April 23, 2018
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How the U.S. Department of Veterans Affairs can address its claims backlog

By Mike Michaud

The U.S. Department of Veterans Affairs claims backlog has been an issue that has risen to national attention and prompted much outrage. And for good reason — the number of veterans’ claims currently pending approval by the VA totals almost 880,000. Claims pending more than 125 days, which are considered “in the backlog,” total nearly 600,000.

This number is unacceptable and must be addressed. The VA has put in place an agency-wide plan to fix it, which it says will eliminate the backlog in 2015. I applaud this ambitious goal, but I don’t know if the numbers will add up. I believe Congress has an important role to play in making sure the VA accomplishes its goal to provide veterans the benefits they’ve earned faster.

But understanding how to address it requires a bit of context.

Unfortunately, the backlog is not a new problem. The current paper-based system was established following World War I, and it was not until 2009 that our nation finally invested heavily in modernizing the claims processing system.

And while the VA has been dealing with stacks of paper, the complexity of modern claims has increased and has been layered with challenging policy requirements. For example, World War II veterans filed for an average of one to two medical conditions in each claim, while Iraq and Afghanistan veterans file for an average of 15 to 20. This increase in the number of medical conditions significantly increases the complexity of claims and the time it takes to adjudicate them.

But it’s not just the complexity of claims that has caused the backlog to skyrocket.

VA Secretary Eric Shinseki made the right decision in 2009 to make Vietnam veterans who were exposed to Agent Orange eligible for benefits. However, it did add 260,000 complex claims to the VA’s workload when the agency was already experiencing high overall demand and working to expand benefits to our troops coming home from Iraq and Afghanistan.

And while the paper-based system and a massive influx of claims added substantially to the backlog, it isn’t the full story.

The most time consuming portion of claims processing can be waiting to receive information in support of a claim from the Department of Defense. On average, the VA spends 175 days trying to obtain service treatment records from the defense department, which represents approximately 70 percent of the average claims processing time. Fixing this issue has been described by the VA and defense department to be a real “game changer” for our veterans’ ability to get timely decisions.

To address some of these issues, the VA is currently in the process of implementing its multi-pronged “Transformation Plan,” which consists of many initiatives, the most significant of which is moving to a fully electronic processing system. In addition, the VA is expediting completion of the oldest claims and mandating overtime for claims processors in its 56 regional benefits offices.

While these initiatives are positive and needed, I believe more needs to be done. That’s why I recently spearheaded an effort in the House Veterans’ Affairs Committee to develop a legislative package designed to help the VA meet its goals and get veterans their benefits faster. Here’s a quick overview of some proposals contained in the 10 bill package:

— Require the defense department to provide certified, complete and electronic records to the VA within 21 days. This would greatly reduce the time spent waiting for the defense department to provide information.

— Pay veterans as medical conditions are adjudicated. Veterans currently receive payment when all medical conditions within a claim are fully adjudicated. Changing this will pay veterans faster.

— Enable quicker, more accurate rating decisions by requiring VA to maximize the use of private medical evidence. Instead of requiring a VA medical examination, veterans would be allowed to supply medical evidence from their non-VA doctor. This would also conserve VA resources, which could be applied to other claims processing areas.

— Establish “Centers of Excellence” for claims adjudication. The VA would boost support for the best performing regional offices in order to focus additional attention on the most complex and time consuming medical conditions. This would reduce the time it takes to adjudicate these conditions and decrease error rates.

These are important steps we can take right now to get veterans the benefits they’ve earned faster. Regardless of how it gets done, we must take action now. Nearly a million veterans and their families depend on it.

U.S. Rep. Mike Michaud, D-2nd District, is a ranking member of the House Veterans’ Affairs Committee.

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