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Monday, April 02, 2007

When Time Isn't on Your Side: The Veterans' Medical Disability Claim System Backlog

From Government Health IT:

In addition to coping — until recently — with mold and unsanitary conditions at the Walter Reed Army Medical Center, some injured soldiers face financial problems because the Department of Veterans Affairs struggles to approve disability claims in a timely manner.

The problem is not new, but lawmakers are paying more attention to the backlog of claims at the VA as warfighters return from Iraq and Afghanistan. The VA’s inability to process disability claims quickly has caused veterans to wait for as long as two years before they receive funds to pay for their living expenses and other financial needs.

Last year, the VA received 800,000 applications from recently returned soldiers and longtime veterans. Those applications are in addition to the existing backlog of 378,000 veterans’ claims that can’t be processed without additional information. “While VA made progress in fiscal years 2002 and 2003 reducing the size and age of its pending claims inventory, it has lost ground since then,” said Daniel Bertoni, acting director of education, workforce and income security issues at the Government Accountability Office. The VA has difficulty obtaining the military service records it needs for deciding claims, Bertoni said.

Click on 'Article Link' below tags for more...

In the interest of education, article quoted from extensively:


Despite those challenges, the VA said it resolved or provided adjustments for 2 million claims last year and took steps to improve claims processing. Under the best circumstances, a claim takes four months to complete — to obtain military and private records, schedule medical exams, receive results and evaluate evidence, said Ronald Aument, the VA’s deputy undersecretary for benefits. Appeals can take two years, he added. ...

The VA and the Defense Department have taken steps to fix some of the problems in processing disability claims. To speed service delivery, the VA set up Benefits Delivery at Discharge, a trial project begun last year to collect electronic versions of service members’ disability claim applications, service medical records and other evidence before service members leave the military. The disability claims forms ask for information about disabling injuries and the connection between military service and the injury.

DOD is sharing service members’ demographic data with the VA through a direct feed to the VA-DOD Identity Repository, said Robert Reynolds, executive management officer for policy and programs at the Veterans Benefits Administration. The data includes the member’s name, service locations, date of discharge and the combat data necessary for all VA benefit claims. “Our objective is that we will have the DD form 214 [DOD discharge] data in computable format,” Reynolds said.

DOD is creating a module in its Joint Patient Tracking Application for the VA so that it can track severely injured returning service members, Reynolds said. That veteran tracking application will give VA case managers the medical history they need before they can process benefit claims. Last month, VA Secretary Jim Nicholson ordered priority processing of disability claims for all injured veterans on active duty and serving in National Guard and Reserve units who are returning from Afghanistan and Iraq.


A bill containing provisions that would transform the disability claims process passed the House last week. The Wounded Warriors Assistance Act of 2007 would require the Defense Department and Department of Veterans Affairs to administer a standard separation and evaluation physical that VA officials could use in establishing disability ratings.

The bill would also require the VA and DOD to establish a capability for electronically exchanging medical data. And it would require the VA to use an electronic version of DOD’s DD-214 form, which certifies a person’s discharge from active duty.

In addition, the bill would require a written transition plan for service members, the co-location of VA benefit teams at military treatment facilities and the transmission of records to the VA before a service member’s service ends.

While the rest of us are upgrading our computer systems and hardware at a regular basis, the government is far behind in the technology game -- a lethal move in private sector businesses:

The Defense Department has spent the past three years fielding a modern electronic health records system, the Armed Forces Health Longitudinal Technology Application. But DOD’s ability to process disability claims has lagged far behind.

The Army’s Physical Disability Case Processing System (PDCAPS), for example, can’t keep up with the flood of returning injured soldiers from Iraq and Afghanistan. The Army’s primary disability review boards — one for physical evaluations and the other for medical evaluations — have handled more than 11,000 and 15,000 cases, respectively, each year for the past two years. The boards did so relying on 1980s database technology.

Those were among the 41 findings and observations made by the Army’s inspector general in a recent report detailing shortcomings in the service’s ability to process disability claims. The problems surfaced during revelations about the neglect of injured soldiers at the Walter Reed Army Medical Center. The Army secretary requested the IG audit in April 2006.

The audit revealed policy incongruities between DOD instructions and Army regulations and inadequate training of service members who use the Army Physical Disability Evaluation System (APDES) to manage personnel. “These issues, coupled with the increase in the number of soldiers entering APDES, diminish the ability of the evaluation system to meet the needs of soldiers and…the Army,” the IG wrote. ...

The IG’s audit report recommended that the Army Physical Disability Agency and the Army’s chief information officer develop a modern database application to replace PDCAPS and share data with the Medical Board Internal Tracking Tool and other newer disability applications.

The report said the problems that frustrated soldiers at Walter Reed were partially the fault of a 1985 Clipper database, which is part of PDCAPS. Technicians upload PDCAPS data daily to a primary database in Washington, D.C., which means the system does not operate in real time, the IG’s report said. The Army did not respond to questions about a schedule for deploying a new database.

Ryan Rosenberg, marketing vice president at FileMaker, a database company, said it makes no sense for any organization to use a system based on 1980s technology.

The Senate has provided $36.1 million, and the House $35 million, for improving the VA's IT systems and digitizing records. For more information on these IT problems, read the full IG Report on the Army's Physical Disability Evaluation System [pdf].

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