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Full text of "Delivery of veterans' benefits and services by the Pittsburgh Regional Office and related issues : field hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, first session, June 28, 1993"

DELIVERY OF VETERANS' BENEFITS AND SERVICES 
BY THE PinSBURGH REGIONAL OFHCE AND 
RELATED ISSUES 



Y 4. V 64/3: 103-20 



Delivery of Ueterans' Benefits and... 

I FIELD HEARING 

I BEFORE THE 

* SUBCOMMITTEE OX 

OA^RSIGHT AND IM^STIGATIOXS 

OF THE 

COMMITTEE ON VETERANS' AFFAIRS 
HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRD CONGRESS 
FIRST SESSION 



JUNE 28, 1993 



Printed for the use of the Committee on Veterans' Affairs 

Serial No. 103-20 




SEP 



9 JS34 



1(r 



U.S. GOVERNMENTT PRINTING OFFICE 
76-767 cc WASHINGTON : 1994 

For sale by ihc U.S. Govemmcnl Pnnling OITicc 
Superintendent of Documents. Congressional Sales Otfice. Washington, DC 20402 
ISBN 0-16-0A4453-5 



en 

V DELIVERY OF VETERANS' BENEFITS AND SERVICES 

-' BY THE PnrSBURGH REGIONAL OFPICE AND 

RELATED ISSUES 

Y 4. V 64/3: 103-20 



Delivery of Ueterans' Benefits and... 

FIELD HEAEING 

BEFORE THE 

SUBCOMMITTEE ON 
O^^RSIGHT AND IM^STIGATIONS 

OF THE 

COMMITTEE ON VETERANS' AFFAIRS 
HOUSE OF REPRESENTATR^S 

ONE HUNDRED THIRD CONGRESS 

FIRST SESSION 



JUNE 28, 1993 



Printed for the use of the Committee on Veterans' Affairs 

Serial No. 103-20 




^^p - 9 n4 



U.S. GOVERNMENT PRINTING OFFICE 
75-767 cc WASHINGTON : 1994 

For sale hy the U.S. Government Printing OITice 
Superintendent ol" Documents. Congressional Sales Office. Washington. DC 20402 
ISBN 0-16-0A4453-5 



COMMITTEE ON VETERANS' AFFAIRS 
G.V. (SONNY) MONTGOMERY, Mississippi, Chairman 



DON EDWARDS, California 

DOUGLAS APPLEGATE, Ohio 

LANE EVANS, Illinois 

TIMOTHY J. PENNY, Minnesota 

J. ROY ROWLAND, Georgia 

JIM SLATTERY, Kansas 

JOSEPH P. KENNEDY, II, Massachusetts 

GEORGE E. SANGMEISTER, Illinois 

JILL L. LONG, Indiana 

CHET EDWARDS, Texas 

MAXINE WATERS, California 

BOB CLEMENT, Tennessee 

BOB FILNER, California 

FRANK TEJEDA, Texas 

LUIS V. GUTIERREZ, lUinois 

SCOTTY BAESLER, Kentucky 

SANFORD BISHOP, Georgia 

JAMES E. CLYBURN, South Carolina 

MIKE KREIDLER, Washington 

CORRINE BROWN, Florida 



BOB STUMP, Arizona 
CHRISTOPHER H. SMITH, New Jersey 
DAN BURTON, Indiana 
MICHAEL BILIRAKIS, Florida 
THOMAS J. RIDGE, Pennsylvania 
FLOYD SPENCE, South Carolina 
TIM HUTCHINSON, Arkansas 
TERRY EVERETT, Alabama 
STEVE BUYER, Indiana 
JACK QUINN, New York 
SPENCER BACHUS, Alabama 
JOHN LINDER, Georgia 
CLIFF STEARNS, Florida 
PETER T. KING, New York 



Mack Fleming, Staff Director and Chief Counsel 



SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

LANE EVANS, Illinois, Chairman 



MAXINE WATERS, California 
BOB FILNER, California 
LUIS V. GUTIERREZ, Illinois 
JAMES E. CLYBURN, South Carolina 
MIKE KREIDLER, Washington 
JILL LONG, Indiana 



THOMAS J. RIDGE, Pennsylvania 
SPENCER BACHUS, Alabama 
TERRY EVERETT, Alabama 
JACK QUINN, New York 



(II) 



CONTENTS 



June 28, 1993 

Page 

Delivery of Veterans' Benefits and Services by the Pittsburgh Regional Office 
and Related Issues 1 

OPENING STATEMENTS 

Chairman Evans 1 

Hon. Thomas J. Ridge 2 

Prepared statement of Congressman Ridge 63 

WITNESSES 

Bemier, Jr., Dr. George M., Dean, School of Medicine, University of Pitts- 
burgh 8 

Prepared statement of Dr. Bemier, with attachments 83 

Bushey, Harold, Director, Pittsburgh Regional Office, Veterans Benefits Ad- 
ministration; accompanied by Harry Feather, Senior Management Analyst; 
Michael Vudragovicn, Acting Adjudication Officer; Gerald Serrino, Assistant 
Director; Nick Vrcic, Management Annalyst; Carl Reuter, Loan Guaranty 
Officer and Tracy Alton, Vocational Rehabilitation and Counseling Officer 

and Anthony Annoreno, Acting Chief, Veterans Service Office 41 

Prepared statement of Mr. Bushey, with attachments 139 

Conley, Ronald, National Executive Committeeman (PA), The American Le- 
gion 13 

Prepared statement of Mr. Conley 97 

Coyne, Hon. William J., a Representative in Congress from the State of 

Pennsylvania 7 

Prepared statement of Congressman Coyne 79 

Curley, Kenneth, Past National Commander, American Defenders of Bataan 

and Corregidor 16 

Prepared statement of Mr. Curley 101 

Ehrhardt, Jack, Vet Center Team Leader in Erie, PA 33 

Prepared statement of Mr. Ehrhardt 134 

Fitzgerald, Thomas, Jr., President, Board of Directors, Vietnam Veterans 

Leadership Program 28 

Prepared statement of Mr. Fitzgerald 112 

Graham, Trea, Veterans' Affairs Advisory Board 31 

Prepared statement of Ms. Graham 116 

Kiren, Joseph, Legislative Director, Tri-State Chapter of Paralyzed Veterans 

of America 19 

Prepared statement of Mr. Kiren 105 

Klink, Hon. Ron, a Representative in Congress from the State of Pennsylva- 
nia 5 

Prepared statement of Congressman Klink 68 

Lieberth, Charles, Pennsylvania State Civil Service Commission 29 

Prepared statement of Mr. Lieberth 114 

Reed, William, Pittsburgh Department Service Officer, Veterans of Foreign 

Wars 17 

Prepared statement of Mr. Reed 102 

(III) 



Page 
IV 

Webber, Paul, Western Pennsylvania District Director, Vietnam Veterans 

of America 18 

Prepared statement of Mr. Webber 103 

Zeglin, Charles, Pittsburgh Department Service Officer, The American 

Legion 15 

Prepared statement of Mr. Zeglin 99 

MATERIAL SUBMITTED FOR THE RECORD 

Memorandum: 

To Director, Department of Veterans Affairs from Acting Adjudication 

Officer, re Quarter Progress Report, April 7, 1993 120 

Report: 

"Veterans Administration/Pittsburgh Cancer Institute Collaborative Lung 

Cancer Efforts," submitted by Dr. Bernier 94 

Statement: 

AMVETS 148 

Hon. Rick Santorum, a Representative in Congress from the State of 

Pennsylvania 66 

Hon. John Murtha, a Representative in Congress from the State of Penn- 
sylvania 81 

Study: 

Comparison of Postoperative Mortality in VA and Private Hospitals," 
reprinted from Annals of Surgery, Vol 217, No. 3., March 1993, submit- 
ted by Dr. Bernier 85 

Table: 

Adjudication Division-C&P Issues— WIPP EPC Report, May 12, 1993, 

submitted by Chairman Evans 61 

Written committeee questions and their responses: 

Congressman Ridge to The American Legion 153 

Congressman Ridge to Veterans of Foreign Wars 154 

Congressman Ridge to Paralyzed Veterans of America 156 

Chairman Evans to Vietnam Veterans of America 161 

Congressman Ridge to American Defenders of Bataan and Corregidor, 

Inc 162 

Congressman Ridge to Veterans' Affairs Advisory Board 164 

Congressman Ridge to Vietnam Veterans Leadership Program 175 

Congressman Ridge to Pennsylvania State Civil Service Commission 177 

Congressman Ridge to Department of Veterans Affairs Medical Center, 

Erie, PA 178 

Chairman Evans to Department of Veterans Affairs Regional Office, 

Pittsburgh, PA 180 

Congressman Ridge to Department of Veterans Affairs Regional Office, 
Pittsburgh, PA 189 



DELIVERY OF VETERANS' BENEFITS AND 
SERVICES BY THE PITTSBURGH REGIONAL 
OFFICE AND RELATED ISSUES 



MONDAY, JUNE 28, 1993 

House of Representatives, 
Subcommittee on Oversight and Investigations, 

Committee on Veterans' Affairs, 

Washington, DC. 
The subcommittee met, pursuant to notice, at 8:30 a.m., Univer- 
sity of Pittsburgh Law School, Pittsburgh, PA, Hon. Lane Evans 
(chairman of the subcommittee) presiding. 
Present: Representatives Evans, Ridge, Klink, £ind Coyne. 

OPENING STATEMENT OF CHAIRMAN EVANS 

Mr. Evans. Good morning. This proceeding is an official hearing 
of the House Veterans' Affairs Subcommittee on Oversight and In- 
vestigations. Many hearings conducted by Congress are held to con- 
sider proposals for new legislation or new programs. That is not 
our purpose today. Instead today, we want to review £ind examine 
existing programs; programs which provide important benefits to 
veterans. We want to learn how well these programs are being 
managed, and if the delivery of benefits to veterans can be im- 
proved. 

Many people believe government can do more and still spend 
less. On more than one occasion this subcommittee has uncovered 
faulty management and wasteful spending. Like many here today, 
I believe we can do better. However, I also know that we cannot 
do everything with nothing. 

If we, as the most powerful Nation on the face of the earth, are 
to provide a reasonable package of benefits to those who have an- 
swered our country's call, then we must also be willing to pay for 
those benefits and their delivery. There is no such thing as a free 
lunch. 

Today, our attention is focused on the Pittsburgh Regional Office 
of the Veterans Benefits Administration, or VBA. The VBA exists 
for one purpose; to effectively administer benefits which have been 
earned by our Nation's veterans. Those benefits, I emphasize, have 
been earned. 

The VA administers many veterans programs. These include 
compensation for service-connected disabilities, veterans edu- 
cational benefits, vocational rehabilitation, the VA home loan guar- 
antee program and pensions for wartime veterans. VA, of course, 

(1) 



also operates one of the Nation's largest health care programs, pro- 
vides burial benefits, and operates a major insurance program. 

As the benefit programs administered by the Pittsburgh Regional 
Office of the VBA are the focus of today's hearing, the subcommit- 
tee will not be examining the VA health care system, burial bene- 
fits, or insurance programs this morning. 

The Pittsburgh Regional Office plays a critical role in the deliv- 
ery of many benefits to veterans living in Western Pennsylvania 
and parts of West Virginia. How well is the Pittsburgh Regional 
Office doing its job? Can it do better? Are VA benefits being deliv- 
ered courteously, promptly, and with a minimum number of errors? 
What problems do veterans have when dealing with the VA? What 
problems hamper Regional Office employees? How can these prob- 
lems be reduced, if not eliminated? 

The purpose of the hearing today is not simply to find fault, 
place blame or point fingers. TTiat would not be productive or help- 
ful. Those actions, alone, won't produce improvements. Rather, the 
purpose of this hearing is to identify and understand todaj^s prob- 
lems and the opportunities which exist for improving services to 
our Nation's veterans. 

Many people have helped this subcommittee prepare for this 
hearing. The University of Pittsburgh and its representatives are 
especially appreciated. 

The chair understands that several of the participants in todays 
hearings have other obligations. Therefore, the chair requests the 
cooperation of each participant so that this hearing can be con- 
ducted in a timely manner. 

The written statement submitted by each witness will be in- 
cluded in its entirety in the record of this hearing, without objec- 
tion. Witnesses are again requested and reminded to limit their 
oral statements to five minutes and to summarize from their writ- 
ten statement, as needed. 

It is now a great pleasure to recognize the distinguished ranking 
minority member of this subcommittee. Congressman Tom Ridge, 
a combat veteran of Vietnam, who always aids this committee in 
its deliberations and is the reason that we are here today. Con- 
gressman Ridge, we very much appreciate your leadership, support 
and assistance and look forward to your remarks. 

OPENING STATEMENT OF HON. THOMAS J. RIDGE 

Mr. Ridge. Mr. Chairman, first of all on a personal note, let me 
thank you. You are the chairman of the Oversight Subcommittee, 
and your thoughtfulness and generosity in response to my request 
to have this hearing is very much appreciated, on a personal note. 
I certainly appreciate you arranging your schedule so that you 
could be with us in Pittsburgh today. Your staff has been very 
helpful as well, and I am grateful to them. 

Let's also say thanks to Lou Tronzo and the University of Pitts- 
burgh and its Law School, for all the assistance they have given 
us. My brother went to law school here. I suspect that he argued 
in this moot courtroom. It's beautiful. As we look down at an im- 
pressive and pretty intimidating facility, no wonder he's doing so 
well. If you get through an argument in this magnificent room, 
court rooms don't intimidate at all. 



America has always felt a debt of gratitude toward those who 
serve and protect the principles of this country, its liberties, its 
freedoms, and the opportunities that we enjoy. This coimtry, since 
its birth, has recognized that veterans should be compensated for 
service-connected disability or death. America's commitment to its 
veterans has grown stronger with each war this country has 
fought. It's our responsibility in the Veterans' Affairs Committee, 
to make sure that that support never waivers. 

It's one thing to make a commitment; it certainly is another to 
make sure the commitment is being carried out. If the system is 
broken or in need of repair we have no choice but to fix it, if we 
are to be consistent with our commitment to veterans. Otherwise, 
we are not living up to the promise we made to the young men and 
women when they put on the uniform of this country and went off 
to far away places to represent the interest of the United States 
of America. 

The Regional Office in Pittsburgh is the 19th largest nationally. 
It's pretty astonishing. They have jurisdiction over nearly 600,000 
veterans. They have the responsibility of ensuring that each and 
every one of these veterans are receiving the highest level of care, 
not to mention the benefits and services that they rightly deserve. 

We are here today because in my 11 years as a Member of Con- 
gress, most of that time I have been on the Veterans' Affairs Com- 
mittee, I have personally overseen quite a few of the cases that 
have come before my office. I feel a particular commitment to this, 
and that underscores my commitment to veterans, particularly to 
some of the more difficult or troubling cases that we have seen in 
Western Pennsylvania. 

In the past couple of years there have been some concerns of 
mine based upon what I have observed in these files in terms of 
sensitivity to certain medical conditions, the timeliness of the re- 
sponse, and that's what really precipitated my request for this 
hearing. 

Let it be said from the outset, that I believe strongly giving cred- 
it where credit is due. Most of the claims and most of the claimants 
that work through and need the VA Regional Office need timely re- 
sponses back. I think we need to point that out. If I am 80 percent 
happy with the office that means we have still plenty of room for 
improvement. 

When a man or woman puts on a uniform for the country the 
government doesn't say to them we want you 80 or 90 percent of 
the time, we want you 100 percent of the time. They don't say we 
want your commitment 80 or 90 percent of the time, they want it 
100 percent of the time. 

The reason we are here today is to see what we can do to make 
sure that this Regional Office has the resources, the staff, or what- 
ever else it needs to be 100 percent effective 100 percent of the 
time, to 100 percent of the veterans in the veterans' claims that go 
across their desks. We are talking about the claims process, we are 
not just talking about statistics. 

I know internally there's concern about end products and people 
add up numbers at the end of lines. But it is my understanding it 
takes an average of 220 days for a decision to be reached on an 
original compensation claim, 127 days on an original pension claim. 



120 days on a reopened claim. During the first quarter of this fiscal 
year alone, almost 60 percent of the Board of Veterans' Appeals 
(BVA) decisions, were remanded back to the Regional Office. 

That says to me, that this office needs some help. I don't know 
what that help is and in what form it comes in, but I want to help. 
Lane wants to help. Congress wants to help them do their job as 
effectively as possible. 

We want to know why an audit of the Regional Office done last 
year by the IG showed that claims were not processed in a timely 
manner, and many of the delays could have been avoided or re- 
duced. I want to Imow that. Is it a question of staffing, resources? 
I want to know, I am going to tell you, I handled a claim for a man 
who was a Vietnam veteran who had filed for permanent disability 
for PTSD. He was a combat veteran, decorated, wounded, had the 
stressors. It took me nine years to get him a permanent disability. 
He had not only VA physicians and psychologists saying it was a 
severe case of post-traumatic stress, but we had 12 physicians, psy- 
chiatrists, psychologists, who said the man has a severe case of 
PTSD. 

What in God's name does a veteran have to do to get a perma- 
nent disability, when he's got 12 physicians, psychologist and psy- 
chiatrists saying it's a severe case and he needs permanent disabil- 
ity. 

That may not be a problem within the VA Regional Office. That 
may be a problem systemically within the VA because they are not 
recognizing as they should, PTSD claims. 

Another veteran — I know these files because I review them — had 
surgery on one knee. Clearly, clearly service-connected. The inter- 
nal doctor within the VA and an external orthopedic surgeon say 
because of the strain and because of how he had to adjust phys- 
ically, because of that situation of the one knee he now has prob- 
lems with the other side, his other leg, his other knee, directly re- 
lated to the first surgery. 

In my judgment that veteran should be getting some compensa- 
tion for that claim. You have a doctor inside the VA and you have 
a doctor — a renowned specialist outside — sa5dng it's directly relat- 
ed. I can't get him any disability. He gets disability because they 
pulled shrapnel out of his body. He gets disability because he had 
problems with his feet. But we can't get him another 20 or 30 per- 
cent even when their own physicians say he's entitled to it. 

That's a problem within the VA, generally. Not recognizing exter- 
nal medical evidence, that's one thmg, and we need to fix it. That's 
why I am here. I get really exercised about these things. These are 
not finvolous claims. These are men and women who wore the uni- 
form of their country, who have service-connected disabilities recog- 
nized by the medical community but not recognized by their own 
government. 

That's why we are here. I am most grateful to you, Mr. Chair- 
man, for taking the time and your good staff working with us to 
come and talk with these folks and the veterans and veterans' or- 
ganizations. Having said that and getting a little carried away, you 
will have to forgive me. I also told you that I review a lot of the 
claims when they go through, and there's no real problem. They do 
a pretty good job, and I don't want a pretty good job from the VA. 



I want it as good as we can get it. They have to be as responsive 
as they — let's start the hearing. 

Mr. Evans. The subcommittee is deUghted to welcome two very 
able and distinguished colleagues in the House of Representatives, 
Congressman Ron Klink and Congressman Bill Coyne, as our first 
witnesses this morning. If they would come forward at this time to 
the witness table. 

Ron represents Pennsylvania's Fourth District and Bill rep- 
resents the State's 14th District. We know that you have a busy 
schedule today, and we appreciate your appearing before us and 
giving us your time. 

Your constituents count on the Pittsburgh Regional Office to pro- 
vide quality and timely services to veterans, and we place particu- 
lar importance on your comments. We are pleased that Bill Coyne 
is before our subcommittee once again. He appeared before our 
panel last year when we examined a number of important veterans' 
issues including VA and community services to homeless veterans. 
Welcome back. 

Ron, we also welcome you. This is your first testimony as a new 
Member before our subcommittee, and we appreciate your taking 
the interest and time out of your busy schedule. We will recognize 
you at this point. 

Both of your statements will be included in their entirety. Ron, 
you may proceed when you are ready. 

STATEMENTS OF HON. RON KLEVK, U.S. HOUSE OF REP- 
RESENTATIVES, FOURTH DISTRICT, PENNSYLVANIA AND 
HON. WILLIAM J. COYNE, U.S. HOUSE OF REPRESENTATIVES, 
FOURTEENTH DISTRICT, PENNSYLVANIA 

STATEMENT OF HON. RON KLINK 

Mr. Klink. Thank you. Chairman Lane Evans and ranking mem- 
ber. Congressman Tom Ridge. 1 thank you both for being here, for 
having staff here, and I also associate myself with the remarks 
that were made by both of you to start this hearing. 

I am particularly glad that you are holding this hearing in the 
Pittsburgh area, in order to examine the benefits and services 
available to our local veterans in the Pittsburgh Regional Office of 
the Veterans Benefit Administration. 

Mr. Chairman, as you know, the VA is the only means that we 
have to honor and to care for the men and women who have so 
faithfully served and defended this great country. Unfortunately, I 
have been contacted since going into office just six months ago, by 
an inordinate number of veteran constituents who feel victimized 
by this system, and who ultimately slip through the cracks. 

I realize the needs and problems of delivering benefits and serv- 
ices to our veterans is complicated, and the VA offices across the 
country are being forced to work through continuous budget cuts 
and substandard working conditions; however, the needs of our 
local veterans are clearly not being properly addressed. 

The veterans that have contacted me, for example, feel that they 
are not given the support that they need in developing their claims. 
Approximately 88 percent of the first time claims are denied. It is 
not uncommon for claimants to wait six to eight months for this de- 



cision, just to be told then to contact one of the service organiza- 
tions such as the Veterans of Foreign Wars, the American Legion 
or Disabled American Veterans, to advocate their appeal. 

The veteran then waits another approximate six to eight months 
for the appeal of that decision. Like ranking member Tom Ridge, 
we have also had cases where they have been waiting now for up 
to nine years and, still, no ultimate decision. 

When a veteran files his or her claim they are held to a certain 
time parameter. But the VA, although supposedly held to the same 
parameter does not always feel the need to comply, thus delaying 
the processing of that case. The VA needs to begin pla3dng on a 
level plajdng field. 

This is only one example of the poor treatment that veterans in 
the Pittsburgh area are receiving. I believe that our veterans de- 
serve the very best that this country can offer. I don't believe that 
they are currently being given the help or the respect that they 
deserve. 

The VA was formed as an ally to our veterans, but many veter- 
ans feel that it's playing an adversarial role instead. I believe the 
laws governing the Veterans Adminstration are adequate. How- 
ever, the manner in which they are being carried out need to be 
re-examined, and I think this is a great start to that re-examina- 
tion today. 

I would like, again, to commend the committee for recognizing 
the need to hold the hearing today, and also thank them for invit- 
ing me to participate. I also have for you — which I will present for 
the record — some outlines of several cases which will really tell you 
some examples in detail of what we are talking about. 

I am moved by Congressman Ridge's stories. Just to relate a cou- 
ple of them to you. Number one, we had a gentleman who lost his 
leg in combat, and he was put on 100 percent disability. He con- 
tacted us because he was called in for an examination. When they 
called him in — this is his side of the story but he has no reason 
to be dishonest. They asked him how he felt. He said, I don't feel 
too bad. They put a stethoscope on his chest, and the next thing 
he knows, he's down to 60 percent disability. 

Now, I am sure he didn't grow another leg. But, for whatever 
reason just a how do you feel and a stethoscope on the chest, they 
felt that this was a reason enough to cut his disability down. 

We also received a letter last month from a claimant's widow. 
She had received a letter, advising her that her widow's pension 
benefits would be reduced on August 1 of this year, due to the fact 
that she had been in an approved Medicaid nursing home since Oc- 
tober 29, 1992. The lady is 89 years old. She was really upset about 
this because she has never been in a nursing home in her life. 

The widow's daughter brought the letter into our office and we 
called the phone unit at the Federal Building in Pittsburgh. We 
were advised that the letter is being sent out to people in that age 
bracket, trying to catch the ones that have not reported to the VA 
that they have been in nursing homes. We are setting a trap for 
veterans widows'. 

Instead of processing claims, instead of taking care of the people 
that have been hurt in combat and who bear the wounds both men- 



tal, emotional and physical, we are setting traps for 89 year old 
widows of veterans. What a waste of resources. 

I would like to bring this to your attention. I would like to ask 
for whatever help you can bring to help us to resolve this. I would 
just mention also, according to the National Veterans Legal Serv- 
ice, the Pittsburgh Office is rated 58 out of 58. We would like to 
turn that around. We would like it to be one of the top ten, because 
we have a tremendous number of veterans that really depend on 
the services that this office could provide to them. 

Thank you very much for allowing me to testify. 

[The prepared statement of Congressman Klink appears on p. 
68.] 

Mr. Evans. Ron, we will include those case histories that you 
have given us in the record of this hearing. We will pledge to you, 
that we will work with you on these cases. We appreciate not only 
your personal attention to these individuals but the effort of your 
staff. 

(See p. 70.) 

I think that one thing that we might want to emphasize is that 
once cases are submitted to a Member of Congress, a great degree 
of our available staff" time is taken away from other problems as 
well. We appreciate your doing that. We know probably as a result 
of this hearing, you will get more cases. We would be glad to work 
with you on those issues. 

Mr. Klink. Thank you. 

Mr. Evans. Bill. 

STATEMENT OF HON. WILLIAM COYNE 

Mr. Coyne. Thank you, Mr. Chairman and members of the com- 
mittee. I want to welcome you here today, and thank you for taking 
time to have this hearing here in the City of Pittsburgh, to exam- 
ine veterans' affairs and veterans hospital benefits. 

More importantly, I want to thank you for the opportunity to ex- 
amine the needs of veterans in Western Pennsylvania and West 
Virginia. This hearing should provide the House Committee on Vet- 
erans' Affairs with an excellent opportunity to hear directly from 
veterans, from local Pittsburgh Veterans Benefits Administration 
regional officials, and other parties interested in veterans' affairs 
and veterans benefits. 

You will hear first hand about the concerns that many veterans 
share regarding the future of veterans programs, at a time when 
many Federal programs are being cut back and even cut out. You 
will also hear testimony expressing a wide range of views on the 
m£inner in which these programs are administered by the Depart- 
ment of Veterans Affairs. 

Mr. Chairman, I know that you have given permission for our 
statements to be included in the record. I would hope that would 
be the case with this statement. 

Mr. Evans. Without objection. 

Mr. Coyne. I did want to point out one situation that was 
brought to my attention, that I would hope that the committee 
today would be able to examine particularly with the witnesses 
that you will hear from, from a medical perspective, those people 
who are well versed and trained in medical procedures and who 



8 

work with our veterans here in Pittsburgh and Western Pennsylva- 
nia. 

That is the high ircidence, in this region, of lung cancer cases 
that are discovered here in Western Pennsylvania as opposed to 
other forms of cancer that are aligned and significantly less in 
number than the incidence of lung cancer. I think that might be 
something that the committee will want to explore with the medi- 
cal personnel who will testify here later. 

With that, again, thank you for the opportunity to testify here 
today. 

[The prepared statement of Congressman Coyne appears on p. 
79.] 

Mr. Evans. We thank you both for your testimony. Both of your 
statements will be included in the record. 

Congressman Ridge, do you have any questions? 

Mr. Ridge. I just want to thank my colleagues. I know they are 
both very sensitive to the needs of the veterans in their commu- 
nity. I know how busy they are. As a matter of fact, you are prob- 
ably going to catch an earlier plane to get back to Washington, DC, 
because we go into session at noon today, don't we? We will see you 
back in Washington. 

Thank you for your time and your testimony. 

Mr. Evans. Thank you. We are including in the record a state- 
ment from Congressman Rick Santorum, who is not able to join us 
today. Rick is on leave right now from our committee to serve on 
the Budget Committee, and we appreciate his continuing interest 
in veterans* matters. 

Our next witness is Dr. George Bemier, Dean of the University 
of Pittsburgh School of Medicine. We welcome his participation, 
and ask him to come forward at this time. 

