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Ms. MOFFITT. I guess that if we could have looked at a wider range of cases earlier, we may have seen that there were—the areas of discrepancy that you all are mentioning have to do with, in most instances, the hasty adjudication of these claims.

Had we looked at a broader spectrum of the sampling of cases earlier, we may have identified that earlier. What I mean by that is that this legislation asked that we look at lay evidence and consider it on an equal weight with medical evidence. That is not the criteria that has historically been used in weighing evidence in the past.

As those claims were being adjudicated, had we had full knowledge that that concept had not really been fully understood by the rating specialists, we probably should have taken earlier action to correct it.

But I applaud what Mr. Ross did in July of '96 to say even though the-we're not sure of the scope of the discrepancies, we will look at every single case and make sure that the veteran is given the opportunity to submit evidence from all sources, including lay evidence; and then we will make sure that we follow up on all leads to get that evidence.

Mr. HAYWORTH. I know that we all share the notion that we certainly hope that our fighting men and women never have to bear the burden of battle again. I think all of us are unanimous in that concept.

But God forbid, should there be a future conflict, as the VA deals with those veterans returning home from that conflict, do you think there should be a period of heightened examination?

And akin, indeed, almost to the after action reviews that so many branches of the military use in the wake of military action, should there be an intensive follow up, systematic, systemic plan for offering special scrutiny in the wake of a conflict-say a window from 18 months to 2 years to try and understand all the different maladies and situations that might develop, or has that already been adopted?

Is that standard operating procedure for you folks?

Ms. MOFFITT. Claims start to come in immediately in the aftermath of a conflict. What we need to do better is make sure that the people in the field are adequately trained to handle the cases that come realizing that medical science doesn't know, can't determine what the etiology of the illnesses are from the Persian Gulf.

So when you try to either legislate or rate something that we really don't have a good handle on, sometimes it is the passage of time that allows for better decisions to be made about that.

But as I talked about, what we expect in the reengineered process of the future is a highly trained work force that will have at its fingertips computer-based training that will very effectively teach them anything they need to know that is new with regard to rating practices.

That is not something we have right now. But to look to the future and how things could be done differently, I think that is within our plan. And to give the people on the front line of the VA, those people making the decisions, adequate training up front so that they can make good decisions is how I would approach a future conflict.

Mr. HAYWORTH. Thank you, ma'am.
Thank you, Mr. Chairman.
Mr. QUINN. Thank you, Mr. Hayworth.
Mr. Reyes.
Mr. REYES. Thank you, Mr. Chairman.

You know, Ms. Moffitt, I think one of the things that plays out in these hearings is that there's an overwhelming frustration on the part of not only members of Congress but people that have sought the services of the VA.

I have an ongoing concern that I would like for you to speak to, and that is the national standardization in terms of the types of or the kind of service that veterans receive across the country in the different regional offices.

I think that in hearing your comments this morning about hasty adjudication and lack of training, I would go further and encourage that we sensitize people that provide these kind of services through the VA for our veterans should receive.

And I say that because oftentimes we have I don't know if it's a policy, I don't know if it's an attitude or what it is that the first thing we're looking for is a reason to deny a veteran a benefit.

I mention that because, in my District where we have approximately 60,000 veterans, that is an overwhelming concern of theirs—that it's not so much people that are willing to help or trying to help or trying to determine how they can help, it's almost an endemic situation where they're trying to find a reason not to.

And I mention that to you this morning because it's been raised to me and to other members of this committee as well as the full committee because we've heard this continuously. I would like to ask if you can tell us this morning how do you monitor the standardization of services throughout the country?

What kind of institutional training program do you have to make sure that employees of the Department of Veterans Affairs that are working with veterans and that are making decisions and determinations about benefits that are provided for them—what kind of a system do you have in place that would give you a good grasp on any potential problem areas, any issues like the ones I've mentioned to you this morning?

Ms. MOFFITT. Well, first of all, our philosophy for dealing with claims is "grant if you can and deny if you must." I regret that your constituents feel that that is not how we view our job in the field.

