VA benefits backlog climbs as pandemic drags on

The backlog of initial claims for benefits has been rising in recent weeks, after holding steady amid the 100% telework posture of the Veterans Benefits Administration.

The backlog of initial claims for benefits by veterans has been spiking in recent weeks, after holding steady amid the 100% telework posture of the Veterans Benefits Administration.

The backlog of claims for veterans' benefits -- those that have yet to be addressed for 125 days or longer -- has crept up to over 100,000, according to data released Monday. VBA had been able to keep the backlog well below that number for months, in keeping with an overall Department of Veterans Affairs goal to lower the figure.

Early on, even under telework, the backlog numbers reflected the steady state of just over 70,000 claims that the agency had achieved. That steady state represented a leap forward at the agency before the pandemic, and the agency was also making advancements in handling appeals.

"Significant progress has been made at VBA to reduce the backlog of undecided claims and appeals and the Appeals Modernization Act is already exceeding expectations," Bill Oxford, national commander of the American Legion, said at a March 11 joint hearing of the House and Senate Veterans Affairs Committees. "We're confident this will continue as we watch the backlog shrink in the months ahead."

The COVID-19 pandemic and response appears to be getting in the way.

Under the 100% telework regime, backlogged claims increased slowly but steadily, before spiking in early May. As of May 16, the backlog number was 101,456. A week earlier, the backlog stood at 96,088. As recently as May 2, the figure was just over 80,000.

VBA releases reports on claims processing every Monday, with data current through the previous Saturday. We reviewed reports issued covering March 14, the day after the federal government declared the pandemic a national emergency, and May 18, the last time the VA published its backlog report.

The VBA employees who rate veterans' claims are already trained and equipped to telework, and some do so several days a week. The rating is done on a system called the Veterans Benefits Management System (VBMS), a content management system that collects and organizes records pertinent to pension and disability claims made by veterans.

Jim Rihel, the president of American Federation of Government Employees Local 940, which represents VBA workers in Philadelphia, said that the VBA raters are working hard but are facing headwinds.

"All in all, telework is working, but employees are killing themselves to get their work done in a system that's stacked against them," he said in an interview.

"The networks are garbage," he said. "VBMS crashes on a regular and recurring basis. When you go to open documents, the system will often not open or it says it's run out of memory and you have to do 'X, Y, Z,' such as clearing your cache, or do all these other different things to fix the system so that it does what it's supposed to do."

A VA spokesperson said that the agency "tested its enterprisewide virtual private networks and gateways from March 11 through March 17. This testing had minimal impact on VA's claims processors, and employees who were impacted by the testing worked with their supervisor to mitigate any effect to the employee's performance standards."

Rihel said that VBA was able to keep up initially was because VBA workers behind the scene were in overdrive to meet their standards.

He noted that one VBA office in Wilmington issued 358 decisions in a month for claims despite only having 20 employees overall, and only four or five ratings specialists to handle those cases.

"We're beating the odds. Employees are the one who did it, who came to the understanding of what they needed to do to be successful. But we're probably going to start seeing more turnover and requests for retirement. We just can't keep this pace forever," he said.

Rihel didn't have any explanation for the recent spike. 

"It's possible that all of a sudden they were counted as 'backlogged,'" he said in a follow-up interview on May 20, explaining that it was possible that a large number of cases all hit the 125-day mark at the same time. "It's not unheard of."

A VA spokeswoman explained that certain activities are on pause during the pandemic.

"During this national emergency, in-person examinations required for our compensation and pension program are not being conducted due to safety concerns," the spokeswoman said in an email. "Claims processors are delaying the decision on any claim that requires an in-person examination until these appointments can be safely resumed. In the meantime, veterans are still able to submit claims and VA is developing plans to resume in-person examinations as soon as it is safe to do so."

A coming surge

A separate issue is claims for supplemental entitlements such as increases to existing pension payments and increased evaluations for additional claimed conditions, followed by original case claims for service-connected injuries or illnesses and pension claims.

The pandemic might not yet be completely registering in that data, according to officials at veterans service organizations, because of the complexity of these claims, requirements for medical information and recent process changes.

