Failure of the Department of Veteran’s Affairs to Carry Out its Mission: The Causes and Possible Solutions.
By Adam Russotto, 18 year high school senior and son of attorney David Russotto.
"If an 18 year old can figure this out than how come our Congress can't seem to find a way to finally fix the VA's problems after years of talking about it. As an example, this paper shows that shows that 8100 appointments are past 30 days at Fayetteville VAMC alone! "
- David Russotto
The Mission of the US Department of Veterans Affairs is to fulfill President Abraham Lincoln’s promise “To care for him who shall have borne the battle, and for his widow and his orphan” by serving and honoring the men and women who are America’s veterans. While this mission includes many responsibilities, none are more important than providing quality health care and economic stability in the form of disability benefits, for America's veterans returning from combat. Unfortunately, the Department of Veterans Affairs has consistently failed to deliver on these responsibilities.
The reason why this is so important is because the veterans have protected and served our country. They have risked their lives to fight for our country and make sure we can sleep safe and soundly at night without the risk of attack by foreign invaders. If we don’t deliver our promise of benefits, the veterans often suffer economic and health consequences. They have disorders like post traumatic stress disorder, traumatic brain injury or other physical injuries that make finding a job extremely difficult. The Veterans who don’t have any family or don’t have contact with them are often homeless. There are, for example, up to hundreds of veterans living in the woods near Jacksonville, North Carolina close to Camp Lejeune because they can’t find a job and can’t get their medical or disability benefits. (Brennan) The complete disorganization of the Veteran’s administration has caused veterans to have to wait years for or even never receive their benefits and because of this many are homeless or have died and would have lived if they had received their benefits.
Before examining the causes of the VA’s problems, it is first necessary to give examples of how the VA is failing and what effect it is having on American veterans. The VA is failing in a number of ways, but one of the most problematic areas is the health care and VA hospital. veterans are not being seen quickly enough and either go through unnecessary suffering or even die when they could have been fine if they had just been seen quicker. In Arizona, VA hospitals and possibly more around the country, certain veterans have been put on secret lists where they have wait months to get seen by the VA Doctors and are entered into the computer system fourteen days before they are seen. (Bronstein and Griffen) In this way, these hospital administrators are able to game the system and earn increased bonuses for on time service goals, when in reality they are potentially killing veterans who can’t wait months for these appointments. (Bronstein and Griffen) Additional examples of severe problems at other VA hospitals have come to light recently as well. For example, thousands of appointments for diagnostic medical tests were purged en masse by administrators at the VA Hospitals in Dallas and Los Angeles. In order to make it appear their decade long backlog had been eliminated. (Flatten)
Another area in which the VA’s failings are causing severe hardships for veterans is in the VA’s compensation and pension department where Veteran’s claims for disability compensation are decided. In 2013 more than a million veterans were waiting for those initial benefit claims to be processed. (Tobia) The average wait time for the claims was 318 days. Even more troubling is the fact that as the VA worked to reduce the backlog of new claims, so many were denied that the average time for a denied claim to work its way through the Department of Veterans Affairs appeals process shot up to more than 900 days in 2013, more than double the long term average. (Adams)
Now that two big problem areas have been discussed, it is important to look at why the VA is failing in these key areas. First, there has been a large influx of new veterans into the system as many soldiers have returned home from more than 12 years of war in the Persian Gulf following the attack on the World Trade Center on September 11, 2001. In fact through 2013, more than 1.6 million service members have been deployed in Iraq and Afghanistan. (A New Leash on Life for the Invisible wounds of war) The majority of those 1.6 million were deployed multiple times.
Nearly seven thousand have died, sixty thousand have received serious injuries including traumatic brain Injuries and as many as half are suffering from post traumatic stress disorder. Now that the wars in Iraq and Afghanistan have nearly concluded, the military is rapid releasing soldiers from service, which is adding to the backlog at the VA. (Martinez) Congress has increased appropriations to the VA each year and in fact President Obama vowed in his 2014 State of the Union address to continue progress on trimming the backlog. (US House of Representatives Committee on Appropriations) Unfortunately, the amount of new funds appropriated to the VA have not been nearly enough to keep up with the increased numbers of veterans needing the services of the Dept. of Veterans Affairs.
