DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS-HVAC
September 11, 2013
GERALD T. MANAR, DEPUTY DIRECTOR
NATIONAL VETERANS SERVICE
VETERANS OF FOREIGN WARS OF THE UNITED STATES
FOR THE RECORD
VETERANS’ AFFAIRS SUBCOMMITTEE
ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES
WITH RESPECT TO
“Implementation Update: Fully Developed Claims”
WASHINGTON, DC SEPTEMBER 11, 2013
MR. CHAIRMAN AND MEMBERS OF THE
behalf of the men and women of the Veterans of Foreign Wars of the United
States (VFW) and our Auxiliaries, I would like to thank you for the opportunity
to provide testimony for the record regarding fully developed claims.
Fully Developed Claim (FDC) program is simply the formalization of a local VA
regional office practice which has existed for decades. Historically, many of VA’s Veteran Service
Center Managers (formerly Adjudication Officers) agreed to quickly work fully
developed claims submitted by veteran service organizations (VSOs). This program was regularized by the Veterans
Benefits Administration (VBA) in 2009 and rolled out to all VA regional offices
2010, VBA has refined the FDC program and increasingly encouraged veterans and
VSOs to submit claims which do not require development of non-governmental
evidence. The VA Under Secretary for Benefits, Allison Hickey, expressed a goal
that 20 percent of all claims submitted to VBA should be fully developed. Data obtained from VBA shows that FDCs from
all sources totaled 21 percent of all claims submitted in the month of July
we could claim “mission accomplished” by meeting the FDC goal, that does little
to describe both the benefits and problems associated with the FDC program as
it is currently implemented. In our
testimony we will discuss those issues, as well as our impressions of Section
506 of PL 112-154 which allows VA to award retroactive benefits of up to one
year in certain qualifying FDC cases.
Claims Program – What it is
FDC program shifts the burden of much of the evidence necessary to adjudicate a
claim from VA to veterans and other claimants.
Essentially, in exchange for a promise to process a claim more quickly,
VA requires claimants to locate, obtain and submit all non-government held
records necessary to their claim at the time they submit an application to
who successfully complete this task, and who take no action that disrupts VA in
processing their claims, are rewarded with a decision often within 90-120 days
of submission, rather than the more common eight to twelve months VA takes to
is a clear win for VA. In exchange for
promising to work a claim to completion more quickly, VA is relieved of the
need to develop a claim. This reduces
the number of employees (FTE) necessary to perform this work which allows VA to
assign them to perform other tasks. In
addition, because the bulk of the development is done by the claimant and not
VA, traditional measures of claims processing timeliness (average days pending,
average days to complete) are reduced.
This allows VA to assert that it is processing claims more quickly.
claimants may themselves believe that they have a win since they receive a
decision from VA more quickly than do their peers who submitted claims through
the non-FDC process. One would think
that this is a win-win for both VA and veterans; but is it?
claims adjudication process follows certain basic steps: claims submission,
review, development, decision, and notification. In the FDC program, claims submission,
review, decision, and notification are the same as before. What has changed is that much of the
development occurs before the claim is submitted to VA, not after. Development must still be done, except in
the FDC program, it is done on the veteran’s clock, not VA’s. If the veteran is focused, knowledgeable and
efficient, or has sought the assistance of a trained VSO representative, he or
she can accomplish the development much more quickly than can VA. However, if he or she lacks full
understanding of what is necessary to successfully complete his or her claim,
he or she may take longer to complete the application package. Regardless, development time, whether
performed by the veteran or by VA, should be included when considering whether
veterans are indeed winners.
believe that for many veterans, the total time to gather evidence, submit a
claim to VA and receive a decision is little different under the FDC program
than under the non-FDC model. In
addition to the time factor involved in veteran development, there are also
some hidden costs inherent in the pre-filing development undertaken by
veterans. For example, many private
health care providers are reluctant to provide records directly to the claimant
or charge significant fees which must be paid, while those same records may be
provided to the VA upon official request without cost. As part of the FDC program the VA encourages
that the veteran submit a completed Disability Benefit Questionnaire (DBQ);
however, many VA treatment providers are reluctant to assist the veteran in
this regard. Worse still, we have many
reports of VA health care providers refusing to complete DBQs despite VA
directives to do so. Finally, private
health care providers find DBQ instructions to be confusing.
FDC program is obviously a success for VA, because timeliness numbers appear
improved over traditional claims processing.
For most veterans, however, we suggest that this process, from beginning
to end, is more a draw than a win.