With regard to standardization, GPRA looks at several areas in which we would measure our performance in outcomes to veterans-service to veterans. With regard to timeliness standardization, we look across the Nation to see if there—if claims are being processed timely.

In instances where there are serious workload problems where claims are not being processed timely, we look to broker work to remedy that situation. With regard to accuracy, we look at a cross section of cases from each regional office and the lessons learned from those reviews we share with all regional offices to ensure accuracy in Persian Gulf claims as well as other claims.

One of the tools we now have available to us with regard to standardized training is a national system for a satellite broadcast. This has fairly recently been brought online for us. And that allows

us to provide standardized training to all decision makers in the field so that the policies and procedures to be employed by them in their daily work are coming from a single source that they all can hear.

And as a matter of fact, that is the system that we plan to use to provide training to the regional offices who will take back the Persian Gulf cases on redistribution. We will use the satellite to give them standard policy procedures on how to work these claims based on our experience over the last 2 years.

Mr. REYES. Is there a system in place in terms of—I don't know if it's a rating system or an evaluation system to determine the consistency of service regionally and maybe perhaps a comparative analysis, you know, countrywide or nationwide so that you can identify problem areas or pockets of—or perhaps offices that are not up to the standard, whatever the standard may be?

Ms. MOFFITT. GPRA envisions that, as we determine the performance measures, those will be passed on from the national level, to the area levels, to the regional office directors, down to the managers, as well as the individual decision makers.

That is not in place now. But we do recognize that does need to be in place for an effective implementation of GPRA.

Mr. REYES. Okay.
Thank you, Mr. Chairman.
Mr. QUINN. Mr. Evans.
Thank you, Mr. Reyes.

Mr. EVANS. Thank you, Mr. Chairman. Mr. Chairman, I want to thank you for holding this very important hearing. I associate myself with some of the comments made by both sides of the aisle here today with one exception. I don't think it's frustration anymore it's growing anger at what the VA's response has been to this whole situation.

Based on the American Legion's testimony and VA documents, I believe VA has been remarkably passive in its efforts to obtain adequate and proper information from Persian Gulf veterans, so that it can process their claims.

The VA, over the objections of veterans' service organizations and to some degree Congress, implemented a policy under which Persian Gulf claims would be adjudicated at four regional-or four Area Processing Offices.

By July 1996, as we've talked about, the Compensation and Pension Service had to instruct the four APO's to take another look at nearly 11,000 Persian Gulf war veterans' claims because of the evidence that VA collected information related to these claims in a sloppy and incomplete manner.

It has also been demonstrated that too many of these cases have been improperly entered in the VA's tracking system for Persian Gulf veterans' claims.

After fighting tooth and nail to establish the four APO's to adjudicate these claims, the VA is now saying 24/2 years later that it was wrong. What VA found is that the stakeholders, the veterans' service organizations, and Congress were right, and the 50-some VA regional offices should be adjudicating these claims.

I just wonder, as Bob Filner has asked, where does the responsibility ultimately lie? Why did these four APO's fail? Was it because they weren't given adequate support to ensure their success?

The VSOs assert that even with only four APO's, inconsistency of judgements regarding eligibility for compensation is a significant problem. Will this be a problem that will be resolved or at least exacerbated by decentralizing the Persian Gulf War claims through the regional offices?

Ms. MOFFITT. We will continue, as we redistribute the cases to the regional offices, to review the work that is done and provide continue to provide training and analysis of the inconsistencies to gain consistency.

The decision to specialize the claims in the four Area Processing Offices was done to hopefully allow for quicker processing of Persian Gulf claims.

When the workload was such that they could not handle that in the expeditious fashion that we would like them to and taking into account the 11,000 claims that we took responsibility to readjudicate, we determined that the workload itself was going to mean that Persian Gulf veterans' claims, if left at the four Area Processing Offices, would take many, many more months to complete.

Mr. REYES. Well, we understand that.

