Defense & National Security

Hopelessly broken

Hopelessly broken
Marines hang-out in the recreation area at the Wounded Warriors barracks aboard Camp Pendleton January 12, 2011.

Within five to seven years, the Department of Veterans Affairs estimates that more than one million new veterans will enter their system, in need of disability claims processing, health care, and more.

The influx is both enormous (the VA reports it served 1.3 million veterans in total during 2011) and inevitable: with combat ending and the ranks narrowing after a decade and a half of war, many troops will begin the natural process of transitioning out of the military and returning to civilian life.

The VA that will receive them is already overburdened, battling a veterans’ claims backlog of over a decade that swept past 600,000 overdue claims just last week and shows no clear signs of improvement.

“This is disgraceful. This is an insult to our veterans. And you guys just recycle old programs and put new names on them,” House Veterans Affairs committee ranking member Rep. Bob Filner (D-Calif.) exploded at a June 19 hearing, before testimony was even under way. “We just keep announcing new names, new pilot programs, on and on. If it wasn’t tragic, it would be ridiculous.”

By Fiscal Year 2013, federal funding for veterans, at $140 billion, could surpass total federal funding for education. The VA, including all claims centers and hospitals, employs about 300,000 workers, and 3,300 of those employees have been hired since the start of FY 2010 just to augment the staff processing disability claims. But money and manpower has not been enough to stem the worsening problem of connecting veterans to healthcare and benefits in a timely fashion.

l Backlogged claims: The VA defines a backlogged claim as one not processed within the department’s goal timeframe of 125 days. The claim is the first step in the disability process, and a granted claim, awarded by percentages according to the severity of a service-connected illness or injury, results in a set cash benefit. The backlog dates back to the 1990s and has grown rapidly in recent months. From January 2011 to the week ended July 9, the backlog roughly doubled, from 300,000 claims to just over 600,000. More than two-thirds of all pending claims, each representing an ailing or injured veteran, are now dragging months behind schedule.

l Long waits: The average claim adjudication wait time is as few as 183 days or as many as 300, depending on who you ask. Claims processed in Oakland, Calif., the second-worst backlogged region in the nation according to a May Inspector General’s report, take nearly a year to get approved or denied. The backlog worsened in 2010 when VA Secretary Eric Shinseki added a handful of new medical conditions to the list of ailments presumed connected with exposure to the Vietnam-era herbicide Agent Orange, a move that was lauded by veterans’ groups. But this month the VA officials announced they were nearing the end of processing about 230,000 retroactive Agent Orange claims. And the majority of the nearly 920,000 total claims still pending before the department remain overdue.

l Paper-based system: Lacking technology also slows the process: the VA and Department of Defense use largely incompatible information technology systems, unable to easily communicate regarding veterans’ health records. And, the claims system remains largely paper-based, a decade into the 21st century. House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.) said he was most frustrated with the outdated mechanics of the system, making it taxing on veterans and susceptible to human error.

“What you have now is World War II veterans relegated to carrying boxes of papers down the hallways of (the Veterans Benefits Administration) or regional offices in an attempt to get their claims adjudicated,” he said. “And that’s not right.”

VA knows it has problems

VA officials are amply aware of the problem. On June 19, VA undersecretary for benefits Allison Hickey testified before the House Veterans Affairs Committee that a new electronic Veterans’ Benefits Management System would break the back of the backlog by 2015, processing claims on time with 98 percent accuracy, in spite of the new wave of veterans entering the system. More recently, Hickey told reporters the department plans to fast-track certain claims to regional offices to speed the process of resolution.

But the announcements are the last in a long series of shiny promises, all trumpeting dynamic changes expected to cut through layers of bureaucracy and clear the wait list—and all failing to deliver. As early as 2001, according to archives kept by the blog VAWatchdog.org, the VA was touting a new 120-day task force aimed at making the claims system current. A decade ago, those 120 days came and went.

To hear some lawmakers describe it, the entrenched bureaucracy of the VA is like Pilgrim’s Progress author John Bunyan’s Slough of Despond, in that “here have been swallowed up at least twenty thousand cart-loads, yea, millions of wholesome instructions”—all unsuccessful at providing a clear way above the mire.

Business sense

But former House Speaker Newt Gingrich, who discussed improving care available for military brain injuries and making healthcare vouchers available for veterans while he was on the presidential campaign trail earlier this year, told Human Events in an interview that the answer lies not in more money or more people, but in a fundamental rethinking of the Department of Veterans Affairs. One such effort he proposed: inviting a brain trust of successful business leaders to tackle the VA in a way that could inject the department with market urgency and efficiency.

“If McDonald’s can report worldwide (store sales) at five o’clock every evening,” Gingrich said, with a wry grin. “I suspect, by the way, that one White House dinner that had the right 40 people, all of whom had to have at least a billion dollars in assets, would have so much talent devoted to reforming the VA the following morning, so many resources made available to the VA the following morning, that it would be startling.” Gingrich said choosing those with experience as industry leaders to head the VA could also help to put systems back on track.

“You end up with retired people, academics, what have you, people for whom it’s a good job,” he said. “These are jobs that are so big you don’t want somebody for whom it’s a good job; you want somebody who has already done a job this size.”

Miller also saw hope in a free market opportunity.

