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)
GOAL OVERVIEW
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.
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