Examining VA Efforts to Decrease Delays in Veterans’ Disability Compensation Claims

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                        EXAMINING VA EFFORTS TO5                      DECREASE DELAYS IN VETERANS'6                      DISABILITY COMPENSATION CLAIMS78=======================================================================910                                HEARING1112                               BEFORE THE1314                        SUBCOMMITTEE ON DISABILITY15                        ASSISTANCE AND MEMORIAL AFFAIRS1617                                 OF THE1819                     COMMITTEE ON VETERANS' AFFAIRS2021                     U.S. HOUSE OF REPRESENTATIVES2223                    ONE HUNDRED NINETEENTH CONGRESS2425                             FIRST SESSION2627                               __________2829                        WEDNESDAY, APRIL 9, 20253031                               __________3233                           Serial No. 119-163435                               __________3637       Printed for the use of the Committee on Veterans' Affairs3839 [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]4041                    Available via http://govinfo.gov4243                                __________4445                   U.S. GOVERNMENT PUBLISHING OFFICE4661-149                    WASHINGTON : 20254748-----------------------------------------------------------------------------------4950                     COMMITTEE ON VETERANS' AFFAIRS5152                     MIKE BOST, Illinois, Chairman5354AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking55    American Samoa, Vice-Chairwoman      Member56JACK BERGMAN, Michigan               JULIA BROWNLEY, California57NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire58MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,59GREGORY F. MURPHY, North Carolina        Florida60DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky61MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois62JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois63KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York64JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon65ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey66KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota67    Mariana Islands68TOM BARRETT, Michigan6970                       Jon Clark, Staff Director71                  Matt Reel, Democratic Staff Director7273       SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS7475                    MORGAN LUTTRELL, Texas, Chairman7677AUMUA AMATA COLEMAN RADEWAGEN,       MORGAN MCGARVEY, Kentucky, Ranking78    American Samoa                       Member79JACK BERGMAN, Michigan               CHRIS PAPPAS, New Hampshire80NANCY MACE, South Carolina           MAXINE DEXTER, Oregon81KEITH SELF, Texas                    KELLY MORRISON, Minnesota8283Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public84hearing records of the Committee on Veterans' Affairs are also85published in electronic form. The printed hearing record remains the86official version. Because electronic submissions are used to prepare87both printed and electronic versions of the hearing record, the process88of converting between various electronic formats may introduce89unintentional errors or omissions. Such occurrences are inherent in the90current publication process and should diminish as the process is91further refined.9293                         C  O  N  T  E  N  T  S9495                              ----------9697                        WEDNESDAY, APRIL 9, 20259899                                                                   Page100101                           OPENING STATEMENTS102103The Honorable Morgan Luttrell, Chairman..........................     1104The Honorable Morgan McGarvey, Ranking Member....................     3105106                               WITNESSES107                                Panel I108109Mr. Kenneth Smith, Assistant Deputy Undersecretary, Field110  Operations, Acting Executive Director, Education Services,111  Veterans Benefits Administration, U.S. Department of Veterans112  Affairs........................................................     4113114        Accompanied by:115116    Mr. James W. Smith, Deputy Executive Director, Policy and117        Procedures, Compensation Service, Veterans Benefits118        Administration, U.S. Department of Veterans Affairs119120    Mr. Robert J. Orifici, Executive Director, Benefits and121        Memorial Services, Office of Information and Technology,122        U.S. Department of Veterans Affairs123124Mr. James "Jim" R. Swartz, President, AFGE Local 2823, American125  Federation of Government Employees.............................     6126127                                APPENDIX128                    Prepared Statements Of Witnesses129130Mr. Kenneth Smith Prepared Statement.............................    17131Mr. James "Jim" R. Swartz Prepared Statement.....................    22132133                       Statements For The Record134135Disabled American Veterans Prepared Statement....................    41136The American Legion Prepared Statement...........................    44137Veterans of Foreign Wars of the United States Prepared Statement.    55138139                        EXAMINING VA EFFORTS TO140                      DECREASE DELAYS IN VETERANS'141                     DISABILITY COMPENSATION CLAIMS142143                              ----------144145                        WEDNESDAY, APRIL 9, 2025146147   Subcommittee on Disability Assistance &148                          Memorial Affairs,149                    Committee on Veterans' Affairs,150                             U.S. House of Representatives,151                                                    Washington, DC.152    The subcommittee met, pursuant to notice, at 1:44 p.m., in153room 360, Cannon House Office Building, Hon. Morgan Luttrell154(chairman of the subcommittee) presiding.155    Present: Representatives Luttrell, Bergman, McGarvey,156Pappas, and Morrison.157158         OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN159160    Mr. Luttrell. The subcommittee will come to order. Thank161you all. Thank you to all of our witnesses for being here162today. We are taking a close look at the U.S. Department of163Veterans' Affairs (VA) efforts to decrease delays in veterans164disability compensation claims resulting from VA165overdevelopment. When a veteran files a claim for disability166compensation, VA has a duty to assist them with proving their167claim. This means helping veterans obtain service records and168medical records or scheduling veterans for VA disability169compensation exams. VA cannot make a decision on a veterans170claim until all development is completed. Although I hear from171veterans about how frustrating the wait is for a decision to be172made, many times VA efforts to obtain records and/or exams173leads to an award for disability compensation.174    On the other hand, overdevelopment is when VA takes175unnecessary steps to obtain records or exams. Example, if176existing documents in the veterans claims file are sufficient177to support the claim, VA should not schedule a government-178funded disability exam. Overdevelopment forces veterans to wait179longer than necessary for a decision on their claims and can180lead to incorrect decisions. Unnecessary exams also waste181veterans time and money.182    Further, if a veteran misses a VA scheduled exam without183good cause and they do not reschedule, VA automatically denies184the veteran's claim even when it was unnecessary for VA to185schedule the exam in the first place. H.R. 2137, the Review186Every Veterans Claims Act will absolutely fix this injustice.187    Overdevelopment also drives government waste because VA188pays contracted exam vendors for every exam, even those that189were not necessary. In Fiscal Year 2023, about 2.4 million190exams were completed, a number that rose to approximately 3.2191million in Fiscal Year 2024. Contracted exam vendors were paid192for nearly 95 percent of those exams. In December 2024 report,193in the 2024 report, the VA Office of Inspector General (OIG) of194the Inspector General (IG) found that VA spent about $1.4195million on unnecessary exams from April through September 2023.196The total amount of wasted taxpayer dollars each Fiscal Year is197likely much higher. The OIG review did not cover the full198Fiscal Year or examine all types of claims of decisions, both199approvals and denials.200    We have heard from OIG and the VA employees that201overdevelopment mistakes are due to an inadequate training.202Claims processors as well as confusing and inconsistent203guidance. To address overdevelopment, VA created an204Overdevelopment Reduction Task Force. This task force205recommended dozens of actions, including targeted quality206reviews, updating policy guidance, and increased training.207    I look forward to hearing from VA today on the progress208made in implementing the Task Force's recommendations,209particularly I am interested in whether the VA has implemented210a plan to evaluate the effectiveness of its efforts using clear211result-driven metrics for success and I would like to hear212about any efforts VA is undertaking to further enhance its213strategies to decrease overdevelopment.214    Finally, I look forward to discussing whether VA will215implement technology to ensure that every claims processor who216overdevelops a claim learns from that mistake. The National217Work Queue, also known as NWQ, electronically distributed the218major--the majority of VA claims workloads across all regional219offices (RO). The National Work Queue has largely decreased220decision wait times, thankfully. A key feature of the National221Work Queue is that when a claims processor defers a claim for222development, it is returned to the National Work Queue. The223National Work Queue often then routes the claim to a different224claims processor at another regional office for additional225action.226    We have heard about cases where one claims processor after227another claims processor makes the same overdevelopment error228in the same veteran's claim. These repeated mistakes are so-229called avoidable deferrals, have resulted in months or years230long delays for