those going to claims. they are adjudicated right alongside him unless a terminal lung disease for agent orange illnesses. unfortunately, those claims and we have been able to prove it to the subcommittee, those are the claims that they are closing and calling close in adjudicated. unfortunately, that does help numbers come down. we ask that every time you get a new report on the va's numbers, you look at a cautious way. you question the data. they are not sending in screenshots of their work products. they are creating reports. there is almost no transparency. no wonder mr. can sit down and look at all the numbers the va is working on that are generated on a daily basis.

congress has never denied the va a single penny for doing its job. the current budget, over $54 billion is being paid out to veterans and direct benefits. the balance of their budget that they receive right now is for administration of their business. but they are not doing business properly. i could see here for hours and gave the statement after statement after statement of egregious behavior. wrongful denials and in some cases the liver of malfeasance. all we ask is you continue to press this forward. you consider our mission, to have a full veterans

administration complete the rear commencing the way we do business in demanding full 100% accountability of repercussions for their actions. thank you again, mr. chairman, ranking number 79, esteemed panel. we are grateful for the opportunity to be here to testify in the pr to take any questions from you. >> thank you, ms. price. now we will hear from ms. mcnutt. please begin your statement when you're ready. [inaudible] >> -- complex va claims. my name is betty mcnutt. i am the widow of ronald abram mcnutt, vietnam war veteran. accompanying me today is my attorney, mr. bergmann of bergmann and more. the subcommittee and disability and memorial affairs invited me here today to discuss what has

he come my most complex and now 23-year-old claim. for va dependent being in any compensation, i am here for two reasons. first, i am here seeking justice. i asked the va to correctly promptly applied the law and grant my claims second comes seeking justice of our veteran. in the audience today is her son who lost his father asked for a when he was 12. also in attendance today is my niece, sandra peterson, who is the daughter of a vietnam war veteran, who also died from agent orange poisoning.

mr. chairman, i filed my claim in 1990. the same claim remains pending. i have waited 1600 days fda delays and denials. the va erroneously denied my claim seven times. for nearly 12 years, my claims that title at va because va did not respond to the notice of disagreement. the court of appeals for veterans claims returned my claim to the va three times based on errors, errors conceded by the va. i know va is waiting for me to die. without immediate attention my claim is destined to sit, idle for several more years as a way, hope and pray for resolution.

my late husband, ronnie, was born in memphis, tennessee. on december 31, 1947. as a 19-year-old college student, he was drafted into the u.s. army. ronnie was deployed to the vietnam war in 1968 and 69. on september the 22nd, 1987, at the early age of 39, he died from an aggressive form of cancer, we could be a widow with a young son. his death came quickly from a cancer that dated any parts of his body very rapidly. ronnie died within five months. i brought a picture today of my

ronnie because this hearing today is honestly about my ronnie. he died because of the vietnam war and his service to his country. on his deathbed, he told me about how he swam in the rivers, highly contaminated with agent orange. ronnie told me stories about using discarded agent orange arrows for barbecue pit. first, va has not contested that my husband or a micro in vietnam. second, the law presents veterans on the ground in vietnam exposed to agent orange. and third, a medical expert provided the va with two nexus

medical opinions concluding that ronnie's cancer was likely as not due to his exposure to agent orange in vietnam. va's jackson mississippi regional office made many, many mistakes. first, i'm more than one occasion, the va applied the wrong legal standards to decide my claim. second, va ignored favorite book on medical evidence to my claim. and third, the va thought evidence to deny my claim. a lot was taken away from me 26 years ago and i've done the best i knew how as a widow to provide for my son, brandon. the impact of my husband's death on my son amend this.

words can't tell you. i've had an emotional, physical and financial distress. for me, i suffered unimaginable grief from ronnie's death. for 8600 days, words cannot express myself. going with maybe a benefit -- going without them has meant coming home to a very cold and dark house because my utilities were turned off. it has meant receiving food and clothing from strangers as they sometimes came up sure. it has meant begging for the as a repo man stands in my driveway at 2:00 in the morning to take my car. in conclusion, the va's mistakes

and their delays involve more than just me. it is not about just betty mcnutt. there's many betty mcnutt's out there. congress passed a law meant dating that va expeditiously process appeals like mine. however, va routinely ignores this law. now is the time for congress to put teeth into the outlaw. so other widows, like al can get accurate and prompt decision on their va claims. mr. chairman, no one should have to go through that for a thousand 600 days.

thank you for listening to me. >> thank you for your testimony both ms. mcnutt in this price, thank you for being here and putting your personal view to all of this. i'll start with a round of questions. the clocks aren't up, but we will be a look to see if from this end. keep moving in a timely manner. first question for ms. mcnutt. talking about this process is moving forward with your aunt account and it by your employer, mr. bergmann. tell us when you're engaged in council and how that is held to you to get to where we are today on this process. you just kind of alluded to there's many, many other people. >> i was introduced to agent

orange on his deathbed. after his death, that was forever in the front of my mind. so i proceeded without any help, without any direction. i started researching the chemicals in vietnam. i read an article in a newspaper and it was talking about agent orange. i filed a claim in 1990. most of these were just, as i said, is unclean in the dark, grasping. but as they went along, the more i learned and the more i felt it was some thing that i had to do because my house and told me about this on his deathbed for a reason, which at the time i did not understand.

>> can you give a little insight on how account will -- >> after 20 years of groping in the darkness in dealing with the va all their errors, i prayed. i asked for help. one day i received a call from the vietnam veterans of america. i was told that i might want to seek counsel. i went online and i found mr. bergmann and i decided this is going to be the person that is going to help me. this is who i want to represent me. >> mr. bergmann, can you elaborate a little what you've done to expedite the process if you will? >> certainly, thank you. as mrs. mcnutt has indicated, her claims that for over 12 years. when we came on her case, as

former va count low, my job -- our job as attorneys do so is to connect the dots come and make sure that the evidence that is needed to satisfy the requirement is presented to va. va is supposed to in its nonadversarial posture, supposed to give notice to veterans widows. they routinely do not do that. so what we did and ms. mcnett skis as we assisted in getting the medical evidence. it wasn't difficult. her husband had a very aggressive form of cancer at the age of 39. we put the evidence together with our arguments and submitted it to va. and now, we can do all we can to

dot our eyes, cross their t.'s, but we cannot make va properly apply the law. we been up to the u.s. court of appeals for veterans claims three times. each time the va attorney will try forwarding hey, we made a mistake here this case means to go back. that doesn't help mrs. mcnutt. but we are hop mcnutt. but we are hopeful. it's been 23 years. we are hopeful we are near the end. some of the help we get along the way, obviously the veterans choice act of 2006 is helpful in allowing attorneys early access to assisting veterans and widows. >> thank you. one question for mrs. price. from all the testimonials you've taken on a national scale, what are the most frequent errors you've heard of in the process?

