Friday, December 13, 2013







Granted, the April hearing wasn't a Senate VA hearing.  That's probably why it was an important hearing. April 23rd, Senator Patty Murray, as Chair of the Senate Budget Committee, chaired a hearing.  It is the most important hearing for veterans in 2013.  It was, it remains, the most important hearing.  Committee Chair Murray, of course, is the former Chair of the Senate Veterans Affairs Committee and she continues to serve on the Senate VA Committee.

In real time, we covered the pertinent exchange at length.  I'm both (a) not in the mood and (b) not going to waste space on it.  So we'll do a small excerpt.

For those who don't know, just to set this up, the VA claims system had a huge backlog and, at this hearing, Shinseki and the always laughable Alison Hickey explained a new way of doing things.  And the press just ignored it and continues to.  It's a shell game.  Let's go to the excerpt.

Chair Patty Murray:  As I mentioned, you have a new announcement of a new initiative to expedite claims that have been waiting for over a year.  And that's encouraging and I'm glad to see that the Department's taking action but I do have some questions about how it is going to be implemented.  And I wanted to ask you, if the VA determines the veteran's final rating is lower than the provisional rating, will the Department seek to recover money that's already been paid to that veteran?

Secretary Eric Shinseki:  Madam Chairman, uh, you know, that's a question.  I, uh, I-I, what I would say is, I -- our -- historically, when we've established a standard for a veteran, we've usually stayed with that and, uh, let me call on Secretary Hickey here but my-my intent is that the provisional rating that's provided will be on those issues for which we have clarity and documentation and we can render a, uh, a decision.  For issues that, uh, where documentation isn't provided, those are the issues that remain open up to a year, for veterans to locate, with our help even, documentation that would, uh, allow us to,uh, make a decision there.  Uh, Secretary Hickey.

Allison Hickey: Chairman Murray, thank you for the question, for your, uh, interest in the initiative which we think is, uh, really important to, uh, ensure that we're, uh, taking care of those veterans who have waited the longest while we completed the more than 260,000 Agent Orange claims to take care of our Vietnam veterans over the last two and a half years.  We-we, uh - We are using the provisions that allow us to make good decisions so we will continue, uhm, under this provisional criteria to have -- to use service treatment, to use private medical records, to use the information available to our, uhm, on our veterans in terms of the nature and character of their service.  So all the similar evidence we have used in previous decisions we will use again to ensure that we, uh, don't make any of those kinds of decisions.  I don't expect to see any of those decisions, uh, where we overcompensate for, uh, for a claim.  Uhm, the other thing that that we will do is we will, uh, keep the reason for the provisional decision, we put a really huge safety net under every one of our veterans, we're, uh, going to keep the record for a whole year there -- the ability for our veterans to come back with additional evidence.  Uh, uhm, uh, and we will keep asking if --

Chair Patty Murray:  So the additional year will only be to provide information to have an additional claim, not to lower the claim?

Allison Hickey:  Uh, th-the, uh, the reason for the year is to allow to increase the rating, uh, if necessary so I think in -- The advantage is our veterans for the additional year.  Uh, and then they still have after that, the same appeal, uh, processes that they've had in the past.  So we don't anticipate, uh, having, uhm, uh, conditions where we overpay veterans under this initiative.

In real time, reporting on that hearing the day it took place, I wrote:

What the VA is proposing is that a temporary rating be created.  This temporary rating may become permanent.  Or it might increase or it might decrease.  If you're a veteran qualifying for some small-business program based on your rating, how does this impact that?  Hickey gave no response about that or how the temporary claim would effect anything.
Now I think she's an idiot who should be fired.  But can you be that stupid that when asked a direct question, you completely miss it?  Maybe so.  Maybe Allison Hickey is The Dumbest Person In The World.  However, I just see her as deeply dishonest.
As deeply dishonest is the new program that's being discussed.
Murray is correct.  This is going mean "increasing the workload by requiring two" or more "ratings decisions instead of one." And this is only more clear when Hickey asserts that after a veteran receives a rating he or she finds less than satisfactory and they return with more information, Hickey's words, "we will expedite that claim to the front of the line."
What's really going on here?
The VA has bad press because they've not eliminated the claims backlog, they have not reduced the backlog.  They have been given everything they've asked for.  Congress has actually spent the last years asking them, "Is that all you need?  What else can we do to help you with this?"  VA has insisted they had all they needed.
So this is VA's problem.  At the hearing, Senator Tammy Baldwin observed, "Veterans don't want to hear about new claims or new processes, they want results and so do I."  She's correct.  However, this program's not about veterans, it's about the press.  This is a distraction that will create the illusion of something new which, the VA hopes, will garner good press.
In what world, when you're failing at the claims system, are you allowed to create a new system that will pull more employees away?