veterans even before a claims processor231realizes that the development efforts were unnecessary. The232current system only notifies the most recent claims processor,233to my understanding, that they committed an overdevelopment234error. All the other previous claims processors who committed235the same mistake in the same claim are actually never notified,236that is what we need clarification on, and therefore do not237learn from that specific mistake.238    November 2024 letter then Undersecretary for Benefits, Dr.239Josh Jacobs informed me that there are no technological240barriers preventing VA from notifying all claims processors who241have made the same overdevelopment mistake in a single claim.242Mr. Jacobs told me the VA would conduct a pilot study to243determine the value of additional functionality. I look forward244to hearing about the study, progress, and any findings under245the current Administration. Every veteran survivor deserves a246timely decision on their claim decisions. Wait times will247decrease if we can reduce or eliminate overdevelopment. I look248forward to hearing from our witnesses today about VA's efforts249to do so.250    I now yield to the ranking member.251252      OPENING STATEMENT OF MORGAN MCGARVEY, RANKING MEMBER253254    Mr. McGarvey. Thank you, Mr. Chairman. Good afternoon,255everybody. Thank you all so much for being here today. You all256have heard me say this a million times. I am going to say it a257million more times. Everything we do on this subcommittee is on258behalf of our veterans. Everything. It is to serve our259veterans. Today, that means making sure that the VA systems260used to process disability claims for our veterans work the261best they can. It also means equipping and empowering the262employees who serve the veterans. We need them to be able to do263their best work without unnecessary limits or undermining their264importance to the system.265    Unfortunately, this Administration continues to spread the266false message that VA employees are not dedicated to their267mission, that they do not have the veterans best interest at268heart. There is an email from U.S. Office of Personnel269Management (OPM) that castigated all Federal workers as low270productivity. It is simply not true. It is also hurtful. It271hurts morale at the VA, which ultimately affects the job272performance, which hurts our veterans, which is what we are273focused on in this committee, helping our veterans.274    The Veterans Board of Appeals employees, the Veterans275Benefits Administration (VBA) employees, like those in my276regional office in Louisville, Kentucky, are highly dedicated277to their mission. Many are veterans themselves. They go to work278every day in a stressful, high-pressure environment and work as279hard as they can on behalf of the veterans they both serve and280sometimes served with. They are in systems where they are281forced to work in, and the systems fail. They are not given282adequate training. They are subject to arbitrary performance283metrics and sometimes arbitrary discipline and now even284unnecessary insults. All of that makes it more difficult for285them to do their job, which, of course, ultimately makes it286more difficult to serve our veterans.287    I am interested today in exploring ways that we can improve288outcomes for veterans by making the job of these dedicated VBA289employees easier. The Administration's recent decision to end290collective bargaining agreements with the unions representing291these employees, it is a serious mistake. I think it is going292to harm both the employees at the VBA and the veterans they293serve. That is really important.294    I think it is going to have an adverse impact on our295veterans because the unions are crucial to creating a workplace296that helps employees perform their best, delivering better297results for our veterans. They help employees feel more298invested in their work, and they offer better chances for299mentorship and personal growth. The public sector unions play300an important role in creating a higher quality training for301their members and providing important feedback to management302and policymakers about what is actually happening on the ground303in the organization. This means better retention rates. It304means lower wait time for benefits, and ultimately better305service for our veterans.306    Contrary to belief, public sector unions do not stand in307the way of dismissing bad employees. In fact, they often308facilitate it. It is in their best interest to make sure that309all employees are doing their job well. Public sector unions310do, however, make sure an employee's dismissal is justified,311orderly, and most importantly, legal.312    I am hopeful today that the Secretary will listen to this313committee and request an exemption from Trump's executive order314(EO), because these employees deserve all the rights afforded315to them under law and the Constitution to best fulfill their316mission and, of course, deliver the best possible service and317results for our veterans.318    Thank you, Mr. Chairman. I yield back.319    Mr. Luttrell. Thank you, Mr. McGarvey. Our lead witness320from VA is Mr. Kenneth Smith, Assistant Deputy Undersecretary321for Field Operations, as well as the Acting Executive Director322for Education Services for the Veterans Benefits323Administration. Mr. Smith is joined by Mr. James Smith, Deputy324Executive Director for Policy and Procedures. You guys related?325    Mr. Smith. No.326    Mr. Smith. No.327    Mr. Luttrell. Just checking. Procedures and Compensation328Services. Sorry, man, I lost myself. I am sorry. For the329Veterans Benefits Administration. Mr. Smith is also joined by330Mr. Robert Orifici. Got it. We have been together long enough.331Executive Director for Benefits and Memorial Services for the332Office of Information and Technology. Today's witness panel333also includes Mr. James Swartz, sir, who is the president of334Local 2823 in the American Federation of Government Employees335(AFGE).336    I asked that the witnesses on our panel please stand and337raise your right hand.338    [Witnesses sworn.]339    Mr. Luttrell. Let the record reflect that the witnesses340have answered in the affirmative. Mr. Smith, you are now341recognized for 5 minutes to deliver--Mr. James Smith, you are342now recognized. What is that? I am sorry. Mr. Kenneth Smith,343you are going to start us off with the Smiths. You are now344recognized for 5 minutes to deliver your opening statement on345behalf of the Department.346347                   STATEMENT OF KENNETH SMITH348349    Mr. Smith. Good afternoon, Chairman Luttrell, Ranking350Member McGarvey, and members of the subcommittee, thank you for351the opportunity to discuss VA's efforts to increase efficiency352and process processing veterans disability compensation claims353through the National Work Queue and improvements brought by the354Overdevelopment Reduction Task Force. Joining me today are355James Smith, Deputy Executive Director for Compensation356Service, and Robert Orifici, Portfolio Director for Benefits,357Appeals, and Memorial Services, Office of Information and358Technology.359    The Veterans Benefits Administration has undertaken360substantial efforts to enhance training and quality review361programs by focusing on high standards of performance and362continuous learning opportunities for VA staff. Today, I will363highlight three specific ways VA is better supporting our364employees and veterans.365    The first improvement is enhancing the Exam Scheduling366Assistant, which helps employees correctly determine if an exam367or medical opinion is necessary. Originally launched in 2023,368this tool was refreshed last year through the most recent work369of the Overdevelopment Reduction Task Force. Exam errors370specific to overdevelopment have been one of the top categories371of error and delay, resulting in avoidable deferrals and372rework. Recent enhancements increase the tools used by 48373percent and contributes to a reduction in monthly errors cited374for exam overdevelopment. In Fiscal Year 2025, to date, these375errors have decreased by 7 percent over Fiscal Year 2024. VBA376will integrate this tool into the Veterans Benefits Management377System (VBMS), which we expect to launch in Fiscal Year 2026.378    The second improvement involves training strategy. In June3792024, VBA launched interactive hands-on learning modules and380updated training content, including comprehensive lessons on381requesting exams. These efforts reinforce concepts through382interactive activities, ongoing assessments to gauge mastery of383the content, remedial training, and follow-up assessments for384those who need additional repetition. As recommended by a385recent OIG audit, VA added The Sergeant First Class Heath386Robinson Honoring our Promise to Address Comprehensive Toxics387(PACT) Act specific related medical opinion requirements to all388training products, ensuring employees are well trained to389address common disabilities. During VBA's Quality Standdown on390March 20th of this year, claims processors were provided391additional training and live instructor engagement activities392focused on ordering exams and medical opinions.393    Third, VBA and the Office of Information Technology are394developing a solution to complete claims actions correctly the395first time through improvements to the Veterans Benefits396Management System. This upgraded functionality is being397designed as an error check for the employee, providing real398time feedback on potential errors before the claim is recalled399to the National Work Queue. This effort is aimed at reducing400instances of misdevelopment, while improving first touch401efficiency and reducing avoidable deferrals. This functional402enhancement is currently in development and is planned for403initial testing beginning in Fiscal Year 2026. On the topic of404avoidable deferrals, VA has recently completed preliminary data405analysis for a pilot study. The study aims to develop a406reporting solution for employees to receive feedback on any407claim they touched that resulted in an avoidable deferral. I408look forward to providing results to the committee on this409study and its impact on training and mentoring.410    VA is also working on additional improvements to the411National