claims only, during the two-year period required retraining in other processes, which tapped the human resources needed to function at regular capacity. Also, the backlog swelled in non-Nehmer cases, forcing VA to yet again tackle another issue. This “rob-Peter-to-pay-Paul” approach to reducing the backlog has proven to be an adequate short-term solution, particularly for Vietnam era veterans whose claims certainly deserved much-needed focus. But the problem persists in other areas in the form of a two-year backlog of non-Nehmer claims, which merely shifted the problem rather than eliminate it.
VA proffers Disability Benefits Questionnaires (DBQ) as a possible remedy for reducing this backlog. DBQs are intended to provide medical exam evidence needed to render an accurate and timely disability decision. Ideally, this would reduce the wait time for VHA exams and update exam templates. For the most part, DBQs have proven to be a good remedy for the procedural problems noted in the claims development process. VA exams are scheduled timely and veterans can proactively pursue medical evidence that may help prove their claims. The problem, however, lies in the substance of many of the DBQs. Some service officers believe they raise more questions than answers, particularly where questions regarding “loss of use” and “effective remaining function” are contemplated. We recommend the continuous assessment of their accuracy and timely revision when necessary.
An additional area for discussion is the so-called Integration Lab, or I-Lab. The I-Lab concept was launched in Indianapolis as a single place to test multiple initiatives within a new end-to-end processing model. The I-Lab bundles claims based on complexity and tests the following initiatives concurrently: lean claims, intake processing center, comprehensive screening, express lane, case management, and private medical records. Regarding the “lean claims processing” initiative, this measure sought to eliminate time lost from handoffs, improve communication between Veterans Service Representatives and Ratings Veterans Service Representatives, and draw upon their expertise during development. According to field reports, the claims process was improved when the teams were first formed, but has been hampered by the need to hire and train additional staff as well as confront a growing claims inventory. The “express lane for limited issue claims” initiative removed single-issue claims from the queue and processed them with higher productivity as part of the I-Lab initiative. PVA’s St. Paul, Nashville, and Muskogee service officers reported this to be an effective solution to reducing the adjudication period for single-issue cases from over 120 days to 30, in some cases as quickly as 4 days following examination. This has benefited many veterans where time was of the essence, as seen in ALS cases. The Interim Ratings / Quick Pay initiative launched in St. Petersburg allowed for timely payment of benefits (2-3 days in many cases) once the VA Regional Office received all the necessary information. This was of particular benefit to veterans with ALS and prostate cancer (Agent Orange) claims where, again, time was of the essence.
The I-Lab initiative’s success is buttressed by the successful implementation of another VA initiative: the “Fully Developed Claims” pilot. This pilot, enacted under Public Law 110-389, tested the expedited processing of fully developed claims at 10 stations using a checklist mailed to assist the veterans in submitting evidence, thus streamlining the claims process. PVA’s St. Paul, Albuquerque, Newark, and Muskogee service officers have reportedly had much success with the fully developed claims process, particularly in time-sensitive cases such as terminal illness. Notwithstanding these successes, we remained concerned that due process will be the unintended casualty in this otherwise successful campaign as veterans unwittingly exchange their rights to appeal for quickly adjudicated, inaccurate decisions that would otherwise warrant review.
Chairman Miller, all of these initiatives seem to have two critical aspects in common: they are driven by statistics and very resource intensive. As long as they render real results, as determined through objective assessment, progress is likely despite imperfections. And as stated earlier, PVA appreciates VA's effort to aggressively tackle the backlog through ambitious, visionary initiatives. But one cannot lose sight of the simple virtue of having well trained people do quality work. An organizational culture that places more emphasis on rules than results, statistical validity than solid outcomes, deludes itself and is doomed to mediocrity at best, at the expense of those it purportedly serves.
Historically, due to the nature of our catastrophically disabled membership, PVA has been the subject matter expert for claims involving multiple injuries or conditions. PVA has enjoyed the privilege of providing VA with help in field studies and advice on processes that best meet the unique needs of veterans with catastrophic injuries. PVA National Service Officers have even participated in the training of VA claims processors. This valuable service has tremendously benefited both organizations and illustrates an important, enduring partnership. In recent years, PVA acknowledges more willingness by VA senior leadership to involve VSOs in strategic planning sessions and brainstorming activities. That said, we caution this committee and VA not to construe the VSO community’s participation as unmitigated support for all VA programs and initiatives. A few meetings or presentations where VA is ostensibly seeking VSO input does not imply, on its face, that the exchange was mutually beneficial or that the discussion went beyond a Powerpoint presentation that simply outlined VA plans, especially in instances where such plans remained unaltered by VSO input. PVA looks forward to continuing to make valuable contributions to VA programs and processes whenever possible, particularly as they impact catastrophically injured veterans.
Ultimately, it is imperative for all key stakeholders—the VA, Congress, and Veterans Service Organizations—to be fully involved in the reformation of the claims processing system as a whole. Moreover, there remains a broader range of issues within the scope of the claims processing system that can be addressed. In the end, it must not be forgotten that the people who are ultimately affected by changes within the benefits system are the men and women who have served and sacrificed so much for this nation. We hope that they will always be forefront in your minds as you consider how benefits are provided and how best to speed the access to these benefits earned by virtue of their sacrifice in service to our great country.
This concludes my testimony. I will be happy to answer any questions you may have.
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 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.
Fiscal Year 2010
Court of Appeals for Veterans Claims, administered by the Legal Services Corporation—National Veterans Legal Services Program— $287,992.
Sherman Gillums, Jr.
Associate Executive Director of Veterans Benefits
Paralyzed Veterans of America
801 18th Street NW
Washington, D.C. 20006
Sherman Gillums Jr. is the Associate Executive Director of Veterans Benefits at Paralyzed Veterans of America. He has extensive experience in veterans’ benefits and health care, beginning his veteran advocacy career in 2004 as a PVA National Service Officer at the San Diego VA Regional Office. He had also served as a member of PVA’s National Field Advisory Committee and an Appellate Representative at the PVA National Appeals Office in Washington DC.
In 2011, Mr. Gillums assumed his current position. Since his appointment, he has given voice to PVA’s constituents on a number of important committees including the Federal Advisory Committee for Prosthetics & Special Disabilities, the VA Integrated Products Team, and the VA Schedule for Rating Disabilities revision working group. He also authored a number of articles on veterans’ benefits and employment for the 2013 VA Independent Budget.
Mr. Gillums completed his 12-year military career as a Chief Warrant Officer 2 in the United States Marine Corps after suffering a spinal cord injury in 2002. His personal decorations include the Navy/Marine Corps Commendation Medal (with gold star in lieu of second award), Navy/Marine Corps Achievement Medal, and Global War on Terror Service Medal. He earned his Master’s Degree in Global Leadership from University of San Diego in 2010.
He is married to his wife, Tammie, and lives in Virginia with their children.