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Battle of the Backlog: VA Grapples With More — and More Complex — Disability Claims

  • Deborah Amdur, the new director of the Veteran Affairs Medical Center in White River Junction, during a recent interview at the Valley News. (Valley News - Sarah Priestap)

    Deborah Amdur, the new director of the Veteran Affairs Medical Center in White River Junction, during a recent interview at the Valley News. (Valley News - Sarah Priestap) Purchase photo reprints »

  • U.S. Sen. Bernie Sanders during a Valley News interview. “The cost of war is a lot more horrendous than people realize,” Sanders said. (Valley News - Sarah Priestap)

    U.S. Sen. Bernie Sanders during a Valley News interview. “The cost of war is a lot more horrendous than people realize,” Sanders said. (Valley News - Sarah Priestap) Purchase photo reprints »

  • Deborah Amdur, the new director of the Veteran Affairs Medical Center in White River Junction, during a recent interview at the Valley News. (Valley News - Sarah Priestap)
  • U.S. Sen. Bernie Sanders during a Valley News interview. “The cost of war is a lot more horrendous than people realize,” Sanders said. (Valley News - Sarah Priestap)

White River Junction — The disability check that Larry Greene had been waiting for was a long time coming.

The 63-year-old West Lebanon resident had applied to upgrade his veteran disability benefits after losing his job at the U.S. Postal Service in 1990.

The post-traumatic stress disorder Greene developed after serving two tours in Vietnam had made it impossible for him to keep working.

After leaving his job, Greene spent the next five years navigating the bureaucracy of the Department of Veterans Affairs. Meanwhile, he sought back pay from the Postal Service and patched together his finances with unemployment compensation and the help of his older sister.

Finally, in 1995, the disability check arrived in the mail.

“It wasn’t a very pleasant road to go, I can tell you that,” he said. “But from what I hear, now it’s a lot better.”

Unfortunately, veterans continue to experience huge backlogs on disability compensation claims. On average, veterans have to wait more than nine months before they begin receiving monthly checks to offset the lost salary and costs from the injuries they’ve sustained.

The backlogged claims — those that have been around for at least 125 days — totaled 588,724 as of Thursday , accounting for 69 percent of all the pending claims nationwide, according to the latest VA figures.

Locally, the situation is not nearly as bad. Vermont and New Hampshire veterans get processed more than two months faster than the national average.

A facility on Etna Road in Lebanon handles claims from Vermonters and veterans living in Canada. New Hampshire veterans are processed through the regional office in Manchester.

VA officials say they are making progress in whittling down the stacks of files that have come long overdue. But the backlogs still exist, and employees on Etna Road expect to be working feverishly over the next two years to meet VA goals of eliminating the pent up claims by 2015.

On Friday, the VA announced it would begin expediting compensation claims decisions for veterans who have waited one year or longer.

Meanwhile, the volume and complexity of new claims continue to increase. The Veterans Benefits Administration processed a record 1 million claims each year for the past three years, yet the number coming in exceeds what the agency can handle. Meanwhile, the institution is making a transition from paper files to digital, adding stress to an overwhelmed workforce.

The backlogs in benefits claims do not hinder access to health care for veterans at the VA hospital in White River Junction, where both veterans and hospital officials say patients can be seen without delay.

In fact, Greene and other veterans who receive nearly all of their health care through the VA system hold the White River Junction hospital in high regard.

“As far as I’m concerned, the VA does a wonderful, wonderful job,” said Tom Hunt, 73, of White River Junction.

Rather, the backlogs affect veterans returning from Afghanistan and Iraq filing new claims for disability compensation, as well as those veterans who, like Greene, apply for stepped-up benefits as the VA system expands the list of maladies that qualify.

“More and more veterans, younger veterans, are coming into the VA system,” U.S. Sen. Bernie Sanders, the Vermont independent who is chairman of the Senate Veterans Committee, said in a recent interview with the Valley News.

“They are amongst the problems that we have to address, but I think the VA is making a serious effort to address them.”

What’s Causing
The Backlog

The sheer volume of claims piling up at the VA would be problem enough, but it is not the only reason why the system is struggling.

As the complexity of battle grows, so do the health consequences for the combatants.

“The cost of war is a lot more horrendous than people realize,” Sanders said. “We are talking about tens and tens and tens of thousands of men and women coming home from those wars dealing with traumatic brain injury or PTSD, and sometimes both.”

