Eliminate the Disability Claims Backlog:
(c-123 veterans' perspective: vBA denies all our Exposure claims; consider Just denying them promptly so we can save a year and proceed to the BVA)
VA will provide timely, accurate decisions on Veterans’ disability claims and eliminate the claims backlog in FY 2015. Improving quality and reducing the length of time it takes to process disability claims are integral to VA's mission of providing benefits to eligible Veterans in a timely, accurate, and compassionate manner. In 2013, VBA began measuring the accuracy of individual issues for each claim (“issue-based accuracy”), as it provides a more detailed measure of workload proficiency. However, VBA will continue to monitor and report out on claim-based accuracy as a key indicator for this APG. To improve benefits delivery, VA is transitioning to an electronic claims process that will reduce processing time and increase accuracy. As of the end of September 2013, over 60 percent of VBA’s inventory is in electronic format and is being processed electronically by VBA employees using the Veterans Benefits Management System (VBMS). In addition, VA is delivering training that is more aligned with the needs of the workforce to operate in this electronic environment. VBA is encouraging Veterans to submit Fully Developed Claims (FDC) that include all supporting evidence when the claim is filed. The FDC is typically the fastest way for Veterans to receive a decision on their claims. Increasing the number of FDCs filed electronically by Veterans, or by Veterans’ representatives on their behalf, reduces the major source of delay associated with gathering evidence to support a claim and helps reduce the overall time it takes to process a claim. Through people, process, and technology integrated initiatives, the workforce will achieve the goal of eliminating the disability claims backlog.
VBA’s integrated approach includes technology solutions that drive automation, improve the quality of work, reduce variance, and speed efforts to complete claims electronically. These innovative technologies include VBMS and the Veterans Relationship Management (VRM), integrating business processes to take into account electronic filing of claims, national workload distribution, as well as the receipt of complete and certified medical, dental, and personnel records from the military services. VBA established the Veterans Claims Intake Program (VCIP) in 2012 to streamline the process for receiving records and data into VBMS. VCIP converts claims and other paper records into a digital format that is usable within VBMS. At the end of September 2013, 60 percent of current claims were in the electronic environment and over 250 million images had been converted from paper and uploaded into VBMS.
Because VBA’s organizational transformation is sweeping and multi-faceted, this major change cannot be a “once-and-done,” “flip-of-the-switch” proposition. Transformation is a deliberate and multi-year process. VBA is pursuing transformation according to a carefully developed timeline and an implementation plan that rolls out changes in people, processes, and technology in a progressive, intentional sequence that enables efficiency gains while minimizing risks to performance.
On April 19, 2013, VBA implemented a special initiative to quickly decide the oldest claims in the inventory. This initiative was created to accelerate the delivery of benefits to Veterans who have waited the longest for a decision, and is a key part of VA’s overall strategy to eliminate the claims backlog in 2015. In June, VA completed the first phase of the initiative, which focused on all claims pending over two years. Over 99 percent of these two-year claims (over 67,000) have been processed for Veterans, eliminating those claims from the backlog. Since that milestone, VBA claims processors focused on completing the claims of Veterans who have been waiting one year or longer for a decision. VA had processed approximately 95 percent of the 513,000 one-year claims as of the end of FY 2013. In FY 2014 and 2015 VBA employees will continue to process oldest claims as a priority.
In addition, VBA implemented mandatory overtime starting in May 2013 for VBA’s claims processing staff. VBA also redistributed, or brokered, work among regional offices to maximize the capacity of the entire VBA workforce to ensure that the next oldest claim was completed on the basis of a national workload.
On October 1, 2012, VBA initiated issue-based reviews of rating claims using the existing Systematic Technical Accuracy Reviews (STAR) process. The primary goal was to identify, down to the specific diagnostic code, all existing benefit entitlement errors, and correct actions at the issue level. These new procedures were also developed to more accurately identify issue-specific deficiencies in rating procedures, and to identify targeted training opportunities. Each claimed condition is evaluated independently using the STAR rating-decision checklist. Dual reporting of claim-based and issue-based accuracy statistics continued through FY 2013.
Since inception, the accuracy of issue-based reviews has averaged six percentage points greater than claim-based reviews. This was primarily due to the evaluation methodology for assessing claim-based accuracy, where one error in a multi-issue claim resulted in a 0% accuracy assessment. For the three months concluding September 30, 2013, issue-based accuracy was 96.7% compared to 90.6% for claim-based reviews. Beginning in October 2013, issue-based accuracy will be reported, as it represents a more appropriate way to measure accuracy. Three-month and twelve-month cumulative accuracy reports for the nation and each regional office will be available.
Launched in January 2013, VBA’s Statistical (STAT) Reviews are robust performance analysis mechanisms that use operational data and graphical visual displays to monitor progress and drive performance improvement. These reviews involve rigorous performance evaluations with VBA senior leadership and regional office directors to analyze and measure results. VBA leaders discuss challenges, successes, best practices, and action plans using targeted data-driven performance measures focused on accountability for improved performance.
VBA continued its strong collaboration with the Veterans Health Administration (VHA). VHA supported the oldest claims initiative by expediting the scheduling of examinations. VHA also used all available resources by temporarily assigning clinicians to conduct examinations, maximizing the use of disability contract examiners, and employing innovative solutions such as the Acceptable Clinical Evidence (ACE) process. ACE facilitates the completion of Disability Benefits Questionnaires (DBQs) using existing medical evidence of record when the clinician determines that the evidence is sufficient to complete the requested evaluation, reducing the need to conduct an in-person VA examination. VHA provides clinicians at VBA regional offices to expedite claims processing by clarifying medical opinions and answering claims processors’ questions.
Through these prioritization initiatives, VBA has made notable progress in reducing both the backlog and the pending inventory and is on track to eliminate the backlog in 2015. As of September 30, 2013, the number of disability claims in the VBA inventory had been reduced from the peak of 884,000 to 722,000, the lowest number of claims since October 2010. In addition, the number of claims in the backlog was reduced by more than 31 percent from 611,000 to 418,000 claims.