Yesterdays VA OIG report on Appeals issue

[Berta]

https://www.va.gov/oig/pubs/VAOIG-16-01750-79.pdf

Yesterday the VA OIG released this report on the Appeals situation.

It is a staggering rendition of what so many of you here have had put up with....for years in many cases.

I could copy and past here some of the parts- such as the many errors that still are made at the RO level,

the lack of proper follow- through on remands, payments from BVA grants taking excessive amounts of time- even appeals being closed prematurely,  etc etc- best that everyone read it for themselves.

It even mentions how attorney and agent fees are often higher soley due to RO delays.

Many here have experienced the very issues that this report highlights.

I wonder if this is what caused the firing yesterday of the Secretary.The rumors were there but this might have been the smoking gun.

If so, this should be the first thing the new Secretary deals with.

The problem with VA OIG investigative  reports is that they only involve claims that are  picked at random as I understand it, and the VA OIG does not have the time to access most of the claims at each RO.

I dont know why they don’t access sites like ours to see how many vets have problems due to VA inefficiency and VA errors.

Or better yet. Hear from veterans themselves- but the VA OIG has never gotten directly involved in individual claims issues…unless it could be an issue like Keith Roberts had.

Maybe this could be the first issue the new Sec tackles-

Our Vet Orgs have been ineffective in fighting for our basic rights, to expect our ROs to do much better and follow established VA case Law,and M21-1MR.

Veterans can have input to change this.......I have been griping about these unconscionable issues and errors for decades.

(I changed my VA Template already and am re mailing my recent letter to the new VA Secretary

Is anyone here willing to write to him about their specific problems with their claims that reveal any of the same deficiencies the VA OIG report mentions?)

 

 

 

Secretary Rear Adm. Ronny Jackson

Veterans Administration

810 Vermont Ave. NW
Washington, DC 20420

 

And send a Copy to President Donald J.Trump

                           The White House

                               1600 Pennsylvania Avenue NW

                                  Washington, DC 20500

 

 

 

 

 

Edited March 29, 2018 by Berta
added more

[vetquest]

Yes, I would be willing.

[Berta]

THANKS!!!!!!!!!

Hope others will too.....!!!!!!!!

[Tbird]

vaoig-vba-review-of-timeliness-appeals-process-16-01750-79.pdf

Why the OIG Did This Review

Our prior report, Audit of VA Regional Offices’ Appeals Management Processes (Report No. 10-03166-75, May 30, 2012), concluded that opportunities existed for the Veterans Benefits Administration (VBA) to improve timeliness in processing appeals. The OIG found VA Regional Office (VARO) managers did not assign enough staff to process appeals and diverted appeals staff to compensation claims processing, which VBA considered a higher priority. At the end of FY 2012, VBA reported having 254,604 appeals pending nationwide and an overall average of 903.1 days to resolve appeals. By the end of FY 2015, VBA reported its pending appeals had increased to 318,532 nationwide, and the overall average days to resolve appeals had risen to 935.9.

The OIG conducted this review to determine whether opportunities continued to exist for VBA staff to improve the timeliness of appeals processing. This review focused on appeals in seven phases where VBA was required to take action after receipt of a (1) notice of disagreement (NOD), (2) substantive appeal, or (3) decision from the Board of Veterans’ Appeals (Board). Figure 1 depicts the three stages and seven phases where VBA was required to take action on an appeal.

What the OIG Did

The OIG conducted this review from January 2016 through November 2017. To accomplish its objective, the OIG reviewed applicable laws, regulations, policies, procedures, and guidelines. The OIG reviewed statistically selected random samples of 30 appeals related to rating decisions from each of these seven phases—a total of 210 appeals. Although each selected appeal completed a phase during the first quarter of FY 2016, not all of the appeals were fully resolved. Appeals that completed Phases 4 or 7 were transferred to the Board for further processing. Appeals that completed Phase 5 may have remained pending if there were also remanded issues. The OIG analyzed the time it took VBA staff to complete processing actions in these phases, such as establishing or managing controls in the electronic systems, requesting or obtaining evidence, making decisions, processing payment adjustments, communicating with appellants, and transferring cases to the Board. 

The OIG interviewed appropriate VBA management and staff responsible for processes associated with appeals to obtain an understanding of work performed in each phase. The OIG conducted onsite interviews with VBA management and staff at six randomly selected VAROs and the Appeals Resource Center. The VAROs selected were Chicago, Illinois; Honolulu, Hawaii; Jackson, Mississippi; Montgomery, Alabama; Togus, Maine; and White River Junction, Vermont. The OIG assessed whether VBA staff complied with appeals processing policies and procedures, specifically focusing on those affecting timeliness. 

