Statement for the Record submitted to House Committee on Veterans’ Affairs offers suggestions to address issues such as compensation & pension exams errors, clearer standardized guidance.
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 was the largest expansion of U.S. Department of Veterans Affairs’ (VA) veteran care and benefits in generations and was staunchly supported by The American Legion.
But with that expansion has come new complexities to the Veterans Benefits Administration (VBA) claims environment – something that needs to be addressed, the Legion expressed to an April 9 House Committee on Veterans’ Affairs (HVAC) subcommittee hearing.
The Legion’s concerns were delivered through a Statement for the Record (SFR) to the House Committee on Veterans’ Affairs. Written by Veterans Affairs & Rehabilitation Policy Analyst Brandon McClain, it was submitted for the HVAC’s Subcommittee on Disability Assistance and Memorial Affairs’ oversight hearing: “Examining VA Efforts to Decrease Delays in Veterans’ Disability on Compensation Claims.”
Read the entire Statement for the Record here.
Following implementation of the PACT Act, “The Veterans Benefits Administration was not adequately prepared to absorb this surge in claims,” McClain wrote. “While the law’s intent was to improve outcomes for toxic-exposed veterans, the result has been a renewed backlog and an overwhelmed workforce struggling under shifting guidance, inconsistent training, outdated development standards, and rotational leadership.
“The challenges are not limited to gaps in contractor oversight alone. At the heart of the issue is VBA’s internal capacity to train, equip, and support its own staff in executing these responsibilities with consistency and care.”
McClain noted issues with both the quality and accuracy of compensation & pension (C&P) examinations, as well as insufficient staff onboarding, lack of real time coaching and procedural misinterpretation.
“A deeper investigation into VBA’s training infrastructure reveals that claims processors, raters and quality review personnel are critical to upholding the mission of the PACT Act,” McClain wrote. “As our nation’s technology capabilities and access improves, it is imperative that the claims process is continuously modernized and streamlined.”
McClain shared that C&P exams have been an ongoing challenge for VA, fraught with delays and inconsistencies. Problems that remain today include staff training, procedural consistency, policy implementation and quality control. He pointed to reviews from the Legion, the VA Office of Inspector General and the Government Accountability Office (GAO) that highlight the need for stronger, more coherent training and oversight infrastructure to keep pace with the complexity and volume of modern claims.
McClain shared results from the Legion’s ROAR (Regional Office Action Review) visits to San Juan and other VA Regional Offices that report claims processors feel overwhelmed and underprepared for the wave of incoming claims. “With an average tenure of about 18 months, many staff are handling complex claims for which their only preparation has been passive online training modules,” McClain shared. “The lack of real-time scenario-based instruction has created procedural inconsistencies and growing claims backlogs. While virtual instruction offers convenience, many employees feel that it significantly diminishes the effectiveness of training, particularly for new employees and newly promoted personnel. There is a strong consensus that onboarding and role-specific training should be far more comprehensive to support employees transitioning into higher levels of responsibility.
“Not all errors lead to outright denials, but many create prolonged processing times and burdens on veterans. GAO found that VBA’s training plan lacks clear performance goals or a timeline for assessing further training needs. Additionally, many claims are repeatedly returned to staff due to incomplete Disability Benefits Questionnaires (DBQs) and an unclear rationale.”
McClain praised VA for making incredible strides in modernization and pointed specifically at efforts made at the St. Petersburg (Fla.) Regional Office’s Decision Review Operations Center (DROC). “During The American Legion’s 2024 St. Petersburg ROAR visit, modernization efforts and implementation of AI had obviously improved employee production and claims processing, improved operational efficiency, and improved employee morale,” he wrote. “The regional office implemented Automated Decision Support (ADS) technologies to streamline claims and address the workload. One key component is the Automated Data Ingestion (ADI), which enables Disability Benefits Questionnaire (DBQ) data to be automatically populated into the Veterans Benefits Management System (VBMS) rating calculator. This innovation eliminates the need for manual data entry, which improved both speed and accuracy of the process.
“Additionally, the Health Data Repository (HDR) has emerged as a powerful tool, allowing VA to connect with VistA data sources. The HDR automates the retrieval of medical records and standardizes them into a single documented format that can be seamlessly integrated into the veteran’s records. This dramatically simplifies access to medical history and reduces the need for manual file searches.”
But despite technological gains, McClain noted that Rating Veterans Service Representatives (RVSRs) have expressed significant concerns regarding the effectiveness of AI in the claims adjudication process. “Specifically, the AI is often unable to accurately interpret handwritten information submitted by service members on VA form 526,” he wrote. “As a result, critical data is not being extracted or auto populated into the system, requiring the RVSRs to spend additional time manually reviewing and inputting information that should otherwise be automated. This undermines the efficiency of automated decision support tools and reduces the overall effectiveness of digital claims processing.”
McClain noted that during ROAR visits, a random sample of 50 benefits claim files are assessed for accuracy, potential mistakes, or inconsistencies. Trends from the fiscal ROAR report include:
· 42 percent of sampled cases had duty-to-assist issues where VA did not assist the veterans in obtaining necessary evidence for filed claims.
· 30 percent of sampled cases ignored favorable evidence. When evidence is ignored, veterans are forced to appeal or submit additional evidence, further extending the time it takes to resolve claims.
· 12 percent of sampled cases were PACT Act claims involving errors or oversight in accordance with provisions of the legislation or evolving Standard Operating Procedures (SOPs).
McClain offered several recommendations to address the issues he shared in his SFR, including:
· Adopt best practices seen within the St. Petersburg RO that utilizes AI to improve employee productivity, eliminate redundancy, and increase morale.
· Urge VA to leverage its oversight ability to hold contracted examiners accountable. DBQs should be filled out in their entirety to ensure all claims are processed and always completed thoroughly for every veteran.
· Formalize and expand the Overdevelopment Reduction Taskforce with representation from field level employees and stakeholders like veteran service organizations (VSOs). In addition, appointing a VSO liaison to the taskforce could ensure service officer expertise is consistently and frequently integrated into policy discussions and decisions.
· Tap into VSOs like The American Legion as partners in training delivery. The Legion’s national network of accredited department service officers is available to provide training and instruction, free of charge, on claims development, PACT Act eligibility and evidence standards. American Legion-accredited professionals interact with claims daily and can provide front-line insight in real time.
“The American Legion understands that overdevelopment (of claims) is not a result of malice or neglect, but a consequence of systemic uncertainty,” McClain concluded. “Claims processors, operating without consistent guidance or adequate training default to ‘playing it safe’ to reduce liability or, even worse, losing their job. Contracted examiners are not always aligned with VA standards, further compounding the problem. The result is a costly cycle of delay, rework, and veteran dissatisfaction.
“Time is not a luxury that our veterans have, particularly our aging veterans. Every unnecessary step in the development process is time stolen from those who have already waited too long. It is imperative that VA act swiftly and decisively to ensure that its systems serve veterans with urgency and efficiency.”
- Veterans Benefits