Department of Veterans Affairs Claims Processing Dilemmas

Department of Veterans Affairs Claims Processing Dilemmas

Department of Veterans Affairs (VA) is a cabinet-level agency in the U.S. government. The mission of the VA is taken from Lincoln's second inaugural address and is to "care for him who shall have borne the battle, his widow and orphans." Pursuant to this fundamental mission, the VA administers the largest healthcare system in the country and has trained more than half of all of the physicians practicing in the U.S. today.

Agency Functions.

Today, the VA is the second-largest agency in the federal government and employs more than 220,000 people in three primary functions as follows:

The Veterans Benefits Administration (VBA); this division employs about 13,000 people in 57 regional benefit offices, and provides financial assistance to veterans through disability compensation and pension, education, and home loans;

B.

The Veterans Health Administration (VHA): this division employs around 200,000 people in 163 tertiary healthcare facilities (medical centers) and more than 700 community-based outpatient clinics for eligible veteran patients; and,

C.

The National Cemetery Administration NCA); this division employs around 1,400 individuals in 120 national cemeteries (Kowalski, Harmon, Yorks & Kowalski, 2009).

All three of these VA divisions are unionized and all have experienced significant change in recent years (Kowalski et al., 2009).

3.

Agency News.

The growing backlog of claims by older veterans as well as the flood of veterans returning from combat tours of duty in Iraq and Afghanistan has been criticized by veterans groups and government policymakers alike. According to Dyhouse (2006), "More than 180,000 Iraq and Afghanistan veterans had filed VA disability claims by the end of 2006, while some 600,000 claims remain backlogged" (p. 10). This growing backlog has taken place during a period in which the VA has been specifically tasked with reducing its claims processing backlogs. For example, Hanson (2006) emphasizes that, "The average claim processing time is 120 days (VA's original goal was 100 days or fewer), and the average appeal processing time is 622 days, 122 days over the goal of 500" (p. 10). Not surprisingly, veterans organization such as the VFW are expressing their concern over the lengthy time required for claims processing (Hanson). The director of VFW's National Veterans Service conceded that, "The Department of Veterans Affairs has encountered many obstacles in controlling and maintaining a reasonable pending workload. The increasing levels do not offer much hope in the short-term" (quoted in Hanson at p. 10).

This growing backlog is taking place despite initiatives by the Veterans Benefits Administration to implement new claims processing systems in an effort to handle their backlog of compensation cases (Kowalski et al., 2009). This backlog is due in part to legislative changes and veteran enrollment initiatives that have raised awareness on the part of the veteran community concerning their rights to medical care and disability compensation (Kowalski et al., 2009). Moreover, to the extent that the VA attempts to resolve its existing backlog through expedited processing will also be the extent to which errors will be made and further appeals will be filed. In this regard, Hanson concludes that, "VA's dilemma, then, is that while working faster decreases the backlog, it leads to more errors, more appeals and consequently an increased backlog. So unless something changes, the backlog will continue to rise" (p. 40). In sum, the results of a Government Accountability Office study found that the VA:

1. Had a claims backlog of 600,000;

2. Required between 127 to 177 days to process an initial claim;

3. Resolved an average claim appeal in 657 days; and,

4. Would handle 638,000 first-time claims from Iraq War veterans during the next few years (Dyhouse, 2007).

4.

Rationale for Selecting Agency.