New tool launches to improve the benefits claim appeals process at the VA


shadow

This article originally appeared on the U.S. Digital Service’s Medium channel.

Today, we are celebrating the nationwide launch of Caseflow Certification, the first of many tools that will begin to improve the processing of benefit claim appeals at VA.

Last summer, the Board of Veterans’ Appeals reached out to the Digital Service at VA to assess the disability claim appeals process. We found a familiar sight to anyone who has worked in government — a burdensome medley of antiquated technology, manual processes, and overbearing laws and policies.

This is a story about how the Digital Service is partnering with the incredibly dedicated team at the Board to replace this legacy system at the VA. It’s a story of policy, technology, and human-centered design.

“The appeals process we currently have set in law is failing Veterans — and taxpayers.” — Bob McDonald, Secretary of the VA

Imagine Lawrence — a Vietnam Veteran in his sixties. Lawrence filed a claim seven years ago to increase his disability compensation from the VA after his back injury got so bad that he couldn’t work. Seven years later, he’s still waiting for a final decision. Or think about Lisa, whose husband passed away due to cancer caused by asbestos exposure in the Navy. She appealed to increase his disability compensation package after his death. It’s been three years and she’s still waiting for a final decision too.

Tens of thousands of Veterans are waiting longer than five years for a final appeals decision as the VA continues to face rapid growth in its appeals workload. Between 2012 and 2015, the number of pending appeals climbed by 35 percent to more than 450,000 pending appeals across the VA today. Without significant reform to the current appeals process, this number is projected to soar to more than 2.2 million by the end of 2027.

There are hundreds of thousands of individuals suffering from ailments like post-traumatic stress, exposure to Agent Orange, and tinnitus (ringing in the ears) incurred during their time in service. Veterans and their families are dependent on financial assistance from the benefits claims process to stay healthy and prevent their health issues from worsening.

VA Secretary Bob McDonald recently acknowledged in a public memo that the appeals process is failing Veterans. Since releasing this memo, the VA has partnered with Congress, state and local government officials, Veterans Service Organizations, and other stakeholders to modernize the current appeals process by making it more timely, fair, modern, and streamlined.

So, we partnered with the Board to redesign the system used to track and process benefit claim appeals. Here’s how.

Understand what people need

A human-centered approach (that is, designing for people by first understanding what they need) ensures that we build and design things that actually make sense within the context of someone’s real life. We’ve spent months working closely with the Board and collaborators all across the VA to understand where the Digital Service can have the most impact.

The complex process to review appeals is distributed across many silos at the VA, as required by law. This legal process has only grown more opaque, complex, and harder to understand throughout the years. Laws — established to protect or help Veterans — sometimes end up causing delays.

A diagram of Steps in the appeals process today

Steps in the appeals process today. Imagine how hard it is for a Veteran to understand this.

Imagine a Veteran who has waited years for her appeal to be reviewed — she starts to second-guess the system. As her condition worsens, she wants to be heard. She starts sending the VA evidence — doctor’s notes, medical exams, and personal pleas. Little does she know that each time she submits new evidence, her appeal must be reviewed and decided again. She is unwittingly delaying her appeal with each new submission.

Meanwhile, the software used to track appeals both at the Board and throughout the VA was built in the 1980s, with the maintenance left largely to a single developer. Over the last several decades, the appeals tracking software was expanded to support more complex workflows and only recently, the addition of paperless appeals.

A picture of the current tool used to track and process appeals.

The current tool used to track and process appeals. Note: The file information in this image is fake.

We spoke with VA employees across the country to understand their workflows. We sat in their cubicles and looked over their shoulders to figure out what the pain points were in the existing process. Government employees are users too, and they deserve products that meet their needs — products that are helpful, usable, and simple.

A wall in our office used to track the process and pain points, as we observed from VA employees.

Today the Digital Service launches the first of many tools that will begin to improve paperless appeals processing at the VA: Caseflow Certification

Caseflow Certification is a simple web-app that automatically detects if required documentation has been added to an appeal before it moves forward in the process. This simple check will help reduce preventable errors and avoidable delays caused by disjointed, manual processing.

An image of the Caseflow Certification home screen

Caseflow Certification, the first of many Caseflow apps.

We designed Caseflow Certification using the U.S. Web Design Standards to ensure the website is accessible and consistent with other government websites. Once we had a working prototype, we went back to the VA regional offices to test our assumptions — to keep ourselves honest, and to find out what we needed to improve.
VA Digital Service Team members

Conducting usability research at the New York Regional Office with longtime Veterans Appeals Decision Review Officer Elizabeth (who has since retired).