What the OIG Found

VBA staff did not always timely process the appeals workload. Sample results showed VBA took an average of 111 to 755 days to complete the various phases, and the OIG found significant periods of inactivity throughout all phases. The OIG considered a period of inactivity to be from when VBA staff could have taken action on an appeal to when they actually took an action. Although some appeals had multiple periods of inactivity, the OIG focused on the longest single period of inactivity in each case. On average, a single period of inactivity accounted for approximately 45 to 76 percent of the total processing time in each phase.

Figure 2 shows the average number of days for the longest single period of inactivity as a percentage of the average days to complete each phase.

Figure 2. Average Days of Longest Period of Inactivity as a Percentage of the Average Days to Complete Each Phase

Examples of periods of inactivity in each stage follow.

•    In  one  appeal  in  Stage  1,  VARO  staff  established  control  of  the  appeal  on   September 13, 2014.  VARO  staff  did  not  take   the   next   required   action   until   August 6, 2015—327 days later. This period of inactivity accounted for 71 percent of the time from when VBA received the NOD until it was resolved.

•    In one appeal in Stage 2, a veteran  requested  his  appeal  be  sent  to  the  Board  on  October 31, 2014.  VARO  staff  did  not  certify  the  appeal  to  the  Board   until   December 7, 2015—402 days later. This period of inactivity accounted for 48 percent of the time from when VBA received the substantive appeal until it was certified.

•    In one appeal in Stage 3, the Board remanded an appeal to VBA on February 12, 2015. VARO staff did not take action on the remand until September 24, 2015—224 days later. This period of inactivity accounted for 78 percent of the time from when VBA received the remand until the appeal was resolved.

In addition, the OIG found errors that delayed appeals processing. In Phase 2, the OIG estimated 17 percent of the appeals were closed prematurely. Once the records were closed, processing on the appeals stopped when they required additional action. Also, in Phase 7, the OIG estimated  13 percent of the appeals were not processed according to the Board’s remand instructions.

OIG determined opportunities continued to exist to improve appeals timeliness because periods of inactivity accounted for significant percentages of the total processing time in each phase, and errors caused additional avoidable delays. The OIG reviewed appeals that completed a phase during the first quarter of FY 2016. However, at the end of April 2017, VBA reported pending appeals at VAROs averaging 444.2 days, a 1.4-day improvement compared to the end of the first quarter of FY 2016.

Why This Occurred

Generally, periods of inactivity associated with the appeals process occurred because VBA senior leadership prioritized the rating claims backlog over other workloads and did not dedicate sufficient resources to timely address appeals. Senior VBA leadership acknowledged it knew these actions would have negative consequences on appeals timeliness, but the then Under Secretary for Benefits (USB) made the decision to prioritize the rating claims backlog over any other work. 

In addition, VBA had an ineffective procedure for notifying VAROs when they were required to process Board grants. Some appeals were prematurely closed because VBA staff failed  to update, or incorrectly updated, the electronic system, and they relied on an automated function to close some appeals. Failure to follow the Board’s remand instructions resulted from inattention to detail and ineffective oversight.

What Resulted

VBA’s lack of priority in processing appeals delayed appellants receiving timely resolution of their appeals, which in some cases resulted in appellants waiting years to receive favorable decisions and compensation. For example, one appeal that involved a favorable Board decision took approximately five years from the date VBA received the NOD until the appeal was resolved. This overall period included some processing time that was outside VBA’s control, such as time spent with the Board. However, once the Board ultimately granted the appeal, VBA staff took more than one year to implement the decision. VARO staff’s delay in implementing this favorable Board grant contributed to the delay in resolving the appeal.

Overall, the OIG estimated that VBA staff issued favorable decisions in 29 percent of appeal stages that were completed during first quarter of FY 2016. The OIG estimated the appeals with favorable decisions resulted in additional compensation averaging approximately $32,800 through January 2016, and $650 in recurring additional monthly payments as of February 2016.

Delaying decisions also resulted in some appellants paying more of their benefits to accredited attorneys and agents who were entitled up to 20 percent of the appellants’ past-due benefits. Past-due benefits are calculated from the effective date of the increase in benefits to the date of the decision awarding benefits. Since delays in VBA staff completing decisions that award benefits can result in an increase in past-due benefits, VBA may pay more of appellants’ benefits to their representatives.

Some appellants died before receiving final decisions on their appeals. In accordance with its procedures, VBA counted these as resolved appeals. VBA reported that, at the end of the first quarter of FY 2016, they had resolved approximately 23,200 appeals. The OIG estimated approximately 1,600 of these appeal records (7 percent) were closed due to the death of the appellant. About 1,100 of these appeal records had been pending for more than one year when the appellants died. However, as these appellants died before receiving final decisions, the OIG could not determine whether they would have received any additional benefits. In some cases, VBA will open a new appeal record if an eligible party continues the appeal for the deceased appellant.