The next big reason that the Department of Veteran Affairs has been failing to deliver on its obligations to veterans is that it is a huge bureaucracy that has little or no accountability for top managers. (Jordan) In fact the VA received warnings from a former mental health administrator at the VA medical center New Hampshire on April 2012 that VA medical hospital managers across the country are regularly manipulating the numbers in order to receive thousands of dollars and bonuses. (Jordan) None of these managers were fired or even received disciplinary action. The lack of accountability is widespread that on April 3 2014 the House Veterans Affairs Committee introduced a bill that would give the head of the Department of Veterans Affairs the authority to fire under performing executives.
The final cause of the breakdown at the Department of Veteran Affairs to be covered is the complete failure of computers and information systems at the VA and the Department of Defense antiquated record keeping dating back to the 1960’s was made it nearly impossible for the VA employees to find and share information needed to determine a veterans eligibility for benefits. Due to laws passed by Congress in the Code of Federal Regulations the VA has the “duty to assist claimants.” (38 CFR 21/1032). This requires VA employees to help veterans prepare their claims for disability benefits and to gather the records and documents needed to support their claim. According to veteran’s benefits attorney Don Marcari, “ a veterans claim for benefits cannot be awarded with first having obtained the veterans military personal records from the Department of Defense, in service medical treatment records, and post service medical examination and treatment records from the VA health care facilities. Mr. Marcari adds that “Under the VA’s current system, of record keeping, it generally takes many months and even years for the veterans to get these records.” Mr. Marcari further states “more often then not, when the veterans records are finally received they are missing important pieces of information that are vital deciding if benefits are deserved”. Finally Mr. Marcari adds that “ because they are under pressure from Congress to process claims quickly, VA employees must make decisions even though important information is missing, which leads to a denial of the claim and the beginning of a multi year battle in the VA appeals system,.”
In fact the problem is so bad that the VA Inspector Generals report in 2012 points out that at the VA’s Regional office in Winston-Salem NC, “There was so much paper That it created an unsafe workspace for VA employees and appeared it gave the potential to compromise the integrity of the building” (Tobia) The report went on to say that there were “37,000 claims folders stored on top of file cabinets”. This exposed many claim folders to risk of inadvertent loss and possible misplacement as well as impedes productivity by reducing access to many folders in a timely manner.” (Gusovsky and Pohlman) According to Mr. Marcari, with so many problems finding a veteran’s important documents, “it should come as no surprise that tens of thousands of mistakes are being made. “ All of this has contributed to a massive backlog of not only in initial Veteran’s claims, but also in the appeals process where veterans are waiting more than 900 days to get a decision on their appeal. (Adams)
The problem noted above could have potentially been eliminated or at least alleviated, if the Department of Veteran Affairs could have implemented a modern Information Systems program. The term Information Systems is “ a scientific field of study that addresses the range of strategic managerial and operational activities involved in the gathering, processing, storing and use of information and its associated technologies in society, organization, industry and government agencies. (“Information Systems”) The Pentagon and VA took ten years and spent a billion dollars to develop plans for a common digital records system but the military decided not to use the system last year. (Shane)
Congress has been asking for decades for a military-veterans records system that could track individuals from boot camp through their VA care, thus creating a seamless lifetime military record. (Shane) Congress is so unhappy that members of the House Appropriations Committee approved a plan that would hold back 75 percent of CA’s requested record system upgrade funds until the two departments prove they are close to a seamless record system for troops and veterans. Leo Shane II. “Congress unhappy with the DOD, VA health records progress.” Marine Corps Times. April 16, 2014. The real issue is that the veterans Health Information
Systems and technology Architecture, Known as VistA, which has been the VA’s health records system for a long time, is not interoperable with the DOD’s system. To help alleviate their problem, The VA paid private developers to modify their systems source code. After their work was completed, the DOD decided that it was unwilling to adopt the established VA records system. (Shane) Congressman Sam Farr, a Democrat from California, has blamed most of the confusion surrounding the issue on the DOD’s unwillingness to adopt the established VA record system. Rep. Phil Rae, a Republican from Tennessee, also puts the blame squarely on the DOD, saying the VA “has done its job” in updating its record system.
