VA claims take about six months

The Washington Times Weekly - - National - By Sean Lengell

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.

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