Eliminating backlog of cases, paperwork among VA chief's priorities

"If you were to walk into one of our rooms where adjudication or decisions are being made about disability for veterans, you would see individuals sitting at a desk with stacks of paper that go up halfway to the ceiling. And as they finish one pile, another pile comes in," Shinseki said at a House Committee on Veterans Affairs hearing.

Sorting through the paperwork employs as many people as the number of troops in the 82nd Airborne — approximately 11,100, he said. This year, 1,100 more will be hired, he said, and even more will be needed unless the department moves to a paperless system.

"In my opinion this is a brute-force solution. We need to very quickly take this into an IT [information technology] format that allows us to do timely, accurate, consistent decision making on behalf of our veterans," Shinseki said. "My intent is to get to a paperless solution as quickly as possible."

Moving to a paperless system would allow for better coordination of records and allow the VA to better keep personnel and medical records, some of which are already electronic, together, he said.

Members of the committee peppered Shinseki with questions about the VA's handling of mental health issues. The secretary said that much progress has been made in understanding traumatic brain injuries (TBI) and post-traumatic stress disorders (PTSD) since he served in Vietnam, but there is plenty more to do.

"I am now watching all of our efforts to understand PTSD, TBI, substance abuse amongst our veterans and have a better appreciation of what we put my comrades through when we came back" from Vietnam, he said. "None of these programs were available, in fact. None of these terms were in vogue then. We still don't understand enough. We are still learning."

The chairman of the committee, Rep. Bob Filner, D-California, expressed frustration that screenings for the disorders were done through a self-evaluation, rather than through medical examination, and he implored Shinseki to change that.

"As you know, you can order that to happen and it is not happening," Filner told Shinseki. "We just have to move away from that. The numbers are too high. The denial is too great. The problems are overwhelming us in the civilian world."

Shinseki said that while there is more to do, the VA has made much progress by integrating mental treatment with primary care.

"One of the things we have done at the VA is that we've taken mental health from being in a separate part of the complex and moved it into the primary-care area to reduce the stigma of someone having to go to that part of the hospital," he explained.

Citing VA statistics, he said that since screening began in April 2007 for all Afghanistan and Iraq war veterans, the VA has diagnosed 43,000 cases that had not been tracked before. Of those, 12,500 have since been confirmed TBI cases.

Suicide attempts are also a major issue for the VA, Shinseki said. The department has a national suicide hotline that got 67,000 calls from veterans and some active duty personnel between October 2007 and October 2008 and managed to intervene to prevent suicides in 1,700 cases. Over the past three months, he added, the hotline has helped intervene on 700 calls.

"We are doing more. Not enough. We are learning as we go," he noted.

When nominated for the position, Shinseki said he wanted to work closely with other departments, like the Small Business Administration, Labor Department and Housing and Urban Development, whose programs help veterans. Shinseki said the veterans programs might be practical for non-military people as well.

"I think in many ways the veterans population is a microcosm of what is going on in the country," he said. "If we can harness their talent, their capabilities and partner with them, we may come up with solutions that may be models for others."

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