Even if the DOD and the VA are successful in at integrating their records system, it does not solve the problem that there are tens of millions of existing documents and records that exist only on paper that will need to be scanned. There is hope that this problem can be alleviated through new technology being developed by the Department of Defense and veterans Affairs to help expedite disability claims decisions and reduce the backlog. (Hirsh.) The technology, called the Health Artifact and Image Management Solution (HAIMS), is not an interoperable electronic health record system; rather it is a repository with scanning capability that produces a record from the DOD’s Electronic Health Record, which the VA could retrieve. (Hirsh)
In conclusion, the Department of Veterans Affairs, which is responsible for providing health care and disability benefits to injured and disabled veterans, is failing in its obligations to deliver these services in a timely and effective manner. Those who served in the Armed Forces earned these benefits by risking their lives fighting for our country. Failure by the VA to provide these services can have severe economic and health consequences forv. In some cases these failings have led to homelessness and loss of life. There are many causes for the break down in services at the VA, such as a rapid influx of new vets into the system, wars, failure by Congress to appropriate enough additional funding, and the existence of a huge bureaucracy with very little accountability. However, the most notable cause of problems at the VA has been the consistent failure by both the VA and the Department of Defense to adopt modern computer and information systems. It is hoped by veterans that with all the attention that the issues at the VA are getting in the news media and in Congress, that the problems can be solved once and for all.
Adams, Chris “VA’s time to resolve disability appeals shoots up” Stripes.com McClatchy Washington Bureau n.d. Web. 28 Feb. 2014
Brennan, Thomas “New program assists homeless veterans” n.d. Web. 23 Dec 2013
"A New Leash on Life for the Invisible Wounds of War” fightingptsd.org n.d. Web. 4 Dec. 2013
“Appropriations committee releases fiscal year 2015 Military construction and Veterans Affairs Legislation” n.d. Web. 2 Apr 2014
“Veterans Affairs purged thousands of medical tests to ‘game’ its backlog stats” Mark Flatten n.d. Web. 25 Feb 2014
“Veterans Affairs cut claims backlog by 44 percent since last year’s high” Josh Hicks n.d. Web. 1 Apr 2014
DoD, VA to use scanning technology to speed disability claims Maria Durben Hirsch n.d. Web. 10 Feb 2014
“The Effects of Multiple Combat-Related Military Deployments on Post Traumatic Stress Symptoms” Joseph R. Hoops n.d. Web. May 2012
“Boehner: VA Needs More Power to Fire Bad Managers” Bryant Jordan n.d. Web. 3 Apr 2014
“VA received Backlog Manipulation Warnings in 2012” Bryant Jordan n.d. Web. 24 Apr 2014
“Veterans court faces a backlog that continues to grow” Jerry Markon n.d. Web. 22 Apr 2011
“Pentagon Proposes Cutting the Army to Pre-WWII Level” Luis Martinez n.d. Web. 24 Feb 2014
“Former VA surgeon paints bleak picture of hospital” Jeff Pohlman and Dina Gusovsky n.d. Web. 12 Nov 2013
“High speed drawdown: Army ramps up force-outs” Jim Ticen.d. Web. 21 Oct. 2013
“Congress unhappy with DoD, VA health records progress” Leo Shane III n.d. Web. 16 Apr 2014
“VA-DoD common records system may still be possible” Leo Shane III n.d. Web. 20 Mar 2014
"Veterans Affairs Backlog Files Stacked So High, They Posed Safety Risk to Staff P.J. Tobia n.d. Web 2 Apr 2013
Wikipedia. “Information Systems” Wikipedia. Wikipedia.org n.d. Web