There were members of the press at that hearing.

They ignored this significant development/change.

They have since falsely reported on the 'success' of the VA with the backlog.

And Chair Sanders was praising them yesterday.  'Oh, goodness, you're reducing the backlog.'

No, they're not.

They're slapping on 'provisional decisions' to rush these through so they can move them into the 'decided' column.  Even though they're not.

I have no problem with a hasty VA decision -- which comes with a real appeal process.  I have no fear that veterans are trying to game the system.  Unlike Senator Jon Tester, I don't have visions of them smoking and drinking and see that as abuse of the system.  I think -- whether they smoke, drink, dip, what have you -- they're trying to get the health care they were promised.  Promises were made, promises need to be kept.

But the provisional 'ratings'?  The VA can change them themselves -- even if the veteran doesn't appeal.  Why are these temporary calls being issued?

It's a shell game to move the numbers without really doing so.

"Reducing the backlog at the expense of accuracy is not acceptable," Chair Sanders declared Wednesday morning.

Two days after the April 23rd hearing, Mark Flatten (Washington Examiner) did something none of his peers could do, he reported on veterans fears (justifiable) about the VA's new rating:

Under the new plan, VA will issue a "provisional" rating within 60 days on cases two years old or more. Veterans would then have a year to submit new evidence to increase their rating, or ask that the rating be made final so they can file an appeal.
The apparent catch is that issuing the provisional rating may lead to creation of a new case, thus letting VA "close" the old one when in fact the veteran's claim remains outstanding.
Ronald Robinson, president of the AFGE union local that represents VA claims workers in Columbia, S.C., said the new rules are nothing more than an effort to make the agency's sinking statistics look better.

Chair Sanders declared at yesterday's hearing, "Veterans are still waiting too long for a decision.  And the Inspector General to find issues with the quality, with the quality of the work.  I am concerned by the most recent IG findings which found significant problems with the provisional decisions reviewed at the Los Angeles regional office."

Imagine that.

Problems with the provisional ratings?

Who could have seen that happening?

I said we'd cover a December House Veterans Affairs Subcomittee and I never did.  Sorry.  I don't like writing about this topic.  I can go on over and over about Tim Arango's September 2012 report for the New York Times where US President Barack Obama sent another "unit of Army Special Operations soldiers" into Iraq in the fall of 2012 -- so much for the 'withdrawal.'

But this nonsense?  Senators were present when this new 'system' was announced.  The press was as well.  And yet they've both failed on this issue.  Veterans groups have raised concerns and yet both groups continue to fail and every other month some mouth breathing press loser is trumpeting 'the numbers' and 'the reductions' and never noting provisional ratings or what's really going on.

At the December 4th hearing, the VA's Deputy Assistant Inspector General for Audits and Evaluations, Sondra F. McCauley was one of the witnesses.

Deputy Assistant IG Sondra McCauley:  On April 19, 2013, VBA implemented a special initiative to address the oldest pending disability claims in the current backlog. VBA stated the intent of the initiative was to work all claims pending for more than 2 years within 60 days, beginning April 19, 2013. VAROs were directed to devote all RVSRs and as many Veterans Service Representatives as needed to ensure all claims pending over 2-year old were processed and completed. According to VBA, RVSRs were to immediately process the 2-year old claims based on the available evidence in the veterans' claims folders. Further, rating decisions produced were to be considered provisional ratings unless all evidence in support of the claims had already been received (and the claim was considered ready-to-rate) or the ratings assigned provided the highest evaluation for the particular diagnostic code for each claimed issue. However, if medical examination reports or other Federal records were needed, these older claims could not be processed as provisional rating decisions.  During one review errors were identified at the Los Angeles VARO when leadership provided conflicting guidance on the proper procedures for processing provisional rating decisions. We determined 10 -- 91 percent --  of 11 provisional rating decisions we reviewed were not compliant with VBA's guidance related to the 2-year claims processing initiative. Eight of the 10 provisional decisions were determined to be non- compliant because the rating decisions were made without supporting VA medical examinations as required. One claim was decided without Service Treatment Records, which are considered Federal records and must be obtained by VARO staff prior to rendering a provisional rating decision. In the remaining case, the provisional rating was controlled by a future diary that scheduled the claim for review in 2 years instead of 1 year as required.  Requiring a rating decision to be rendered before a medical examination is obtained as a basis for a decision is in conflict with VBA policy. On May 14, 2013, conflicting guidance was sent to the Los Angeles VARO staff via an e-mail from the VARO Director’s office. The guidance incorrectly stated all 2-year old cases requiring a medical examination must have the medical examinations ordered by May 15, 2013. This conflicts with VBA guidance because if a medical examination was required to decide a claim, the claim could not be completed as a provisional decision until staff obtained the necessary medical examinations. The guidance also incorrectly indicated that any claims with medical examinations not completed by June 3, 2013, were to be decided by a provisional rating.
We are concerned similar errors may exist among other provisional rating decisions completed by the Los Angeles VARO after the conflicting guidance was issued. VBA provided data that revealed the Los Angeles VARO completed 532 provisional rating decisions between April 19 – June 19, 2013. VARO staff completed 470 of those 532 provisional decisions claims after the conflicting guidance was disseminated on May 14, 2013. All 10 provisional rating decisions that we identified as non-compliant were completed after this date. We recommended that VBA review all of the provisional rating decisions completed by the Los Angeles VARO after the conflicting guidance was issued to ensure they are accurate.