“I have often said if the federal government would offer some young group of software developers a million dollars to develop a patch that would allow the DoD and VA systems to communicate, they’d do it in 24 hours,” he said, during an interview with Human Events in his office. “But people, being the humans that they are, like staying with what they know. Unfortunately, it isn’t serving the veterans who are trying to get their disability ratings decided.”

Take a page from the IRS

At the June 19 hearing, Filner pointed out that not all government bureaucracies function with the seeming lack of urgency for which people fault the VA. The Internal Revenue Service, for example, speedily processed millions of tax returns annually by assuming information submitted was accurate, then auditing periodically to encourage honesty and root out fraud.

“Grant the claim, subject to audit,” Filner said. “Send out the check, do something.”

Two relatively junior members of the committee, both physicians who previously served in private practices, offered a more nuanced option: establish a fast-track system for claims of tinnitus, or hearing loss. Touted as the number-one service-connected disability each year by the American Tinnitus Association—over 840,000 veterans received compensation for tinnitus in FY 2011—the condition is also easy to diagnose with a simple examination.

“Hearing, you can test it pretty easily, make those determinations,” Rep Phil Roe (R-Tenn.) told Human Events. “Many veterans have been in combat; It just happens. Those are simple things they should get off the table.”

Rep. Dan Benishek (R-Mich.) said he planned to introduce a bill, in this legislative session or the next, to make tinnitus a presumptive temporary assignment.

“Audiology, it’s a simple determination: a guy has hearing loss or he doesn’t. Why does that take 18 months then to make a determination that a guy has a hearing loss?” Benishek told Human Events. “Why can’t we make a temporary disability for hearing loss, get him his benefits immediately? Why can’t we eliminate that 30 percent from the backlog and speed up the process.”

According to worksheets provided by the VA, a hearing loss claim grant now requires completion of five steps, included review of a veteran’s medical records and history, before diagnosis and claim adjudication can be made.

Challenge veterans service organizations

Gingrich laid much of the onus for sparking change within the VA at the feet of veterans service organizations, the congressionally charted, independent advocates for veterans.

“With very bold and dramatic change, for that the veterans’ organizations would have to decide that they are prepared to see change at the VA. I think today they’re not prepared to say that,” he said. “Their job is to represent the veterans, and they ought to be clear and aggressive about whether they think this generation of veterans is getting the care they need in the way they need it, in a timely manner and a convenient manner. I think it’s very hard to answer yes to that.”

Gingrich said he suspected many organizations calculated it was safer to work within the bureaucracy than to anger decision makers and risk losing valuable access and clout.

Filner’s June 19 rant did not spare the organizations either.

“Why are you so afraid of blowing up the whole system? Why are you guys playing their game?” he asked. “You represent the veterans. Do something real.”

Human Events reached out to two of the highest-profile organizations, Disabled American Veterans and Veterans of Foreign Wars, for comment.

VFW Public Affairs director Joe Davis said more attention should be paid to the positive work of the VA in adjudicating thousands of new Agent Orange claims from those who served in the Vietnam era, welcoming large numbers of veterans into an already overburdened system, and taking steps to provide ample care for veterans of the current conflict immediately following their years of service. In spite of speed bumps, the department, he said, was on the right track.

“You’ve got to look at the big picture instead of just banging,” Davis said.

David Autry, deputy national director of Communications for DAV, said veterans’ organizations were working hard to assist the VA’s efforts to implement an electronic system and to challenge poor performance.

“We have to work within the system that we have, but we are continually urging the VA to straighten up and fly right,” he said.

Start fresh

Jim Strickland, a Vietnam veteran and manager of VAWatchdog.org, is tired of watching veterans struggle to play by outmoded rules.

“The Department of Veterans Affairs is hopelessly broken and the really big problem is until Congress acts decisively, VA will not repair itself,” he told Human Events. They need to remodel the Department of Veterans Affairs. They need to reorganize the VA and give them a new mandate.”

Strickland said that despite ample funding, the system was often arcane, operating by laws and disability schedules created decades ago.

As the system stands, he said, “the VA is at war with veterans.”

In Congress, some are beginning to acknowledge that the department is at a tipping point.

“The VA is well intended as it is, and it still moves at glacial speed,” Roe said. “If it continues to get worse, you do have to think outside the box.”

Gingrich said a fundamental re-conception of the VA was in order to make the system convenient for veterans rather than bureaucrats and give more attention to post-traumatic stress and traumatic brain injury, the signature wound of the wars in Iraq and Afghanistan. The issue was so important, he said, that he would like to see it a part of the Republican presidential platform.

“We’re faced with a new generation of veterans’ problems vastly different than earlier ones,” he said.

Miller suggested his committee might be able to pursue more aggressive solutions for reforming the VA after the end of combat activity in Afghanistan, and said he was willing to countenance a more radical change.

“We do know that throwing money and people at the problem hasn’t solved it,” he said.

Invited to comment on this story, VA spokesman Josh Taylor referred to the electronic management system for claims, reiterating the department’s goal of resolving the backlog by 2015.

“This administration has shown unwavering commitment to serve Veterans,” the spokesman said in a statement. “VA has completed a record-breaking 1 million claims per year the last two fiscal years, and we are on target to complete another 1 million claims in FY2012. But too many veterans have to wait too long to get the benefits they have earned and deserve.”

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