A CLAIM BECOMES A CALAMITY.....

Discussion in 'VMBB Fire For Effect' started by rooter, Sep 28, 2012.

  1. rooter

    rooter *VMBB Senior Chief Of Staff*

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    Marty Robbins old hometown, Glendale Arizona--a su
    September 27, 2012

    Veterans Wait for Benefits as Claims Pile Up
    By JAMES DAO


    For Dennis Selsky, a Vietnam-era veteran with multiple sclerosis, it was lost documents. It seemed that every time he sent records to the Department of Veterans Affairs, they disappeared into the ether.

    For Mickel Withers, an Iraq war veteran with severe post-traumatic stress disorder, it was a bureaucratic foul-up. The department said he received National Guard pay in 2009, though he had left the Guard the previous year, and cut his disability compensation by $3,000. He filed for bankruptcy to protect himself from creditors.

    For Doris Hink, the widow of a World War II veteran, it was the waiting. The department took nearly two years to process her claim for a survivor’s pension, forcing her daughter to take $12,000 from savings to pay nursing home bills.

    These are the faces of what has become known as “the backlog”: the crushing inventory of claims for disability, pension and educational benefits that has overwhelmed the Department of Veterans Affairs. For hundreds of thousands of veterans, the result has been long waits for decisions, mishandled documents, confusing communications and infuriating mistakes in their claims.

    Numbers tell the story. Last year, veterans filed more than 1.3 million claims, double the number in 2001. Despite having added nearly 4,000 new workers since 2008, the agency did not keep pace, completing less than 80 percent of its inventory.

    This year, the agency has already completed more than one million claims for the third consecutive year. Yet it is still taking about eight months to process the average claim, two months longer than a decade ago. As of Monday, 890,000 pension and compensation claims were pending.

    Skyrocketing costs have accompanied that flood of claims. By next year, the department’s major benefit programs — compensation for the disabled, pensions for the low-income and educational assistance — are projected to cost about $76 billion, triple the amount in 2001. By 2022, those costs are projected to rise nearly 70 percent to about $130 billion.

    These are the compounding wages of war, and they are not just the result of recent conflicts. The department is administering pensions for World War II veterans while handling new claims from Vietnam veterans struggling with the multiplying ailments of age. Indeed, nearly a third of all pending new claims are from Vietnam-era veterans, roughly equal to the number from Iraq and Afghanistan war veterans.

    Thanks to superior battlefield medicine and armor, those Iraq and Afghanistan veterans have survived combat at a higher rate. As they return home with more wounds, and perhaps more savvy, the ones who file for disability compensation are claiming on average nearly 10 disorders or injuries each, compared with 6 for Vietnam veterans and fewer than 4 for World War II veterans. Their complex claims are often more time-consuming to process, adding to the backlog.

    At the same time, a higher percentage — nearly half — of Iraq and Afghanistan veterans are filing for disability compensation, partly because of the weak economy. That is double the rate for previous wars.

    “We’re not gaining any ground here,” Eric K. Shinseki, the secretary of veterans affairs, acknowledged in an interview over the summer. “Am I impatient? Yes, but I’ve got a fix.”

    That fix is the department’s “transformation plan,” which calls for a new training regimen that Mr. Shinseki says will improve speed and accuracy in processing claims; creation of special teams to handle complex claims; and new digital technology that will replace the current paper-choked system.

    When all those pieces are in place by 2015, Mr. Shinseki says that every claim will be processed in fewer than 125 days, with almost no errors — a pledge that veterans’ advocates view skeptically.

    Current and former front-line workers, who spoke out of frustration with the widespread criticism of their agency, offer a different analysis. The dysfunction, they say, stems from inadequate training and weak management, an excessively complicated process, and assembly line-like performance standards that require them to meet production quotas under threat of demotion or firing. The solution, they say, is clear.

    “They need more workers,” said Mark Locken, a retired Army artillery officer who worked for the department for three years in Boston before quitting in May because, he said, of the stress.

    The history of the backlog, which predates the Sept. 11, 2001, attacks,suggests another source of the problem: a bureaucratic culture with conflicting missions.

    On one hand, Department of Veterans Affairs employees are urged to be advocates for veterans. “I tell them: you’re going to take care of these young men and women for life,” Allison A. Hickey, a retired Air Force brigadier general who is under secretary for benefits, said in an interview.

    Yet those workers are also required to be stewards of the public dime, called on to distinguish the truly needy from the less needy from the fraudulent.

    That means they must evaluate veterans to determine whether their illnesses or injuries are real, and whether they are the result of military service, or something else. If those problems are deemed “service connected,” the workers must then quantify their severity and attach dollar values.

