What’s Up at the VA?

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MARWAN NAAMANI / AFP / Getty Images

A U.S. soldier guards a bombed-out car on a Baghdad street, 2003.

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.

screen-shot-2013-04-15-at-5-39-15-pm

VAOIG

Disability claims piled up at a North Carolina VA office last year.

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?

Obama Welcomes Wounded Warrior Project's Soldier Ride To White House

Win McNamee / Getty Images

President Barack Obama and VA Secretary Eric Shinseki at a veterans’ event last Wednesday at the White House.

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.

20 comments
cristo52
cristo52 like.author.displayName like.author.displayName 2 Like

Veterans have been getting the short stick since the end of World War I. Nothing changes, because the people who handle the money - that's the U.S. Congress - have little contact, little knowledge and little compassion for and with Veterans. Most politicians - there might be a handful who don't - use Veterans the way President Obama uses children. They make a great photo op. Instead of assuming all Veterans are liars - which is how the system is designed - assume all Veterans and truthful honest and have the best interests of their country at heart. Make all claims presumptive, get the process going, and then review as needed. in other words, turn it around. I believe it was only last year that ALS - which is a presumptive claim - was adjudicated at 100% at diagnoses.  Prior to this change, Veterans with ALS were awarded a portion of the 100% disability rating they would eventually be eligible for and had to go back for a second and third examination before they were granted 100%. Unfortunately, ALS is a disease that could take the victim in 12 - 15 months, and with the speed in which the VA moves, death was often the final adjudication. The V.A. battles every Veteran on every claim. If you were hospitalized while in the service for a heart condition and you made a claim 30 years out, you'd have to show continued treatment of that heart condition over the 30 years in order to be awarded compensation.  A lot of Veterans didn't complain when they had a few chest pains, they just went on with their lives, but when it mattered, when the heart disease need treatment, the V.A. would not honor the claim.  Recently, the V.A. has improved it's  outpatient treatment. They have posted signs in the waiting rooms  (where that wall-mounted TV drones on and on) that urge Veterans to let someone on staff know if they have been waiting for more than 15 minutes past a scheduled appointment time. That's good. But once you get in with the doctor, don't think you can lay out a list of things that are bothering you; it can't be done. If you have an eye infection, that's what the appointment is for. So don't ask him to look at your bad knee, or your soar throat, or your tender foot. Improvements to the V.A. have come slowly, but there have been improvements. It's a far cry from the V.A. hospitals of the Vietnam era depicted in the movie "Coming Home." But the politicians have to stop waving the flag on a few select days a year and remember, a Veteran is a Veteran 365 days a year and for life. Congress drafted them or asked them to volunteer. They served without complaint. It's the responsibility of Congress to get this right. So far, they have not.

vingtsun
vingtsun

The VA should have adopted, and modified if necessary, the USPTO system of incoming correspondence.  Instead, as is typical of the government and their cronies, the system was contracted out.  USPTO patent examiners have quotas, and if they surpass their quota they are awarded bonuses.  Does the VA even have a quota for the reviewers?  If so, i would love to know what it is.  I FAXED two appeals to the Roanoke office, while faxing it was verified by someone in the office.  Two months later - surprise, surprise - no record of the appeals.  So, my congressman/s office email the appeals down, go acknowledgment of receipt.  Three weeks later still not entered into the computer system.  Seriously - scan the paperwork, give it a barcode, enter it into the system - this way easily tracked.  They keep dumping money into VA but get worse results...  As you all are aware - there are no phone numbers listed to the VA only the 1.800.827.1000 number, which usually routes you to "...call back later..." voice message.  Why is the VA held to a LOWER standard, if that is even possible, than the rest of government?   It is time for a leadership change, preferably with someone that is competent...  I am not a Jon Stewart fan but go to the dailyshow.com and search VA Backlog and spend the next seven minutes shaking your head in agreement!

