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HVAC Disability Claims Process Hearing

 

STATEMENT OF  

JAMES D. WEAR, ASSISTANT DIRECTOR, VETERANS BENEFITS POLICY  

NATIONAL VETERANS SERVICE  

VETERANS OF FOREIGN WARS OF THE UNITED STATES     

BEFORE THE   

COMMITTEE ON VETERANS’ AFFAIRS  

UNITED STATES HOUSE OF REPRESENTATIVES   

WITH RESPECT TO  

CLAIMS REPRESENTATIVES’ ROLE IN THE DISABILITY CLAIMS PROCESS  

   

WASHINGTON, D.C.                                                                                         April 18, 2012     

MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:  

On behalf of the more than 2 million 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 testify today regarding the Veterans Service Organizations’ role in the disability claims process.  

In 2011, the Veterans of Foreign Wars (VFW) helped more than 97,000 veterans and survivors receive over $2 billion in compensation and pension benefits.  In addition, in FY 2011 the VFW represented more than 3,700 appellants at the Board of Veterans Appeals.  Our allowed rate (one or more issues granted on appeal) of 30.7 percent was second highest among the major veteran service organizations.   Our allowed rate was higher than that achieved by attorneys.  It was fully eight percentage points higher than veterans who had no representation.   

We are proud of these achievements.  They show that representation by our service officers and appeals consultants clearly helps veterans and other claimants perfect their claims and obtain the benefits to which they are entitled under the law.   

However, we are not alone in this work.  The American Legion, Disabled American Veterans and the Veterans of Foreign Wars represent nearly 1.6 million veterans and survivors already receiving compensation, pension or DIC from VA.  Together, we represent tens of thousands more with claims and appeals awaiting decisions from VA.  

As part of this process, we answer millions of telephone calls and emails a year.  We interview hundreds of thousands of individuals annually, explaining what benefits they may or may not be entitled to, help them complete forms, assist in developing claims, review VA decisions, identify errors, and work with VA to get them corrected.  

We provide all these services to veterans and the VA for free.  We do not take a dollar in grants or payment from the Federal government to provide these services.  We do these things because we recognize that the laws and regulations dealing with veterans benefits are often complex; the claims process is often treacherous to navigate.  We do these things because veterans have already sacrificed for our country and whatever assistance they receive from our government should not require additional struggle and turmoil.  

We readily acknowledge that nearly all VA employees are dedicated to doing the very best they can for veterans, we also realize that they are, at present, overwhelmed with over 1.5 million pending compensation, pension and education claims, and over a quarter of a million pending appeals. They are people working within an extraordinarily complicated and frequently archaic claims processing system.  Since there are few automated quality controls, they are dependent on both how much they know and how well they apply it to their work.  In short, VA decision makers are human; they make mistakes.  

Quality of decision making is problematic.  A review of the latest quality data for ratings indicates that the best regional office (Lincoln, NB) has a four percent error rate.  The national average has remained nearly stationary at 16 percent for months.  Recent changes in the Baltimore regional office, still the worst in the nation, have resulted in significant improvement (for it); errors occur in “only” 29 percent of its rating decisions, down from a 33 percent error rate just a few months ago.  

The VFW has nearly 1,300 accredited individuals.  Most of these are county and state employees who provide assistance to veterans and survivors who have given the VFW their power of attorney (POA).   Service officers employed by the VFW and work within VA regional offices number 245.  This is the group that receives specialized training and routine information dissemination from our national office in Washington concerning changes in law, regulations, VA procedures or court decisions.  

New VFW service officers are given a 40 hour classroom “boot camp” where they receive intense training in all VA benefit programs, with a special emphasis on compensation and pension.  They are also taught representational skills; they learn about the appeal process.  We give them the basic knowledge they need to intelligently discuss disability and survivor benefit programs with claimants, help them fill out appropriate forms, tell them what evidence is needed to complete their claim, outline the claims process within VA and other things.   