Finally, appeals processing errors resulted in VBA losing control of some appeals, misrepresented VA’s reported statistics, and caused unnecessary delays in resolving appeals. Based on sample projection results, the OIG estimated 2,300 appeals records were closed prematurely during the first quarter of FY 2016. VA considered these appeals resolved; however, appellants were likely unaware since VARO staff did not notify appellants at the time VA closed the appeals. In addition, the OIG estimated 630 remanded appeals were returned to the Board without following the Board’s instructions. As a result, these errors could cause significant delays in appeals processing and misrepresent appeals statistics.

What the OIG Recommended

The OIG recommended the acting USB continue to monitor the effectiveness of VBA’s appeals realignment and increased resources towards meeting its established targets related to appeals processing timeliness. The OIG recommended the acting USB monitor the effectiveness of the Caseflow application to ensure Board decisions are timely controlled and assigned to the appropriate VARO or the Appeals Resource Center. In addition, the OIG recommended the acting USB implement a plan to amend VBA procedures for closing appeals records to prevent appeals being closed prematurely, to remind staff of their responsibilities when processing remands and recertifying appeals to the Board, and to ensure compliance.

Agency Comments

The Executive in Charge (EIC), formerly known as the acting Under Secretary for Benefits, noted that the OIG report did not assess the statutory features of the current administrative appeals process for impact on timeliness. The EIC explained that this finding is misleading because it implies, without further analysis, that VBA could have timely processed appeals, in the current process, with its finite resources. In fact, for the past few years, VA has been clear that the current appeals process is broken and provides veterans a frustrating experience. To address this problem, VBA and the Board of Veterans’ Appeals worked with Veterans Service Organizations, advocacy groups, congressional staff, and other stakeholders to design a new appeals process that is timely, transparent, and fair. These efforts resulted in the enactment of the Veterans Appeals Improvement and Modernization Act of 2017, which VA will implement in February 2019. While VBA agrees with OIG’s suggestion that VBA had opportunities for improved timeliness in its appeals processing, which VBA has already demonstrated with its realignment of appeals and the resulting 24-percent increase in FY 2017 production, it does not agree that VBA could have timely processed appeals in the current process with its finite resources. The legacy appeals system does not allow VA to drive timeliness. This is a factor of veterans’ choice and the inefficient “churn” inherent in the system.

The OIG disagrees that the finding is misleading. The OIG did not state VBA could have timely processed appeals in the current process with its finite resources. Rather, the OIG report states that VBA dedicated resources disproportionately to process the claims backlog, despite being aware of challenges in the appeal process and anticipating that processing more claims would result in more appeals. Ultimately, VBA’s decision to prioritize the disability claims backlog negatively affected appeals processing timeliness. This workload decision does not negate the OIG’s conclusion that periods of inactivity demonstrated that opportunities existed to improve the timeliness of completing the appeal phases. 

The EIC concurred with Recommendations 1, 2, 3, and concurred in  part  with  Recommendation 4. The EIC’s comments and actions are responsive to the recommendations. The OIG will follow up with the implementation of the recommendations as required.

 

[broncovet]

This is one of the few "credible" VAOIG reports I have read.  Most say things like "action has been taken to resolve these issues,"  when we all know that has not happened.  The VAoig AT LEAST admitted to what many of us already know.  

For example, it took my VARO 3 years to implement a Board Remand, and only then, after I cut and pasted to them the exact words that the VARO was to remand my TDIU issues, and after contacting Allison Hickey in an attempt to force the VA to comply with the remand.  

However, its still "troubling" that the VAOIG "makes recommendations", rather than making arrests, or really doing anything about it.  

It would be like the DEA (Drug Enforcement Administration) "making a recommendation" THAT individuals should not sell or use drugs.  

The DEA does not make recommendations, they bust down doors and make arrests.  That is what is needed.  

[Berta]

Yeah, the IG is hindered from taking any actions against the VA. Just like what the Feds are going through now-

with FBI -gate.  They need another Special Counsel  to handle that and VA needs someone like a Special Counsel too ,to give teeth to the deficiencies,  to find out  who these people are who make so many errors on our claims, and to CAN them.

Shulkin has been talking a lot today on TV about what he went through...( he is pretty pissed off. )

The former Sec Shulkin  will be on Brett Bares show at  tonight 6 PM EST (Fox Channel 360 Directv.)

I cant wait. 

 

 

[broncovet]

Berta..did you see the Bret Bares show, and, if so, was it productive??