>> must specifically, as counsel, mr. bergman said, failure to apply the law correctly, complete disregard of medical evidence provided, most specifically from civilian providers. that is very high on the list. and the third one i missed rides to the top pretty regularly is the almost complete and under disregard for anything that is considered a policy rule, regulation or law. completely incapable of rudimentary reading of their own warrants of a policy. i have a very specific one in my case. the secretary sent down a policy

change and order directly to the regional offices with regard to those of us to expose in iraq and afghanistan. april 6 to 2010. that application of that law -- that policy change has to the best of my knowledge not been addressed once in the almost 5000 victims i know personally. >> thank you both for your testimony. they're very courageous to come and appreciate your willingness to share your stories. we don't want to see anybody else have to go through what you

appeals were each case that comes down from the court as language guiding to the law

section 7112 that says this case will be giving expeditious treatment. i realize i'm not being responsive. >> nevermind. i can ask the va for some of that information. they say their lack of training i don't understand not. stronger force should be on the law by putting someone in place or maybe more than one person

that would oversee the this law is enforced, that it is a serious matter and that somethings got to change. if you can't perform your job, find another job. >> thank you. >> thank you, mr. chairman. and thank you for having this hearing and all for being here. i want to build on what the ranking member just asked. mr. bergmann, you've been on both sides legally and with your planet previously and what you do now. do you have any advice or guidance he would give this committee on how the va could work its claims process better? >> i guess the advice i would give, sir, that there be accountability. what i see as a lack of accountability. at the agency level, where we

are not supposed to be on opposite sides of the aisle. the va will not talk to s. if we do get someone on the telephone, they'll ask us how we got their number. we get different responses each time. we cannot handle many cases at the agency level sometimes because we don't know where our file is because the kid different responses to that. so i think if we can hold the folks deciding these claims accountable, that would help veterans and widows and their counsel in expediting the process. >> accountability is a great team to bring to our attention. training and incentives. do you have any advice in those areas? >> as mrs. price talk about, she

indicated her concern facing blacks on diyers do not follow simple guidelines. absolutely, training is key. i think the va's oig report indicated and i may be misquoting it. i think the oig is going to provide it with court later today. only 20% are properly trained. that means 80% are undertrained. these are people who are deciding our veterans disability claims. not acceptable i would say. >> okay, thank you. mrs. price, i want to thank you for service. mrs. mcnutt, thank you for your husband davis. >> thank you, gentlemen. mr. rourke. >> thank you, mr. chairman. but also like to thank the chairman for organizing today's hearing in a manner which is organized it.

very often we will hear from the va and afterward bso's caruthers impacted. out of the two years the va's response to the issues you brought up. the review here is accountability. we want to see how that accountability is implemented and what the consequences are much, doesn't do their job properly or when there is the case of malfeasance by someone who's working against the interests of the veterans they are supposed to serve. we want to have the consequent desire specifically. i think you raise a great point. one hit home with me and sounds like the rest of the committee. ms. mcnutt, as i said when i had a chance to meet you before the hearing again, i commend you on your courage and be here. i hope your story helps

galvanize the va. one, to resolve your claim, which is taken for too long already, but also to serve as the ad an inducement to ensure no one else is suffering what you've been through and to bring stories like yours to our attention as an oversight committee and body and attention to the va. your support of him and legacy in both of you, your reference on behalf of other veterans who are suffering the same kind of problems. i really don't have any questions. i'll reserve those based on the issues you brought up. i want to let you know your stories have hit home in a really do think they'll have their intended effect of changing the culture and adding additional power to her ability to exercise oversight over the va. thank you, mr. chairman.

high-heeled that. >> i thank the chairman. >> thank you, mr. chairman. i appreciate you holding this hearing. i appreciate the testimony. i know pretty well we worked together over the years on va issues and mrs. mcnutt, thank you for your courage. i know you will make a difference for others and i really appreciate so much both of you testifying today. mrs. price, first of all, thank you for your service. thank you for testifying. how want to ask a couple questions if that's okay. you have met with me over the years on particular case where can i really appreciate you work with my district office as well to help our true american heroes, veterans. i have a question with regard --

again, can you explain, lab raid a little bit on your particular case with the experience that you had over the years? i think that would be helpful to the committee as well. >> it's been my honor and privilege to work with europe the last few years. i know you are extremely supportive of all of us have come home, whether we need va services are not. but to answer your question, when i got home, i was still on active duty. i was stationed at.com and i was injured. i went through the medical board process. when time is finished, took about 10, 11 months to get your board process. i stayed on active duty for 18 months total in my first reading

from the va came in and said you have 30%. there is a toluca criteria that has been around for decades based on a court case. it has to do with every single one of us that have bilateral appendage injuries. i might ask, ears, eyes, anything to s. up until the time i had a tro hearing, it appeared to be the same case manager because i'm annulling fish entrées english aficionado. who is a person road, the verbiage in the exact same person every time. the raw gravy on my hands is 230% or that's a big number, but they have a very algebraic method of using cumulative mass.

both of my hands i had the bones removed in attendance rerouted so that i could actually even hope this. i can't tie my shoes. i can't but buttons. i can't do support acts, all kinds of things. my last surgery was follows on active duty. i also contracted this lung disease. why settle this information and elaborate radiance, testing that took five hours. the first letter that came back to me with telling me that the imputation role didn't apply to me, which is a very basic rule the va hasn't had a certain calculation model and say okay were done. we are too high. now you go over to the imputation and treated us lots of views or loss of the land. what makes it and keep it to use the imputation role.

i have essentially that same answer, all three appeals. my long stay told me, they told me i didn't qualify. i was a convoy driver, 350 missions. i drove humvees, even iraqi city bus in downtown bag that and provided all that information in my case. pictures taken by combat drivers of me driving. they still denied me over and over and over again. i have ptsd. for a variety of reasons. when i filed the claim, they denied me right away immediately. they said, you don't have it. our evaluator said he must have had a bad childhood. no, actually i didn't.

my childhood wasn't terrible. it wasn't great. i was a kid, but it had to do with the issues that have been over there. i was being treated by their own psychiatrist or psychologist for for years that i etf e. yet they still denied me. does that answer your question, congressman? thank you very much. >> i know my time has expired. but we have another round? i know you have three. can i have one more question? stating from 2009 the average number of issues come including a disability claim increased from two-point name for 4.9 in the va is the shooting lanes as in organizational structure to process complex claims.

three or more medical issues that did not involve special populations of veteran. that's a quote here. can you expand upon your thoughts about this aspect of the va's testimony? >> specific to the process. >> does anybody here driving traffic? you have lanes. there's only so many. in theory, everybody uses express lanes. it would be good ones that go into the express lanes. i love that they took that title. those complicated claims are still being ignored and still

being pushed aside because the lame mayhap as a group of adjusters and readers dealing with them. instead of them being either brokered out to offices that don't have a backlog like nebraska the oklahoma, they're not brokering them out. and then they have the core, which i don't even give a decor is. if you hit three, but it doesn't fit into what seems to be a fluid special or complex, you end up in the corner. they're also not giving any information as to what the qualifications are these people managing of the readers recommend this lanes because experienced does not tell me

anything. how many is that they have raided medical claims before they went to the va clinics >> no questions? chairman miller? nothing? i want to thank you all again for your >> at this time, i welcome panel two, which includes mr. sherman gillums come associate director for veterans benefits, paralyzed veterans of america, mr. ronald abrams, executive director of the national veterans legal service program and mr. zach

hearn commit director for claims of the american legion. we appreciate your attendance today. a complete and written sando be entered into the hearing record. you are not recognized for five minutes for your testimony. >> thank you, mr. chairman. chairman runyan, members of the sub committee on behalf of paralyzed veterans of america come out to thank you for the opportunity to discuss complex claims, a topic that is near and dear to veterans like me and those who represent tba. complex claims in both cases they require the most experienced minds to properly adjudicate. this video is claimed for mandatory but small school issues with the most complicated circumstances to unravel such as military trauma, pts and catastrophic disability. since the membership is predicated on disability, that would be my focus. they have expertise in advanced and complex claims and assist