STATEMENT OF DR. GEORGE M. BERNIER, JR., DEAN, SCHOOL 
OF MEDICINE, UNIVERSITY OF PITTSBURGH 

Dr. Bernier. Good morning, Mr. Chairman and members of the 
committee. My name is George Bemier. I am a physician and 
Dean, of the University of Rttsburgh School of Medicine. I am 
pleased to have the opportunity to testify before this subcommittee 
about the role of the Department of Veterans Affairs played in 
Pittsburgh through the Pittsburgh Regional Office of Veterans' 
Benefits. 

My remarks will deal rather specifically with the health care is- 
sues in our affiliated hospitals. I would like to welcome you here, 
to Pittsburgh, and wish you a pleasant stay. 

As you know health care is most prominent or one of the most 

Erominent industries in Pittsburgh. One of the reasons that Pitts- 
urgh has become a nationally recognized city for excellence in 
health care is the relationship between the health care providers 
like the Pittsburgh based VA Medical Center and the University of 
Pittsburgh Medical Center. 

One basic idea regarding the delivery of health care to veterans 
is that it has been improved by affiliation agreements between VA 
hospitals and medical schools at various locations throughout the 
country. This has certainly been a case in Pittsburgh, where the 
University of Pittsburgh has worked in a collaborative manner 



with the Pittsburgh VA hospitals, to enrich the clinical care envi- 
ronment within the VA hospital system and enhance the research 
and educational opportunities available in the region. 

In addition, using sharing agreements avoids costly and unneces- 
sary duplication for both veterans and nonveterans' medical cen- 
ters. Faculty and medical staff, also, have commonly had joint ap- 
pointments. I would like to give you a couple of examples where 
this has been of great benefit. 

One is the collaborative effort between the VA medical center 
and the teaching hospitals in the development of state of the art 
procedures such as those found in liver transplant program at the 
University Drive VA Medical Center in Pittsburgh, one of only two 
that are held nationally. 

Since the transplant program at the University Drive VA draws 
upon the same faculty, fellows and residents that the program at 
Presbyterian Hospital does, the VA gains the benefit of what all 
will acknowledge is the world's most advanced transplantation 
program. 

Mother collaborative agreement between the VA Medical Center 
and the University of Pittsburgh School of Medicine is the funding 
for a PET scanner and cyclotron which is located in Pittsburgh and 
serves the tri-state region including Pennsylvania, Ohio and West 
Virginia. The PET scanner permits non-evasive observations of cell 
function, beyond the technical capability of MRI and other scan- 
ners. This type of technology permits both a high level of patient 
care and research, due to its far reaching applications. 

The second area of interest is the development of high tech 
shared medical services and equipment within the VA system 
which are essential to the well being of the veterans treated in 
those facilities. Funding for VA health care can be leveraged by 
shared purchases and other cooperative agreements. 

Thirdly, the level of research and training associated with such 
complex procedures greatly enhances the opportunities available to 
trainees to develop their medical education and professional 
courses within the VA system. The development of complex treat- 
ment and research services also provides the VA system the oppor- 
tunity to recruit and retain physicians who are the best and bright- 
est in the country. 

Provided that the VA continues to reasonably fund its research 
programs, clinical investigation will continue to find the VA a con- 
genial environment which will greatly benefit its patients. The 
issue that has just been raised about lung cancer in the VA popu- 
lation is one that is under very active study by our Pittsburgh Can- 
cer Institute in collaboration with the VA. 

The primary missions of the VA medical system are to provide 
quality clinical care for veterans and to be prepared to serve active 
duty personnel where needed. The Highland Drive VA Hospital in 
conjunction with the University of Pittsburgh, provided clinical 
treatment for those brave men and women who served in the Gulf 
and who suffered from post-traumatic stress disorder. 

The 15 members of the Army Reserve's Quartermaster Detach- 
ment who survived the Iraqi scud missile explosions were treated 
for the stress disorder in an outpatient setting by a clinical team 



10 

comprised of psychiatrists, social workers, and nurses from our VA 
hospital. 

The development of a clinical treatment program for veterans of 
armed conflict is essential to their well being. As you know, an esti- 
mated 15 percent of Vietnam veterans suffer from post-traumatic 
stress disorder, and are in need of adequate treatment. In addition, 
civilian victims of stress related injuries who suffer from post-trau- 
matic stress disorder benefit from the expertise which has been de- 
veloped within the VA health care system. 

The care that veterans and their families receive in the VA hos- 
pital system has also been the topic of review on numerous occa- 
sions, and several academic studies have been prepared on the sub- 
ject. I would like in particular to direct the attention of the distin- 
guished members of this panel to a report published in the Annals 
of Surgery entitled. Comparison of Post-Operative Mortality in VA 
and Private Hospitals. 

This study was conducted by one of our faculty members. Dr. 
John Stremple, and was a comparison of post-operative mortality 
and morbidity rates for each type of surgical procedure performed 
within the VA system and the prevailing national standard. The 
study found that post-operative mortality in 113 surgical procedure 
groups is comparable to that in the private hospital settings. 

Tins finding is significant, because it demonstrates that veterans 
are receiving quality care within the VA hospital system when un- 
dergoing surgical procedures. 

I believe it is important to analyze and review the quality of care 
and benefits that servicemen and their families receive in the VA 
health care system. The VA health care system, especially through 
its affiliations with academic medical centers, is able to provide 
quality health care to veterans, develop a meaningful environment 
for clinical research to apply to patient care, and to track and re- 
tain well qualified medical staff. 

I am especially delighted to have been able to share my thoughts 
on this issue with you, and I would be very pleased to continue to 
work with the Congress on these very important issues. 

Thank you. 

[The prepared statement of Dr. Bemier, with attachments, ap- 
pears on p. 83.] 

Mr. Evans. Thank you, doctor. We appreciate your bringing this 
study to our attention. We are going to include the reprint in its 
entirety in the record of this hearing. We think it's very useful in 
our deliberations regarding the future of the VA health care sys- 
tem. We want to make sure it's a competitive system, as we look 
toward national health care reform. This is very valuable in that 
regard and we are going to put it in the record and share it with 
our colleagues as well. We appreciate your bringing it to our atten- 
tion. 

(See p. 85.) 

I have two questions. You said that in regard to Congressman 
Coyne's concern about the high incidence of lung cancer in this re- 
gion, that there is a pending research on that particular issue? 

Dr. Bernier. Yes. By a joint collaboration with the Pittsburgh 
Cancer Institute which is part of the University's health care sys- 
tem and faculty members who are at the University Drive Hospital. 



11 

Mr. Evans. Will there be a report issued in the near future? 

Dr. Bernier. Yes, there will. 

Mr. Evans. We would appreciate receiving a copy of it once that 
report is completed. It may not be made part of tins record by the 
time it's completed, but you could assist us by sending us a copy. 

Dr. Bernier. Certainly. I would be very pleased to do that. 

(See p. 94.) 

Mr. Evans. We also appreciate the cost sharing between the VA 
and the hospital here, at the University of Pittsburgh School of 
Medicine. 

Can you elaborate today more than you did in your statement, 
on how the purchase cost has been shared, where the equipment 
is located and so forth, and some of the savings? 

Dr. Bernier. This is a very expensive piece of machinery. It's 
called a PET scanner. It costs in the neighborhood of $2 to $4 mil- 
lion. The PET scanner, itself, is sited at Presbyterian University 
Hospital. It takes very special physical arrangements in order to 
accommodate it. It's a very heavy piece of equipment which re- 
quires extensive shielding. 

This particular piece of equipment which was purchased jointly 
by the VA and Presbyterian Hospital and which is available for 
veterans and nonveterans, is an extraordinary piece of equipment, 
in that it's able to study metabolic activities in a way that no other 
form of imaging to date is able to do. 

It is proved as an investigative tool and as a patient care tool, 
to be a very important and a very productive undertaking. 

Mr. Evans. Is there a waiting list to use this equipment? 

Dr. Bernier. There is a waiting list, yes. On the waiting list, this 
is shared between both institutions. 

Mr. Evans. How is the cost allocated between the different hos- 
pitals involved? 

Dr. Bernier. I would have to give you the precise details on that. 
I would be happy to get that and send it to the committee. 

Mr. Evans. We are looking toward cost sharing in the future, of 
making the VA more cost-effective and providing better services. 
That would be very helpful to us. 

Dr. Bernier. Yes, I would be happy to provide that. 

Mr. Evans. I yield to Congressman Ridge. 

Mr. Ridge. Doctor, it's good to see you again. Thank you very 
much, for your testimony. It's very encouraging, to see how well the 
VA hospital works with the world class medical institutions in the 
Pittsburgh area, and the synergy between the VA and public and 
private institution's health care delivery system within Western 
Pennsylvania. 

I think you are to be applauded, because I am convinced that 
working together you have developed some new treatment modali- 
ties. You are on the edge of the research and development side of 
things. You keep pushing medical development further and further, 
which is good not only for veterans but very good for the civilian 
population as well. It's good for all of us. 

I am encouraged by that strong statement of commitment and 
the relationship that you have. 

I have just; a quick question, with regard to the good work you 
are doing with the clinical treatment program for PTSD. I know 



12 

that among the VA medical centers you have been very much a 
leader. I know that after the problems with Desert Storm and the 
14th Quartermaster Corps you set up a special team and have done 
all you could professionally, medically and emotionally do, to deal 
with that problem. 

In your medical judgment, is it appropriate medically to subject 
veterans to periodic re-examination and re-assertion of the combat 
conditions that resulted in the emotional turmoil within them and 
PTSD. It may seem a bit abstract, but let me put it in a more con- 
fined context for you. 

Within the VA generally — it's not the Regional Office here, it's 
within the VA compensation system generally — there is a tendency 
to call back veterans who have acute PTSD on a periodic basis to 
see how acute the PTSD is. It seems to me that after a point in 
time, after you have had an opportunity to go in and examine and 
re-examine, whether the individual be a veteran subject to the 
stressor in PTSD or a civilian subject to a stressor or stressors in 
PTSD, there comes a point where you say, this person has a severe 
case of PTSD and we are not going to make them relive whatever 
that horrible experience was every year or two. 

It is medically appropriate to continue to — be it civilian or mili- 
tary — to have them come back in every year or two to relive it 
again? 

Dr. Bernier. I am not a psychiatrist, so I can't speak from that 
authoritative point of view. What I would say is that if one is deal- 
ing with what eventually becomes a chronic problem, then probably 
one set of groundrules ought to apply there. 

If you are dealing with something that comes and can be man- 
aged and can be handled, then I think you might use a different 
set of groundrules there. 

Mr. Ridge. I will explore that further. I very much appreciate 
your broader testimony about the relationship of the VA with the 
other quality institutions around here. I look forward to seeing you 
in the future. Thank you, doctor. 

Dr. Bernier. Thank you. 

Mr. Evans. Thank you, doctor. We appreciate your testimony. 

The members of our first panel are Ron Conley, accompanied by 
Charles Zeglin; Joseph Kiren; William Reed; Paul Webster and 
Kenneth Curley. If they would come forward at this time we would 
appreciate it. 

Ron and Charles are representing the American Legion. Ron is 
a National Executive Committee member, and is no stranger before 
this subcommittee. He has testified before us before. Charles is a 
Department Service Officer. Joe is Legislative Director of Tri-State 
Chapter of Paralyzed Veterans of America. William is a Depart- 
ment Service Officer of the Veterans of Foreign Wars. Paul is West- 
em Pennsylvania District Director, Vietnam Veterans of America. 
Kenneth is a past National Commander, American Defenders of 
Bataan and Corregidor. 

We welcome each of you, and thank you for your participation in 
this hearing. We will start with you, Ron. The entire statement of 
each member of this panel will be made part of this record. 



13 

STATEl^IENTS OF RONALD CONLEY, NATIONAL EXECUTIVE 
COMMITTEEMAN (PA), THE AMERICAN LEGION, ACCOM- 
PANIED BY CHARLES ZEGLIN, PITTSBURGH DEPARTMENT 
SERVICE OFFICER; JOSEPH KIREN, LEGISLATIVE DIRECTOR, 
TRI-STATE CHAPTER OF PARALYZED VETERANS OF AMER- 
ICA; WILLIAM REED, PITTSBURGH DEPARTMENT SERVICE 
OFFICER, VETERANS OF FOREIGN WARS; PAUL WEBBER, 
WESTERN PENNSYLVANIA DISTRICT DIRECTOR, VIETNAM 
VETERANS OF AMERICA; KENNETH CURLEY, PAST NA- 
TIONAL COMMANDER, AMERICAN DEFENDERS OF BATAAN 
AND CORREGIDOR 

STATEMENT OF RONALD CONLEY 

Mr. CONLEY. Mr. Chairman and members of the committee, the 
American Legion appreciates the opportunity to appear before you 
and offer comments on the dehvery of benefits and services by the 
Pittsburgh Regional Office of the Veterans Benefits Administration. 

Mr. Chairman, we want to commend you for scheduUng this 
hearing, to examine the issues relating to the increasing backlog 
and claims pending in the Pittsburgh Regional Office, and to seek 
possible solutions to this chronic problem. 

The American Legion has pointed out that the length of time and 
lack of care taken in processing benefit claims is creating an unnec- 
essary disservice to the veteran and his family. The entire time in- 
volved in processing claims in the Pittsburgh Regional Office is far 
greater than the national average. If you would compare the Pitts- 
burgh office with another division in similar size you will find that 
it takes longer to process a claim in Pittsburgh. 

The decline in service provided bv the Veterans Benefits Admin- 
istration is graphically illustrated by the increase reported in the 
processing time. The Department of Veterans Affairs reported na- 
tionally, that claims for service-connected disabilities in fiscal year 
1990 were completed in 151 days. In fiscal year 1992, 164 days, 
and in fiscal year so far in 1993, it rose to 174 days. By comparison 
in fiscal year 1992, it took the Pittsburgh Regional Office 192 days 
to complete similar claims. In September of 1992, it rose to 221 
days. 

The Veterans Benefits Administration stated processing time 
goal is only 106 days. It takes Pittsburgh 28 days longer than the 
national average, and 86 days longer to complete a claim, than the 
goal set by the Veterans Benefits Administration. 

In fiscal year 1990, DIG claims were being completed in 94 days. 
In fiscal year 1992, 99 days. Currently, it has increased to 103 
days. In the Pittsburgh Regional Office for fiscal year 1992, the 
time for DIG claims completion was 125 days. I believe the goal set 
by the Department of Veterans Affairs is only 77 days. Therefore, 
it takes Pittsburgh 26 days more than the national average and 48 
days longer than the goal set by the VA. 

Many more comparisons could be made substantiating the length 
of time it takes to assist the veterans in the Pittsburgh Regional 
Office. However, we want to keep our statement as illustrative and 
concise as possible, because we realize that you do have a full 
schedule. 



14 

It is our firm belief that the number of days reported under the 
current work related standards do not accurately reflect the total 
time required to complete the actual claims process. Months after 
the Regional Office has taken credit for claims certified, at least 
one-half of these claims have been subsequently remanded back to 
the Regional Office because additional due process development 
and re-adjudication was necessary. 

The Regional Office is not penalized because of unfinished work. 
The claims are merely added back to the pending workload, caus- 
ing the veteran a longer delay in receiving his benefits. 

The American Legion will continue to advise this committee, to 
ensure that the veterans and their families receive the Congres- 
sionally mandated monetary benefits to which they are justly enti- 
tled, in a timely manner. We are deeply concerned about the length 
of time it is taking to process claims, because not only does it cause 
the veteran and his family to suffer but it causes a morale problem 
within the VA. It also causes a morale problem with our own serv- 
ice officers because of fi*ustration. 

A better sense of realism must be developed by the VA in deter- 
mining their staffing and productivity goals for time elapsed for 
claims to be processed. The workload in Pittsburgh alone, is in- 
creased 101 percent in 1992. This amounts to a larger workload in 
adjudications. 

Currently, there are 24 adjudicators on the roster. However, 
there are less people working actually on claims. One is a Congres- 
sional liaison, and we understand his claims are now backlogged 
£uid he needs an additional adjudicator to process those claims. 
One performs educational work. In my written statement I have re- 
ported five trainees, but I would like to correct that to ten trainees. 

It is our firm belief, that more adjudicators need to be hired, and 
an ongoing educational and training program needs to be insti- 
tuted. Not only does it take months to hire additional personnel 
but it takes a minimum of two years on the job before an individ- 
ual has sufficient training and experience to become fully produc- 
tive. 

The net result of inadequate staffing and training is more mis- 
takes. The employees assigned to adjudication should do only adju- 
dication. To assist the adjudicators and become more efficient, 
there is a need to modernize the computer and backup systems. 
Computer capability between the Regional Office and the VA hos- 
pitals is a must, and should be a number one priority. 

It is imperative, that VBA managers be able to accurately meas- 
ure both the quantity of work accomplished and the quality of that 
work. By effective management techniques procedural errors could 
be cut in half. A training program should be in place for those em- 
ployees engaged in positions of decision making authority. Quedity 
must be the priority and standard by which the personnel perform- 
ance of adjudicators, supervisors and management personnel is 
evaluated. 

The American Legion believes that by hiring additional adjudica- 
tors, updating the computer system especially between interagency 
facilities, proper training for all personnel including management, 
scrutinizing the work performed and speeding up the process of 



15 

claims, veterans and their families will most certainly benefit. 
Claims processing time must be cut in half. 

Mr. Cnairman, thank you for conducting this hearing. The Amer- 
ican Legion will continue to monitor the situation in the Pittsburgh 
Regional Office along with the processing of claims, and will also 
continue to make recommendations to improve the service given to 
our veterans. This concludes our statement. 

[The prepared statement of Mr. Conley appears on p. 97.] 

Mr. Evans. Thank you, Ron. Mr. Zeglin. 

STATEMENT OF CHARLES ZEGLIN 

Mr. Zeglin. Mr. Chairman and members of the committee, let 
me commend you for your remarks. I feel that combat veterans are 
not getting the full equity. 

In my written report I reflect upon the enactment of the Judicial 
Review Act of 1988, and we have to back track to get some of the 
cases that we feel that — now we have a problem. I feel, personally, 
that the clear errors that were committed on these patients dealing 
in combat and the prisoners of war, that they should have been 
rated on the Regional Office level. 

The Regional Office indicates that this is a job for the veterans 
appeals. The veterans appeals, naturally, is the source for an ex- 
cuse because the Regional Office will say look our ratings were 
upheld by the Board of Veterans' Appeals. You will have no argu- 
ment. This has to be resolved by the VBA. 

But I have a letter that is available to everybody that's ref- 
erenced veterans panel manual, volume 1. This letter will indicate 
that the procedure in the Board of Veterans' Appeals is flawed. I 
shall read the letter for the record. This is by a retired BVA mem- 
ber. It's in a sworn statement. 

Provided, after 23 years with the VBA — mind you, 23 years is a 
long time — as a senior staff attorney and as a member at the VBA, 
I was directed by section chiefs to obtain courtesy signatures from 
the VBA members who had not reviewed the opinion of records in 
these cases. In fact, I recall taking stacks of decisions to the offices 
of members knowing to be willing to give courtesy for signature. 

I watched them sign decisions without reviewing decisions or ad- 
ministrative record. Over the years I have observed many others, 
including the VBA members, engaging in the same practice. Al- 
though I believe that such courtesies were improper because they 
deprived the claimants of due process, I was compelled to follow 
this practice while a staff attorney and long member, in any hope 
of promotion. 

They make a comment of a bonus system that may have pro- 
duced many delay in the resolution of appeals, because VBA mem- 
bers were not eligible for cash bonuses in consecutive years, and for 
this reason some VBA members allegedly held back cases decided 
in a non-eligible year, so that they could receive credit for decisions 
in the bonus eligible year. 

This is a flawed system. They have been operating for 23 years, 
I would say rubber stamping whatever happened in the Regional 
Offices. The rubber stamping I felt, because the average rate of 
turn down of denials are more than 90 percent. A veteran cannot 
be wrong, especially the combat veterans and the prisoner of war. 



16 

His only defense is his narrative in his claim. Nobody speaks for 
him. 

I just read a letter by the Chief of Compensation and Pension in 
Washington DC. This is a reply to a case of letters that was re- 
ceived by request by our national organization, who asked the field 
for special cases. I won't mention the name, but the man's name 
is Stanley. He had filed a claim for black out's since 1983. Nothing 
was done or not to this day a mention was ever made of black out's. 

How did he get the black out? He lost his oxygen bailing out the 
D-17, lost consciousness. When he landed and during the satura- 
tion bombings of Germany, the German populous showed that 
when an airman floated out the skies he was really in for it. Stan- 
ley got it. Stanley was tied to a chair and beaten by the SS until 
he was unconscious. His face was beaten to shreds. The cosmetic 
scars are there today. 

This poor man is homeless today. He's on the street, because he 
can't make it. But the claim for his black out's — and his last black 
out was in November of 1992. The first time he fell over in a res- 
taurant. The medics have a record of it and it's in his claim file. 

There was also a claim for frozen feet. He was a prisoner of war 
for 18 months. Incidentally, he flew 60 missions with the Royal Air 
Force before he came over to the United States Air Force. He was 
shot down over Bremen, Germany, and beaten. Stanley suffered 
dizzy spells. He was able to make it, but the real black out came 
in 1983. 

Mind you, to date, that claim has not been resolved. It has been 
ignored. He's been before the appeals board and he's been before 
the traveling board of the veterans Board fi*om Washington, DC. 
His claim remains unsolved. You should see the letter that the 
chief of compensation and pension wrote about his frozen feet, a 
man who was a prisoner of war for 18 months, starved, beaten. 

He said that this man did not deserve service connection for fi*o- 
zen feet because the only thing you can go on is his word. When 
he approached the prisoner of war case it's his narrative. That's his 
only protection. This was disregarded. He said the vascular condi- 
tion that you have in your hands are something else and it's not 
frozen feet. Service connection for frozen feet is denied. 

You can draw your own conclusion from the type of care our pris- 
oners of w£ir are receiving. We have the names. We have numbers. 
We have a cross section of cases which we would be glad to share 
with you, that will show the tjrpe of care our combat veterans and 
prisoners of war are receiving to this date. That is the end of my 
statement. 

[The prepared statement of Mr. Zeglin appears on p. 99.] 

Mr. Evans. Thank you, very much. Mr. Curley. 

STATEMENT OF KENNETH CURLEY 

Mr. Curley. Mr. Chairman, I would like to thank you for the op- 
portunity to appear on the psinel. My address will be short and 
sweet. My name is Kenneth Curley. I am the National Service Offi- 
cer and Past National Commander of the American Defenders of 
Bataan and Corregidor, Inc. For over 20 years I have been working 
with former Japanese prisoners of war, of whom I am one. 



17 

With the help of the Pittsburgh Veterans Affairs Regional Office, 
we have been taken care of since Public Law 97-37 was introduced 
in the 1980's. With cooperation on all levels of the Regional Office 
staff, we were able to get the POW program started. They assisted 
us in setting up meetings with the medical centers at Highland and 
University Drives. We began seminars for our POW population. 
These meetings identified and familiarized the POW's entitlements. 

The regional staff also was key in helping us xinderstand exactly 
what Public Law 97-37 meant, as well as putting our claim to ben- 
efits to which we were entitled. The POW Protocol Program began 
here in Pittsburgh and later spread to almost every State in the 
Union. This was due in large part, to these dedicated personnel. 

I want to thank you. 

[The prepared statement of Mr. Curley appears on p. 101.] 

Mr. Evans. Thank you, Mr. Curley. Mr. Reed. 

STATEMENT OF WILLIAM REED 

Mr. Reed. Mr. Chairman and members of the committee, I wish 
to thank you for inviting the Veterans of Foreign Wars of the Unit- 
ed States to participate in this very important hearing. Our organi- 
zation has a great interest in helping the veteran, and all the pro- 
cedures used by the Department of Veterans Affairs which would 
affect the veteran. 

I believe we can all agree, that there are problems within the Re- 
gional Office in Pittsburgh which must be faced and an adequate 
solution found, without disrupting the adjudication procedure of 
said office any more than it has been. 

We find that one of the main problems is in the timeliness of the 
delivery of the decisions and benefits to the veteran. In all fairness 
to the Regional Office it must be pointed out that at times the indi- 
vidual may be responsible for some of the unusual long delays, by 
not cooperating. 

Looking at the Regional Office staffing and resources, workload 
and working conditions, being that the adjudication section has a 
workload that continues to increase instead of becoming less can 
have an adverse affect on the people working in said operation 
thus, causing a morale problem which affects the production level 
and the quality of the end product. This, I feel, is taking place in 
the aforementioned section at the present, and something needs to 
be done. 

Referring to the section, adjudication excellence is a function of 
how well the section is staffed and trained. We must look at the 
associated problems of attrition and the reality of the adjudication 
persons occasionally being called upon to work in ether than strict- 
ly adjudication problems. I, personally, feel that the appropriate so- 
lution to the present situation would be to request increased fund- 
ing sufficient to ensure adequate staffing to process all claims in 
a timely and accurate manner thus, clearing the backlog of claims 
which now exist. 

I want to thank you for allowing me to present my statement be- 
fore you. 

[The prepared statement of Mr. Reed appears on p. 102.] 

Mr. Evans. Thank you, Mr. Reed. Mr. Webber. 



18 

STATEMENT OF PAUL WEBBER 

Mr. Webber, Mr. Chairman and members of the subcommittee, 
Vietnam Veterans of America appreciate the opportunity to present 
its views on the VBA practices at the Regional Office here, in Pitts- 
burgh. We appreciate the intent of this hearing is one designed to 
bring reform to the overall practices at this Regional Office. 

I would like to talk about the outreach program as it exists at 
the present time. A representative goes out and visits house bound 
veterans and assists them in filling out their claims. We know that 
Mr. Opatchin goes to the Butler VA Hospital on Monday and Tues- 
day and is in his office on the fifth floor from 2:00 to help out- 
patients fill in their claims and assist in their needs. 

What we feel is needed for the outreach program to be more effi- 
cient are two modifications. First and simply, some publications. 
These should either be in local newspapers or veterans publica- 
tions, so veterans would be aware of the assistance that is avail- 
able to them. At the present time we can find no evidence of a rep- 
resentative from the Pittsburgh Regional Office being in any coun- 
ty outside of Allegheny or Pittsburgh. Most counties have a Veter- 
ans Advisory Board, and would be receptive to an open meeting 
with the outreach representative. 

It would be more efficient to have a representative of the out- 
reach program to be available at either the county courthouse or 
veterans' service organizations for at least one day a month, to as- 
sist veterans filling in their claims, completing paperwork, answer- 
ing questions for the veterans and their families. 

The second viewpoint is, why not relocate some Regional Office 
staff to where it is needed, in the highly populated veterans areas. 
There are approximately 500,000 veterans in Western Pennsylva- 
nia, and the Pittsburgh Regional Office has most of these veterans 
in the state. It seems like it has the same RO staff as the less pop- 
ulated veterans regions. 

I would like to talk to you about lifting the ban on use of attor- 
neys. The law limits a veteran's use of attorney until after the 
Board of Veterans' Appeals has made its initial decision. This must 
be modified. The service organizations do a fine job in representing 
veterans, but due to the over burdening caseload they are some- 
times less aggressive than an attorney would be, in determining 
the VA records and evidence to support and often complete claims. 

Completing claims needing additional development could be an 
advantage if an attorney were available in the early stages of bene- 
fit claim processing. Veterans could have the right to hire an attor- 
ney or should have the right to hire an attorney if they feel it is 
in their best interest, to serve in the manner. Instead, they have 
to use the free Regional Office representative. 

This step would benefit the VBA by assuring a better develop- 
ment of claims and hopefully, few — excuse me, I am very nervous. 

Mr. Evans. You are doing fine. 

Mr. Webber. Thank you. An additional benefit resulting from 
this would be expanded availability of attorneys to use veterans 
as — I lost my track here — ^veterans law and as a legal practice. 
Today, development is slow. 

