Circumstance has forced James Badini to take a long look at
the nation's veterans benefits claims system, and he doesn't like what he sees.
Mr. Badini developed severe allergies and bronchitis while
serving in the Air Force from 1967 to 1971. His health condition worsened, and
in 1974 he filed two disability claims with the Department of Veterans Affairs
Two years later, the VA ruled that Mr. Badini was not
entitled to receive benefits for his allergy. He appealed the decision and in
1978, four years after he filed the claim, the VA awarded disability compensation
for his allergy condition.
As for his bronchitis case, Mr. Badini is still fighting the
VA—more than twenty years after he filed the claim. "Part of it is my
fault," he said, noting that at times he simply stopped pursuing the
claim. Still, he puts most of the blame on the VA, which, he said, simply
botched his case.
"People who wouldn't normally make mistakes [do] make
mistakes because they are under pressure to put out so many cases," he
Complaints like Mr. Badini's are common in the veterans
community. Many have waited years to have their claims resolved, with the
delays caused mainly by a huge backlog of cases. Others say that their cases
have been bungled by the VA, causing further delay and hardship.
Statistics from the past paint a bleak picture of the
benefit system. According to the VA itself, a veteran who filed a new
compensation claim in early 1994 waited an average of 213 days for a decision
from the regional office. Moreover, if that decision were appealed, the
veteran could expect to wait more than two years for a ruling from the Board of
Veterans' Appeals (BVA). If the BVA sent that case back to the regional office
for reprocessing, another year or two would elapse before a final decision was
For years, descriptions of the VA's adjudication system
ranged from merely "inefficient" to "in crisis." Finally,
in 1994, Congress started to address the issue, passing legislation that gave
the agency a mandate to streamline the appellate claims process and reduce the
overall time required to process a claim.
Many veterans advocates agree that since then, the VA has
reduced the overall case backlog and the time it takes to process a claim.
The number of claims pending fell from 531,000 in September
1993 to some 450,000 in September 1995. The number of days needed to process a
new compensation claim dropped from 170 at the end of 1994 to 146 at the end of
1995. The time it takes for the BVA to rule on a case has also dropped, from
781 days in 1994 to 687 days in October 1995.
Opinions differ, however, as to the degree of progress one
should ascribe to these changes.
According to VA officials, the system is now working much
more efficiently than it did just two years ago. "We've been able to
implement a more simplified and targeted process," reported Stephen L.
Lemons, central area director for the Veterans Benefits Administration (VBA),
referring to efforts to cut red tape and put more people to work resolving
Mr. Lemons and his colleagues at the VA said that the
process will continue to improve and that, over the next few years, the backlog
will reach manageable levels.
Veterans service organizations are far less optimistic.
Kenneth A. Goss, the Air Force Association's director of
National Defense Issues, said: "While the VA says it is working to fix the
claims-processing system, far too many vets die or are left destitute before
their request for aid is answered. Claim files get lost, misrouted, or stuck in
one place for far too long. Statistics quoted by the VA are averages; far too
many vets wait years to get their claims resolved."
"The backlog is coming down, and so is the timeliness
of the processing claims, but not dramatically enough," said Robert J.
Collins, a field representative for the National Veterans Service of the
Veterans of Foreign Wars (VFW).
Others have different concerns. "The problem is
quality," said Rick Surratt, assistant national legislative director at
the Disabled American Veterans (DAV). Mr. Surratt and others accused the VA of
being sloppy in its claims processing. This, they said, forces the VA to devote
precious time and resources to cleaning up its mistakes and imposes
unnecessary burdens on some veterans.
The benefit claims system has three distinct levels: the
VBA, which processes all claims for benefits through its regional offices; the
BVA, which hears all cases in dispute between veterans and the VBA; and the
Court of Veterans Appeals, which hears a handful of cases each year that are
still in dispute after the BVA has rendered a decision.
Long, Complex Process
This process, like many within the federal government, can
be long and complex. It begins when a veteran files a claim for benefits with
one of the VA's fifty-eight regional offices around the country. Most claims
fall into one of three categories: disability compensation, pension benefits,
or educational benefits.
Each claim is examined by a rating board at the regional
office. According to the VBA, more than fifty percent of all such claims are
routinely granted at this first stage.
If the rating board does not grant all or part of a claim,
the veteran is entitled to file a notice of disagreement disputing the
decision. In Fiscal 1994, only 1.3 percent—61,813 out of the nearly 4.7
million claims filed—were disputed.
Veterans who dispute a claim first receive a VBA hearing,
conducted in Washington by VBA staff. If the decision of the rating board is
not altered, or if the veteran is still not satisfied, the case can be appealed
to the Board of Veterans Appeals.
The BVA is not part of the Veterans Benefits
Administration. It is a separate body within the VA charged with ruling on
claims cases appealed from the regional offices. Only 45,000 cases, or roughly
one percent of the total number filed in 1994, were appealed to the BVA.
The BVA has broader authority than a traditional appellate
tribunal. Usually, appellate bodies only decide whether the law was properly
applied in the case at hand—they do not reexamine the factual evidence. This
board, however, is empowered to decide questions of fact as well as law.
For instance, if a veteran claims that the VBA denied
benefits because it misread his medical records, the BVA could reexamine the
records and decide to reverse the original ruling.
According to the federal government's most recent
statistics (from 1994), outright reversals of VBA decisions occur in twenty
percent of claims appealed. In these cases, the BVA orders the VBA to award the
benefit or benefits previously denied.
