A Modern Claims Process for a Modern VA

Let’s face it, Veterans benefits processes haven’t changed much since the 1950s, but the world has changed around it. There are more benefits being bestowed every year from Congress. Modern conflicts, with multiple deployments for the same handful of people, have increased the number and complexity of injuries. Today’s wired generation of Veterans have an expectation for quick, automated customer service. While we are an organization full of tireless and dedicated individuals working to help Veterans every day, doing business the old way is simply not an option. President Obama, Secretary Shinseki and Under Secretary for Benefits Hickey are fed up with that status quo, and are committed to transforming those processes and transforming VA into an organization that works better for Veterans and achieves our Department wide goal of processing claims within 125 days with 98% accuracy. That’s no small improvement. From October through June of fiscal year 2012, VA averaged 245.2 days for the completion of a claim and 87% accuracy.

Today, we’re issuing a new report on two pieces of the Transformation puzzle: a revamped training model for our employees who work daily with Veterans’ claims and a radically overhauled quality assurance program at each regional office designed to quickly identify and correct errors in claims processing and provide on-the-spot retraining at the earliest possible stage in the process. As Brittany Piccini, a VA employee in Anchorage, Alaska, put it, “we are looking into the future instead of working in the past.”

Our new training program, known as “Challenge,” has already been implemented for all new hires and anyone changing duty positions within claims processing. Challenge Training is conducted in residence and lasts 8 weeks, depending on the level of the processing position. Over 1,300 claims processors have already received this training which allows them to complete 150% more claims per day with a 30% increase in accuracy. This improvement is a priority not just at VA headquarters, but also for our employees in our 56 regional offices across the country. Speaking of transformation, Mark Miller, an employee at VA’s Huntington, WV regional office, said, “I love being able to see our claims being completed, seeing pending numbers of claims decrease, and to be able to give the Veterans the help and service they deserve.”

Similarly, the implementation of Quality Review Teams (QRT) will allow VA to process claims at a faster rate with greater accuracy. Previously, claims were not audited until after they had been fully processed and adjudicated. Resources that could be used in the processing of claims had been used for “end-of-the-line” checks. Now that QRTs have been implemented at all 56 regional offices, claims are checked at three different points during processing, are corrected on the spot, and allowed to move forward resulting in fewer “end-of-the-line” errors and freeing resources for the efficient processing of disability claims. Melody Trainor, a VA employee in Fort Harrison, Montana, says that QRTs are her favorite of all of VA Transformation initiatives. “QRTs should have been done a long time ago,” she stated. Her coworker in Fort Harrison, Chad Pomelow, added that QRTs, “will save us time in not having as much re-work. The end result will be a more productive VA.”

QRTS and Challenge Training are just two of the many initiatives VA is rolling out over the next several months to reduce our backlog and modernize claims processing. Everyone in our organization, from Secretary Shinseki to the newest hire at our most rural RO, is committed to serving Veterans and making our claims process something we can be proud of, and more importantly a process that serves the needs of the men and women “who have borne the battle,” as President Abraham Lincoln said. Those that have worn the uniform of our country deserve nothing less.

Richard Allen Smith is a Web Communications Specialist for the Veterans Benefits Administration, U.S. Department of Veterans Affairs. Richard served on active duty in the United States Army from 2003-2008 and deployed to Afghanistan with 1st Battalion, 508th Parachute Infantry Regiment, 82nd Airborne Division in 2007.

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30 Comments to “A Modern Claims Process for a Modern VA”

  1. Jack Baker says:

    Hello, This sounds like a great program however; the time frame listed, even on the high end is no where close to what I have experienced even for the current claims. I know because I have had my claim in since mid June of 2011 and I still have not been notified of anything. I there anything being done to speed up the claims that are currently being processed.

    • Richard Allen Smith says:

      Thank you for your comment Jack. Too many veterans have to wait too long to get the benefits they have earned and deserve. That’s unacceptable, and we are implementing a robust plan to fix the problem. Many of the transformation initiatives we are currently implementing, including segmented lanes and improved training for new employees; will shorten the process for future claim submissions. Since you have a claim already pending in the system, some of these improvements may not directly impact your claim. However, we are re-deploying 1,200 claims experts to target and tackle the most complex claims in the backlog (claims pending more than 125 days). These experts will complete 100,000 of the backlogged claims by the end of 2012.

      Our transition from paper to electronic records will also improve the way you access benefits and claims information (including online through eBenefits) and share records with VSO partners, medical providers and others. For your current claim contact your Regional Office to ensure they are not waiting on additional evidence from you.