Advances in battlefield armor have saved many lives, allowing soldiers to survive explosions that would have killed them decades ago. The soldiers may return alive, but they nevertheless sustain severe concussive injuries that must be treated, said Brad Mayes, director of the Boston regional office of the Veterans Benefits Administration.

Even if a soldier never gets struck by a bullet, the protective gear they are wearing can strain their bodies.

An average claim for a single veteran these days has 10 different health problems listed, each of which has to be examined by VA doctors, Mayes said. There tend to be a lot of orthopedic claims — low back pain, knees, disc compression injuries.

The average claim for Vietnam-era veterans historically had about four conditions.

Post-9/11 claims still make up a relatively minor portion of the backlog, only 22 percent, according to VA data. Vietnam-era claims account for the largest proportion of backlogged claims at 38 percent.

Most are supplemental claims that come as a result of expanded benefits, according to the VA. For example, the VA has been offering retroactive benefits in recent years to Vietnam veterans exposed to Agent Orange, a toxic herbicide that has been linked with cancer and other diseases. These claims are coming in 40 or 50 years after the veteran served.

“Talk about taxing the system,” Sanders said. “(The VA) did the right thing because this is horrible, people dealing with diabetes and a host of other issues because of exposure to Agent Orange.”

On top of this, the VA is moving to electronic records, an immense undertaking involving warehouse loads of files. There’s so much paper that, in August, the VA’s inspector general said the weight of documents at the agency’s Winston-Salem, N.C., office had compromised the structural integrity of the building.

The VA has been sending files to third-party contractors to be scanned and, starting on Friday , any new claims filed by Vermont and New Hampshire veterans will be completely digital, Mayes said.

The transition has been a huge undertaking for regional offices everywhere, Sanders said, and further strained the VA’s ability to keep up.

“I don’t know that there are many institutions that have more paper than the VA,” Sanders said. “And then on top of that, you’re getting very complicated cases. This is not like applying for Social Security.”

The ‘125-Day’ Goal

Benefits claims for U.S. veterans living in Vermont and Canada end up in a modest office building on Etna Road in Lebanon.

The 23 employees there processed 1,903 benefit entitlement decisions last year, according to Mayes. The Etna Road location is the smallest of the Veterans Benefits Administration’s 56 regional offices nationwide.

It has also been among the most efficient, Mayes said, reducing the number of pending claims 33 percent last year.

The average time it takes to process a claim on Etna Road is around 209 days, Mayes said. That compares to a national average of 278 days.

Being ahead of the other regional offices is good, but everybody knows there’s work to be done, Mayes said. The goal is to lower that average below 125 days by 2015. In other words, the goal is to eliminate the backlog in less than two years.

“One-hundred and twenty five days. That’s the goal,” Mayes said. “If anybody can get there, these guys can.”

He says this as Nancy Renehan stands nearby. Renehan, a White River Junction resident and 22-year employee of the VA, manages the regional office on Etna Road.

Renehan is proud of the progress her staff has made in reducing the backlog, particularly given the hurdles they’ve overcome in recent months.

Last November, her staff moved out of White River Junction and into the temporary digs in Lebanon to make way for a planned $2.6 million renovation to modernize the Veterans Benefits Administration’s office at the VA Hospital. When they return to White River Junction in another year and a half, they will have a much improved facility that Mayes expects will make them even more efficient. But the move to Etna Road was tough.

Besides the time it took to move files, computers and staff, technology malfunctions set back their productivity a full month, Renehan said, and they’ve been hustling to catch up since.

“Our challenge was our move,” she said. “That was our biggest challenge because we had basically been meeting our numbers until the move.”

The claims processing area is a quiet collection of cubicles and file cabinets. A few desks are cluttered with paperwork, but the place looks nothing like the images distributed last year of the regional office in Winston-Salem, where piles of brown folders were stacked three feet high atop file cabinets that stretched across several thousand square feet of floor space.

Hanging from the ceiling by the processing area are four colored square signs, stacked in columns of two-by-two. The red one says “Express Monday,” yellow is “Special Ops Tuesday,” blue is “Core Wednesday and Thursday,” and the green one is “All Rating Non-Rating Friday,” or basically taking care of whatever needs doing.

The signs went up on Jan. 1, part of the huge transformation plan that the Veterans Benefits Administration has rolled out to eliminate the backlog.

The plan the agency introduced in January is broken down into three pillars — people, process and technology. The first pillar involves retraining and reorganizing its workers, more than half of which are veterans. (On Etna Road, veterans comprise 98 percent of the office, Mayes said.)