PeterGreene
PeterGreene like.author.displayName 1 Like

Lets not forget the presumptive service connection laws that allowed ill Gulf War veterans to file claims in the past few years.  Speaking as one of those ill Gulf War vets, not only has my claim been log jammed, its been going in circles because the raters didn't understand the presumptive laws.  Neither did the C&P doctors who performed my exams for presumptive service connection.  The VA IG office has found huge error rates at every office they've inspected in the last two years.  That means the VA's own incompetency has contributed to this backlog.  That is also why I have little faith that they will get the system fixed any time soon.

FrankVera
FrankVera like.author.displayName like.author.displayName like.author.displayName 3 Like

The problem with the VA is not Secretary Anthony Principi , the American Federation of Government Employees (AFGE) is the main reason that the VA is so dysfunctional.

The VA has shifted from providing medical care and compensation to our nation’s veterans to being a type of welfare for the callous, lazy, and incompetent.

It must be stated that there are some caring and competent employees unfortunately, they are the exception.  

There are four nails in the coffin of the VA.

1)Affirmative Action
2)   Welfare back to work
3)   The VA shields its doctors from medical malpractice cases
4)   The AFGE places the well-being of the employees above the health and safety of the Veterans

Mission shift:

The primary purpose of the VA was to provide quality medical care (for service-connected conditions) in a timely manner and ensure that the veteran receives the compensation that is authorized by law for service-connected injuries.  In other words, the VA was created to act as the workmen’s compensation insurance for those who were injured in the military.

When the VA fails to complete their primary mission to care for the injured what is their purpose. The answer can be found in the NEW mission statement that can be found at all VA hospitals and clinics.

The new mission of the VA is “research, and education”.  This is to provide research subjects “veterans” and training aids “veterans” the medical schools.

I agreed to defend the country during its time of need.  I never agreed to be a lab rat for the rest of my life.

Frank Vera

www.veterans-affairs.org

PEBFORUMDOTCOM
PEBFORUMDOTCOM like.author.displayName like.author.displayName 2 Like

The problem isn't in the number of claims or the wait.  The problem is the VA's priority system for processing claims.  The most seriously disabled veterans are not receiving the priority they need sometimes waiting years.  Please take a look at the petition on change.org meant to get those ost seriously disabled their ratings first. 

https://www.change.org/petitions/the-department-of-veterans-affairs-and-congress-give-priority-for-ratings-and-benefits-to-seriously-ill-injured-veterans#

 “No one who fights for this country overseas, should ever have to fight for a job, or a roof over their head, or the care that they have earned when they come home.”

— President Barack Obama, on Nov. 11, 2011


VADELAYDENYUNTILUDIE
VADELAYDENYUNTILUDIE like.author.displayName like.author.displayName 2 Like

I agree wholeheartedly. Any Vet already deemed unemployable by another federal agency be it Social Security, or even the VAs own caregiver program should be given immediate priority for a rating. The VA just announced a change to priorities requiring the oldest claims to be completed first. With some 250,000 claims over a year old, this does little for those suffering with complicated severe disabilities. Suicides are up, because those with serious disabilities are suffering in despair with no income or healthcare since they haven't got a rating--almost 20 vets a day. It isn't from their wartime experience, it's from the ridiculous paper chase the VA REQUIRES these vets to be put through taking years for resolution. Claims MIS-rated have to be appealed. Appeal time: 4 years. The VA should give these severely disabled vets the benefit of the date and rate them 100 % at discharge and tweak the rating later. NEVER MAKE A SERIOUSLY INJURED/ILL VET WAIT. Especially if another federal organization has already rated them disabled! I signed the petition. I have a nerve disease rated at 60%, and am waiting for TDIU. Already rated 100% unemployable by SSDI.

sharder8
sharder8

The backlog started way before 9/11.  I know what I started going through, when dealing with the VA, back in April of 1986, when I walked in with a thick medical file from active duty.  The VA got their copies of my records and did the medical workup on my claim.  Result, denied my active records, denied I had any physical problems, denied what my MRB stated.  Basically, they told me I was full of crap and there was nothing wrong with me. 

I re-opened my case in 1999, with a different Regional office.  Result, based on previous records, nothing wrong with me . . . denied.