Work Queue to support improved timeliness through412better workload management. These include advanced data413analytics and predictive modeling to prioritize claims in near414real time and distribute claims based on complexity, urgency,415and employees skill and experience to speed up the claims416process. These improvements will also allow employees to417request additional work in real time directly from the work418queue and promote supervisory focus on coaching and quality.419Together, these upgrades ensure claims are handled by the most420suitable staff, leading to a faster decision and continued421reduction of the claims backlog, and higher quality decisions422for veterans. This project is estimated for completion in423Fiscal Year 2026.424    VBA remains committed to delivering the highest standard of425service to our Nation's veterans, their families and survivors.426While significant progress has been made, we recognize the need427for continuous improvement and adaptive--adapting to evolved428needs of those we serve.429    Thank you for continued support and collaboration as we430honor our veterans' sacrifices. Mr. Chairman, this concludes my431statement. My colleagues and I are ready to answer any432questions you or other members of the subcommittee may have.433434    [The Prepared Statement Of Kenneth Smith Appears In The435Appendix]436437    Mr. Luttrell. The written statement of Mr. Smith will be438entered into the hearing record. Mr. Swartz, you are now439recognized for 5 minutes, sir.440441                   STATEMENT OF JAMES SWARTZ442443    Mr. Swartz. Chairman Luttrell, Ranking Member McGarvey, and444members of the committee, on behalf of AFGE and National445Veterans Affairs Council (NVAC), I appreciate the opportunity446to testify today. My name is James Swartz, and I am President447of AFGE Local 2823 representing the Cleveland, Ohio Regional448Office. I am a U.S. Army Service-Connected Veteran and I have449the privilege of continuing to serve my fellow veterans, first450as an Registered Nurse (RN) at the Cleveland VA and then in VBA451for the last 23 years. On behalf of over 320,000 VA employees452AFGE represents, including thousands of claims processors. It453is a privilege to offer AFGE's views on the National Work Queue454training and how VBA can enable employees to more efficiently455and effectively process veterans' and the beneficiaries'456claims.457    VA should modify the National Work Queue so that a claim458remains within the same regional office for the duration of its459processing. Variations between regional offices can cause460claims processors from different ROs to misunderstand each461other's work, resulting in a correct claim being unnecessarily462deferred or delayed. Furthermore, by keeping a claim in a463single regional office, managers have more control to send464claims back to the original Veterans Service Representative465(VSR) who wants worked on it. This would allow the VSR to learn466from this error and not repeat it. This would also let the VSR467and our Rating Veterans Service Representative (RVSR) who are468already familiar with the claim to efficiently address follow-469up work, saving other employees from wasting time to470familiarize themselves with a new claim.471    If VBA, despite record production and quality from472employees while working from home during COVID-19 pandemic, is473going to require claims processors to report to the regional474office, why continue to shuffle work throughout the country and475not instead leverage employee ability to collaborate with the476colleagues sitting next to them?477    As Congressman Self asked about the last time I testified,478despite the claims backlog, one of the most consistent479complaints from the claims processors is they do not have480enough work to meet the performance metrics and must waste time481asking for more work. The reason for this problem is the482internal controls VBA has put on the National Work Queue.483    To address this, AFGE recommends, first, the National Work484Queue should automatically provide claims to individual claims485processors work queue when they are out of cases to develop or486rate. Second, claims processors should have a limited ability487to temporarily hold onto the claim before it is retracted by488the National Work Queue. Having the claim stay within one489regional office for its duration would avoid delays and give490ROs more control over their workload. It would also allow491secondary claims to be associated with the primary claim and492worked on simultaneously. Third, the National Work Queue must493better filter automatic ready-to-rate claims, ensuring494employees do not waste time on cases that are not ready to495rate. Fourth, VBA should program the National Work Queue so496employees who have previously worked on the claim have the497claims returned to them. This would allow claims processors to498learn from any mistakes that were previously made and improve499efficiency and quality.500    New employees do not understand the claims process or VA501lingo that is critical for employees to do their job. This is502an easy problem to fix. All training should require hands on503experience using the tools employees will actually use.504Training must also focus on mastering the basics, including505learning the claims process, VBA terminology, and what a claim506looks like. AFGE urges VBA to reorder its curriculum to allow507instructors to reference the material that was just taught,508reinforce the concept, and use this to teach higher level509concepts. VBA must also improve PACT Act training as Talent510Management System (TMS) self-reviewed courses are ineffective,511especially considering constant updates to the Standard512Operating Procedure (SOP) and manuals that are not reflected in513the training.514    Finally, on behalf of AFGE and NVAC partners who have long515worked with this committee to help improve the VA and its516delivery of benefits in health care to our Nation's heroes, I517respectfully urge you to ask Secretary Collins to use the518authority granted to him by President Trump's executive order519to certify VA employees, including the employees under the520jurisdiction of the subcommittee at the Veterans Benefit521Administration, National Cemetery Administration, and the Board522of Veteran Appeals, are not involved in national security and523are, in turn, exempt from the executive order.524    The rights guaranteed in our collective bargaining525agreement are critical to our ability to support the VA's526mission and better serve veterans and their families. VBA is527two generations of employees, both the mentors with528institutional memory who are close to retirement and the next529generation who are just beginning their journey of caring for530veterans. Within 5 to 10 years, this knowledge will be lost531forever if there are no exemptions made, combined with the532proposed rifts. AFGE and NVAC stand ready to work with the533House VA Committee and VBA to address these issues.534    Thank you and I look forward to your questions.535536    [The Prepared Statement of James Swartz appears in the537Appendix]538539    Mr. Luttrell. The written statement of Mr. Swartz will be540entering into the hearing record. We will now move to541questioning. Mr. Smith, Kenneth Smith, Mr. Swartz seems like he542nailed it right on the head. Now, this is kind of the543conversation you and I have been having the past couple of544years.545    Can we have a, not totally granular, but dive into the546National Work Queue 2.0? You mentioned first touch efficiency.547I think that is brilliant. Then what Mr. Swartz said, how a548specific claim will return to a particular Veterans Service549Organization (VSO) before it is--so it can be completed or550repopulated into the work queue and then out to another551regional office.552    Mr. Smith. Thank you for the question. We are working on553new capability to focus on direct feedback to employees at the554development action. This is a solution that we have been555thinking carefully about since our conversations over the last556year, year and a half. The idea here is to provide an error557check right after they have completed their actions and before558it returns to the National Work Queue to prevent delay on that559claim. This is part of an interactive discussion between my--560VBA and the Office of Information and Technology, who is561working on that solution right now.562    Mr. Luttrell. As we are doing our best to inform anyone563that they have made a mistake from the top down, what are we564doing from the bottom up as far as training and readiness is565going, so the mistake window is closed?566    Mr. Smith. Yes. I mean, we have completely revamped our567training. Mr. Smith and his team have been working diligently568on that to build in more training about exams, to make sure569that we order the right exams the first time and not570overdevelop. It has been added into all of our existing571training products as well as our most recent Quality Standdown,572where we took our entire workforce offline for a day to focus573on specific training needs.574    Mr. Luttrell. Mr. Swartz mentioned that some of the VA575employees are saying there is not enough work for them, which I576find that--I have heard that myself from VA employees. I would577like to hear your response and I--okay, so you are going to get578into the National Work Queue thing. I got it. All right.579However, if we do have certain employees at regional offices580say there is nothing here for me. We have a miss somewhere.581    Mr. Smith. Yes, sir. There are 918,000 veterans waiting for582decisions in the National Work Queue right now.583    Mr. Luttrell. Is that number----584    Mr. Smith. I----585    Mr. Luttrell. That number is down?586    Mr. Smith. It is. Since over the last year we have dropped587it almost 6 percent.588    Mr. Luttrell. Six percent?589    Mr. Smith. Mm-hmm.590    Mr. Luttrell. Okay.591    Mr. Smith. The very fact that we do not have any work,592there are two potential reasons for that that I can understand.593You know, one is it has not been assigned to the employee or594they have depleted all the work in their queue. That is why we595want to be able to allow them to pull claims in when they are596ready and then have us, have the National Work Queue push597claims to