them. the special monthly compensation offered the exception and we appreciate the focus on complex claims. veterans benefits has made tremendous backlog since launching initiatives. during our june 2012 testimony, complex claims remain problematic because disability benefits questionnaires, evaluation builders and will space calculators too often oversimplify cases they require critical thinking and objective reasoning, not algorithms to adjudicate with true efficacy. so the achieved processes are qualified by context as it relates to complex claims. the complex kind of defining accuracy in the eye of beholder. if i accuracy the veteran receives maximum entitlement and

accuracy targets. if the reader and that's a given data set such as the box is checked in results and follows the rules-based prompt, decision will be freebase in its algorithmic instruction. disability evaluation do not encourage the application of judgment based principles like reasonable doubt or guide rating specialist or ambiguities in evidence that weapons and the difference between total loss of bladder control versus your genetic letter sent to someone with a sign up for dysfunction. this is where we have issues with the way complex claims are adjudicate under rules-based system. a veteran with severe disability may receive an accurate smc rating the definition based on limited evidence but not the most accurate rating possible that affects the case in point that sees all too often with lou

gehrig's disease. a neuron disease does not slow down for the painstaking protocol ca must follow. since the passage of presumption will underpin entitlement to veterans and survivors, bb has worked over 6200 claims which has made our staff with complex faces an extremely staunch insistence timely and accurately adjudicated. you can imagine my reaction i heard about a veteran in san diego who receive notice he needed to submit to a compensation exam to prove his name for skilled care despite medical evidence of such need for the same position. ba has a prerogative to call claimants in for exams first unit to a claim. this prerogative has become one of those in tractable rules we criticize. the problem is the veteran was in hospice, said he could not submit to an exam. the experience link o2 is bound by the rule that exams are

mandatory, even though we do not have a mr. grant this are to claim in the regulatory discretion to do so under title 38, which states in a hospital exam report from a government or private entity may be expected without further examination. unacceptable critical evidence allows the examiners to supplement files with a telephone interview with the claimant in order to complete a dbq. neither option is exercised here. there is hospice and skilled care noted in the medical records trigger the requirement to order an exam in the name of quantity. instead of serving the evidence of an attack, does substantiating the need for regular skilled care. common sense will give way to a calculator, which is supposed to be decision support tool, not replacement for once reasoning faculties. to make this point, i offer an analogy. three plus two always equals

five and if every disability metrics like decibel level or percentage of range of motion will be achievable under the current system. these claims are like adding to or rational numbers. hi, 3.14, so on and so forth plus the square would have to to arrive at an outcome that could not be precisely found with a calculator. these claims call for an informed, qualitative analysis to find the most accurate albeit imprecise answer. that answer is never found in san diego cases the claim ultimately died in the veteran finally succumbed to assail us. this is a missed opportunity to do the right thing. unfortunately, this is not an isolated case. we see step across the country point to the was suggested by taking the unnecessary steps in similar cases. i can point to and in nashville for ms. mcdonald who will testify and of course in new jersey, i also have a case for you if you're interested.

we understand the dilemma to reduce the backlog while achieving timeliness and accuracy targets. .. in these claims with answers binary prop suggestions and. thank you, mr. chairman. and member of the committee. i'll be happy to answer any questions you have.

>> thank you. i recognize mr. abrams for five minutes. >> thank you. i've been involved in veteran's law for over 40 years. the va has faced huge backlogs before, and the va has had to deal with reducing the backlog, claims faster, and almost every instance the error rate, especially the error rate for complex claims has gone up. you simply can't go too fast when you have complicated claims. the fist thing we have to talk about is what is a complex claim. some claims by their very nature are complicated. special monthly compensation,

traumatic brain injury. the regulation dealing with tbi is so complicated that some people call it the i did -- da vinci code. look at it sometime and you'll be impressed. some claims can be complex as they are developed by the va. or as evidence from the claimant comes in. ancillary issues arise, different theories of service connection come up, they can become more difficult. and some claims more than a few and more than i like can become complicated because va error. and in those cases, the veterans face a nightmare. not only do they have to get the right evidence before the va, they have to overcome the unfair

denial, which is an obstacle that stands in their past. the worst type of vaers are the premature adjudication. some varo incorrectly adjudicated and prematurely deny claims based on an adequate evidence. especially an adequate va exams. these errors reveal for many veterans that the claims process can be adversarial. based on my experience, working for the va for many years, working for n vrk ost. going on quality checks to over 40va regional offices for the

american lee gone who should be commended for doing that work. shows to me that the error rate at the va has been consistently, at least 30% in the various ros. sometimes it's higher. it's unrealistic to assume that the va will ever get it real error rate to 98%. over 70% of the claims appeal to the board of veterans appeals are reversed or remanded. and over 70% of the claims taken to the court are sent back because of the va error.

in it rush to judgment, we have found that many ro varo prematurely deny or ignore many claims and potential claims. unfair premature denial cause unnecessary appeals and years of delay before deserving veterans obtain justly iraned -- earned benefits. and even more important, some veterans fall through the cracks. if many are done in a premature matter and many deserving veterans are unfairly denied. what will happen is veterans be

appeal the backlog will vently grow and be facing this over again. i wish to comment the undersecretary general hickey for her commitment to the fully developed claim program. i think it's the best thing that the va has tried in over 40 years. and i encourage it. we suggest the following. the va measurement system which is encouraging people to prematurely adjudicate claims. has to be over hauled even if congress has to pass a law. the va needs more people to work these claims. inspite of electronic this and lanes and all the other things the va is trying to do, which is a good thing. they need more people to work

the claims. finally, the adjudication culture at the va needs to be changed. many va managers that we've met on our travels act like they are producing wig ets rather adjudicating claims filed by real people. you saw the real people here today. their bill should not be prompt adjudication, the goal should be a time, accurate, and fair adjudication, which in the long run, not in the short run, is the best way to finally adjudicate claims and reduce the backlog. thank you. >> thank you. with that we have pending votes on the floor. we may get to questions after mr. hearn. if not we'll go to recess and

questions after we come back. >> good afternoon, mr. chairman. ranking member tie titus, and members of the committee. we're here to talk about the implementation of special operations lanes. va created these to address accurate sei. what we never talk about why accurate sei matters. va estimates they will process over a million claims again this year. the difference between their goal of 98% accurate sei and 97% is over 10,000 veterans who may not get the better -- beforts they earned. we know the real gap in accurate sei is far more than 1% as well. that is why the american legion is constantly raising the importance of accuracy. those who wind up on the wrong end the accuracy rate may be

stereo. why still problems? it's a complicated system. it takes experience and attention to details to get thicks right. putting experience pearls tell me on tougher claims is good start. when they -- across the country with the right personnel to execute this plan it will probably help with improving the figure. but there are still some systemic problems which hamper the ability to get it right for veterans. to see inside the officers outside the bellway and get a true picture how it borics in the field. through these visit, we've seen patterns. for example, consistency from one office to office leaves much to be desired. policies embraced by leadership and one office may be given lower priority in other

officers. with mixed commitment you get mixed results. va officer seems to struggle with finding the right balance and development for claims which leaves to adjudication. you can't build house on a shaky foundation. on our review visit we exam a sample of claim for veterans. the american legion represents. often it's been under developed or overcomplicated. both of these errors are a recipe for bigger errors later in the process. for example, in april of 2013 we visited the nashville regional office. according to the april 27th monday morning workload report they had a 95% accuracy rating. during the review of 22 cases we found 11 where we commented regarding case development to include 7 with errors. our review paints a far dimmer picture of accuracy than

indicated in the workload report. in one case, a veteran was seeking service connection for ptsd. evidence indicated the veteran served in the persian gulf during desert storm and was fearing death. no exam was provided by va. denied the service connection for due to a lack of diagnoses. deny the veteran benefits without due process. conversely, sometimes va doesn't seem to know when to stop and overcomplicate the claim. in june we vet visited the reno. the june 3rd reports indicate they had 92% 2 accuracy rating.

