VA claims take about six months
Veterans filing disability claims with the Veterans Affairs Department wait for an average of almost six months for a response — about six times longer than is typical in the private sector.
Pending disability claims with the VA take an average of 177 days to process, according to VA records. For some, the wait time is almost a year.
And for veterans appealing a decision on a claim, the average wait time is 657 days.
For people filing disability claims with insurance companies, about 75 percent to 80 percent of claims are handled within 30 days, said America’s Health Insurance Plans, a trade organization. Federal law requires disability claims with private insurers to be settled within 45 days, although extensions of 30 days or longer are possible.
“The backlog issue is not going to go away until the federal government rolls up its sleeves and takes a serious look at expediting the resolution of claims,” said Luz Rebollar, a national service officer with AMVETS who guides veterans through the VA claims process.
The biggest factor in the growing backlog is the increased number of veterans using the system. The VA processed almost 775,000 claims last year, pushing the backlog total to about 600,000.
With the VA expecting 800,000 claims this year, in part because of the thousands of troops returning from service in Iraq and Afghanistan, the problem is poised to get worse before it gets better, said Dan Bertoni, the Government Accountability Office’s acting director of education, work force and income security issues.
“We had a claims system that didn’t work well in peacetime, and it’s certainly showing strain now,” Mr. Bertoni said.
The VA issues more than $24 billion in benefits annually to more than 2.7 million veterans. Basic benefits range from $115 to almost $2,500 per month.
The VA says it’s unfair to compare processing times with that of the private sector because the department must prove that the injury or ailment was service-related — a complex process that includes many hurdles beyond its control.
The types of injuries suffered by troops, particularly in Iraq and Afghanistan, also are difficult to evaluate. These claims can involve post-traumatic stress disorder and environmental and infectious disease risks.
And claims are becoming increasingly complex, as veterans include more potential disabilities per request than in the past, with each requiring a separate evaluation and rating, the VA says.
Some claims involve injuries or ailments that are decades old, further complicating the evaluation process.
“There is a large block of time involved in all of this evidencegathering,” said Ronald Aument, the VA’s deputy undersecretary for benefits.
Still another problem is the VA’s difficulty in obtaining medical records and other evidence from the Defense Department, which uses a different computer system, requiring medical records to be physically delivered.
The agency says it’s working to reduce the appeals processing times by paying greater deference to decisions made at the appeals level.
The VA also plans to hire 400 additional claims specialists by summer to help chip away at the backlog. Mr. Aument says his goal is to reduce the average wait time for claims to 160 days by the end of fiscal 2007, which ends Sept. 30.
“Once these additional people come fully trained and productive, then I’m confident we’ll make a major dent in the backlog,” he said.
Mr. Aument said the agency’s long-term target for processing a claim is 125 days. Speeding up the process anymore would require changes in laws that would cut corners and “infringe on veterans rights.”
That’s not fast enough for some on Capitol Hill.
“No veteran should have to wait six months or a year for their claim to be decided and then endure an appeal that adds another year or two,” said Rep. Doug Lamborn, Colorado Republican, at a House Veterans Affairs subcommittee hearing in March about the claims backlog. “For some veterans, this is not mere inconvenience, it is financial and potentially emotional disaster.”
In a report submitted at the same hearing and to other congressional panels about the VA’s claims backlog, the GAO said the backlog problems “may lie in more fundamental reform of the VA’s disability compensation program.”
The GAO suggests that the VA update its 62-year-old criteria for awarding disability claims, which the agency says often results in claimants being classified as “disabled” when they wouldn’t be in the private sector. It also said the VA also could streamline the process by overhauling the structure and division of labor among field offices, which had caused wait times to vary greatly for veterans in different cities and regions.
“There are some management and program design problems that have to be addressed before the backlog issue is to be solved,” Mr. Bertoni said.