Printer Friendly Page
YOUR VETERANS' BENEFITS ADMINISTRATION AT WORK
AND REWORK
AND REWORK SOME MORE -- Veterans' Advocate Jim
Strickland
with a look at the waste of "rework."
Veterans' Advocate Jim Strickland
provides regular columns for VA Watchdog dot Org.
If you would like to contact Jim about
his columns, you can email him here...
The archive of Jim's articles
is here...
---------------
Rework, repeating a task more than once to
correct poor workmanship is a curse to any industry. If the cost of
producing a widget is (x) and the finished product is rejected by
quality inspectors at the end of the process, the cost of reworking,
correcting defects or scrapping the product altogether may increase cost
by a factor of 2 or more.
William Edwards Deming, Ph.D. was a professor, author, lecturer, and
expert in statistics and quality control in manufacturing processes. He
is widely known as an important influence on the Japanese manufacturing
industry as it was being rebuilt after WWII. He stressed that quality
should be built in at the first step in any process, eliminating the
need for inspection, rejection and rework. During his time, many
American industries, most notably automobile manufacturers, ignored his
philosophy while the Japanese embraced his teachings. The results a half
century later are evident.
The foundation of Dr. Deming’s method of process control is relatively
simple; improving product quality beginning at the first step of the
process reduces expenses while simultaneously increasing production.
Deming said, “Defects are not free. Somebody makes them, and gets paid
for making them.” All industries and businesses deliver a product.
Rework of a defective product is not free, it is an expensive way to
convey a good or service to a client, customer or a patient. From fast
food hamburgers to heart surgery, there’s a measurable goal to be
achieved and an outcome that either meets the stated goal or fails. You
want your cheeseburger hot and fast and your bypass operation should
improve your life…if either the product or the service fail to meet
their goal and require rework, you become a very unhappy customer and
the expenses of the business rise dramatically.
The product of the Veterans Benefits Administration (VBA) is the
adjudication of a fair and equitable decision regarding, and if
justified, the award of appropriate benefits to a deserving Veteran. If
a VBA decision is defective, it must be reworked or “appealed”,
compounding time and expense. The substantial expense of rework at VBA
is paid for by the American taxpayer. There are other expenses that are
associated with rework of a flawed decision by VBA, such as the
financial harm that time and again occurs when a Veteran must wait
months or years while rework takes place.
The process of obtaining an award of benefits for a disability begins at
the Veteran’s “Veterans Affairs Regional Office” or VARO. There are 57
VAROs that process disability claims. When the Veteran disagrees with
the decision of the VARO, the Veteran has the right to appeal that
decision to the Board of Veterans Appeals (BVA). If that decision is
thought flawed by the Veteran, it may then be appealed to the U.S. Court
of Appeals for Veterans Claims. In some instances a Veteran who
disagrees with a decision of that court may appeal to the U.S. Court of
Appeals for the Federal Circuit and then to the Supreme Court of the
United States.
In a May 5th, 2005 Government Accountability Office (GAO) report of
testimony before the Subcommittee on Disability Assistance and Memorial
Affairs, Committee on Veterans' Affairs, House of Representatives,
Cynthia A. Bascetta, Director, Education, Workforce and Income Security
notes that, “VA still lacks a systematic method for ensuring the
consistency of decision-making within VA as a whole…”, and later Ms.
Bascetta says, “As you know, in January 2003, we designated VA’s
disability program, along with other federal disability programs, as
high-risk. In part, we designated VA’s program as high-risk because of
concerns about consistency of decision-making.”
(This report is here
http://www.gao.gov/new.items/d05655t.pdf )
The GAO document goes on to inform us that, “During fiscal years 2003
and 2004, respectively, the regional offices made about 715, 000 and
598,500 decisions involving disability compensation claims…veterans
submitted Notices of Disagreement in about 13.4 and 14.5 percent of all
decisions involving disability ratings, and of the veterans who filed
Notices of Disagreement, about 34.9 and 44.4 percent went on to submit
appeals to the Board. Assisted by 240 staff attorneys, the Board’s 52
veterans law judges decide veterans’ appeals on behalf of the
Secretary.”
Reading deeper into this lengthy document we discover, “In some
instances, the Board may find that a case is not ready for a final
decision and return (or remand) the case to VBA for rework, such as
obtaining additional evidence and reconsidering the veteran’s claim. If
VBA still does not grant the requested benefits after obtaining the
additional evidence, it returns the case to the Board for a final
decision. Of the appeals involving compensation cases decided during
fiscal year 2004, the Board reported that it granted requested benefits
for at least one issue in about 18 percent of the cases, denied all
requested benefits in about 23 percent of the cases, and remanded about
58 percent of the cases to VBA for rework.”
It’s troubling when we look at the decisions of the court and find, “Of
the 3,489 cases decided on merit during fiscal years 2003-2004, the
court reversed or remanded in
part or in whole about 88 percent of the cases.”
Thus, in 2004 VBA fell behind in its work when compared to 2003 and
adjudicated 598,500 claims out of 57 offices. Of these, Veterans filed a
Notice of Disagreement (NOD) in almost 90,000 of these claims. Some
39,000 of those were submitted to BVA on appeal and given a look by one
of their 240 VA lawyers and/or 52 law judges. Approximately 23,000 of
those were remanded to their respective VARO for rework. That’s about
1600 appeals and 400 remands per VARO in 2004 out of the nearly 10,500
decisions each VARO was responsible for in 2004.
