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“I used to take them at their word. I can’t do that anymore.”
August 30, 2012 5:05 PM   Subscribe

824,273 disabled veterans are currently awaiting a response on claims from the US Department of Veterans Affairs. On average, it takes the government 257 days to respond, and there has been a 7.2% growth in claims over the last 1.3 years -- so the delays are growing. While they wait, veterans often cannot access health care from the agency or receive disability compensation. Plus, the backlog on claim appeals is at least 3.5 years. So how can veterans avoid the backlog? A special investigation by the Bay Area Citizen shows that processing speed is a matter of geographic location: veterans in sparsely populated areas have their claims filled faster than those living in urban centers. Interactive Map: Where is Worst Backlog? Related video and transcript.
posted by zarq (33 comments total) 9 users marked this as a favorite

 
aaaand as usual the Onion is pretty much on fire with the topic
posted by The Whelk at 5:07 PM on August 30, 2012 [7 favorites]


Interesting that Spokane doesn't have any backlog (at least none that are mentioned on that map). I guess that's a good thing in general for veterans in this area.

I am a bit stumped as to why we can't do better for our veterans, and why this claims process seems to be such a sticking point. Surely our military keeps some of the best records around about people who have served and what they've been through...
posted by hippybear at 5:14 PM on August 30, 2012 [1 favorite]


Well, money spent on veterans is money that doesn't go towards arms manufacturers or lobbyists.
posted by "But who are the Chefs?" at 5:16 PM on August 30, 2012 [4 favorites]


The IRS processes millions of tax returns by assuming that most people file correctly, and then randomly auditing people. It seems to me that the VA could use a similar method for processing claims- default to approval, and then randomly check for fraud. Because making veterans wait six or eight months (or longer) for care is shameful.
posted by ambrosia at 5:17 PM on August 30, 2012 [12 favorites]


You know the people that equate supporting the troops with supporting never ending wars?

They built this.
posted by COD at 5:20 PM on August 30, 2012 [7 favorites]


Somewhat coincidentally, a friend of mine who came back from deployment more than 6 months ago just today had a hell of a time with the VA. It's sucking out there right now.

This just sucks and I find it infuriating. Taking good care of our veterans (in particular, the GI bill) drove much of America's success in the middle of the 20th century. Fucking them over is not a way to honor the troops. (Also, letting private enterprise fuck them over (I'm looking at you, for-profit colleges and predatory financial 'advisors!) is just as bad.)
posted by rmd1023 at 5:29 PM on August 30, 2012


The Government has been fucking vets since the Revolutionary War. Really, the only time the government ever really, truly made good on its obligation was after World War II.
posted by absalom at 5:29 PM on August 30, 2012 [1 favorite]


Did Obama fix this?

Obama has apparently tried, with his administration appropriating hundreds of millions of dollars for a new computer system (which hasn't helped because apparently the VA is still largely a paper file organization) and has worked to hire thousands of new claims processors nationwide.

I suspect (now that I read a bit more about the situation as reported in the Bay Citizen) that it's the paper file situation which is holding up a lot of claims. With paper files, not only do you have to actually physically acquire the files, but there's a huge chance that there is more than one file which has to be all gathered in to the same place at once.

After what he was able to do re: 911 responders and such, I'd love to see Jon Stewart take this up as a cause. He got shit done.
posted by hippybear at 5:30 PM on August 30, 2012 [4 favorites]


This was also in the news last week:

VA office stacked 37,000 files on cabinets after running out of storage

At the VA's Winston-Salem Regional Office in North Carolina, an estimated 37,000 claims folders had been stored on top of file cabinets, according to the Inspector General's report released last week. Those piles had been stacked two feet high and two rows deep. The file cabinets were so close to each other that drawers could not be opened completely ...

"The excess weight of the stored files has the potential to compromise the structural integrity of the sixth floor of the facility," said the Inspector General report. "We noticed floors bowing under the excess weight to the extent that the tops of file cabinets were noticeably unlevel throughout the storage area."


The full report with more photos here.
posted by carter at 5:32 PM on August 30, 2012 [3 favorites]


Well, money spent on veterans is money that doesn't go towards arms manufacturers or lobbyists.

