From: Ronald Robinson <>

Subject:

To:

Cc: "Alma Lee" <>, "Jan Hoppenstein" <>, , , , ,

Date: Thursday, March 31, 2011, 9:32 AM

Dear Congressman Clyburn:

AFGE Local 520 would like to thank you for hosting and moderating the Sixth Congressional District Veterans Forum on March 18, 2011.

As the representative of the employees of the Columbia VA Regional Office, a retired Army veteran who have been laboring in the foxholes of the Columbia Regional office for 15 years as a work study working with correspondence clerks, development clerk, claims clerk, program support assistant, veterans service representative and senior veterans service representative and US taxpayer, I appreciated your comments on your commitment and interest in the affairs of the veterans of South Carolina.

The veterans who attended the Forum presented legitimate questions regarding the claims process. However, if the answers given were checks and presented to the bank, they would be returned due to insufficient funds.

Local 520 would like address the current State of Affairs of the VBA Claims Process through the prism of previous VA reports, studies, and congressional testimonies and examples from the Columbia VA Regional Office.

Therefore, we have prepared a report for your review because “Those that fail to learn from history, are doomed to repeat it.” - Winston Churchill

AFGE Local 520 looks forward to hearing from you on the matter.

Ronald Robinson

Acting President

AFGE Local 520

PO Box 1778

Columbia, SC 29202

(803) 239-7682

Enclosure

AFGE Local 520 Claims Processing Report

CF:

VA Secretary

Chairman, VA Advisory Committee on Minority Veterans

Under Secretary of Benefits

Associate Deputy Under Secretary for Field Operations

Southern Area Director

President, AFGE

President NVAC

VBA Locals Presidents

AFGE LOCAL 520

CLAIMS PROCESSING REPORT MARCH 2010

Dedication: To all who have served and made a deposit into America’s bank account and if entitled to compensation or pension deserve a timely and accurate withdrawal.

Those that fail to learn from history, are doomed to repeat it.- Winston Churchill

INTRODUCTION

There is a tremendous effort underway to improve the claims process. However, it appears that Veterans Benefits Administration (VBA) is traveling down the same road and have failed to learn from the past. Therefore, AFGE Local 520 would like speak on this issue and provide some history because - Those that fail to learn from history, are doomed to repeat it.- Winston Churchill

Administrations come and go. Each has tackled the claims processing with great promises and little or no results. The annals of VBA are cluttered with studies, pilot programs, directives and models to improve the claims process and these efforts continue today. However, the claims continue to increase and the promises continue to be unrealistic.

VA Claims Processing Task Force Report to the Secretary of Veterans Affairs dated October 2001 states,

  • “While some of VBA actions have been important first steps, the Task Force believes that VBA Central Office decisions regarding choices about how to improve the processing of claims has exacerbated the claims backlog crisis. VBA has also created many problems through poor or incomplete planning and uneven execution of claims processing improvement projects. VBA Central Office choices have essentially served to reduce the availability of skilled labor for processing claims, while diverting experienced staff to implement unproven process changes that were poorly planned or managed. At its core, the Veterans Benefits Administration serves the veteran best by getting claims processed expeditiously and in a quality fashion.”
  • Encl 1 gives and excellent example drafted by an experienced employee
  • The Claims Processing Improvement (CPI) promised, “This new model, … would require an immediate analysis of each claim coming into the RO. This “triage” would allow the RO to process those claims requiring little or no development in a more expeditious manner, thus reducing processing time and freeing direct labor hours for those claims requiring more development and time to process. Claims Process Improvement Task Team Report November 30, 2001

The GAO Report to Chairman and Ranking Member, Committee on Veterans’ Affairs, U.S. Senate, July 2002 states,

  • “For the nation as a whole, VBA reported an accuracy rate of 81 percent for fiscal year 2001, VBA’s goal for fiscal year 2002 is 85 percent, and its strategic goal is to achieve a national accuracy rate of 96 percent by fiscal year 2006.”
  • The current accuracy rate is 83%.
  • “VBA has set production and inventory goals for fiscal year 2002, which it believes will put it on track in reducing the average time to process claims to 100 days by the end of fiscal year 2003.
  • The current goal is now 125 days.