our review of cases resulted in 59% of reviewed claims for va benefits. in one instance a veteran was seeking service connection for ptsd. during a july 2011 exam the examer linked the veteran's condition to military service. the regional office returned the results to restain his opinion and again the examer stated the veteran's ptsd is related to service. after the second review they adjudicated the benefit in september of 2012 and sent the notice letter in january of 2013. va conducted two exam when only one was necessary and took over two years from the date of the first and another four months to november it. the american legion believes adopting the strategy.

it needs to start with the right mind set. it should not be achieving 98 percent accuracy. it needs to be i need to get every step right for this veteran. until the problem gets fixed we're losing the good faith of the city of veterans every year. thank you, i'll be happy to take questions. >> thank you. there's less than five minutes left we're going have to go in to recess and be back half hour to 40 minutes. so the committee stands in recess. [inaudible conversations]ard. giving women the right to vote, that was hard. >> subcommittee will come to order. we will begin a round of questioning. i will start that off. my first question will be for

mr. abrams. you note in your written testimony that one manner in which claims become complex because the va error. cases that disorder often appealed angry man had. often more than once, further increasing the complexity of the claim procedurally. number one, can you elaborate on the common errors which causes claims to be more complex due to va error on appeal? and number two, to think greater focus on appeal and remanded claims would assist va learning from it mistakes and making less of these types of errors in the future? >> yes, i can. let me give you an example. suppose a veteran files a claim for pts d. the veteran alleges that he suffered a stress the next goes to combat.

the veteran service records show a combat infantry badge, which means the veteran was in combat. however, to be a comment in an effort to go fast set up an examination and fails to tell the medical examiner to accept as true the fact that the veteran was exposed to combat. the va examiner looks at the file, doesn't see any evidence of a stressful and then in service. doesn't know how to read etd 214 and determined he could not diagnose ptsd without a stressor. therefore, he right a negative medical opinion. and diagnoses the veteran with anxiety disorder or something like that.

the va then denies the claim. to resolve the claim could take five to eight years. the va needs to take the time to start. this is just a simple error. i could get into complicated ones that we be you're much too late. that is a simple error that can be fixed at the va takes the time at the start to tell the doctor what evidence to accept as true. that is not for the doctor to determine. as for the adjudicator, the va adjudicator to make that finding. your second question was if they got more involved. i'm not sure what you mean by more involved. with free man's?

>> a closer attention to the process. >> well, they should. they need to analyze the types that come back from the word and take action to train on that. we start my look at thousands of cases a year and keep a list of the common errors the va makes that we can win the core four. in my testimony, we listed some of those that you can see. i am hope being that the va does that. i am not sure that the two. >> thank you. again, for mr. abrams said mr. gill's tummy both provided your written testimony issues with adjudicators probably topping monthly compensation for us dearly disabled veterans. why do you think that calculating snc is so problematic for va adjudicators?

>> to operate answer that first quick >> yes, please. first of all, in my experience and i think you have staff members who have traveled to, you know, our rose who have seen that. snc is inherently difficult issue. the va looks for magic words that aren't there. and the case i wrote about in my testimony, the veterans military doctors said he had lost all function in his right hand. he at last the use of his right foot. the va did not concede loss of use of the right-hand because the doctor didn't say the magic word. when they contacted the doctor, the doctor changed his written

comments and said he had lost the use of the right hand. well, lots of use of the right-hand and massive use of the first generates an aloe. prd had an aloe because of his dramatic brain injury. this is a man who was shot in the head in iraq, had 18 service-connected conditions, operates on a gradeschool level, has tubes in his head that food comes out of, has terrible scars on his face, lost in the sense of taste and smell and, you know, has suffered tragic rooms. i got involved because they wanted to help this guy. my heart went out to him. even after we produce clear evidence that he should get it

smc are to, the va did next. i was able to reach the component of the va that does the work. i asked them why action had not been taken. they told me that they were looking for lots of owl and utter control. i said that isn't relevant. you don't mean it. he already qualified. the lady was able to hear me out. i took her through the regulations and statutes, which would take me a long time to go through. the veteran ended up getting the r2. it's on our website. we had a mix of the va that the band in animal house. it didn't have lots of use.

the momentum of the auction. they were going to accept those words. kind of silly. secondly, the people doing the work didn't know below. the va needs to do more to train people to understand smc. the legion, ammo ph does a lot of work on that issue. if you looked in our text book, we have a formula that service office there is an va can use to properly evaluate. it's complicated and you have to look at it each time. thank you. >> mr. gillums. >> in order of the affected adjudicated claim come you have to have the tuition for things that are pretty abstract. in one case, you have a veteran with als. because he or she is trace function or a leg or can barely

stand, they will find the veteran has greater useful function of legs. a lot of it over time would be cultural. this new crop are being trained to follow rules. i'll give you an example. if a veteran presents with a letter from exclamation, saying that he needs skilled care, that letter will trigger not some deliberation. it triggers the need for a cpa exam. the cnp examiner will see whether this skill carries needed or not. they will dictate whether the claimant accepted or denied. if you understood essence e., yet to complete a medical opinion senate should be resolved. increasingly, this contemplative

aspect of waiting is being pushed out of the culture, pushed out of the process. there is no contemplation of evidence. it is either there or it's not. they've got three out of five function where they can wear the 35 tried to stand and occurs subsequent injury. a lot of it has to do with the fact that induct the reasoning way of training it to people that made the adjudication of bit longer, that's the insight. >> i recognized ms. titus for questions. >> thank you very much. two questions. first, we've heard a lot about putting these complex cases in

these planes come it easy, medium and hard. i understand the value of that. if that's not oversimplifying it for better understood nuance a little more. are we really creating a system that's going to produce more errors on the road in attribute to the appeals backlog is my first set of question. something i mentioned earlier, the raid as you pay, complex cases. would it not hurt as the great aspects and veterans get paid for those until you get to the end. >> daylight be enable their specialists and not claim, posttraumatic stress disorder,

military trauma. one of our severe disability cases. that can manage from regional office to regional office. every regional offices to interrupting. the latter doing the right thing. the ones we hear about where it doesn't matter what process they have in place of the people are inadequately trained. the greatest process the world won't help them. to your question about the pay-as-you-go, for veteran who just need relief, they need some resources. it may be okay. my fear is when you pay a veteran. but the veteran gets 100% rating, the mentality would be scout 110. what more do you want? where you're coming back to us? or that is going to be a completed claim. how do you monitor the completion of that claim? for veteran's 100 getting a check, still a lot of work needs

to be done in our cases. but you know, we've got to make sure there's no creeping standard where they get paid, that's it on the back earner. >> this past year when we were going out and doing the strips for the ftc and we visited to include the one and we know, we did discover it did bring some order to the regional office by having segmented lan. one of the things we were not there, i would ask employees different questions. one was how much it. steve have? it was overwhelming and i would talk to coaches in middle management of seniors have two talk about the relative greatness i guess of the staff at the losses. i've heard senior leadership say on repeated occasions that while the effects of the case and the increase in claims affected the

backlog and referred conversation about 9/11 and the increase in cases for mayor. the one thing nobody seems to discuss is you can't beat back the hands of time and that we now hate inherent in this country where baby boomers are retiring in larger numbers. they didn't linda va at the time initiative. soon i got this knowledge vacuum in the regional office. there just isn't -- there are enough people, but there's not enough experience there. so it does help, but a lot of it to his he simply don't have that much asked earrings but the nonoffice. and to go to the raid as you say, i do think it would be beneficial. if you think about the effects you could have, let's say someone is trying to get service-connected for three or four conditions and you can get than 50% or 60%, now they've got access to health care through

the va. it is a very good avenue for them. i also think that, also in the cases of preference for federal employment on when it comes to issues dealing with va mortgages for not having to pay the funding fee. of course these are important. you get money into the veteran's pocket. i do see the benefits. i agree there are some things are the least of the data as to how va would monitor this and make sure the cases and claims are being set to the wayside while other things are occurring, but it is something worth considering i think. >> thank you. in fact it is the policy of the va that when it has enough evidence to pay partially, it pays. the problem is that the workers don't get anywhere credit and therefore, they are not encouraged to do it and we find many, many cases.

