In accordance with your p May 23, 1997 007 invitation, I write to provide you with the comments of the Disabled American Veterans (DAV) on theperations Veterans Auran of Veterans' claims for the benefits provided under the VA's compensation and pension program are processed at the VA's 58 regional offices, and most of the administrative functions associated with delivery of the benefits take place there as well. The program management and policy making functions are performed by C&P staff located at VA's Central Office here in Washington, D.C. Of VA's various programs, none has perhaps been the source of more frustration and complaints in recent years than its compensation and pension program. The DAV attributes that to several factors. First, eligibility determinations for other VA benefits are much simpler in that they are governed primarily by such factors as the period, length, and character of service. Entitlement is essentially automatic where the veteran has the required service. Veterans expect good service from these programs, and they generally meet expectations. The complexity inherent in disability benefit determinations makes the compensation and pension program much more difficult to operate. The determination of entitlement goes far beyond basic eligibility requirements. Objective and subjective information must be weighed carefully with appreciation for the nuances and an understanding of the esoteric language of medicine and disability evaluation. Difficult questions of cause and effect are often confounded by concurrent or intervening factors. This necessitates extensive rules, some covering areas not susceptible to simple language. This area of law can be learned and effectively applied nonetheless; thus, the complexity does not excuse incorrect application or omission of the controlling rules. The Honorable Jack Quinn Second, because of what has been referred to as VA's "splendid isolation" during the years before judicial oversight, VA adjudicators did not appreciate the supremacy of the law over personal beliefs about the merits of veterans' rights or even over administrative convenience. What may have started as conservative views about the treatment that should be accorded veterans' evidence or cases in certain regularly encountered situations probably grew into outright arbitrary practices and unwritten rules that either ignored the veteran's rights in law or even directly contravened the law. These unwritten rules were no secret and were sometimes discussed openly, even sometimes stated as reasons for denial of claims. The advent of judicial review brought enforcement of the letter and spirit of the law, and that exposed the widespread deficiencies in VA decisionmaking. The effect of judicial review shocked the VA system, and the adjustment to this new climate has been a challenge for VA because the old mindset is so deeply ingrained in its adjudicators. In the early years of judicial review, there was some intransigence on VA's part. There was no effective effort to bring decisionmaking into conformance with the law and the Court's pronouncements on the law. Because the decisions of the Board of Veterans' Appeals were directly under the eye of the Court, the Board was forced to comply more closely with the law. Its allowance rates rose from the historic annual average of about 12% to around 20%. Its remand rates rose to close to 50% at times. This added work involving appeal cases in the regional offices was enough to clog an already saturated system. These effects were of course made worse by added claims from military downsizing and the Persian Gulf war. Claims backlogs grew, and delays became protracted. With the results from VA's Business Process Reengineering (BPR) study, came a change in direction from VA's C&P service. VA acknowledged that poor quality was at the root of its claims backlog and timeliness problems. VA's BPR plan became its blueprint for fixing the system. Its BPR plan also became C&P's GPRA Business Line Plan for the fiscal year 1998 budget submission, and we assume that this and plans from the other VBA business lines will be integrated with the plans of the other administrations within VA to form the agency's strategic plan. We believe that the BPR plan correctly identifies the major problems responsible for the backlog and timeliness problems in compensation and pension claims. We also believe that the plan includes the correct solutions. However, the success of the plan depends to two things: the details of implementation and the level of management's determination to bring adjudicators into compliance. Some of the most important details will be the standards and parameters for quality measurement. The level of determination will be reflected in the strength and effectiveness of the accountability mechanisms that are put in place and the level of enforcement. As is required by GPRA, VA has been consulting with stakeholders in developing the details of the plan. Formulation of the implementation procedures has been assigned to various committees. Some of the members are from the regional office adjudication divisions. The Honorable Jack Quinn Unfortunately, some of these individuals have attempted to use their position to insert recommendations for changing certain substantive or fundamental procedural elements of the programs. Some of these recommendations were not tied to any increased efficiency, but rather removed or altered some aspect of the program that the individual or individuals apparently had some personal disagreement with in principle. We have pointed out to C&P that such efforts pervert the BPR effort and tend to damage the cooperative spirit and effort between VA and stakeholders. Most of our concerns to date have been rapidly and satisfactorily addressed. Accordingly, without getting into the details of C&P's GPRA plan, which we are sure VA will provide you, we must say that we are quite pleased and more encouraged about C&P's strategic direction and sincerity than we have been in recent memory. It is our belief that the soundness of the plan cannot be tested without moratorium on interference from outside, however. The veterans' community and