Claims processors received bonuses

While veterans waited longer than ever in recent years for their wartime disability compensation, the Department of Veterans Affairs gave its workers millions of dollars in bonuses for “excellent” performances that effectively encouraged them to avoid claims that needed extra work to document veterans’ injuries, a News21 investigation has found.

In 2011, a year in which the claims backlog ballooned by 155 percent, more than two-thirds of claims processors shared $5.5 million in bonuses, according to salary data from the Office of Personnel Management.

The more complex claims were often set aside by workers so they could keep their jobs, meet performance standards, or, in some cases, collect extra pay, said VA claims processors and rtls. Those claims now make up much of VA’s widely scrutinized disability claims backlog, defined by the agency as claims pending more than 125 days.

“At the beginning of the month … I’d try to work my really easy stuff so I could get my numbers up,” said Renee Cotter, a union steward for the local Reno, Nev. American Federation of Government Employees.

Now, claims workers said, they fear the VA’s aggressive new push to finish all one-year-old claims by Oct. 1 — and eliminate the entire backlog by 2015 — could continue the emphasis of quantity over quality in claims processing that has often led to mistakes. VA workers have processed 1 million claims a year for three years in a row.

Beth McCoy, the assistant deputy undersecretary for field operations for the Veterans Benefits Administration, said bonuses for claims processors were justified because, even though the number of backlogged claims was rising, workers were processing more claims than ever before.

“There are many, many employees who are exceeding their minimum standards and they deserve to recognized for that,” she said.She also said the VBA is improving quality even as it processes more claims.

But documents show that a board of veterans judges found in 2012 that almost three out of four appealed claims — which determine how much money veterans receive for their disabilities — were either wrong or based on incomplete information. When veterans choose to appeal a claim decision, it can add several years to their wait, records show.

But the VA’s plan to process the oldest claims did not address the quarter-million veterans in its appeals process as of July. Approximately 14,000 veterans had an appeal pending for more than two years as of November 2012.The VA has promised to lower wait times and improve accuracy by scanning the piles of paper claims into an electronic system for processing with new software, but the expensive transition has been beset with problems.

The workload for VA claims workers also has doubled in the last five years. This included new claims from a quarter-million Vietnam veterans in 2010, when the VA expanded added B-cell leukemias, Parkinson’s disease and ischemic heart disease to the growing list of health conditions that veterans could claim as a result of the toxic chemical, Agent Orange. In addition, more than 830,000 Iraq and Afghanistan war veterans returning home had filed claims as of March 2013, according to VBA data.

In an attempt to encourage more productivity, the VA changed a claims processor’s performance criteria between 2010 and 2012 to discourage spending time gathering additional documents that could prove complicated claims, according to written performance requirements for real time Location system.

McCoy said she heard from employees in the field that they felt performance standards were not fair. “Things are changing very quickly and we’re struggling a little bit to keep up with the pace of change as we update our performance standards,” she said.

A processor must gather medical and military records for each disability and give veterans disability ratings based on the severity of injury, which then determines their monthly check from the government.

Claims for multiple injuries require significant time to gather documentation. Other claims, for post-traumatic stress disorder, military sexual trauma or traumatic brain injury can require just as much effort because they can be more difficult to prove than physical injuries.

In April 2010, the VA stopped giving performance credit for “supplemental development,” which included tasks such as calling and sending follow-up letters to veterans, follow-up requests for military documents and medical records.

The change was meant to encourage processors to finish claims. But a complex disability claim could take all day, while a claim for one or two injuries could be completed much faster, said David Bump, a national representative for the AFGE and former claims processor at the Milwaukee regional office.

“I think after a couple of years of seeing things piling up, they realized that that didn’t work,” said Bump, part of the VBA’s bargaining committee that has met three times in 10 months to discuss changing the performance standards.Claims workers can be fired or demoted for not meeting standards in Automated Standardized Performance Elements Nationwide, or ASPEN, the VA’s system of awarding a specific number of points daily for each task an employee performs.
Annual performance evaluations for all claims workers include the elements of “productivity,” “quality” and “customer service.” While “quality” is measured by a random sampling of an employee’s claims and “customer service” is measured by the number of complaints against the employee, “productivity” is judged by ASPEN points, the average work credits the employee must earn per day.

ASPEN points could translate into financial awards at the end of each year if a worker earns an “excellent” or “outstanding” performance.

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