So in the only examination thus far, 90% of the provisional ratings in the LA area did not follow the (limited) procedures and are most likely incorrect.  The new rating is prompting the IG to call for all of the LA area's provisional ratings to be reviewed.

"In fact, it appears the employees were encouraged to violate VA policies," Senator Johnny Isakson noted yesterday of the IG findings on the LA area.  He noted that the IG recommendation of a review of all provisional rating decisions had been completed and the VA founds  "100s that contained errors."

Hundreds.  Plural.  And we're only talking 532 decisions.

Senator Patty Murray noted what she's hearing from veterans in Washington state, "[. . .] I have heard  repeatedly from veterans that they were confused and frustrated with the provisional rating process. Some believe their claims have been flat out rejected and others didn't understand that they have a year to submit additional evidence. Secretary Hickey, we need to hear more from you today about how the VA's going to improve outreach and communication with veterans [. . .]"  [Note, at the end of yesterday's snapshot, the press release issued by Senator Murrary's office can be read.]

"During Committee oversight," Chair Sanders declared yesterday morning, "my staff has identified clear and unmistakable errors in provisional rating decisions."

Appearing before the Committee was the VA's Under Secretary for Benefits Allison Hickey.  In her opening remarks, Hickey declared, "In June, VA completed the first phase of the initiative, which focused on all claims that had been pending over 2 years. While some claims from that category were still outstanding due to the unavailability of a claimant and other unique circumstances, approximately 99 percent of these 2-year claims (over 67,000) had been processed for Veterans, eliminating those claims from the backlog. Since that milestone, VBA claims processors have focused on completing the claims of Veterans who have been waiting over 1 year for a decision. VA has processed approximately 96 percent of all 513,000 claims pending over 1 year."

Chair Bernie Sanders noted Shinseki's proposed goal for 2015, 125 claims processed within 125 days processed with 98% accuracy.  Sanders wanted to know if VA was "on track to achieve the Secretary's goal" by 2015.  Hickey responded that "we are on track barring any implications to our full" budget request for 2014 Fiscal Year, she stated they would meet the goal.  We'll note this exchange.

Chair Bernie Sanders:  In April of this year, VA rolled out an initiative to provide decisions on the claims that have been pending the longest.  While I appreciate VA's efforts to provide the veterans that have been waiting the longest with decisions, I continue to have concerns about this initiative.  The IG, the Inspector General's, recent findings regarding provisional ratings decisions at the Los Angeles regional office which found a number of errors was very, very concerning.  I understand the office corrected the inappropriate guidance that was issued to staff in June and is now in the process of correcting any errors in claims which may have been improperly adjudicated.  So this IG report is very, very concerning to many of us.  Can you explain to this Committee the actions that have been taken to remedy the problems in Los Angeles. 

Allison Hickey: Uh, Chairman, I absolute can do that but let me first --

I'm not Bernie Sanders.  I don't give a damn about Allison Hickey whose ass should have been fired long ago.  She was asked a question.  I'm not going to waste my time including her distractions and her efforts to avoid answering by eating up time.She said "the regional office knew in one week."  In one week of implementation, the regional office knew. May 14th

The obvious question there is, if they knew one week after it was implemented, (that would be May 21st) why did the IG find errors June 19th?

If, as Hickey stammer, "they themselves identified within a week," why weren't they fixed.  How incompetent is management at the VA?

I guess the answer to that question was staring at the Committee members (Allison Hickey).

3 veterans at the hearing that I spoke with yesterday self-identified as Democrats but stated that maybe the answer for veterans is to have one party in charge of the Senate and another in charge of the White House?  It was felt that the Committee is largely toothless, offers supposed indignation ("weakly stated," one veteran said) and then smooths over everything with ridiculous comments like Brown's that a lecture is not needed. It was noted that Ranking Member Richard Burr would be better right now as Chair Burr because he's not "playing footsie" with the VA.  Let's move to some of his exchange.

