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Veterans Disability Claims Backlog, Setting the Record Straight

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There's a lot of confusion and misinformation regarding the disability claims backlog at the Department of Veterans Affairs (VA). Setting the record straight requires some honest brokering with many years experience in both customer service and writing computer software for moving from paper-based customer service to workflow systems.

It takes a customer service rep (eighteen years) and it takes a nerd (sixty years).

That makes it personal for me, particularly as I work with lots of veterans and military families groups. I take this personally, since I figure if someone's stepping up to protect me, I need to reciprocate. That's particularly true when a fellow citizen goes overseas and risks taking a bullet for me.

One advantage of a deep dive like this means that I can include some recommendations for moving ahead faster.

Here's the deal, using the best metaphor I can figure.

The VA disability claims process has been like a car with the "check engine light" on for a decade or longer. Wasn't much of a problem until maybe around 2005, when the car filled up, and more people needed that ride. Vets needed a much bigger car back then, but that costs money, and no one in Washington stood up for that.

Here's what the VA's VBMS screens look like. Similar to Gmail. Web based. Searchable. Fast.

This got worse in following years, since Washington did stand up for Vietnam era vets, particularly when it came to the Agent Orange situation. As troops returned from Iraq and Afghanistan, that's like the car getting more riders, who needed a longer ride.

Sure, I'm understating the case, the case load of Veterans Affairs got a lot worse, with the Camp Lejeune situation only beginning to heat up. The deal is that people knew about this maybe eight years ago or longer, when that engine light went on. The new car didn't start to get made until 2009, when Washington stood up to support Vietnam vets as well as the vets returning from Iraq and Afghanistan.

Problem is that normally, in Washington, big software projects frequently fail, they don't get the job done, and projects are abandoned after spending maybe a billion or more. In plain terms, the software specs are frequently written by big shots who long ago got out of touch with their customers.

Maybe twenty years ago, private industry figured a better way to build software for real people was basically:

1. Listen to customers, get an idea what the majority want and need.

2. Write some code, ask customers about it.

3. Repeat, forever.That's the approach Veterans Affairs took in 2009, which really was swimming upriver. This was really a big deal challenge:

  • The old systems needed to be kept running while the new stuff was built.
  • The new systems needed VA customer service reps to work with VA software people, which is the opposite of the big shot way of doing things. That's big deal culture change and that's always painful.
All this was happening as the VA got way more claims, and the claims got way more complicated. That's to say that they built a new car while driving the old car, and the wheels are falling off the old car, and they have a lot more riders coming.

Meanwhile, explaining this is really hard, and in the Washington way of talking, there's no way to win. People don't generally know that VA is getting through huge, unprecedented numbers of claims, over a million per year for the last three years. Last year they paid around $54 billion. Around half of vets in the backlog, mostly Vietnam vets, already receive cash from a prior claim.

Also, the VA gives Congress the reports they ask for. You can get more info, just ask. The downside of this is that it can look like VA is withholding vital info, if you don't know the way they talk.

This all only makes sense to me since I'm a customer service rep and a software developer, and I know something about charts, numbers, and statistics. I can tell that VA has the worst of all worlds:

1. Gotta keep the old stuff working.

2. Gotta build the new stuff.

3. Gotta focus on finding and preventing the slow parts/bottlenecks.

4. Gotta move customers from old to new systems.

That means a new paperless system, the Veterans Benefits Management Systems, which has means of expediting claims. It moves toward replacing huge piles of paper with online workflow. That means it's much easier to move case files from one worker to another, and it means no one loses track of paper.

Part of this involves means by which vets can fill out their own claims, via online eBenefits, which is kind of like TurboTax or similar. It's good for straightforward cases like when you don't need a CPA to do taxes.

If a vet needs help filing, that's much like getting a CPA to help with taxes.

Veteran Service Organizations can use the VA stuff via the Stakeholder Enterprise Portal, online.

VSOs sometimes use claims management systems, like VetPro. VA is testing a "digits to digits" interface for those systems. The deal there is to eliminate more paper, and to generally accelerate the process, since the outside systems talk directly with VA systems. Security and privacy have already been addressed.