them that is matched to their experience and598training. Newer employees that are trained on a smaller subset599of disabilities or types of claims get disability claims that600they can work until they are fully trained and able to do all601of them. More experienced staff can handle the more complex602claims.603    Mr. Luttrell. I understand this correctly, now a claim will604move from the National Work Queue into a regional area. A VA605employee will be able to pull that claim without having a606supervisor load up their desktop more or less, and the607supervisor providing, I guess, oversight and training. An608employee can, can move as much as possible. I am sure there is609a baseline somewhere. It is like, hey look, you are--your610minimum is this weekly, monthly.611    Mr. Smith. My expectation, and this is still, we are still612working on the exact development and solution with Mr.613Orifici's staff. The concept that we are operating under is614that we will be able to distribute enough claims every day,615prospectively, to keep people busy. Then if they actually run616out because things are not ready for them, that they will be617able to request additional work.618    Mr. Luttrell. I know we do not have a stat yet on--I am619going to walk that one back. I want to think about that one for620a second. Sir, Ranking Member, I will yield to you for your621questioning.622    Mr. McGarvey. Thank you, Mr. Chairman. Mr. Swartz, I want623to dig in a little bit about the recent executive order and the624collective bargaining agreement that AFGE negotiated with VA.625Aside from just being a gross breach of good faith, it also has626some very real practical and detrimental consequences on the627day-to-day work of those who are involved in processing claims.628Again, that means our veterans. Anything that harms our629frontline employees' ability to do their job by definition630harms their ability to serve the veterans who are at the heart631of VA's mission, who are at the heart of the mission of this632committee.633    Mr. Swartz, ask you some questions. To your knowledge, has634the Secretary submitted a request for an exemption to the635collective bargaining EO for VBA employees?636    Mr. Swartz. No, sir.637    Mr. McGarvey. Thank you. Mr. Swartz, can the union members638at VA collectively bargain for wages or promotions?639    Mr. Swartz. No, sir. That is banned by law, I believe.640    Mr. McGarvey. Okay. Can the union collectively bargain641performance standards surrounding either quality or timeliness642of claims processing?643    Mr. Swartz. No, sir.644    Mr. McGarvey. When was the last time the union workers at645VA went on strike?646    Mr. Swartz. Never. It is against law.647    Mr. McGarvey. Perfect. Can the union collectively bargain648for more or better training?649    Mr. Swartz. No, sir. I do believe that is where the union650would be very beneficial for both the employees, the VBA or VA,651and also for the veterans. Most of us are workers ourselves. We652are aware of what is going on. We do the work, we talk to the653first line employees, and more often they will come to us and654let us know what their training needs are. Many of them are655afraid to actually go to managers or supervisors. We have even656worked with a lot of supervisors when employees are running657into trouble so that we can work with the employees to get them658where they need to be.659    Mr. McGarvey. What would you say is the biggest impediment660to frontline employees operating more efficiently with higher661quality? How do you think AFGE can help remedy that?662    Mr. Swartz. The number one issue would have to be training,663and that is where the VA would be, or, I am sorry, the unit664would be able to work with the VA in order to establish what665training is needed and to help the employees be able to get to666their--get these training needs met when it becomes an issue,667before it becomes a problem.668    Mr. McGarvey. Just looking at this, how does the lack of a669union with collective bargaining rights impact the ability of670frontline employees to do their job well and better serve671veterans?672    Mr. Swartz. I would say one of the biggest things has673probably have to do with moral, the moral impact that it would674have. The employees will no longer have a voice. They will no675longer feel comfortable or competent to be able to go to the676agency and discuss what their training needs are or discuss677even what some of the roadblocks are in the way of them678performing the mission.679    Mr. McGarvey. Is VBA planning to consult frontline680employees in development of new technology modules?681    Mr. Swartz. Not that I am aware of.682    Mr. McGarvey. Okay. What about the training content?683    Mr. Swartz. Again, not that I am aware of. I have been684fortunate enough at, I hate to say it, at my regional office,685but I have been able to work with management to get employees686some of the additional training necessary.687    Mr. McGarvey. For Mr. Kenneth Smith, I will just ask you688those exact same questions. Is VBA planning to consult689frontline employees in development of new technology or690training modules?691    Mr. Smith. Usually management develops the solutions and692then we brief the union when it is time to implement.693    Mr. McGarvey. I would just suggest from being in the694private sector and other things, getting the input from the695people who are actually doing the work on the ground before you696develop the training is a best practice. What about the697training content, is it the same thing?698    Mr. Smith. I believe that there--and I will ask Mr. Smith699to weigh in on this. I believe there are union members on the700training team.701    Mr. Smith. That is correct. Not only are they on the702training team, they develop the content and then also Subject703Matter Experts (SMEs) from the field, more often than not are704labor BUEs. They are actually the ones providing the training.705    Mr. McGarvey. Again, we want the best training. We want the706best employees. This is what helps our veterans. Thank you guys707so much.708    Mr. Chairman, I yield back.709    Mr. Luttrell. Thank you, sir. Mr. Smith, did the710Overdevelopment Reduction Tax Task Force, was that disbanded711last year?712    Mr. Smith. I would not say disbanded, sir. It completed713work at the end of July. We are working right now on some714additional initiatives. Such as, we are collaborating with the715Board of Veterans' Appeals and Office of General Counsel to716take a look at end-to-end automation and process and procedural717efficiencies.718    Mr. Luttrell. Did it perform its functionality as it should719have? It seemed like that was a pretty short window.720    Mr. Smith. Yes, sir. They made more than 50 manual updates721to streamline and clarify guidance as well as promoted and722executed some enhancements to the exam scheduling assistant to723make it more--a little better for employees.724    Mr. Luttrell. That is onboard and running.725    Mr. Smith. It is up and running, but it is a standalone726tool. What we are doing right now is building that into VBMS so727that the claims processors do not have to lead the VBMS728environment to use it.729    Mr. Luttrell. Besides updating the VBA manual on March 10,730what else is the VA doing to ensure claims processors731understand the long-standing rules for when to schedule an732exam?733    Mr. Smith. That is core to our training. All of our734training content reinforces the requirements for training for735ordering exams and medical opinions. We have done that through736our Overdevelopment Reduction Task Force. Those recommendations737reinforce that leading to a 7 percent decrease in738overdevelopment errors.739    Mr. Luttrell. You mentioned 7 percent reduction off of the740gross number. What is projection for this year and what was741our--did we break a record last year? Or last year--in February742for disability claims?743    Mr. Smith. Yes. We completed more than a million claims744earlier this year than ever before.745    Mr. Luttrell. Job well done.746    Mr. Smith. Thank you.747    Mr. Luttrell. I will share that with everybody I know. How748are we looking for what month is it? April, May, June? How -749what is the projection downstream?750    Mr. Smith. We are looking--right now we are running eight751and a half percent ahead of where we were this time last year.752We are looking to complete more than 2.5 million claims this753year.754    Mr. Luttrell. What is our total that are outstanding? I755mean, eventually I would assume we are going to run out of756veterans.757    Mr. Smith. Well----758    Mr. Luttrell. If we are working at this rate, seems like. I759probably should not say it like that. I got 40,000 veterans who760will kick my butt for saying that. I did not mean that in a bad761way. What I meant was, for the record, what I meant was762eventually all our veterans will be whole.763    Mr. Smith. Yep. We continue to receive about 10,000 new764claims a day. Our inventory right now is 918,000. We have been765fortunate with some high productivity. We have been completing766north somewhere between right around 11,000 claims a day to767help us decrease the inventory and get ahead of the backlog as768well.769    Mr. Luttrell. Okay, well. Outstanding. Before I move on,770Mr. Smith, do you have anything you would like to add? I would771hate for you to come all the way--we are having markup in772multiple committees currently today. Obviously, that is why--773the ranking member and I are the only ones here. Mr. Smith, I774am not going to let you come all the way to DC. and not say775anything.776    Mr. Smith. No, I appreciate the opportunity. I would like777to circle back to the Overdevelopment Task Force. In addition778to what Mr. Smith shared some of the feedback not only from,779you know, our partners across the different business lines, but780our SMEs from the field to include bargaining unit employees781(BUEs), was that the class size was too large. We shrunk the782class size. We focused on four phases of a training process.783Planning, design development, implementation, evaluation, or784the Kilpatrick Model. We are focused on making data-driven785decisions and updates to the training based on feedback, the786assessments that the employees complete themselves as well as787data