In the last six months, we have surrounded ourselves with the support necessary to change the way the agency approaches technology, process, and policy. We recognize that significant legislative and additional process reforms are needed to truly modernize and provide Veterans and their families the service they deserve. Through the delivery of this small project, we’ve established a strong foothold for the future improvement of dozens more workflows at the Board and beyond.

To the outside world, it may be hard to grasp the importance of these simple fixes. Today there are more than 450,000 Veterans that have appeals pending. Each one of these appeals undergoes a protracted cycle of review, delay, and miscommunication. 80,000 Veterans have appeals older than 5 years. 5,000 Veterans have appeals older than 10 years.

But these are just numbers. Behind each of these appeals is a Veteran — a Lawrence or a Lisa. The invisible hand of integrated technology, corresponding process enhancements, and legislative changes that reduce manual processing has the ability to improve Lawrence’s and Lisa’s lives, and make good on our promise to America’s Veterans.


This article originally appeared on the U.S. Digital Service’s Medium channel. It was written by Kavi Harshawat and Mary Ann Brody.

Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Michael A Kline    

    Im a Blind Veteran an have been asking for help.Please God before i die can i just get a little help financial,They told me never give up.An i have been waiting 35 years an haven’t gotten a penny.I waited 9 years to get a guide dog.It took 8 years to get medical.An no financial help at all.Been to Blind Rehaps thank someone for that me.I needed Surgery an couldn’t wait.So i went to a civilian hospital to get help.An if i didn’t i would be dead now.

    1. Louis J. Hansen    

      Michael: where do you live and who is your advocate with the VA?

    2. Ricky G. Lackey    

      I was in communications around blazing generators blasting and the equipment usee buzzing and humming loudly for the 3 years I was in 75-78. I have had ringing in my ears and loss of high pitch hearing ever since. Was told I couldn’t get VA help due to my income being what it is!…I gave up years ago!

  2. Robin Alan Hammons    

    Why isn’t the E-Benefits e-mail “Compose new e-mail” function working, and why isnt the “Chat” function working? They have been down for a long time, and I believe this doesn’t help veterans and it keeps us from communicating with your agency. Please fix this as soon as possible.

    1. Dan Fenton    

      I have tried numerous times to have a live chat and NEVER been able to have one!

    2. Richard T McFqll    

      I have an appeal from a claim from the 1970’s. This happened when the Phila Va was destroying files and slow tracking many others. This appeal is nearly 40 years old. I bet mine is one of the oldest. The VA should fast track appeals based on age pending. If that happens, I may get help while I am still alive. I am sure that the oldest appeals have ended more cases because the vets passed away. This a travesty.

  3. William F. Wilderson Sr.    

    I am one of the hundreds of thousands of Vietnam Vets suffering from PTSD, Agent Orange and Tinnitus. My appeals have been delayed for years. Each time I inquire I’m told the wait time gets even longer. I have complied with volumes of documents and references. I can only hope the DAV can do what the VA and VFW have not been able to do. That is get resolution for me and my family before I die.

    1. Julia Perry Briggs    

      William, I wish great blessings on you and your family. You can see in my Comment what I was put through, but in my mind, you VN vets and your needs, particularly about the chemical exposures, is the most horrific VA crime, ever.
      Again, my blessings.

  4. Wayne T Munson    

    I filed a “Notice of Disagreement” regarding and Agent-Orange designated CRSC in October 2015. I keep checking but there is never any status change. The same text ahs been there every month.

    I also tried to use the “IRIS” system to log an inquiry, but each time it required a “Dependent ZIP CODE” and a “Veteran ZIP CODE” even though I had correctly entered my ZIP CODE as the veteran each time.

    So, we have a new system?

    1. Julia Perry Briggs    

      Wayne, I wish great blessings on you and your family. You can see in my Comment what I was put through, but in my mind, you VN vets and your needs, particularly about the chemical exposures, is the most horrific VA crime, ever.
      The IT systems have been a disaster, and I think that those of us with complex cases not only will be left behind with these IT improvements, I think that the VA is so screwed with its bad handling of the new Vets who haven’t even gotten their cases worked through and a Decision the first time, that we with complex cases have been tossed into a corner. I work directly with staff in the BOVA in Cleveland, and they screw things up, too.
      Again, my blessings.

