Benefits delayed are benefits denied.
If you are a veteran who has a service-connected disability, you need to pay attention to the Department of Veterans Affairs’ new rules governing disability claims processing. These new rules have been implemented since March, and they have already delayed benefits for many veterans and could potentially reduce their benefits even further. That’s because the new rules are preventing the claims processors from quickly and accurately processing their disability claims.
The new rules are also unfairly targeting the claims processors themselves. AFGE members in West Virginia recently held an informational picket to raise awareness on the issue. They received support from local veterans groups in the area, including a veterans' motorcycle club.
How claims get delayed under the new rules:
- New rules set an unworkable time limit on claims processing.
The claims processors, known as Veteran Service Representative (VSRs), are required to review a claim and complete all transactions within 27 minutes instead of 42. If they fail to do that, they fail the new performance standards. Why is this a problem? After all, shortening the processing time frame should speed things up, right? Not quite.
When a VSR reviews a claim, he/she goes through various steps before reaching a conclusion whether the condition is service-connected. The VSR has to review 400-500 pages of the veteran’s private medical record, service medical record, and VA hospital records to get all the information he/she needs to request an exam. He/she then orders an exam for every condition the veteran claims is service-related – hearing loss, Post-Traumatic Stress Disorder, etc. If the veteran claims 29 conditions, the VSR has to request 29 exams using seven different computer systems. It usually takes about 22-25 minutes to request one exam. By reducing the time for this task by over a third, this makes an already complex and nuanced assignment even more difficult, and will almost certainly both harm the quality of care for veterans and set up employees to fail.
When the VSR can’t finish the claim for whatever reasons – may it be additional information from veterans is needed or simply a lack of time to finish an exam request, the claim gets sent back into the system, or “the cloud” – a national queue – and waits there for at least 30 days before another VSR can take a look at it.
With the new time limit, the VSRs simply don’t have enough time to do what needs to be done, and every time the VSR sends the claim back into the system, it delays the entire process. The VSR who picks up the half-done claim will also have to review everything from the bottom up as VSRs now process claims filed anywhere in the country, not just in their area like before. This delays things further as the VSRs have to spend more time doing research on both VA and contract hospitals before they can order an exam.
Before the new standards were adopted, generally only 5 people were involved in processing and approving a claim if they had everything they needed. Now, 15-20 people could be involved in processing just one claim.
The new rule was supposedly intended to cut down the claims backlog, but it has produced the opposite effect. At the West Virginia office, the claims backlog has increased dramatically.
- Claims processing rules change daily.
As if trying to dig up evidence of an illness that happened in 1972 and buried somewhere in those 500 pages is not hard enough, before the VSRs can start the review process, they have to check the claims processing rules that change daily. For example, a new evidence of illness may be needed to order an exam. That’s why they need to consult their electronic manual for every claim so they don’t get hit with an error – another performance standard. Previously, everyone used a paper manual that saw maybe one change once a month via fax. Now VBA sends over new rules via email daily.
Because the VSRs have to review the manual, review the claim, AND complete all transactions within 27 minutes, they don’t have time to review what has been done, and errors are bound to happen. A veteran may not receive the benefits he/she is entitled to due to an error. And if the employee goes over the time limit, he/she would be put on a performance improvement plan that could lead to a removal. It’s a lose-lose situation for the veterans and employees.
“I have 27 minutes to do a claim, I’m not going to be able to order 29 exams. There’s no way possible that I can do that and plus review your service treatment records or something else,” said a VSR in West Virginia.
The VSR added that several veterans spent years – sometimes six or seven – trying to gather the information the VA needed, but the new rules don’t even give the VSRs enough time to review the information.
- The new performance monitoring system only looks at the number of claims processed, not items that have been completed.
The system the VA uses to decide to keep an employee doesn’t work like it should. It doesn’t give the VSRs credit for the number of items that have been completed for a claim – just the number of claims that are processed. It also doesn’t look at the number of times a claim has been reviewed by different VSR.
This has a potential to skew the “success” of a VBA office. At the West Virginia office, the productivity is at an all time high, but 52 VSRs failed the standards. Before the new performance standards came along, only a few people out of 75 failed. The VA is aware of the problem. They told managers not to put the employees on a Performance Improvement Plan until they get the system worked out. The employees, however, are still required to follow the new standards.
Veterans and AFGE members are fighting back
AFGE Local 2344 members at the West Virginia office held an informational picket earlier this month to raise an awareness on the issue.
"I hope by us going out and raising awareness of this to the public, it will bring attention to the issue and resolve this matter because it doesn't only affect the people that handle the claims, it will impact the lives of the veterans and their families," said AFGE Local 2344 President Patty Nash. "If that happens, we will not be honoring the words of President Lincoln when he promised to take care of the veterans of the United States: “To care for him who shall have borne the battle and for his widow, and his orphan.”
The employees also received support from veterans organizations in the area. On the picketing day, more than 100 riders who are members of the American Legion, the Veterans of Foreign Wars, and others drove by the office to show their support to the cheers of the employees.