Re-opened again in 2009, this time with the help of a knowledgeable legal VSO.  Result, denied, same as first 2 times.

Filed a CUE claim in 2009.  That broke my claim wide open, as the DRO actually started looking at all the medical evidence and made discovery.  Denied the CUE, because the DRO had no way of understanding why the rater ignored all the medical evidence and went with the findings of the VA Doctor.  DRO requested we re-open again.

Reopened claim again, this time there are notes in my file from the DRO and CUE hearing.  (One of those notes was a no contest of tinnitus on rating, based on MOS.)  Low and behold, I'm now rated at 70% service connected, based on original documentation (stated as such in findings).  I was back paid 2 years, because they could confirm my 2nd hip replacement, as I had to do a phone hearing based on no travel due to hip replacement.  Tinnitus was denied yet again, as was hearing.  Filed an appeal on hearing and tinnitus.  Filed with BVA on CUE and back pay.  Filed documentation verifying my enlisted service, as VA was denying I was prior enlisted.  Filed documentation to add wife and kids to my claim.  All this was done in June 2012. 

As of today, over 10 months later, I have heard nothing on my appeal of hearing loss and tinnitus. Heard nothing back on enlisted verification.  Heard nothing back on adding wife and kids (documentation included birth certificates and wedding license).  Appeal with BVA is in process, which could take up to a couple more years.

Just about 26 years, to win, based on original documentation . . . How many years have been spent by VA failing to look at documentation and question conflicting reports?  How much time has this added to the backlog?  Why did I have to get a Congressman involved to find my records at the VA?  (Side note, week prior to Congressman notifying me where my records were, my VSO and I talked to records at that same regional office.  We were told they were burned in the fire and that they had no records on me.)

The VA has consistently made a game of the process!  They can claim the backlog started after 9/11, but I'm here to tell you that is a BS excuse that they are trying to sell to Congress, the media, and Veteran's.

On the bright side, the medical care I've gotten from the Bend VA Clinic has been OUTSTANDING, as has been my experience with the Portland VA Regional Hospital.  It's the doctors, nurses, and support staff on the medical side that are winning the hearts and minds of the Veterans.  Yes, I still hear horror stories about other VA Hospitals and Clinics, but I can only speak from my personal experience.

Marine-grunt-squad-leader,-1968
Marine-grunt-squad-leader,-1968 like.author.displayName like.author.displayName 2 Like

@sharder8 VA employees at the Phx facility have said to me that "if you've seen one VA hospital--you've seen one VA hospital "=meaning of course that they're all different in many ways.


You might be familiar with the fox channel, which was on in every waiting room during the bush admin.  Since then they've switched to CNN, a welcome relief for constant mindless babble about how war is great by chickenhawks who wouldn't be caught dead (pun intended) in a war zone.


Keep working at it.  You need to work every angle.  Talk to people and get them to explain to you.  You can get bumped to the top of the list, and you have good reason.  Talk to the social worker at your clinic, especially.  They know some tricks.


One reason Vietnam vets are coming in droves IS 9/11, but not the reason given here (except the suffering for decades....I was so messed up that I had almost 30 jobs, and 3 different decent career paths that I totally wrecked due to PTSD symptoms that I denied for years).  It was really difficult cataloging all my bad behavior, but eventually, after a long time, got my claim in order and turned it in.  I got fired from my job for threatening an employee ("makes me feel like shooting someone", I said, in respnse to a situation with another person, third party;  she turned me in and that was that.  I didn't feel like shooting someone, it was a figure of speech--but--go figure.  There's no slack....once, at that job, someone came up behind me in my wide-open cubicle, with my back to the door, and started to chew my ass about something or other--I had a customer service job at that point, almost the bottom of the barrel, next to pizza delivery and cab driving--so I jumped about a foot out of my chair and spouted an obscenity in pretty loud language, which they didn't appreciate.  There were other things.  The service rep I started out with said I couldn't have been in a worse job, under the circumstances, and it didn't last long.  People with bad nerves don't handle stress very well, and believe me, it gets worse with age, no matter what.  I'm convinced the nerve problem--and consequent worsening of PTSD symptoms--is an actual physical injury due in part to the agent orange.


anyway--the reason the vietnam vets I know (and me too) are coming in droves is because they see the country going down the same dead end that it was stuck in for ten or so years in Vietnam, with death and destruction that could only bring back horrid memories of dead friends and ravished innocent lives.  And it just freaks us out and brings it all back, vividly.  The nightmares and all.  