Access to Justice Act established last year would help in the de- 
velopment of a Court of Veterans Appeals, a practicing attorney en- 



19 

tering the field of veterans law, by making attorney fees available 
on a limited basis. However, much more is needed to be done. 
Here, an attorney available at the Regional Office, it seems likely 
that members of the private attorneys involved in veterans law 
would increase. This could be done by legally, eliminating the ban 
of attorney fees under the VBA. A practicing attorney should be 
limited to charges reasonable fees after the RO's first decision of 
a claim. 

Acceptance of non-VA medical records. Currently, the VA adju- 
dicators will only accept physical exams for rating purposes and 
exams performed by the VA physicians and the Veterans Medical 
Center. This restriction must be lifted. 

Surely, doing so would be an incentive with the VA's own rules, 
revoking decisions by giving the benefit of the doubt on the veter- 
ans. If veterans' private medical records are substantially com- 
pleted and support the claims for significant disability ratings and 
set of disability ratings in a single claim, the RO adjudication 
should be allowed to use the records and rating claims. In this 
process we assume the cost of exam by the outside physician would 
be the responsibility of the veteran. 

The adjudication should be done more efficiently and timely if 
the RO accepts the nonveteran's medical evidence in its adjustment 
of the claim. It seems reasonable to accept outside medical exami- 
nations not only for the sake of evidence but also for some quality 
and thoughtfulness in medical exams over burdening VA request 
for medical exams have created ways to earn performance credits 
for exams that they haven't done. Under circumstances they should 
be good reasons for VA to accept nonveterans medical exams. 

Lacking legislative need to do so however, we doubt the VA will 
change its current practices, assuming that legislative reform for 
VA accepting outside medical exams. We further believe that VA 
should require a nonveteran physician to provide supplemental in- 
formation if needed to adjustments to a claim. As we understand 
it, claims for social security disability are handled in this manner. 

A needy and sufficient requirements for VA as to the VA, provide 
additional information based on examination of VA simply throw 
out the entire form and enter a nonveteran information. We are 
asking additional materials and substantial delays in schedules — 
when outside medical records are not used. 

Mr. Chairman, this concludes my testimony. 

[The prepared statement of Mr. Webber appears on p. 103.] 

Mr. Evans. Thank you, Paul. We appreciate your testimony. Mr. 
Kiren. 

STATEMENT OF JOSEPH KIREN 

Mr. KiREN. Mr. Chairman and members of ^he subcommittee, it 
is an honor to appear here today on behalf of the Tri-State Chapter 
of the Paralyzed Veterans of America. The Tri-State Chapter ap- 
preciates your invitation to present testimony regarding the deliv- 
ery of benefits and services by the Pittsburgh Regional Office of the 
VA on issues touching veterans here, and across the country. 

The delivery of benefits and services, and the issues of quality 
and timeliness, are at the very core of the relationship between the 



20 

VA and the individual veteran. On one hand, "justice delayed is 
justice denied," on the other hand, "delay is preferable to error," 

Mr. Chairman, unfortunately, veterans today are getting the 
worst of both maxims: shoddy quality and unconscionable delays. 
This is true in Pittsburgh, and it is true over much of the country. 
Response time to veterans' claims for benefits is worsening at an 
alarming rate. At Pittsburgh it now takes an average of 220 days 
for a decision to be reached on an original compensation claim, 127 
days for an original pension claim, and 120 days for a reopened 
compensation claim. 

This phenomena is net recent, but has been many years in the 
making. We are faced with the situation where there is no timeli- 
ness and precious little quality. 

The Tri-State Chapter stands ready to assist Congress and the 
VA in fashioning fair and workable solutions to adjudication prob- 
lems. We understand that often times there is no solution, but this 
is no reason to shrink from our responsibilities to our veterans. 

Pittsburgh has taken steps to deal with this backlog. Within the 
last four months the Regional Office has hired six new adjudicator 
trainees, and is in the process of adding to the rating board staff. 
Unfortunately, this is a case of robbing Peter to pay Paul. By add- 
ing to the rating board they are stripping people from the author- 
ization end, which will cause problems and further delay claims 
processing in the very near future. 

The need for proper case development is essential. This will de- 
crease the percentage of remands. This can be accomplished by bet- 
ter training of existing personnel, and a temporary re-deployment 
of other staff to decrease the present backlog that currently exists. 
We approve of temporary re-deployments but not to the extent of 
cannibalizing further the benefits delivery system. To do so would 
be to invite mrther delay into the process. 

The Tri-State Chapter supports the VBA computer moderniza- 
tion process. The fact of the matter is that this step long planned 
and long overdue, would improve the quality and timeliness of the 
Pittsburgh Regional Office, and all other Regional Offices. The VA 
recognized seven long years ago that there was a need for a mod- 
ernized benefits delivery system. The delay in instituting this pro- 
gram can be blamed on the GAO, which believes that this mod- 
ernization program is premature. 

PVA is satisfied with the VA's response to the GAO repoit, and 
their justifications for proceeding with the implementation of this 
program. We believe that it is time to move forward with this mod- 
ernization program. 

Similarly, the VA computer system Target is not being fully uti- 
lized. It is essential that information be entered and it is essential 
that the information be entered correctly. This is a simple thing 
that can be accomplished immediately, that would have an impact 
on the intolerable delays that we are presently faced with. It would 
assist us and other VSO's in helping our members and fellow veter- 
ans in processing their claims. 

The VA must institute a better system of case file management. 
Presently, all VA files are placed in a file room in a secured area. 
These files are removed for such matters as benefits terminations 
and for similar reasons. Each file is logged in and out. 



21 

The problem with the current situation is that on any given week 
there are over a 100 files found unallowed for. They are not where 
the file log says they are supposed to be. This can only cause fur- 
ther delays in an already dilatory system. Tighter controls must be 
implemented to better keep, and more accurately track, the files 
that are being worked on by VA personnel. This is not only a prob- 
lem in Pittsburgh, it is a national problem as well. 

To relate a personal story as to one element of the Regional Of- 
fice's attempts at outreach, I was sent a letter fi*om the Regional 
Office to participate in a focus group. The reason for the focus 
group was to purportedly gather opinions on topics related to the 
delivery system of veterans benefits. When I arrived I was assigned 
to a group, whose sole purpose was to critique a form produced by 
the VA on income verification match. Every one who attended took 
the time, and for many, experienced the considerable difficulties 
necessary to attend. 

They did this in order to have real input into the delivery of ben- 
efits. Instead of working together to find solutions, a real form of 
outreach, we critiqued the form. 

Mr. Chairman and members of the subcommittee, our veterans 
deserve better. They deserve prompt, efficient and fair resolutions 
to their claims for benefits, benefits earned by service to this coun- 
try. They deserve a Regional Office that is helpful to the veteran 
and to his or her dependents and they deserve to have this dis- 
graceful delay in processing claims ameliorated. 

Mr. Chairman and members of the subcommittee, we must not 
only be "speakers of words, but doers of the deeds." As I stated pre- 
viously, we here the Tri-State Chapter stand ready to assist you in 
any way we can to fashion workable and fair solutions to the prob- 
lems that exist, here in Pittsburgh, and the problems that exist 
throughout this country. 

Th^ik you, Mr. Chairman. I will be happy to answer any ques- 
tions that you or members of this subcommittee have. 

[The prepared statement of Mr. Kiren appears on p. 105.] 

Mr. Evans. Thaiik you. We want to thank this entire panel. The 
veterans' organizations provide our front line information of what's 
going on within the VA system. We thank you. I have a number 
of questions. I will start with Mr. Conley. 

Your testimony reports that Regional Office statistics may not 
give us an accurate picture of timeliness because of remands to the 
Regional Office. For example, you stress the importance of having 
methods which accurately measure the amount and quality of work 
being done. 

How could both the amount and quality of work being done be 
measured more accurately, in your opinion? 

Mr. Conley. Mr. Chairman, you realize that any time that you 
put stress on people to accomplish a particular goal you are going 
to end up creating some mistakes. I don't think the VA and the 
goals that they set in the time period to get these claims accom- 
plished is realistic. They have to be more realistic in processing 
claims, as far as nationally and how it's going to be done. 

That stress would be taken off the adjudicators £ind, therefore, 
they would be able to do a better job in processing those forms and 
won't have to worry about making mistakes and getting them 



22 

kicked back. Of course, any time you do that, that is a waste of tax- 
payer money. If we become more proficient in making sure that 
those claims are properly filled out before they are processed. 

Mr. Evans. Does anyone else on this panel have a comment 
about that same issue? 

(No response.) 

Mr. Evans. Mr. Zeglin, can you give us any additional informa- 
tion on the attitude of the Regional Office to VA and private sector 
expert medical opinion? 

Mr. Zeglin. Yes. We usually — it was the old format, where one 
could go to the Board and discuss a claim and try to effectuate a 
change, where we felt there was an inequity. For many years now 
they say appeal it. I told you about the appeal board. This is the 
same business. 

The evidence we submit either fi*om the private sector or fi-om 
the VA sector, it received the same consideration, the lack of due 
process. 

We have a veteran, who is 70 percent disabled. It took 17 years 
to effectuate service connection for this man. He was concussed 
very badly. He's the only man I know that walked away fi'om his 
grave. He was unconscious and declared dead. He said man, I could 
move and got out of there. This man is 70 percent disabled now. 
The goal is to get him 100 percent. 

Just at the last supplemental statement of the case he was de- 
nied. His neurologist said he's totally disabled. He has to drink cof- 
fee through a straw. Incidentally, he suffers fi'om a tremor. Actu- 
ally what happened to him was, the doctor said he was brain dead 
temporarily and he declared so. For the kindness of God, that he 
got out of there or he would have been buried alive. 

The neurologist said he is totally disabled. As I said, he drinks 
coffee through a straw. He cannot button his — can't dress himself, 
cannot drive, cannot operate any machine. The 70 percent was con- 
firmed and continued, and the total 100 percent disability was de- 
nied. That's going back to the Board of Veterans' Appeals. 

Those are the kind of situations that exist and have existed, and 
that's why I am so concerned about having a clear and unmistak- 
able error — when I say clear and unmistakable of error, that means 
the denial of due process. We want to reach back to get these cases. 
We want to bring them back and declare — this is a clear and un- 
mistakable — you have to fix it. You have to give this man due proc- 
ess. It's not being done. They said let the VBA do it. 

I read to you what is happening in the VBA. The system is 
flawed. Something has to be done about it, we've got to change it, 
because there was too much injustice rendered to the veterans who 
had filed claims prior to the promulgation of the Judicial Court. 

Mr. Evans. Thank you. Congressman Ridge. 

Mr. Ridge. Thank you. First of all, I want to note for the benefit 
of the witnesses and the audience and those who have testified 
about the claims process, I think it is not something that is en- 
demic simply to the VA Regional Office in Pittsburgh. There are 
complaints about the process itself, nationwide. 

A couple of our colleagues on our Subcommittee on Compensation 
and Pension are working on a means to improve the process itself, 
and we start some hearings within a week or two. 



23 

Very much a part of that process is the ability to provide to the 
Regional Offices and to the VA, a fall and complete claim file. The 
veterans' service organizations through their service officers, do 
yeoman work in that regard. 

I wanted to know fi-om you, Mr. Zeglin and Mr. Conley, whether 
you are satisfied? Looking constructively and critically at your own 
organizations, you have a lot of volunteers helping veterans. What 
type of training of service officers within the Legion, the VFW, PVA 
and other organizations, is provided to help people gather an ade- 
quate and complete file to give to the VA? 

I have seen in my own office, I have seen where the information 
sent to the VA was incomplete, and you couldn't make an adjudica- 
tion based on that. We improve the process immeasurably if we 
make sure it's done right. 

Would you two care to comment on that? 

Mr. Conley. Congressman, the American Legion has a school in 
Washington, DC, for Department Service Officers throughout the 
country. We work with the Department of Veterans Affairs in 
Washington, DC, to make sure that all of our service officers are 
fully competent in dealing with the process of claims. 

Those people come back to their different areas and the Pitts- 
burgh area. We then hold a school within the State of Pennsylvania 
for post service officers, to more or less make available to them 
that knowledge that these service officers picked up in Washington, 
DC. 

Those post service officers that fill out claims — and I know you 
have quite a few of them up in Erie — they work with the service 
officers in the Pittsburgh Office. We realize too, the more facts we 
have and the proper forms that we have filled out, that it makes 
it easier to get the process adjudicated within the VA. 

We have had that working relationship with the Department of 
Veterans Affairs in Washington, to make sure that all of our serv- 
ice officers throughout the country are competent to fill out those 
claims. We constantly try to make that system work better than 
what it is. 

Mr. Zeglin. Congressman, I make reference to the prisoner of 
war and a combat veteran. His only defense is his narrative and 
he don't write a narrative. I have to tell the prisoner, you have to 
say what you did and what it was because nobody will know it. We 
have a narrative. This happened to me. This is not given credence. 
This is not due process, and it happens. 

It happens, because do me something and we will send it to the 
VBA. That's the reply we get. They ought to take those cases to 
task and believe these poor men, that this happened to me. That 
is in the law. That's 38 U.S. Code 1145, to give precise credence 
to this, and it's not being done. I hope this will improve and hope 
that this meeting will produce this. Thank you. 

Mr. Ridge. I appreciate that testimony because within the stat- 
ute and within the history of interpretation, there is a presumption 
in favor of the veteran. I know, again, dealing with the case work 
that I have had when you are going back to help all veterans, find 
it is particularly difficult with World War II or Korean veterans. 
You don't get too much on your DD-214. It tells you where you 



24 

were, the decorations that you had, when you got in, when you got 
out and a few other things. 

You never have the narrative of the combat, the narrative of the 
situation that results in your claim. Sometimes even the medical 
records way back then are either incomplete or unavailable. At 
some point in time we have to give the Regional Offices encourage- 
ment. The presumption is in there, but Members of Congress and 
everybody else has to encourage them and support them when they 
start. We are supposed to resolve the doubt in favor of the veteram. 
We are not doing that all the time. 

Joe, I know you are looking to say something. Go ahead. 

Mr. KiREN. I really feel because of all the cases that I have seen 
go through our office and the others, that reasonable doubt is way 
out there in left field somewhere. Instead, it should be at the very 
beginning. You should look at the reasonable doubt at the very be- 
ginning and keep that in mind all the time. 

It seems like we go through all the information, we get every- 
thing we can. We get affidavits, and then the Board reviews that 
and says that it isn't factual enough. Where does the reasonable 
doubt come in. It needs to come in at that spot. 

Mr. Ridge. At the front end of the process? 

Mr. KiREN. At the front end, and all the way through. It seems 
like we go through the whole process and at the end the veteran 
remembers — where is the reasonable doubt when he is denied, and 
he's done everjrthing he can. 

The other issue is when the medical records are lost, the veteran 
gets the impression that it's his fault. It's by no means his fault. 
He didn't have access to his records. He didn't carry them around 
in a pouch. They weren't on a video tape somewhere, someone fol- 
lowing him through action. 

They are totally frustrated just by these two points; reasonable 
doubt and lost records. If they could do something they would. 
They have done everything they humanly possibly can. That's what 
Mr. Zeglin said, it happens over and over. 

Mr. Ridge. We run into that all the time, again, trying to get an 
adequate claim file. That St. Louis fire has been used as a reason 
to deny benefits for a long time. You can understand why the VA 
wants to do it. You get a letter or two from a buddy and some of 
them will say yes, I was with Sergeant Smith and he was a POW 
or was shot on that day. That ought to be enough. 

You have a veteran speaking up for a veteran, and that should 
be enough. 

I want to go further, Joe, with you. You are concerned about 
management's use of the end product method of assessing claims 
within the VA, the success of processing claims. Do you want to 
comment a little further on that end product? It looks to me like 
it's a means to statistically identify what you are doing, but it 
doesn't necessarily identify whether you are doing it either right or 
well. Do you have some thoughts on that? 

Mr. KiREN. If I understand the question correctly, that was when 
I said that justice needs to be done. Is that what you are referring 
to? 

Mr. Ridge. There's someplace in your statement that, because of 
time 



25 

Mr. KiREN. The one I just said or the one that you are reading. 

Mr. Ridge. It was overlooked. Using the end product method of 
assessing claims, processing time and measuring job performance. 
The VBA says let's change that. Why do you think we ought to 
change it? 

Mr. KiREN. I still don't think I understand your question. Are 
you referring to the statement you have or the one that I just 
made? 

Mr. Ridge. The one that you made but you skipped over a para- 
graph, and on page six of your testimony you highlight a matter 
that is a concern of mine. I know that, because of time, you over- 
looked it. 

It's a work measurement standard, called the end product. You 
believe £uid your organization believes it should be changed. I 
wanted you to amplify that for purposes of the record. It's the last 
paragraph on page six, Joe. 

Mr. KiREN. I have a different one that you have, Tom. 

Mr. Ridge. We will get you a copy. 

Mr. KiREN. I said I would be happy to answer questions, I didn't 
say I would be able to. 

Mr. Ridge. I have dealt with you often enough, to know that you 
are very able to do so. 

Mr. Kiren. What this means is if the claim is processed and done 
it looks like you have completed something. If you haven't put 
enough into it and done it correctly, the statistics don't show you 
that the claim is flawed. If veterans are being denied benefits be- 
cause you are just pushing them through the system, then that's 
not doing what we have said we are going to do for our veterans. 
The current method rewards speed, but does not reward quality, 
which is integral to treating veterans correctly. 

That needs to be changed because you are rewarding someone for 
completing a lot of things, but if it's shoddy you are not doing — 
not you, we, as the Nation aren't doing what we are supposed to. 

Mr. Ridge. I appreciate that. Mr. Webber, I want to thank you 
for your testimony. I might recommend to you, that the Regional 
Office conducted a very successful outreach program in my Con- 
gressional district within the past couple days. Joe Serrino was up 
there and brought a group of people with them. We had 150-plus 
people there, dealing with some of the concerns that you have, 
identifying for people in the community the kind of outreach pro- 
grams that are available. More importantly, advising them as to 
benefits that are available, eligibility for those benefits. 

It is very helpful to the veterans community in Erie, PA, and the 
like, and I am personally going to encourage the Regional Office 
the next time that they conduct one of those to get in touch with 
you, if you don't mind. I think that your suggestions are real good. 

Mr. Webber. I would appreciate that. We would like to see more 
outreach programs going on, just like you mention. You don't see 
it anywhere and it's not a consistent thing. They seem to do it in 
the summertime when they can go to a fair or carnival, but it's not 
a consistent place. It's not findable, where it's a consistent place. 

We would open our doors to our organization, to have an out- 
reach man come and sit there for the day. We would line up the 



26 

people for them and whatever is needed. This is the type of pro- 
gram that we would like to see get started. 

He's not only talking to the veteran, but he's talking to the fam- 
ily and taking care of the entire needs of the veteran, which our 
service organizations would like to see. 

Mr. Ridge. I appreciate that very much. Mr. Reed, in your testi- 
mony you talk about the problems with staffing and resources. 
That seems to be a pretty consistent thread through much of the 
testimony that we have heard, and I think we are going to hear. 

Do you have any thoughts or any experiences yourself, with the 
refusal of the Regional Office to use medical testimony outside the 
VA, in support of a veteran's claim for benefits? Do you have any 
personal knowledge or experience with that? It's one of the con- 
cerns we have, not only with the Regional Office but around the 
country. 

Mr. Reed. There have been times when I received outside medi- 
cal statements which have been forwarded, put in the process, and 
in the end, it seemed that they had either been looked at and ig- 
nored or felt that this was from doctor "so and so." 

It does occur at times. 

Mr. Ridge. It's one of the things that we are going to take up 
with the panel later on. Again, adjudication officers and those in 
the VA regionally are getting some direction fi'om Washington, DC, 
and one of the questions that both Congressman Evans and I have 
are the relevance, the appropriateness and use of external medical 
records, medical opinions, from somebody outside the VA in fur- 
therance of a veteran's claim. 

Mr. Curley, you mentioned and commended the Regional Office 
for their POW protocol and the work that they have been doing 
with you and the group that you represent. You are very much a 
part of that group, and I very much appreciate your testimony 
today. 

Are the men within that group working, have access to, or do 
they use the VA medical facility? Do you find men there now, 20 
or 30 years later, who are still dealing with a traumatic event? We 
now call it PTSD, but you were subjected to it 40 years ago. Are 
they using the VA medical facilities too? 

Mr. CURLEY. In Pittsburgh, our POW population is not doing too 
badly. But as service officers — national service officers — we have 
problems in other states. We find it's a matter of interpretation, 
when somebody reads — the burden of proof is in the veteran's cor- 
ner. Well, when somebody reads something, they interpret it to suit 
themselves in some states. 

In Pittsburgh — I am speaking personally — we have pretty good 
rapport here. We also have a program at the VA Medical Center 
up on Highland Drive, where we have once-a-month meetings with 
our people to inform them of what they can do and what they are 
entitled to, and how to go about it. 

We find that one of the problems with our veterans is that they 
are their own worst enemies because they can't express themselves. 
They can't bring themselves forward to explain what they want. 
They need help to do that. That's what we try to do on our part. 
I think it helps in some areas. 



27 

For instance, when we have a problem I'll compose a letter to 
send to our Congressmen or Senators — I'll take it to them up there 
and will be told about correct format to follow. Don't use exact 
same words but put it in your own writing. They finally look at it 
and tear it up. If you don't help yourself you are not going to make 
anything out of it. This is what we find in our POW population. 

Mr. Ridge. Thank you, Mr. Chairman, for the extension of the 
opportiuiity to discuss this with the veterans. What I have found 
with some veterans, however, is that after several years of denial 
and frustration, they kind of throw their hands up and say, "I don't 
want to deal with it anymore," and walk away from it. 

Mr. CURLEY. Right. Everything we should do within the VA sys- 
tem should be geared to promoting, encouraging and pushing the 
veteran to utilize it, and the VA to provide the assistance needed. 
We are seeing a sjTidrome that develops with some veterans that 
just throw their hands up in the air and say: "What am I going to 
do? I have been trying for five or ten years, now, I'll try to deal 
with it privately, I'm out of here!" 

Mr. CURLEY. We have a couple of our veterans from the Latrobe 
area, who won't have anything to do with the VA. We have even 
offered to go there, and pick them up and bring them down to in- 
troduce them to the VA and they won't do it. They have had bad 
experiences in the past. 

I c£ui honestly say that back in the 1950's and when we first 
came home in 1946-— I was discharged that year, until the time 
that Public Law 97-37 came out, it wasn't the same as it is today. 
I can honestly say that, from my viewpoint. I can honestly say this, 
that we don't get the same consideration in other states as we do 
here, in Pittsburgh. 

Mr. Ridge. Mr. Chairman, I want to thank this panel not only 
for their personal service as veterans but also the service that they 
have continued to undertake on behalf of all other veterans. Thank 
you, for your strong and compelling testimony. 

Mr. Evans. We want to thank you all for testifying. The issue of 
outside medical opinion, I think, is going to be very important in 
dealing with Persian Gulf veterans' problems. I hope that if it is, 
you will advise us and keep us informed. Thank you very much for 
testifying today. 

The members of panel two are Trea Graham, Thomas Fitzgerald, 
Charles Lieberth and Jack Ehrhardt. Trea is a member of Con- 
gressman Rick Santorum's Veterans' Affairs Advisory Board. Tom 
is President of the Board of Directors, Vietnam Veterans Leader- 
ship Program. Charles is a member of the Pennsylvania State Civil 
Service Commission and he is presenting his own views. Jack is a 
Vet Center Team Leader in Erie, PA. We want all of you to come 
forward now to the witness table. 

This may be one of the most decorated panels we have ever had 
testify before us today. We will start with Mr. Fitzgerald. 



28 

STATEMENTS OF TREA GRAHAM, VETERANS' AFFAIRS ADVI- 
SORY BOARD; THOMAS FITZGERALD, JR., PRESIDENT, 
BOARD OF DIRECTORS, VIETNAM VETERANS LEADERSHIP 
PROGRAM; CHARLES LIEBERTH, PENNSYLVANIA STATE 
CIVIL SERVICE COMMISSION; JACK EHRHARDT, VET CEN- 
TER TEAM LEADER IN ERIE, PA 

STATEMENT OF THOMAS FITZGERALD 

Mr. Fitzgerald. Thank you. Good morning, Members of Con- 
gress, colleagues, and distinguished guests. I am here as a veteran, 
who has had many concerns with the veteran community, in par- 
ticular with unemployed and homeless veterans. As such, I have 
been privileged to work with what I feel is one of the finest veter- 
ans' organizations, the Vietnam Veterans Leadership Program of 
Western Pennsylvania, or what we know as WLP. 

I have been honored to serve as the Board of Director's President 
for the past ten years and have been, therefore, personally involved 
with veterans who have experienced many problems. 

In brief, WLP is the greater Pittsburgh career advising and job 
placement assistance non-profit corporation for all unemployed, 
under employed and homeless veterans of the U.S. military service. 
WLP was established by Vietnam veterans to serve all veterans. 
With a full-time staff of eight professionals, WLP provides employ- 
ment services for more than 700 veterans annually. 

Recently, WLP was named Point of Light 753, for its work with 
corporate voluntarism. When WLP opened its doors ten years ago 
it was a fledgling organization operated by a small group of caring 
veterans, who had a great desire to help their fellow unemployed 
veterans. This startup took place at a time when the Pittsburgh 
Steel mills and factories were closing their doors. 

The unemployed veterans who were the last returning from Viet- 
nam and were the first laid off during the downsizing of Pitts- 
burgh's manufacturing base. This group of veterans had the right 
ideas but not the organizational expertise to alone create a strong 
service base for local veterans. Many veterans groups tried to help, 
but the actual creation of such an agency was very time consuming 
and difficult. 

As a member of the original WLP team, I can say that from the 
first support meeting the Department of Veterans Affairs Regional 
Office has consistently stood by us for the past ten years. During 
this time WLP had received many different tjrpes of assistance 
from the Regional Office, veterans direct referred assistance, oper- 
ational guidance, community relations and support of WLP's ef- 
forts, veterans employment assistance, and training facility space. 

The Regional Office has also consistently written letters of sup- 
port for WLP for government funding proposals and has partici- 
pated in the WLP fund raising events. Most notably, the Regional 
Office has already allocated valuable staff time and resources for 
Pittsburgh's stand down for homeless veterans. In particular, they 
have pledged assistance for proof of veterans status, veterans bene- 
fits processing, and identification construction for each homeless 
veteran and volunteer. 

If I may share my personal point of view, I have encountered 
many veterans with unique problems, who were having difficulty 



29 

with the Department of Veterans Affairs. When I became aware of 
their concerns I have called the Regional Director, Mr. Harold 
Bushey and the Assistant Director, Mr. Gerry Serrino, and they 
have always personally reviewed these issues. In all cases the prop- 
er service was rendered or very reasonable conclusion was reached. 

I w£int to share that I work as an Allegheny County Police Homi- 
cide Detective. Through this position I deal with many grieving and 
distressed families of homicide and suicide victims. These victims' 
families are hard pressed and have many issues to deal with. I 
have many of these families ask for assistance with the Veterans 
Affairs Regional Office. 

Most of these families have never previously dealt with Federal 
Agencies and usually do not know where to begin. I have, person- 
ally, called the Regional Office for assistance, and they have always 
shown compassion and have rendered immediate service. 

On behalf of these families I would like to thank the Regional Of- 
fice for being there when these families really needed them. I 
thank you for listening to us this morning. 

[The prepared statement of Mr. Fitzgerald appears on p. 112.] 

Mr. Evans. Thank you. Mr. Lieberth. 

STATEMENT OF CHARLES LIEBERTH 

Mr. Lieberth. Members of Congress, staff, veterans representa- 
tives and guests, I appreciate this privilege to testify before your 
Committee. I thank you, very much, for that privilege. 

