The Veterans Administration is the only government agency that is virtually autonomous. Even the U.S. Supreme court has determined that they do not have any authority over the Veterans Administration with regard to claims processing.
Unlike other governmental agencies, the VA has not been audited by any external oversight agency. Though it would not matter if they were…they have been audited by their own Inspector General and with regard to claims processing, found woefully deficient. There have been no sanctions, no high level resignations or even actual changes to correct the deficiencies.
The VA has processes and policies in place that, in most cases, have not been changed in decades. The most specific and disastrous of these are the manner in which they hire and promote employees to process claims.
Since the beginning of the first Gulf War, veterans returning from combat in the Middle East have faced an ever increasing “backlog” of claims and an administration that perpetuates the backlog by continuing to hire and promote unskilled / untrained workers to handle the complicated and highly impacting job of claims processing. When these practices are combined with systemic breakdowns which disregard policy, procedure and outright violate regulations, then there is no other result than for the backlog to grow.
Outside of the Veterans Administration (and the U.S. Government), the private sector has an abundance of highly trained claims processing professionals that are educated in the complicated process of handling medical claims. The entire private health insurance industry is supported by these individuals. Yet, the Veterans Administration director, Mr. Shinseki freely admits that who the VA hires and promotes to handle Compensation and Pension claims are untrained. This hiring procedure IS the primary cause of the backlog. Not the endless statements of how many claims they are processing.
Each time there is a major change or addition to the list of issues that a veteran can claim, it only comes after YEARS of study and a lengthy vetting process. The Regional Processing offices are NOT caught off guard. They were not blind-sided, yet this IS their standard excuse as to the continued and ever-increasing backlog in processing claims.
The secondary cause to the ever-increasing backlog is the actual processors. In 2008, the VA instituted the Benefits Delivery at Discharge (BDD) program. This program was designed to ease the processing burdens both in time and manpower for the VA. The VA has been getting claims and medical information directly from the Services, as the member was being discharged. This program was initiated to streamline the claims process, since, (in theory) everything contained in the service member’s Active Duty medical record was an “automatic” service connected injury or illness, and there was no “development” (investigation) of the injury or illness. Yet, the processors still rejected claims done through the BDD or low-balled them, in direct conflict of their own rating manual and policies.
This system process of claim received; VA denies or low-balls claim, veteran requests reconsideration, VA again denies or low-balls claim, veteran files Notice of Disagreement, VA again denies or low-balls claim, veteran files a formal appeal – this process takes 2-5 YEARS, and then it only gets resolved CORRECTLY if the veteran or a Veteran’s Service Officer, is vigilant, thorough and persistent. Most veterans do not have the fortitude to “fight the system”, become disgruntled and walk away with whatever paltry, half-baked rating the VA offers.
It is no longer tolerable that the VA will take upwards of 3 years to fully vet and properly adjudicate a claim. It is unacceptable that the VA will withhold “back-pay” for months, when it does finally properly adjudicate a claim, based solely on their backlog.
When a processor makes an obvious error, their supervisors have the authority and ability to send a claim back to the processor to correct their mistakes. Rather than do that, the VA policy is to make the VETERAN file an appeal (in some fashion) and essentially start the process over.
These policies, actions and continued behavior are no longer acceptable to those of us paying the bills.
We, the American taxpayers, need to DEMAND a universal overhaul of the VA, including hiring practices, adding mandatory claims processing deadlines and an independent oversight organization with the authority to employ sanctions and repercussions for this continued dereliction of duty, waste of Federal taxpayer funds and abuse of the very people, our veterans, who are the very purpose for this bloated, runaway agency’s existence.