I don't think it works that way.
posted by headnsouth at 5:41 PM on August 30, 2012


Geography is a red herring, the problem is the huge backlog etc. The problem is not that the backlog differs between this or that area.
posted by anonymisc at 5:41 PM on August 30, 2012


Came in here to mention the VA files story, but carter beat me to it.

People often point out the relative sizes of federal government spending. Why you concerned about foreign aid (less than 1% of the budget) when Medicare/Medicaid/CHIP is 21 percent of the budget? Fix Medicare!

Which sounds great.

But then you see this and think, how much time/money is wasted out of sheer incompetence?

Time/money/effort was put into a 12-page report to illustrate that HOLY FUCK THERE'S TOO MUCH GODDAMN PAPER IN THIS BUILDING. Never mind that the 12-page report won't solve the problem of the TOO MUCH GODDAMN PAPER IN THIS BUILDING. In fact, this 12-page report's conclusion was CALL SOMEONE TO DO SOMETHING ABOUT THE FACT THAT THERE'S TOO MUCH GODDAMN PAPER IN THIS BUILDING.

Maj. Eaton: We have top men working on it now.
Indiana: Who?
Maj. Eaton: Top... men.

posted by Cool Papa Bell at 5:51 PM on August 30, 2012 [2 favorites]


Obama didn't break it.

My point was that he didn't fix it, either. I'm center left, but I tire of the easy, snarky political crap when it doesn't fix the situation. Being a vet, I'm with my shipmates.
posted by Mojojojo at 5:51 PM on August 30, 2012 [3 favorites]


The IRS processes millions of tax returns by assuming that most people file correctly, and then randomly auditing people. It seems to me that the VA could use a similar method for processing claims- default to approval, and then randomly check for fraud. Because making veterans wait six or eight months (or longer) for care is shameful.
posted by ambrosia at 7:17 PM on August 30 [1 favorite −] [!]


I love this idea so much I just submitted it to the White House contact form (with attribution).
posted by joannemerriam at 5:57 PM on August 30, 2012


The only guy who made any substantive improvement in the VA Health Systems was fired after a very short tenure.
posted by klarck at 6:11 PM on August 30, 2012 [3 favorites]


I tire of the easy, snarky political crap when it doesn't fix the situation.

That's fair enough, Mojojojo, and I actually expected my comment to be deleted right after I posted it. But it irked me no end to see a story about wounded vets unable to get care while the TV in the next room was showing footage of people out to elect a guy all too likely to create even more of them. I just had to vent.
posted by uosuaq at 6:12 PM on August 30, 2012


[Folks maybe look at the links instead of turning this into more lazy election-season snark, please?]
posted by jessamyn at 6:13 PM on August 30, 2012 [2 favorites]


i think i'm gonna start reading the onion for my daily news.

they seem to be pretty on top of things.

it's gotta be bad when the at last half of my major news sources are satires.
posted by sio42 at 6:13 PM on August 30, 2012


824,273 /58 = 15091.

Keep in mind that not all facilities are equal. Also, it may help to know that most veterans can get medical help while their claim is being adjudicated.

I went through this process a few years ago, before the glut from the two wars began to reach the system. A bunch of what we called the Stormies were around, but mostly is was the Vietnam and Korea guys, and a few of the guys that killed Hitler.

Something to understand about this: when your rep files the claim, the adjudicator will send out a packet with the rating. Most times, for various reasons, the rating is below what the vet thinks it should be. An appeal alway takes a long time--an appeal goes to DC. But you can file a notice of disagreement, which goes back to the regional office for adjudication. This process can take as little as two weeks. Sometimes it takes 90 days. In some offices it will take longer.

In order understand what the rater has to deal with you need to realize two things:

1. The rater is not a doctor.
2. Your doctor is not a rater.

When you read Code of Federal Regulations, Title 38, you get an overview of the rating process, including Prt 4, schedule of ratings. This is what the rater uses. Your doctor doesn't consult this when he makes your examination for rating. He just writes up your condition in his own words, according to the way he's been trained to describe your situation.

The rater gets your entire medical packet, not just the one this doctor writes up. In it will (or should be) every record that you've ever accrued from any hospital, military or civilian. Mine was about six inches thick.