  5. Tee Jr. Masaniai    

    My Left Ankle Damages during Boot-Camp during my time with “United States Army: from 1966-1968”, and continued on During my time with “United States Marine Corps: from 1968-1972” has not been rating, nor, consider Service Connected for some devious reason. And it bothers me big time when I walk any distance. X-ray showing torn badly without any ligaments according to Doctors examined me several times. I am asking for my (Left Ankle) to be Service Connected, and rating back to 1989 where it should been in the first place, according to Medical Records. As well as my (R) Knee; Complete Knee Replacement I got Shot at in Vietnam During combat operation. And also my Right Wrist Fourth metacarpal Fusion plus shorten the Ulnar does bothers me big time. This happened During Liberty calls inside a Tavern, to which I save my fellow Marines from a Brawl fight which broke my Fourth Metacarpal compound fracture; while we were on (AIT) Combat Training at Camp Horno, Calif. I am asking for help with my Medical Disability Claim Benefit. Why some of my Disability matters has not being rating, etc. Including my Agent Orange issue foremost. Thank you.

    1. Julia Perry Briggs    

      Tee, I wish great blessings on you and your family. You can see in my Comment what I was put through, but in my mind, you VN vets and your needs, particularly about the chemical exposures, is the most horrific VA crime, ever. I have been documented as a victim of VA medical negligence and won in principle an 1151 case, but I still have physical problems related to my 1982 navy injury. It even prevented me from being allowed to try and have my own children.
      The IT systems have been a disaster, and I think that those of us with complex cases not only will be left behind with these IT improvements, I think that the VA is so screwed with its bad handling of the new Vets who haven’t even gotten their cases worked through and a Decision the first time, that we with complex cases have been tossed into a corner. I work directly with staff in the BOVA in Cleveland, and they screw things up, too.
      Again, my blessings.

  6. Mary E. Joffrion    

    The claim process is terrible and if your case is closed all your information previously uploaded is deleted, the whole process is a farce. I despise how easily the VA dumps your information. I requested in writing through my VA representative for a hold for a month on appointments (should they be scheduled) so I could visit my husband overseas and I wasn’t gone two weeks and I was informed my claim had been closed!

  7. George H. Zemanek    

    Am under the Federal “poverty Guideline but am considered NSC, despite being a Vietnam Vet. All I asked for is not to be billed for Rx. Psych…Was denied for service connected. Asked VA to review decision. Answer due in June. Expect no for answer.

    Means test shows how much out of pocket my expenses were for 2015. What a joke! Means test! No money, but administrators get “obscene” salaries.

    VFW is going to step in after June decision. I ask not for money, only a break on my meds!

    P.S. The Honorable Senator Cornyn has been helping me with VA issues.
    Why is it that Pharmacy can over rule Dr. Orders? Another big problem!!!

  8. Donald D. Stithem    

    Why can I not get any response to my messages, emails, phone calls, chats, etc. in regards to my appeal? I have submitted all paper work, forms, medical records, etc., no response, nothing. When will I hear something? Thanks.

  9. James H. Lucas, Jr.    

    Caseflow…..interesting. I will try it. JHL

  10. John Do    

    I did not mean to repeat myself. You did not accept my CAPTCHA Code* the first time. No need to be so curt! Veterans’ have much to be angry about.
    You will not hear from me again.
    Do not reply…Thanx
    George

  11. Ángel R Morales    

    Do I have to create an acct to sign in to Caseflow? Thanks.

  12. Walter Arthur Kayden    

    I have dealt with the VA system since the 1980’s. My original claim for PTSD was diagnosed in 1998 by a contracted PTSD counselor and I did not get a rating until July of 2003. I saw one doctor for unemployability in 2000, paid her $300 and nothing happened. I did see a Vet Center counselor during the 80’s but he never mentioned PTSD, he just ask me to stop drinking alcohol. I do have a claim for mal practice from November 20, 2000 and have appealed it so many times and still no final decision. The mal practice involved a endoscopic doctor burning a large hole in my rectal wall when he removed a carcinoid polyp on November 20, 2000. This was at the VAMC in Milwaukee WI. A simple outpatient procedure turned into a 12 day night mare for myself and my wife. I still have rashes over half of my body from the Agent Orange during my 15 months in Vietnam from January 8 1968 to April 8 1969. I am happy that I did get 100% for my PTSD but with all the other problems that I have had, I believe my rating should go up to 200%.