"What I imagine is that we're not really seeing the ratings affected by COVID as much yet because those statistics are from when [veterans service organizations] were still able to review ratings decisions," Veterans of Foreign Wars National Veterans Service Director Ryan Gallucci said in an interview.

"It's hard to tell because we're less than two months into this pandemic, so if a veteran filed a claim even in normal times, it wouldn't have been processed by now."

There are some hints that the lack of medical appointments to confirm disability status is taking a toll. The total numbers for supplemental entitlement claims are down from the beginning of the year and from the beginning of the pandemic, but the percentage of claims that have been pending for more than 125 days is beginning to tick up, from 15% in mid-March to 20% at present.

Melinda Staton said that as veterans benefits coordinator for the American Legion she had seen a drop in the number of incoming claims. While the VA has granted extensions for submitting paperwork to support claims, older veterans can face technology hurdles.

"Our elderly veterans often lack technology such as smartphones and computers," she said. "Even with the extension, they're unable to submit claims due to the lack of capability to print and scan documentation."

Once VA offices reopen, however, she anticipated an influx of new claims.

"Our veterans can't get to medical appointments, which can exacerbate symptoms, especially if the [injuries] are service-connected. They would need then to put in a claim for increased benefits."

Disabled American Veterans National Service Director Jim Marszalek said in an interview May 4 that he anticipated a higher number of claims once in-person examinations were reinstated.

"It's business as usual at this point, everyone's adapted. Most of our veterans are older and more susceptible to diseases. They've been okay with [deferring] examinations, since they don't want to assume any risk. However, some states are reopening in a few days and so we [anticipate] potentially more exams being done."

Review and reopening

As of April 3, the VA had suspended in-person non-urgent medical examinations and expanded use of telehealth appointments while allowing raters to defer making decisions on certain claims that require in-person evaluations, such as examinations for orthopedic and mental health issues.

On April 30, the VA suspended the 48-hour review period, which refers to the time period in which a veteran service organization can review the proposed ratings score assigned to a veteran who has applied for benefits before it's officially issued.

The two-day time timeframe to assure quality control and that all relevant evidence has been considered, as a ratings decision determines what healthcare services and financial support for which a veteran can qualify.

Sen. Jon Tester (D-Mont.) of the Senate Committee on Veterans Affairs and several veterans service organizations including VFW sent a letter to VA Secretary Robert Wilkie asking him to reconsider his decision to revoke the 48-hour review.

Raters issue veterans a disability rating on a scale of 0 to 100, in 10 percent increments. The numbers represent the lost earning potential of a veteran due to a service-connected disability. Higher numbers can correspond to an increase of benefits such as waivers for co-pays and prescriptions costs, while others can allow a veteran to access programs for educational programs and vocational training to reenter the workforce.

"It serves as a gateway for other benefit programs. It can be a major factor in a veteran's ability to receive care," Gallucci said.

However, he noted, VFW had found that when officers were still allowed to review cases, some veterans' claims were denied instead of deferred, adding to further speculation that the numbers did not accurately reflect the full scale of the backlog.

"VA is supposed to defer those claims and rate on anything else that was examined or for which there has been sufficient evidence," he said. "There is a fair amount of subjectivity. Each claim is supposed to stands on its own merits, but there is human error."

A congressional staffer on the Senate Veterans Affairs committee confirmed this in an interview. "We are receiving feedback that some veterans' claims are being unintentionally denied instead of deferred."

On May 7, the VA announced a three-phase plan for beginning to reopen its facilities on a regional basis as the number COVID cases trends downward. That includes in-person visits for claimants by appointment only. Up to half of VBA employees would return on a rotational basis, but the agency would consider continuing telework fulltime for eligible employees who were able to complete their duties remotely.

The three veterans service organization officers we spoke with said that while the VBA has assumed a telework posture, their ability to access the needed systems for helping veterans file claims and navigate the process had not been significantly impacted.

"We're still able to access certain VA systems. Most of our service officers are able to do telework. If veterans need assistance, they can still find an advocate to help them," Gallucci said.

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