Claims Backlog Drops

August 28, 2015

A historic milestone was reached this week with the VA’s announcement that initial claims for veterans’ disabilities and survivor benefits dropped to 98,535. This is an 84% reduction from the high water mark of 611,000 claims in the pipeline in March 2013.  

Almost five years ago, former VA Secretary Eric Shinseki announced that the VA would eliminate the backlog of initial claims that were waiting for more than 125 days for a decision, by the end of 2015. Now, the VA appears to be in reach of that goal.  

According to the VA, the quality of the decisions remains high as the numbers have dropped. The accuracy of disability decisions has climbed steadily from 83% in 2011 to 91% today. The accuracy of “individual medical issues” within a claim is now at 96%. Rated against eight distinct “error categories” – such as correct effective date, correct decision related to military service, etc. – VA arrives at the right decision 98% of the time.  

MOAA commends VA Under Secretary for Benefits, Allison Hickey, for building the transformation strategy that led to these encouraging results. In many appearances before Congress, Hickey referred to upgrades in “people, process and technology” as at the heart of her strategy.   

Now, almost all claims are managed and decided on a digital platform, eliminating cumbersome paper files. Mandatory overtime for many claims workers has been the practice in recent years. Hickey’s office also negotiated an arrangement with the Pentagon to certify the completeness of medical records for separating and retiring servicemembers and speeding their delivery electronically to decision makers.   

Along the way, the VA welcomed the collaboration of veteran and military service organizations, including MOAA, to improve the process further. Nearly half of all claims made to VA and 90% of claims filed by MOAA are Fully Developed Claims, which VA has credited with expediting decisions on initial claims.  

Are we there, yet?  Not at all. The Veterans Benefits Administration (VBA) just announced that it was suspending mandatory overtime for adjudicators. It remains to be seen if the progress achieved to date can be sustained with reduced time devoted to the backlog. The VA is banking on its electronic platform, the Veterans Benefits Management System (VBMS), to support high quality production, even as the number and complexity of veterans’ claims continues to rise.  

Moreover, the VA and Congress need to step up on the thorny problem of reducing the backlog of appealed claims that go through a complex process. More often than not, the Board of Veterans Appeals sends these claims back to a VA regional office for further work.   

Appealed claims take on average over three years to resolve. A number of studies demonstrate that in the end, veterans win much more often on appeal than the government, indicating that the process is flawed. Veterans are getting the wrong decision out of the gate.  

Other challenges include slower decisions for National Guard and Reserve veterans who served on active duty, as well as comparably lower ratings on their claims for the same conditions filed by their active duty counterparts. This may be the result of incomplete documentation of service-related conditions at separation, and other factors. Women veterans also tend to receive lower ratings than their male counterparts for similar conditions.  

Although there are still areas where improvement is needed, there is clear cause to celebrate significant progress in battling the backlog of claims that has bedeviled the VA for too long. MOAA will continue to work with our VSO partners, Congress, and the VA to ensure that the gains made so far lead to further progress for our nation’s service men and women who have “borne the battle.”  

Deputy Director of Government Relations, Col. Bob Norton, USA (Ret) said, “We feel very confident that Under Secretary Hickey will continue to drive progress on the backlog going forward, including reductions in appealed and non-rating claims.”