it is not a matter of va policy, which says when you have enough evidence, pay them at this level and then when we get more, we will update. they want to take the time to do it because they are measured by how many cases they do, which goes back to my point of the work measurement system in sherman's point that if you give somebody some income and maybe he will go away if the thought and there will anymore to do. so they really want to get rid of the case at that point. thank you. >> thank you. >> thank you very much, mr. chairman for having this important hearing. information that the va has provided a recently suggested simply breaking up the workload into what they call this segment of planes resulted in a 10%

processing increased during the first 60 days. also, easy claims saw an increase in timeliness of 100 days faster than the special operations claims. however, we know that va continues to do a poor job in handling them of our most challenging claims at va oig noted in their testimony in the first round of inspections. 31% of the tbi claims reviewed show that staff at errors. after informing staff of errors and va taking action, the va oig return to note that 29% at tbi claims reviewed were found to be in error. you look at 12 of the 20 offices reviewed were noncompliant with vba on it for two consecutive inspections. they also noted even after extremes amplification of ptsd

claims, 5% of these claims are still incorrect. in my mind, the facts before themselves that we need to take the land further by creating a few specific hospices that specialize and focus is on complex claims like tbi and the end nst. these officers and specialists aligned in cross functional teams focused and trained in extremely complex cases. i believe most of you at the table support h.r. 2088 that would create centers or adjudication excellence. my question, i'll start with mr. gill on. you articulate the problem with underqualified individuals handling complex claims. in your opinion, would we be better off if we specialize in

his complex medical conditions? the other two panelists can answer that as well. >> a fuss about qualifications and some of the cases i've seen more about the rules that constrain their ability to make judgments using the experience they might've accumulated over the years. the rules are just different. even in cases where you've got somebody qualified him of the rules are different. the rules say you have to do the steps. you can no longer exercise common sense. if it says hospice, common sense says that is probably skilled care. you have to ask for an exam at the raise the rating stands. it's an accurate rating. that's where you get an error. that's an error. you have to exercise reasonable doubt. that's an error of law. it really depends on the convergence of both an

inexperienced corps of new readers who don't have the freedom to exercise their judgment when it's necessary. if you were to sort of compartmentalized in the knowledge, it depends on how you run it. if they are allowed to exercise that qualitative deliberative thought process as we look at these claims in these compartmentalized thinners of excellence, then it would work. i don't think that's necessarily it. just give them the ability to make decisions in exercising good judgment and having rules dictated as a quality of review standard. >> thank you. first of all, i think the asset the fairness is time. if we set up lanes and their

pressure to go real fast, it won't matter if they're the most knowledgeable people on the planet. secondly, you are taking the veterans claim away from his local representative. the american legion or others of his organizations representative in boise, idaho, is not going to have access to the file or to you with the raiders if the case goes to denver. i make you mad at, but that's a problem in any case. until you fix how they count their work, these are fixes to sound good on paper, but aren't going to make a major impact. that is the first thing to do. if sounds great. i also worry that if people are trained to deal in smc and that is all they do, the rest of the

va readers are not going to note since you must they're trained. they'll only have a small component of people to do it. there's a lot of roseanne comments. it's worth a try if we can also implement some way to give them time to do it or to higher a lot more people. i keep saying that. a lot more oil. thank you. >> thank you. generally speaking, like bond said, the idea of local adjudication for claims. i think what you are saying the vc were essentially going to create a workforce of warrant officers, whether specialize in particular areas. this is the thing that i kind of question. if you're a high-performing regional office in your assigned special monthly conference

edition and you are working in a different office and assign something easier, what is that going to do to the morale for people working? i'm stuck with the tenebrous game. i don't think that it's necessarily the way you want to go about it. you have to have a comprehensive approach to training and evaluation. i was speaking earlier in our office about it. 10, 12 years ago when he passed no child left behind, be concerned in the education community west teachers are going to start teaching to the test. but for some of the evaluations do. congresswoman titus could attest to years in academia. you don't want to test knowledge of multiple-choice exams. that is comprehensive understanding and that is what our big concern is that the american legion. thank you.

>> i thank the gentleman and i thank you call today for your testimony in the work you do on behalf of disabled found [inaudible conversations] [inaudible conversations] >> this'll be our final count today. we welcome mr. tom murphy, director compensation service the veterans benefit administration, all so this sub one of the regional office. we also welcome sondra mccauley, deputy assistant general for audit evaluations of the office of inspector general department of veterans affairs. ms. mccauley is accompanied that

mr. brent arronte, director of san diego benefit inspections division. we appreciate your attendance today. complete amid statements will be in the hearing record. mr. murphy, you're now recognized for five minutes. >> chairman runyan, ranking member tightness, thank you for providing me the opportunity to discuss va policies and procedures for adjudicating complex disability claims. the company today by ms. edna macdonald of the regional office. the vba continues to express an increasing number complexity number complexity of regional issues you between 2011 and 2013, the average number of issues and claims increased by 31% from 5.52 mike 72. in response, bba implement the new operating model. epa has noticed increase in complexity from the newer generations of veterans who participated in operations during iraqi freedom and udon.

you can hear a greater chance of surviving are his injuries and often return home with multiple serious conditions. in addition, vba continues to receive credit for veterans of the vietnam era. many become complicated because they are subject to federal court orders in the u.s. department of veterans affairs department of veterans affairs. organizational model incorporates cross functional teams working on one of three segmented lanes, express cooperations. things were created based on complexity and priority of claims. the express lane develops and writes claims with a limited number of issues and subject manner, which could be developed and rated more quickly. corley and includes claims that three or more medical issues that do not involve special populations of veterans. the special operations plane applies intense focus and case management on specific categories of things that require special processing or training. it's comprised a regional office most highly skilled personnel specialist experience and

training. vba is simplifying ratings by building a decision support tools to make employees more action and decision are consistent and accurate. one of them is the evaluation builder essentially an interactive reading schedule. the reader uses check docs is associated with the veterans events. dbq's are designed to simplify rating decisions. they replace exam reports and capshaw made the medical information up front and present the findings in a reader friendly format. grants or consider complex for a variety of reasons. here are three examples. due to complexities of reading tbi come the special operations and processes these claims. since march 2013, all of this site are required to complete specialist training. this web-based modules 22.5 hours and how to read a claim for residuals of tbi. due to the myriad of systems they may experience, it's unclear which symptoms are solely attributable to tbi. in october 2011, compensation service provided guidance that