that has gleaned from quality reviews. We are committed to788continuous process improvement with the goal of putting789veterans first in every decision made.790    Mr. Luttrell. Mr. Orifici.791    Mr. Orifici. Thank you for the opportunity. We are792extremely excited about the work that we are doing in support793of VBA and claims process. We are utilizing a lot of the794current technologies including Artificial Intelligence (AI) to795help us get ahead of the claims process.796    Mr. Luttrell. Are you where you need to be or is the VA797where they need to be in the AI space, since it is forever798changing? I would recommend you keep us very well read on if we799are slowing so we can get ahead of it.800    Mr. Orifici. No, we are definitely leaning into it. We are801utilizing it to its most. We are very excited about the802interactive assist that we have for claims with helping them to803avoid deferrals and help them make the right decisions. This804will also tie back into ordering the right exams when they are805needed and not ordering exams when they are not.806    Mr. Luttrell. Mm-hmm.807    Mr. Orifici. We have a lot of very interesting pilots808coming up that we are working with VBA on. That should yield a809lot of benefits when it comes to making the right decision the810first time versus having to defer back to correct later on.811    Mr. Luttrell. Okay, thank you. There will always be812something that populates. There will always be a problem set813that exists. The VA is such a wonderful working machine. Right?814I mean, I say that wholeheartedly. It has its problems. It815does. We should forever be changing in order to keep up with816the wants and needs of our veterans' space. As we move into, as817our older generations, we are moving into the younger818generations, our generation of war fighters are coming into the819VA, and there are a lot of us. Then, you know, it pains me to820say this, but we are always on the threshold of activation821again.822    If we do have to go to another theater of war, it will823populate more and more and more of us. The VA, as hard as we824work, will always have to work harder every single day. Every825day, I am sure you do the same thing. Every day I wake up and I826walk into the--I look in the mirror, I was like, it is not827about me. It is about everybody I represent. Guess what,828gentlemen? You represent the most cherished asset we have, and829that is our veterans that allowed us to do the things that we830do today. Okay?831    Ranking Member, you got any closing remarks?832    Mr. McGarvey. Thank you, Mr. Chairman. I echo those833remarks. I thank you for your service and thank you all for the834service you perform, particularly on behalf of our veterans,835the men and women who are putting on a uniform, willing to836sacrifice everything to keep us safe and keep us free. What I837am going to ask you all to do is on this committee, we actually838do our best to work together because we understand the mission839of this committee is to serve our veterans. Make sure you got840the best management, make sure you got the best labor, and that841everybody is getting the training they need, and that everybody842has access to the tools they need and the morale they need, the843retention that we need to keep people there to keep these844claims going forward, because that is what is going to help our845veterans out. Hope you all can continue to do that good work,846because it is going to take care of the men and women who took847care of us.848    Mr. Chairman, I please ask unanimous consent to enter into849the record the following letter to Secretary Collins, from Rep.850Takano, yourself, Senator Blumenthal, and 126 other members of851the House and Senate condemning the Trump Administration's852decision to obviate the collective bargaining agreements,853bargaining rights of Federal employees, and urging the854Secretary request waiver from those requirements.855    Thank you.856    Mr. Luttrell. Without objection. Thank you again,857gentlemen, for coming today. I ask unanimous consent that all858members have 5 legislative days to revise and extend their859remarks and include extraneous material. Without objections, so860ordered. This hearing is adjourned.861    [Whereupon, at 2:18 p.m., the subcommittee was adjourned.]862863=======================================================================864865                         A  P  P  E  N  D  I  X866867=======================================================================868869                    Prepared Statements of Witnesses870871                              ----------872873                  Prepared Statement of Kenneth Smith874875    Good morning, Chairman Luttrell, Ranking Member McGarvey, and876Members of the Subcommittee. I appreciate the opportunity to appear877before you today to discuss VA's efforts to improve efficiency in878Veterans' disability compensation claims processing through the879National Work Queue (NWQ), and the efficacy of VBA's quality assurance880and training programs resulting from the Overdevelopment Reduction Task881Force (ODRTF). Joining me today are James Smith, Deputy Executive882Director of Compensation Service, and Robert Orifici, Executive883Portfolio Director for Benefits Appeals and Memorial Services, Office884of Information and Technology.885    VA is committed to providing outstanding customer service to our886Nation's Veterans, their families, and survivors, and we are steadfast887in our commitment to timely and accurate decisions on Veterans'888disability compensation claims. VBA has a robust training and quality889review program holding employees, regional offices (RO), and program890offices to a higher standard for producing quality claims decisions891while also promoting continuous learning and performance improvement.892We appreciate the Subcommittee's interest in this topic, and I know we893share the same goal of collaboration and continuous improvement.894895Over-Development Reduction Task Force896897    On January 31, 2024, ODRTF's second phase (ODRTF 2.0) kicked off898with a focus on improving the claims examination process. The task899force put an emphasis on contract examinations, utilization of private900Disability Benefits Questionnaires (DBQ) submitted by Veterans,901utilization of the Examination Scheduling Request tool, and902effectiveness of automated examination ordering. It also explored903opportunities in policy, processes, and technology to eliminate over-904development.905    When ODRTF 2.0 concluded in July 2024, VA implemented numerous906recommendations in several areas including improvement of the private907DBQ submission process; guidance to field employees on appropriately908requesting examinations; and employee training to assist claims909processors in scheduling more informed, intentional, and accurate910requests for disability examinations and medical opinions.911    One of the recommendations that VBA implemented were improvements912to the Exam Scheduling Assistant (ESA). This tool provides claims913processors with a series of questions for each claimed disability and914helps determine whether an examination or medical opinion is warranted.915VBA is in the process of integrating the web-based ESA tool into the916Veterans Benefits Management System (VBMS) so that claim data can be917auto-populated, reducing duplication of work and increasing the918accuracy of examination decisions. The integrated tool will continue to919present the claims processor with a series of questions to aid in claim920development. The anticipated date of release of the integrated tool is921Fiscal Year (FY) 2026.922    Additionally, since June 2024, VBA has made procedural changes to923clarify and emphasize that examinations are not required when there is924sufficient evidence of record to decide the claim. VA regulations925direct decision-makers to render a decision without the need of further926examination or development, if the medical evidence of record is927sufficient. This includes accepting private DBQs when sufficient, which928avoids scheduling unnecessary exams. VA is continuing to guide claims929processors on this concept as another update to VA's procedures manual930relating to medical evidence sufficiency was just published on March93110, 2025.932933Training and Quality Initiatives934935    In June 2024, VBA began efforts to modernize training for all936disability compensation claims processors. This program has937specifically focused on reducing over-development in medical opinions938and examinations - streamlining when, why, and how they are ordered.939These lessons emphasize hands on learning and reinforcement of concepts940through interactive and engaging activities, ongoing assessments to941ensure learners are mastering the content, and remedial training and942follow-up assessments for those who fail to grasp the concept the first943time it is assessed. Some of the specific training courses provided in944support of minimizing over-development include courses on preventing945deferred rating decisions in the claims process, identifying the need946and sufficiency of VA examinations, reviewing DBQs to determine if a947medical opinion is necessary to decide a claim versus when it can be948decided based on the evidence of record, and a renewed training on the949duty to assist requirements for our Rating Service Representatives who950render decisions on Veterans' claims for compensation benefits.951    When training newly hired claims processors, VA emphasizes the952negative impact over-development has on claims timelines. How, when,953and whether to order examinations consistent with regulatory guidance954are addressed in several courses during initial claims processor955training. The courses emphasize the impact of 38 C.F.R.Sec.  3.326 -956specifically, that medical evidence accompanying a claim, whether957submitted by the claimant or received from a Federal records custodian,958might render a claim ready for decision without the need of further959examination or development. This scenario is frequently seen with cases960of active, presumptive cancer, or claims for increase for total joint961replacement - an examination would provide no new information beyond962what is already available in the medical records, so the claim should963be decided immediately.964    Examination