Ranking Member Richard Burr corrected Hickey's claims (lies) that the leadership knew in one week of the LA problems and immediately addressed them.  Under strong questioning from Burr, Hickey did admit that the same mistakes continued to happen for weeks

Ranking Member Richard Burr:  Were provisional decisions included in determining the number of claims VA has completed during the calendar year 2013?

Allison Hickey:  I'm going to ask -- Well -- She's just told me "yes" so I will answer "yes" on behalf of Deputy Under Secretary.  There were 14,000 of those claims which were 3% of all of the claims we had done in the oldest claim initiative which was 67,000 two-years-and-older 512,000 one-year-and-older.

Ranking Member Richard Burr:  You - you highlighted 90% quality or accuracy, you used both words.  Last week, the American Legion testified and I quote, "VA's accuracy statistics from the Monday accuracy reports are not consitent with the review of recently adjudicated claims as conducted by the American Legion.  According to the Legion, they reviewed 260 decisions and found errors in 55%.  Also National Veterans Legal Service Program testified that current error rate was somewhere between 30 and 40% -- in some RO's it's higher.  Are they wrong?

Allison Hickey: Uhm, uh, so Senator Burr, they -- It's an apple and orange discussion, if I may have a moment to clarify that. First of all, let me just state for the record and for every time I talk on this subject anywhere: We will not trade production for quality. It is an and equation.  Both must rise which is why it's 125 and 98.  But there is a very different way the IG and others are looking at issues then we do.  I will tell you that our process has been validated by an external agency --

Ranking Member Richard Burr: Ma'am, let me ask my question again: Are they wrong?

Allison Hickey: Uhm.  Uh-uh-uh.  [Laughing] Senator Burr, they are right for the way they look at it, we are right for the way we measure it which is statistically --

Ranking Member Richard Burr: General, General.  They're the customer, aren't they?

Allison Hickey:  Actually, the veteran, the family member and the survivor are my customers, Senator.

Ranking Member Richard Burr: Yeah and these are the organizations that represent them --

Allison Hickey:  They are, Senator 

Ranking Member Richard Burr:  -- and -- Should this Committee believe that there's any VSO in America that believes that the accuracy or the quality is at 97% right now?

Allison Hickey:  Uhhhh, Senator Burr, I would ask you to ask them for their opinions, I can't speak for them.

Ranking Member Richard Burr: They testified on it. But that's not necessarily something that computes. 

Allison Hickey:  Senator Burr, I have a statistically valid validated process that goes further --

Ranking Member Richard Burr: I asked -- I asked a very simple question: Are they wrong?  And I guess the answer is "yes" because you're saying your statistics are different than what their review has been. 

Allison Hickey: They have a different process, Senator.

Ranking Member Richard Burr:  Okay.  According to VA's Monday Morning Workload Reports, there are at least 266,000 appeals that have not been resolved. That's about 100,000 more than were pending five years ago although appeals are not counted in VA's backlog statistics, they represent individuals who have yet to know what benefits they will receive. Do the performance standards for regional office directors and service center managers include how quickly and accurately they're handling appeals

Allison Hickey:  So Senator Burr the answer is -- the simple answer to your question is yes, they do.  However, I would also tell you that a veteran does know our opinion to an answer on their claim.  Uhm, uh, they get and, uh, many cases, they are deriving resources uh-uh associated with that claim already even though they might be appealing only a part in piece of-of our decision.

Ranking Member Richard Burr:  So you have a metrics that you use to determine this?

Allison Hickey: We absolutely have metrics on --

Ranking Member Richard Burr:  Would you provide that metrics for the Committee?

Allison Hickey:  We will do that, sir.

Ranking Member Richard Burr:  On average, how long have those 266,000 appeals been pending?

Allison Hickey:  Uh, Senator, the Chairman cites some, uh, 800 days so I will, uh, accept th--

Ranking Member Richard Burr:  Do you track, does the VA track that?

Allison Hickey:  We do, Senator Burr. 

Ranking Member Richard Burr:  Okay.  At what point is an appeal -- is an appeal considered to be backlogged?

Allison Hickey:  We do not have a backlog number for appeals.

We need to stop it there.  But hopefully you're getting what the press didn't.  The VA does not include "appeals" in the backog.  In April, they came up with the 'clever' (dishonest) policy to just slap decisions on claims -- provisional ratings.  And that moved them out of the backlog.  Every one of those 'provisional ratings' may be appealed.  The VA doesn't care, it doesn't count appeals as part of the 'backlog.'

You'd care if you went from an unacceptable 200 day wait to an 800 day wait.

But the press whores for the VA.  They're too stupid to do their damn job.  This was all apparent at the April 23rd hearing.  I'm not a genius and it was obvious to me then.  This is a con game and veterans are getting very outraged while it continues and people like Senator Sherrod Brown look the other way and insist that the VA doesn't need a lecture.

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