diabetes Over 6 Years Old

[carlie]

The figures may have changed slightly but the same problems continue.

http://www1.va.gov/opa/feature/Speeches/docs/dec00ss.pdf

A SNAPSHOT OF VA COMPENSATION AND PENSION

JOSEPH THOMPSON, VA UNDER SECRETARY FOR BENEFITS

PRESENTED AT THE VA EX-PRISONER OF WAR ADVISORY COMMITTEE MEETING

DETROIT, MICHIGAN

December 4, 2000

An interesting feature of compensation and pension is how long people have been in

military service who are filing claims. Those with three years or less service constitute 27

percent of our claims. Those with 20-plus years constitute 38 percent of our claims. Now

many of you may not understand this, but if you retire from active duty and you get compensated

by VA, you can’t collect both your retired pay and your compensation at the same time.

You have to opt for one or the other. Most opt for compensation because it’s tax free. So if

VA pays $500 a month in compensation, they’ll take that in lieu of $500 or retirement pay

because this is not taxable. So you’ll see a fair number of claims from people who are retired,

and you can imagine that in 20 to 25 years in the military you’ll pick up your share of things

that go wrong. Reopened claims are a little bit different. You’ll see they are overwhelmingly

from veterans with zero to three years military service. The reason is that Vietnam and Korea

had a fair number of folks who served three years or less; Vietnam, particularly, so reopened

claims are going to reflect that.

Here is an interesting graph that represents what the military is seeing today. Realize

that DoD does have its problems recruiting people into the military. I think these numbers are

very illustrative of that. Thirty-seven percent of all people who enlisted in the military failed to

complete their first enlistment. This is an all-time high. They do not complete their enlistments

for a variety of reasons: medical and physical, performance reasons, fraud on their enlistment,

and other. This is interesting from VA’s perspective because they do end up at VA. Many of

these folks who wash out early do come to VA for help. They turn to us sometimes as a last

resort.

This graph illustrates the distribution of disability evaluations. It’s a little complicated so

let me explain. If we were considering a hundred different disabilities, this is the breakdown on

average in FY2000 of how we would have decided those issues. Fifty-three-point-seven

percent would have been denied coming out of blocks, either as non-service connected or

nondisabled. Another 23.4 percent would have been found to be zero percent disabling. That

means you have some disability but it doesn’t rise to a level that warrants compensation.

Seventeen-point-seven percent would be a 10 percent disability evaluation and then you can

see 20, 30, 40 to a 100 percent constitute about five percent of all the evaluations. If you

count 10 percent, zero and denials, you account for about 95 percent of all the decisions we

make. The popular perception is that we are dealing overwhelmingly with people with very,

very severe disabilities. While that does happen, most of the things we look at are not usually

that profound.

If you look at claims per veteran, and many file for more than one disability, then in 71

percent of the cases we find some kind of service connection. It may be zero – often times it is

zero – which means that you get treatment for the disability but no compensation. The flip side

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of that is that in 29 percent of the cases we find nothing.

All of these statistics and demographics are in our annual report — the first time this

agency has pulled all of its benefits information together and I think it will really help us shape

our programs in the future.

Now I’ll talk about issues that I think are of great interest to most veterans. This is our

balanced scorecard, the way we have of measuring our own performance. We look at five

things: accuracy, speed, unit cost, veteran satisfaction and employee development. I’m going

to talk about two of them, accuracy and speed. Accuracy is how many mistakes we make and

speed is how quickly we do things.

I’ll start with a premise – we make too many mistakes. We acknowledge that going in.

We are devoting a lot of time, money and human resource to make that better. The STAR

system, our acronym for the system we use to track errors, is a zero defects sytstem. If there

are close to 200 ways to make a mistake and if you make only one mistake, that doesn’t mean

you have a point-five percent error rate; it means you have a 100 percent error. Any mistake is

fatal. That’s why we call it a zero defects system. It is very stringent.

Payment errors, where we actually calculate the wrong amount, is a relatively small

percentage of the errors we find. Most of the errors we find are procedural in nature. That

means we strung the case out longer than we needed to; we didn’t ask for all the information

we needed; and a variety of other things. I’ll go through some of the errors.

Fundamental result – This is an error where we just got it wrong. We made an incorrect

evaluation; maybe the veteran was 20 percent disabled and we put 10 percent – or the

other way around, we over-evaluated.

Wrong decision to grant or deny – We should have granted when we denied or vice

versa.

Wrong effective date – You would think it’s easy to decide when to start paying benefits.

It should come from one of two dates, the date the veteran filed or the date of the disabling

event. Actually, there are 35 pages of matrices on how to calculate an effective date.

The law is that complicated, so we get that wrong a fair amount of time.

Other errors don’t necessarily affect payment, but are serious to us nevertheless.