      • william says:

        Richard Allen Smith
        Because I have two claims and multiple injuries does that make my claims complex? I’ve been waiting since November, 2011. Also; do I qualify for the 1,200 claims experts to target my claims if my claims are deemed to be complex? One more thing I already have a rating of 10% for one injury and I can’t help but help to think after reading so much information about claims accuracy, what is the chance my very first claim with the 10% rating was not rated correctly?

    • Chris Stamper says:

      Dont feel bad Jack I have been denied I think eight claims since 2003 all of which were very similar. Up until late 2010 I kept getting denied. Now, Because I had to keep working jobs that were so physically demanding I had gotten to the point I could hardly walk. God forbid trying to put on shoes and socks or trying to tie my shoes. I have had a double hip replacement and a pretty serious back surgery in the past two years. I also cannot function very well without steroid injections in both knees and back. The VA has taken so long that I am now forced to go back to work after two years of being at home due to the operations I had received. My family is broke and I am having a difficult time making bills. I cant wait to get an eviction notice where I live because by the time the VA gets a hardship notice of it I and my wife and kids will be on the streets. Now I have finally completed all my QTC appointments but am pretty sure it will be another six months or more before they get me finallized. They have had completed documantation on several medical issues and wont even do a partial compensation to prevent us from being evicted. I am at my whits end. Suffering from severe depression, and intermittent explosive disorder from a major head injury in the Marines, this is just what I need all this extra stress worrying about money, jobs, family, and trying whatever I can think of to bring money into my house. I guess we have to try to stay positive as pointless as it my seem.

  2. Susan Fillippeli says:

    I keep hearing that the claims processing is speeding up, yet my father has had an Aid and Attendance claim in DEVELOPMENT for 383 days. Every time I call, I’m told they can’t tell me how long it will be before someone deals with it. I am beginning to suspect that the VA is slow walking these claims in hopes that the WWII vets will die before they make a decision. I am ashamed that my country is treating my father, who served proudly in WWII and Korea, this way.

    • lorens says:

      @susan, i totally agree from your point of view, the VA announces a couple of isssue to help out minimizing backlog claims …eq. hiring more adjudicators , new methods of streamlining the process….but the outcome does not seem noticeable and just because of this game of waiting time ..some of the claimants just died without even getting the compensation that they supposed to recieve.

  3. Jay Johnson says:

    LOL, you guys at the VA also say you have a solution. But it doesnt work. Why the hell have I been waiting 4 years for my claims? Why can’t a regional office get the rating right in the first place? Why is there so many remands and claims granted at BVA. Its because the local RO people dont know what they are doing! I think issue with the back log is the employees are worried if they do claims faster and right the first time they might be out of a JOB!

    • Richard Allen Smith says:

      You bring up a valid concern, Jay. As you see in my original piece, QRTs and Challenge training are going to standardize the claims process nationwide so that the problems you describe won’t happen.

      • Dennis says:

        Mr. Smith,
        All that stuff sounds good and all, but what of the rejections of the claims that said the VA said they never received and the DAV has the stamp and the BVA refuses to reopen or review the claim or appeal. Then when it is done or reviewed they say it was not in the proper time allowed. Second, What about the appeals that have been in place for 7 and 8 years that have not been decided on but 100% is granted and only a one year back pay is given when this was the reason for the discharge in the first place. Does the VA go back and admit their mistakes or carelessness, or is it just a be happy and move on type of situation?

  4. Ronald Alvin Goodwyn says:

    I filed my claim way back in 2007 and I’m still waiting on a decision of my first appeal. Love VA Healthcare, hate VA Benefits process. It’s the worse.of the worse the US government has to offer.

  5. maurice wyman scott says:

