Triaging Causes for Delays in the VA Claims Process

Government waste and abuse are at the forefront of the national conversation, with stories popping about potential mismanagement of taxpayer dollars across the federal government, including in many areas that CAMI has consistently researched and highlighted. Among the most vexing and longstanding problems: an enormous claims backlog at the Department of Veterans Affairs (VA).

Right now there are 946,000 pending claims awaiting a decision by the VA, including 251,000 that have been outstanding for more than 125 days. In fact, the average time it takes for a veteran to receive a decision on their claim is approximately five months. No wonder our nation’s veterans are so frustrated. When they agreed to serve in the Armed Forces they were promised a certain level of care once they left the military, but for too long, the government has not been holding up its end of the deal.

The VA has acknowledged the crisis and has long struggled to get benefits claims processed in a timelier manner. In 1996, Congress granted the VA authority to conduct a pilot in 10 VA regions for persons other than VA employees to conduct veterans’ disability examinations. Despite the success of the pilot providing "adequate and timely disability examinations", it was not until 2014 — nearly 20 years later — that Congress expanded the authority to more VA regions.

Unfortunately, satisfactory remedies remain elusive. Moreover, a deeper dive into VA processes and back-end technologies suggests that the problem lies not with the lack of remedies, but with internal obstacles that, if overcome, would enable the agency to properly triage and address the backlog.

For example, collecting medical evidence for a service-related disability claim is often a sticking point and a significant cause for delay. Information has to be collected and analyzed from a variety of often disconnected systems, including Department of Defense records, Tricare, or private medical treatment, all of which have their own systems and often rely on paper processing. Digitizing all of the evidence and integrating the systems through which medical evidence is collected could significantly expedite what is now a claims process that simply isn’t providing veterans the services they deserve.

Another area for improvement would involve new ways to triage and standardize processing of the most common claims. For instance, by expanding the VA’s use of artificial intelligence and machine learning, the VA could structure medical data collection in ways that dramatically accelerate action on most claims.

The VA can also improve its internal systems to ensure that providers have the most up-to-date information about the veteran at the time of a disability exam. This may seem obvious, but it is actually extremely complicated in the current system. Today, those records are rarely complete or up to date, even when the veteran has seen other VA providers and booked appointments through the VA system. This too is a challenge that smart, nimble technology applications can help address. Likewise, incorporating special headphones can enable a veteran to test for hearing loss–a widespread issue among veterans that often requires ongoing attention– without having to search for a special soundbooth.

Unfortunately, responsibility for the claims process is currently spread across different offices — a result of various reorganization efforts that, ironically, were intended to address this very problem. In reality, and as any successful transformation effort in government or the private sector has shown, accountability and responsibility for getting claims across the finish line must be consolidated under one entity inside of the Agency reporting directly to VA leadership. Moreover, clear metrics and performance outcomes must be established to which leaders are held accountable; employees must be encouraged and incentivized to embrace speed, ingenuity, and agility to tackle big problems like the claims process.

The challenges facing the VA are not insurmountable, but in order to fix them, the Department is going to need transformation beyond the right technological tools. The planned upcoming competition for the VA’s Veteran’s Processing Automation contract offers a great opportunity to access all kinds of innovative solutions, provided that it gives companies the kind of flexibility needed to attack the problems.

In the end, the VA’s culture must reward efficacy and positive results, whether delivered by internal employees or the private sector. Indeed, leveraging the private sector to help deploy proven solutions will be a key component of any transformational initiative. Ultimately, a robust partnership built around common goals and expectations will deliver the most significant results for America’s veterans.