  13. Robert Frost    

    I’m a veteran, as was my dad who was 100% and recently died at the VA on the 31st of the month at 23:45 hours. Now because he didn’t live the “whole month” they took back the FULL month’s compensation from my mother and fathers account. THE 31st at 23:45 HOURS AND THEY TAKE HIS FULL MONTH’S COMPENSATION AWAY FROM MY MOM THAT PAYS ALL OF HIS BILLS!!!!???? In what way is that right? My parents are “old school” and my dad was the primary provider with his retirement from his 25+ years of service and his VA compensation. Now my mom just gets less than $500.00 from her social security which she can’t even cover 1/4 of their bills with and the VA is taking money away from her over 15 minutes!!! If that wasn’t bad enough, the DIC paperwork is on similar forms as the VA appeals system and goes through the same process as doing the VA appeals. Why isn’t this sort of thing a simple process and automatic? A Veteran rated at 100% who died of a service connected disability at the VA itself yet the dependent spouse still has to fight the VA paperwork nightmare to get what is rightfully due. Why is this? Where is the sense in taking the whole prior months compensation because the veteran didn’t make it “through” into the next month by 15 MINUTES??? 15 MINUTES!!!! All of the VA’s paperwork and filing processes needs to be revamped! And don’t tell me how “E-Benefits” helps or make it go faster when it just gives one access to writable PDF’s that still need to be printed out on paper to be filed with the VA. Money should never be taken away from the Veterans spouse like this because when a Veteran dies, their bills don’t pass away with them and still need to be paid.

  14. Johnny Moore    

    How do you sign-in to Caseflow and VACOLS? This web page does not link Caseflow or VACOLS.

  15. John Kittler    

    There is only ONE thing that counts – resolution.

    It is a waste of time and literally useless propaganda to suggest this
    system is worthwhile before it has proven itself on the battle field
    of VA claims.

    I see way too much emphasis on spin in the VA
    and way too little application of support to the doctor,
    shrink or caregiver at the VA to support the Veteran.
    They are overloaded, have been for too long.

    This might help, but I could care less about the system
    until it has proven itself.

    In the meantime, hire another doctor or something
    and quit blowing your horn about the VA getting better,
    because until the Veterans see it, we don’t give a crap
    about your article.
    John Kittler
    Captain USN (ret)

  16. Dennis Neilson    

    What the hell is a vacols sign in? I have only been trying for 3 years to be verified for type 2 diabetes and ischemic heart disease; both of which were certified by VA clinic. My initial denial was based upon evaluations that NEVER occurred . I have requested copies of emails my servicing rep claims to have sent but for some reason they never come. Should I hire an attorney or change reps? Any ideas. I want face to face with someone who can make a decision. Has anyone tried a Senate staffer?

  17. Adriane Reesey    

    I have been told that since I requested a hearing for my appeal, that it could take upward of 5 years; I this true?
    Will this process cut that time?

  18. thomas 89031    

    A good site to visit and share information or ask questions about claims is : http://www.hadit.com

  19. James T Gavin, Jr    

    I put in a claim in 1985 for being exposed to Agent Orange in 1966 to 1987 in Vietnam. My Claim # is 077522. I have not received any correspondence from the Va or compensation for this claim. I am 100% with PTSD and receive compensation. But nothing regarding my claim for being exposed to Agent Orange? Why … and who or what do I to get answers?

  20. Lewen Bill Street Jr    

    My father is a 92 year old vet. He served in the Navy on the ship USS South Dacota. From 1944 to 1946. When he was in bootcamp he suffered from phnomonia, he went into a coma and was not expected to live. A letter was sent to his mother stating that he was in a coma and not expected to live.they even called her to let her know of his condition. Lewen did come out of the coma and was sent back to boot camp to finish. His lungs and heart was severely damaged, he was unable to pass the swim test,but sent on his ship to fight the battles during the ww11 era. He returned home and never talked about his experiences to anyone. In 2004 . he was placed in the hospital not expecting to live. Lewen spent three months in hospic. And returned home, lewen is home bound and needs a 24 hour care. So his daughter went to the VA for help. Every clame he put in was denied for some crazy reason. He experienced hearing loss, damaged lungs, bad heart, diabetes, bad knees and naropthy. The government owned him while serving in the military and yet they hold no responsibility. The government treats our veterans like crap, or like they just don’t exist. Wrong wrong

  21. Lewen Bill Street Jr    

    The VA gave lewen a hospital bed, he was continuely sliding out of it, it’s been 3 months and still nothing from the VA to replace the bed. Lewen has had several Dr orders for him to have a walk in shower. Denied from the VA. So lewen continues to get bed baths.

