August 27, 2013

VA rewarded workers for avoiding complicated claims

The department gave millions of dollars in bonuses to avoid claims that needed extra work to document veterans' injuries.

By MARY SHINN, DANIEL MOORE and STEVEN RICH The shington Post/News21

While veterans waited longer than ever in recent years for their wartime disability compensation, the Department of Veterans Affairs gave its workers millions of dollars in bonuses for "excellent" performances that effectively encouraged them to avoid claims that needed extra work to document veterans' injuries, a News21 investigation has found.

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At the Healing Horse Therapy Center in Florida, Army veteran Jessie de Leon copes with the aftermath of the sexual trauma she experienced while in the service.

Kelsey Hightower/Wahington Post/News21

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Stephen Leon, a combat veteran who is 70 percent disabled, holds granddaughter Ashley Leon at his apartment in Revere, Mass., in June.

Mary Shinn/Washington Post/News 21

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In 2011, a year in which the claims backlog ballooned by 155 percent, more than two-thirds of claims processors shared $5.5 million in bonuses, according to salary data from the Office of Personnel Management.

The more complex claims were often set aside by workers so they could keep their jobs, meet performance standards or, in some cases, collect extra pay, said VA claims processors and union representatives. Those claims now make up much of the VA's widely scrutinized disability claims backlog, defined by the agency as claims pending more than 125 days.

"At the beginning of the month . . . I'd try to work my really easy stuff so I could get my numbers up," said Renee Cotter, a union steward for the Reno, Nev., local of the American Federation of Government Employees.

Now, claims workers said, they fear the VA's aggressive new push to finish all one-year-old claims by Oct. 1 -- and eliminate the entire backlog by 2015 -- could continue the emphasis on quantity over quality in claims processing that has often led to mistakes. VA workers have processed 1 million claims a year for three years in a row.

Beth McCoy, the assistant deputy undersecretary for field operations for the Veterans Benefits Administration, said bonuses for claims processors were justified because, even though the number of backlogged claims was rising, workers were processing more claims than ever.

"There are many, many employees who are exceeding their minimum standards, and they deserve to be recognized for that," she said.

She also said the VBA is improving quality even as it processes more claims.

But documents show that a board of appeals found in 2012 that almost three out of four appealed claims were wrong or based on incomplete information.

About 14,000 veterans had appeals pending for more than two years as of November.


In an attempt to encourage more productivity, the VA changed claims processors' performance criteria between 2010 and 2012. The changes discouraged them from spending time gathering additional documents that could support complicated claims, according to written performance requirements for claims processors.

McCoy, the VBA official, said she heard from employees in the field that they felt the performance standards were not fair. "Things are changing very quickly, and we're struggling a little bit to keep up with the pace of change as we update our performance standards," she said.

A processor must gather medical and military records for each disability and assign disability ratings based on the severity of injury, which then determines the monthly check from the government.

The VA paid $44.3 billion in disability benefits and $5.5 billion to survivors of veterans with a service-connected disability, according to its annual benefits report for fiscal 2012. A veteran who is rated 10 percent disabled receives a standard $129 per month.

Claims for multiple injuries require significant time to gather documentation. Other claims, including for post-traumatic stress disorder, military sexual trauma or traumatic brain injury, can require just as much effort because they can be more difficult to prove than physical injuries.

In April 2010, the VA stopped giving its employees performance credit for "supplemental development," which included tasks such as calling and sending follow-up letters to veterans and follow-up requests for military documents and medical records.

The change was meant to encourage processors to finish claims. But a complex disability claim could take all day, while a claim for one or two injuries could be completed much faster, said David G. Bump, a national representative of the AFGE and former claims processor at the Milwaukee regional office.

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Air Force veteran Damon Wood was diagnosed with post-traumatic stress disorder after serving in Iraq and Afghanistan. He has been waiting 20 months for a disability rating.

Jessica Wilde/Washington Post/News 21


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