    Is that traumatic brain injury from high school football or a roadside bomb in Iraq? Is that back injury a 10 percent disability or 30 percent? Is that post-traumatic stress disorder real?

    Medical questions without simple answers must be settled by harried bureaucrats and overworked doctors applying black-and-white rules to very gray ailments. Their decisions mean the difference between monthly checks of a few hundred dollars versus a few thousand.

    When veterans are not happy with the results, as is often the case, they can appeal, or reapply, submitting new documents and diagnoses to bolster their claims — and adding years to the process.

    About half of the current backlog is due to veterans reapplying for denied claims or seeking to increase existing benefits because of new or worsening conditions. So the backlog grows, and along with it, the pessimism of some advocates.

    “They are rearranging the decks chairs on a sinking ship,” said Katrina Eagle, a lawyer who represents veterans before the agency. “You can hire people and buy new software. But nothing will improve.”

    Bureaucratic Behemoth

    Born from a system that paid pensions to Revolutionary War soldiers, the Department of Veterans Affairs has grown into a behemoth with more than 270,000 employees who maintain 131 cemeteries, operate 152 hospitals and disburse benefits to more than four million veterans. The nation has a total of about 23 million veterans.

    Congress, the courts and the executive branch have contributed to the growth by creating new benefits and rights like perennial blooms. Typically, Congress has accomplished that by establishing “presumptive connections” between military service and certain diseases, allowing veterans to seek disability compensation if they received a diagnosis within a certain period.

    There are now scores of diseases that are presumed to be the result of, or aggravated by, military service, from anemia to yellow fever. Each time the government adds a new one, thousands of veterans apply for benefits.

    In 2010, for example, Mr. Shinseki announced that three diseases — ischemic heart disease, Parkinson’s disease and b-cell leukemia — would be considered the result of Agent Orange exposure for veterans who served in Vietnam. As of this week, the department had processed more than 240,000 claims for those diseases filed in just the last two years.

    Since at least the 1960s, multiple sclerosis has been on the presumptive list, and in the decades since, tens of thousands of veterans with the disease have received benefits from the Department of Veterans Affairs. Dennis Selsky, 69, is one.

    A Navy reservist from the Philadelphia area who was called to active duty for 10 months in 1968, Mr. Selsky worked as an ordnance specialist on domestic air bases. Two years after leaving the service in 1970, he says, doctors told him he had multiple sclerosis, which Mr. Selsky believes he contracted from working on planes contaminated with the herbicide Agent Orange.

    Two years ago, he learned from the National Multiple Sclerosis Society that he was eligible for veterans compensation, applied and was granted the minimum benefit: a 30 percent rating, worth $435 a month. That seemed low to him because, he says, he has tremors, walks with a cane and is losing his vision. So Mr. Selksy, who spent 31 years with Verizon before retiring in 1998, appealed, seeking a 100 percent rating that would pay about $3,000 a month.

    Then his problems with the Department of Veterans Affairs began in earnest.

    First, the Philadelphia regional office lost part of his file, his wife, Sheila, said. Then it lost authorizations to obtain records from his cardiologist, podiatrist, neurologist and ophthalmologist — more than once. After the office finally obtained those doctors’ reports, it still required him to see department doctors to confirm his diagnoses.

    Each appointment and lost document has added weeks to the processing, now in its 15th month. So have skeptical department examiners, who have requested additional information on whether Mr. Selsky’s heart palpitations and vision loss are related to his multiple sclerosis. “This should be a slam dunk,” Ms. Selsky said. “He keeps getting worse, and they keep fighting and fighting and fighting with us. The stress is unbelievable.”

    Mr. Selsky may have also been the victim of another problem common to claims processing: the chaotic handling of records. Lost or mishandled documents are perhaps the No. 1 complaint about the processing system. Indeed, a 2009 review by the department’s inspector general found rampant cases of mishandled mail, including documents being improperly put in shred bins at 40 of the department’s 57 regional offices.

    Workers who process mail in the Philadelphia regional office, which handled Mr. Selsky’s claim, say that veterans’ records have for years piled up in gray file cabinets or cardboard boxes because they were thought to lack clear identifying information, like Social Security numbers.

    Ryan Cease, a former mail handler at the regional office, said that earlier this year he saw workers who were cleaning up the mail room in preparation for a visit by a senior official tossing records into boxes marked “for shredding.”

    Suspicious, he and a fellow worker later leafed through the boxes and found numerous records that they believed could have easily been identified.

    Mr. Cease, through another employee, sent an urgent e-mail to the department’s central office. After an investigation, the department concluded that nothing improper had occurred.

    “We have not shredded any documents up there,” Ms. Hickey said.