All issues not addressed – Where the veteran might have claimed something in a

multi-issue claim that we didn’t fully address or, more likely, there are benefits that flow from

decisions we make. In other words, if the veteran was found to be permanently and totally

disabled, did we also consider telling him or her about dependents’ educational assistance for

spouse and children. If we don’t thoroughly address all those issues, the case is in error.

Duty to assist – We have a affirmative obligation to assist veterans with their claims to

try to help them secure evidence. If we do not do that to the extent we’re supposed to, that

puts the case in error.

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And third, this is the most common one, documentation notification — Some of our

letters our incomprehensible. You might have noticed that. That would be an error. Sometimes

we don’t send letters to the right party. The veteran has someone he gives power of

attorney to t and if we don’t notify them in addition to the veteran, that case is in error.

So these are serious errors as far as we are concerned, but they don’t necessarily effect

the dollar amount actually paid to the veteran.

Here’s a breakout of the errors, themselves. About six percent of the time we’re making

a mistake that affects payment. Twenty-nine percent are in those other error categories and

about 65 percent of the time there is no mistake.

This is not acceptable to us. This is way too high and we’re putting a lot of effort into

trying to fix this.

Many of our VA folks are trainees. VA is a wartime-era agency. We hire people based

on periods of war. When I came to work in the mid-seventies, the class of ‘46 was retiring.

Thirty years of service at age 55 is federal retirement. In the mid-seventies we saw the World

War II generation leave and not too long after that Korea. Today we’re seeing Vietnam walk

out the door. Add 30 years to the Vietnam era, figure out the average age and you’re getting

right around retirement age. So we are seeing an enormous amount of turnover and some of

this is reflected in our staffing.

Authorization – An authorizer makes all decisions that are not disability evaluation

decisions: decisions about your dependents, decisions about your service, decisions about

your income. You can see that approximately 31 percent of these people are what we consider

to be fully trained and experienced, with more than three years of experience. Sixty-nine

percent are in training. They need some help to a greater or lesser extent. They can’t get

through their workday without some kind external assistance. This is a serious situation for us

and hopefully we’ll be able to work through it.

Rating specialists – We’re in a little better shape here. These are the people who

make the disability evaluation decisions. About 53 percent of them we consider fully trained,

but still just less than half are in some kind of training status. Again, it’s a serious situation for

us and it’s not going to get better. The Vietnam era of employment has not begun to crest. It

won’t crest for another three to four years. When it does, we expect to lose between a third

and a half of all the experienced people we have in our regional offices today.

One bright note – we think our accuracy is improving somewhat in appeals. A veteran

can appeal his case. If he doesn’t like the decision made in a regional office, he can go to the

Board of Veterans Appeals. If the Board finds that the case is not complete, it will remand it

back to the regional office. Here are the numbers. The remand rate in FY1997 was in the high

forties (percent). It is down to 29 percent today. We think that is a good sign. Some remands

are necessary and not a result of anybody making a mistake. If a case is in the appellate cycle

and the law changes, by definition it must be remanded back to the regional office. We see

that today with Congress changing the law on duty to assist this year. Every case that’s sitting

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in the Board of Veterans Appeals today that has duty to assist as an issue will go back to the

regional office; not because anybody made a mistake, but because the law under which the

original decision was made has now changed.

We are doing a number of things to improve rating accuracy. We have a host of issues

all designed to try to make quality decisions.

By the end of this fiscal year 2001 we expect to get the quality rate from 64 percent to

72 percent as a result of the quality initiatives we have undertaken.

Let’s talk about the other half of the equation, speed – how quickly we do things. I know

we’re a bureaucracy and I know we’re slow, but it isn’t because people are sitting around being

passive. There are a variety of factors that contribute to how long it takes to do a claim, and

I’m going to talk about some of them.

Access to evidence – When a veteran files a claim with us, in 99.99 percent of the

time we have to get more information. It is extraordinarily rare when everything is included

with the original claim. We have to go typically to third parties and the time it takes those third

parties to get information back to us is listed here. It takes an average of 166 days to get

information out of the CURR, the Center for Unit Records Research. This is particularly important

for post-traumatic stress disorder claims. If a veteran files a claim for PTSD and does not

have in his or her individual record anything that could be considered a stressful event, then

we need to go secure the unit records. Getting those unit records takes on average five-andone-

half months. They have to go in and find the unit records we’re looking for by day, by

event, dig it out of cardboard boxes somewhere and send it back to us. That’s quite a bit of

work, but luckily there aren’t that many claims that fall into this category. This does not represent

a huge number of claims, but it does add a significant amount of time to processing.

The National Personnel Records Center does add time to many claims cases. A year

ago, they were taking 122 days on average to return information to us. Today it’s 112 days.