    The modern process has gotten better, but in getting better, its gotten worse, the better is giving hope without admitting wrong doing. The personnel within the system have destroyed countless veterans, and they must be held accountable for that. In approving my claim, while the truth is they destroyed most of the evidence over the years within my c-file, that they knew couldn’t be recovered, but the most outlandish thing was going so far as just simple things, like pulling the signature pages from previously wrongly denied claims, so they attempt to get away with not backdating it to the right date. The proof in these forms of corruption still exist, one month ago, i had a c and p, which said that my TBI and Kidney was not a result of service connected injuries, a couple of days ago, I had another C and P, for my kidney, who stated, well i’m not going to have to examine you;, because your file speaks for itself, so yes it was caused by your service related injuries. The system especially in Columbia area of South Carolina is mostly rigged, the contracted doctors tell the truth, and the employee doctors, say whatever the regional office wants them to say. Si the system has only gotten better, because yesterday, they just denied the Veterans, today, they just destroy the evidence. I recently had a conversation with two, one previous, and one current VSR, who told me finally the truth, the system is gamed. If you get them on two much back payment, they will just remove the items for the most part, that proves your case way back then. The pain and suffering that this agency for over eight years has caused me personally can’t be just washed away because now they admit the truth, the truth has to be said it was when I started. The truth never seems to happen until the new media gets ahold of it, so tonight, Im releasing my story to 84 outlets, the details will make columbia ashamed, but hopefully it will encourage the regional office to investigate what has happen, and stop it from happening again. Our lives are worth more than a missile, so its time that we stop being the targets.

  6. Mary H says:

    This is all fine and dandy that claims are supposedly being processed faster for the veterans of recent conflicts. However, what about claims for other veterans. In my brother’s instance he filed years ago for service connected disabilities. After about two years they send him a notice that his claim was too old and he needed to refile. Now it has been two more years and still nothing!! He is 6’3″ and down to 145 lbs. due to two years worth of cancer surgeries and treatments. He has had a back disability since before he retired 10 years ago and the “wart” they diagnosed while on active duty turned out to be cancer that wasn’t treated until it had spread to lymph nodes years later. He is now at stage IV cancer because it took a year after diagnosis for them to approve chemotherapy!! It wasn’t until I contacted Sgt. Schraff who contacted VA Hq before he finally got his “purchase order” for chemo.!! By then they said, “well if you made it a year without recurrence you don’t need it anymore. Guess what? Three months later the cancer showed up again. Had he had the chemo and radiation when he was supposed to maybe he wouldn’t be dying now..still without his disability being processed!!

  7. Ginny L says:

    I have been fighting for my benefits for 23 years. Endometriosis, loss of creative organs, shoulder injury with spontaneous dislocation, migraine with neuro accompaniment, PTSD for military sexual/physical trauma and hearing loss. In 2001, with new evidence, I was denied everything except my shoulder and loss of an ovary due to cysts, not endometriosis. I waited for the BVA, then in 2004, they conveniently lost paperwork and closed my claim.

    In 2010, with new evidence, I opened my claim again. This time, I was awarded for the endometriosis after an MD wrote that there is clear documentation of the symptoms in the military records that are indicative of endometriosis. I was also approved for the migraines since that was all over my records. However, I am in appeal for the rest of it, including a CUE, to be back paid to 2002. Now, I find out that appeals are reviewed at the RO for a decision, then if claim still not accomplished, then off to the BVA. That sounds like even more trash inducing, hurry up and wait; not to mention, condescending treatment of me, and other vets like me!! And the government doesn’t care that I lost my ability to survive in this world!

  8. Dave McDonald says:

    Your healthcare system is great. Your claims system (as you are aware) needs work. I am sure you have heard this story before: VietNam Vet receives claim denial; files lengthy appeal with new and material medical information and VA confirms receipt and assignment to a VRO. Then nothing! I wait, and wait, and wait, and wait. Inquiry letters go unanswered for now 15 months. What’s the deal???

  9. Richard M. Slajchert says:

    I can certainly identify with many of the comments. My claim is in there for about 2 years now, and can’t help wondering if their waiting for me to die to avaid paying the claim. I can understand some delays, but the lack of any contact from VA to me is unacceptable. When a claim is challanged it seems that the whole waiting game is back on, and still no notice of an approximation as to when to expect any action. I know that for some, who have contacts and no how to work the system, the action is nowhere the waiting that most of us must endure. I want to beileive that the VA is trying, but is it going to be too little, too late. Thanks,,Richard

  10. john davis says:

    I!ve never been so disapointed in my life.My first claim was filed in 2001.Our Government is truly frustrating.What realy appalls me is when I think of how many WW2 Veterans and Korean War Veterans have had to listen to these Lies. The thouth that Veterans are supposed to make keep and produce their own records is trully a good example of the enefectual Veterans Administration. Only in America by Americans..The V.A. employees are more concerned about their Jobs than any Veteran..After over a century of these Lies now they ( the V.A.) wants everone to think their advocates for Veterans..
    to me this is truely obsurd..Its been 12 years since i filed my first claim..
    whatever you do don!t misspell a word..Veteran of the Ho Chi Min trail..John The Seeker.