Training does not stop there.  Every VFW service officer who works within a VA regional office is required to attend training each year.  This training is very technical in nature, with a heavy emphasis on topics related to the rating schedule.  Most of our trainers are recently retired VA subject matter experts who provide instruction as good as or better than that received by VA employees.  Our goal is to ensure our service officers know VA laws and regulations as well as or better than the VA employees with whom they deal with in their offices.  Once a problem with a decision has been identified, we expect our service officers to use the facts, laws and regulations to convince VA to change the decision in favor of the claimant.   

In all, we provide approximately 80 hours of classroom training each year to VFW service officers who work within VA regional offices.  

Change does not stop between training conferences.  The Veterans Benefits Administration (VBA) frequently adds or modifies regulations and policies dealing with its benefit programs.  The VA Office of General Counsel, the Court of Appeals for Veteran Claims, the Court of Appeals for the Federal Circuit and others publish decisions which change how VA works.  Our national staff is constantly monitoring the various sources of change to identify those things which may affect veterans.  We analyze these changes, discern how they might impact veterans benefit programs and then notify our service officers of the change and what it means to them.  These Updates are distributed several times each month.  This is how we keep our service officers up to date.  

Veteran service officers offer a host of services to veterans, dependents and survivors.  While each claimant is different and has different needs, the veteran service officer performs the following roles:  

Information dissemination – Generally, the first contact a service officer has with a claimant is either in person or on the telephone.  The veteran has questions, concerns or problems.  The service officer must identify each issue and provide the most accurate information available.  Veteran service officers often perform outreach, meeting groups wherever they might gather.  This typically involves talking about the things which are likely to interest the group, then taking specific questions after the conclusion of his remarks.  

Claims intake and preparation – This can be done either in person or on the phone.  It is most effective when the claimant can sit down with the service officer. This allows the service officer to review available records as the application for benefits is being completed.   The service officer asks questions and helps the claimant focus the issues.  It is also an opportunity to begin to discussing what evidence is needed to perfect the veterans claim.  

Facilitator/aid in development – A well trained service officer will usually know what evidence the VA needs to favorably consider the claim.  He/she should tell the veteran what that evidence is and explore with him just how that evidence can be obtained.  This is also an opportunity to begin to manage expectations of the claimant.   

Problem resolution – informal intermediary to clarify issues, obtain evidence – VA employees know who the good service officers are, and they use them to help expedite claims.  It is not unusual for a VA employee to alert a service officer of the need for a particular piece of evidence in order to make a decision (e.g., “If you obtain this piece of evidence, I think I can grant the claim.”)  This type of communication acts as an incentive for both the service officer and the veteran to obtain that evidence and submit it quickly.  This type of informal interaction becomes a win-win for VA and veterans.  

Final quality control of VA decisions – Long established VBA policy requires that proposed rating decisions be provided to service officers holding veterans power of attorney for at least two business days.  During that period service officers have an opportunity to review not just the rating, but also the record on which the rating was based.  Any errors identified during this review are brought to the attention of either the rater who made the decision or a designated supervisor.  This process is designed so that errors can be corrected before the rating is sent to the veteran.  While some local VA managers occasionally try to reduce or eliminate this review period, VBA leadership has always recognized the importance of this step and have taken corrective action when necessary.  

Counselor/interpreter of VA decisions – Not every decision made by VA is favorable to veterans.  There are times when the evidence and the law do not allow VA to grant the benefit sought.  One of the jobs of a service officer is to explain decisions to claimants in ways that they will understand.  They discuss the problem which forced VA to deny the benefit sought and explain what evidence is necessary to obtain a different decision in the future.  

Appellate counselor – Sometimes the VA just makes a wrong decision.  When that happens the service officer discusses appellate options with the claimant and helps him/her file a notice of disagreement when appropriate.  During the appeal process the service officer may discuss the case with a Decision Review Officer, represent the veteran on appeal and write an argument on behalf of the claimant to the Board of Veterans Appeals.  

Representation at the BVA – The national Veterans of Foreign Wars maintains a staff of highly trained appeals consultants at the Board of Veterans Appeals.  Their job is to review the case when it comes to the Board, formulate the best possible argument on behalf of the appellant.  They also represent appellants in personal hearings before Veteran Law Judges at the Board.  As mentioned above, we helped appellants obtain reversals by the Board in 31.7 percent of the appeals considered in 2011.  