My comments will focus on the leadership, the extensive related 
activities, the broad network of veterans activities initiated, devel- 
oped and implemented with Harold Bushey, Director of the Re- 
gional Office of the VA. I will only highlight several of the special 
projects that we shared in our efforts and concerns together. 

These are external activities. They are the only ones that I will 
comment on. I feel that they are very important in the delivery of 
services to veterans. I won't comment on the internal affairs and 
process and procedures that others have testified to. 

In the early 1970's Mr. Bushey played a dominant role with me, 
in conjunction with government agencies, public and private em- 
ployers of the area and the educational institutions, in holding a 
series of job fairs and educational fairs to assist returning Vietnam 
veterans. We placed over 2,000 returning Vietnam vets into jobs, 
into job training programs, into higher educational facilities. This 
was done at a time when certain groups showed no respect for the 
service and sacrifice that Vietnam veterans had made. 

We shared in the development of a minority business opportuni- 
ties committee, part of the Federal Executive Board. The first mi- 
nority owned and run bank was a major achievement that we were 
able to achieve in the early 1970's. His continuing chairmanship of 
that Committee has led to many projects and programs that have 
benefitted minorities; racial, gender, handicap and especially 
veterans. 

When I was Pennsylvania's Secretary of Labor and Industry I 
initiated the first high level state government conference on Agent 
Orange which was, again, at that time, a difficult concern to try to 
implement. Director Bushey provided exemplary support and as- 



75-767 0-94-2 



30 

sistance in the development of that. A major outcome was the first 
Herbicide Commission in Pennsylvania. 

Director Bushey and I developed the Federal Education Center 
in Pittsburgh in the early 1970's for the Federal employees. Scores 
of employees improved their careers and service through certificate 
programs as well as bachelor and masters degrees. Director Bushey 
served in a predominant role for over 20 years as past Chairman 
and special project Chair, members of the Western Pennsylvania 
Society of Public Administration. So many of these directly bene- 
fitted veterans and their families. 

Again, when I served as the senior Pennsylvania Administrator 
for Senator John Heinz, Director Bushey supported vigorously a 
special project that we implemented in Pennsylvania. Some of you 
may recall, it was 'Tiire a Vietnam Vet" job pledge project in Penn- 
sylvania. John Heinz and Rocky Bleier served as co-chairmen. It 
was a highly successful program, resulting in the hiring of over 
10,000 veterans throughout Pennsylvania. 

Bushels support and assistance continued when this project was 
then picked up by Governor Thomburgh in his first term. As an 
aside and not part of the testimony here but what has been said 
and what Congressman Ridge's question stated, when I was with 
John Heinz we established five field offices throughout Pennsylva- 
nia. The heaviest workload on caseload for the staff of these offices 
was Social Security, Black Lung and veterans concerns. There's a 
relationship among those three. 

Much of it is based on information that is needed, whether it's 
in evidentiary form or affidavit form or whatever. Sometimes I 
would wonder, as I reviewed these cases as an advocate for veter- 
ans, that wouldn't it be something to consider that prior to the day 
of discharge — because there's the anxiety of the veteran to sign and 
get the hell out right away. This was especially important when I 
was 

Mr. Ridge. I think there is still the same desire. 

Mr. LlEBERTH. In 1946, after five years, the anxiety was really 
there. The point that I wanted to make was that in that anxiety 
to hurry up and get out and get home, I wonder if there shouldn't 
be a counseling service provided whereby the about to be dis- 
chsirged veteran could provide to a military personnel and would be 
part of that discharge process, to go over some of the injuries re- 
ceived and some of the areas that you were in and so on. 

I was subject to that St. Louis fire too, when I had to look into 
something. The story was, the first destroyed the records. 

The point that I am trjdng to make is, as we get older the mem- 
ory plays tricks on you. You tend to forget and the gears don't get 
into gear. I am just wondering if there shouldn't be a statement 
filled out prior to discharge on the injuries that you had and the 
sickness that you had, where you served and so on. 

If you read the monthly veterans magazines every month there 
are pages of veterans trying to find information ft-om somebody 
about an incident that occurred in 1943 and 1944 and so on. 

Mr. Evans. Mr. Lieberth, this is an issue that we are trying to 
address, not through this committee, but through the Armed Serv- 
ices Committee. Right now, I am told that the Marine Corps and 
Navy are not even giving in-depth discharge physicals. 



31 

What we want to see, particularly because of the problems we 
suspect coming out of the Persian Gulf War, we want to see more 
in depth medical review. Your points are very timely, and we ap- 
preciate your testifying to them. We hope that we will be able to 
include legislation requiring something similar to what you are re- 
questing, in the Defense Authorization Bill. I appreciate you bring- 
ing up this important issue. 

Mr. LlEBERTH. Thank you. I will continue then, with my testi- 
mony. When the natural disasters hit Pennsylvania, I recall that 
Harold Bushey was there with strong support, service and assist- 
ance, as we coped with Hurricane Agnes, the devastation in the 
1977 Johnstown Flood. To me, Harold Bushey exemplifies leader- 
ship, good government official. 

I will reference just a few — in fact just a handful — of long public 
career achievements that I was able to share with Harold Bushey 
over the years. For 40 years I have been in public service, now 
semi-retired; 15 of those years were in direct Federal service. I can 
say with absolute candor and professional objectivity, that my rela- 
tionships with Harold Bushey were exemplary in his support on be- 
half of veterans. 

Thank you, very much. 

[The prepared statement of Mr. Lieberth appears on p. 114.] 

Mr. Evans. Thank you. Ms. Graham. 

STATEMENT OF TREA GRAHAM 

Ms. Graham. Gentlemen and ladies, I appreciate the opportunity 
to be here today. The timeliness and responsiveness of the Depart- 
ment of Veterans Affairs in processing claims is a critical issue to 
our area's veterans. I am grateful to you, Mr. Chairman and Mr. 
Ridge, for taking the time to come to Pittsburgh today. 

For several years I have served on Congressman Rick Santorum's 
Veterans' Affairs Advisory Board. This Advisory group is composed 
of veterans and other interested individuals from the Pittsburgh 
area. While we come from a wide variety of backgrounds, we share 
a common commitment to the veterans of our area £ind a strong be- 
lief that individuals, through concerted action, can change the way 
that our government serves us. 

I was inspired to become involved in veterans' issues because of 
my husband. Master Sergeant David Graham, 112th Securitv Po- 
Hce of the Pennsylvania Air National Guard. Most recently he 
served in Desert Storm. During the Gulf War I was particularly 
frustrated in dealing with the various layers of bureaucracy, which 
prompted me to help establish a support group at the Air National 
Guard base for the families of service men and women. 

This support group was very successful in providing our families 
with the resources to deal with the long separation from our 
spouses, parents and children, serving in the Gulf War. 

After David returned from six months duty in the Persian Gulf, 
shifting my focus to the concerns of veterans seemed to be a logical 
next step. When I joined Congressman Santorum's Veterans Advi- 
sory Board I was elected to participate with five other citizens, in 
identifying veterans benefits issues. 

We quickly discovered that timeliness in processing benefits 
claims was a serious concern. In the Pittsburgh region for example, 



32 

it was taking an average of eight months for a claim to be prepared 
so that it could be processed. Our benefits committee decided to in- 
vestigate why. Our committee's initial goal was to determine if the 
Pittsburgh Regional Office was performing on a par with other Re- 
gional Offices, serving communities with similar caseloads. 

If problems could be identified we intended to work with Con- 
gressman Santorum and the VA to correct them. During a meeting 
last year with the Congressman's Benefits Committee and William 
Bums who, at the time was Chief Adjudication officer, we exam- 
ined VA statistics from a ten month period, between October of 
1991 through July of 1992 from the Regional Offices in Boston, 
MA, Jackson, MS, Newark, NJ, and Little Rock, AR. 

We compared these statistics with information from the Pitts- 
burgh office. While timeliness seems to be a problem throughout 
the country, we learned that the Pittsburgh region had one of the 
poorest records of timeliness in virtually every category that we 
could evaluate. 

Working in cooperation with the Regional Office, Congressman 
Santorum and the Congressman's staff, we sought changes. Indeed, 
since last year change has occurred. Mr. Bushey and his staff have 
been very helpful in lending their time and their assistance. Since 
our study began Director Bushey, recognizing the deficiencies, has 
implemented a comprehensive action plan for the improvement of 
claims processing timeliness. 

The first quarterly progress report dated April 7 of this year 
which set forth a now strategy for the division, was recently pre- 
sented to the Congressman's staff. In addition, I am pleased to ac- 
knowledge that the Regional Office has added the largest class of 
adjudication trainees, ever. As of next month the rating board will 
be expanded by two positions. 

As a direct result of these initiatives, timeliness comparisons 
that were conducted between October of 1992 and last month illus- 
trate that our Regional Office is moving in the right direction. 
While the national averages during this period remained the same 
or got worse, our timeliness by in large, has improved. 

All this sounds great. Indeed, it is great. However, it's important 
to remember that while these are all positive changes, the Pitts- 
burgh Regional Office will have to continue its effort to improve the 
productivity level in adjudication. I say this for several reasons. 
The training of new adjudicators takes between 12 and 18 months. 
When trainee adjudicators are added, the training responsibilities 
fall on the present adjudicators. Also, when adjudicators are pro- 
moted to the rating board it depletes the pool of experienced 
adjudicators. 

At this state, five of the new adjudicators have not yet completed 
their training, and there are plans to promote two adjudicators to 
the rating board. Therefore, on paper, there may be 23 adjudicators 
but in reality it will still take time for the Pittsburgh Regional Of- 
fice to perform as if there were 23 fully trained adjudicators. 

This situation is further complicated by a noticeable increase in 
workload, attributed to the downsizing of the military. Last year 
alone, the Pittsburgh Regional Office had its pending workload in- 
creased from the year before by 27 percent, compared to a national 
average increase of 15 percent. During a similar period Pitts- 



33 

burgh's rating board workload increased by 100.1 percent, com- 
pared to an increase of 46.4 percent nationally. 

As these facts reveal the positive changes that have been imple- 
mented so far in the Pittsburgh Regional Office, they have not to- 
tally solved the problem. Simply put, even though the Regional Of- 
fice has illustrated its commitment to improving timeliness in sev- 
eral ways since our study was initiated, there is still more to be 
accomplished. 

I was very happy to hear, that Congressman Santorum's office 
was given assurances during a face to face meeting with the Direc- 
tor and his top management as recently as last Wednesday, that 
the Adjudication Division would continue to be the region's number 
one staffing priority. The Congressman's office was also assured 
that more adjudicators would be brought on board in the months 
to come. 

This is important, because even when the recently hired trainees 
are in place as full-time adjudicators, our Regional Office will still 
lag behind other similarly sized regions in adjudication manpower. 

It's my hope that our efforts on the Veterans Advisory Board 
have helped to focus attention on the need to improve the timeli- 
ness of the Pittsburgh Regional Office. We all share the belief, that 
more can be done. In particular, we will suggest the following. 

One, that our Regional Office recruit experienced adjudicators 
fi-om within the VA system, to provide immediate assistance. Two, 
that the Director consider delaying his selection of two senior adju- 
dicators for the rating board until a sufficient number of adjudica- 
tors are in place. Three, that the Pittsburgh Regional Office con- 
tinue efforts to improve the efficiency of the office. One idea that 
has considerable merit would be a broader cross training of benefits 
counselors as adjudicators. 

Members of the Armed Forces served when our country needed 
their service. If they were asked to march, they marched. If they 
were asked to fight, they fought. These men and women did not re- 
spond to Uncle Sam's call to arms by saying not right now, give me 
eight months. I think our country owes it to these veterans to re- 
turn the courtesy, and process their benefit claims in a timely fash- 
ion. 

Thank you. I will be glad to answer any questions. 

[The prepared statement of Ms. Graham appears on p. 116.] 

Mr. Evans. Mr. Ehrhardt. 

STATEMENT OF JACK EHRHARDT 

Mr. Ehrhardt. Mr. Chairman, panel and honored guests, thank 
you for allowing me to share my views. As I traditionally do, I am 
going to break away from my written testimony just briefly. 

You have heard many statistics and many of the problems that 
have existed. My opinion is that most of those are due to a lack 
of resources. I would like to turn a little bit more now to a clinical 
opinion which has not been rendered very much today. 

First of all, in the timeliness of adjudication of particularly post- 
stress cases they are very difficult because, in the school of psychia- 
try and among clinicians and probably amongst everybody in this 
room, there are two schools of thought. One of those is called the 



34 

pre-disposition view, which means that some personahty flaw 
caused this person to react to his war-like stress. 

The other view is called the occasion view; and that view is that 
the traumatic occasion is responsible for post-traumatic stress. 
That view and that argument goes on in the mind of every clinician 
and every adjudicator, and probably every person that comes across 
this. That's what makes these claims so difficult. 

In terms of adjudicating these claims it takes a preponderance of 
evidence. You have to know if the stressor did exist. These things 
take a great deal of time to accumulate both the clinical evidence 
and the administrative evidence to adjudicate the claim. In defense 
of my co-workers at the Regional Office, they have the very difficult 
task before them, and one that requires a great deal more re- 
sources than we presently have alloted to this situation. 

The second thmg I want to address is outside medical opinions. 
Every veteran is afforded the opportunity to bring in private sector 
or private clinical/medical opinions to his claim. This is difficult 
too, because before that can be done or before the Regional Officer 
or adjudicators can request that information, that individual pa- 
tient has to sign to release that information at the private facility. 
This often delays the information getting to the adjudicators and 
into the system. 

It is one of the problems of the proper adjudication of claims, be- 
cause often the information comes in from the private sector people 
in bits and pieces. Often, just because a private practitioner re- 
ceives a request for information from a veteran or from the VA, 
they don't always respond. 

Lastly, the subject of re-evaluations has come up. In post stress 
cases which I will speak to, they are a great deal different than 
medical cases. I can give you a highlighted example. Several years 
ago I hurt my knee during playing softball. I had the cartilage 
torn. Before I had my surgery I was very, very disabled. After the 
surgery there was a verv quick recovery and I was back to being 
as good as I was before the surgery. 

I am speaking to this in terms of review because people talk 
about review. In that case if you would have reviewed my medical 
situation prior to the surgery, you would have found me very dis- 
abled. After the surgery you would have found me ready, willing 
and able to go back to work. 

There is a difference between medical cases and psychiatric ones. 
Psychiatric change or the change from a post stress situation to 
someone who has been treated and more healthy and returned to 
work is a lot different. I think we need to find a better and more 
equitable way of reviewing and adjudicating medical cases as op- 
posed to psychiatric ones, because they are very much different. 

In addition to that, although many veterans are upset by the an- 
nual review of their cases, particularly those who have post stress, 
we do have to admit that both social security and other government 
agencies and the private insurance companies too, all do review of 
medical cases for improvement. In defense of that, that's just some- 
thing that we have to tolerate. 

I think what we need to do is find a more kind and compas- 
sionate way of doing it. Sometimes for the veterans who receive the 
form letters, they are very threatened by those. We are going to re- 



35 

view your case and would like for you to report to this examination. 
For those people who already have post stress and are frustrated 
by that, that becomes a very threatening thing and yet, a very nec- 
essary one. 

Other than that, I think my written testimony speaks for itself. 
I would be glad to answer any questions that the committee has 
to ask. Thank you. 

[The prepared statement of Mr. Ehrhardt appears on p. 134.] 

Mr. Evans. Thank you, very much. Trea, your statement refers 
to a quarterly progress report dated April 7, 1993, which sets forth 
a new strategy for Pittsburgh Regional Office adjudication. Would 
you please submit that to us, and if you don't have it could you 
send it to us by mail perhaps? 

Ms. Graham. I do have it with me. This is a VA document. As 
a citizen, is it appropriate for me to submit something that's a VA 
document to the committee? I would be happy to. I have a copy 
with me. 

(See p. 119.) 

Mr. Evans. Absolutely. If we can get a copy of it so that you have 
your own copy. We had talked earlier about a question raised by 
some of the veterans' organizations, that is, should the Veterans 
Benefits Administration use something other than end products to 
measure work and what might be a possible alternative. Do you 
have any opinions on this? 

Mr. Ehrhardt. As a line staff worker, our superiors tell us that 
you guys want statistics. You want to see statistics. You want to 
see in pure numbers, what we are doing. 

From a line staff worker and a clinician's point of view, the sta- 
tistical numbers really don't have as much importance as how 
many people we really help. We could tell you we are helping 5,000 
people and that might look good on paper, but it's not what we 
really do. 

I don't know how we are ever going to find a way to measure in 
the human services how we help the human element, and be able 
to put that in a report to the Congress. Many of the things that 
we do at the line staff level just don't respond that way. 

How do you measure a successful case? Is it that the fellow got 
the disability he wanted? Is it that he got a percentage of that dis- 
ability? Is it that we got him to medical care when he needed it? 
Is it that we found him a home when he was homeless? These 
things are very, very hard to measure. 

When we talk about the end product I guess for me the end prod- 
uct would be that every single veteran reaches both his vocational, 
family and social potential to the maximum of his ability. I guess 
to me, that would be the end product. How we get them all to the 
end product, we would all be making a lot more money than we are 
if we knew the answers to those questions. 

Mr. Evans. In the re-evaluation of PTSD claims, are the Vet 
Center personnel called on to make their own assessments for the 
benefit of their reviewers? 

Mr. Ehrhardt. In the early years we weren't. But in more recent 
years because of the level of expertise on post stress that is in- 
volved in the Vet Center program, we are now more solicited for 
opinions and particularly our clinical opinions, on these cases. 



36 

That only becomes a sticky wicket in that our apphcation for the 
veteran for cHnicians only goes so far legally, and then it is up to 
the service organizations or whomever has that veteran's power of 
attorney to carry that claim. The Vet Centers have become much 
more active in writing the clinical opinions and turning in evalua- 
tions along with the compensation and pension exams that are or- 
dered by the Regional Office. 

In many cases compensation and pension examining physicians 
will often call on the opinions of local Vet Center personnel for ad- 
ditional opinions or consultations in that regard. I think that's a 
very positive step. In the Vet Center program, a great knowledge 
base has evolved on the subject of post stress disorder because so 
many of the people work with that on a day-to-day basis. Those 
opinions are valid and are becoming much more evident as we go 
on in time. 

Mr. Evans. In your statement you refer to the good working rela- 
tionship you have with the Regional Office and town meetings are 
very helpful to you. Do you have a direct working relationship with 
WLP and with the veterans advisory committees of local Members 
of Congress? Do you work directly with them? 

Mr. Ehrhardt. Yes, a lot of them. We have a good line of com- 
munication with the Regional Office people and I think it's getting 
better. We have lines of communication with all of the service orga- 
nizations. It's quite a network out there, that I think for whatever 
reasons — we could belabor that forever — they dropped off in the 
1960's and 1970's. 

I think as we came through the 1980's the service organizations 
and all the people that are responsible for helping veterans have 
really increased their communication. I think there's a lot more co- 
operation as opposed to competition among the service centers, the 
VA and the Department of Benefits. 

Mr. Evans. Congressman Ridge. 

Mr. Ridge. Thajnk you, Mr. Chairman. I just want initially the 
record to note, that witnesses Fitzgerald, Lieberth and Ehrhardt 
are all highly decorated combat veterans, who bring their advocacy 
not just fi'om a professional point of view but from a very deep per- 
sonal point of view. I thank them very much for their testimony 
today and their advocacy on behalf of veterans. 

Ms. Graham, I understand that your husband has a very distin- 
guished career in the service as well. You bring, I think, a wonder- 
fiil perspective as the spouse of a service person. When a man or 
woman puts on a uniform of the United States of America his or 
her spouse and his or her children and their family, bear an enor- 
mous burden and a lot of the pain while during their active service 
and subsequent to getting out of the service. I appreciate your ad- 
vocacy as well. 

I want to follow up on some of the things that you commented 
about, working for our colleague Congressman Santorum. You men- 
tioned in your discussions with Mr. Bushey and the folks at the Re- 
gional Office, that commimication is continuing to improve, trying 
to streamline the process. There seems to be a consistent thread 
throughout just about everybody's testimony, and that is inad- 
equacy of staffing and particularly in the adjudication process. 



37 

You also mention that you had done some comparisons between 
this Regional Office and others. Do you have an idea — and perhaps 
I could get that from Mr. Bushey — in order for this Regional Office 
to have the same complement or a similar complement to that of 
Regional Offices with the same kind of caseload in terms of how 
many more adjudicators they should have? Do you have any idea 
in that regard? 

Ms. Graham. Yes. I would say initially, that I think we all need 
to be realists. Our Committee took the realistic point of view, that 
asking for more money wasn't going to be the way to go. This Re- 
gional Office has a budget, and they have to work within those 
constraints. 

I think that what we have seen since we have begun to address 
this timeliness issue, is that when it was brought to the Director's 
attention he took a look at it and decided to reassign some prior- 
ities within the constraints of his budget and his personnel. That's 
to his credit. 

I would like to say that in my personal opinion, it's more a man- 
agement problem than Oh, my God, we need to hire some more ad- 
judicators. We do need more adjudicators, there's no question about 
it. I would say that we are probably five short, full-time trained ad- 
judicators. 

The statistics that we used as a Committee were VA statistics. 
We didn't go out and gather any new information. We did utilize 
the resources that we had available, which were the service organi- 
zations in Pittsburgh who know exactly who does what and how 
many of whom there are within the VA. What we essentially did 
was corroborate the VA figures that we started with, that they are 
correct. Compared to those other Regional Offices with similar 
caseloads, Pittsburgh is short. 

Mr. Ridge. I appreciate your sensitivity to budget. Nobody appre- 
ciates it more than Mr. Bushey and members in the VA system it- 
self, because there are enormous constraints. I would tell you how- 
ever as a veteran, I think that caring for veterans is a continuing 
cost of Defense. If we have to nudge a few more dollars in that di- 
rection, so be it. We are downsizing our military to an extent that 
almost historically the largest reduction in force and force com- 
plement that we ever have. 

I think we may have a few more dollars, at least try to find 
some. My concern is as you explained the situation and as has been 
explained by others, there are fewer benefit counselors. Take some 
of these adjudicators and move them up to another facility or give 
them other responsibilities. 

In balance what you are doing is, you have a finite number of 
people in the whole claims process, and if the only thing the Ad- 
ministrator can do is move them from one part of the claims proc- 
ess to another part of the claims process, I am not sure how much 
better the claims process or how much more efficient it is going to 
be. You do need a minimum number of personnel. 

I appreciate your concern with the budget, because we are clearly 
running a major deficit. We have to be concerned. But just reas- 
signing people within a process, we may have to do more than that. 
Have you looked at that? 



38 

Ms. Graham. Yes, and I would follow up by saying yes, there is 
a budget constraint and yes, it has to be worked within. Yes, if you 
look at the VA statistics Pittsburgh, even with the changes that 
have been made, I would say we are about five full-time adjudica- 
tors fewer than similarly sized regions. Yes, moving people around 
just isn't the answer. 

When I spoke about management decisions, I think what I was 
insinuating and now I will say, is that the director is responsible 
for all of the people who work for him. I would submit that if you 
have a budget that you have to work within, maybe you need fewer 
people doing something else. 

That leaves you open to train and hire and maybe invite from 
other VA regions, full-time adjudicators to fill a need that is more 
important. That's why I said it was a question of priority. 

Mr. Ridge. I think you are right. I think that a lot of it has to 
do not only with this regional center but with the ability of man- 
agers managing, whether it's a private institution or public institu- 
tion or whatever it is, it's a real managerial challenge as well. 

Ms. Graham. Right. This is a bureaucracy and it is a government 
office, but that does not mean that it can't run efficiently and can't 
have it's priorities more correctly oriented. 

Mr. Ridge. I concur, completely. Thank you. Mr. Fitzgerald, I 
know the WLP and am very familiar with it since I was there to 
cut the ribbon with you way back then. I was curious as to whether 
or not you see within the Pittsburgh office, more and more veterans 
of all areas coming to the WLP for the purpose of having some 
case work done to get assistance with claims processing. 

Is the WLP out there doing that now? That wasn't the original 
mission but are you doing more of it? 

Mr. Fitzgerald. Yes. When we get a client to come into the 
WLP we become case manager. What we have done is set up rap- 
port with all the different veterans' organizations including the Re- 
gional Office. As our client sits down with us we go through the 
case file with him. If he's having problems with the Regional Office 
then we go to the Regional Office and make phone calls, and we 
get things done for him. 

If it's the VA Medical Center then we call up there. We have 
made contacts in areas where we can get our clients through the 
system much quicker. That's why we can go through 700 people a 
year. They are not all receiving the same type of services. With 
eight people we are able to do that, because some just need some 
job search work £ind some just need tips on how to go to an inter- 
view, and some just need some job tips. We are able to go through 
much more that way. 

Our clientele remains pretty steady, at 700. We are looking for 
a new influx with the downsizing. I think it's going to get quite 
large. We have just received a grant through the federal govern- 
ment through Rick Santorum's office to prepare for that, and pos- 
sibly hire a couple of people who are going to do nothing but help 
people. 

Mr. Ridge. Very good. Mr. Lieberth, I know that wherever and 
whenever you go in Western Pennsylvania, if a veteran has a prob- 
lem, he or she is probably knocking on your door. I don't think 



39 

there's anybody that has been identified longer in Western Penn- 
sylvania as being a veterans' advocate. 

Can I presume that you have established your own little network 
of communication within the VA system to help individual veterans 
out, or do you refer them to WLP or other agencies within the vet- 
erans' community within Pittsburgh? 

Mr. LlEBERTH. When I was more active in other positions of au- 
thority in order to strengthen the advocacy role on behalf of veter- 
ans, we started a lot of external activities on behalf of veterans 
such as job fairs, the Governor's outreach offices, one of which was 
up in Erie, PA. 

For example, the Erie office, I found that many of the veterans 
were not in a service area proximity and so they didn't benefit by 
services that were available. Much needed services were needed. 
We developed these outreach centers that took mobile units and set 
up two or three day offices in the boondocks, semi-rural areas and 
so on. 

My efforts have always been on an advocacy role and to give the 
benefit of the doubt to the veterans, especially in the absence of 
documentation. In my day when I was a veteran in the time of 
1941 to 1946, information processing and securing and establishing 
was primitive, really. It's become somewhat more sophisticated. 

The basic problems still remain. That is, an information base, an 
evidentiary base. On reasonable doubt, my dictum has always been 
that you lean on the side of the veteran. I do think that the whole 
communication system has increased tremendously through 
WLP's, and through Congressional committees that have been es- 
tablished. 

Harold Bushey established an informational committee that 
Bemadine Kersting headed. She's off on extended leave right now 
for illness. My experience has been to share information as much 
as you can with that appeal, that claim, or whatever it might be. 

Mr. Ridge. Thank you. I wanted to make note as part of the 
record that privately I told my colleague and fi-iend Lane Evans 
that there is no one in my Congressional district — no one — who has 
spent more personal, as well as professional time, who is more sen- 
sitive to the emotional and psychological problems encountered by 
veterans and not just those who you share the Vietnam experience 
but all veterans who share combat experience, than you. 

You noted in your introductory comments that it is an honor for 
you to testify before this committee. Frankly, I think it is a high 
honor for the Congress of the United States to receive testimony 
from you and from Charlie Lieberth and Tom Fitzgerald. I just 
thank you for that testimony. 

I am interested in your view of how the presumption in favor of 
the veteran in absence of concrete and maybe substantive, either 
clinical evidence or the historical evidence, is implemented. We 
want it to exist. I get a feeling in reviewing some of my cases, 
that — I think Joe Kiren mentioned it — the presumption winds up 
at the end of the system rather than at the fi-ont of the system. 

From an advocate's point of view, is the presumption strong 
enough? Should the Congress of the United States give the claims 
adjudication people a broader base to make some decisions on the 
presumption, broader than it has to date? I know you are seeing 



40 

not only Vietnam veterans but, as Tom pointed out, you are start- 
ing to see more Korean War veterans and more are starting to 
come into the process. 