Think about this: you send a claim to the rater, which is a cover letter describing your illness or condtion, along with the pertinate data from your VA-mandated medical examination. Usually your rep gets he needs, but a lot of times a few key items are left out.

The rater comes in to work, and a guy pushes a cart filled with claims packets over to his desk. He picks up your packet and begins to read, taking some notes here and there. He looks at every lab report and doctor exam, reads all the notes taken by duty nurses. Then he tries to fit the last exam you had for this particular ailment into a paragraph in Part 4, CFR-38. (take a look at part 4). Not all those round descriptions your doctor wrote will fit the square holes in Part 4, so the rater takes his best guess.

Then he writes it up and sends it back to your rep. You get 20% when you believe you deserve 100%.

You do not file an appeal at this point. You will file a letter of disagreement. You have a year to get your shit together and do this. You go back to your medical records and figure out where you failed to show him how he gets to 100%. This is not magic, because, usually you can see where you left out or didn't make clear a certain issue. Meanwhile your benifits will begin, at the rate the rater gave you in the letter you are going to disagree with.

The adjudication on the letter of disagreement usually can happen with a few weeks. If you still can't come to terms, then you will file a letter of appeal. The appeal takes three years, and always has. If you are successful, you will get your upgraded rating, and back pay starting with the day you made your original claim, or sometimes, back to the day you first walked in to the VA.

It should be clear from my poor sketch, here, that a bottleneck in claims times rests primarily on the number of raters. I hope I have not glossed over the term rep. You need a service rep to handle this heavy lifting. I used the guys from the state veterans affairs office. (this is not the VA at the federal level.) Many people us AMVETS or VFW reps: VSO, as we like to say (Veterans Service Officer).

Not all VA hospitals are the same. Some are horribly crowded and understaffed. The sheer volume of patients is overwhelming. I go to two hospitals here on this side of the world, Roseburg, and Portland. Now and then I have to go to Seattle. All of the facilities have first rate staff, and they treat us with respect.

A small dispensary near my house is a rehab facility, and they don't take outpatients. If they did, I wouldn't have to drive a hundred miles, or 280, or 500 miles to get done what I need to get done. But I'm alive today because they do the things they do well.
posted by mule98J at 6:28 PM on August 30, 2012 [15 favorites]


So I actually do related work to this. I work in poverty law, helping people deal with their applications to disability benefits. I've only been working a month (just finished law school; this is my articling year) and I'm up in Northern Ontario. While there are differences (namely that delays don't affect basic health care), I can understand at least one thing.

Paper files are not all that unreasonable in these circumstances. My office is mainly paper, which surprised me. However:
- You're dealing with dozens of faxes between clients (who often don't have computer access or knowledge), doctor's offices (which they have little control over; records are paper-based, handwritten, and images), and various other stakeholders. If it's computer-based - emailing those docs is unlikely, so you've got to print it to fax it. And every fax has to be scanned and filed. Honestly I dunno how much more efficient computers are, without broad-population/tech changes.

However, even in very rural Ontario, we're a lot speedier. And I mean rural in the fly-in/fly-out, 4-8 hours' drive to a specialist. Not clear exactly how long it is for the initial decision (haven't been there long enough to see full stuff, but it's about 3-5 months), but upon a denial it's 30 days for a review (which rarely works, but has to be done), and then 6 months or less for an appeal to an administrative tribunal. These cases rarely go to court, that's a big step (which our clinic doesn't handle) and admittedly that takes longer. And we complain about our wait times, because we've got people who might not have a home without funding. (note: funding, when it's approved, is generally backdated to the time that the application was filed. Is that true for the VA?)

Is there anything like the clinic system down in the various states? Publicly-funded lawyers (or paralegal-types) who help those in need to navigate the bureaucracy and appeal their cases?
posted by Lemurrhea at 6:31 PM on August 30, 2012


I keep getting a window with the article instead of the actual article. I'm guessing Houston is a troublespot based on the veteran panhandlers on every underpass intersection
posted by Renoroc at 7:00 PM on August 30, 2012


I keep getting a window with the article instead of the actual article.