and medical opinion training courses have also been965updated to include the most recent guidance on requesting evidence,966sufficient examinations, and Sergeant First Class Heath Robinson967Honoring our Promise to Address Comprehensive Toxics Act of 2022 or968PACT Act-related claims and toxic exposure risk activity opinions.969These concepts are reinforced throughout training with knowledge checks970and instructor guidance.971    Additional training is provided to claims processors on a recurring972basis for topics such as the different types of medical examinations973and opinions and in which scenario each is required or not required to974grant a claimed issue. An important part of this training is975specifically focused on preventing the ordering of additional976development for examinations and medical opinions when the evidence of977record allows the claimed issue to be resolved in the Veteran's favor.978This information is laid out and reemphasized throughout the training979program for new claims processors.980    In June 2024, VBA hosted the first ever VBA-wide Quality Standdown,981highlighting the Agency's commitment to the importance of high-quality982actions and positive work experience. This provided claims processors983with targeted instruction on medical exam requests and the rework984process. In the post-event survey, with 77 percent of employees985reporting positive sentiments with improvements noted in 3 month986rolling quality. In Fiscal Year 2025, VBA plans to host regular events987collaborating with the Board of Veterans' Appeals and Office of General988Counsel to further improve measurable outcomes and engage employees in989content directly related to accuracy trends.990    VA acknowledges that there is always room for improvement, however991VBA's quality data shows that monthly errors cited for examination992over-development in Fiscal Year 2025 to date has decreased by just over9937 percent from Fiscal Year 2024. VBA achieved this while the average994number of claims processors on production increased by nearly 11995percent. Additionally, in disability compensation rating claims, 3-996month issue-based accuracy improved from 91.5 percent at the close of997Fiscal Year 2024 to just under 93 percent at the close of January 2025.998This portrays that the changes VBA implemented to improve quality999assurance and training programs are having a positive effect. VBA will1000continue to find ways to improve.1001    VA's commitment to continued process improvement of quality1002programs has been further strengthened by additional safeguards that1003have been built into the processing software used to develop and decide1004claims for benefits. For example, modifications were made to the1005examination process by updating a tracking indicator in the VBMS system1006to clarify the status of medical examinations and what additional1007evidence, if any, may be required. This allows claims processors1008involved with the claim to quickly surmise the status of the claim and1009to determine what other development actions are required to decide the1010claim.10111012Implementing VA Office of Inspector General (OIG) Recommendations10131014    In the OIG Report, ``Staff Incorrectly Processed Claims When1015Denying Veterans' Benefits for Presumptive Disabilities Under the PACT1016Act,'' \1\ OIG made a process recommendation and a systems1017recommendation. VA has made significant progress in addressing both. As1018previously noted in this testimony, VBA is scheduled to implement the1019web-based Exam Scheduling Assistant (ESA) tool within the VBMS in early1020Fiscal Year 2026. However, the ESA tool has been available as a stand-1021alone, web-based tool for claims processors since November 2023, in1022addition to RO guides developed by the Medical Disability Examination1023Office such as the ``Exam Scheduling Request Reference Job Aid'' and1024``Medical Opinion Guide.''1025---------------------------------------------------------------------------1026    \1\ https://www.vaoig.gov/reports/review/staff-incorrectly-1027processed-claims-when-denying-veterans-benefits-presumptive1028---------------------------------------------------------------------------1029    Transformative changes are currently being implemented in the1030National Work Queue (NWQ) system, as well as how the NWQ team trains1031the field on workload management, which will impact the efficiency of1032claims processing within VBA. VBA has implemented training to address1033workload management issues, to include local auto-assignment rules.1034Supervisors have provided positive feedback that the training has1035significantly helped, and they also bring that knowledge back to their1036RO peers.1037    While the December 2024 OIG report highlighted inconsistencies in1038claims processing, VA is actively addressing these issues by refining1039the Adjudication Procedures Manual and enhancing examination tools.1040Most recently, on March 10, 2025, VBA published a revision to the1041Manual to add a note on the threshold for evidence of a current1042disability-or persistent or recurrent symptoms of disability-for the1043purpose of determining whether to request an examination and/or medical1044opinion and to cross-reference similar principles discussed in other1045portions of the Manual. Based on this progress, VBA has requested1046closure of the related recommendation and continues to work toward1047closure of the remaining recommendation.1048    VA is committed to continued process improvement for processing1049PACT Act claims and is implementing OIG's recommendations. VA is1050continuing to update the Manual on when personnel should request1051medical disability examinations and opinions. Additionally, VA is also1052working on enhancing systems and tools involving the examination1053process.10541055National Work Queue Initiatives and Improvements10561057National Training and Supervisory Workload Management Training (SWMT)10581059    In August 2023, NWQ conducted national training for all regional1060offices, with over 600 claims processing managers attending, focusing1061on local rules and deferral routing. This content has since been1062incorporated into the SWMT, launched in February 2024. SWMT is designed1063to equip new supervisors with the principles and best practices for1064workload management. To date, 300 supervisors have benefited from this1065training. Additionally, NWQ offers personalized consultations with RO1066managers to enhance their understanding and application of local1067workload routing rules.10681069NWQ 2.0 and Enhancements10701071    NWQ 2.0 will represent a significant leap forward in VBA's claims1072processing capabilities. One of the areas of concern raised by Congress1073during a previous oversight hearing and confirmed by an internal ``red1074team'' is the routing of work back to an employee who previously worked1075on a claim. The current system, which utilizes Prior Assignment Routing1076(PAR), has limitations, and does not always ensure that the claim1077reaches the actual claims processor who previously worked on it. To1078address this, VA has developed requirements for a new approach to1079replace PAR, allowing for claims to be routed back to the employee1080based on the last creditable transaction. VA is taking this one step1081further and is carefully evaluating other approaches to implement1082themes from the ODRTF while also reducing missed development. This1083targeted approach will is expected to improve the first touch1084efficiency and reduce avoidable deferrals, while still maintaining a1085routing process to get the claim back to the last person who took1086action on the claim.1087    Another key improvement in NWQ 2.0 is the introduction of a1088``pull'' capability to allow a claims processor the ability to take the1089next claim to be worked out of a dynamically optimized list of claims1090pending assignment. Through this capability, claims processors will be1091``badged'' with attributes, including experience level and proficiency1092levels for specific categories of claims. When the employee is out of1093work, they may request an additional claim, and the system will1094automatically assign a claim that meets their competencies. Eventual1095functionality will allow employees and their supervisors specific,1096actionable feedback for additional training, while ensuring that claims1097requiring special handling are directed to claims processors who are1098both trained and qualified, thereby enhancing the efficiency and1099accuracy of our service to Veterans.1100    VBA and the Office of Information and Technology (OIT) are1101currently working to define requirements to achieve outcomes for both1102reduction in erroneous development, the ability to leverage the prior1103claims processor's expertise as well as provide feedback on errors if1104subsequent development is necessary. This functionality will be1105released incrementally, with the first deployments starting in Quarter11064 of this fiscal year. As functionality becomes available, VBA and OIT1107will collaboratively confirm that the functionality is working as1108intended and adapt requirements to ensure VBA has the capability needed1109to distribute claims effectively.11101111Deferrals11121113    The deferral process is a critical component of VBA's commitment to1114quality and employee development. Deferrals are a mechanism for1115employees working later stages of the claims process, to ensure the1116completeness and accuracy of claims processing. It allows for mentoring1117and constructive feedback, particularly for junior employees. When an1118employee completes all required actions, they are certifying that the1119work done is accurate and is ready for the next action by subsequent1120claims processors to complete the claim. The most important movement of1121a claim is the movement from evidence development to the decision1122phase. In this scenario, if the decision-maker cannot make a decision1123due to a misstep in evidence development, they will issue a deferred1124decision and direct additional action be taken to remedy the issue.1125This type of deferral may be categorized as either avoidable or1126unavoidable. An avoidable deferral is an error in workmanship, while an1127unavoidable deferral typically arises when new evidence has been1128introduced subsequent to the last action. This process is not unique to1129NWQ; it is an electronic adaptation of VBA's longstanding practice.1130    Avoidable deferrals are routed back to the last employee who1131handled the claim for correction. This reflects a simple accountability1132framework: employees are accountable for certifying the claim is ready1133for a decision and should only certify claims for decision when they1134have personally reviewed and have ensured that all necessary actions1135have been taken. This fundamental management determination and process1136ensure accountability and are longstanding principles that are hard1137coded into VBMS. As of February 2025, 99 percent of all avoidable1138deferrals were being routed back to the RO and 92 percent were routed1139to the specific employee that last worked the claim in the prior claim1140cycle.