Now, there is the testing of the Integrated LAB project and the promise of breaking the back of the claims backlog by reducing to 0 the claims that are 125 days old and attaining a VBA accuracy rate of 98% by 2015. Although the current promise maybe sincere, it is unrealistic considering the current state of VBA claims processing affairs and VBA history.

  • October 2010 – C&P claims over 125 days; 207, 951; 36.4%
  • March 2011 - C&P claims over 125 days; 470,037; 58.2%

The VBA can point to two wars, a recession, judicial and legislative changes, and the new Agent Orange disabilities, and relaxed requirement for Post Traumatic Stress (PTSD) to account for its inability to get a handle of the claims processing problem which are valid. However, this was addressed in the VA Claims Processing Task Force Report to the Secretary of Veterans Affairs dated October 2001 and the Claims Processing Improvement (CPI) was designed to account for these changes.

  • “VBA’s Business Processing Reengineering (BPR) analysis and other improvement initiatives, including case management and merging of the Adjudication and Veterans Assistance Divisions, have been based on several assumptions, some of which have been invalid: VBA’s workload would remain static or decline in the out-years; there would be no future wars, military conflicts, or major legislative C&P benefit changes; and claims processing performance was not influenced by the number and size of Regional Offices. Several of the key trends that merit mention because of their continued or future impact on claims processing are:
  • Several of the key trends that merit mention because of their continued or future impact on claims processing are: In 1991, VBA began experiencing an increase in the volume of pending claims. VBA cited several reasons for the increased backlog of claims including the impact of judicial review, military downsizing, the Gulf War, increasingly complex claims, the changing mix of claims, and staffing levels. The advent of Judicial Review in 1988, and its consequences, while certainly a contributing factor to the complexity of VBA’s workload, is but another legislative fact of life that has always been, and will continue, to impact VBA’s workload.
  • The number of armed conflicts involving U.S. deployment of forces increased during the 1990’s and the volume and frequency of legislative and regulatory benefit changes have continued. For example, during the tenure of this Task Force, the Congress has been considering a proposal for a 10-year extension of the December 31, 2001, deadline to file for Gulf War presumptive disabilities. VBA continues to react to these fact of life changes as being unusual, rather than recognizing that they are, and will continue to be, an inherent part of doing business. ”

Therefore, the VBA should focus on a short term goal and that is to stop the hemorrhaging of the claims backlog and then work to improve the claims process day by day. VBA should also provide employees with effective training, equitable performance standards, standardization of operations, a work environment that is conducive to really promoting employees ideas, improving employee morale and labor-management relations and most importantly bring some integrity and accountability to the organization.

Furthermore, VBA needs to acknowledge the factors that should have help reduced the impact of the increase in claims:

  • improved technology
  • access to nationwide VAMC electronic medical records (Note: employees are still downloading paper copies of these records for the claims file)
  • the increased budget and employees
  • overtime
  • new training initiatives
  • the certification of VSRs
  • the improved delivery of evidence from third parties entities – National Personnel Record Center, the Social Security Administration, Joint Services Research Records Center and the service departments through Defense Personnel Records Imaging System (DPRIS) (Note: Documents on CDs from the SSA are still being printed and placed in the c-file and most of the medical records are duplicate copies of VA medical records)

-For example, a quote taken from the DPRIS website by former Under Secretary for Benefits Department of Veterans Affairs Vice Admiral Daniel L. Cooper (Ret.) states, “ (DPRIS) has greatly improved our ability to gain access to personnel information needed to support the people who matter most – our veterans. Getting these records used to take several months – now, for the veterans who left Service in the last 10 years, we can get the personnel records in hours.”