A summary page with links to actual articles which outline the problems starting with revelations in April of this year.
posted by hippybear at 7:05 PM on August 30, 2012


Paper files are not all that unreasonable in these circumstances. My office is mainly paper, which surprised me. However:
- You're dealing with dozens of faxes between clients (who often don't have computer access or knowledge), doctor's offices (which they have little control over; records are paper-based, handwritten, and images), and various other stakeholders. If it's computer-based - emailing those docs is unlikely, so you've got to print it to fax it. And every fax has to be scanned and filed.
posted by Lemurrhea at 8:31 PM on August 30


I work for a medical center and fax out my doctors' clinic notes weekly. This isn't really correct. I don't have to print things out to fax them—our patient records system has the functionality to fax directly from the system, which is faster and also means there's a record of what I sent out, to whom and when. Received faxes do need to be scanned (but not filed; afaik we shred them, although I have nothing to do with that so maybe I am wrong about that). But, once they are in the system, they're instantly available to everybody who has access to the system. We don't need to go to a physical place to pull the records.

Paper files are hugely inefficient in this context.
posted by joannemerriam at 7:30 PM on August 30, 2012


I'm pretty sure the VA uses paper files only for the intake process - when you're actually being treated by the VA that's all electronic. Making the intake process require a computer would disenfranchise a whole segment of vets as well. Spouse is a VA doc; took a job there to avoid dealing with insurance companies.
posted by These Premises Are Alarmed at 7:40 PM on August 30, 2012 [1 favorite]


I live in a town ten miles from an AFB. Boise has a VA. My husband is a Nam vet, had contact with Agent Orange and has been seen at the Vet's for various things to document AO issues, but generally he sees a local GP, since the wait time at the VA is absolutely insane.

I've lived in worse military towns, but this one still pays a lot of lip service to "Support the Troops" while having that "hand out" get-the-bucks mentality.

I get so effin' tired of hearing rah rah Support the Troops, when what it really means is support this damn war, support Halliburton, support private contractors making money hand over fist. Meanwhile the benevolent congress screwed over Nat Guard people by sending them on four or five tours to the Middle East without allowing half the benefits a regular enlisted was given. Amazing we can buy state of the art killing materials, but don't support the vets when they get back home; Vets have repeatedly been denied treatment for hazards they have been exposed to, for example, ie Agent Orange and GWI.

The one thing I will say about the Boise VA, when the paperwork finally gets done, they do a damn fine job with they have to work with.

This is a pretty pdf of the 2013 budget rollout containing the proposed increase. What I would like to know is how it matches up in dollars per individual over time--say 1995 to present. I'm pretty sure they're hella short on mental health dollars, but nothing's new there; neither the Nam vets or the Gulf vets were well served, so why should this last crop be.

Interestingly enough, with regard to IT and presumably the paperless issues, the VA.gov webpage has this tidbit:

The 2013 budget proposal includes $3.3 billion for information technology, a $216 million increase over the current budget. VA operates one of the largest consolidated IT organizations in the world, supporting over 300,000 VA employees and about 10 million Veterans and family members who use VA programs. About 80 percent of the IT budget supports the direct delivery of health care and benefits to Veterans and their families.
posted by BlueHorse at 10:51 PM on August 30, 2012 [3 favorites]


Incidentally, the building in DC now known as the National Building Museum was the national headquarters of the U.S. Pention Bureau, built as a state-of-the-art processing center in the 1880's to handle the hundreds of thousands of Civil War veterans. In addition to innovative pre-electrical ventilation and lighting systems taking advantage of natural light and air, the building was designed with wide, short stairwells, far easier for amputees on crutches or in wheelchairs to ascend and decend. At the time of it's construction, veterans' pention claims amounted to upwards of two thirds of the Federal budget!
posted by The 10th Regiment of Foot at 5:16 AM on August 31, 2012 [1 favorite]


Apropos of something: It's been only three or four years that the computers at the VA have been linked. Used to be hard to get stuff from one VA to the other. I've actually had to deal with two different data bases in the same hospital which didn't communicate with each other. That's changed. The vet's account is generated from a central database in the facility. To get data from another VA facility, an operator logs on, and hits the code for a particular VA anywhere, and the patient's records from that facility are displayed. Last time I checked, not every VA was linked into this system, but I'm guessing that most of them are.