\2\1141---------------------------------------------------------------------------1142    \2\ Deferrals may not route back to the previous employee if the RO1143has the avoidable deferral routing turned off for specific employees1144due to a new work assignment.1145---------------------------------------------------------------------------1146    Supervisors play a crucial role in monitoring deferral frequencies1147and developing plans for improvement. As part of recent national1148events, such as the Quality Standdown and SWMT, supervisors have1149received training on new tools to evaluate deferral trends and errors1150trends. These tools include the Deferral, Error, and Transaction1151Dashboard which compiles six reports into one easy to use tool, for1152reviewing deferral data and recommending appropriate remedial training.1153This report also houses all errors in one report, providing a breakdown1154of errors by body system and claimed condition. These tools will allow1155VBA to make data driven decisions to enhance training and drive quality1156improvements.1157    VBA is taking a data driven approach to construct a pilot for wider1158communication of a claim's deferral. VA's duty to assist often requires1159more than one review in the development process. While VA is working to1160ensure these claims are routed back to the same claims processor and1161has made substantial improvements in this area, employee leave and1162capacity may require assignment to another claim's processor for1163subsequent action. While the deferral process assigns accountability1164for full and complete evidence development to the last employee to work1165the claim in the development cycle, VBA does recognize the potential1166for feedback to the claims processor(s) who worked on the claim1167upstream from the final certification of completeness. This feedback1168would be focused on training and awareness of the need for quality at1169each step of the process, with the intended effect of constructive1170supervisor-employee discussions and continuous improvement. Available1171data will be evaluated and shared with RO supervisors to determine the1172utility of the feedback, which is in addition to existing feedback from1173VBA's formal quality management process.1174    OIT and VBA are also evaluating other efforts to prevent deferrals1175before they occur. One area of exploration will use Artificial1176Intelligence (AI) and machine learning to analyze a claim, reference1177policy manuals and user training materials, and provide guidance to1178claims processors on which actions should be taken. These efforts are1179using historic claims and deferrals to train AI models to better1180understand what steps will be needed to lead to the correct outcomes1181the first time. VA plans to begin a small pilot on this and other1182efforts by the end of this fiscal year.11831184Conclusion11851186    VA remains committed to identifying areas where we can improve our1187systems and processes to increase the efficiency and quality of1188benefits that we deliver to the Nation's Veterans. We will continue to1189leverage internal quality reviews, adapt our training programs, and1190continue advancements in NWQ 2.0 to ensure that all claim processors1191are equipped with the best tools to complete our sacred mission and to1192uphold President Lincoln's promise to care for those who have borne the1193battle and for their dependents. Mr. Chairman, this concludes my1194statement. We thank the Committee for your continued support of1195programs that serve the Nation's Veterans and look forward to working1196together to further enhance delivery of benefits and services. My1197colleagues and I are prepared to respond to any questions that you or1198other members of the Subcommittee may have.11991200                   Prepared Statement of James Swartz12011202[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]12031204                       Statements for the Record12051206                              ----------12071208            Prepared Statement of Disabled American Veterans12091210    Chairman Luttrell, Ranking Member McGarvey and Members of the1211Subcommittee:12121213    DAV (Disabled American Veterans) is grateful to provide a statement1214for the record for this oversight hearing titled, ``Examining VA1215Efforts to Decrease Delays in Veterans' Disability Compensation1216Claims''.1217    DAV is a congressionally chartered and Department of Veterans1218Affairs (VA) accredited veterans service organization. We provide1219meaningful claims support free of charge to veterans, family members,1220caregivers and survivors.1221    To fulfill our service mission, DAV directly employs a corps of1222benefits advisors, national service officers (NSOs) and transition1223service officers (TSOs), all of whom are themselves wartime service-1224connected disabled veterans, at every VA regional office (VARO) as well1225as other VA facilities throughout the Nation, including the Board of1226Veterans' Appeals (Board). During 2024, DAV filed 561,358 claims for1227over 1.5 million specific injuries and illnesses on behalf of thousands1228of veterans, resulting in more than $30.4 billion in earned benefits1229for veterans and their families.1230    We currently provide representation for nearly 250,000 pending1231claims and appeals before the Veterans Benefits Administration (VBA).1232Based on over a century of direct experience, we are pleased to provide1233our insights and concerns related to the significant issue of1234overdevelopment within the VA claims and appeals processes. This issue1235directly affects the efficiency of VBA and the well-being of millions1236of veterans who rely on timely access to their earned benefits.1237    Our testimony outlines the significant problems with1238overdevelopment in several areas, which include feedback from our1239service officers; claims related to the PACT Act; military sexual1240trauma (MST); and disability benefits, as well as appeals under the1241Appeals Modernization Act (AMA) and DAV's recommendations.1242    Overdevelopment, characterized by redundant and unnecessary1243requests for additional evidence delays decision-making, creates1244inefficiencies and imposes undue burdens on veterans. Additionally, the1245implementation of the Veterans Benefits Management System (VBMS) and1246the National Work Queue (NWQ) have contributed to challenges in1247overdevelopment despite their intended purposes of streamlining the1248claims process.1249    Examples of overdevelopment noted by our service officers1250illustrate the broader systemic inefficiencies within the VA that1251continue to hinder the timely and accurate resolution of claims and1252appeals. For example:12531254      Improper indexing of evidence in VBMS results in1255unnecessary efforts to develop evidence already present in the1256claimant's record.12571258      VA claims processors that initiate examinations for1259conditions unrelated to Toxic Exposure Risk Activity (TERA) leads to1260wasted resources and unnecessary processing steps for TERA claims.12611262      VA requests for additional examinations despite claimants1263providing DBQs completed by private physicians results in delaying the1264veteran's access to benefits.12651266    The VA's statutorily required duty to assist is a foundational1267obligation that requires the agency to assist claimants in gathering1268relevant evidence to support their claims. Unfortunately, unclear and1269inconsistent communication regarding the duty to assist has contributed1270significantly to overdevelopment. Claimants often receive vague or1271redundant notifications requesting additional evidence without1272sufficient guidance on what is needed. This ambiguity results in1273repetitive submissions, unnecessary delays, and excessive evidence1274gathering, which burden both claimants and the VA system. Notifications1275intended to update claimants on claim statutes frequently lack detail,1276leaving claimants uncertain about next steps and prolonging the process1277further.1278    The severity of the overdevelopment problem is fully displayed in1279the 2024 Office of Inspector General (OIG) report titled, ``Staff1280Incorrectly Processed Claims When Denying Veterans' Benefits for1281Presumptive Disabilities Under the PACT Act'' (Report Number 24-00118-128201), which identified critical systemic issues in PACT Act claims1283processing. Claims processors often requested unwarranted examinations1284and medical opinions, even for conditions presumptively linked to1285service. These unnecessary actions caused delays and incurred $1.41286million in avoidable expenditures over 6 months. Underpayments totaling1287$56,700 were identified for improperly denied claims, along with 8701288potential errors affecting veterans' benefits. Examinations containing1289inadequate or conflicting information were not sent back for1290clarification but were prematurely used to deny claims, further1291exacerbating delays and appeals.1292    Additionally, the OIG report indicated that the VA had an1293overdevelopment-reduction task force and the Deputy Under Secretary for1294Policy and Oversight stated that overdevelopment is expensive and time-1295consuming and has been a known problem for years.1296    Another area that has been plagued with systemic inefficiencies and1297overdevelopment are claims dealing with MST. According to the 2021 OIG1298report, ``Improvements Still Needed in Processing