fighting should be related to the veteran's tbi condition unless such symptoms are clearly attributable to other process. in addition, vba has instituted safeguards to ensure can distance the attackers. all are required tbi claims until the individual demonstrates 90% accuracy in reading such claims. as a result of these efforts cannot bba have a tbi increased to 21% of best-of-seven to 47% in 2013. further, accuracy of rating during fiscal your 13 with 92.37% from a slightly higher than national average for operating claims are in the same period. service connection for ptsd requires three things. medical evidence diagnosing the condition and in-service stressor in a nexus connect the two. in 2010, secretary should seki made it easier to establish and provide the statement alone can

now establish the required service trust. via provided training on this regulation change to ensure can just inaccurate ratings. he raised ptsd claims are processed by this thing as well. complications arise in situations where there is no collaborating evidence in the veteran's military records. in these cases come the va must notify the veteran the evidence from outside attorney records may be used to support the claim ms attempt to obtain any such evidence identified. in 2011, bba connect quality review of these claims, which found approximately 25% error rate based primarily on incomplete development. we developed and implemented an mst-based ptsd package and emphasize the recognition of the types of evidence. following the training, fst-based ptsd is a level level comparable to that of other level for ptsd. the va has been complexity of

claims in recent years here to address the trend, va implemented in mono special operations focusing on complex disability claims. this concludes my statement, mr. chairman. i'd be happy to entertain any questions you are the subcommittee may have. >> thank you, mr. murphy. without i recognize ms. ms. mccauley. >> mr. chairman is set to become a thank you for the opportunity to express work in the claims processing issues. with me today is mr. brent arronte, director of the san diego inspection division. in addition to a nationwide potted some of the oig reports on individual effect msm providing timely and accurate benefits and services to veterans. a major concern is continued noncompliance with vba policy despite recommendations for addressing issues we identify. specifically in response to

may 2011 report, bba required second signature reviews of tbi claims until they rate 90% accuracy and claims processing. however, in fy 2013 can we saw slight improvements. they remind for two consecutive inspections. half of the hours were due to staff using inadequate medical exams to great tbi claims. in january 2011, we projected vba and correctly process 15% of hundred% disability evaluations for about 181,000 veterans and paid 943 million without adequate supporting medical evidence. he va implemented training in internal controls to address this issue. however, bba continually cover

repeatedly delayed completing its review of all hundred% disability evaluations to ensure each had a future examination date entered in the electronic record. a second cycle of inspections continue to show a high error rate in processing these evaluations. in most cases, errors occurred when staff did not enter suspense diaries in vba's electronic system to request medical re-examinations as required. we continue to review the va's systematic analysis of operation and organized means every great veteran service under, dsp operations to identify problems and propose correct elections. we found six barrels remain noncompliant in this area are both cycles of our inspections. generally, bear management did not provide adequate oversight to ensure sales timelier complete.

we correlation to sao noncompliance in bank into a temporary director or manager positions for advance or greater. currently, we are assessing bba's initiatives to improve claims processing and eliminate the backlog. we are reviewing the initiative vba began on april 19, 2013 to process within 60 days i'll claims over two years old. i've know, we determined 10 of 11 provisional rating decisions at the los angeles burial were not compliant with vba guidance. we found the director's office had enough conflict think i'd just ask or require provisional ratings without supporting medical evidence. concerned that additional errors they exist, we recommended that bba review for accuracy all 170 provisional rating completed by the los angeles bureau after the

conflict has issued. findings from our ongoing audit of the veterans benefit management system, vba suggests in progress. while vba has reduced its inventory of average days to complete claims, we cannot determine another transformation initiatives. moreover, a behalf as has performed issues and uses legacy systems to process claims. we've initiated a review to determine the extent to which vbms helps va with the decisions. we hope to report finance and early 2014. in conclusion, vba has made progress, but continues to face challenges to improving processing accuracy and time limits. inefficiencies we not only added burden of delays veterans, but also improper payments that bba will not likely recover.

we will continue to look for ways to promote improvement in vba delivery during our future audits and inspections. mr. chairman, this concludes my statement. we would freeze to answer any questions you or members of the subcommittee may have. >> thank you. i'll begin with the round of questions for mr. murphy. we will both touch on it. it must have been given one word for accuracy. mr. murphy, the va uses the term accuracy this morning. we heard from veterans, representatives and office of inspector general who indicated claims are not being correctly decided at a very high to. development of the medical examinations are not adequate. they are not consistently returning to report to facilities is required due to

pressure to meet production requirements. in a moment, or thank you to explain in detail how va calculates and represents a 91 claims based accuracy. i find the va's representations of accuracy to be even more concerning to be over 92%. it specifically tasked to perform reviews of claims and reports over 30% of cases nationally employees are not compliant with policy if individual error rates as high as 51st and peers so here's the question. does accurate standards mean the veteran received the correct rating decision for the claim conditions on full and proper the claim in the factory indicates anything less than this, what does this mean? >> accuracy means exactly what you said, mr. chairman. to the veteran was he the proper

benefit entitlement payment or decisions into my? best measure of accuracy and a vet quality analysis and reported out. that's at the 91% means. that number is drawn from a true statistically valid nationwide sample, random sample applied to regional offices, elected in the national leachman evaluated, returned to the office and found that sun is rolling 12 month efforts. >> would describe it with the oig numbers? >> vig and dba don't measure what an error is back with the same way. did the benefit entitlement iran number one intends to look at it from the standpoint of did you follow the process? if you're very further process got the benefit and title decision right, i will not call that an error.

however, the ig will. something more important you need to hear from the ig report that says resample claims we consider at higher risk of processing errors. best these results do not represent the overall accuracy of disability claims processing and this va regional office. this is a page from the title of the ig report. there is one of these initial report. the ig by design targets a specific subset of knowing high errors. if you take that number and extrapolated out to see the entire regional offices this way, to .. or represent tatian the sum of work for the regional office here that i'm not disputing that is an accurate representation for the subset they look at. but not for the totality of work that comes out of the office. >> i'm having the discussion that we had also broken down to just tbi cases in your numbers conflict fair.

>> yes, our numbers conflict fair. the ig report to look at her with a years of work. the numbers i give you are some of the last 90 days worth of work. my point is this. when you look at where we were and where we are, and the ig report is much but reflect it up where we wear, not necessarily where we are sitting out today. >> ms. mccauley, caterers onto that? >> yes, the numbers we reported with the 31% accuracy -- error rate was based on a first round of inspections from 2009 to 2012. more recently we found a 29% rate with the 2013 inspections. we do look at specific high-risk types of claims. and so, we are not looking

across all the different kind of claims to come up with an accuracy rate, but rather to focus and undoes tbi or temporary 100% disability evaluation better shown repeatedly to have a high error rate. also, there is a big difference in terms of how we call errors and how vba calls errors. we don't focus just on the benefits and titles. when we look at the claims, we look at the processing of the claims human error, system error, processing error. did they follow regulations that goes into the accuracy of the claims? sometimes the benefits entitlement may be correct for a moment, but sometimes errors have potential impact on benefits down the road, future benefits for the veterans. so we look at the totality of the claims processing so we look at the totality of the claims processing exercise.