    Mr. Cease is not so sure. “I’m convinced,” he said in an interview, “that mail was shredded and that the mail was identifiable.”

    Manpower Shortage Cited

    In 2009, Kathryn Kausch learned that her mother, Doris Hink, was eligible for a pension because her husband, who died in 1987, had served honorably during World War II. Ms. Kausch sent in the paperwork, hoping the funds would help pay assisted living costs for her mother, now 89, who has dementia.

    The application was rejected because her mother’s assets were above the $80,000 threshold. But in a year, those assets had shrunk and Ms. Kausch reapplied in January 2010. That September, the Philadelphia pension office asked for additional documents, and she sent off a fat packet of bank statements, medical invoices and other financial records.

    In November, the office notified her that it had not received the documents and was rejecting her mother’s application again. But Ms. Kausch produced a receipt showing that the documents had been delivered, and the office acknowledged it had received them. Then she hunkered down to wait. Months passed.

    Ms. Kausch began dipping into her savings to pay her mother’s bills at an assisted living center. Then in July 2011, Ms. Kausch was laid off from her job at Xerox. Desperate for help, she called her congressman, Representative Michael Fitzpatrick, a Republican from the Philadelphia suburbs. A week after his office made inquiries, her mother’s pension was approved.

    But Ms. Kausch’s problems did not end. Her mother is eligible for $22,000 in retroactive pension payments dating to 2009. But because of her mother’s dementia, the department must approve Ms. Kausch as her mother’s fiduciary. Though the department has conducted the required interview, it has not filled out the final paperwork, despite calls from Mr. Fitzpatrick’s office.

    “No wonder our government has such problems,” Ms. Kausch, 58, said. “It seems you get lost in this bureaucratic paperwork.”

    A routine pension claim, undisputed by the department, took nearly two years to process, and only after a congressman’s intervention. An equally straightforward fiduciary application is still pending after six months. Why?

    Employees and veterans advocates repeatedly point to one reason: a lack of manpower. Though the Veterans Benefits Administration, the division that oversees entitlement programs, has grown significantly in the past decade, to 20,600 employees from 12,150, it still often assigns mandatory overtime to meet workload demands. And because the processing is so complicated, it can take two years before new hires are fully productive, the department says.

    With its staff stretched to the limit, the Veterans Benefits Administration supervisors set priorities for processing claims, workers say, with seriously wounded recent veterans, the homeless and terminally ill often rising to the top. Veterans or survivors who are already receiving benefits but applying for new ones may, as a consequence, be given lower priority, the workers say.

    Another problem, front-line claims workers say, are production quotas that determine whether they will be promoted, given raises, demoted or fired. The pressure to meet those quotas cause some workers to skip complicated, time-consuming files and reach for simpler ones, workers and advocates say.

    “Given the choice, they’ll go for the thin folder every time,” said Gerald T. Manar, a former manager for the Veterans Benefits Administration who now works for Veterans of Foreign Wars.

    More processors would make a difference, most experts say. But at a time when both parties are talking about slashing the federal deficit, hiring more employees may be impossible. Since 2004, the department’s total budget — which includes health care, administrative costs and entitlements — has doubled, to $127 billion. “New employees hired into a broken system that awards process instead of outcomes will not get us there,” Mr. Fitzpatrick said.

    For Mickel Withers, a veteran of the Georgia National Guard, the system was not exactly broken. But it was blundering. After serving on a bomb-detection team in Iraq in 2005 and 2006, he left the Army in 2008 with a diagnosis of post-traumatic stress disorder and started receiving $3,080 a month in disability compensation from the Department of Veterans Affairs.

    But this May, a check arrived for only $109. The department told him they were docking his compensation because they had determined he received drill pay from the Guard in 2009. Veterans are not allowed to receive both kinds of pay. In fact, Mr. Withers had left the Guard as a sergeant in 2008, but it took the department weeks to confirm that fact. With two children and a wife to support, he had to seek emergency housing assistance from a veterans group to pay rent and filed for bankruptcy to avoid debt collectors.

    It was his second bad experience with the benefits system: In 2009, the department overpaid the art school he was attending, then tried to collect the money from Mr. Withers. It took months to resolve that dispute.

    “I think they are so overwhelmed over there, they just glance at things,” he said. “It doesn’t make me feel good about the system.”
  2. Maine04657

    Maine04657 New Member

    Joined:
    Sep 13, 2012
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    Maine
    Sad. I have watched my whole life as care for both vets and active military have gone from come in and we will take care of what ails you to these days where you have to get approval to get treated. If you serve or served then you should have to do nothing but show your ID and get whatever treatment you need without further questions.
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