Does Congress need to make a stronger presumption in favor of 
the veteran? 

Mr. Ehrhardt. Yes, sir, we certainly do. I can only speak with 
real authority to the post stress cases. There are three things the 
veteran needs to have. He has to have a recognized documented 
stressor. He has to have a record of treatment, and he has to have 
a diagnosis of post-traumatic stress disorder. 

How many of these opinions does he need. It appears that in a 
lot of cases that the evidence in favor of the veterans has to have 
an overwhelming preponderance. I think we need to give the adju- 
dicators a lot more leeway, in how much evidence is necessary and 
how much credence we put into testimony or the statement of the 
veteran. 

On the issue of documenting the stressor, that gets very difficult. 
Many of the times when the stressors were occurring it was not a 
time when people could sit around and say let's document this be- 
cause 20 years from now we are going to have to tell somebody that 
this bunker has blown up or that this helicopter has crashed, or 
that this guy was wounded in front of me. 

That is really a very difficult thing to do, the documentation of 
the stressor. I think in most cases — I can't speak to all cases but 
in most cases that I have heard — generally speaking when the vet- 
eran says these things happened, they generally did. We certainly 
have, as everybody who works in the systems does, quite a few fic- 
titious veterans. Everybody wants to be the last survivor or Khe 
Sanh these days. 

In most cases and I think in enough percentage of them, we need 
to take a lot more look at what this guy is saying and give him 
indeed, the benefit of the doubt. 

Mr. Ridge. That's strong testimony and something, Mr. Chair- 
man, that I think we ought to take a look at. That's not just some- 
thing that this Pittsburgh Regional Office has to deal with, it's 
something that the system needs to deal with nationwide. 

The stronger use of that presumption earlier on in the adjudica- 
tion process might not only expedite the claims, it might, more im- 
portantly, involve treating veterans more equitably, humanely and 
more appropriately. I appreciate that. 

Mr. Ehrhardt. And, it would also remove some of the stress 
fi*om the adjudicators and the people who have to decide these 
claims, if they had a broader base to review the claims with. I 
think the way the law is written now, that there's a great deal of 
restriction on the people who have to adjudicate. 

Mr. Ridge. Quite a bit of restriction, and as you pointed out ear- 
lier, an enormous amount of uncertainty. 

Mr. Ehrhardt. Right. 

Mr. Ridge. I thank you for your testimony. 

Mr. Lieberth. May I make one quick comment? 

Mr. Ridge. Please. 

Mr. Lieberth. In my public experience repeatedly at times, there 
are assaults made to eliminate or modify dramatically, veterans 
preference. I would just encourage your Committee to be stalwart 



41 

and say that there is no extreme tampering done with veterans 
preference! 

Mr. Ridge. We hear you loud and clear. Mr. Fitzgerald, do you 
want to say something in that regard? 

Mr. Fitzgerald. Yes, I would like to comment on that, about the 
different veterans. I was involved in a study with the homeless 
shelters here in Pittsburgh, and we have found that most of your 
homeless veterans do have some type of psychological problem, be 
it substance abuse or alcohol abuse. 

We found a lot of veterans, one in particular was 86 years old, 
had retired in 1966 and can no longer live on his pension. Out of 
the 24 that we interviewed there were six of them that were over 
70 years old and could no longer live on their pensions. This is 
what is happening to them. They can't go for veterans benefits be- 
cause they didn't apply for veterans benefits back when they got 
out, because they didn't have a means to. 

We also — which was very disturbing — we were finding Desert 
Storm veterans to be homeless. To be so quick from one war to the 
streets, is really a shame. 

Mr. Ridge. I see our friend in the back, Ron Conley, who has 
been very active and involved in homeless veterans' issues for a 
decade, nodding in agreement. I appreciate that testimony. 

Mr. Chairman, thank you. 

Mr. Evans. Thank you. I appreciate your testimony here today. 
Jack, I know that during the 1980's the ups and downs of the Vet 
Center program probably caused a lot of counselors to suffer from 
stress themselves. 

Mr. Ehrhardt. Now and then. 

Mr. Evans. We appreciate your sticking with us. 

Mr. Ehrhardt. Thank you. 

Mr. Evans. Thank you all, very much. Our final witness is Har- 
old Bushey, Director of the Pittsburgh Regional Office, Veterans 
Benefit Adminstration. Harold if you will come forward £uid once 
you are seated please introduce and recognize those staff members 
that are joining you at the table. 

STATEMENT OF HAROLD BUSHEY, DHIECTOR, PITTSBURGH 
REGIONAL OFFICE, VETERANS BENEFITS ADMINISTRATION; 
ACCOMPANIED BY HARRY FEATHER, SENIOR MANAGEMENT 
ANALYST; MICHAEL VUDRAGOVICH, ACTING ADJUDICATION 
OFFICER; GERALD SERRINO, ASSISTANT DIRECTOR; NICK 
VRCIC, MANAGEMENT ANNALYST; CARL REUTER, LOAN 
GUARANTY OFFICER AND TRACY ALTON, VOCATIONAL RE- 
HABILITATION AND COUNSELING OFFICER AND ANTHONY 
ANNORENO, ACTING CHIEF, VETERANS SERVICE OFFICE 

Mr. BuSHEY. Mr. Chairman and Congressman Ridge, I would 
like to introduce my co-workers. With me on my immediate right 
is Harry Feather, ADP Division Chief; Mike Vudragovich, Acting 
Adjudication Officer, Jerry Serrino, my Assistant. Mr. Reuter, Loan 
Guaranty Officer on my left, Mr. Vrcic, Management Analyst and 
Tracy Alton, head of our Vocational Rehab and Counseling Divi- 
sion. 

It's a pleasure to be here today Mr. Chairman, and also Con- 
gressman Ridge, from last year when we examined the homeless 



42 

problem. We really appreciate your concern for helping us. I do 
want to take this opportunity not only to thank you for your con- 
cern but to theink the two preceding panels. 

Those people on both panels share my concern and your concern. 
We all work as a partnership together even though sometimes we 
are in disagreement on claims. We work as a partnership. I want 
to tell you for the record that they have all helped us tremen- 
dously. When they see a case that drops between the slats they get 
in touch with us immediately. 

Again, I would just like to outline my paper, and then we will 
open up questions. I appreciate this opportunity to take you 
through the decisions and problems that we face, and how we are 
dealing with them. 

There is currently, nationally, 557,000 case backlog in the com- 
pensation and pension claims across the country. Despite the ex- 
tensive use of overtime, innovative claims processing and other 
measures to reduce the pending backlog, it has been projected — 
and I know the committee knows most of this — that the workload 
will balloon to nearly 900,000 cases by the end of fiscal year 1994. 
I know that you will be addressing that soon. 

I wish we could say the solution to our problem lies in funding. 
If that were so, I would simply say give us the resources and we 
will do our job. But a good illustration of our problem is the rela- 
tionship between the workloads of Veterans Services Division 
which answers inquiries and assists veterans in filing claims, and 
our Adjudication Division which processes compensation, pension 
and education cases. The more claims that we have the greater 
number of cases we have relative to their status. 

If we concentrate on the resources and claims processing then we 
have less staff available to respond to benefit inquiries, and we ex- 
perience lost calls and delays in interviews and inquiry responses. 
Emphasis in veterans' services results in less claims processed and 
generates more inquiries. 

As the Director and manager of the Regional Office, it is my re- 
sponsibility to make these resource decisions in the most effective 
manner. It is the purpose of this hearing to review how well we 
meet the needs of the veterans from the area. I would like to high- 
light some of our accomplishments, some of which have received 
national recognition. 

In the partnership in which we work with the American Legion 
and Ron Conley and the VA Medical Center on Highland Drive, we 
were the first office in the country to convert a VA property into 
a home for homeless veterans. It serves as a national model and 
we continue to lead the way, with three facilities operating success- 
fully in our jurisdiction and a prospect for a fourth, currently being 
discussed with other service organizations. They are totally in- 
volved with us in that partnership. 

We have been employing total quality management principles 
and have been able to provide improved telephone service by that, 
expended access, and reduced missed calls. By using an innovative 
combination of Veterans Claims Examiners and Veterans Benefits 
Counselor positions, we have significantly improved our inquiry 
response rate to where it is currently better than the national 
standard. 



43 

Our work with the Desert Storm veterans was reviewed during 
a field hearing and at the briefing of the local Congressman and 
Senator and the quality of that service provided Desert Storm also 
received national recognition. As a result of that project, and our 
concentration on it, it contributed to our pending workload build 
up. 

In February of 1993, we had a seminar for Congressional District 
Office Staff personnel reviewing our procedures and ascertaining 
how we might improve services. There were no complaints or sug- 
gestions for improvement but rather, we were commended for those 
services we provide. I want the record to say that all the Congress- 
men and Senators in this area have worked very closely with us, 
trying to help us resolve our problems. 

More recently, we have initiated a series of town meetings, one 
you mentioned a little while ago, where we literally bring in the 
Regional Office to the population centers remote fi*om Pittsburgh 
and provide information about benefits and discuss problems with 
veterans, whether it be the explanation of a letter or a process of 
how we might assist them. It was very successful. We appreciate 
your staff. Congressman Ridge, helping us with that. 

We currently have started training on how to conduct focus 
groups, a process in which we will bring in veterans and solicit 
their views on how we can improve services. That was mentioned 
before. 

While we take pride in these accomplishments we recognize that 
there are needs for improvements in other areas. A crucial area of 
concern for every Regional Office is what we have been discussing 
today, the Adjudication Division, our major workload and perhaps 
our most critical function, the processing of disability compensa- 
tion, pension and education benefit claims. 

Claims processing has been influenced by three important devel- 
opments; changes in the due process required by the court deci- 
sions. The full impact of judicial review was not apparent at the 
Regional Office level until late 1991. Before the advent of the court, 
BVA remanded about 18 to 20 percent or 8,000 to 9,000 of its cases 
each year for Regional Office action. That figure has gone to 52 
percent in the Nation. That's because of the court system. 

It has been estimated that it now takes at least 25 percent 
longer to prepare a rating decision or a detailed statement of the 
case for the veterans who appeal decisions. Similarly, guidelines re- 
quired claims examiners to develop and review all records cited by 
the claimant, no matter how remotely they may be related to the 
issue under review. 

Communications with claimants are more fi*equent and greatly 
more detailed, taking 12 to 13 percent longer to complete. VA now 
must secure the personal medical records of veterans, and time- 
frames have been established of how long we wait before proceed- 
ing to further develop the case. Our VA hospitals have been cooper- 
ating tremendously in this endeavor. 

These actions can typically delay a final determination as much 
as 120 days. The Court of Veterans Appeals, known as COVA, has 
had significant impact on claims processing. COVA decisions have 
required expanded, more complex rating decisions, which thor- 



44 

oughly discuss the evidence and reasoning used to reach the 
decision. 

Additionally, authorization personnel are now required to provide 
a much more detailed response to claimants, especially when ad- 
dressing the basis for any denial. The changes that are made are 
good, but it must be recognized that they add to the process time 
of a case. The veterans have received the additional benefits of ju- 
dicial review and court system which automatically makes the 
claim processing a longer action. 

A claim, in October of 1991, took an average of 145.4 days to 
process. The averaging processing time for this same claim in May 
of 1993 is 191.2 days. 

These issues, along with numerous special projects such as social 
security and internal revenue wage matches and prominence given 
to Desert Storm cases and changes in the staffing and complexity 
of workloads, have combined to drain resources which would other- 
wise be dedicated to normal claims processing at the Pittsburgh 
RO. 

The effect on our operations was noticed in January of 1992, 
when it was observed that our timeliness in processing claims for 
the first time had increased tremendously. We were not in an ac- 
ceptable range of a few key end products; that is, time to process 
new claims and re-open claims. Initially we attributed the dif- 
ferences to the national timeliness problem causes previously men- 
tioned, emphasis on Desert Storm and our emphasis on clearing 
out old cases which is the timeliness figure which represents the 
old age of cases completed. 

By April we had our quarterly reports showing a beginning of a 
trend, as the disparity between local and national figures widened. 
Our problems had become compounded by the loss of key staff 
among our claims examiners. Emphasis was placed on training of 
correspondence and development clerks as well as new claims ex- 
aminer training. By September we were looking for new ways to 
address the timeliness problem, and we had key staff visits made 
to the New York RO, where they are trying innovative methods in 
processing compensation and pension. 

We talked to the compensation and pension personnel as to what 
had worked elsewhere, trjring to work smarter and not harder. 
Most importantly, to secure fi'om our own employees their ideas as 
to how to do our job better. What came out of this was a departure 
fi'om traditional ways of doing things; that is, veterans' claims ex- 
aminers located in Veterans Services Division to work simple cases 
on the spot which do not require development, employee involve- 
ment and commitment to an improvement plan developed in con- 
junction with our C&P service, the posting of progress charts in the 
division for all employees to see and most importantly to see the 
progress. 

While the quality of our work never suffered as evidenced by 
VACO, quality reviews and appeal rates that are better than the 
national average, we have seen improvements in monthly trend 
data that are encouraging. Further evidence of the improvement at 
the Pittsburgh Regional Office can be seen in the reduction of the 
pending workload. 



45 

Since October of 1992 through the beginning of June of this year, 
we have been able to reduce our pending workload by over 3,000 
cases. During the same time frame the pending workload nation- 
ally only went down to 700. 

The Pittsburgh Regional Office has demonstrated an improve- 
ment, from October of 1992 until May of 1993. Of the 13 measured 
end products, the total number of claims pending decreased from 
ten of these end products from October to May, the number of 
claims pending over three months for 12 of the EP's decreased, and 
one stayed the same during the period of time. The number of 
claims pending over six months also decreased for 12 of these end 
products. 

This decline in pending claims in all age categories indicates 
management's improved emphasis on the claims adjudication proc- 
ess. As our claims examiner trainees gain more experience we ex- 
pect to see an even greater positive impact on progress. We intend 
to aggressively pursue our plan and achieve our stated objectives. 

I want to thank you for the opportunity to testify before your 
subcommittee. I know that you folks are going to be helping us, 
and I really appreciate it. I will answer any questions that you 
have. 

[The prepared statement of Mr. Bushey appears on p. 139.] 

Mr. Evans. Thank you, Mr. Bushey. The new Regional Office ac- 
tivities you identified such as more frequent VA communications 
with claimants, more detailed rating decisions and more detailed 
statements of the cases, aren't these exactly the types of actions 
that the Regional Office should have been taking all along? 

Mr. Bushey. You are right. We have been taking those actions 
and working on them, but addressing in a new and innovative 
ways. We have been doing it, but have expanded and improved on 
it. Frankly, when you are under these heavy workloads — it was 
brought to our attention and we addressed them completely. We 
did bring in TQM, and that's a new process of getting the employ- 
ees. Even though we got their employees opinion has it worked. As 
I said, it has reduced the number of inquiries by just those TQM 
sessions. 

I agree wHh you, those are the things that we should be doing, 
and are doing. 

Mr. Evans. I am directing another question to you, but if other 
panel members can assist you, please identify them. According to 
your statement: "All the resources which would otherwise be dedi- 
cated to normal claim processing of the Pittsburgh Regional Office" 
are not being used this way today. 

Can you identify all of these resources and tell us specifically 
how the resources are being used today? 

Mr. Bushey. Yes. What we did in terms of adding more adjudica- 
tion staff, we downsized our finance division, we downsized our 
VR&C division, and we downsized our administrative division. 
That's the way we were able to move additional people into adju- 
dication and get them into this training that we have done before. 

As you know that each year in the budget we have asked for ad- 
ditional people. In fact. Congress, I just left Baltimore about two 
weeks ago with a director's conference, and that was the most pop- 



46 

ular subject through the whole week, was clearing out the work- 
loads. 

The one thing that we would appreciate as you address the prob- 
lem — I know you are going to be doing it in other hearings — is to 
take a look at that figure from last year when the previous Admin- 
istration, the CBD, said the need for 1,306 positions nationally is 
greatly needed to clear out the backlogs at that time which were 
heavy backlogs but lower than what they are today. 

Perhaps in answer to one of your questions, do you need addi- 
tional resources, yes, we do. The way you figure those resources is 
1.5 of that 1,306 which roughly brings 20 additional people on. This 
is to clear out the backlogs and to stay current. Otherwise, you 
have a continuing problem. Even though you reduce your timeli- 
ness you put a plan into effect and it's working, but either we got 
to be honest or frank with the veteran and say because you got 
these additional benefits of judiciary review the cases are going to 
take longer to process. We do need nationally, the resources to 
clear out these backlogs. 

I can't be any frank than that with you, since you are asking me 
the points. 

Mr. Evans. One of the earlier witnesses today testified that at 
any given time there's about 100 records that can't be accounted 
for. Is that a problem for just the accounting for records or is that 
also a problem of not having clerks to keep track of the records? 

Mr. BuSHEY. Medical records are a problem and so are our 
records. Occasionally we do lose a file, but not 100 records. That 
does happen. One of the big problems that we have is the military 
records which prolongs the processing time, and this is a national 
problem. 

The new procedure that is being done with the Army is working 
great. We are getting records back in three to four weeks, where 
it used to take four or five months. All the other services are four 
to five months. So, you are adding on four to five months onto that 
time and the medical exam, and you have a six month old case. 
They are running higher how. The average is seven months, to the 
Nation. 

Mr. Evans. How many adjudicators does this Regional Office em- 
ploy? 

Mr. BuSHEY. I will direct that question to Mike, and you can give 
him the breakdown. It's 23, 1 think. 

Mr. VUDRAGOVICH. It's 12 fiiUy trained adjudicators. We have 
five in a trainee status. We have six senior claims examiners. We 
have one on extended maternity leave right now. 

Mr. Evans. Do you know how that compares to 1979, or could 
you give me a comparison if you don't have it? 

Mr. VUDRAGOVICH. No, I don't. 

Mr. Evans. The concern that we have is that budget cuts have 
been cited for the decline and adjudicators are not keeping up with 
the rate of increase in claims. We wanted to compare that to 1979. 
If you could supply that for the record, we would appreciate that. 

Mr. BuSHEY. Yes, we will get that for you. 

(See p. 144.) 

Mr. Evans. How many of these adjudicators — ^the ones that you 
have now — are not adjudicating claims? 



47 

Mr. VUDRAGOVICH. They are all doing claims processing work. 
We have one who specifically does education claims. Our education 
workload is a very small percentage of the workload. Instead of 
spreading it over all the adjudicators we, with CO's suggestion, 
concentrated education claims on one individual. That person gives 
full time work to the adjudication of education claims. 

Mr. Evans. How many of these adjudicators are trainees and 
what is the percentage of trainees? 

Mr. VUDRAGOVICH. We have 12 that are trained. We have five 
new trainees who started off sometime since the first of the year. 
Initially we hired three in January or February, that timefi*ame, 
and we selected two more. It's about that 

Mr. Evans. You agree, it takes about two years for a person to 
actually get the background and the training? 

Mr. BUSHEY. That's correct. 

Mr. VUDRAGOVICH. To become fully trained, yes. 

Mr. Evans. To come on board and really be efficient. 

Mr. VUDRAGOVICH. Yes. 

Mr. Evans. Let me yield to Congressman Ridge at this point. 

Mr. Ridge. Thank you very much, Mr. Bushey. It's a pleasure to 
be with you again. As I said at the oulset on a personal note, my 
office very much appreciates the relationship we have had with you 
and your team. You were kind enough and fair enough to point out 
that we haven't always agreed with regard to the ultimate disposi- 
tion of some claims. That's not why we are here. 

You have decisions to make and as an advocate I may object to 
it, but what we are trying to do is streamline the processes so that 
these differences cam be resolved in a more timely fashion. I appre- 
ciate very much your testimony. 

I am interested if I might move around to part of your manage- 
ment team, if you don't mind. 

Mr. Bushey. Sure. 

Mr. Ridge. I want to talk to Mr. Feather about total quality 
management. It's something that we do in the private sector. I 
don't think we do it enough, call upon or demand it enough, in the 
public sector. I am kind of interested in your assessment in the 
communication and how you structure the communication within 
the Regional Office, between the top management and the division 
chief, how this new special processing unit plays into the overall 
management, again with the emphasis now on adjudication of 
claims, and what kind of formal structure do we have within the 
VA Regional Office to make sure that everybody is doing their job 
and that the information doesn't just go from the top down. 

My experience has been people at the lowest level administra- 
tively, that are doing the hands-on day-to-day work sometimes are 
the best sources of information, and, certainly, the best to identify 
where problems are. 

How do you structure that relationship, and how do you see to 
it that the communication flows freely up and down the chain? 

Mr. Feather. I think there were several points made during the 
questions, and one had to do with total quality management as a 
vehicle. 

Mr. Ridge. Right. 



48 

Mr. Feather. The Regional Office has been involved with total 
quality management for several years now, in terms of establishing 
a quality plan that we communicate to all of our employees 
through a packet that we submitted to them as well as having 
training sessions for them. 

We have active TQM teams. Mr. Vrcic who is our quality coordi- 
nator, would probably be best able to identify what each of those 
teams is involved in and the progress that they have been making. 

We have always had, in terms of your question about commu- 
nications, we have always had an open door policy to communicate 
things up and down through the Regional Office. Mr. Bushey has 
always been an advocate of the open door policy, encouraging any- 
body who has a problem or question, to talk to him directly. The 
rest of the staff, 1 feel, shares that same policy. If someone has a 
problem or question of me, there's nothing to stop anybody from 
ever asking a question or getting what I would consider a reason- 
able response. 

Mr. Ridge. Is there any relationship between the development of 
the special processing unit and the apparent acceleration or im- 
provement in time with regard to processing claims? I know this 
has given my office one more point of access to the Regional Office 
with regard to particular claims. 

Is there any relationship? Is that why you did it? And, how does 
that fit in with the overall normal structure of claims adjudication 
and benefit provision? 

Mr. Feather. The special processing unit was designed to spe- 
cifically address Congressional inquiries. Previously we had Con- 
gressional telephone inquiries going to our Veteran Services Divi- 
sion. They were providing telephone responses to those inquiries. 
Written responses were coming from our Adjudication Division, 
where all of our written inquiries were sent to. 

What we wanted to do was to consolidate that responsibility into 
a single unit which we developed using a Veterans Benefit Council 
and a trained adjudicator. Again, with the emphasis on trying to 
get the responses to the Congressional offices as quickly as we 
could. 

In those cases where we had some difficult situations they could 
be hand carried and made sure that everything was done as quick- 
ly as possible to get resolution. 

Mr. Ridge. Have you learned anything from the operation of the 
special processing unit that you have been able to take to the over- 
all process itself? Ideally, I think you would want a system that 
could exist without a SPU, because that means you wouldn't need 
a special mediary to move things along. 

I am just wondering from whomever is in charge of this office — 
because it's kind of intriguing and I don't know who this individual 
would be — do they have access to you, Mr. Bushey and you, Mr. 
Feather, to say here's a log jam in the whole system? What you 
ought to do is put a stick of dynamite there and eliminate the log 
jam because I am seeing enough cases to suggest that institution- 
ally we have a problem here. 

Who does this individual, he or she, report to? Who does the SPU 
director report to? 

Mr. Bushey. Reports to the Director's office and also to the VSO. 



49 

Mr. Ridge. Very good. I wanted to if I might, highlight some of 
the concerns that I have. Again, these are anecdotal. I was involved 
in a claim and it's been resolved. I am just talking about the timeli- 
ness. 

A veteran died. The necessary information is sent, marriage and 
death certificates, to the Regional Office for certain benefits to 
which this widow is entitled. It took something like seven months 
to get the benefits. There was another incident — I don't recall spe- 
cifically — again, involving a death benefit. There seemed not to be 
an interminable delay, but the processing of death benefits aren't 
unique. 

I am just wondering if you have an ongoing reassessment of 
some of the process of standard claims. I mean, why would it take 
seven months for a widow to get these benefits? My office for- 
warded everything down. I am not interested in this particular 
case. Do you have teams reviewing on an ongoing basis some of 
these normal, predictable claims, so that you don't wait seven 
months to get the benefits? 

Mr. Serrino. It's done a couple of ways. One is, you have made 
reference to and some other people earlier, to end products. To give 
you an example, a 110 end product is an original claim. One of the 
things that it will track is timeliness; what is our average timeli- 
ness in a month for doing those particular types of claims that you 
referred to. 

Mr. Ridge. Would you get audit for an end product if a veteran 
submits a claim and you say no in a timely basis? 

Mr. Serrino. We processed it, yes. 

Mr. Ridge. You process it and say no 

Mr. Serrino. That's right. 

Mr. Ridge. You get credit for an end product? 

Mr. Serrino. We are not getting credit for end products. What 
they are looking at is, how long is it taking us to process new and 
original claims in that particular instance. 

If we do let's say 100 in a month, what they will do is look at 
the average processing time. That's the figure that we will have 
and we will have what the national average is, and now with our 
new system we can pull some select other offices that we want to 
compare ourselves to that are comparable. 

A second thing that comes up in terms of quality is, semi-annu- 
ally our comp and pension service will pull cases in and do quality 
reviews, to see how our office processed the case and was it done 
in a proper and appropriate manner. I am pleased to say that we 
have validated within those parameters for at least the last five 
years and probably longer. 

Those are a couple of ways that quality is looked it. Another 
way — and I think maybe there might be some confusion — I would 
like to go through for those people who might not be familiar with 
the process. 

When somebody files a claim and it goes before the rating board 
and the rating board makes a decision, the service organizations 
have a couple of avenues open to them. One is, they can go to our 
hearing officers locally and ask them to look at the case. This is 
a new vehicle as you are aware of in the last few years, and it's 
been very excellent. What it does is, it brings a veteran in. In a 



50 

lot of instances a veteran will say I have had these medical records 
at home or I saw this doctor. When I was in the service at this par- 
ticular place things that he did not file and we did not get through 
the initial development of the case whether we did it or a service 
organization. 

The first thing that we find is that at that level I thought we 
were doing pretty good. Our hearing officers are granting 45 per- 
cent of the cases that come before them. That means that they are 
going back for local development. Sometimes they are finding er- 
rors of our people as well. Compared to a national average of 33 
percent 

Mr. Ridge. Let me interrupt you there. You said 45 percent of 
them are being handled? 

Mr. Serrino. What I am saying is, the ones that are appealed 
to our hearing officers. 

Mr. BUSHEY. That's in Pittsburgh. 

Mr. Serrino. Forty-five percent, almost one-half of them as a re- 
sult of additional development or where it is found that maybe we 
should have got additional evidence, the veteran brings in some- 
thing, I am saying are getting turned around. 

Mr. Ridge. They are disposed of there and not referred back? 

Mr. Serrino. Yes. 

Mr. BuSHEY. Right. 

Mr. Serrino. "niey are disposed of favorably there in terms of 
the veteran. 

Mr. Ridge. Okay. 

Mr. BuSHEY. The national average is 33 percent. 

Mr. Serrino. The second thing that happens, it goes before the 
Board of Veterans' Appeals. There was mention of something called 
the remand rate and there's something else called the grant rate, 
and if I might distinguish between the two. 

Decisions made by the Court of Veterans Appeals set precedent. 
Our Board of Veterans' Appeals will send cases back because of 
those precedents. They sometimes will send cases back because our 
statement of the case isn't clear enough or they want additional 
evidence, or things like that. 

How we compare in terms of that remand rate is, we are — the 
national average is 50.5 percent. That's a lot of cases that are com- 
ing back from the Board of Veterans' Appeals, That's because of the 
new judicial review. So, 50.5 is the national and 50.4 percent is 
Pittsburgh. We are right on target there with the national average. 
We want better than that. As you said, we want to be perfect, num- 
ber one. 