  11. Peter Conway says:

    The VA should have to approve a claim that they can’t address in a timely manner.
    242 days to address a claim? Ridiculous …..we’ve seen nations form in less time.
    Claim officials make up 4% of VA’s staff, yet it is their #1 problem….no rocket science needed to fix this problem.

  12. william says:

    I’m a firm believer of training as part of new hired employees. The problem over the years has been do to companies, organizations, state, local, and federal government has gave up training new employees because of a polarized political belief. The belief is work experience is more important than secondary education and training. Training used to be a big part of every company, organization, state, local and federal government, but partly do to economics and politics, training has been lost. At one point every college and university took it onto themselves to take the training out of the varies different work environment and incorporate it into their programs of study. However, do to politics training took a back set and college was seem as an unnecessary evil because work experience was seem to be the best way to go in hiring new employees.

    So, at lease the VA is noticing training is an essential part of hiring new employees and it wouldn’t surprise me to see more companies, organizations, state, local, and federal government organizations go back to the basic and implement more training programs because training is the most important part of hiring new employees. Now some of the older employees can always go back and be retrained again. Now if there are some employees who never had and formal training from a bona-fide training program they too can benefit from the new bona-fide training program that has now been put in place. I think the VA is on the right track with their “Challenge” training program and such program can only mean good things for Vets.

  13. william says:

    From October through June of fiscal year 2012, VA averaged 245.2 days for the completion of a claim and 87% accuracy

    Are the 245.2 days counted as work week days or are they counted as work days and weekend days, I always wonder about that? I’m having a hard time in counting how many days I have been waiting since my claims were received: 10/17/2011?
    Again, as I sated before is there a chance that my first injury rating of 10% was not accurately rated?

  14. william says:

    Stay strong and keep going in the right direction. It is not easy when the mind is playing tricks on you. I do understand!

  15. Tomica Rankins says:

    Hello everyone, my region office is in Winston-Salem, NC and since I got out in 2007 I have been fighting with them on my claims. I love how they say “service connected, zero percentage” like it means something to them but not to you. I’m actually going to be on the other side soon as a Claims Assistant to see what actually happens behind the walls. I only can express as a disable veteran my frustration with the process, but do believe it will get better. In submitting claims I learned you must have your paperwork (keep copies) in order and have patience. At times I want to give up and say I can’t win but when you back hurts, knees in pain where you can’t climb the steps, you mentally have to pull yourself up and keep going and I truly believe in the quote “tough times never last but tough people do”. I am a Veteran and my presence will be known…

  16. Denis Maxson says:

    Great to see training being emphasized. I was wondering how many of the million claims currently at the VA are over 365 days?

  17. BR says:

    Its nice to hear about the “processes” to speed up disability claims. However, what about the folks who are in the VA appeals hamster wheel? Are the 1,200 “experts” going to be used only for initial claims? I’ve heard rumours that DRO’s will be pulled to adjudicate initial claims leaving the rest of us schmucks who requested DRO reviews to wait even longer. I’m on month 14 of waiting for a DRO review. Every time I try to get an answer I get nowhere. I also have heard that DRO reviews are taking 2 to 3 years….really!!! Like I said I can never get a straight answer.

  18. Stephen Coffman says:

    I suggest that if a veteran has a claim that is older than 365 days, the VA award an interm disability rating of 50% until the actual claim is settled. If the settled claim is more than 50% the interm payments are deducted from the award. If the settled claim is less than 50% then the government has the option of recovering the excess.

    This would help the veteran and give the VA an incentive to complete the claims.

    I submitted a claim years ago. I was a MEDVOL in the Edgewood Arsenal Experiments. I submitted the EKGs that were taken at Edgewood before the experiments started. The EKGs were perfecta s was my health. I submitted documents showing that I was subject to two injections of a substances referred to as TAB. I submitted lab notes from the Doctor saying that the subject that was injected twice with TAB had evidence of heart damage. I have submitted EKGs and proof of my quadruple bypass.

    So what does the VA need? Other than for me to pass away so they do not have to address the claim?