>> one more question, talking about how you compile statistics. does the va keep track of accuracy in appeal of a number of years of experience by the dro? >> from the standpoint of i can go back to my office and give your part that says no, i don't reported that we had a routine basis. however, in determining the training we do in the types of training, where we spend our affair, where the errors come at a high concentration of errors, i use that data every single day to determine exactly what training they need to be doing, where you need to be concentrating that come even done to the regional office level by tracking and looking at errors than an issue-based level, which were started doing more than a year ago at this point, i now have the ability to stay tbi is a high error rate in the regional office and target just the tbi as an example.

so to go back to the office and say here it is, no i don't track it that way. in all of the training process we do, that information is good uttered on a regular basis. >> where my head is on this, is it because of a lack of asked. that sum of all? they came back in the last panel that maybe we don't even have enough people with the experience to rate these things. is that trackable in your statistics? >> when i go back to your first question, mr. chairman. this is an excerpt from the waco report. the two met at brain injury review 30 cases in errors that affect veteran benefit, zero. potential to affect veteran benefits, the difference of rules between how the ig looks at it and how i'd look at it is eight out of 30. there was a 30% error rate you are talking about. the veteran received the right check?

gas. with a process done differently but they got the right check? in error in the ig and the veteran focus was the right decision in the right compensation received by that veteran. >> but i'm trying to ask, is it possible to find the analysis of some of that has more experience in phase certain regional office has more experienced personnel in it, are you getting a better outcome there? >> re: get a better output -- >> with the experience of the claim adjudicator? >> yes, no question. we track that. in fact, we call the consistent he studied the first week of office. we broke it on the it on the six questions to all people. this one has been to be on diabetes. what we did is broken down by lanes. we broke it down for the quality review teams.

i lay out the segment population at a glance and by a meaning in the mid-90% french, the special operations plane got those questions right at a much higher percentage. at the 93%, 94% where the average for the population was in the mid-80s. the point being the higher experience level, better education and more training with those individuals is yielding better results, market distant results. at the same time, we are concentrating those more trained, more experienced people on the most complex conditions we are dealing with. >> if at all possible, that you have staff be able to reach out at you and take a look at those numbers. >> yes, sir. happy to provide. >> recognize the ranking member, ms. titus. >> thank you, mr. chairman. i'd like to recognize those to if we can get them back into some order order to time.

mr. murphy, i'd be happy to talk about a a rate as effective at the notion of the three different lanes and how to deal with complex cases. we know that the va has the authority to do pay as you rates. i wonder if you would talk about that. talk about what the problems are why you don't use up more often and is that they probably can address that how you compensate the people who make these decisions based on a full claim decided or parkland decided to address these concerns brought up in the previous panel. being that the previous panel product comments about you didn't get credit for it, so it wasn't worth it. without saying yes that's right, no that's not right, let's take that as a base to talk about what we put in place actively right now, which is exactly what you're describing. received acclaim from permit better with 10 issues. break that down into 10 issues and have one great time for 10

readers with one each. break it down to 10 individual issues and make decisions on the 10 individual issues and compensate the veteran if they're entitled to it as the rating decisions become -- as they're made aware before to do the other. the problem with madison assistant right now today, that is very difficult to do. there are some barriers in terms of its much less efficient in the amount of time it takes our overall process to rate 10 individual issues at one each. the fixes we put in place will allow that to go significantly faster and been our intent is to do exactly that, which is rate by issue. so we understand within your bill. they testified on that previously that we've agreed without the concept. at this point in time, there were complications due to her system limitations. >> when you anticipate those

changes will be made? >> i can't put an exact day. what i can tell you is every 90 days be doing a release. i'm not sure which one of those releases that some of these changes are in. one of the changes that is going in and being piloted right now is the vbms authorization mumble and when they been in place to help these individual issues as they are deciding to go through the system quicker. in other words, when i had the vbms authorization model in place come all process individual issues without impacting the total system time. >> will there be safeguards in place so you don't just pay a better and offer a few things and think it will go away as opposed to really do complete? >> we are looking to break in the stance that comes then as a single claim, but it is posted in our system and we track it as though they are 10 individual claims. this isn't just i'm going to receive a claim in break it up by issues.

this is the true issue based quality, everything. >> i know that some of the cases in the reno office have been farmed out to other offices where they can emit vast and stuff like that. if you start break in the claim done so some things are easy and a more complex and you end up into different lanes, you're not going to end up into different places to have your claim completely considered? >> well, depending on mr. or ms. those question a little bit ago about centers of excellence, we certainly need to consider whether those different issues into different lanes even need to be in the same regional office. why a figure with the concept of centers of excellence in the trade happens to be on issue number one in st. petersburg issue number two. why would we not send that claim quite i can move them around the country with a few keystrokes. we still don't have the final

this is exactly how it is going to be, but weeks are the options from how i get it to her system right and fast. >> we just don't want to make it more difficult for a veteran to track where their claim is or understand what is happening with it and when it is happening without scattering it around or making it more complicated. >> yes. you are seeing one of the information points you are interested in is from the reno office. >> we are waiting for some of those answers. >> just under 700 right now. you've heard what we are doing with the 2-year-old claim and 1-year-old claim and now to the 334 days. if the capacity of the regional offices in place to meet timelines we put into meet these different deliverables on the oldest claims, we ship them off to other regional offices. in other words, we make the oldest claim issue a national problem and not one type to a particular regional office. it just so happens in reno today

they have a large number of the older claims. they sent those to other offices that have capacity to give veterans done in a timely manner. thank you. >> i think the gentlelady. >> thank you, mr. chairman. i want to thank the panel as well for the testimony today. mr. murphy, vba currently adjudicate claims related to camp with june in louisville, kentucky. and claims related to radiation in mobile, alabama. can you explain to the committee why this is? >> those claims actually fall under the title of this hearing. they are complex claims. they are highly complex claims. but we don't want to do is have a veteran because they went to regional office ones get one decision an equivalent case in a different rating decision. in order to do that, in order to concentrate efforts in the way we do claims in a paper world, we concentrated them in single places. we provide special training for

the processors and raters to work the claim at the same time we worked with dha and provided training to the individual cmp examiners that work these conditioners and send a factory single jointly trained rating board so they get a consistent accurate output. >> so those two areas are specialized in this particular -- >> yeah. >> for the oig, ms. mccauley, your inspections on this difficult medical conditions, how often is training and a lack of knowledge regarding policies and procedures a problem? how often is that? >> it certainly has shown itself to be a problem as a result of our inspections. ..

and ptsd. similar to what we heard mr. murphy mention about radiation in mobile, alabama. >> we haven't done exam the issue of the specialized, but certainly additional training would be a help in term adjudicating the claims. >> so the better-trained but the better specialized the workers the work and the work you have done, the more accurate they can

timeliness they can process those particular claims? >> we would expect that, yes. >> great, thank you. >> mr. murphy, to follow up on my previous questions about camp will june and mobil, alabama where you specialize in the particular areas. one of the problems i have seen over time being on this committee is particularly in some regional offices where the error rate is over 50%. when you look at the turnover rate in those area they might not be an employer of choice. and constantly training individuals in particularly without veterans coming back from iraq and afghanistan with tbi and ptsd and mst, issues i think it's important that the the new system i like the idea when you look at the medical conditions. with the medical conditions you can move that anywhere around the country in the timely

fashion so if there's a certain regional office that is specialized, such as camp will june, in louisville, kentucky to deal with the issues. they can get an accurate decision in a timely manner. as i understand some of the concerns some of the vso have it's not done in a regional office. it's not done anyway when you look at the cases being broke toard other areas. they are not performing adequately. i would like to just, you know, see whether or not you would really consider looking at, you know, centers of excellence for those very complex cases since you can move it electronically once the system is up and completely running fully. >> we would consider the centers of excellence concept. in fact, my staff is going through now pulling numbers in terms of accuracy, rating capacity, et. cetera. on regional offices right now to identify are there some clear