The more important figure that I think we ought to look at is the 
appeal rate, those cases that have gone to the Board of Veterans' 
Appeals and they say the Pittsburgh office goofed; the veteran 
should be getting benefits that he's not getting. The national aver- 
age is, they grant 14.9 percent of the cases that come in. The num- 
ber that are overturned — let me correct that. The number that are 
overturned nationally are 14.9 percent. The Pittsburgh offices cases 
there are 12.3 percent overturned. We are a little over two percent 
better than the national average in terms of the number of cases 
that we have overturned by the Board of Veterans' Appeals. 

Mr. BuSHEY. That's a quahty indicator. 



51 

Mr. Serrino. These are all the quality indicators that we have 
that we look at. 

Mr. Ridge. How is the Regional Office vis-a-vis the best Regional 
Office rather than the national average? How is Pittsburgh vis-a- 
vis the best office? I used to come home from time to time and say 
I did something and my dad would say how are you doing it. I 
would say I did it better than John and he would say who did it 
the best. I would say Fred, and he would say how did you do 
against Fred. 

Mr. Serrino. I don't have the number here. You are right, it 
would be great to compare ourselves with the best. Right now we 
are not the best I know that, but we are in the ball park. 

Mr. BusHEY. We have been the best. We were up in the top third 
of the country in 1992. 

Mr. Ridge. Let me ask a little bit more about the end product 
because it's a real dilemma. Our mutual friend, Jack Ehrhardt, 
pointed it out. One, Congress constantly has pressure on you to 
send up the statistical information in which Congressman Evans 
and I believe very strongly that those who require the information 
from any agency also should be required to read it and file a report 
that they understand it too. That will be the cause of another 
inquiry. 

The end product, it seems to me, does not necessarily say that 
we are doing things right or well in the sense that if you have a 
troubled adjudicator — your adjudicators are pressured. Everybody 
tells me that they are pressured. Just about every witness says you 
need more adjudicators. 

You have a stack of claims on the desk. There's nothing wrong 
with wanting to be judged effective and to be judged useful, and 
to be judged by your peers or whatever it is, the team that takes 
a look at your performance as well. Is there a better way to deal 
with assessing how well adjudicators are doing than just a statis- 
tical end product? You can dispose of it easily, denied, and then 
you are back in the system. 

Mr. Serrino. There are a couple of things there. One is that 
claims examiner will adjudicate the case. It's reviewed by an au- 
thorizer, who has to sign off on the case that it's done properly. The 
third thing we have done is, we have what we call a quality review 
specialist in the Adjudication Division. It's his job to look at trends 
and things like that. We have a certain adjudicator that is coming 
up with problems with certain types of cases that might need train- 
ing. Is there a common thread. Do we see a trend or need for 
things like that. 

To give you an example, one of the things that we watch closely 
is — I know Jack and our friend Elmer Smith who isn't here from 
your District 

Mr. Ridge. Yes. Another good man, yes. 

Mr. Serrino. Who have both been very concerned about PTSD 
cases. 

Mr. Ridge. Yes. 

Mr. Serrino. We know our grant rate is comparable to the na- 
tional average. We are granting them as much. Of course, as was 
pointed out here before, that's not saying much. Maybe the whole 



52 

VA ought to be granting more PTSD cases and maybe we ought to 
be granting greater percentages. 

What we will do is, we will bring in people and try and bring in 
training to sensitize people to those things. You also have another 
variable in there, your members on the rating board. Unfortunately 
or maybe fortunately, Mr. Bushey or I cannot go and tell a rating 
board specialist how to rate a case. I guess I sort of liken it to the 
Supreme Court because sometimes I think some rating board spe- 
cialists think they are judges. 

We will and Mike will look at the people, we want to make sure 
the people we put on there are very compassionate. Sometimes you 
get people that are very legalistic in their interpretations, some- 
times you get people that literally interpret the veteran gets the 
benefit of the doubt. It is the way that I think you and I would like 
it to be interpreted. 

Mr. Bushey. As Jerry said, we built that into the promotion re- 
quirements now, that the person must be compassionate. It's put 
in a grade GS-11. I know you are not familiar with the structure. 
They have to serve in that for one year before they get the 12. 

If we see a lack of compassion — in one regard the money store — 
that's one of the problems, that they won't be on the board. We are 
concerned about the veteran, as well as you are. 

Mr. Ridge. I know you are. You are a veteran. 

Mr. Bushey. Right, exactly. 

Mr. Ridge. I understand that. I would say if it were your claim 
as if it were mine or members of the staff, that you want it done 
immediately. 

Mr. Bushey. Right. 

Mr. Ridge. We understand that there's some logistical pressure. 

Mr. Bushey. Going back to your end products, I agree with you 
on 13 end products that they measure by. There could be a better 
way, and I think our service is tr3dng to look over the system. 

Mr. Ridge. I would like to work with you on it. 

Mr. Bushey. That just measures timeliness. 

Mr. Ridge. Yes. 

Mr. Bushey. You are doing now, they are striving for more qual- 
ity. That's one of the things that we are high on, we are a good 
quality station in terms of what they have found — except for timeli- 
ness. 

Mr. Ridge. Who, under your supervision Mr. Bushey, is in 
charge of the quality management teams? 

Mr. Bushey. Nick Vrcic, my management analyst, handles the 
TQM teams. The quality reviewer is in the Adjudication Division. 

Mr. Ridge. Right. I want to talk a little bit about claims and pre- 
sumptions. I guess I would talk to Mr. Vudragovich. 

Mr. Bushey. Correct. 

Mr. Ridge. Let's talk a little bit about the veteran who has cor- 
roborated internal VA medical testimony relative to his or her con- 
dition with an external medical opinion that is independent but 
consistent and even uses the same language in a system that in 
spite of the external corroboration to an internal assessment with 
very specific language, let's talk about an adjudication system that 
says no to the veteran. How does that happen? 



53 

Mr. VUDRAGOVICH. If it does happen I certainly don't agree that 
things of this nature should occur. 

Mr. Ridge. I am not laying it at your doorstep personally. I am 
saying how does a system that is supposed to have a presumption 
in favor of the veteran — I know my cases and I know my veterans 
and know the medical testimony — how does a system that the VA 
doc says directly related, the orthopedic specialist says directly re- 
lated, and they get a letter from somebody in the compensation bu- 
reau that says no compensation. 

When they pull shrapnel out of his behind, got it, no problem. 
Or, they are missing a limb, you get it. Here, maybe it's a little 
more complicated. I didn't give you a chance to answer the question 
and I apologize. Help me with this one, because I am struggling 
with it. 

Mr. VUDRAGOVICH. Sometimes I struggle too, in looking at the 
medical evidence that is presented. I, personally, believe that if we 
train the people and can teach them to be compassionate 

Mr. Ridge. Have you ever looked internally — maybe this is a 
proper point of inquiry — to see the number of claims that have 
been disallowed even though the external medical testimony may 
have even been in conflict but substantial body of external testi- 
mony was in conflict. Are the adjudicators looking for that impri- 
matur, that stamp of approval, from within the VA system? 

Mr. VUDRAGOVICH. I think the rating board — I think as you are 
aware, whenever we make a decision, say basic service connection; 
that we are talking about private medical evidence earlier as op- 
posed to VA testimony or VA evidence. 

Normally if you get a private medical statement, to grant service 
connection you need some sort of VA affirmation to say yes, this 
is correct. This is proper, this is the disability that the person has. 
If you can tie them in somehow, which I assume you are talking 
about secondary service connection or service connection for one 
disability due to an already service-connected disability. 

Mr. Ridge. Yes, secondary service. 

Mr. VUDRAGOVICH. One knee, secondary to the other knee. 

Mr. RiDGE. You got it. It sounds to me like you might know one 
of the cases. 

Mr. VUDRAGOVICH. I am sure that I do. In specific cases like that 
you try to get as much evidence as possible and make a fair deci- 
sion, fair to the veteran. It's the rating boards' responsibility to try 
to apply the law as equally as possible to all of our claimants. 

In cases like that, yes, we will go for a VA examination. Some- 
times we will request a medical opinion from the VA examiner to 
see what the tie in is, if there is some way to tie that disability 
in, that additional condition. 

Mr. Ridge. Do we need a regulation that says that the adjudica- 
tors at the VA — if a physician within the VA, if a physician within 
the VA system says — or establishes a causation and corroborates 
the disability or causation — should that be prima facie evidence 
and the adjudicator ought to say that ought to be an easy end work 
product. Here is the claim — the VA physician says it sure is related 
to that. Yes, and out the door. Do we need that? 



54 

Mr. VUDRAGOVICH. Congressman, you would make it much easier 
on the rating boards if you did that. It would take away a lot of 
their judgment. 

Mr. Ridge. My concern is, you have medical people making medi- 
cal judgments and somebody at a rating board sitting — maybe 
trained, sensitive and compassionate, but who may not be medi- 
cally inclined — saying the heck with the VA doc, the heck with the 
psychiatrist, the heck with the orthopedic surgeon. We don't care 
what the medical doctor said in the VA, claim denied. 

Again, I am not critical — I am just saying, what do we need to 
do systemically? 

Mr. BUSHEY. You are talking about the system. 

Mr. Ridge. Yes. 

Mr. BuSHEY. That's one of the things that they are working on, 
going back to one person ratings rather than the three person rat- 
ings. That's one of the things that the Comp and Pension Service 
is looking over, to see whether they might return to that so that 
they have one person type rating. 

Mr. Ridge. I went a little deeper than even the person, because 
there is some dispute as to one or three people. I am just wonder- 
ing if we ought to say — maybe this is how we strengthen the pre- 
sumption, one of the ways that we strengthen the presumption. If 
you got a physician within the VA health care delivery system who 
offers for the adjudicator's review the testimony that seems to abso- 
lutely corroborate the claimant's position, how does the non-medi- 
cal adjudicator say it wasn't service related? You really don't have 
the medical problem that you think you have, in spite of the fact 
that the VA said you had it. 

I am thinking that maybe we ought to look at that. 

Mr. Serrino. There are two things here. We have two things, 
first off, a rating board doctor that will review the medical reports. 
That rating board doctor will work with the rating board special- 
ists. 

The situations you are saying, shouldn't need any laws. We 
should be able to do that on our own. I don't think people need to 
be led by the nose to water. 

Mr. BusHEY. We agree on that, too. 

Mr. Ridge. Of course, we are going to run into an occasion where 
the veteran — I don't want to deny the veteran the opportunity to 
go outside the system as well to say gee, I think the doctor made 
a mistake or that there's at least a legitimate difference of opinion. 
Maybe with external medical information as well as some other 
corroborating evidence, I might be able to persuade the rating 
board to get a different disposition. 

That's clearly within the system. I am even looking beyond that, 
where there shouldn't be much controversy and say what the heck 
are you doing. We are supposed to be looking holistically and sup- 
posed to be working as a system, on behalf of the veteran. I am 
repeating myself. 

Let me ask you — Mr. Chairman, I don't mean to be dominating. 
Go ahead, I will defer to you. 

Mr. Evans. No, that's fine. 

Mr. Ridge. Thank you. With regard to the managerial challenge 
that a lot of people have talked about today in the adjudication 



55 

process — I think Mr. Bushey, you mentioned that you could use an- 
other 15 or 20 adjudicators. Is that about right? 

Mr. Bushey. Yes. 

Mr. Ridge. That's almost a doubling of what you have available 
today? 

Mr. Bushey. That's if you were taking into consideration clearing 
out all the backlogs, even if it was a temporary ceiling for two 
years, assuming that our intake wouldn't stop. Our intake is in- 
creasing at all RO's. In fact, the other point that happened at our 
Director's conference — and you had two members over from the 
Senate and Congressional group. We raised on the floor that our 
people work for two years now are working overtime, almost six 
days a week. 

It becomes a morale problem. They are getting burned out, and 
that they are also refusing overtime because of family commit- 
ments and things of that nature. It's just being burnt out. When 
they were asked to raise their hands, every one of 58 directors 
raised their hand; they are running into the same situation. 

It's an ever continuing problem, and I don't know it's going to be 
adjusted. Again, we have to do our job and be innovative and try 
to come up with working smarter and not harder. 

Mr. Serrino. One thing that would help, I think tremendously 
is, from time in memorial we get a budget and we get a FTEE or 
personnel ceiling that is set by the Office of Management and 
Budget. It would make a heck of a lot more sense if they gave us 
a program budget and if we can save money in one area and put 
it into staffing, if we could do those kind of things. 

It seems that your hands are tied in that respect. You are pa5dng 
people to manage, and you ought to make them manage. 

Mr. Ridge. Do you have money to pay them overtime, or do the 
adjudicators get overtime or comp? 

Mr. Bushey. They get both. They have a choice, between comp 
and overtime. Overtime, we have to pay them overtime. If they 
elect to take comp time they can take comp time. Most of it is over- 
time. It's overtime money that is supplied to us by the area offices 
and the CBD. They are looking all over to find additional money, 
trying to keep their head above level. 

Mr. Ridge. Mr. Chairman, you and I have a plane and have to 
move on. I would like to ask unanimous consent to submit for pur- 
poses of the record, additional questions to our friends at the Re- 
gional Office. 

Mr. Evans. Without objection, so ordered. The written responses 
to those questions will be made part of the record. I have a little 
more time and would like to ask some questions, and yield back 
when I am done with those. 

I know the remand rate situation is really a national problem, 
that you are faring better than the national rate. Really, doesn't 
the remand rate tell us in effect that the Regional Offices of the 
VA as a whole, really isn't doing a good job because they are send- 
ing these cases back to the adjudicators? 

Mr. VUDRAGOVICH. Mr. Evans, part of the reason that they are 
sending them back is because of the Court of Veterans Appeals. 
The court will make a precedent decision. The case may already be 
at the BVA based on the criteria that was in effect at that time. 



56 

The rating board made their decision based upon the law in effect 
say in maybe 1991 or 1992. 

The court hands a new decision down which may change that 
part of the law. So, what BVA does is send the case back to the 
Regional Office. The Regional Office has to consider the issue based 
upon the court decision that was just promulgated. At that point 
in time based on the direction by the court, if the Regional Office 
can grant the benefit it does. 

If not, then the claimant would be sent a supplemental state- 
ment of the case — and it would go back to the Board of Veterans' 
Appeals for their review. Depending on the board decision, and cer- 
tainly if it's unfavorable, then the veteran would have the oppor- 
tunity to present the case before the Court. 

Mr. BuSHEY. You are right. Congressman, it is not good. It is an 
average of 50 percent that is being returned to all stations. We are 
slightly below that, so we are doing a little bit better. It's not good. 
It was a result of the COVA and the courts, because every time 
that they make a precedent decision it affects all cases, and they 
go back to the stations for further development. 

Mr. Evans. What might we be able to do to reduce the remand 
rate considerably, by 50 percent? Is it better education? 

Mr. BuSHEY. Better education, and as the courts continue — I 
think they are getting better themselves and getting a little more 
consistent. That was raised at our Director's conference too, be- 
cause that is not good, that 50 percent remand nationally. I agree 
with you. 

Mr. Evans. How many days could it take before a claim delivered 
to the Regional Office was actually recorded or entered into the 
VA's recordkeeping system? 

Mr. VUDRAGOVICH. Generally from one to seven days, depending 
on the volume of work and number of correspondence clerks we 
have available. 

Mr. Evans. Is that one to seven days put into the calculation for 
the statistics about the time to process a claim? 

Mr. VuDRAGOVlCH. Yes, it would. It would be fi-om the date that 
the claim is received, not the date that we record the claim. 

Mr. Evans. What percentage of calls to the Regional Office are 
not being completed, when lines are busy or the call wasn't 
answered? 

Mr. BuSHEY. He's Tony Annoreno, and he's the Acting Chief of 
the Veterans Service Office. The lost call rate is, again, below the 
national average. He will give you the actual figure. 

Mr. Annoreno. The actual lost call rate that we have experi- 
enced probably was around 14 percent. Within the last three 
months actually, we have been reducing it significantly by utilizing 
personnel in different areas to basically handle calls during busier 
times, when we receive an influx of calls whether it be my coun- 
selor's in the personal interview activity or any of my special units. 

We do get busier times and we are handling those calls as they 
do come in. This month here, we are about 9.8 percent and are con- 
tinuing to keep at it. 

Mr. BuSHEY. Tony, the national average is what? 



57 

Mr. Annoreno. I believe it's about — I am not certain exactly. 
The standard is ten percent. We are supposed to answer 90 percent 
of our calls, and our standard is ten percent. 

Mr. Evans. You are below 

Mr. Annoreno. At this point this month, we are. We did have 
difficulty, I will admit that. 

Mr. BUSHEY. One other thing that we do though is, we keep code 
a phones on 24 hours a day. Any overload goes into the code sys- 
tem and they are immediately called back the next day and even 
in the evening. The code a phones work, and that's one of the ways 
that we reduce our lost calls. 

Mr. Evans. What are some of the most typical questions that 
people ask? 

Mr. Annoreno. We have a number of types of questions, many 
questions relative to types of benefits that we have, explain the eli- 
gibility requirements. Also, status of claims, quite often. Depending 
upon the time of the month, status of the check, question on the 
amount of a check. Depending on the time of the year we may also 
encounter a lot of educational calls, beginning of enrollment and 
such, as well as calls from our pension recipients concerning forms 
that they may have to complete that they have specific questions 
on them. 

Mr. Evans. Before recognizing Congressman Ridge for further 
questions, I wanted to thank you very much for your testimony. We 
have some disturbing issues that have been raised, but I think you 
are getting some good help out there to veterans. 

I am curious about your focus groups and town meetings. They 
are something that we normally do in politics. I think you are mak- 
ing some efforts to reach out to veterans. Which is necessary. We 
are not here to simply criticize you, we want you to know that we 
appreciate the good work that you are doing. I appreciate your 
coming before us and being straightforward with us as well. 

Congressman Ridge. 

Mr. Ridge. Mr. Chairman, I thank you for the good words. I do 
recommend — I don't know what the closest Regional Office to you 
is — they had a very successful outreach forum with representatives 
from the different VSO's and other organizations and even individ- 
uals up in Erie, PA. 

I don't think they have a traveling team. We have to deal with 
the veterans in Western Pennsylvania. You are on your own, Mr. 
Chairman. I suspect that the VA Regional Office would respond to 
a call from the chairman of the Oversight Subcommittee. I don't 
know for sure, but I think they would probably say yes. 

I want to talk quickly about two things. One, again, about the 
special processing unit. It was just made known to me that this 
was a recent development, and different Regional Offices use it dif- 
ferently and give it higher priority. It is my understanding that in 
some Regional Offices the SPU has really the authority to go right 
to the different division chiefs and basically with the imprimatur 
of the Director — you have a problem, you cut through it and go 
with it. 

What is the relationship in that regard, between the SPU and ei- 
ther you, Mr. Bushey or the unit chiefs, division chiefs within this 
Regional Office? 



58 

Mr. BUSHEY. Direct access to my office. They come directly to 
Jerry Serrino or myself or my management analyst. If they have 
a problem and we would loosen it up if there is a problem, so that 
it is direct to our attention. 

The one thing that we would like to close on too is, believe me, 
the message is that the veteran, in doubt, gets the benefit. I have 
used everything but baseball clubs to make sure that they know 
that. 

Mr. Ridge. I appreciate that. I was curious about that. So that 
I understand completely though, before the roadway was cleared 
you, as director, would like to know what the special problem is 
and you will help him clear it, rather than them going independ- 
ently of you. 

Mr. BuSHEY. Exactly. 

Mr. Serrino. They normally go right to our rating board with a 
case and it's earmarked as a special. If they have any problems 
with them they come up to us. 

Mr. BuSHEY. Come directly to us. 

Mr. Ridge. They punch it up to you. Secondly, with regard Mr. 
Chairman to the whole question of remand and the 50 percent re- 
mand, I didn't want it to go left unstated. Part of the problem — 
and it's not specific to this Regional Office — I think one of the rea- 
sons we still have a substantially higher remand rate than we 
want is that they get up to the board, they get up to the court, and 
the record is still inadequate. 

We will serve the veteran best, by trjdng to get all information, 
as complete a file, as quickly as you possibly can, and we possibly 
can get it earlier on. I think that we have been talking about re- 
sults. We know that the output reflects the input. 

Maybe that's where Congress ought to be focusing some of the 
efforts, as we go about looking constructively and critically at the 
VA system, maybe we better start looking to inputs ourselves as 
we are assessing the resources that you have and the direction that 
you are given by Congress as to what you ought to be doing at the 
front end. 

I do think that one of the reasons that you have so many re- 
manded is that they are being remanded for more testimony, re- 
manded to clear up this discrepancy, remanded for these additional 
medical or military records. Again, that delay in the process. 

I know that by the time the three million men and women who 
served with me in Vietnam probably got their draft notice and most 
of them ended up in the field, it was probably a lot quicker than 
most of them had claims adjudicated. That's for veterans of all 
wars. The point is, that if the government spares no expense to get 
you there, when you come back with problems and disabilities, we 
should not spare the expense. 

We ought to be doing as an effective and efficient job in taking 
care of you as we did training you to get you overseas. Again, Mr. 
Chairman, to you, a great debt of personal theinks, and also to your 
wonderful staff who helped make this a quality hearing. 

I must tell my colleagues and the friends here, I have done a lot 
of these hearings around Pennsylvania and around the country. We 
are knocking on almost four hours with only three panels. I appre- 
ciate the lengthy public discussion of these matters. 



59 

Again, I would ask unanimous consent to include written ques- 
tions and written responses, as part of the record. Thank you. 

Mr Evans. So ordered. I will be doing the same thmg. As 1 said, 
those written responses as well as the questions, will be made a 
part of the record of this hearing. „r i i r a 

Thank you, Congressman Ridge, for hostmg us. We look torward 
to working with you on these issues, and appreciate your continu- 
ing leadership. _ , . . J- J 

Thank you all, very much. The hearmg is now adjourned. 

[Whereupon, at 12:29 p.m., the hearing was adjourned.] 



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63 



STATEMENT OF THE HONORftBLE TOM RIDGE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 
COMMITTEE ON VETERANS' AFFAIRS 

DELIVERY OF BENEFITS AND SERVICES BY THE PITTSBURGH REGIONAL OFFICE 

JUNE 28, 1993 



Mr. Chairman, I would like to thank you for all the work you and 
the Committee Staff have done to organize today's hearing. I 
appreciate you arranging your schedule so that the hearing could be 
held in Pittsburgh. 

I would also like to acknowledge the University of Pittsburgh, 
especially the Government Relatins office, for all the help they have 
given us. 

America has always felt a debt of gratitude toward those that 
serve and protect the principles of the country. This country, since 
its birth, has recognized that veterans should be compensated for 
service-connected disability or death. America's commitment to its 
veterans has grown stronger with each war that this country has had to 
fight. 

It is one thing to make such a commitment and another to ensure 
this commitment is carried out. If the system is broke we have no 
choice, but to fix It. Otherwise, we are not living up to the promise 
we made to the young men and women who have served. 

The Regional Office in Pittsburgh has jurisdiction over 560,700 
veterans, which makes them the nineteenth largest regional office 
nationally. They have the responsibility of ensuring that each and 
•very one of these veterans ace receiving the highest level of care, 
not to mention the benefits and services that they rightly deserve. 

And I am concerned that they are not doing their job correctly. 
During my elven years in Congress, every caseworker who has worked in 
my office, and I personally, have seen too many veterans who were not 
treated with the proper respect and dignity. 



64 



I have seen too many examples of the Regional Office repeatedly 
denying a veteran disability, even when their claim is strongly 
supported by medical evidence. Eventually the veteran — who is sick 
to begin with — will either give up the fight or die. This could be 
called the "leave me alone syndrome." 

When we talk about the claims process, we are not talking about 
mere statistics. I don't care about how many end products are in the 
system In a given month or the number of work credits. what I care 
about and what my constituents care about is why it takes an average 
of 220 days for a decision to be reached on an original compensation 
claim, 127 days for an orignal pension claim, and 120 days for a 
reopened claim. I also am left to wonder why during the first quarter 
of this fiscal year alone, a total of 57.5% of Board of Veterans' 
Appeals (BVA) decisions were remanded back to this Regional Office. 

I want to know why an audit of the Regional office done last 
year, by the Inspector General of the Department of Veterans' Affairs 
showed that claims were not processed in a timely manener and many of 
the delays could have been avoided or reduced. I fully agree with the 
IG'3 assertion that claims processing delays may result in financial 
hardship for the claimants. We are not talking about numbers here, we 
are talking about people's lives. 

The purpose of today's hearing is to find out what solutions are 
needed to rectify the problems that exist in this Regional Office, 
which I believe are the timliness of claims processing; the lack of 
recognition of stress conditions; and the lack of sensitivity toward 
the veteran on the part of some of the workers. If we find that these 
problems or some portion of them exist in the Regional Offices 
throughout the country, then it is my job to see that I fix them back 
in Washington. But, if we find that the problems or some portion of 
them are specific to Pittsburgh, then it is the management's job to 
make sure that there is change in policy and attitude. The Regional 
Office has to carry out their mission of serving the veterans. 



65 



Mr. Chairman, I would like to once again thank you for your 
efforts with regard to this hearing. i would also liKe to welcome all 
of our witnesses and thank them for their input. 




66 



CONGRESSMAN 

RICK SANTORUM 

18th District, Pennsylvania 

Ways and Means 
COMMITTEES: SubcomnUttee on Human Resources — Ranking Member 
Subcommittee on Oversight 

1222 Longworth House Office Building • Washington, D.C. 20515 

Testimony of Hon. Rick Santorura 

before the 

Subconunlttee on Oversight and Investigations 

June 28, 1993 

Mr. Chairman and Members of the field hearing: 

I am honored to be here today In Pittsburgh to discuss with you 
Important Issues facing the veterans community In western 
Pennsylvania. As a former Member of the House Committee on veterans 
Affairs, I have placed the needs of America's veterans among the 
highest priorities of my office. 

In the Spring of 1991 I formed the veterans Affairs Advisory Board 
which Is composed of Individuals from Allegheny County who play an 
active role In the region's veterans community. The aim of this board 
was to raise my own awareness of the unique concerns of the nearly 
200,000 veterans living In Allegheny County. The Board has easily 
surpassed my original expectations. Many of Its recommendations and 
Insights have resulted In positive gains for our veterans. 

When the Subcommittee on Oversight and Investigations last held a 
field hearing In Pittsburgh on April XI, 1992, at the Highland Drive 
Veterans Administration Hospital, I delivered testimony regarding the 
plight of homeless veterans In Allegheny County. The impetus for this 
testimony was derived from survey results provided me by the members 
of the Social Services Committee of my Veterans Affairs Advisory 
Board. The work of my Advisory Board, along with efforts of other 
veterans advocates, directly contributed to a heightened awareness of 
the homeless veterans crisis In Allegheny County. I was pleased to be 
Informed that Congress specifically appropriated additional funds for 
homeless veterans initiatives nationwide, and that the Highland Drive 
VA received over $1 million dollars to create a 50-bed Domiciliary 
Care facility for homeless veterans. It Is noteworthy to say that 
Highland Drive was the only Medical Center authorized this fiscal year 
to activate such a facility for homeless veterans. 

The Initiative of the Social Services Committee, specifically Chairman 
Tom Fitzgerald and Vice Chair Lieutenant Commander Karen Trueblood, 
Illustrated precisely what I had envisioned as the role of my Advisory 
Board. 



67 



-2- 

Today, Trea Graham, a member of the Benefits Committee of my 
Veterans Advisory Board, will personally report on the efforts of 
her committee. Since last yea, the Benefits Committee, in 
cooperation with the Department of Veterans Affairs Regional 
Office in Pittsburgh, has conducted a study of the timeliness in 
processing benefits claims in the Adjudication Division. 

Although there is more to accomplish, through the cooperative 
efforts of the Benefits Committee, VA Regional Director Harold 
bushey and my office, tangible improvements in the Adjudication 
Division have been realized. Ultimately, I believe that this 
positive relationship will ensure that deserving veterans receive 
their benefits in a more timely fashion. 

