The VA Claims Backlog

by Scott Hogenson
If you can’t tell a pectoralis major from a latissimus dorsi, you may have trouble filing a claim.

The backlog of disability claims at the U.S. Department of Veterans Affairs has catapulted the agency into an unwanted spotlight. Unlike other scandals besetting the Obama administration, there is nothing to indicate that the VA is targeting conservative vets with systematic delays or passing their telephone records along to the Justice Department. Simply put, the VA backlog has grown because of the technical burdens veterans face in navigating a complex process in a vast bureaucracy.

VA Secretary Eric Shinseki promises to do his best to reduce the backlog. So far, his most visible step is a dictate that VA employees who review claims work mandatory overtime to tackle the problem, which is staggering. As of June 22, VA reported that 833,130 vets had pending compensation and pension (C&P) claims. That’s more people than reside in San Francisco. If these claimants represented a single city, it would be the 14th largest in America. Backlogged claims, defined as those pending more than 125 days, represent nearly two-thirds of that total.

Most of the discussion of the claims backlog misses the mark. Secretary Shinseki and others at VA repeatedly tell us that the key to reducing the backlog is computerization. VA’s goal is to move from paper records to digital ones. It’s a good talking point, but it won’t get the job done any time soon.

The implementation of digital technology is important going forward, but it won’t do anything for the millions of veterans whose military records are old, faded pieces of paper. Newly discharged veterans may well be able to provide VA with electronic records, but the odds drop to near zero for veterans of previous eras.

Veterans who need to file a claim must first obtain their military records. For vets relegated to paper, these records are stored somewhere in America; the exact location depends on the military branch in which they served and when they served. Once the paper has been retrieved, the veteran must go through the pages one at a time and determine which ones provide evidence to support his or her claim.

VA can obtain a veteran’s military record and review it for evidence, but veterans need to ask themselves whether a claims reviewer or they themselves will be more thorough in identifying the necessary evidence. There are veterans’ groups that can assist with assembling C&P claims, and this a valuable service, but for most vets the process still relies on paper. Technology is no quick fix for what ails VA today. It will do little to reduce paper at the source, meaning the paper problem will continue to plague the front end of the process for many years.

Meanwhile, the other prevailing narratives describing the reasons for the backlog are also false. We are told that VA is swamped with claims from Iraq and Afghanistan veterans and with Agent Orange claims. In fact, claims filed by Iraq and Afghanistan veterans represent only about one-fifth of all pending claims and just 23 percent of backlogged claims. Two-thirds of all pending claims — 67 percent — were filed by older veterans of the Gulf War, Vietnam, Korea, and World War II. Claims from Iraq and Afghanistan veterans are often more complex than those from veterans of other wars, but they still account for only a small portion of the backlog.

As for Agent Orange, there are just slightly more than 1,000 such claims in the backlog. All Agent Orange claims, whether new or reopened, and including those involving interim decisions and cases under review based on the new Agent Orange standards — all these taken together amount to less than 0.0022 percent of all claims.

VA data also show that an estimated 11 percent of veterans filing claims for additional disabilities are already rated 100 percent disabled or Individually Unemployable, which carries a 100-percent-disabled rating. This is not to intimate that anything is amiss with such claims, but questions involving complete disability are inherently complicated, requiring sufficient evidence and the time to evaluate it.

Much of the reason for the claims backlog is that there is a lack of medical knowledge among those who file claims and some of those who review them. The process is couched in excruciatingly precise medical, physiological, and anatomical terminology.

Say, for instance, a veteran suffered a leg wound and is unable to walk very well. He cannot simply file a claim for a bum leg. He can, however, file a claim for Disability 5311, which is classified under Disabilities of the Foot and Leg. The veteran must then provide evidence of injuries involving “Group XI, Function: Propulsion, plantar flexion of foot (1); stabilization of arch (2, 3); flexion of toes (4, 5); flexion of knee (6). Posterior and lateral crural muscles, and muscles of the calf: (1) Triceps surae (gastrocnemius and soleus); (2) tibialis posterior; (3) peroneus longus; (4) peroneus brevis; (5) flexor hallucis longus; (6) flexor digitorum longus; (7) popliteus; (8) plantaris.”

This is the necessary language for determining a medical disability. Anything less precise would lead to fraud and chaos. But ordinary war-fighters have no familiarity with this tribal language. It’s also important to understand that claims are not reviewed by doctors; reviews are largely conducted by mid-level GS federal employees. Compounding the problem is the fact that a “fully developed claim” must be named as such in the application, meaning the veteran must first know where and how to find the needed information, something VA is not very helpful in providing.

Knowing where to locate this information and understanding it is only part of the challenge. The information must also be translated into the necessary language. The solution is to be examined by a physician. However, medical exams performed by or at the behest of VA do not normally occur until after the claim has been filed. With little knowledge of what information is needed, where to find it, and how to have it translated, hundreds of thousands of veterans are left in limbo. They often file incomplete or flawed claims, which may be denied for that reason and not because of the absence of a real disability. Others that are not denied can be mired in the backlog for months or years as the veteran tries to assemble the necessary evidence.

To VA’s credit, it has processed more than 4 million C&P claims in the past four years. But the data reflect a failure of imagination on the part of VA management, since this number falls nearly 500,000 short of the number of claims received. It’s not enough to tell veterans to “Visit VA-dot-gov” and file a C&P claim. The military should provide service members who are leaving active duty with a VA-oriented physical exam that pinpoints problems and describes them within the framework of the VA disability codes. This information could then be used by the veteran to file a better-developed claim.

There has been progress on this front. The Integrated Disability Evaluation System (IDES) was launched in 2007 and provides a means by which seriously wounded, ill, or injured service members can be more quickly moved into and processed through VA’s disability system. But it is used primarily for those leaving the service for medical reasons. For the vast majority of people mustering out of the military under ordinary circumstances, IDES does not apply. A simplified version of IDES that can be universally applied and provide separating service members with the basic technical information they need to begin the VA claims process would do much to close the veterans’ medical-information gap and get them on track to filing a fully developed claim.

Veterans who do not have the skill set to distinguish between a pectoralis major and a latissimus dorsi need a little hand-holding, and veteran service organizations like Disabled American Veterans, the American Legion, Paralyzed Veterans of America, and others offer free help to veterans navigating the VA claims process. They do it because they want to.

But this process is rightly the responsibility of the Department of Veterans Affairs, and VA should be more rigorous in helping veterans who enter the system after they shed their uniforms.

— Scott Hogenson is a Navy veteran and served as deputy assistant secretary for public affairs at the U.S. Department of Veterans Affairs from 2005 to 2007. 

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