outliers that say this should be a ceo for ptsd, this should be for military sexual trauma. we are going through the process now. we're beginning the process. it's not quick. it's going to take some time to do to make sure we get it right. it there are some centers of excellence tounge it right. there are some lessons. should i make them the center for all over the country. number two, if the answer is no, i should not. what are they doing different to get it right that i need to teach the other regional offices. either way it goes, the analysis we're doing is going yeeltd good things for us. back to the other part of your question the vso having some concern about the not being able to have that interaction and look at the file and review it. in the paper world, that was a problem. in the electronic world with the stakeholder entry we haven't placed and come up releases which allow them to see more of the claim file and the decision that is being made. they'll be able to perform that review from anywhere in the country regardless what regional

office is working the file. >> i appreciate that answer. for me, i think the number one priority should be making that sures are veterans are taken care of. not whether or not the claim is processed in the regional office. particularly that regional office is not performing the way it should be. so thank you very much. thank you, mr. chairman. >> i thank the gentleman. and i have a another question. i know, mr. oh -- your testimony highlights that they approved policy and procedures to ensure more timely and accurate decisions to veterans of complex claims. setting aside the discussion we just had, about strong concerns and how they calculate accuracy, va's work toward better policies and procedure is welcome, but what the committee is hearing from the ig is that the regional office repeatedly failing to comply with the policies in

place to directors, auditors, managers, it with be a the receipt call exercise. but to the veteran who underrated or denied because of regional offices noncompliant. this is a complete failure. as i read the american legion testimony. for those in the quote for those veterans va accuracy might as well be zero. the inspector general consistently reports that the need for policy guidance oversight training and supervisor review and 17 of 20 recently respected officer remain on noncompliant. most of which were found to be repeatedly out of compliance. how are you going enforce compliance or put in to put it another way, what will be the penalty for noncompliance? >> i can't answer directly your question whab the penalty for noncompliance. that falls under the office of field operation and deputy undersecretary. however, i can tell you what

we're doing to ensure compliance is happening and the solution is not going out yelling at regional offices direct, directors and telling them you must follow the process. the solution to put a system in place that takes them down the path. and camp how we're doing that today is number one i talked about how we changed rules around ptsd. we no longer had to make a determination about the stressor and get a buddy statement saying what happened. we changed the rules so saying the veteran came in and feared in my life. and assess for ptsd. that's the way we handle from the rule side. when i look from the sm putting in place to ensure at the grassroot level take us back to the temporary 100% and the example there is in the system we nut place with vbms, you can no longer hit a button and move through a screen. you are forced to stop and put a

routine future exam date in place and place if under control before they are allowed to press the button and move through the screen. i forced the behavior without having to go out and push and discuss and come back and re-examine. i know, that it's happening because i can track it and see it on my system. and i report every two weeks. that every two week report everlast year i was seeing 600 case. now 50 cases. the reason for that is today there's somewhere in the neighborhood of 74 or 75 percent of our cases are electronic through vbms. we are working through the lapse of the paper. as we move to the electronic environment, the compliance rate will go up and then i'll see the number drop over time. so the answer to your question is, is i fix it by putting procedures in place that drive the ro in the right direction and put system i think i think if -- fixes in place that force the behavior to ensure the veteran gets the right decision. >> before i yield, e i remind you and remind everybody how

many times secretary sat there and talked about accountability. you do all the system call stuff you want. if you are not motivating people to do it, i know they are highly motivated people who want to do right by the veteran. there's a lack of accountability there. and across the board, but with that i'll yield to mr. oh -- >> thank i apologize for missing the second half of the hearing. i'll get ab update how you responded to the specific issues raised by ms. price and the veteran service organizations that were here. so just briefly bring up two issues. one, is in el paso at fort bliss we have 1800 cases, 1100 are

backlogged at the derail site in seattle. and so just a plea from cornel and william beau month from us in our office representing those soldiers, you know, whatever you can do provide additional intention and focus on that so we can get the folks through there. we have some associated problems with our wounded warrior transition unit there, and part is having the folks who are in this backlog, the bureaucratic loop. the second one ms. price medicationed she filed a fully developed claim and took us through every part what she went through to do that. we been pushing for fully qopped claims filed online. we think that come out of the committee. we can cut the wait time.

in el paso right now for atm veteran is 450 days out waco regional office down to something like 100 or less. i want to pick on what she said. i want do you address the concern it raised with me and others there may be a problem with fully developed claims and our ability to process them in a timely fashion and do so accurately. >> let me start with aye does. with understanding what you're talking about and fort hood and the department of army. >> fort bliss. >> sorry. >> yeah. we put definitive actions in place you'll see the numbers at that regional office start going in the right direction. first of which is in april all of the employees at the seattle d -- broarking we shut down gives an immediate trained capacity to go and start working in the cases. two, is in a may of tbirt we

hired an additional 36 raiders in that regional office. in may of 2013, army reserve personnel were activated and deployed in seattle to help it in getting these cases through quicker. staff at the regional office has been working mandatory overnight and right after the holidays they will resume mandatory overtime through 2014 provided the funding is available us. one other item we have done is we had capacity in providence to take some of those cases. we're working faster so 250 cases per month are being brokered to providence in order to help take some of the pressure off the derail site in seattle. so i think in the coming months you'll see drastic changes in

there. one other comment about the process in general. to look at the process and say it's merely a simple claim is to call complex merely a complex claim and call a complex claim a simple one. as a result, a timely claim going through the process is measured at 295 days. not the 125 days like we see for the traditional bundle. the second part was about ms. price and the fdc and i guess i'm not sure what it is you're asking me there, congressman. >> i guess the concern was apologize again. i missed almost everything you've had to say in response to the stories we've heard earlier. you may have already answered many of the concerns --

raised. one of those was ms. price, i believe before transitioning out had already prepared and filed a fully developed claim. and yet he an incredibly arduous, lodge battle to get that claim adjudicated in a satisfactory way. and so it causes concern for me and others when we're trying to direct veterans to file those fully-developed claims online and telling them they can get those claims resolved and in some cases close to 100 days versus the average el paso 4050 days. a story like this gives me pause. i want to know whether it is truly exceptional or whether there's more to that. she seemed to indicate from other veterans that she had met with and assisted she's seeing similar cases to hers. and so just wanted to get your quick feedback on that. again, if you've already answered it or would like to an it in more detail at the

followup meeting i would be happy to meet thin. if you could talk about how exceptional a case like that is. >> i have to say discussing in individual veteran and veterans circumstance. what i can tell you is this based on the time frame that ms. price submitted her claim in 2009, when we were receiving fully developed claims at less than 2% to the today where we're receiving 27% of the claims. they're going through with our highest priority and being tracked and monitored on a national basis and national level. so my point is this, the experience that she saw is by no means typical of the process usually in today when the claims are going through in 115, 120 days through the fully developed claim process. other things that happened in the early stages of it, we had a high rate of those claims that were entered in the to fully developed claim process and various reasons right, wrong, or otherwise were removed from the process and put through the normal channel. we track and monitor that routinely now to make sure a

fully developed claim that comes in maintains its path through the fully developed claim process. there are specific rules that will pull that claim out that have process. but now we put the control measures in place, it's not being used or abused. it's not being used to the rate it was when the fully-developed claim process was new. >> my time is expired. i yield back. >> thank you. members, are there any further questions? on behalf of the subcommittee, thank you all for your testimony. you are now excused. i thank everyone for being here with us today. ensuring our veterans receive timely and appropriate decisions regarding their service connected claim is a top priority for the committee and the department. it is unacceptable for the price that -- to be the accuracy of those decisions. will certainly be a seeking more information in the near future on areas discussed as a va continues to march toward the