Research by Veterans for Common Sense estimates the number of Iraq and Afghanistan veterans will total 600,000 by September. The current claims backlog could discourage a new generation of veterans from seeking care, fears Brian Hawthorne, legislative spokesman for Student Veterans of America.
Shinseki has promised to "break the back of the backlog this year," setting up pilot programs across the country to test the most successful procedures from different regional offices. But there's no one silver bullet that will create efficiency in all the bureaucracy's hospitals, clinics, nursing homes and rehabilitation centers.
NationalJournal.com consulted different government officials and veterans groups about solutions to tackle the backlog and make the massive medical bureaucracy more accessible.
1) Computerize Records
Computerization is a widely accepted solution to tackle the VA's mountains of paper claims, but it's proved difficult to actually implement such a system.
Roger Baker, the VA's assistant secretary for information and technology, was charged last year with overseeing the creation of software to process education claims for the Post-9/11 G.I. Bill. He has expressed confidence in large-scale automation and software projects such as the Veterans Benefits Management System to improve work flow, calling them "the long-term solution" to the department's delays.
But Paul Sullivan, spokesman for Veterans for Common Sense, testified before the House Committee of Veterans Affairs in February that the plan was an insufficient "update of previous failed computerization attempts" and lobbied for more comprehensive computerization planning.
Hawthorne said the VA needs to completely stop taking paper claims and be forced to rely on and improve its computer processing.
2) Rely On IRS-Style Auditing System
3) Improve Coordination With The Defense Department
House Veterans' Affairs Committee member John Hall, D-N.Y., said the Defense Department has historically been too turf-conscious to effectively coordinate with the VA.
"Seamless transition from active duty to veterans' status has not happened because of Defense Department's reluctance to overlap personnel to handle veterans' matters," Hall said. "Secretary of Defense Robert Gates and Secretary Shinseki have a closer relationship than their previous counterparts, and I'm hopeful they'll share more information as we go forward."
With that in mind, the Subcommittee on Disability Assistance, which Hall chairs, held a hearing in February to review two new programs established by the VA and Department of Defense. Hall said at the hearing that such efforts to organize benefits and records before discharge "would help significantly transform today's VA claims processing system so that we may soon play 'Taps' for the VA comp [compensation] & pen [pension] backlog."
4) Stricter Turnaround Time For Claims
The success of Shinseki's pilot programs at regional offices and other initiatives will depend on the department's ability to stick to their timelines.
Since the VA missed a deadline to create comprehensive claims processing software in time for the G.I. Bill launch, Baker has made efforts to change the culture at the Department of Veterans Benefits and "establish a strict adherence to milestones."
"Missing a milestone has some really big implications within the organization," Baker said. "We're working on processes to improve our system development results, and it is no secret that they were not good when I walked in the door."
5) Better Prioritize Claims
Implementing education claims from the Post-9/11 G.I. Bill became a massive claims processing challenge for the VA, and Baker said finishing the simplest cases which had been waiting the longest was a key strategy in managing it.
One successful example of prioritizing claims is alerting the VA to the cases of homeless veterans to expedite their cases, according to P.J. Walker, supervisor for the Veterans of Foreign Wars' National Service Office.
Yet having worked as a claims adjudicator, Walker expressed concern about tying up the process by running too many simple claims at the risk of the more complex cases.
"There has to be a balance until you get more trained decision makers on hand," Walker said. "Someone has to make the decision which claims get processed at which time. That can become a management nightmare. In moving the claims as fast as you can, they might overlook something that could be detrimental to the veteran."
6) Improve Staff Quality in the Bureaucracy
At the House Veterans Committee's 2010 Claims Summit in March, the National Association for Uniformed Services gave testimony calling for an increase in salaries and benefits to keep the existing experienced staff at the department.
Yet some see the long-time established employees as more of a hindrance than a resource. Paul Sullivan, spokesman for Veterans for Common Sense, accused the Bush administration of excessive patronage appointments at the VA without regard for experience.
Walker said a larger problem is the loss of the previous generation of staff before the newer generation gains claims experience. "It takes them two to three years of training before they are prepared to help reduce the backlog," Walker said. "But we also need to change the culture of the VA and get modern thinkers who didn't come up in the VA who can think of new solutions to improve the claims backlog."
Hawthorne contended there should be task forces for different types of claims to establish familiarity and expertise with different conditions such as Agent Orange to avoid errors and gaps in coverage.
7) Increase Involvement With Outside Groups
Many hands make light work, and the private sector could help manage simpler problems while the VA consults with veterans' groups to establish more efficient overall practices.
Since the start of the wars in Iraq and Afghanistan, established veterans service groups have helped in numerous ways to make sure service members are aware of their eligibility and can take advantage of their benefits. And newer groups like Iraq and Afghanistan Veterans and Student Veterans of America have grown in recent years to provide transition and consultation for their base in the younger generation of veterans.
Walcoff said the VA also used contractors to help with less complicated claims when it was inundated with college benefit claims at the launch of the Post-9/11 G.I. Bill in Fall 2009.
Walker of the Veterans of Foreign Wars said veterans groups can independently appraise and in some cases appeal for better benefits on behalf of service veterans or widow dependents. "VA has begun to streamline some of their applications, but the word is getting around -- get a service organization to assist you to reduce the processing time to as little as possible," Walker said.
8) Create Standardized Templates For Physicians