Facing an unprecedented backlog of disability benefits claims, the Department of Veterans Affairs (VA) has recruited an automated system to help speed along the processing time for approving claims. VA officials announced the automated system on Tuesday, January 18th, noting that it had launched in December but was still in its pilot testing phase and is not yet up and running across the entire system. Thus far the program has only been used to process disability claims related to hypertension, though VA officials are hoping to expand its scope to other medical conditions. When the automated system is used, it has the potential to bring processing time to about two days, versus the 150 days that some claimants experience.
Why the backlog?
The VA deems a case “backlogged” if it remains unprocessed after 125 days. In 2012, the VA reported about 600,000 backlogged cases. That’s a substantial amount of people waiting 4+ months for benefits approval. However, the Veterans Benefits Management System and National Work Queue led the charge to make the system paperless, resulting in the VA reducing its backlog to about 70,000 cases by 2017. But a few things have happened between then and now that have contributed significantly to a renewed increase in the backlog of claims.
The first and most obvious is of course COVID-19. Military records are required in order to process disability claims. Records from the National Archives and Records Administration (NARA) are not digitized, so in-person work restrictions in the early COVID era caused a significant growth in the number of outstanding requests for military records, leading to substantial increases in the number of backlogged cases. Going from 70,000 prior to COVID to about 180,000 in mid-2021, the backlog now clocks in at 260,000 unprocessed claims over 125 days old.
Secondly, two new laws were enacted related to military disability eligibility that has the effect of increasing the number of veterans eligible to claim benefits. The Blue Water Navy Act of 2019 (this opens a document) expanded the definition of qualifying service for Agent Orange exposure, and the William M. Thornberry National Defense Authorization Act of 2021 added three conditions to the list of those associated with exposure to Agent Orange—bladder cancer, hypothyroidism, and Parkinson’s Disease. Taken together, it’s estimated that these new inclusions for eligibility have added around 110,000 new claims to the backlog.
How automation can help
According to VA officials from the newly created Office of Automated Benefit Delivery, the new system was designed to eliminate unnecessary medical examinations, streamline workflows, and bring manual processing efforts to a minimum. While manual processing often takes over 100 days, sometimes over 150, use of the automated system could process claims in as little as two days, depending on the circumstances of the case. The new system uses an algorithm to determine if there is sufficient medical evidence to assign a disability rating. If so, the system then calculates a disability rating and drafts a proposed rating decision. However, if the medical evidence provided by the veteran is not sufficient for the algorithm to assign a disability rating, the system will automatically request a medical exam from the veteran. In cases in which the system requests a medical exam from the claimant, the claim can still be processed in about 50 days, which isn’t ideal but still cuts the 100-150 day wait times down significantly. And of course, decisions made by the algorithm are still subject to manual quality reviews.
VA officials are hopeful that the new system will help to streamline the claims decision process, making it faster, fairer, and more accurate, all while providing a more seamless user experience for both veterans and VA employees.
What’s next?
Still in its beta testing phase, the new system is currently only processing claims related to hypertension, but VA officials are looking to expand the algorithm’s scope to include other conditions like asthma, sleep apnea, and prostate cancer, with the ultimate goal of adding three new diagnostic codes per quarter.
As the new system expands to address more claims, the VA has plans to expand personnel as well. The VA has hired about 1,000 new claims processors and support staff and plans to hire and complete training for about 1,000 more by the end of Spring. While the new additions go through the training process, the VA is using funds from the American Rescue Plan to pay overtime for claims processors in order to power through as much of the backlog as possible.
With the backlog of cases and extended wait times making headlines throughout the pandemic, the streamlined processing of claims likely comes as welcome news to many veterans throughout the country who are anxious to hear back from the VA on the status of their claim.
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