  • the reduction of the number of days given to veterans to supply evidence from 60 to 30 days
  • the reduction of the number of days given to veterans to supply nonfederal records from 60 to 40 days
  • the creation of PensionMaintenanceCenters, AppealManagementCenters, NationalCallCenters, and ResourceCenters
  • QTC examinations
  • the consolidation of special issues claims at one Regional Office – mustard gas, radiation, AO claims for dependent of Vietnam Vietnams
  • Reorganization of ROs to compensation centers.

The VBA needs to resurrect the VA Claims Processing Task Force Report to the Secretary of Veterans Affairs dated October 2001 and reevaluate its analyses and assessments. It identified the problems clearly. However, some of the solutions went a rye because VBA failed to correct the main problem - Regional Office automony and a lack of accountability by Central Office. Therefore, VBA continue to fail the American veteran and make promises that they cannot keep.

  • “The Task Force was surprised by the apparent lack of uniformity in interpreting directives, compliance and ultimate accountability at the vast majority of the Regional Offices visited or represented in discussion groups. VBA’s Central Office leadership gives the impression of neither demanding adherence to nor being completely aware of the actual compliance to directives at the individual Regional Office level.”VA Claims Processing Task Force Report to the Secretary of Veterans Affairs dated October 2001, Section C – Conclusions C.1 Accountability, Leadership, and Organization, pg 16
  • “Even more important to Cooper than his new model for processing claims is bringing discipline and accountability to the organization. "If there is one word that I will hang my hat on - and we mention frequently in the [task force] report and I mention it ad nauseam in any talk I give - it's accountability," Cooper says. "I honestly felt that there was not sufficient accountability everywhere. I was convinced that when headquarters said 'everybody do this,' 57 different offices set up the polling machine and they all voted." Reversing Reinvention, Government Executive, June 15, 2003
  • Example - VBA Letter dated January 12, 2011, Subject: VBA Policy on Management of Veteran’s and other Government Paper Records gave additional instructions regarding the safeguard of veterans records which was effective immediately. However, it still has not been executed at the RO. Management is still debating it as of the date of this report.
  • “VBA regional directors traditionally had a great deal of autonomy in running their offices, something Thompson was loath to change. So, instead of ordering regions to adopt his model, Thompson gave the regional directors substantial flexibility in adapting it to their circumstances. By 2001, as Thompson's term drew to a close, many offices still had not fully adopted the key innovations. Some had not even broken down the wall between service and adjudication. At the Chicago Regional Office for example, a separate phone team talked with veterans, rather than the team handling the claim. Thompson stepped down as undersecretary for benefits in September 2001, two months short of his four-year term. Secretary Principi asked for Thompson's resignation and that of his deputy, Patrick Nappi, subsequent to the discovery of an embezzlement scheme involving two employees at the Atlanta Regional Office. Neither Thompson nor Nappi were implicated in the scheme. Thompson served as special assistant to the secretary until January 2002, when he retired to become a management consultant.”Reversing Reinvention, Government Executive, June 15, 2003
  • “Thompson's focus on data integrity also has had a significant effect. “Joe used to say, 'Give the VBA a number, and they'll hit the number,' and that was because they would find ways to cheat," Walcoff says. "Joe made it very clear when he first came on that if there was one thing he was going to accomplish here, he was going to bring some integrity to the organization. And we worked hard at it, and we brought stations in and brought directors in and we put numbers in front of them and said, 'How do you explain this?' We got to the point where I think you could at least give some credence to the data we were presenting." Reversing Reinvention, Government Executive, June 15, 2003

Those that fail to learn from history, are doomed to repeat it.- Winston Churchill

ANALYSIS AND ASSESSMENT

AFGE Local 520 would like to use the annals of VBA directives, studies and snapshots of the Columbia Regional Office’s operations as an example of what continues to plague VBA and the claims processing – Regional Office autonomy and a lack of accountability by Central Office. This is by no means all inclusive, but a synposis of the problem. If you want a complete picture, AFGE Local 520 is willing and able to meet with anyone at anytime and provide it.