Making this happen means engaging in serious conversation with all VSOs, from the ground up, which is totally contrary to the usual Washington way of doing things. That is, talking with national leadership needs to be complemented with direct engagement with disability claim line workers, everywhere.

This means serious and ongoing real engagement with all customers, which is really hard to do. You need to listen to the majority of customers, who are largely quiet, not so much listening to noisy special interests.

That means engagement with line workers as well as the big shots, and in practice it means customer service reps talking with other Customer Service Representatives (CSRs).

There's talk of a Presidential commission to make this happen, but I'm not a patient guy, and I've already chatted with fellow nerds and CSRs in Washington who want to make stuff happen. Here's the beginning of recommendations, which need a bit more reality testing, and then approval by the big guys.

(I'd like to present recommendations in priority order, but they're pretty intertwined, so in no particular order...) 1. Continuous engagement with VA workers, VSOs, vets, in social media.
  • Keep everyone in the loop, and most of all, that means two way communications with the customer service people in Veterans Affairs, and also with Veteran Service Officers, who help vets with the process.
  • Specifically, we need private discussion groups where CSRs, internal and external, talk to Veterans Benefits Administration (VBA) management and get answers where that makes sense.
My commitments:
  • Continuing engagement with engagement as illustrated by the thing you're reading right now, assuming that I'm not pissing off the people I need to talk to.
  • Participation in discussion, mostly to help articulate suggestions in the form that my fellow nerds might need to code.
2. Permanent employee innovation.
  • That means, perhaps as part of discussion groups, asking employees and VSOs what might make the system work better. Several years ago, I helped in a very minor way with an employee innovation effort which resulted in real results, one of which is the Disability Benefit Questionnaire (DBQ) thing below. This needs to be part of VA culture. (It needs to be part of the culture of any organization, but that's a separate article.)
3. Identify bottlenecks, like records transfer from DoD, Guard and Reserve. VA Center for Innovation people and VBA developers, have an idea what they are.
  • Some can be solved with software improvements, but the most difficult involve getting treatment records and related info from other Federal agencies, which leads to ...
4. Get the tech people in different agencies to start talking with each other, now, and get management approvals ready for the flow of data. Some of this is already in process, but not enough. They can blame me. 5. Create workarounds in situations where getting service treatment records or related data will take too long. That kind of thing's a big judgment call, and I'm happy to trust VBA workers with that.
  • For example, the employee innovation effort cited earlier involved a suggestion from VA in Pittsburgh. If a private physician verifies a medical condition, no point in having a VA doctor do the same. That involves private doctors filling out the Disability Benefit Questionnaire. However, DBQs need significant usability improvements, which VA folks and I have already discussed. (VACI folks, I'm still on board for a thing.)
  • Very specifically, if a vet can show a medical condition, and getting records showing a service connection are too slow, give the VBA worker the okay to approve. I trust the line workers with such decisions. Blame me if it doesn't work.
6. Improve the user experience for all Veterans Benefits Management System (VBMS) UIs so that experienced people can submit claims with minimal additional help. That is, if you know how claims work now, and you're Internet-literate, there should be no need to wait for, and maybe travel to, classes.
  • In the interim, maybe we need a quick VMBS for Dummies? I'd qualify the the latter part of that.
7. Get everyone on board to help vets build Fully Developed Claims(FDCs). FDCs are pretty much like filling out one of those forms CPAs give you, where you fill in lots of information, and provide the documentation needed to submit your taxes.
  • That needs the communications efforts described above, plus... this should be part of the Transition Assistance Program that active service troops do when leaving service. That's in process, needs to be accelerated.

Turns out that VA has 56 regional offices, each running the old paper-based system, that's like 56 cars that are breaking down, some badly. The challenge is to replace each old car with new ones, while gracefully transferring riders to the new cars. In practice, that means getting a lot of paper scanned into the new systems, a lot of work. Key to that is getting everyone on board, something assisted by the recommendations above.

Okay, that's the gist of things, and I'll add one more personal commitment:

I'll run these suggestions by VA people and others in Washington, and VSOs, and will update. If it means more time in Washington, even in August, well, I'll do what it takes. After all, a nerd's gotta do, what... well, you know the rest.

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