Think we had it bad from agent orange--and for the person above making light of it, it absolutely does cause nerve damage and if anyone doubts that they should try spraying themselves with roundup eveyr day for a year and seeing how they do--the Vietnamese still post higher birth defect rates than probably anywhere else.

Anyway don't just sit and wait.  Get and stay proactive any way you can.

Also--I think Shinseki is doing a great job turning around an agency that was planted full of Bush era moles, and they definitely didn't, and don't --some are still there and with the same disdain and bad attitudes about vets with problems--he apparently changed the culture a lot.  I didn't even know about the reason presumptive conditions came about, but everyone should try to remember that those issues have been "under consideration and up for discussion" for 40 years now, so it's not new.  And it's not unjustified.  And Shinseki didn't make those changes on his own, nor was it a hasty change. 

I also hope people realize that if we'd got some help 40 years ago, I don't believe any of us would be filing for disabilities for mental and nervous issues.  And everyone needs to understand that there isn't a one of us, I think, that thinks it wasn't his or her own fault.  Nothing like a little guilt, every day, to make your life fun.

Sorry about the long story.  Hope my thoughts help someone out there.



sharder8
sharder8

@Marine-grunt-squad-leader,-1968 @sharder8 - I'm younger, but entered Basic May 27,  1975.  My trainers were those that had just come back from VN.  Most of my NCO's had one or more tours of VN and even today, many of my friends were in VN.  I hear you loud and clear. 

My problems have been so much with the medical side, but rather the admin/comp/pen side.  There is where the back log the author of this story sees the problem . . . but, claims it only goes back to 9/11.  That's where I disagree and tried to point out.

Marine-grunt-squad-leader,-1968
Marine-grunt-squad-leader,-1968 like.author.displayName 1 Like

@sharder8 @Marine-grunt-squad-leader,-1968 Thanks, good to hear from you.  Talk to a social worker there, even if you have to go out of your way to get into the medical system...some of them are magic and know things.  If you're lucky and persistent you'll find the right person...keep up the good work.  Best of luck.

mitc5502
mitc5502 like.author.displayName 1 Like

One of the upsides to this is that the stigma for seeking help is fading.  Just imagine if WWII, Korea, Vietnam, etc... vets had the access and willingness to receive treatment when the really needed it.  Not only would we have healthier vets today, they also wouldn't be adding to the current backlog.  The fact that the system is backlogged is an indicator that the military, VA, and VSOs are getting vets to seek the help they need, which is just as important as actually providing the help.

hight_jaimie
hight_jaimie

that's fine and i'm glad it's being done; yet, i hear nor see any progress ongetting paid for your rating; you know3 that process that determines your rating and payout. well, mine began 01/16/13 i;ve yet to see it!

MikeSmith1
MikeSmith1

Agree this is a much needed perspective.  Love Kayla more than my rifle...

DHMazur
DHMazur like.author.displayName 1 Like

Thank you for this calm and insightful report.  Discussions about military issues often break down into accusations that someone doesn't support or respect the military enough, but almost always these accusations are made for reasons that have nothing to do with actually supporting service members.  The easiest way to win a political debate is to challenge someone's patriotism or respect for the military, but the harder task is to actually understand whether our policy choices are in the best interests of the military and the society it serves.  Kayla Williams does a great job of explaining some of the factors that contribute to the VA backlog.  There's more to it than the easy (and misleading) claim that civilians just don't care about the military.

(By the way, I loved "Love My Rifle.")

A former Air Force officer and author of "A More Perfect Military: How the Constitution Can Make Our Military Stronger"

WoundedTimes
WoundedTimes

Job well done.  Glad someone else is giving a history lesson since most reporters just jump on what is easy.


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