CLAIMS INVENTORY

“VBA’s workload is normally discussed in terms of the number of pending claims or the backlog in VBA Regional Offices. Pending claims are generally assumed to be original and reopened claims for disability compensation. However, this shorthand description of

the workload over-simplifies what is, in reality, a heterogeneous that consumes direct labor hours of the C&P workforce. To complicate matters further, these end products do not account for all categories of work required in the Regional Offices…,” VA Claims Processing Task Force Report to the Secretary of Veterans Affairs dated October 2001

The RO 319 rating inventory as of February 17, 2011 had 5800 Ready For Decision (RFD) claims. As a result mandatory overtime was enacted. Employees are spent as it is especially, when overtime is not allowed during the week.

Currently the RFD is over 6500.

Those that fail to learn from history, are doomed to repeat it.- Winston Churchill

STANDARDIZATION IN RO ORGANIZATION STRUCTURE

Claims Process Improvement Task Team Report November 30, 2001 states,

“The most effective way to measure performance is to ensure effective measurement systems are in place. To be effective, those systems must be measuring the same things. This cannot happen if each RO is allowed to organize the claims process differently from other ROs and create, post and fill positions different from those used in other ROs. Uniformity in decision-making and standardization in RO organizational structure are musts”.

“Any deviation from the model (other than those specifically indicated in the implementation plan, including (but not limited to) changes in position description, creation of additional positions or changes to grade structure should only be permitted based upon a specific request to the Under Secretary. Continuous monitoring of the process must include meaningful site visits on a regular basis.”

“The GS 12 “Super Senior” position remains viable under this new structure.”

“We also recommend that the Claims Control Specialist (CCS) as listed in the Task Force Report be graded at the GS5/6/7 level. We believe that the position requires analysis of the claims in order to establish correct end products, to ensure appropriate suspense dates, to keep the Claims Automated Processing System (CAPS) records properly updated and to ensure that the claim considered by the VSR or RVSR at the appropriate time.”

However, here are the results today.

