Getting to backlog zero: Strengthening the claims process

The VA is required to help veterans collect the evidence needed to substantiate disability benefit claims. To approve a claim, the VA is looking for two things: that a veteran has been affected by an injury and that the injury was sustained during a veteran’s service. The largest contributor to today’s backlog is difficulty in tracking down records that prove the connection between an injury and a veteran’s service.

The VA has made great progress toward ending the VA backlog through efforts such as a special initiative to rate all claims pending over one year and by instituting a new electronic claims process. But despite this progress, the VA has not addressed some of the challenges to evidence gathering that often slow down claims processing. No electronic claims system, no matter how good, will work if the underlying process remains broken. What veterans need is a clear plan to improve how the VA collects and evaluates medical evidence, and to direct needed federal records to the VA.

Almost 40 percent of veterans are registered for VA health care. Many others receive private care for injuries sustained during service. Under the law, VA claims processors can accept private medical records and evidence disability claims, yet in practice many do not.

Instead, the VA keeps veterans waiting while it duplicates evidence it already has. Refusing to trust private medical evidence or weed through unfamiliar forms, many VA claims raters order a medical exam from a VA doctor. While scheduling and completing this exam took just an average of 26 days in 2012, past reports of regional data show that veterans in some regions wait much longer. No matter the wait, this unnecessary step slows down the decision on a veteran’s claim and adds to the pressure on the system for veterans who do need an exam through the VA system for financial or other reasons.

To turn things around, the VA needs to encourage claims processors to accept medical evidence. For instance, the VA should build upon an ongoing initiative to standardize the evidence it collects from health care professionals. In 2011, the VA implemented a series of forms, called disability claims questionnaires (DBQs), which collect information that claims raters need. If widely adopted by private health care professionals, these forms will ensure that private records include the evidence the VA needs in a form familiar to claims raters. The VA should track the impact of DBQs on the disability claims process and use this information to conduct strong outreach to educate private care providers why they should use DBQs. To encourage even more providers to adopt DBQs, the VA should simplify the forms to ensure they don’t put an extraordinary burden on already hectic schedules of medical professionals.

The disability claims process is not just slowed by the problems with private records, but with public records, too. We need a smooth, integrated way to transfer medical records for veterans of all generations from the Department of Defense to the VA. Delays in transferring these records can greatly impact the time a veteran waits for a decision on a claim. Unfortunately, the latest news on record integration doesn’t give veterans much hope.

The DoD and VA abandoned a plan to create a shared health record; instead the DoD announced that it would start a bidding process for a new electronic record-keeping system. While the DoD pledges to create a system to send data to the VA by 2014, we will have to wait until the DoD develops their new system to have full resolution of this issue. Finding and implementing a new health record system will likely take more than three years, meaning we will not have a complete system until well after the VA’s goal of ending the backlog by 2015.

The VA also faces difficulty in finding other public records. Service records can be hard to track down, particularly for National Guard and Reservists. There is no single source of National Guard records, meaning the VA must go state to state to obtain these records. Records from the Social Security Administration and Department of Labor, used to access benefits from these agencies, can also be used to substantiate a claim. While recent initiatives have sped up the process of getting these records, there is still no long-term plan to show how the VA will continue to get what it needs when it needs it.

The VA has pushed one new initiative that is making a difference: fully developed claims (FDC). When filing an FDC, a veteran submits their claim with all the available evidence to substantiate their claim. As a result, FDCs significantly reduce the burden on the VA because the VA does not need to track down a veteran’s records. The VA has worked to encourage more veterans to file FDCs by working with veterans service organizations, such as Disabled American Veterans, the VFW, and American Legion, whose participation is critical in getting more veterans to use this option. And, last month, the VA announced that they would incentivize veterans to file an FDC by rewarding them with an additional year of benefits. This initiative not only helps veterans who file FDCs but it also allows the VA to dedicate more resources to processing claims that were not filed as FDCs.

The VA should be applauded for the work they have done to address the problems that created the VA backlog. But until the government addresses the issues in sourcing and sharing documentation to prove a claim, the entire process remains vulnerable to long delays, which means too many veterans waiting for help.

For veterans who continue to wait for decisions on their claims – thousands of whom have been featured on TheWaitWeCarry.org – there is far more work that must be done on their behalf.

O'Gorman is political director for Iraq and Afghanistan Veterans of America.