Congress have properly been quite critical of C&P's past inaction. Now that C&P has a strong plan and gives all appearances of being serious about making improvements, we should give them a chance and necessary time and resources to do so. That does not mean we should not monitor and help them along the way or not advise them when they are getting off track. Congressional and stakeholder involvement is expected under GPRA. It does mean that we should hold off in imposing recommendations from the Veterans' Claims Adjudication Commission and others that do not harmonize with the BPR approach. Additionally, many of the Commission's recommendations would involve program changes detrimental to veterans that do not increase efficiency at all—they merely reduce VA's work by reducing veterans' access and entitlement to benefits. Moreover, if BPR is successful, such adverse actions may never become justifiable. We therefore urge you to support C&P's BPR plan and to provide the investment in resources necessary initially to achieve the long-term efficiencies and cost-savings. Sincerely, RICK SURRATT Assistant National Legislative Director RESPONSE TO FOLLOW-UP QUESTIONS FOR DEPUTY NATIONAL LEGISLATIVE DIRECTOR Question One: Do you believe that VBA has worked with you and taken your concerns seriously about inefficiencies and errors in the processing of Gulf War claims? Answer: Initially, VBA was slow to act on our concerns. However, for the most part, VBA is beginning to address many of our concerns regarding the handling of Gulf War claims. However, we are closely monitoring the situation to determine if VBA will properly handle our concerns regarding the scope of the VA's fourth review of Gulf War claims and our concern that many Gulf War veterans are underrated. Question Two: The Committee has been concerned that the VBA has not adequately informed Gulf War veterans of the development needed to claim benefits for undiagnosed illnesses. In particular, VBA failed to inform veterans that “lay statements” could be used as evidence in claiming benefits. Could you please give us your recommendations of the type of outreach VBA should perform to inform veterans of the information they need to claim benefits? Answer: When a veteran files a claim for service connection, he or she should be provided a fact sheet outlining the type of evidence, i.e., service medical records, private medical records and lay statements, necessary to establish a claim for service connection. Each type of evidence should be briefly described so that the veteran can understand what is required and how each type of evidence can be used to support his or her claim. It is exactly this type of information, and more, that DAV National Service Officers solicit from veterans in order to best assist and represent them in their claims with the VA for disability and other benefits. Question Three: How do you view centralization of claims processing in general? Do you see any lessons learned in your experience with the centralization of Gulf War claims? Answer: In general, the centralization of claims processing for insurance and education claims is working without any adverse impact on VA claimants. With respect to compensation claims, however, centralized claim processing is fraught with many problems. As evidenced by the fiasco of centralization of Gulf War claims, centralization of compensation claims processing does not appear to be working. We are beginning to also hear concerns with the centralization of POW claims processing. As we saw with the processing of Gulf War claims in four area processing offices, the allowance rate for undiagnosed illnesses varied greatly from a high of 20% in the Western area to a low of almost 5% in the Southern area. A number of factors could account for this huge variance in the allowance rate, such as training, biases, workloads, or claim development, to name a few. It would be interesting to determine which factors were responsible for such a wide variance in the allowance rate. The handling of Gulf War claims has also further reinforced our belief that it is important that veterans and their representatives have access to the decision makers. Statistics demonstrate that veterans fare much better when they are able to meet face to face with the decision maker. The ability to observe the demeanor of a veteran claiming to be suffering from various illnesses assists an adjudicator in reaching a fair and equitable decision. If there are any lessons to be learned as a result of the centralization of Persian Gulf claims, it is that, under the current structure and within current resources, the process does not work very well. Many veterans are frustrated because of the logistic hassles involved in having their claims adjudicated in another location -- they want to deal directly with the National Service Officer who will be handling their claim. Question Four: How do you view the VA's goal of a 92 percent accuracy rate for claims? Answer: The VA's goal of 92 percent accuracy rate for claims is very admirable; however, it depends on what factors the VA is using to determine accuracy. For years, the VA has stated that they have had a 97 percent accuracy rate, yet two thirds of the cases appealed to the Board of Veterans' Appeals were either remanded or overturned on appeal and, of the cases appealed to the Court of Veterans Appeals, more than 50 percent of those appeals decided on the merits were reversed, vacated, or remanded, in whole or in part. Question Five: In your view, are the criteria used to determine accuracy in the adjudication process useful in measuring the effectiveness of the claims adjudication process? How should effectiveness be measured? What should be measured to determine effectiveness? Answer: The bottom line in determining the effectiveness of the claims adjudication process should be whether the claim was properly decided the first time. To determine whether a claim was accurately decided, all that is necessary is to determine whether the case was properly developed and, if so, were the pertinent statutes, regulations, and case law properly applied to the correct facts, resulting in a legally sound conclusion. |