Military Sexual1299Trauma Claims,'' (Report Number 20-0041-163), nearly half of MST-1300related claims denied during a 6-month review were processed1301incorrectly. Claims processors failed to apply liberal evidentiary1302standards, essential for MST cases due to the difficulty of documenting1303such incidents. The report attributed these failures to inadequate1304training and oversight, which perpetuates errors and prolongs the1305process. Claimants submitting MST-related claims often faced redundant1306evidence requests and unnecessarily lengthy appeals due to mistakes in1307the initial claims process.1308    Appeals processing under the AMA has also been affected by1309overdevelopment. The 2023 OIG report--``VHA Faces Challenges1310Implementing the Appeals Modernization Act'' (Report Number 22-02064-1311155) highlighted inefficiencies in providing guidance for higher-level1312reviews and supplemental claims. Claimants often encountered delays1313caused by inconsistent processes, inadequate tracking systems, and1314excessive evidence-gathering requirements. These issues undermine the1315AMA's intent to streamline the appeals process and result in1316unpredictable outcomes for veterans seeking resolution.1317    The VBMS has also contributed to overdevelopment. According to the1318GAO report titled ``VA Disability Benefits: Training for Claims1319Processors Needs to Be Enhanced'' (GAO-24-107510), VBMS faces technical1320limitations, including system defects and slow response times. These1321issues necessitate manual interventions that perpetuate redundant1322evidence requests and inefficiencies. Furthermore, VBMS has not fully1323integrated appeals capabilities, complicating claims resolution and1324adding to claimants' frustrations.1325    The NWQ, established to balance workloads across regional offices,1326has created additional challenges. Less experienced claims processors1327often request additional evidence, which leads to redundant requests1328and delays as processors seek clarification or additional records1329unnecessarily. The lack of standardized protocols across offices1330further exacerbates disparities in decision quality and timeliness.1331    Fragmented record retrieval processes also remain a significant1332hurdle. The NWQ and VBMS exacerbate these delays by frequently1333transferring claims between offices, further complicating an already1334disjointed system. As we have pointed out, overdevelopment is a1335significant problem within the claims and appeals processes.1336    DAV recommends the following targeted reforms:13371338      Streamline the claims process: Eliminate redundant1339evidence requests and enhance automated systems to track claims1340progress in the NWQ and VBMS.13411342      Simplify forms: Redesign VA Forms, such as 21-526EZ and134320-0996, to eliminate unnecessary sections and provide clearer1344instructions, ensuring veterans can submit accurate claims and appeals1345efficiently.13461347      Enhance communication protocols: Establish clear and1348consistent standards for duty-to-assist notifications, providing1349veterans with specific and actionable guidance on required evidence and1350detailing claim status updates.13511352      Expand training programs: Equip claims processors with1353specialized training to handle complex cases, including PACT Act1354claims, MST-related claims, and AMA appeals. Emphasize proper1355application of evidentiary standards and effective communication with1356veterans.13571358      Standardize NWQ protocols: Ensure claims are assigned to1359processors with relevant expertise to improve decision quality and1360consistency across regional offices.13611362      Strengthen compensation and pension examination1363protocols: Minimize errors by enforcing comprehensive evaluations and1364implementing peer reviews of examination reports for accuracy and1365accountability.13661367      Streamline record retrieval: Collaborate with the1368Department of Defense to create a centralized, efficient system for1369accessing veterans' medical and personnel records. Efforts should also1370focus on simplifying processes for obtaining private medical records.13711372    Systemic reforms are essential to eliminate the barriers imposed by1373overdevelopment and ensure the VA fulfills its obligation to serve1374those who have served. DAV urges Congress to enact these critical1375reforms, empowering the VA to provide timely and equitable benefits for1376all veterans.1377    As an accredited veterans service organization, DAV remains1378steadfast in its commitment to advocating for the fair and timely1379resolution of claims and appeals. Our cost-free advocacy empowers1380millions of veterans and their families to navigate the complexities of1381the VA system.1382    Mr. Chairman, this concludes DAV's statement for the record.13831384               Prepared Statement of The American Legion1385[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]13861387  Prepared Statement of Veterans of Foreign Wars of the United States13881389    Chairman Luttrell, Ranking Member McGarvey, and members of the1390subcommittee, on behalf of the men and women of the Veterans of Foreign1391Wars of the United States (VFW) and its Auxiliary, thank you for the1392opportunity to provide testimony on this topic.1393    Myriad reasons may cause delays in the Department of Veterans1394Affairs (VA) disability compensation claims process. However, despite1395the reason, they often result in underpayment of claimants and denial1396of benefits, at least for a period of time. We will limit our statement1397to four common causes of delay: failure to conduct a full review of the1398record prior to filing the claim, claim overdevelopment, review of the1399physician's medical opinion by a lesser credentialed medical1400professional, and anomalies in claims processing automated tools.14011402Failure to Conduct a Full Review of the Record14031404    A VA Veterans Service Representative must perform a full review of1405a record during the development of the claim. In some cases, claims1406processors will focus on the first contention in the record and then1407base examinations and other actions only on that specific claimed item,1408rather than consider the entire scope of the claim. Ordering medical1409examinations based on an incomplete understanding of the record could1410cause unnecessary or duplicative examinations and medical opinions as1411the details of the record emerge. Superfluous medical examinations1412contribute to a disjointed process and unnecessary delays.14131414Overdevelopment14151416    Overdeveloping the claim by ordering unnecessary medical1417examinations slows down the claims process and often frustrates the1418veteran. Claims for conditions related to toxic exposures seem1419especially prone to overdevelopment. Presumption of service connection1420satisfies the need for a medical opinion if the claimant's service1421record substantiates service in an exposure location and eliminates the1422requirement for further medical examination. Any additional1423investigation or medical examinations would be redundant and should be1424considered overdevelopment. As an example, for a veteran exposed to1425burn pits, VA would automatically grant service connection for a claim1426for chronic obstructive pulmonary disease (COPD), which is a1427presumptive condition attributed to that exposure. VA should not order1428a medical examination and incur a delay to determine some other cause1429of the COPD, such as the veteran's smoking habits. The VFW recommends1430that VA cross reference any previous claims and/or existing medical1431records to prevent ordering an unnecessary medical examination that1432would contribute to a delay in adjudicating the claim. VA also1433acknowledges claims overdevelopment as a problem area and established1434its own overdevelopment task force in 2021 to educate claims processors1435on strategies to reduce or eliminate this practice.14361437Review by Lesser Credentialed Medical Professional14381439    Sending the physician's medical opinion to a lesser credentialed1440medical professional, such as a nurse practitioner, for confirmation/1441certification causes unnecessary delay and should not routinely occur.1442Claimants could perceive this practice as developing evidence to deny1443the claim rather than offering the veteran reasonable doubt. Time lost1444in sending the medical opinion report to this medical provider and1445awaiting action contributes to the delay with no increase in accuracy,1446quality, or completeness of the claim, and often results in an improper1447denial of benefits.14481449Automated Tools Performance Degradation14501451    Automated tools ease claim preparation, submission, and tracking.1452However, VA must monitor their use to detect problems and develop1453solutions at the earliest possible opportunity to prevent delays.1454Beginning in May 2024, our VFW Service Officers noticed delays over1455several months in electronic claims submissions to the Veterans1456Benefits Management System. Delays of 40 days were routine persisting1457through December 2024. During those months, we met several times with1458VA to solve the problem and determine the cause. The situation is1459currently resolved with submissions occurring mostly within a day or1460two, but we still do not know conclusively what caused the delay or1461what to do if it occurs again. A 40-day delay to simply add evidence to1462a veteran's record is unacceptable and provides the opportunity for1463other situations that could have adverse effects, such as when VA1464decides a claim when there is additional evidence waiting for initial1465processing that would have resulted in a grant of benefits. When this1466happens, the veteran must file an appeal and wait months or years for a1467benefit delayed by an incomplete claims file.14681469Information Required by Rule XI2(g)(4) of the House of Representatives14701471Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has1472not received any Federal grants in Fiscal Year 2025, nor has it1473received any Federal grants in the two previous Fiscal Years.14741475The VFW has not received payments or contracts from any foreign1476governments in the current year or preceding two calendar years.14771478                                 [all]