In another 46.7 percent of the claims that come up for a
review, the BVA does not reverse the judgment but remands them to the regional
offices for further work. Cases are remanded for a variety of reasons, but
chief among them is that the regional office did not have adequate service or
medical records to make an informed decision on the claim. The BVA will order
the regional office to search for additional records or, in the case of medical
questions, may ask for a new physical examination.
In 22.7 percent of the cases, the regional office decision
is affirmed by the BVA and the veteran's claim is once again denied.
The remaining cases, which constitute just over ten percent
of the total, are dismissed because the veteran dies during the appeals
process or the BVA decides that the claim was entirely groundless.
If the BVA rejects a veteran's claim, he is entitled to
another appeal, this time to the Court of Veterans Appeals. The court is the
VA's final level of adjudication and only decides questions of law. If no legal
issue is at stake, the court will not accept a veteran's case for review.
At all levels in the process, the law requires that, in
close cases, the benefit of the doubt be given to the veteran.
Paved With Good
Still, despite good intentions, the system has not worked
for many veterans in the past. Problems stemmed from a number of causes,
including mismanagement and personnel cuts. VA officials have acknowledged that
too many agency employees were engaged in administrative tasks when they should
have been directly involved in processing claims. Also, the number of
full-time employees working for the VBA has shrunk in recent years.
"They're trying to do more and more with less and
less," said Mr. Collins of the VFW.
Military downsizing has put extra strain on the system, as
greater numbers of service personnel have become veterans. This, in
conjunction with the upsurge of ailments and disabilities attributed to service
in the Persian Gulf War, has led to more claims being filed with the VA.
Another problem was that the Court of Veterans Appeals,
created in 1988, began handing down decisions that foisted more work on the
regional offices and the BVA. Court rulings struck down or altered rules and
procedures used by the VA to adjudicate claims. This, in turn, forced the
offices and the BVA to reopen a substantial number of cases, adding to the
In addition, the advent of the court brought new
responsibilities to the regional offices and the BVA. Notably, written
decisions regarding a case had to be much more detailed. This, of course,
required decision-makers to spend more time on each case.
By 1994, the consensus in the VA, veterans' organizations,
and Congress was that something needed to be done to make the claims system
faster and more efficient. In that year, Congress passed the Veterans Benefits
Act, making procedural and other changes designed to allow the BVA to handle
more cases more quickly.
Before enactment of this legislation, three board members
were required to render a decision in each veteran's appeal. The new law authorized
the BVA to allow one board member to decide an appeal. This, according to
Charles L. Cragin, BVA chairman, has allowed each board member to handle
twenty-five percent more cases than before.
In addition, the act eliminated the BVA's long-standing
sixty-five-member cap, giving the BVA the authority to hire more members to
reduce the backlog.
Saving Time and Money
The law also authorized and encouraged the BVA to develop
new ways to save time and resources. For instance, hearings have been conducted
via videoconferencing. According to Mr. Cragin, innovations like this have
reduced delays and freed board members to handle even more cases. "When a
board member doesn't have to travel, that saves time and resources," he
Finally, the act established the Veterans' Claims
Adjudication Commission, a nine-member panel created to look at the problems
facing regional offices and the BVA and to recommend additional ways to reduce
the backlog and processing time.
The commission plans to issue a final report on its findings
and recommendations this spring.
Though the act focused primarily on overhauling the BVA,
change was also taking place at the regional offices.
"We found that we needed more decision-makers,"
said J. Gary Hickman, director of the VA's Compensation and Pension Service.
The number of people actually deciding claims has been
increased from 500 to almost 900 over the last few years, Mr. Hickman said. During
this period, the VBA also authorized $20 million to pay overtime for workers
in the regional offices, allowing them to work more hours in order to further
alleviate the backlog.
The VBA has established a medical records center in St.
Louis, Mo. Before the center opened, employees at regional offices often
wasted much time trying to track down a veteran's records. Now, all medical
records are available at one location and are easier to access.
Finally, the VBA, like the BVA, has also turned to
technology to maximize efficiency. All regional office employees now have
personal computers, for example. "As we've been able to modernize our
equipment, we've obviated the need for clerical personnel," said the
VBA's Mr. Lemons. By cutting back the number of administrative workers,
regional offices have been able to divert more employees into claims
Even so, veterans' organizations said that the VA has a long
way to go before it declares victory in the war to reduce the claims backlog
and processing time.
One recurring complaint concerns the quality of the
decisions rendered. "The problem is that regional offices] don't get it
right the first time," said DAV's Mr. Surratt, who added that roughly
two-thirds of the cases appealed from the regional offices are either reversed
or remanded. He recommends that the VBA examine old remanded cases to find the
errors that occurred most frequently and develop a strategy to avoid them in
According to Mr. Surratt and others, poor quality at the
regional offices overloads the BVA. It also makes more work for the regional
offices because almost half the cases heard by the BVA are sent back for
Mistakes also take their toll on the claimants. Some
veterans' cases bounce between the regional office and the BVA several times.
Many of these have also been held up at the VBA as they move back and forth
between the rating board members at the regional office and the hearing
officers in Washington.
Veterans' organizations have said that improving quality is
the only way the VA can ever reduce the claims backlog to a manageable level.
Said Ronald W. Scholz, national service director at the Paralyzed Veterans of
America, "If you do it right the first time at the regional office, you
will, over time, be able to eliminate the backlog."
David Masci, a
reporter in Washington, D. C., covers veterans affairs for Congressional
Quarterly. This is his first article for Air Force Magazine.
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