Duty Station / CA-5 / CA-6 / CA-7 / TOT / SVSR / DRO / FTEs
310 - Philadelphia / 20 / 24 / 7 / 51 / 2 / 15 / 1318.61
351 - Muskogee / 18 / 12 / 1 / 31 / 12 / 16 / 1034.55
317 - St. Petersburg / 49 / 25 / 0 / 74 / 20 / 26 / 924.9
349 - Waco / 6 / 44 / 5 / 55 / 23 / 29 / 814.58
335 - St. Paul / 19 / 32 / 1 / 52 / 2 / 19 / 775.08
331 - St. Louis / 14 / 23 / 0 / 37 / 8 / 11 / 660.95
362 - Houston / 8 / 15 / 1 / 24 / 7 / 21 / 627.81
316 - Atlanta / 6 / 15 / 0 / 21 / 10 / 10 / 618.98
346 - Seattle / 5 / 12 / 3 / 20 / 4 / 21 / 605.21
319 - Columbia / 3 / 2 / 1 / 6 / 1 / 5 / 596
318 - Winston-Salem / 43 / 35 / 0 / 78 / 16 / 25 / 587.39
325 - Cleveland / 4 / 20 / 1 / 25 / 9 / 9 / 574.76
330 - Milwaukee e / 25 / 30 / 1 / 56 / 7 / 8 / 540.35
377 - San Diego / 10 / 18 / 0 / 28 / 5 / 11 / 522.38
341 - Salt Lake City / 11 / 6 / 1 / 18 / 2 / 8 / 498.02
345 - Phoenix / 4 / 11 / 0 / 15 / 9 / 13 / 453.01
320 - Nashville / 0 / 0 / 0 / 0 / 7 / 13 / 441.6
314 - Roanoke / 5 / 20 / 0 / 25 / 11 / 10 / 401.21
307 - Buffalo / 2 / 3 / 2 / 7 / 3 / 6 / 372.64
339 - Denver / 4 / 5 / 0 / 9 / 4 / 10 / 342.11
343 - Oakland / 8 / 19 / 1 / 28 / 7 / 5 / 284.9
322 - Montgomery / 9 / 14 / 1 / 24 / 10 / 16 / 251.36
329 - Detroit / 4 / 10 / 2 / 16 / 11 / 7 / 250.95
344 - Los Angeles / 4 / 10 / 1 / 15 / 6 / 9 / 247.91
326 - Indianapolis / 12 / 6 / 1 / 19 / 5 / 8 / 237.8
328 - Chicago / 10 / 10 / 0 / 20 / 5 / 8 / 232.31
348 - Portland / 3 / 15 / 1 / 19 / 7 / 11 / 222.86
334 - Lincoln / 2 / 9 / 0 / 11 / 3 / 7 / 214.68
306 - New York / 13 / 4 / 0 / 17 / 0 / 8 / 213.18
315 - Huntington / 9 / 7 / 0 / 16 / 6 / 13 / 205.44
313 - Baltimore / 17 / 7 / 0 / 24 / 8 / 12 / 204.73
350 - Little Rock / 1 / 11 / 3 / 15 / 8 / 6 / 203
327 - Louisville / 10 / 12 / 0 / 22 / 5 / 6 / 194.37
402 - Togus / 2 / 5 / 1 / 8 / 8 / 6 / 190.25
321 - New Orleans / 3 / 1 / 2 / 6 / 4 / 5 / 182.6
311 - Pittsburgh / 6 / 2 / 2 / 10 / 4 / 6 / 174.78
355 - San Juan / 1 / 3 / 1 / 5 / 3 / 7 / 149.28
304 - Providence / 4 / 1 / 0 / 5 / 1 / 4 / 149
358 - Manila / 2 / 3 / 1 / 6 / 1 / 4 / 141
333 - Des Moines / 1 / 6 / 0 / 7 / 2 / 6 / 131.63
301 - Boston / 7 / 5 / 1 / 13 / 1 / 7 / 125
309 - Newark / 0 / 3 / 0 / 3 / 3 / 5 / 118
308 - Hartford / 2 / 1 / 1 / 4 / 5 / 4 / 108.2
452 - Wichita / 3 / 3 / 1 / 7 / 3 / 4 / 108
354 - Reno / 4 / 4 / 0 / 8 / 2 / 2 / 98.43
340 - Albuquerque / 4 / 5 / 1 / 10 / 1 / 5 / 93.95
459 - Honolulu / 4 / 2 / 1 / 7 / 1 / 3 / 92
347 - Boise / 3 / 3 / 0 / 6 / 1 / 3 / 71.6
373 - Manchester / 3 / 2 / 0 / 5 / 0 / 1 / 65
438 - Sioux Falls / 1 / 0 / 0 / 1 / 2 / 2 / 62
436 - FortHarrison / 1 / 4 / 1 / 6 / 2 / 4 / 57.9
437 - Fargo / 1 / 1 / 1 / 3 / 1 / 2 / 50
463 - Anchorage / 0 / 2 / 0 / 2 / 1 / 1 / 44.72
460 Wilmington / 1 / 0 / 0 / 1 / 0 / 1 / 27.9
405 -White River J / 1 / 0 / 0 / 1 / 0 / 2 / 25
397 - BVA / 5 / 6 / 0 / 11 / 8 / 27
PMC Milwaukee / 0 / 0 / 0 / 0 / 2 / 0
PMC Philadelphia / 0 / 0 / 0 / 0 / 7 / 0
PMC St Paul / 0 / 0 / 0 / 0 / 3 / 0
Sacramento / 0 / 0 / 0 / 0 / 0 / 3
Sepulveda / 0 / 0 / 0 / 0 / 0 / 2
Cheyenne / 0 / 0 / 0 / 0 / 0 / 1
Ouster / 0 / 0 / 0 / 0 / 0 / 1
417 / 548 / 48 / 1013 / 309 / 520

Those that fail to learn from history, are doomed to repeat it.- Winston Churchill