Complexity of Claims

Tom Murphy, VBA’s director of compensation services, agreed that initial accuracy has a significant role in keeping the backlog down.

“If you’re having quality issues, it takes longer to work a case the second or third time than it takes to get it right the first time,” Murphy told the committee. “This ties back to the secretary’s goal of 98% accuracy.”

Recent years have seen the development of new complications to the claims process. A claim in the post-World War II era might have included approximately three contentions — an injured knee, a gunshot wound to the arm and an injured back, for example, Murphy pointed out.

A claim today has an average of 5.5 contentions, and sometimes that number is much higher. Also, those conditions can be much more complex and harder to assign a cause to than injuries in previous conflicts.

“It’s the nature of war today and the type of contentions,” Murphy said. “TBI and PTSD count as a single contention, and each is significantly more complex and takes much more time to evaluate than a relatively straightforward evaluation for a knee injury.”

While the loosening of PTSD claim regulations has helped PTSD-claim error rates, it also has tied up employees who otherwise would be helping winnow down the backlog.

Agent Orange claims also have kept the system clogged. VBA has 13 brokering centers around the country — centers filled with claims adjudicators who help with overflow from claims-processing centers nationwide. 

“For 14 of the last 16 months, those centers have been dedicated to working the new presumptive conditions that were granted a year ago for Agent Orange,” Murphy said. “Only now are those facilities returning to regular production.”

Most of these were reevaluations of previous claims, which take much longer. “We consumed 37% of our workforce that was working claims, in general, on grading those Agent Orange claims,” Murphy said.

Asked if VBA had done anything to prepare for the influx of appealed claims, Murphy said, “I don’t know that it’s necessarily a question of [being] prepared. The law required it.”

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