What’s Up at the VA?

Part 1 of 3: How we got here.

You may have heard: there’s a big disability claims backlog at the Veterans Benefits Administration (VBA), the part of the Department of Veterans Affairs that handles vets’ disability payments.

Nearly 600,000 of the 850,000 pending claims have been sitting around for more than 125 days.

Obviously, this is a huge problem. Unfortunately, much of the media coverage has been hyperbolic, misleading, or inaccurate.

There has been plenty of finger-pointing, and even calls for resignations, including in the pages of Time and on its Battleland blog. But there hasn’t been, frankly, enough time spent digging into the details.

My biggest fear is that the relentlessly negative coverage will drive veterans away from VA, preventing them from getting the medical care they need, or the compensation they deserve.

So I’d like to provide more history and nuance to the discussion.

Today, I’ll detail how the backlog came to be.

What’s the backstory?

Like many Americans, I started doing my banking and booking my travel online ages ago. I currently also manage my retirement savings online, handle virtually all communications electronically, and engage in dozens of other routine business matters without ever touching a piece of paper.

Over at the Veteran’s Benefits Administration, however, the process of filing a claim requesting cash benefits for a service-connected disability has still been done

— by filling out paper forms
— that get shipped off to a regional office
— and have to be supported by other pieces of paper – from the military, from doctors, and so forth – to supply the supporting evidence.

This unwieldy process could be very time consuming, but VA was managing to keep up relatively well.

Then 9/11 happened.

It was clear that the United States was about to engage in a lengthy, troop-heavy military response, especially once the Bush Administration set its sights on Iraq.

Then-General Eric Shinseki, the Army chief of staff in 2003, suggested that the size of the planned deployment to Iraq would be insufficient. But his concerns were dismissed (although ultimately vindicated).

We went to war with the military we had under then-defense secretary Donald Rumsfeld, and wounded warriors returned to the VA we had under Secretary Anthony Principi from 2001 to 2005. His successors, Jim Nicholson and James Peake, did little to transform the VA’s antiquated systems during their tenure through 2009, even as a growing number of wounded veterans began coming coming home from Iraq and Afghanistan.

Then what happened?

President Obama appointed Shinseki as his first, and only, VA secretary. Shinseki decided to embark on an ambitious program to computerize claims processing by 2015. As Craig Newmark, of CraigsList fame, explains, VA did not go about this in the usual, massively expensive, top-down way the federal government manages IT projects.

Instead, the VA decided to have those who would actually use the system (claims processors) work with software developers. This process took longer but will create a system more likely to meet the needs of those who actually use it. VA also worked closely with major congressionally-chartered veterans’ service organizations (VSOs) like Disabled American Veterans, which have employees that help veterans submit claims, as it developed the new systems.

This year, 2013, is the year in which regional offices are being transitioned to the new electronic system.

Change is hard, especially major changes being made in a huge and complicated bureaucracy. I am ashamed to admit that while my household has largely switched to Macs, we still own one PC, which I use solely to manage our household finances – the costs of my time and energy involved in transitioning all previous transactions and learning a new system have been prohibitive.

Or imagine a kitchen remodel – in the midst of it, with no appliances, countertops, or cupboards, it’s a disaster. But the investment should pay off when complete with a more functional space, more energy efficient appliances, and so forth.

During the remodel, however, you may only be able to eat frozen dinners microwaved in the garage, and anyone seeing this from the outside would only notice a destroyed space and terrible functionality.

Huge growth in claims

This transition is being attempted while the number of claims being filed is higher than ever:

— Based on a 2008 Institute of Medicine report, Shinseki added three conditions (leukemia, Parkinson’s Disease, and ischemic heart disease) to the existing list of Agent Orange “presumptives” (health problems that are ‘presumed’ to be caused by some aspect of military service).
That means that veterans who served in Vietnam when Agent Orange was being used and developed those conditions did not have to prove the illnesses were service-connected. This led to 260,000 previously-closed claims being reopened and new claims being filed.

More than a third of the VA’s claims processors were shunted to deal with this sudden influx of claims. Nearly all have now been handled.

— In 2010, Shinseki changed the burden of proof required to link post-traumatic stress disorder (PTSD) to combat deployments.
Previously, exposure to a particular stressor had to be documented, which could be more difficult for those who were not assigned to combat arms jobs.

This change meant that the VA now understood that anyone in a combat zone could be exposed to trauma: nurses see severely wounded fellow soldiers, truck drivers are hit by IEDs, mortars can land next to supply clerks at supposedly secure bases. (It was a particularly beneficial policy change for female veterans, who many had assumed could not see combat due to the policy banning women from combat arms jobs and units.)

— At around the same time, the national conversation about PTSD began to shift, and it became more widely understood that its symptoms are a relatively common reaction to trauma, rather than a sign of weakness. The number of claims submitted for PTSD began to climb dramatically, both among veterans of the current conflicts and by Vietnam veterans, whose symptoms were either late to emerge or had been suffering without compensation for decades.

Between 2006 and 2012, the number of Vietnam veterans being compensated for PTSD grew from 193,000 to 326,000, while the total of post-9/11 war vets receiving VA disability payments for PTSD soared from 27,000 to 196,000.

— The percentage of claims filed and number of conditions claimed by current-era veterans increased.

Roughly half of post-9/11 combat veterans have already applied for disability benefits – a far higher rate than in any previous conflict. The average number of conditions for which disability payments are being sought has averaged 3.89 per World War II veteran, 6.16 per Vietnam veteran, and 9.72 per Operation Iraqi Freedom/Operation Enduring Freedom veteran.

This could be due to a variety of factors, and likely is due to a combination of them: multiple deployments, improved medical technology that led to higher rates of survival in severely wounded warriors, increased education, improved outreach by VA, and better support and advocacy by VSOs.

For example, when I was leaving active duty, I had one problem that I knew was related to my service: pain in my right foot related to treatment and surgery in Iraq.

However, I’d been urged to use a VSO representative, and he encouraged me to also list exposure to toxic fumes: even though I was not at that point experiencing any lung or other problems, should I develop them later in life it would be easier to prove that they were service connected if I documented immediately that I had spent months breathing in burning plastic, lithium batteries, feces, and more.

When my claim was reviewed, the processor had to evaluate both conditions and comb through my records to confirm both the exposures, and whether or not I was currently experiencing any medical problems related to them.

Those PTSD and Agent Orange decisions Shinseki made added to the backlog.

He did this knowing it would temporarily worsen the backlog.

They were the right decisions and will benefit more veterans in the long run.

But in the short run, these choices exacerbated the backlog.

Part 1: What’s up at the VA?

Part 2: What the VA is doing about the backlog

Part 3: What the rest of us can do to help

Kayla Williams is a former sergeant and Arabic linguist in a Military Intelligence company of the 101st Airborne Division (Air Assault). She is the author of Love My Rifle More Than You: Young and Female in the U.S. Army and a fellow at the Truman National Security Project.