Crisis at the VA as Benefits Claims Backlog Nearly Tops One Million
Monday
- June 1, 2009
The Public Record
Author: Jason Leopold
During the past four months, the Department of Veterans Affairs backlog of unfinished
disability claims from veterans grew by more than 100,000, adding to an already mountainous backlog that is now close to topping
one million. The VA's claims backlog, which includes all benefits claims and all appeals at the Veterans Benefits
Administration and the Board of Veterans Appeals at VA, was 803,000 on Jan. 5, 2009. The backlog hit 915,000 on May 4, 2009,
a staggering 14 percent increase in four months.
The
issue has become so dire that veterans now wait an average of six months to receive disability benefits and as long as four
years for their appeals to be heard in cases where their benefits were denied.
Rep. Tim Walz, D-Minn.,
a member of the House Veterans Affairs Committee, said during a hearing in March that the VA is “almost criminally behind
in processing claims.” Overhauling the VA represents one of the most daunting challenges facing the Obama administration
after years of mismanagement and neglect by the Bush administration who stacked the agency with political cronies that kept
the agency underfunded, wrapped in bureaucratic red tape and placed the interests of veterans last on a list of priorities. Indeed, one of the VA’s biggest failures during the Bush administration’s tenure was its inability to
fully implement critical components of the Mental Health Strategic Plan (MHSP) at regional offices throughout the country. The MHSP, unveiled in 2004, would have provided veterans who show signs of suicide or are suffering
from post traumatic stress disorder with immediate mental health care and eliminated the waiting period for receiving treatment.
But according to a November 2006 report by the Government Accountability
Office (GAO), spending for the program was substantially less than what the VA had proposed - leaving untreated tens of thousands
of veterans who were at risk of suicide.
In June 2007, in response to a VA inspector general’s report that also criticized
the VA’s failure to implement the MHSP, William Feeley, the VA’s undersecretary for health, operations and management,
issued a memo requiring VA hospitals and outpatient treatment centers to provide urgent mental healthcare within 24 hours
and non-urgent care to veterans within 14-days.
But Feeley, who was one of a handful of VA officials who received
lucrative bonuses in 2006, admitted in a deposition last year that he never conducted any oversight to ensure his directives
were being adhered to. In that deposition, Feeley said an uptick in veterans suicides and suicide attempts did not mean VA
failed to provide proper care to veterans.
"A suicide does not mean negligence on the part of a medical
center director or a network director," Feeley said. "Suicide occurs just like cancer occurs." In his prior position as director of the Veterans Integrated Services Network in upstate New York, Feeley
was required to implement several elements of the MHSP at the network's community-based outpatient clinics with a population
of at least 1,500 veterans. But Feeley said in his deposition that he only read an executive summary of the MHSP after it
was released in June 2004 and had no idea whether the clinics adopted the proposals.
Secretary of Veterans
Affairs Eric Shinseki recently named Feeley, who veterans groups had have long demanded be fired, as the director of the VA’s
West New York Healthcare System in Buffalo, New York, removing him from a top position in Washington, yet leaving him employed
with VA due to his prior civil service career with the agency.
To date, beyond a suicide hotline set up
last year and thousands of newly hired mental health employees, the VA has failed to adopt a comprehensive suicide prevention
program as outlined in the Feeley memo and the VA’s 2004 MHSP. In January and February, for the first time in military history, the number of battlefield suicides was higher than
the number of combat deaths in the war zones, according to the Pentagon.
Last year, 140 U.S.
soldiers committed suicide, a record high, and during the first four months of 2009, 64 U.S. soldiers have committed suicide.
Military officials said a U.S. soldier is now more likely to commit suicide than a civilian and the Army has recently commissioned
a $50 million study to explain the suicide epidemic.
It’s a “very disturbing” trend, said Army
Vice Chief of Staff Gen. Peter Chiarelli during a recent conference call with reporters.
Chiarelli said trying
to reduce suicides “is one of the hardest problems” he’s witnessed in his three-decade military career.
He added, “There is no single solution…suicide is a multi-dimensional problem that requires a multi-disciplinary
approach to tackle it.”
Chiarelli, and other Army officials, however, fail to address
one of the obvious causes behind the spike in suicides: multiple deployments in Iraq and Afghanistan are taking a toll on
soldiers. Chiarelli did say that he believed if soldiers had
better access to mental health care providers it might reduce the number of suicides.
Although President
Obama has proposed increasing the VA’s budget by 10 percent to $15 billion and as much as $113 billion for fiscal year
2010 as a way of meeting these challenges, the administration still lacks the manpower, data, and analysis to properly plan
for the funding increase, according to a recent report by the Government Accountability Office.
Shinseki, a staunch
advocate of veterans, promised recently that he would take “on the issue of the backlog," but he also admitted
that he doesn’t understand how it turned into a full-blown crisis.
While veterans groups
say they are pleased with Obama’s choice of Shinseki and other veterans’ advocates to lead the VA, they said they
could no longer sit by and wait for relief.
