Ray Pryor, USN (Ret.)
Mr. Chairman and Members of the Subcommittee:
Thank you for providing AMVETS (American Veterans) the opportunity to testify regarding the issue of disability claims ratings and benefits disparities within the Veterans’ Benefits Administration.
This hearing is very important in as it addresses an issue that continues to plague the Veterans’ Benefits Administration (VBA) and leaves veterans frustrated and suspicious of the system that is in place to support them after their service to our nation. In examining the factors that have lead to the disparities in claims ratings, two large over-lying conditions are present that have allowed the gaps in ratings to exist and several circumstances have occurred which have exacerbated the problem.
First and foremost, we are working with a system that is based on humans making decisions. Their perceptions, understandings of conditions, and occasional mistakes are going to play a role in disparities. If this was the only issue then the disparities would not be regionally based they would be proportionally distributed throughout VBA. However, there is evidence that displays disparities between Regional Offices. AMVETS believes these disparities are caused by two separate but related groups within the claims process: (a) the Veteran Service Representative (VSR), the Rating Veteran Service Representative (RVSR) the Decision Review Officer (DRO) on the rating side; and (b) the Compensation and Pension Doctors (C&P) whose evaluation of a veteran is used by the regional offices to decide a claim.
The reason these two groups have such a great influence on the outcome of the veterans claims and why there are regional disparities is due to the personalities of the doctors, the raters and review officers, and the personalities of the Regional Offices as a whole. These regional personalities develop because new raters and DROs are trained by the region, and styles and common terms and language are used by the raters when filing a claim. Terminology such as “full range of motion” compared to “essentially full range of motion” could change a rating by ten percent. Likewise, physician’s perceptions and similar language usage can alter a claim. Veteran Service Officers (VSO) will state they routinely see Compensation and Pension Exams which will describe the patient with cookie cutter language leaving room for subjective interpretation.
In addition to these personalities that determine compensation on similar if not identical claims with a broad range of outcomes is the backlog of claims that are in the VBA and the performance credit system that monitors the number of claims filed by the raters and DROs. Currently, there is no oversight of the quality of work the DROs perform. As identified by the AMVETS sponsored “National Symposium for the Needs of Young Veterans,” DROs are evaluated on the number of claims they submit, but there is no distinction between positives and negatives in the performance evaluation. There is only a requirement to process a certain number of claims and they receive credit for all claims they move forward, regardless of the number of that are overturned or remanded. The backlog has increased the challenge to push more claims through, but because of the need to push them through, incomplete and poorly written claims are routinely submitted and remanded cycling the claim through the system a second or third time, exacerbating the systems backlog.
AMVETS suggests three recommendations which will assist in narrowing the disparities in claims and reduce the backlog. First, a centralized training facility that will be tasked with teaching new raters and DROs in a standardized outlined process in filing and reviewing claims. This will remove much of the regional personality that affects the disparity in the claims at the rater/reviewer level. Secondly, there needs to be improved oversight of both the rater/reviewer and the C&P doctors. In regard to the C&P, oversight should be in place to ensure the examiner’s guide is being utilized. This could be done through a “whistle blower” program that will allow veterans to feel safe in identifying C&Ps who are misdiagnosing claimants, or any other mechanism that could track validity of physical exams. Oversight could be improved in the rating and review of claims also. A system needs to be developed that will not only ensure claims are being filed, but that claims are being filed properly and completely. H.R. 3047 makes efforts to improve the credit received system under which the DROs and RVSRs currently work. This legislation would not credit a regional office for a claim until the expiration of the appellate period. This system or a system that monitors the ratio of cases remanded or overturned to the total number of cares referred is essential in improving the claims process. Lastly, understanding this is a two to three year process, hiring more staff to reduce the burden of the backlog is critical. There is no single, simple solution to the disparity problem, but identifying the roots of the problem and tasking VA with finding solutions to these problems is critical if improvements are going to be recognized in the claims system.
Mr. Chairman, this concludes my testimony.