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Disabled veterans struggle with broken claims system

Service members who were disabled while on active duty are supposed to receive monetary assistance from the U.S. Department of Veterans Affairs (VA).
File Photo: Robert Wake (L), an Iraq war veteran suffering from posttraumatic stress disorder (PTSD), talks to physical therapist Nicole Bormann before a session in the VA Medical Center August 10, 2009 in St Louis, Missouri. Wake served in the MP ...
File Photo: Robert Wake (L), an Iraq war veteran suffering from posttraumatic stress disorder (PTSD), talks to physical therapist Nicole Bormann before a...

Service members who were disabled while on active duty are supposed to receive monetary assistance from the U.S. Department of Veterans Affairs (VA). But an increasing number of veterans never receive their disability benefits, or receive them far too late. While the VA has struggled to process claims in a timely fashion for years, the backlog of unprocessed claims has ballooned.

As of May 20, the VA had 838,821 claims waiting to be processed. Two-thirds of those claims—559,186 of them—have been pending for over 125 days and have been classified as "backlogged." An additional 249,604 claim appeals are pending, from veterans who believe the VA ruled incorrectly on their initial claims. The average wait time for a claim to be completed is 345 days, but appeals can take much longer.

"At some offices, the wait is disastrous. It's unbelievably long," said Paul Sullivan, a Gulf war veteran, former VA official, and the current managing director of public affairs for Bergmann & Moore, a law firm which helps veterans with claims appeals.

By February 2014, some 34,000 soldiers may have returned home from Afghanistan. Most of those who have already come back from the wars in Iraq and Afghanistan will spend this Monday observing Memorial Day and paying tribute to those who did not make it home. But for a large portion of the survivors, the danger is not yet over. Thousands of soldiers make it through enemy fire only to find their lives--or at least their health and financial security--threatened by bureaucratic inefficiency.

VA Secretary Eric Shinseki has made it his mission to reduce the backlog. In March, he vowed that the VA would eliminate the backlog by 2015 and make sure that none of the claims takes longer than 125 days to process. But in the meantime, time is running out for thousands of disabled veterans.

While veterans wait for their claims to be processed so that they can cover health care expenses, many see their medical conditions worsen. Nearly 20,000 veterans have died while waiting for their disability claims to be processed. That's about 53 dead soldiers per day. By comparison, the wars in Iraq and Afghanistan in their entirety have resulted in 6,708 total casualties, according to Pentagon statistics.

"We've had clients here that have died waiting ten-plus years for a VA decision," said Sullivan.

To cut the backlog and prevent further deaths, Shinseki is implementing the Veterans Benefits Management System (VBMS), the VA's first attempt at processing its claims electronically. But veterans services groups are skeptical that a dramatic shift is achievable in such a short period of time, given the magnitude of the problem.

"I'm not going to say it can't be done; I'm going to say it's a very large challenge right now," said Disabled American Veterans (DAV) national service director Garry Augustine.

The size of the backlog can be blamed on a "perfect storm" of contributing factors, said Sullivan. The VA is only now digitizing its records, and many processing centers continue to rely on an antiquated paper filing system. To make matters worse, the department failed to plan for the increase in claims that was inevitable when the Bush administration started wars in Iraq and Afghanistan.


Contemporary wars aren't the only source for new claims. In recent years, the VA has made it easier to file claims for disability based on Agent Orange exposure and post-traumatic stress disorder. Those decisions, changing cultural norms that have lessened the stigma of seeking help for mental illness, and claims from Vietnam War veterans make up a significant percent of the backlog: 37%, according to recent reports.

Congress' repeated failures to pass an adequate budget haven't helped, said Veterans of Foreign Wars (VFW) deputy director Jerry Manar, who previously worked for the VA.

"Many years in the past 20, 30 years, Congress has not passed a budget. They certainly haven't passed it on time," he said. "Any time Congress passes a continuing resolution ... typically the VA will not hire during that resolution." Only in the past few years has the VA been able to make a dedicated effort to staffing up.

Modernizing the VA bureaucracy is expected to help speed up the claims process and trim the backlog. But in the short term, Shinseki's efforts to digitize the entire claims process have made the backlog even worse, as the transition further lengthened delays in processing pending claims. At Fort Harrison in Montana, one of the sites where they have begun implementing the VBMS pilot program, the average number of days pending skyrocketed by 61%, according to a February VA Inspector General report.

While VBMS is undeniably disruptive and has so far exacerbated the backlog, the VA doesn't have the option of sticking with its old system. Right now, veterans seeking benefits need to rely on snail mail and a vast, diffuse filing system spread out across states and even continents. Soldiers who are critically injured in Afghanistan may receive treatment in Germany, get transferred to Walter Reed, and then undergo rehabilitation in their home towns--making it nearly impossible to keep track of all the medical records. Keeping those records in a central electronic database would ensure they don't have to.

In the meantime, the VA has adopted the practice of expediting certain claims, known as Fully Developed Claims (FDCs). These claims are "critical to eliminating the backlog," according to recent testimony given by VA undersecretary for benefits Allison Hickey to the House Veterans' Affairs Committee.

To file an FDC, a disabled veteran first submits an "informal claim" to the VA. Then he gathers the medical records and other evidence which the VA would usually be tasked with gathering on its own. Once all of that information is packaged into an FDC, the veteran can submit it back to the VA. FDC approval times are usually faster, because veterans are sometimes able to gather their own records more efficiently than the overextended VA staff.

To make sure more FDCs are filed, the VA has partnered with the DAV and American Legion, enlisting those organizations' services in training their members and assisting them in putting together FDCs.

"We give the VA what they need in order to process the claim, and not have the VA go out and send a letter to ask the veteran to get particular info," said American Legion director of veteran affairs and rehabilitation Verna Jones. Staff in her organization assist veterans in collecting all of the medical records needed to get a claim recognized as fully developed. Additionally, they provide training on how veterans can use the FDC process on their own.

"The goal with the VA is 90 days, and that's for [processing] fully developed claims," she said. "The average now ... is 128 days." While far off the VA's stated target, that's still a fraction of what the average veteran outside the FDC process needs to contend with.

"It's not going to work for everybody, but it should work for a good majority of the veterans," said American Legion deputy director for claims, veterans affairs and rehabilitation Richard Dumancas. He strongly encouraged all veterans with access to the necessary medical records to try applying through the FDC process.


While these improvements may help to cut the backlog in the long run, VFW's Manar sees little hope that Shinseki will meet his 2015 target.

"The secretary pulled that year out of thin air," he said. He estimated that it would take another four to five years to work out the kinks out of VBMS.

House Veterans Affairs Committee chairman Jeff Miller has introduced legislation that he hopes will help the VA make its target year. On May 23, he proposed a backlog task force made up of representatives from both the public and private sector, which would spend 60 days examining the claims process and coming up with recommendations to make it more efficient.

"Government bureaucrats under both Republican and Democrat administrations created the backlog, so it's only natural to solicit outside help from the private sector and the VSO [veterans service organizations] community in working toward a solution," said Miller in a statement. But Manar called that "a terrible idea," given the complexity of the VA claims process.

"I don't object to study this and make recommendations, but to impose a 60-day time limit with the idea that this work is anything like what insurance companies do in private industry is ludicrous," he said.

As overwhelming as the disability claims backlog may appear, he added, it is only a fraction of the true problems facing the VA. Focusing on the disability benefits backlog means disregarding similar backlogs in pension claims, education cases, and claims to add dependents to veterans' benefits.

The VA "has diverted its authorization people to focus on disability cases rather than doing this other work," said Manar. "Well, this other work is piling up."