Earlier this year, two veterans advocacy groups asked a federal
appeals court to step in and force the VA to immediately tackle the massive benefits claims backlog and implement mental health
care plans. The organizations, Veterans for Common Sense and Veterans United for Truth, who
represent the interests of more than 12,000 veterans, said in court documents filed May 1, with the 9th Circuit Court of Appeals
that, in some cases, the VA’s failure to provide timely mental health care treatment for veterans “resulted in
suicide.” The problems persist because “VA has not implemented critical provisions,
involving suicide prevention, required by its own plans, the veterans advocacy groups alleged in court papers. “As such,
services to which VA acknowledges veterans are entitled are being unreasonably delayed, in some instances denied entirely
because the delay leads to the death by suicide of individual veterans. “An injunction compelling VA to implement its own directives is both appropriate and required,” the advocacy
groups said in an appeal brief. “At a minimum, a remand is necessary to remedy the district court’s erroneous
discovery rulings and ‘systemic’ evidentiary standard.”
Two years ago, Veterans
for Common Sense and Veterans United for Truth sued the VA alleging some war veterans were turned away from VA hospitals after
they sought care for post traumatic stress disorder (PTSD) and later committed suicide.
The veterans groups
sought a preliminary injunction to force the VA to immediately treat war veterans who showed signs of or were already suffering
from PTSD. In addition, they wanted a federal judge to force the VA to overhaul its internal systems that handle benefits
claims and medical services. But U.S District Court Judge Samuel Conti ruled last summer that he lacked the legal authority to implement those
measures. However, Conti did say in an 82-page ruling that it was “clear to the court” that “the VA may
not be meeting all of the needs of the nation’s veterans.”
Conti wrote that
the veterans groups should get “Congress, the Secretary of the Department of Veterans Affairs, the adjudication system
within the VA, and the Federal Circuit” to address the matter.
The veterans’
groups appeal to the 9th Circuit says Conti’s ruling was legally flawed and that he “erred in denying relief to
remedy both VA’s mental health care delays and the lack of procedural safeguards to challenge those delays.” Gordon Erspamer, a San Francisco attorney representing the veterans groups, said
in an interview that the case is “odd” because Conti’s “findings of fact departed from his ultimate
ruling.” Paul Sullivan, executive director of Veterans for Common Sense, said in an interview
that the motivation for the appeal to the 9th Circuit was VA's failure to fully implement its Mental Health Strategic Plan
and to conduct oversight of it. He said he has received reports about veterans packing parking lots to wait for medical care. Internal VA memos that surfaced during the trial last year showed that VA officials were aware that
more than 1,000 veterans had attempted suicide per month, which attorneys representing the veterans advocacy groups argued
could have been avoided if the MHSP, which called for the development of a "national, systemic program for suicide prevention,"
was implemented.
“The VA has provided no documentation that they implemented
any aspect of their strategic plan,” Sullivan said. “From our point of view, although it appears VA is taking
some steps in the right direction VA’s system still remains in deep crisis.”
A VA spokesperson
would not answer specific questions about claims made in the lawsuit, specifically, whether the agency has conducted any oversight
to ensure its mental health directives are being followed by its healthcare facilities around the country. Sullivan added that number of suicides and PTSD cases will likely increase “with the escalation
in Afghanistan and the increasing use of multiple deployments.” Secretary of Defense Robert Gates said earlier this year the Pentagon would end the so-called “stop
loss” program sometime in 2010 – the program that ordered soldiers to remain in the military for months, and in
some cases longer, after their enlistment contract had expired. News reports said that 40 percent of the nearly two million
U.S. service members sent to the Iraq and Afghanistan wars have already been deployed twice or more. Lawmakers have proposed several pieces of legislation aimed at streamlining the backlog of benefits
claims associated with mental health diagnosis. Rep. John Hall, chairman of the House Veterans' Affairs Disability Assistance and
Memorial Affairs Subcommittee introduced one such bill, HR 952, the "Combat PTSD Act" in February. The legislation,
which has 85 cosponsors, would streamline claims for post traumatic stress disorder, some of the most difficult and time-consuming
claims VA processes. In addition, Hall and House Veterans Affairs Committee Chairman Rep. Bob Filner
introduced and passed a comprehensive package of pilot programs to start repairing VA's broken claims system.
But without immediate
intervention by Shinseki on the benefits claims backlog, the VA will continue to be mired in controversy. “This is an unmitigated disaster, and grounds for the removal of top [Veterans Benefits Administration]
and [Board of Veterans Appeals] officials,” Sullivan said. “President Obama and Secretary Shinseki need to clean
house at the Veterans Benefits Administration now, before VA's claim system collapses. Although hiring more claims processors
will help, VBA also desperately needs new leaders and new policies.
“The
wars and economic devastation continue to generate a flood of new patients and claims for VA. However, the Captain of the
ship has changed at VA, and a new course has been plotted. Only time will tell if Secretary Shinseki can turn the ship around
without additional damage to VA or harm to our veterans.”
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