Fix the VA before more veterans die

The Department of Veterans Affairs (VA) is supposed to provide veterans with medical care and disability benefits.  But veterans are dying because of the VA’s failure to do both.  While recent headlines attack the VA’s abysmal medical care, its disability benefits system is also broken.  That system must be fixed before bureaucratic incompetence kills more veterans.

The VA’s medical care system is grossly dysfunctional.  A federal court stated in 2011 that the VA’s untimely delivery of mental healthcare contributed to veterans’ deaths.  The court reported that despite VA policy requiring veterans exhibiting mental health issues to be evaluated within one day, many suicidal veterans had to wait several weeks to obtain a mental evaluation and over 85,000 veterans lingered on waiting lists for mental healthcare.  Meanwhile, an average of eighteen veterans committed suicide daily and one thousand more attempted it monthly.  

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Rather than cure its deficiencies, the VA hid them.  Until recently, VA policy required a veteran requesting a primary-care appointment to be seen within fourteen days.  But according to a VA audit released this month, nearly 58,000 veterans have waited at least ninety days to see a physician and almost 64,000 more were never scheduled for appointments over the past ten years.  (An updated audit shows that these numbers may have been understated.)  Instead, these veterans were placed on secret waiting lists and their records were destroyed to conceal lengthy delays and boost VA employees’ compensation.  By one estimate, at least forty veterans died in Phoenix alone because of this absent medical care. And a new congressional report concludes that malfeasance at VA medical centers may have killed more than 1,000 veterans over the past decade.

This scandal has focused public attention on the VA’s medical care system.  But other VA failures must also be remedied before the media spotlight dims.

The VA administers disability benefits poorly.  Through its claims processors, the VA determines veterans’ disability benefits eligibility.  Over 533,000 disability benefits claims are pending, with almost 280,000 of them undecided for 125 days or more.  These numbers are reductions from recent highs, but the progress is illusory.  Gains stemmed from shifting the backlog to appeals by moving appeals personnel to initial claims.  Under President Obama, pending appeals have grown 50 percent to over 250,000.  This caseload will likely double before 2018.  Indeed, the American Legion recently found errors in 55 percent of the disability benefits decisions it reviewed.  Appealing benefits decisions takes an average of 562 days.  Last year, an average of fifty-three veterans died daily while awaiting their disability benefits.             

Deficient training and a skewed work credit system have broken the VA’s disability benefits system.

Despite having to grasp complex legal and medical criteria to perform their jobs, claims processors receive subpar training.  VA training curriculum lags behind the rapidly changing rules that govern disability benefits claims.  Moreover, although claims processors vary by experience and ability, they receive the same hours of annual training and repeat introductory courses for years.  Finally, unqualified instructors are employed and online training without teacher interaction is overused.

The VA’s work credit system emphasizes speed over accuracy.  Claims processors receive maximum work credit only by resolving entire disability benefits claims during an initial review.  Yet the time needed to complete each claim varies by how well other VA employees develop disability benefits applications and the number and complexity of veterans’ alleged disabilities.  To maximize their pay, claims processors are incentivized to prioritize easy disability benefits claims, which increases the wait for other veterans.  Moreover, claims processors are driven to render decisions without key medical data, which increases appeals.  Reviewing a disability benefits application often takes hours.  Still, if a claims processor deems an application incomplete or a veteran needs another medical exam, the claim requires further review.  But doing so reduces work credit, unless the missing evidence is ignored.  

The claims processing system must incentivize accuracy.  Claims processors’ and their managers’ compensation should be reduced when incorrect disability benefits decisions are rendered.  Doing so will bring about better hiring practices and training and balance quantity and quality in the claims processing system.  As claims processors make fewer errors, appeals will drop, so more appeals personnel can resolve initial claims. 

This system must also be streamlined.  VA employees who develop disability benefits applications and their managers should forfeit work credit when applications are incorrectly deemed complete.  Moreover, legislation offering extra benefits to veterans who file complete applications should be extended.  Finally, the VA and Defense Department should develop an integrated electronic records system.  With these proposals, claims processors can work more efficiently due to fewer incomplete applications, which extend claims resolution by 200 days on average.   

Past VA reforms were insufficient.  President Obama increased the VA budget to hire more claims processors and authorize overtime.  But these measures did not cure the underlying problems.  Congress passed legislation that ignored calls to change the VA’s training and work credit system.  The medical care scandal should spur Washington to act boldly.  Veterans deserve more than the usual half-measures from politicians who send them to war.          

Leaf is an attorney at an international law firm, where he heads a pro bono case aimed at reforming the VA’s disability benefits system.

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