VA is in the midst of tremendous change.  Historically, technological advances in VA have been done in fits and starts.  Three phase plans often failed to move beyond the second phase.  Even when new programs were rolled out in the last two decades, they were often deployed long before adequate testing was completed, leaving users in the field with programs which required thousands of man-hours to fix.  

However, VBA appears to be moving forward today with IT programs which promise to speed processing while finally introducing tools which promise to improve quality.  We welcome this progress.  We hope that VA has learned lessons from its past and from private industry which will allow it to implement change with minimal negative impact on its employees, service officers and veterans.  

It is important to understand that veteran service organizations are both advocates for veterans and partners, or stakeholders, with VA.  In order for us to do our job effectively, we must have access to VA computer systems, records, facilities and personnel.  Without this access, we might as well stand on the curb and shout at regional office buildings.  

Our relationship with Secretary Shinseki and VBA leaders has steadily improved over the last four years.  VA has shown progressively greater transparency in many of the things it does.  We have tried to demonstrate to VA that while we are advocates for veterans and will hold VA accountable for doing its many and varied jobs, we are also willing to work with VA to help ensure that change, when it occurs, is at least neutral in its effect on veterans.  More importantly, we seek to identify win-win opportunities: opportunities for improvement which help both VA and veterans. A recent development within VBA illustrates both the difficulties and benefits of working closely together to achieve win-win situations.  

Last summer VBA deployed elements of what has now become known as the Simplified Notification Letter.  In its earliest manifestation, VA rolled back the clock to 1945 and began issuing rating decisions which looked remarkably like those written at the end of WWII.  Decisions did not contain a discussion of the evidence considered or an explanation of the reasons for the decision made – commonly referred to as “reasons and bases.”  Decisions granting an evaluation did not contain a summary of the rating criteria used to assign the evaluation nor an explanation of what was needed to obtain the next higher evaluation.  These elements are required by VA regulations and court decisions.  The explanation for these changes was that it allowed raters to increase production by 30-40 percent.  

National service organizations were not consulted on these changes.  When we became aware of them, the VFW went to the VA regional office in Atlanta to review both the ratings and notification letters to veterans.  We discussed our findings with project managers who made a few changes to the program which provided additional, but very generic, explanations to veterans.  

These changes did not, in our view, meet regulatory and court mandated requirements for explaining VA decisions to veterans.  In order for a veteran to understand a decision and determine whether it was correct or not the law requires that he/she be provided certain information.  We believed this program failed to provide veterans with the information required by law.  We continued to press VA on this program.  

To their credit, VA made additional modifications and information was added.  Both the VFW and DAV continued to object to this program because notice remained inadequate.  It was only in the last few months that we were all able to arrive at a point where the notice provided by VA, when properly done, was adequate to satisfy our concerns, while allowing VA to achieve increased production without further degradation of quality.   

We work with VBA at the national level almost daily.  The VFW and representatives from the largest veteran service organizations have been meeting with VBA on a number of initiatives, including eBenefits (working on ways to improve functionality and customer satisfaction for veterans) and the Veterans Benefits Management System (VBMS) (to ensure the needs of veterans representatives are addressed in VA’s next generation claims processing system).   

We recognize and support VBA’s plans on expanding customer and service organization interaction with VA.  VA has plans to allow claimants and service officers to submit information and claims electronically.  VA indicates that it embraces the idea of permitting veterans to change their contact information, such as an address or to report changes in income (for pension) and add or subtract dependents by computer.  Any initiatives which allow claimants and their representatives to submit data electronically or to effect minor changes to awards based on user input, portends great savings in time and money to VA, while offering enhanced service to veterans. The VFW looks forward to continuing and improving our working relationship with VA to find common sense solutions to reducing the claims backlog, while improving rating decision outcomes.   

Mr. Chairman, this concludes my testimony.  I would be happy to answer any questions that you or the members of the Committee may have.  

Information Required 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 2012, nor has it received any federal grants in the two previous Fiscal Years.  

 

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