Ms. MOFFITT. With regard to the resources that they have, to the extent that their Area Directors were able to add resources, we have—we had four Area Processing Offices plus two additional offices working those cases. Some 56 rating specialists working full time on those cases.

That is just not enough resources to bring to the issue. But importantly, as you have mentioned, veterans want their cases handled locally. And especially if we can't handle them expeditiously, the longer they sit thousands of miles away where they are not able to, on a day to day basis, find out the status of those claims, that only exacerbates the problem.

So veterans and their advocates have told the Secretary in town forums, have expressed to all of you, that they want those claims adjudicated locally. And in responding to that and the workload strains, I'm taking responsibility to move those cases back to the regional offices,

Mr. EVANS. Of the four APO's, were there any that stood out as being particularly efficient and accurate in processing claims?

Ms. MOFFITT. All of—to say the other way, I think definitely Nashville, because of the large numbers—they had some 45 percent of all Persian Gulf cases—struggled-has struggled the most to take care of that workload.

But with regard to the other issues, I think basically they've all handled them about the same.

Mr. EVANS. Are there any practices used by the APOs that did a good job, in this case Nashville, that could be applied to the RO's now processing Persian Gulf claims?

Ms. MOFFITT. We plan to use the experiences of the APO's and use the rating specialists, the section chiefs, other managers to help train the regional offices as they get these cases back so that lessons learned will be passed on now to those rating specialists and managers at the other regional offices.

Mr. EVANS. All right; thank you, Mr. Chairman.
Mr. QUINN. Thank you, Mr. Evans.

Second round. My question was the same, Lane, about going from area to regional and if that's going to create a problem.

Let me ask a straightforward question. You talked earlier about training to get this done. You just mentioned it in response to Mr. Evans' question. When and how long might that training take? When's it going to be done? Will it be ongoing?

Ms. MOFFITT. We plan our first satellite broadcast for all of the decision makers in the field on May the 29th. It will be basically a two hour session to go over the principles of rating undiagnosed illnesses.

On June the 2nd and 3rd, we plan to call in a representative from each RO to a central location for 2 days of training to go indepth into the issues. In addition, the regional offices have hearing officers who are subject matter experts with regard to these Persian Gulf claims insofar as when veterans filed an appeal and asked for a hearing, those cases went back to those regional offices.

Those are the planned training sessions. Any other training that is necessary, either through nationwide conference calls, additional satellite broadcasts, Area training, we will undertake as we determine what the needs are of those regional offices.

Mr. QUINN. But for right now you're looking at the first week in June?

Ms. MOFFITT. Yes, sir. Mr. QUINN. Which would be only 2 or 3 weeks from now? Ms. MOFFITT. The first being actually May 29. Mr. QUINN. Okay. Ms. MOFFITT. And then in the first week in June. Mr. QUINN. And this is not a question, before I yield to Mr. Filner my time, but more of an observation. One of the things we've heard time after time, in hearings here and in other issues when it it relates to veterans, is the

the fact that there's miscommunication or a lack of communication.

And I think this is going to be one of those areas where when we make the move back to the regional offices, not only the training that you just outlined is going to be critically important, but the communication that takes place. That's why the VSO's want the claims, I believe, back to the regional offices for the reasons you just mentioned—want them closer, not 3,000 miles away.

But communication will be a key. And I don't need an answer. I'm just saying for the record today that I hope we pay attention to that, as I know you're aware. But for me, it becomes more and more important every time we make a move like this and for some of the reasons we've already heard this morning.

This frustration and almost anger with the Persian Gulf situation I think lies in the whole communication effort or lack thereof.

Ms. MOFFITT. I agree with you, sir. Mr. QUINN. Thank you. I yield the balance of my time to Mr. Filner.

Mr. FILNER. Thank you, Mr. Chairman.

Kris, are you aware of a VA White Paper on Persian Gulf Development? I don't know if it was done internally or —

Ms. MOFFITT. I'm not sure what you're referring to.

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