A remand is rework of rework. The work has was done once at the initial
filing, again at the BVA level when it was considered by one of the 240
lawyers or 52 judges and a third time at remand to the VARO.
A GAO report in 2002 said that, “VA reported an accuracy rate of less
than 70 percent for regional office disability decisions when it tested
a new quality assurance program in fiscal year 1998.”
You’ll find this report here
http://www.gao.gov/new.items/d02806.pdf
This 2002 GAO document establishes that, “an analysis in 1997 of about
50 decisions in which the Board had granted benefits previously denied
by regional offices…concluded that most of these Board decisions to
grant benefits had been based on the same evidence that the regional
offices had considered in reaching their decisions to deny benefits.”
In a May 2005 statement to the U.S. Senate Committee on Veterans
Affairs, Rick Surrat, Deputy Director of Disabled American Veterans
(DAV) told the members that although recommendations to improve the
process of claims processing had been made in 1995, based on Blue Ribbon
Panel and other government funded commissions in 1993 forward, “The
recommendations received little serious consideration.” by VA. Mr.
Surrat went on to say that, “…lack of emphasis on quality resulted in
high error rates, inconsistent decisions, and the appearance of
arbitrariness in VA’s decisions, which led to a relatively high number
of appeals and necessitated more rework of claims.”
If you’ve followed my fuzzy math this far, you probably have your #2
lead pencil out and you’re adding all this up along with me. I’m no
mathematician so you should go ahead and continue crunching the numbers
if you have the heart for it. I don’t need any more evidence to
understand that at least one third to one half of the work done by VBA
is pricey rework.
I started looking at this for personal reasons. I’m 100% IU. It took me
about 3 years at the local level to win my claim. In July of this year
my wife applied for her CHAMPVA benefits and at about the same time my
son applied for his Chapter 35 college education benefits. Earlier this
week, my wife received a letter denying her CHAMPVA application because
her sponsor was not Totally and Permanently Disabled. About the same
time my son got a letter that his benefits were denied because his
parent was not 100% disabled.
In addition to noting my 100% status, my award letter states that, “No
future examination will be scheduled.” On the same page it says that my
dependents are authorized Chapter 35 education benefits retroactive to
the date of my award.
In a statement before the Senate Committee on Veterans Affairs on
October 27th 2005, The Honorable Daniel L. Cooper, Under Secretary For
Benefits, Department of Veterans Affairs said, “A total disability
rating based on IU can result in eligibility for additional benefits for
a veteran’s dependents and survivors. Educational benefits for the
veteran’s spouse and eligible children are available under the
Survivors’ and Dependents’ Educational Assistance Program (title 38,
United States Code, Chapter 35). The Civilian Health and Medical Program
of the Department of Veterans Affairs (CHAMPVA) provides reimbursement
to eligible dependents for most medical expenses, provided that they are
not also eligible for health care benefits provided by the Department of
Defense. To be eligible for both of these benefits, the veteran’s IU
determination must be considered permanent. Permanency for eligibility
to Chapter 35 and CHAMPVA requires that there not be a future
examination scheduled.”
Based on that statement from a man who knows the rules, it’s abundantly
clear that my wife’s and son’s benefits were wrongly denied.
I began to investigate what caused the problems and I initiated my now
necessary appeals processes to obtain benefits. I found that although my
VARO does not use the term “Permanent and Total” for some reason, the
CHAMPVA office in Colorado seemingly requires that exact phrase be used.
Although I can’t be sure with my quick investigation, it seems that the
Chapter 35 Dependents Educational Assistance folks use a form that lists
my disabilities and since they don’t total to 100% (I’m IU, remember? I
don’t have to be 100% to be 100%.) they automatically deny all IU
applicants.
This results in rework on top of rework. My initial claim was as clear
as it could possibly be. Over 3 years none of my evidence changed
appreciably from the day I first requested IU benefits. Nonetheless, it
was some 36 months of form letters, denials, appeals and more denials
before a Decision Review Officer finally assessed my entire file and
immediately awarded the correct benefit.
The Military Construction and Veterans Affairs and Related Agencies
Appropriation Bill, 2006, recommended nearly $154,000,000.00 be given to
VBA for administrative expenses. You’ll find that report here,
http://thomas.loc.gov/cgi-bin/cpquery/?&sid=cp109ZS9Co&refer=
&r_n=sr105.109&db_id=109&item=&sel=TOC_132440&
In an age when our country is at war, unprecedented VA budget cuts are
proposed, there is a rapidly increasing utilization of VA health
services by an aging baby boomer population and we are caring for
thousands of recently severely injured Veterans, the excessive cost of
rework by VBA is unconscionable.
To successfully serve the next generation of Veterans our VA will
require leadership capable of getting the VA to do the job of delivering
the correct benefits award decision in a timely fashion to the Veteran.
A decision must be accurate the first time so that successful appeals,
remands, appeals to a higher court or any other rework will be reduced
to less than 1%.
A dramatic reduction in appeals or ‘rework’, may even encourage VA to
downsize some of those 240 lawyers and 52 judges and spend much of that
$154,000,000.00 where it belongs, caring for a disabled Veteran.
---------------
Larry Scott