  22. rick gallaher    

    How very complex can you desk drivers make things — a web based tool does not remove the complex nature of the BS you all have created.

    A vet with PTSD and TBI can no way get past this process. You have created just one more process as a barrier to receiving the care that is due everyone who served

  23. Larry J. DENNING    

    My hearing case is still in appeal. In the mean time my hearing gets worse.

  24. Darin Gravitt    

    From my own experience and claim denials at the Regional level, I believe there would be less problems with appeals if the initial decision makers were better trained. This is also in lieu of medical care Veterans receive for their disabilities was better diagnosed and documented. I have many errors and many misdiagnosis or under diagnosis documented in my file to the point that it looks like a complete nightmare to anyone trying to interpreted it. This is another problem with Veterans trying to have their claims approved. Also, those at the Regional level not even taking time to look closely at what is sent to them and just pushing it on to appeals because they don’t want to do the work and deal with it, especially if it is a lot of documentation or paperwork to go through. It is not entirely their fault and a big part of the blame is the work load is too much and the VA in general is not equipped to handle the numbers.

  25. Christopher Wallace    

    I am a Coast Guard Veteran with epilepsy and have been denied twice. Myself and I need the assistance very badly before I a am homeless. Any help would be appreciated.

  26. gerald palmer    

    I was supposed to be discharged with 100% disability from the brain surgery at a VA hospital. I was on active duty and when I went back to the base at Little Rock AFB, we didnt even have a hospital only a first aid center. I was given 2 weeks off and went back to work. Stupid little new airman me followed the orders. Have had such problems after I wont go into it, just a sample of the sorry treatment the military gives us.

  27. Julia Perry Briggs    

    I’ve been bugging them for over a decade about a CUE, and they keep ignoring it and attempting to adjudicate things. I was therapeutically deceived, exploited, STALKED over State lines for 7 months, and thrice raped by a VA doctor in 1986. This system is never going to work for CUE cases.

  28. Rod Oshel    

    (1) What is the web link to Caseflow; (2) What is VACOLS userid and how do I get a VACOLS userid?

  29. John Sprague    

    When I see 4 people smiling cluelessly in a picture as proof of the value of their work, I usually run. If you really want the VA Appeals process to be effective, you have to start from the ground up. The reason there are so many appeals is because there are way to many errors in the originating claims. Fix that, and the appeal problem goes away all by itself.

    This is like….tossing money into a sinking ship. No matter how much money you thrown into it, it is all going to waste.

  30. Dan Saito    

    The CaseFlow article doesn’t tell us how to get VACOLS login ID.

  31. Tyrone S. Bates    

    I filed a claim for 100% disability in January 2015!
    The VA ok’d my claim for 100% disability September 2015 due to agent orange disability’s and ptsd!
    I believe that I have retroactive pay from the time the claim was filed?
    7 months and still no back pay?
    Am I wrong about the retroactive pay?

  32. steven McMillan    

    I filed a claim for Agent Orange for Type 2 diabetes. And I have not heard a thing in almost a year and a half. Can any one help me with this. Thank You

  33. Frank Thomas Walker Jr.    

    I was in Korea 3 times (once as POW/MIA – where my finger was shot off, one testicle, shoulders beaten so badly that I cannot lift a coffee mug and my back was broken) then served as a consultant twice in Vietnam for over a year, thus exposure to Agent Orange. I am diabetic, have an enlarged heart, have had several stints, a defibrillator-pacemaker, have had 3 major strokes and numerous TIA’s

  34. Frank Thomas Walker Jr.    

    Continued Comment. In 1968 after a year in Walter Reed Hospital for more back surgery, I was honorably discharged. I have been denied “0”% disability and like someone else posted, once they deny you if you do not get an appeal started immediately, they shred every item you have so painstakingly gathered. Recently I was placed in a NH and because they would not sit me up twice a day, I am literally drowning from fluid collecting in my lungs. In addition I am on a feeding tube. No faith that my percentage of disability will be changed. Last week the NH called an ambulance to send me to the VA and 20 miles down the road the driver called to alert the VA, and they literally had the driver turn around and take me back to the NH. Our only hope of my getting out of this death trap is resting in an Omsbudsman. We shall see.

Comments are closed.