I would like to thank the committee for spending the time to 
listen to the testimony of veterans' advocates like Trea Graham 
who have helped to raise the consciousness of the unique needs of 
our nation's veterans. 



68 



Testimony of Honorable Ron Klink 

before the 

Committee on Veterans' Affairs 

Subcommittee on Oversight and Investigations 

June 28, 1993 

I would like to thank Chairman Lane Evans and Congressman Tom 
Ridge, Ranking Member of this Subcommittee, for bringing this 
hearing to the Pittsburgh area in order to examine the benefits and 
services available to our local veterans at the Pittsburgh Regional 
Office of the Veterans Benefits Administration. 

Mr. Chairman, as you know, the Veterans Administration is the 
only means we have to honor and care for the men and women who have 
served so faithfully defending this great country. Unfortunately, 
I have been contacted by numerous veteran constituents who feel 
victimized by the system and ultimately slip through the cracks. 

I realize the needs and problems of delivering benefits and 
services to our veterans is complicated and the Veterans 
Administration offices across the country are being forced to work 
through continuous budget cuts and substandard working conditions. 
However, the needs of our local veterans are clearly not being 
properly addressed. The veterans that have contacted me for 
example, feel that they are not given the support they need in 
developing their claims. Approximately 88% of first time claims 
are denied. And it is not uncommon for claimants to wait six to 
eight months for this decision, just to be told to contact one of 
the service organizations such as the Veterans of Foreign Wars, the 
American Legion or the Disabled American Veterans to advocate their 



69 



appeal. The veteran then waits another approximate six to eight 
months for the appeal decision. 

When the veteran files a claim he/she is held to certain time 
parameters but the Veterans Administration, although held to the 
same parameters, does not always feel the need to comply, thus 
delaying the processing of cases. The Veterans Administration 
needs to begin playing on a level playing field. And this is only 
one example of the poor treatment veterans are receiving. 

I believe our veterans deserve the very best this country can 
offer and I don't believe they are currently given the help or 
respect they deserve. The Veterans Administration was formed as an 
ally for our veterans but many veterans feel it is playing an 
adversarial role instead. I believe the laws governing the 
Veterans Administration are adequate, however, the manner in which 
they are carried out needs to be re-examined. And hopefully, today 
we can begin to do just that. 

I would again like to commend the committee for having the 
recognize the need to hold this hearing here today and also to 
thank them for inviting me to participate. I would also like to 
present to you a few of the veterans' cases that have come to my 
attention. 



70 



Claimant: Does not wish to be identified 

Wife does not wish to be identified for fear of 

retaliation against her husband 
Type of Claim : Overpayment of VA benefits 

This Veteran is currently in a VA facility. On April 15, 1993 a 
notice from St. Paul was forwarded indicating that an overpayment 
had been created in his account in the amount of $18,651.00 due to 
the fact that the VA continued to pay benefits at an unreduced 
rate. 

His wife contacted the VA Regional Office in St. Paul and told them 
that she fills out his EVR's and reported to the VA that when he 
was in a private nursing home his expenses were much greater than 
they were at the present time being that he was now in a VA Medical 
Center. She reported when he was moved from the private nursing 
home to the VA. Although the VA discontinued the Aid and 
Attendance benefits they continued to send his pension to his wife 
for her living expenses. 

While she was still on the phone with St. Paul, they contacted the 
Regional Office in Pittsburgh and were told that they had never 
received anything from the wife concerning this matter. 

Unknown to the VA the wife sent everything registered mail, 
(returned receipt requested) and received the receipt back stamped 

from the VA. 

On June 15, 1993 a Financial Status Report was forwarded to the 
Regional Office in St. Paul concerning this debt, with a statement 
from the wife requesting a waiver due to the fact that everything 
was reported in a timely manner. She feels it is not her fault 
that her papers are laying somewhere up at the VA lost in the 
shuffle. 

On June 17, 1993, the wife received a letter dated June 14, 1993 
stating that the VA received her claim for benefits and there was 
no further need for action on her part at this time. 



71 



claimant: Does not wish to be identified 

Type of Claim : Computer Letter from VARO Concerning Nursing Home 

On May 28, 1993 the claimant's widow received a letter form VARO 
advising her that her Widow's Pension benefits would be reduced on 
August 1, 1993 due to the fact that she had been in a Medicaid 
approved nursing home since October 29, 1992. She is 89 years old 
so when she received this letter it really upset her because she 
had never been in a nursing home. 

The widow's daughter brought the letter into our office and we 
called the phone unit at the Federal Building in Pittsburgh. We 
were advised that this letter is being sent out to people in her 
age bracket to catch the one's that have not reported to the VA 
that they are in a Nursing Home. We sent a 4138 (Statement in 
support of claim) advising the Veterans Administration that the 
widow was never in a nursing home. This was done on June 7, 1993. 

As of June 17, 1993 the office had heard nothing. 

Note: 

What a waste of taxpayers money trying to catch 
"old people" ! Manpower (VA) , postage and aggravation to the 
people. If they would handle claims coming in and solve those, 
they wouldn't have time to play "detective". 



72 



Claimant : Does not wish to be identified 
Type of Claim : DIC, Widow's Pension with A&A 

In September of 1984 the claimant applied for Widow's Pension and 
was denied because of excessive income. 

On February 19, 1985 the claimant re-opened her claim based on the 
fact that her income had decreased. Widow's Pension Benefits were 
granted at this time. 

On February 20, 1986, the claimant received a letter stating that 
her benefits were being discontinued effective March 1, 1985 
because of Social Security income that the Veterans Administration 
said she never reported. A corrected EVR (Eligibility Verification 
Report) was submitted on February 25, 1986 showing the widow's 
income. 

On April 12, 1986, the claimant received an overpayment letter from 
St. Paul Regional Office showing an overpayment of $1,406.00 A 
4138 (Statement in Support of Claim) was filed on April 29, 1986 
requesting a waiver of the debt based on the fact that she claimed 
she notified the VA that Social Security had begun but the VA 
continued sending her checks so she felt that she was entitled to 
them. Also she requested that it be investigated that her husband 
was 40% Service Connected for Diabetes and died from an Acute 
Myocardial Infarction due to Diabetes Mellitus so she felt that she 
should be receiving DIC benefits. Another letter was received on 
May 5, 1986 from St. Paul with a Financial Status Report attached. 
This was filled out and returned on May 16, 1986. 

On May 28, 1986 the widow received a letter from VARO Pittsburgh 
advising her that her request for a waiver had been denied based on 
the fact that she misstated her income when she re-opened her claim 
for benefits on February 19, 1985, that she knew she was going to 
be receiving Social Security in March of 1984 and did not report 
it, but continued to receive Pension from the Veterans 
Administration. She again requested a waiver and received a letter 
dated June 3, 1986 that her request was being referred to the 
Committee on Waivers and Compromises for review. 

On August 4, 1986 after investigation her request to look into DIC 
benefits a letter was forwarded to her from the VA Regional Office 
in Pittsburgh advising her that the claim for Service Connected DIC 
benefits was denied, that the Veterans death was NOT due to his 
Service Connected Condition. On August 15, 1986 A POA (Power of 
Attorney) for the American Legion was forwarded to VARO along with 
a Notice of Disagreement on October 9, 1986. A Statement o.f the 



73 



case was sent and an appeal was forwarded to the American Legion on 
October 16, 1986, requesting a personal hearing at the Regional 
Office in Pittsburgh. On November 6, 1986 a hearing date was sent 
to the widow for November 21, 1986 at 10:30 AM. Benefits were 
denied based on the hearing and this claim is still pending with 
the Board of Veterans Appeals in Washington DC according to the 
American Legion. 

In March of 1987, the widow received another letter from St. Paul 
concerning her overpayment and a Financial Status Report was 
forwarded on March 27, 1987 stating that she could not pay this 
debt back. 

On January 3, 1989 she re-opened her claim for Widow's Pension with 
Aid and Attendance based on the fact that she is legally blind and 
also has several health preventing her from taking care of herself. 

As of June 16, 1993 this claim is still pending and is her claim 
for DIG benefits. 

This claim is taking 9 years for a decision. 



74 



Claimant : Does not wish to be identified 

Type of Claim : Higher rating for service connected knee condition 

On March 19, 1991 the claimant filed for a higher rating of his 
Service Connected knee condition along with a Medical report from 
his private physician. This was forwarded to the VA Regional 
Office in Pittsburgh- 

On April 8, 1991 the claimant received a letter from the Regional 
Office that they had denied his claim for increased Service 
Connected benefits based on the report from his physician. 

On May 20, 1991 a Notice of Disagreement was filed with the 
American Legion. On July 29, 1991 a Statement of the case was sent 
to the claimant. On October 1, 1991 additional Medical evidence 
was submitted to the American Legion. 

On October 25, 1991 the claimant received a letter from VARO, 
requesting additional evidence. This evidence was submitted on 
November 27, 1991 to the American Legion. 

On February 14, 1992 the Veteran received a letter from VARO again 
denying his claim for a higher rating. A Notice of Disagreement 
was filed February 26, 1992. 

The Veteran received a statement of the case and forwarded Appeal 
to the American Legion March 25, 1992. 

On March 24, 1993 the Veteran called and was very upset. He had 
not heard anything from the VA since February 1992. The service 
officer was contacted. There was nothing in the Veteran folder but 
the statement of the case dated March 25, 1992. They never 
received the appeal that the Veteran had forwarded to them. The 
service officer asked us to contact the Veteran and have him call 
him. This office contacted the veteran and relayed the message. 
On April 27, 1993 the service officer contacted our office and 
asked us to fax all the paperwork we had in the claimants file to 
him. This was done. On May 20, 1993 the Veteran called the office 
and requested we call the service officer and have him call him. 
We left a message with the secretary as the officer was not in his 
office. 

We have not heard from either of them since May 20, 1993. 



75 



Claimant: Does not wish to be identified 

Type of Claim: Higher Rating for VA Compensation 
Right Knee Condition 

The Claimant called our office on April 24, 1991 for information on 
how to file for a higher rating for his VA Compensation. He is a 
20% Service Connected Veteran for a right knee condition. We 
advised him to come into the office and we would do the paperwork 
for him. 

On May 15, 1991 the Veteran came into the office and we filled out 
a 4138 (Statement in Support of Claim) along with Medical Records 
from his private physician and Medical Records from the Military. 
This information was forwarded to the DAV VARO, Pittsburgh Pa. 

On May 22, 19991 the claimant received a letter from a National 
Service Officer, DAV advising him that his claim has been submitted 

to the VA and it would take approximately 4 to 6 months for the VA 
to fully develop his claim. 

On March 17, 1992 the Veteran called. He wanted to know who his 
POA was. After checking with the DAV concerning his claim he was 
advised by them that they had no authorization to process his 
claim, that they were not his Power of Attorney. No work had been 
done on his claim since it was first submitted. We found out that 
in 1988 he changed his POA to the American Legion. 

The office notified that American Legion of the problem, they 
obtained his records and started working on his claim. On November 
12, 1992 he received a letter from VARO denying him an increased 
evaluation. He contacted our office and advised us that he would 
let us know if he wanted to file a Notice of Disagreement. 

On November 18, 1992 the American Legion Service Officer filed a 
Notice of Disagreement on behalf of the claimant. 

On January 23, 1993 the Veteran called to check on his claim. We 
contacted the service officer who checked on the claim the same 
date and advised us that the case was in the rating board. 

On March 4, 1993 the claimant again called our office to check on 
his claim. We called the American Legion and the service officer 
again and advised us that this case was still in the rating board. 



76 



On June 11, 1993 the Veteran called the office to check on his 
claim. We contacted the American Legion who again checked on this. 
The service officer called our office and told us that this claim 
has been in the rating board since November 1992. He was going to 
personally contact the rating board and see why this is taking so 
long. 



Federal Burial - VA form 21-530 was filed on January 27, 1993. 

A call was made to the Pittsburgh Regional Office on June 15, 1993 
to find out why this claim had not been paid and was told that 
although they had a death certificate it was not on the computer 
that the Veteran was deceased. The reason they had put a stop to 
his pension checks was because the Income Verification report had 
not been returned. This complaint was from a widow who was having 
problems collecting her widows pension from the V.A. 



77 



Claimant: Does not wish to be identified. 
Type of Claiin: Reduction of benefits. 

Claimant, a World War II veteran went to the Bethesda Naval 
Hospital where he was diagnosed as having bone cancer. His leg was 
amputated at the hip and he was given 100% disability. He returned 
to his home in Lawrence County and was summoned to the Pittsburgh 
Office for a physical. He appeared at the proper time for his 
appointment and his physical consisted of an introductory "How do 
you feel?" and a stethoscope was placed on his chest to check his 
heart. His disability was reduced to 60% although he was still 
unemployable . 



78 



The following is a summary of a letter written by a Viet Nam 
Veteran. 

I am writing this letter to express the main problems that are 
facing the veterans in this district. 

I would like to use and discuss my case as a general example 
for you to fully comprehend the of the treatment that we are 
receiving at the hands of the V.A. 

According to the National Veterans Legal Services in 
Washington D.C. the Pittsburgh Regional Office is ranked 56 out of 
58 Regional Offices in the United States. 

The Pittsburgh office interprets the law on a personal level 
and places the veteran in a adversarial position which is contrary 
to the concept of the Veterans Administration. The Pittsburgh 
Office encourages employees to make medical opinions and legal 
conclusions which according to the U.S. Court of Veterans Appeals 
is illegal. 

It seems that the veteran is required to live by the rules and 
regulations, that is he must file his papers in the time allotments 
allowed and if he does not he must start over. However, the V.A. 
does not live by the same rules. Their answer, when asked why they 
do not follow the rules is. If you win we will pay you 
retroactively . 

NOTE: This veteran would be willing to testify before any 
committee or board at any time. 



79 



The Honorable Willizun J. Coyne 

Testimony for the 

House Committee on Veterans' Affairs 

Subcommittee on Oversight and Investigations 

Field Hearing 

Pittsburgh, Pennsylvania 

June 28, 1993 

Mr. Chairman, Members of the Committee, I want to thank you for 
this opportunity to testify today. More importantly, I want to 
thank you for holding this hearing in Pittsburgh to examine the 
needs of veterans in western Pennsylvania and West Virginia. 

This hearing should provide the House Committee on Veterans' 
Affairs with an excellent opportunity to hear directly from 
veterans, local Pittsburgh Veterans Benefits Administration 
Regional Office officials and other interested parties. You 
will hear first hand about the concerns many veterans share 
regarding the future of veterans programs at a time when many 
federal programs are being cut. You will also hear testimony 
expressing a range of views on the manner in which these programs 
are administered by the Department of Veterans' Affairs. 

It is appropriate the Veterans' Affairs Subcommittee on 
Oversight and Investigations should choose to hold this field 
hearing in Pittsburgh since this area is the home to one of the 
region's largest concentrations of veterans. The Pittsburgh 
Regional Office of the Veterans Benefits Administration has a 
jurisdiction encompassing 560,700 veterans. Allegheny County 
alone is home to 179,000 veterans, the highest number of veterans 
in any one county within the Commonwealth of Pennsylvania. The 
veteran population in the Commonwealth of Pennsylvania overall 
exceeds 1.4 million. 

As the U.S. Representative for the 14th Congressional 
District, which includes the City of Pittsburgh, the North Hills 
and many surrounding boroughs and townships, I understand how 
important veterans programs are to the people of this area. My 
constituents share with all Americans a feeling of gratitude for 
the sacrifices made in the defense of our country by veterans and 
their families. I can also report that veterans issues and 
questions regarding the administration of veterans programs rank 
second only to Social Security issues in terms of constituent 
contacts to my congressional office here in Pittsburgh. 

Veterans of every major U.S. military conflict make their 
home in western Pennsylvania. The diverse nature of the local 
veterans population — including veterans from World War I, World 
War II, Korea, Vietnam, and Operation Desert Storm — requires 
that the Department of Veterans Affairs must allocate its 
financial and human resources in the most effective manner 
possible. 

The veterans population in this region has a broad range of 
needs. Many older veterans find themselves needing to rely 
increasingly on veterans health care programs. The number of 
older veterans in Pennsylvania and across the country continues 
to increase as senior citizens account for a steadily growing 
segment of the overall U.S. population. At the same time, the 
post-Cold War downsizing of active U.S. military forces is adding 
to the number of veterans who need assistance re-entering the 
civilian workplace. These new veterans will create fresh demands 
for VA vocational programs. 

It is also a tragic fact that a large number of veterans in 
this area are homeless. It is estimated that there are between 
1700 and 1900 homeless individuals in Allegheny County at any 
given moment, and approximately 35 to 40% of these are veterans. 
The Federal Government has a special duty to reach out and help 
those homeless veterans who are unemployed, have suffered 
financial loss or who suffer from severe medical or psychiatric 
problems. 



80 



As a result of the size and diversity of the local veterans 
population, it should be noted that fiscal 1992 Veterans Affairs 
expenditures in Allegheny County totaled $322,977,541. This 
represents the largest amount spent by the Department of Veterans 
Affairs in any single county within the Commonwealth of 
Pennsylvania, and amounts to 21 percent of total statewide 
Veterans Affairs expenditures. 

A significant portion of the Veterans Affairs expenditures 
in Allegheny County are allocated to provide medical services and 
to cover administrative costs. Over $188 million, or 58 percent, 
of total Veterans Affairs Fiscal 1992 expenditures in Allegheny 
County were used to cover medical services and administrative 
costs. By comparison, less than $80 million, or 25 percent, of 
total VA Fiscal 1992 expenditures in Allegheny County were used 
to provide VA compensation and pensions. 

Since there are many needs which must be met with these 
limited VA resources, it is vital that the Pittsburgh Regional 
Office make every effort to administer VA programs in the most 
cost effective manner possible. We are fortunate to have in 
Pittsburgh many dedicated Veterans Affairs professionals who are 
committed to working productively with veterans and the local 
community. While no organization is perfect, and there is always 
room for improvement, I know that the men and women of the VA's 
Pittsburgh Regional Office are ready to work with this Committee 
to achieve the best results possible for the veterans of this 
region. 

I want to note as well the key role played by local veterans 
organizations in highlighting opportunities for improving the 
quality of veterans programs. I am very proud of the leadership 
which is being provided in this area by local veterans 
organizations. The members of these groups deserve the 
recognition and thanks of the Congress, the VA, and our local 
community for reaching out to their fellow veterans and playing 
an active oversight role in focusing attention on opportunities 
to improve VA programs and service delivery. 

In closing, I want to thank the Committee again for holding 
this hearing in Pittsburgh. I am confident that you will find 
your time here to be well spent. 



81 



STATEMENT OF U.S. REPRESENTATIVE JOHN MURTHA REGARDING THE 

PERFORMANCE OF THE PITTSBURGH REGIONAL OFFICE OF THE 

VETERT^S BENEFITS ADMINISTRATION 

SUBMITTED TO THE HOUSE VETERANS AFFAIRS SUBCOMMITTEE 
ON OVERSIGHT AND INVESTIGATIONS 

IN REFERENCE TO THE JUNE 28, 19 9 3 HEARING 

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE. I appreciate this 
opportunity to submit testimony to the House Veterans Affairs 
Subcommittee on Oversight and Investigations regarding the 
performance of the Pittsburgh Regional Office of the Veterans 
Benefits Administration. 

Veterans in the area of Western Pennsylvania which I represent rely 
on the Pittsburgh Regional Office as the coordinating point for the 
benefits and services which they have earned through their loyal 
service to our nation. These dedicated men and women deserve 
nothing short of the finest treatment in return for their years of 
sacrifice, and it's our duty to ensure they receive it. 

When I learned this hearing was to take place, I immediately 
contacted Veterans' organizations in my Congressional District to 
ask for feedback on the performance of the Pittsburgh Regional 
Office. The general reaction from area Veterans was positive. The 
consensus of the organizations and individuals I have spoken to is 
that the Pittsburgh Regional Office has improved their performance 
over the past few years, especially in their dealings with Veterans 
from the area outside the immediate Pittsburgh metropolitan area. 

Veterans in a number of the counties I represent, which are up to 90 
miles from downtown Pittsburgh, have complained in the past about 
what they felt were unreasonable delays in hearing cases and making 
final decisions. In addition, there appeared to be a feeling among 
Veterans from these areas that the Pittsburgh office was oriented 
toward the problems of Veterans in metropolitan areas, especially in 
areas such as housing and employment assistance. But recent 
initiatives by the Pittsburgh Regional Center, such as an outreach 
program for counseling for Vietnam Veterans, have been well-received 
by Veterans in my area, and the overall feeling of Veterans' groups 
toward the Regional Center are now much more positive. 

A suggestion I feel has merit which came from an area Veterans' 
group involved a further increase in outreach by the Regional 
Office. This proposal involves regularly-scheduled meetings between 
top officials at the Pittsburgh Office and Veterans in the outlying 
regions served by the Office. These types of meetings would lead to 
the top officials becoming more aware of the concerns of Veterans 
at the grassroots level, especially in the more rural areas of 
Western Pennsylvania. 

I wanted to mention one particular area of praise which I received 



82 



for the Pittsburgh Office. The Veterans Office at Indiana 
University of Pennsylvania, which certifies benefits for over 400 
students a year, reported to me their very positive relationship 
with the Pittsburgh Regional Office. With furthering their 
education such an important and vital activity for Veterans, I'm 
pleased that the Pittsburgh Office maintains such a positive 
relationship with a major educational institution like Indiana 
University of Pennsylvania. 

I also wanted to make some observations about the Pittsburgh 
Regional Office based on the day-to-day involvement my staff and I 
have with the Office. I receive a large number of inquiries about 
Veterans' benefits and compensation from constituents, and my first 
source of information about the details of these cases is the 
Pittsburgh Office. For the vast majority of inquiries, the 
response I receive is prompt, within two weeks of the initial 
inquiry. I have occasionally been disappointed at the quality of 
the response, feeling that a more detailed explanation for the 
decision of the Veterans Benefits Administration should have been 
expected. The most common complaint I receive from constituents is 
that they feel cases sit in the Pittsburgh Office for too long a 
period of time without a decision being made. 

Most complaints I receive about the Veterans Benefits 
Administration are not directed at the Pittsburgh Regional Office, 
but at the overall polices on the federal level. In particular, the 
burden of proof on Veterans to show that medical conditions are 
service-related has proven to be a time-consuming and overly- 
bureaucratic process. Although I understand that many of the 
records of Veterans Benefits Administration were destroyed in a fire 
at the St. Louis records facility, at times I feel there is not 
enough sensitivity given to Veterans seeking treatment. The 
bureaucratic difficulties in the Veterans Benefits Administration, 
as in many other federal agencies, continue to frustrate me, and I 
hope that this Subcommittee will continue its work to untangle this 
maze of often conflicting and contradictory regula'tions to make the 
Veterans Benefits Administration more "Veterans friendly." 

In conclusion, I'd again like to thank the Subcommittee for coming 
to Pittsburgh and focusing on the Pittsburgh Regional Office. 
Although these hearings tend to focus on the negatives, the 
Pittsburgh Regional Office generally serves Veterans in Western 
Pennsylvania well. I hope the Subcommittee will be able to use the 
suggestions made here in a manner which will help Western 
Pennsylvanian Veterans get their benefits in the most efficient 
manner with as little red tape as possible. 



83 







University of Pittsburgh 



SCHOOL OF MEDICINE 
Office of the Dean 

STATEMENT OF DR. GEORGE M. BERNTFR, TR. 
DEAN. SCHOOL OF MEDICINE 
UNIVERSITY OF PITTSBURGH 

BEFORE THE HOUSE VETERANS AFFAIRS 
SUBCOMMITTEE ON OVERSIGHT AND INVF^STIGATIONS 

FIELD HEARING AT THE 

UNIVERSITY OF PITTSBURGH SCHOOL OF LAW 

JUNE 28, 1993 

Gcxxi morning, Mr. Chairman and members of the Committee. My name is George 
Bemier, M.D., Jr. I am a physician and Dean of the University of Pittsburgh School of 
Medicine. I am pleased to have the opportunity to testify before the House Veterans Affairs 
Subcommittee on Oversight and Investigations about the role the Department of Veterans Affairs 
(VA) plays in Pittsburgh through its Pittsburgh Regional Office of Veterans Benefits 
Administration (VBA). 

I would like to welcome members of the Committee and their staff to Pittsburgh and wish 
them a pleasant stay. As you know health care is mo".! prominent in Pittsburgh. One of the 
reasons that Pittsburgh has become a nationally recognized city for its excellence in health care 
delivery is the relationship between health care providers like the Pittsburgh-based VA medical 
centers and the University of Pittsburgh Medical Center. 

One basic idea regarding the delivery of health care to veterans is that it has been 
improved by affiliation agreements between VA hospitals and medical schools at various 
locations throughout the country. This has certainly been the case in the Pittsburgh area where 
the University of Pittsburgh has worked in a collaborative manner with the Pittsburgh VA 
hospitals to enrich the clinical care environment within the VA hospital system and enhance the 
research and educational opportunities available in the region. In addition, utilizing sharing 
agreements avoids costly and unnecessary duplication for both veterans and non-veterans medical 
centers. Faculty and medical staff often have joint appointments too. 

An example of the positive results of the collaborative efforts between VA medical 
centers and teaching hospitals is the development of state-of-the-art procedures such as those 
found in the liver transplant program at the University Drive VA Medical Center in Pittsburgh, 
one of two VA liver transplant programs nationally. Since the transplant program at the 
University Drive VA draws upon the same faculty, fellows, and residents that the program at 
Presbyterian University Hospital does, the VA gains the benefit of what all will acknowledge 
is the world's most advanced expertise and talent. 

Another collaborative agreement between the VA medical centers and the University of 
Pittsburgh School of Medicine resulted in funding for a positron emission tomography (PET) 
scanner and cyclotron which is located in Pittsburgh and serves the tri-state region including 
Pennsylvania, Ohio and West Virginia. The PET scanner permits non-invasive observation of 
cell function beyond the technical capability of magnetic resonance imaging and other scanners. 
This type of technology permits both a high level of patient care and research due to its far- 
reaching applications. 

A second basic idea is therefore that the development of high-tech, shared medical 
services and equipment within the VA Hospital system is essential to the well-being of the 
veterans treated in these facilities. Funding for V A. health care can be leveraged by the shared 
purchases and other cooperative agreements. Thirdly, the level of research and training 
associated with such complex procedures greatly enhances the opportunities available to trainees 
to further ' their medical education and professional courses within the VA system. The 
development of complex treatment and research services also provides the VA system the 



M240 SCAIFE HALL. PITTSBURGH. PA 15261 (412) 648-8975 
TELEFAX NUMBER: (412)6481236 



84 



opportunity to recruit and retain physicians who are the best and the brightest in the country. 
Provided the VA continues to reasonably fund its research program, clinical investigators will 
continue to find the VA a congenial environment which will greatly benefit patients. Certainly, 
citizens who have served the country in our nation's armed forces deserve to be treated by the 
best the country has to offer. 

In this era of health care reform, I believe it is essential to stress that these 
arrangements result not only in high quality patient care, increased educational and training 
opportunities for young physicians which lead to a better qualified medical staff, but also cost 
savings for the country as a whole. Shared services between VA medical centers and teaching 
hospitals reduce the cost of duplicating services and research initiatives in the health care 
industry thereby reducing overall health care costs. 

The primary missions of the VA medical system are to provide quality clinical care for 
veterans and to be prepared to serve active duty personnel when needed. The Highland Drive 
VA Hospital, in conjunction with the University of Pittsburgh Medical Center, provided clinical 
treatment for those brave men and women who served in the Gulf and suffered from post- 
traumatic stress disorder. The fifteen members of the Army Reserve's 14th Quartermaster 
Detachment who survived the Iraqi Scud missile explosion were treated for the stress disorder 
in an outpatient setting by a clinical team comprised of psychiatrists, social workers, and nurses. 