The system on which they are being trained has been completely overhauled and the four colored signs are a reflection of that. The most straightforward claims (estimated at 30 percent) flow through an express lane, similar to a supermarket check-out line. The most complicated cases (10 percent) go into “Special Ops.” And the rest go through the core lane.

There have been many across the board changes to how claims are evaluated and processed. Disability benefits questionnaires, for example, which are the forms physicians complete during an exam, have become automated in a way that officials hope will eliminate errors that contribute to the backlog, according to the plan.

Processing claims is getting faster, Renehan said.

“It’s working pretty good for us right now,” she said.

The conversion from paper to digital has been among the most significant changes, and is considered key to addressing the backlog.

Veterans can submit claims online through a portal called “eBenefits,” which should speed the processing of claims and streamline the sharing of information between the VA and Department of Defense.

Officials say it improves access, reduces errors and cuts the time veterans must wait until receiving their disability checks.

Meanwhile, the regional offices are focused on getting rid of the paper.

On Etna Road, the ratings specialists, which determine what level of benefits the veteran is entitled to, were the first to make the switch to digital about a month ago, Mayes said.

The rest of the Etna Road office will go all-digital on Friday . Paper claims may still be submitted, but they won’t be kept around and will immediately be converted into digital format. Currently, only 3 percent of claims are submitted electronically, according to the VBA. It expects that 10 percent of claims nationwide will be submitted electronically by the end this year and grow to 75 percent by 2015.

Mayes, who called himself a “dinosaur,” said the transition to digital scared him a little bit. But he and Renehan think it will ultimately help them cut waste and serve veterans better.

“To me, the biggest thing it’s going to allow us to do is it’s going to allow us to get rid of the paper,” Mayes said. “There’s a tremendous amount of overhead involved in moving paper around. When you eliminate that overhead ... then we can redirect that overhead to actually processing work.”

Impact on Care

The transformation plan is ambitious. Even Sanders, who has been among the VA’s greatest defenders, acknowledges the difficulty in implementing it.

“Gen. (Eric) Shinseki, who is the secretary of the VA, hopes that the system will be up and running, completed by 2015,” Sanders said. “We’re making some progress on that, but that’s going to be a tough transition.”

Meanwhile, VA officials say the backlogs have no impact on veterans’ ability to get care.

Service members returning from Iraq and Afghanistan automatically get five years of health care benefits, regardless of whether they’ve filed a disability claim or where that claim is in the process.

(The VA disability compensation rates last year ranged from $127 per month to $2,769.)

“Somebody that’s getting out today, they don’t need us to make an entitlement determination to get health care for five years,” Mayes said. “The young men and women that are getting out today, they’re not being held up from health care because we are trying to determine whether or not they have a disease or injury related to their service.”

If there is an impact, it is in how that veteran is prioritized within the system. The benefits claims are intended to make up for lost earnings from a disability.

But they also establish within VA a higher priority for getting certain types of treatment.

“Where they are in the tier, it does have an impact,” said Deborah Amdur, the director of the VA Medical Center in White River Junction.

For example, only veterans who receive at least 30 percent disability can get reimbursed for travel expenses to the hospital.

Veterans interviewed for this story had no complaints about the level of benefits or treatment they’ve received at the VA medical center.

Hartford resident Dan Hillard, 69, has been battling prostate cancer since he was diagnosed in 1997 and also struggles with PTSD. He said the care he has received at the VA in White River Junction “is fantastic,” and is so highly regarded by other veterans that they drive from hours away to seek treatment there.

“Go take a look at the parking lot. You can just drive around and at least 50 percent of the cars have New Hampshire plates,” he said. “I’m not sure all of them are coming from Hanover, Lebanon and Enfield.”

Gioia Grasso Cattabriga, 59, of West Lebanon knows fellow female veterans who drive north from Manchester to be seen at the White River Junction VA hospital.

Cattabrigo visits the White River VA six times a year for treatment, mostly routine checkups, and considers it very accessible. More than that, it has also established a new center aimed specifically at treating female veterans such as herself.

“My experiences with care have been remarkably good,” she said.

Greene, who’d been frustrated with the disability claim process, said those issues had not affected his opinion of the care he’s received.

He grew up going to the VA. His father served in a World War II. In all that time, he’s held the hospital in high regard.

As for the delays on his claim two decades ago, Greene said he does not blame the individuals who worked with him. Instead, the fault lies with a bureaucracy in great need of reform.

“You couldn’t put your finger on any one person,” Greene said. “I would put it on the system itself. There’s got to be a faster way of doing claims.”

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.