That’s because we’ve hired people to work there. NPRC is part of the National Archives system.

We’ve hired VA employees to work there to help them work down their backlogs. This is

one of the major sources of slowdowns of claims. For any veteran who was discharged before

1993 and files an original claim with us, we have to go to the records center and get his or her

service medical records. This is also the place that had the fire in 1972, so a lot of those

records were destroyed. So it takes us quite a while to get information out of the NPRC.

On average, it takes us 50 days to get private medical records. We’re going to be much

more aggressive with that in the upcoming year. We typically write the veteran and ask for

release for us to go to the doctor to get the medical records. We’re going to use the telephone

a lot more than we have in the past to try to speed this up.

VA exams take 41 days, on average. Hospital records take 31 days. And, if you were

discharged since 1993, your records go directly to VA. We keep them in St. Louis and it takes

two days for us to get them.

We are also increasing the number of decision-makers in the regional offices. This is

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important. Even though we have gone down in staffing in many cases, we have actually

moved people out of other operations into compensation and pension to help out there. In

compensation and pension staffing, we will go from 4,291 three years ago to 6.588 by the end

of FY2001. This is why a lot of those folks are in training.

Reduce the backlog – It is important for us to get rid of the stuff that’s filling up the

pipeline. We think that 250,000 pending claims pending at any given time is an appropriate

amount of work for our 6,000 workers. The amount of claims in the system above that – what

we consider in excess of our capacity – was up just under 400,000 total claims in the system in

February 1999. We ended this fiscal year at 309,000, and with any luck we’ll eliminate excess

pending claims above the 250,000 level by the end of FY2001. This is the result of people

working very hard and will ultimately affect how long it takes us to do claims.

Average days pending – When we look at the work sitting in regional offices –that 250

to 300 thousand claims – we look at how old they really are. In December 1999, they averaged

156 days. Today, they are in the 130s and that’s going down. This is good because this

is a leading indicator on how long it takes to do claims. This is the first thing that goes down.

The second thing that goes down is the actual cycle times. We continued to go up for about

the same period and peaked in February-March at about 176 days to do a claim. We ended

last fiscal year at 168 and expect to end this fiscal year at 158. Nothing to write home about,

but it is trending in the right direction. There are a couple of codicils, though, which I’ll mention

later.

National Personnel Records Center – We hired 30 VA people to work at the center to

help reduce backlogs and when they showed up for work October 1, 1999, they had 62,000

requests for records backed up. They’ve helped trim that down to about 41,200. We are

probably going to add another 20 or so employees to the NPRC this year. We’ve got to get

this down to a manageable number because this eats our lunch. Even though it’s not our job

to do this, we think it’s money well spent .

I’ll mention just a few other issues. We have new legislation; duty to assist legislation,

there’s legislation on Filipino veterans. We pay Filipino veterans the half-pay rate. They don’t

get dollar-for-dollar for disability compensation. However, the law changed. If they live in the

United States, they will get dollar-for-dollar; so we’re going to have to find these veterans and

figure a way to confirm their residency.

New presumptive conditions – We are going to service-connect Vietnam veterans for

diabetes. We’re considering other presumptive conditions, as well. That is going to add work.

This new legislation will give our workload a fairly good bump over the next two years. If

nothing changes, we expect our pending claims to climb up to 300,000 instead of trending

down to our desired 250,000 level. That actual days pending which we projected to go down

to 119, will probably go up to 150. The average days cycle time for completing a claim instead

of going down to 158 will go up to 171 this year and 183 next year. Now this is if nothing

changes, but we believe something will change; two things are going to change.

We are going to go to Congress through the Office of Management and Budget to ask

for a supplemental appropriation to help pay for some of the changes in the law. But more

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important than that, we have taken some fairly dramatic steps to change the way we do business

in the regional offices. We’ve put some teams together to look at how we can approach

some of this work differently. They’ve come up with a number of recommendations we think

will really help us do this work appropriately.

In the Gulf War, we got in the hole for a couple of reasons. One is we grossly underestimated

how much work would come out of that war. The war lasted a week, combat lasted a

week; we assumed it would have a minimal impact on what we did. The fact is that we got a

ton of claims, not just because of the war, itself, but the military downsized at the same time so

a lot of guys were getting out. We created something called the Transition Assistance program

that actually put counselors at the separation centers and told people exactly what they had

coming to them so they were much more ready to file claims. We got in a big hole as a result

of that. We are working to make sure that never happens again.

[TiredSgt]

This was a very informative post! Made for a good read - thanks for sharing.

[Pete53]

Actually it is the same as usual and does not make to much difference who is running things. I still think that Principi was the best one since I have been in the system and than it was Derwinski and absolute robber to Veterans.