Returning soldiers confront medical claim complications

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Some injured soldiers at the Walter Reed Army Medical Center are now facing financial problems, in addition to unsanitary conditions, because the Department of Veterans Affairs struggles to approve disability claims in a timely manner. Some veterans are forced to wait two years before they receive funds to pay for their living expenses and other financial needs.

Officials from the Government Accountability Office testified in a hearing before the House Veterans Affairs Subcommittee on Disability Assistance that the Department of Veterans' Affairs' system for handling disability claims is not acceptable to serve troops returning from Iraq and Afghanistan.

Building up a backlog

Last year, the VA received more than 800,000 applications from recently returned soldiers and veterans, in addition to the existing backlog of 378,000 veterans’ claims, according to a Government Health IT article. Veterans Affairs Secretary Jim Nicholson testified in February that he expects to receive 1.6 million additional claims in the next two years. Lawmakers are now paying more attention to the backlog of claims at the VA as soldiers return from Iraq and Afghanistan.

The reason for the huge backlog is because the claims process is cumbersome and paper-intensive, said Linda Bilmes, professor of Harvard’s John F. Kennedy School of Government at the hearing. Bilmes co-authored, with Nobel laureate professor Joseph Stiglitz, the paper “Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits,” for which the authors looked at the cost of providing medical care and disability benefits to veterans deployed in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF).

Time-consuming practices

The Veterans Benefits Administration (VBA) grants a wide range of benefits and services for veterans, their families, and their survivors. Based on Bilmes’ and Stiglitz’s research, the VBA takes an average of six months to process an initial claim, and an average of about two years to process an appeal, Bilmes said. “It is also far below the standards of the private sector medical insurance industry, which settles 30 million insurance claims – including appeals – within an average of 89.5 days,” she added.

The process is too complex. A veteran must apply at one of the VBA regional offices, where a claims adjudicator will determine the veteran’s service-connected impairments and assign a rating for the veteran’s disability. Claims specialists must then figure out the percentage disability for each condition. If the veteran disagrees with the board, the veteran may appeal to the courts. “This process often takes years during which the veteran is left in limbo,” Bilmes said.

“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 at the hearing.

Despite those challenges, the VA said it resolved or provided adjustments for 2 million claims last year and took steps to improve claims processing. “Expediting the claims process is critical to assisting OIF/OEF veterans in their transition from combat operations back to civilian life. VA also is continuing to focus on reducing the pending workload and improving the overall timeliness of processing for all veterans,” said Ronald R. Aument, deputy under secretary for benefits for the Department of Veterans Affairs, at the hearing.

Expediting the claims process

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. VBA is aggressively pursuing measures to decrease the pending inventory of disability claims and shorten the time veterans must wait for decisions on their claims. “Under the very best of circumstances, it takes about four months to fully develop a claim (obtain military and private medical records, schedule necessary medical examinations and receive results, and evaluate evidence,” Aument said at the hearing.

The VA also set up Benefits Delivery at Discharge, a trial project that will collect electronic versions of service members’ disability