Further, we should not be pitting one veteran against another for VA
resources. There are other problems
inherent with the FDC program which limits its usefulness and effectiveness:
a claim is already pending before VA, the submission of a claim under the FDC
program is barred.
FDC will not be accepted if an appeal on another issue is pending if the claims
folder is not located at the home Regional Office (RO), such as if the pending
appeal has been brokered out to another RO or if the appeal has already been
sent to the Board of Veterans Appeals.
Fast Letters make it clear that submission of any additional evidence, no
matter how inconsequential to the claim, results in the subsequent exclusion of
the claim from the program.
of an appeal on a previously decided issue will kick a claim out of the FDC
VA is responsible for developing necessary records held by the federal
government, such as active duty service medical records, VA will not accept an
FDC where development of National Guard and Reserve medical records are
required. Keep in mind that during the
wars in Iraq and Afghanistan, approximately half of all those deployed were
activated Guard and Reserve personnel.
While service treatment records created for Guard and Reserve members
during a period of deployment are technically federal records, the physical
location of those records becomes the issue and is outside of the veteran’s
are unintended consequences of the FDC program.
Principle among them is that many veterans believe that they should
submit only one issue with a fully developed claim. The theory here is that each additional issue
claimed substantially increases the likelihood that a VA employee will decide
additional development is needed, thereby kicking the entire claim out of the
FDC program. Further, veterans often
limit the single FDC issue to what they view as an “easy claim” or a “sure
thing” in the hope that a quick decision will lead to monetary benefits. This strategy may prove successful in the
short term, but at a cost. Claims filed
later have later effective dates. This
means that some veterans lose months of benefits in exchange for a quicker
decision by VA.
VFW supports the FDC program. Throughout
this Fiscal Year the percentage of FDC claims submitted by the VFW has steadily
increased. In July 2013, 21.8 percent of
all claims submitted were accepted by VA as fully developed.
Section 506 of
Public Law 112-154
506 states, in pertinent part:
(2)(A) Effective dates.
The effective date of an award of disability compensation to a veteran
who submits an application therefor that sets forth an original claim that is
fully-developed (as determined by the Secretary) as of the date of submittal
shall be fixed in accordance with the facts found, but shall not be earlier
than the date that is one year before the date of receipt of the application.
Definition. For purposes of this
paragraph, an original claim is an initial claim filed by a veteran for
our view, this law, while well intentioned, will have minimal impact on claims
processing by VBA. Further, few veterans
will benefit from this liberalizing statute.
There are several reasons for this conclusion:
only applies to original claims.
According to VA, original claims make up 40 percent of its
workload. As of August 31, 2013, VA had
240,000 original claims pending. Section 506 would not apply to the vast bulk
of pending disability claims.
as an FDC will be difficult. The data
shows that 23 percent of original claims have eight or more issues; most of the
remaining claims have more than one issue.
As discussed above, the more issues submitted with a claim the more
difficult it will be to submit a fully developed claim.
encouraging veterans to file for compensation for conditions they believe are
related to service is the right thing to do, the possibility of receiving an
additional year of benefits will encourage veterans who have previously not
submitted a claim to file one. As a
consequence, this provision solicits more claims when VA is struggling to dig
out of its current backlog problem.
veterans are encouraged to submit fully developed claims, because of the number
of issues claimed and the increased difficulty in submitting an FDC with each
additional issue, we anticipate that many claims will not qualify for the FDC
program, resulting in increased customer dissatisfaction when they do not
the same reasons, a decision that a claim is not FDC eligible and, hence, not
eligible for up to one year of retroactive benefits, will result in increased
even if a claim does qualify for FDC processing, there is no guarantee that VA
will award retroactive benefits because the award is based on “facts found” and
is not automatic. Again, failure to
award retroactive benefits will result in increased customer dissatisfaction
and increased appeals.
VFW fully supports the FDC program as amended by Section 506. We have invested hundreds of man-hours in
training VFW service officers in preparing and submitting fully developed
claims which meet the requirements of the program. We believe that this program can be a win-win
for both veterans and VA. However, it is
important to recognize the limitations of this program, and the implications it
may have on some veteran’s claims.
This concludes my testimony. Thank you
for the opportunity to submit the VFW’s views for the record.
by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of
Representatives, VFW has not received any federal grants in Fiscal Year 2013,
nor has it received any federal grants in the two previous Fiscal Years.
Monday Morning Workload Report;
August 31, 2013; http://www.vba.va.gov/reports/mmwr/
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