Which brings up Health-e-vet. This program provides the veteran a secure account, from which he can assess his records--all of them. He will be able to read every interaction he ever had witht he VA, including notes from those phone conversations he had with operators on the lower branchesd of the phone tree. (Caller was irate, but calmned down when I told him I wouldn't put him on hold....) Anyhow, this tool represents the vet's complete medical history, including prescriptions, active and inactive. He also may order refills. To get the account, the vet is usually required to visit a bureaucrat at one of the VAs to establish usernames and passwords. If you want copies of your medical records, just hit print.

I didn't mention in my other post that you need to keep everything the VA sends you. Just put it in a box, and if you aren't up to processing it, take it to your VSO and let him figure it out. I say this not to be snide, but it's a hard fact that many veterans are not in the mood to concentrate on this kind of thing. They are ill, and it really is more than a convenience to get someone to do the bureaucratic heavy lifting when filing a claim.
posted by mule98J at 9:11 AM on August 31, 2012 [1 favorite]


Surely our military keeps some of the best records around about people who have served and what they've been through...

Har. In a bureaucracy that large, things slip through the cracks all the time. The Army completely lost my husband's medical records, just, totally gone. Luckily he had hard-copy print-outs of some of them.

I will say that his experience with the VA in Alaska has been pretty much wonderful. I think his claim took about a month, and that included the records snafu. The care he's received has been fantastic, and I'm glad that he'll have some level of permanent access to it. The main VA facility in Anchorage is brand new and gorgeous.

It was amazing to see the contrast when he briefly switched over to the DC VA. The providers were mostly great, but the administrative bureaucracy was inefficient, rude, and borderline abusive.
posted by charmcityblues at 10:42 AM on August 31, 2012


The IRS processes millions of tax returns by assuming that most people file correctly, and then randomly auditing people. It seems to me that the VA could use a similar method for processing claims- default to approval, and then randomly check for fraud. Because making veterans wait six or eight months (or longer) for care is shameful.

Yeah, but the IRS has information to back up what you're submitting - records from your bank, your employer, etc. And the stakes (for those of us who get most of our income from W-2s or 1099s) are pretty low.
There's no equivalent with your medical records, and we're talking about claims that could potentially run up to the millions of dollars.
posted by Coffeemate at 11:57 AM on August 31, 2012


When I started my outprocessing from military service I was lucky enough to have a good DAV rep who had me do a quick start about 45 days out from my EAOS. I now tell every service member I meet who will be separating about this just because it helps the process along so well.

I went on terminal leave in August (given six months worth of meds to ride out the wait), my official end of active duty was in October, and my final adjudication for disability came in the following February. I was contacted in March by my local VA hospital to start receiving services, although I was advised I could go in earlier if I was having any difficulties.

I think many servicemen don't get good gouge on what you need to do to process your request for benefits, or many just aren't in the shape to pay attention (which is where the DAV is so important). The system can work if you work it, but you need to keep at it, and most important, always keep a hardcopy of your complete medical record.
posted by tetsuo at 12:09 PM on August 31, 2012 [1 favorite]


VA literally burdened with paperwork backlog: Rachel Maddow describes the miserable backlog of claims made by veterans to the Department of Veterans Affairs and how the sheer volume of the paperwork for those claims threatens the structural integrity of one of the VA offices.
posted by homunculus at 12:20 PM on August 31, 2012 [1 favorite]


Those in Southern California (average wait in LA: 363 days, SD: 291 days) might consider contributing to Legal Aid in support of the Bill Smith Homeless Veteran's Program.
posted by snuffleupagus at 7:26 AM on September 4, 2012


On records: when it comes to proving service-connection to obtain disability benefits, both military service/medical records and post-service VA and medical records can be and usually are relevant.

One common military records related bugaboo is that a 16-18M of personnel files were lost in the 1973 fire at the National Personnel Records Center.

As to electronic medical records, while there is a current mandate and active program to digitize the VA's records, it's behind schedule and I'm not clear on whether its adequately funded to do more than make plans. I think there is a more mature effort to transition to electronic record-keeping on a go-forwards basis.

As it is, veteran's advocates have to request copies of files from the various regional VA centers where a veteran has received treatment over the years. From what I've been told, sometimes they can be provided as PDFs on disc, even when generated from a physical archive file. Sometimes not.
posted by snuffleupagus at 7:44 AM on September 4, 2012


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