  19. Robert Martinez says:

    I’ve been assisting my father-in-law with his disability and aid and attendance application. It has been a nightmare to figure what needs to be done and how to do it. I contacted the local VA and the Compensation/Pension’s person told me she couldn’t talk to me unless I had a doctor’s referral. I told her I just had a few general questions. She again said that I needed a doctor referral in order to just ask a few general questions. So, the next time we went to see my father-in-law’s primary VA provider, I asked for a referral to be able to meet with the compensation/pension people. She told me she didn’t know what I was talking about. By the way, my father-in-law is a WW2 vet(90 years old). I then tried contacting the regional office in Waco, Texas. The person told me that they couldn’t talk to me. It had to be my father-in-law. However, I told him he was 90 years old and had recently suffered a stroke. He then told me my father-in-law could fill out some other form to give me permission to ask general question about pensions. So much for them providing assistance. Pathetic and Inexcusable!! So, I just decided to see what I could find online and do the research myself. But I tell you what, from now on whenever I see a recruitment office, I am going to stop and talk to new recruits and tell them to reconsider joining the military if they don’t want to deal with this type of treatment. What needs to happen is this work needs to be handed over to a private organization, because this government run entity has failed and will continue to fail its veterans. Shame on you.

    • spouse of a veteran says:

      Robert , i agree with you totally. Just make sure that a family member always knows exactly what is going on with your claim/claims and where your claim is at in the process line. Let someone know where you keep all your documents/medical records. I always make sure i get a copy of the test results etc. And if you have private doctors present or past , keep those records in the same file with the rest of your VA paperwork. That is your proof , also you are the only one who will not misplace it. I cant stress this enough, because alot of veterans are suffering in really bad shape, so someone needs to know exactly what is going on and to be able to follow up if need be. Make sure that a family member is on your file , who can speak on your behalf. That is very important incase something was to happen/make a copy of that form/statement also. I know it can get over whelming but its the right thing to do for all involved..

  20. Stephen says:

    Give it up! Is getting a VA claim settle REALLY worth the stress?

  21. Herb says:

    I have been trying to get the VA to give me a determination on my claim.In 2006 I filed in orlando,fla. that same year my sisters husband died so I went to stay with her in Las Vegas. Then in 2008 I was told to come back for a test because I had kept my Fla.address. I had to borrow the money to fly back to fla even though I was enrolled in the VA Health care in Vegas. (The VA knew I was going to the VA there.) I took a test in Florida and about 6 months later I was turned down.

    I went back to Las Vegas and a doctor in the VA told me to refile so I filed my claim there. The VA in Reno had my claim from June 11th 2011 until May 28th 2012. My sister was put in a care home so I lost my place to live. I have friends in florida I can live with, so I came back. The VA suddenly discovered that my mailing address was Florida ( It has remained that address for 12 years). Just as the VA announced they were sending the claim to make a final determination in Reno, my claim was transferred and sent to Bay Pines in Florida now they said they got to start all over again. Surprise! Surprise! What did they do in Reno for those 300 and some days It has been well over a year. I believe that is long enough. Don’t you agree!?!

  22. Robert Macias says:

    Remarks by Secretary Eric K. Shinseki
    VFW Annual Convention
    Reno, Nevada

    “…July 24, 2012 In 2009, VA inherited a budget totaling $99.8 billion—a good budget, not spectacular, but a good one. In 2010, the President increased our budget to $127.2 billion—a near 30 percent increase in a single year. The President’s 2013 budget request, currently before the Congress, is for $140.3 billion—a 40 percent increase since 2009…” “…You heard the President yesterday—solve the backlog!..”

    Eric, that’s a lot of money! You better show something for it and fast! I would love to see specific examples of pensions that were processed in a timely manner. Do any veterans really get what they deserve? I mean, is anything appropriate ever awarded to anybody. Or, does everybody get the old round around. Is this just a big joke and a waste of tax payer money. I don’t know about you, but I’m writing to both my congressman and the white house and will ask the same questions. Got put a fire under Eric and this department’s rear end. If nothing changes significantly soon, I will call upon my fellow vets to come together and tell congress to reduce funding instead.

  23. william says:

    They didn’t have any contingency plan to put in place in order to keep pace with the over load of new claims. Everyone knew the Commander in Chef was bringing home all the solders, sailors, airmen, and marines. None of the management had any idea of what to do in order to keep up so they decided to put it all on the Vets because they figure we all are trained to take the pain and in my case keep soldering on. By the way I hope they enjoyed their vacations this summer and I hope they enjoy their comfortable homes they can afford to live in. Because my summer wasn’t a happy one at all; pain and no money is not a good thing to mix together. So, to all of you at the VA; I hope you enjoyed your summer because I didn’t. I did my part when I took the pledged to serve my country and I served it the best way I could.