The development of a clinical treatment program for veterans of an armed conflict is 
essential to their well-being. An estimated 15% of Vietnam veterans suffer from post-traumatic 
stress disorder and are in need of adequate treatment. In addition, civilian victims of stress- 
related injuries who suffer from post-traumatic stress disorder benefit from the expertise 
developed in the VA health care system. 

The care that veterans and their families receive in the VA hospital system has also been 
the topic of review on numerous occasions and several academic studies have been prepared on 
the subject. I would like to direct the attention of the distinguished members of the panel to a 
report published in the Annals of Surgery titled "Comparison of Postoperative Mortality in VA 
and Private Hospitals." This study was conducted by one of our faculty members, Dr. John 
Stremple, and mandated by Public Law 99-166, Section 204. The study was a comparison of 
postoperative mortality and morbidity rates for each type of surgical procedure performed within 
the VA system and the prevailing national standard. (Annals of Surgery . March 1993; 217:277- 
285). 

The study found that postoperative mortality in 113 surgical procedures or procedure 
groups is comparable to that in private hospitals. That finding is significant because it 
demonstrates that veterans are receiving quality care within the VA hospital system when 
undergoing surgical procedures. 

I believe it is important to analyze and review the quality of care and benefits that service 
men and women and their families are receiving in the VA health care system. The VA health 
care system, especially through its affiliations with academic medical centers, is able to provide 
quality health care to veterans, develop a meaningful environment for clinical research to apply 
to patient care, and attract and retain well qualified medical staff. I am especially delighted to 
have been able to share my thoughts on this issue with members of this Committee and would 
be pleased to continue to work with the Congress on these very important issues. 



85 

Reprinied from: ANNALS OF SURGERY. Vol. 217. No. 3. March 1993 



Comparison of Postoperative ©flfigll^Js'jn] 

Mortality in VA and Private Hospitaislj^-'^^YT ^9 " "^ 

John F. Siremple, M.D.,*t Dean S. Bross. Ph D.t Chester L. Davis. Sc.D..t OFjJai 

and Gerald O. McDonald. M.D § ^** SCHOOL OF MEOIC<Nt 

from the Department ot Veterans Alfairs Medical Center,' Pittstxjrgh. the Departrrtent 
of Surgery,^ University of PiltstMrgh School of Medicine. Pittsburgh, Pennsylvania, and The 
OSces of Quality ManagementX and Deputy Director of Surgical Service,§ 
VA Central Office, Washington, DC 



Objective 

This study compared unselected VA (Department of Veterans Affairs) and private multi-hospital 
postoperative mortality rates. In the absence of national standards tor postoperative mortality 
rates and in view of the unique volume and range of surgical procedures studied, the second 
objective is to help establish national standards through the dissemination of these postoperative 
mortality norms. 

Summary Background Data 

Public Law 99-166. Section 204, enacted by Congress December 3. 1985. required that the VA 
compare postoperative mortality and mort>idity rates for each type of surgical procedure it 
performs with the prevailing national standard and analyze any deviation between such rates in 
terms of patient characteristics. 

Methods 

The authors compared postoperative mortality in the VA to thai in private hospitals, adjusting for 
the patient characteristics of age, dtagnosis. comortjidity. or severity of illness. We used a total 
ot 830.000 patients discharge records (323.000 VA and 507,000 pnvate patients) from 1984 
through 1986 among 309 indrindual surgical procedures within 113 comparison surgical 
procedures or procedure groups 

Results 

The auttiors found no significant differences in postoperative mortality rates between the VA arxj 
private hospital systems for 105 of ttte 113 surgical procedures or procedure groups VA 
postoperative mortality rates ttiat were higher than those in pnvate hospitals were found fof 
suture of ulcer, revision of gastric anastomosis, small to-small intestinal anastomosis, 
appendectomy, and reclosure of postoperative disruption of abdominal wall (p = 05). Vascular 
bypass surgery, portal systemic venous shunt, and esophageal surgery showed a significantly 
lower postoperattve mortality in the VA as compared writh thai in private hospitals (p - 0.05). 

Conclusions 

VA postoperative mortality in 1 13 surgical procedures or procedure groups is comparable to that 

in private hospitals 



277 



86 



278 



Stremple and Others 



This study compared unselected Department of Vet- 
erans Affairs (VA) and private multi-hospital postopera- 
tive mortality rates. These data include the broadest 
range and largest number of different types of surgical 
procedures studied to date. 

In the absence of national standards for postoperative 
mortality rates in private hospitals and in view of the 
unique volume and range of surgical procedures studied, 
the second objective of this report is to help establish 
national standards through the dissemination of these 
postoperative mortality norms. These standards and the 
large postoperative mortality data base' may then be 
valuable to other government agencies and quality re- 
view organizations when examining national health care 
policy issues.^"* 

This report examines the method and a portion of the 
clinically relevant results of the completed Phase II re- 
port on the Quality of Surgical Care in the VA, which 
was issued to the Congress of the United States on April 
1 , 1 99 1 . The Phase II report to Congress compares post- 
operative mortality and morbidity in the VA with pri- 
vate hospitals and analyzes VA mortality through indi- 
vidual medical record review as required by Public Law 
99-166, Section 204, enacted December 3, 1985.' 



METHODS 

Data Sources 

The National Center for Health Service Research and 
Health Care Technology Assessment (NCHSR) pro- 
vided the VA with hospital discharge data from the Hos- 
pital Cost Utilization Project (HCUP-2). This database 
contains more than 3 million patient discharges each 
year from 406 private short-term, general and nonfed- 



The VA Office of Quality Management designed the study to include ■ 
the specific comparisons of VA to private hospitals, using Hospital 
Studies Program statistics, and is solely responsible for mterpreimg 
the results. The role of the Hospital Studies Program at the National 
Center for Health Services Research and Health Care Technology 
Assessment was limited to providing the data file requested by the 
VA. No official endorsement by the National Center for Health Ser- 
vices Research and Health Care Technology Assessment is intended 
nor should it be inferred. 

The opinions and conclusions expressed are solely those of the authors 
and should not be attributed to the Department of Veterans Affairs 
or the National Center for Health Services Research and Health Care 
Technology Assessment of the Department of Health and Human 
Services. 

Address reprint requests to John F. Stremple. M.D Chief Surgical Ser- 
vice. VA Medical Center, University Drive C. Pittsburgh, PA 1 5240. 

Accepted for publication June 4, 1992. 



eral public hospitals. Teaching hospitals and hospitals 
with higher bed size are over-represented in both the VA 
and the HCUP database. The VA Patient Treatment File 
(PTF) database contains more than 1 million patient dis- 
charges each year from 172 VA Medical Centers includ- 
ing all 132 with surgical services and also includes 105 
teaching and 27 nonteaching surgical services. 

The VA PTF and the HCUP databases contain a mini- 
mal amount of data pertaining to surgical risk. Age and 
comorbidities are present, but neither database records 
the American Society of Anesthesiologists (ASA) physi- 
cal status risk classification of the patient or whether the 
operation was an emergency or scheduled as an elective. 
They also do not contain information about the indica- 
tions for Of>eration or the cause of death. No information 
is available within the VA PTF system nor the HCUP 
database regarding the survival of patients beyond the 
date of discharge. Therefore, the analysis of mortality 
rates was restricted to 30-day in-hospital deaths only. 

Selecting Surgical Procedures 
for Comparison 

Before beginning any comparative analyses of these 
two databases, we compiled a list of surgical procedures 
to be studied. In making up this list, all attempts were 
made to include as many procedures as possible to fulfill 
the intent of Public Law 99-166 provided that a suffi- 
cient number of patients had undergone the procedure 
in the VA for a meaningful analysis to be carried out. A 
further criteria imposed on the surgical procedures to be 
studied was the requirement that patient deaths occur- 
ring after one of these procedures could legitimately be 
presumed to be related to the procedure itself Thus, 
diagnostic or palliative procedures were excluded as well 
as those identified as treatment of complications.' 

A surgical procedures list that included all procedures 
meeting these requirements, provided that a minimum 
of 100 cases per year were present in the VA, was assem- 
bled. To permit less common surgical procedures to be 
studied, the list was expanded to include procedures ac- 
counting for at least 10 deaths a year within the VA even 
if they were performed on fewer than 100 patients. In a 
further effort to examine even more of the less common 
procedures, groupings of related procedures were con- 
structed by employing the hierarchical nature of the In- 
ternational Classification of Diseases, Ninth Revision, 
Clinical Modification (ICD-9-CM) coding system. The 
result of this selection process was 66 individual surgical 
procedures and 47 surgical procedure groups, which 
were used for data analysis and comparison. These 1 1 3 
were comprised of a total of 309 individual surgical pro- 
cedures. 



87 



Study Population 

Data availability considerations for both the VA and 
NCHSR/HCUP data led to the selection of the 3-year 
time frame from 1984 through 1986. The NCHSR data 
was restricted to men over 1 8 years to be more compara- 
ble to the VA population. For the analysis, we studied all 
patients who met the sex and age criteria and had one of 
1 1 3 surgical procedures or procedure groups identified 
on the list. This gave us a total of 830,000 patient dis- 
charge records, including 507,000 private patients and 
323,000 VA patients. 

Definition of Variables 

Variables in patient characteristics included age, diag- 
nosis, comorbidity, or severity of illness. Age was catego- 
rized into four ranges; <50, 50 to 64, 65 to 79, and >80 
years of age. Age was categorized instead of being used as 
a continuous variable because we did not want to assume 
that risk increased linearly with age. 

Beginning with a set of diagnosis classification catego- 
ries used by the Health Care Financing Agency (HCFA) 
in their mortality analysis, we constructed a 1 5 category 
classification scheme that was more appropriate to the 
VA patient population. The classification scheme relied 
exclusively on the principal diagnosis in assigning a pa- 
tient to a diagnosis category. The categories in this diag- 
nosis classification scheme were: cancer, stroke, severe 
acute heart disease, metabolic and eleclrolylc disorders, 
pulmonary disease, ophthalmologic disease, low-risk 
heart disease, gastrointestinal disease, urologic disease, 
orthopedic conditions, infectious diseases, symptoms 
and ill-defined conditions, severe trauma, follow-up care 
without acute diagnosis, and other. 

Thirteen comorbidity conditions, determined from 
tK>th the principal and secondary diagnoses, were identi- 
fied as having a possible influence on mortality. Each 
comorbidity was analyzed in a separately adjusted com- 
parison of VA and private patients. The comorbid con- 
ditions were: neoplasms, diabetes mellitus, nutritional 
deficiencies, metabolic or immune disorders, alcohol- 
ism, drug dependency, hypertension, atherosclerosis, 
other chronic ischemic heart disease, chronic obstructive 
pulmonary disease, pneumoconiosis, liver disease, and 
renal disease. 

To adjust the mortality rate comparisons for the sever- 
ity of illness of patients in both hospital systems, we ap- 
plied the Disease Staging method to the two databases.' 
This system, developed by Systcmctrics, Inc., and 
known as Coded Disease Staging, was selected because of 
its availability within the NCHSR database. Coded Dis- 
ease Staging employs a computer algorithm operating on 
the ICD-9-CM codes for diagnoses to identify each dis- 



Postoperative Mortality in VA and Private Hospitals 279 

ease a patient has and to assign the severity to one of 
three stages. These stages represent the progression of 
disease. When stages are used, comparisons are valid 
only between groups having the same diagnosis and sur- 
gical procedure. Therefore, we adjusted for severity of 
illness by identifying the most important diagnosis group 
or groups that corresponded to each surgical procedure. 
The adjustment for severity is calculated only from those 
identified diagnosis groups. 



Statistical Analysis 

The statistical significance of the overall mortality rate 
comparison was assessed using the Chi Square technique 
with the Yates correction for continuity at the 5% signifi- 
cance level.'" Whenever a significant statistical differ- 
ence was found in comparing the overall VA postopera- 
tive mortality rates to those in private hospitals, a more 
detailed comparison was made by adjusting for age, 
diagnosis, comorbidity, or severity of illness in an at- 
tempt to account for the difference. Hypothesis tests 
were carried out that adjusted for each of these patient 
characteristics in comparing the mortality rates. These 
adjustments took only one patient characteristic into ac- 
count at a time because of limitations in the data sup- 
plied by NCHSR. The VA was provided only with sum- 
mary statistics by NCHSR and could not access the data- 
base itself to protect patient privacy. As a result of 
NCHSR confidentiality constraints, the VA did not re- 
ceive data in cells with small numbers of patients. Conse- 
quently, a true multivariate analysis was made impossi- 
ble, and thus, our analysis utilized one patient character- 
istic at a time. The significance of a comparison between 
the VA and HCUP data controlling for any one patient 
characteristic was assessed using the Mantel Haenzel 
test, corrected for continuity.'" All comparisons were de- 
fined j prion and, therefore, no adjustment to the signifi- 
cance level is necessary for multiple hypothesis tests. 

To illustrate the extent to which population differ- 
ences due to age, diagnosis, or severity of illness have 
contributed to the differences in postoperative mortality 
rales, the direct standardization method has been ap- 
plied. The VA postof)erative death rates were directly 
standardized using the distribution of the private hospi- 
tal population as the standard population. This standard- 
ization was repeated separately for each of the patient 
charactenstics analyzed. Directly standardized rates 
were used for illustration only, and can make the VA 
death rales immediately comparable to pnvate hospital 
death rates with no further adjustment because both 
death rates are based on the same standard population 
distribution. 



88 



280 Stremple and Others 
RESULTS 

We observed ten or fewer deaths in VA and private 
hospital samples for 39 surgical procedures or procedure 
groups. None of the differences were significant. Because 
our samples showed so few deaths, there is little value in 
attempting to ascertain mortality rate standards for these 
procedures. 

Analysis of 41 surgical procedures or procedure 
groups with unadjusted mortality rates showed no signifi- 
cant differences between VA and private hospitals (Ta- 
ble 1 ). These rates did not differ significantly after adjust- 
ing for age with the exception of three procedures; 
ventriculostomy, partial gastrectomy or other gastro- 
enterostomy, and amputation above knee. Adjustments 
for differences in the diagnosis classification for these 
three procedures confirmed the findings of the unad- 
justed comparison, reinforcing the conclusion that no 
difference was present in any of the 4 1 surgical proce- 
dures. In addition, the postoperative mortality rates for 
the 41 procedures in Table 1 are reliable as standards 
because at least one sample has a sufficient number of 
deaths. 

The mortality rates for 1 9 other surgical procedures in 
VA and private hospitals did not differ significantly 
when difference in age, diagnosis, or comorbidity were 
taken into account (Table 2). Once adjustments were 
made for age or diagnosis, comorbidity was not found to 
influence the remaining procedure groups sufficiently to 
explain the remaining mortality rate differences. The 
single exception was for esophageal anastomosis or 
esophagocolostomy. This procedure is not a common 
one, and the sample from private hospitals had only 58 
patients. When overall mortality rates were considered, 
the VA mortality rate was 11.89% compared with 
24.14% in private hospitals. However, this difference be- 
came insignificant once adjustments were made for the 
presence of neoplasm comorbidity. 

When adjustments were made for the severity of ill- 
ness, the mortality rates of six surgical procedures or pro- 
cedure groups were found comparable although they had 
seemed, at first, to differ significantly (Table 3). 

After fully controlling all of the available mortality 
data for age, diagnosis, comorbidity, or severity of ill- 
ness, one factor at a time, we found no significant differ- 
ences in the postoperative mortality rates of the VA and 
the private hospital samples for 105 of the 1 13 surgical 
procedures or procedure groups, despite some very large 
sample sizes. 

We were unable to identify a plausible reason for the 
higher VA postoperative mortality rate in 5 of the 1 1 3 
procedures (Table 4). In four of these five procedures, 
the differences between the VA and private sector sam- 



ples were reduced by age adjustment (appendectomy) or 
diagnosis adjustment (reclosure of postoperative disrufv 
tion of abdominal wall, suture of ulcers, revision of gas- 
tric anastomosis). Nonetheless, the residual difference 
was still significant. 

Vascular bypass surgery (other than coronary artery), 
portal systemic venous shunt, and esophageal surgery, 
showed a significantly lower mortality in the VA relative 
to private hospitals even when patient characteristics are 
taken into account (Table 4). Adjustments for patient 
characteristics made little difference in the comparison. 

DISCUSSION 

Of the 1 1 3 surgical procedures and procedure groups 
studied, 78 showed no significant difference in unad- 
justed mortality rate. When the results of a significance 
test revealed a difference between VA and private hospi- 
tal mortality rates, the two patient populations were fur- 
ther analyzed to ensure that the comparison was not af- 
fected by differences in patient population characteris- 
tics. 

Appendectomy is one procedure in which a great deal 
of information is concealed by the use of a single overall 
or unadjusted mortality rate. This operative procedure 
had a VA unadjusted mortality rate of 1.43%. Adjusting 
for age alone, using the four very wide age categories, 
decreased the mortality to 0.68%. While the reduction is 
considerable, it is still higher than the 0.23% found in 
private hospitals. Patients in the private hospital sample 
were primarily under 50 years of age; here, only 5 deaths 
were observed. While this is the most populous age 
group in the VA, it accounts for less than half of the VA 
sample. We can speculate then that since most of the 
appendectomy patients are well below the age of 50 in 
the private hospital sample, our crude adjustment sys- 
tem did not take out the full effect of age. A more refined 
age adjustment may have reduced the difference even 
further The elderiy patient with acute appendicitis fre- 
quently has atypical symptoms and signs" and seem to 
progress to perforation faster. Perforation occurs in 
about 40% of elderly patients within 24 hours of the on- 
set of symptoms.'^ 

Small-to-small intestinal anastomosis had a postopera- 
tive mortality rate of 17.36% in the VA, significantly 
higher than the 9.42% in private hospitals. The mortality 
rate rose among VA patients over 65 years of age, but 
this increase was not found in private hospitals. Below 
age 65, the VA mortality rate is not significantly different 
from that of private hospitals. The patients in the private 
hospital sample who had this procedure fell into the 
diagnoses categories of gastrointestinal disease and 
cancer While there are fewer patients with cancer, this 



89 



Postoperative Mortality in VA and Private Hospitals 281 



Table 1. SURGICAL PROCEDURES WITH ADEQUATE SAMPLES FOR POSTOPERATIVE 

MORTALITY STANDARDS AND NO UNADJUSTED SIGNIFICANT DIFFERENCES 

BETWEEN VA AND PRIVATE HOSPITALS 



Private 







Death 




Death 


Type Procedure 


# Cases 


Rate% 


# Cases 


Rate% 


General surgery 










Sympathectomy 


487 


1.23 


671 


1.79 


Endarterectomy 


8451 


1.68 


12766 


1.83 


Total splenectomy 


1105 


7.15 


2178 


6.70 


Local excision ol otiier lesion o< stomach tissue 


103 


11.65 


193 


8.29 


Partial gastrectomy or other gastrectomy 


3139 


9.14 


3855 


895 


Total gastrectomy 


742 


1199 


771 


1012 


Total colectomy 


366 


10.66 


544 


882 


Other small to-large ntestjnal anastorrxjsis 


1234 


8.02 


198 


1212 


l^ge-to-large rtestmal anastomosis 


1542 


2.92 


163 


2.45 


Otiier biopsy ol pancreas 


116 


12.07 


190 


9.47 


Unilateral repair ol mgunal hernia 


39614 


0.20 


60125 


0.20 


Brfateral repair ol rigunal hernia 


1601 


0.50 


8802 


0.22 


Unilateral repair ol femora) hernia 


764 


1.44 


925 


1.41 


Repair umljilical heme 


2748 


0.80 


2738 


0.47 


Repair ol ventral hernia 


46S0 


0.52 


4948 


061 


Thoracic surgery 










Thoraclomy and topectomy 


5020 


4.02 


4253 


386 


Segmental resection lung 


1905 


4.04 


1511 


3.57 


Complete pneumonectomy 


875 


10.17 


856 


11.45 


Reopening recent thoracotomy 


182 


18.13 


34 


11.76 


Mediastinoscopy 


1462 


2.67 


688 


189 


Excision or destoiction lesion o( chest wal 


559 


1.97 


339 


2.36 


Decortication of ling 


306 


588 


403 


546 


Esophagectomy 


248 


1452 


302 


993 


Orthopaedic sugery 










Interna) fuatioo lemur without Iractue reduction 


734 


422 


1079 


3.89 


ArWotomy for removal ol prosthesis h^j or knee 


394 


2.79 


374 


1.60 


Total knee replacement with prosthesis 


3634 


022 


6766 


0.41 


Tolal hip replacement 


6025 


093 


9604 


098 


H^)operatKXi 


3604 


461 


4208 


544 


Amputatxm above knee 


5676 


1300 


2719 


11.66 


Urology 










Nephrostomy 


447 


537 


1177 


4.59 


Nephroureterectomy 


1660 


2.59 


3119 


2.73 


Formation of cutaneous uretero Jeostomy 


148 


608 


182 


659 


Retropubic proslateclomy 


.952 


0.53 


1284 


1.25 


Radical prostaleclomy 


1585 


0.82 


14S4 


055 


Neurosurgery 










Ventricutoslomy 


222 


2477 


378 


30.42 


Ventricular shunt 


694 


7 06 


899 


645 


Revision or removal ol ventncular shunt 


317 


379 


377 


371 


aolaryngotogy 










Complete laryngectomy 


801 


2.12 


438 


160 


Radeal laryngectomy 


1444 


1.59 


457 


1.53 


Radical necti dissection 


2833 


205 


946 


148 


Ophthalmotogy 










Insert intraocJar lens prosthesis at cataract 










extr (one stage) 


y.vl 




220 


000 



90 



282 



Stremple and Others 



Table 2. SURGICAL PROCEDURES WITH NO SIGNIFICANT DIFFERENCES AFTER 
ADJUSTMENT FOR AGE, DIAGNOSIS, OR COMORBIDITY 







Death 


Adj 




Death 


Procedure Group 


# Cases 


Rate% 


Rate % 


# Cases 


Rate% 


Rale adjusted lof age 












Exploration thoracotomy 


830 


904 


9.71 


, 543 


1344 


Transurethral resection bladder neck 


9342 


0.48 


059 


14567 


073 


Radical cystectomy 


915 


2.30 


3.09 


960 


4.60 


Transurethral prostatectomy 


37355 


0.41 


0.50 


71071 


0.51 


Suprapubic prostatectomy 


1340 


0.67 


0.87 


2150 


163 


Spinal fusion 


2025 


1.14 


0.71 


3631 


061 


Disarticulation of hipt 


170 


32.35 


0.00 


64 


15.63 


Rate adjusted tor diagnosis 












Skull procedures 


4093 


12.07 


12.34 


7345 


13.78 


Lens procedures 


5597 


0.18 


0.11 


" 21825 


0.06 


Vagotomy and pyloroplasty 


1096 


7.66 


5.39 


1739 


5.69 


Rectum resection 


2770 


4.91 


3.85 


3605 


3.44 


Cholecystostomy 


349 


27.51 


15.04 


283 


15.44 


Cholecystectomy 


11878 


2.05 


1.65 


29340 


1.70 


Bile duct surgery 


3321 


6.23 


9.84 


1746 


10.14 


Other biopsy of kidney 


239 


5.44 


2.12 


330 


1.82 


Ureterotomy 


2149 


2.00 


1.00 


3966 


0.63 


RemovaJ ot intern^ fixation device 


5250 


0.53 


0.25 


6014 


0.13 


Other amputation below knee 


5369 


6.43 


465 


3344 


481 


Rate adjusted lor presence of neoplasm 












Esophageal anastomosis or 












esophagocolostomy 


429 


11.89 


12.14 


58 


24 14 



' The standard population is the private hospital population We then applied the VA death rates to the standard population to give us a directly standardized mortality tor the VA. 

An adjusted death rate tor the private hospital populaton would be identical to the unadjusted dealh rates 
1 1^ deattis a/TX)ng disarticulation ol hip patients were observed m the VA within the age ranges provided in the pnvate hosprtai data base 



diagnostic classification likely affects the difference in 
rates. The VA mortality rate among cancer patients who 
underwent this procedure was 24% while that in private 
hospitals was only 1 2%. 

A comparison between the VA and private hospital 
data of any diagnosis defined by the term "other" is sus- 
pect. Coder interpretational difference could lead to an 
increase or decrease in the use of such catch-all codes 
that describe similar patients and consequently to an ap- 
parent difference in mortality rates." Revision of gastric 
anastomosis is an example where much of the difference 
is traceable to patients categorized in the "other" diagno- 
sis group. If the principal diagnosis were restricted to 
gastrointestinal disease diagnosis, the significant differ- 
ence between VA and private hospital mortality for revi- 
sion of gastric anastomosis would disappear entirely. 

Those surgical procedures with a significant difference 
in mortality rates between VA and private hospitals that 
could not be explained by age, diagnosis, or comorbidity 
were reexamined using severity of illness data, adjusting 
the VA mortality rates to the severity levels of the pa- 



tients in the private hospital sample.''* To use the patient 
severity data generated by Systemetrics, it is necessary to 
restrict the comparisons to a small number of explicitly 
defined principal diseases. Because our analysis uses 
only a subset of the patients in each database, the conclu- 
sions that may be drawn are limited unless the number 
of patients used in the adjustment process is large. 

Suture of ulcer had a postoperative mortality rate al- 
most 1 1% higher in VA than in private hospitals. Adjust- 
ment for severity reduced this differential to less than 
4%, but the VA mortality rate remained significantly 
greater than that in private hospitals. Two other proce- 
dures, appendectomy, and reclosure of postoperative 
disruption of abdominal wall did not show as much of a 
reduction in the VA mortality rate after adjusting for 
severity. Age and diagnosis adjustments were as effective 
in reducing the mortahty rate difference in these two 
procedures, but the residual difference still showed a sig- 
nificantly lower mortality rate in private hospitals. 

Reclosure of postoperative disruption of abdominal 
wall is obviously not a primary or principal operative 



91 



Postoperative Mortality in VA and Private Hospitals 283 



Table 3. SURGICAL PROCEDURES WITH NO SIGNIFICANT DIFFERENCES AFTER 
ADJUSTMENT FOR SEVERITY 



Procedure Group 
(and Disease) 



Death 
Rate% 



Adj 
Rate% 



Death 
Rate% 



Other exploration arvj decompression of 

spinal canal (other musculoskeletal 

conditions) 
Small intestine surgery (vascular 

insufficiency ol tnlesline and other 

gaslroinlestinal conditions) 
Colon surgery (cancer of colon and rectum) 
Reduction of Iracturet (intracapsular/ 

extracapsular fractures of the hip) 
Revision of amputation (skin ulcerations 

and gangrer^) 
Laminectomy (t^erniated mlervertebral <*sc; 

cervical. thoracic, lumbar) 



300 


1433 


1285 


156 


9.62 


3555 


4.39 


467 


5528 


6.28 


4748 


3.50 


346 


1403 


5.49 


t772 


3.61 


3.55 


538 


1.86 


3435 


003 


003 


17234 


009 



'The standard population IS the prrvaiertosprt^pcciolalxin We then appfced Ihe VA death rales to tt« standard popJaiwo lo g^e us a d*ecOy standardized mortality for the VA 

An adjusted death rate lor the private h06p4al popUattfn -hoM t)e identca^ to the Lnad)usled death rales 
t The comparison of rrxxtaMy rales adiusted lor severMy for reckjclnn of Iractue showed a sqnrfcanltykMef death rate n the VA Ths opposes the sigritcantly higher mortality 

rale in the VA preserit ri the ent»e sarripte even after adfistrrwr^ lor age. dagnosis. or oirnortidrty. The orty corxAcion corr^lite with both f^yiings IS t^^ 

VA and private hospitals do not difler for tha procedae group 



procedure. In retrospect, it should not have been in- 
cluded as such in this study;' rather it is an operation for 
a complication, i.e., disruption of abdominal wall. 

Vascular bypass procedures (other than coronary ar- 
tery) had a significantly lower mortality rale in the VA. 
Age, diagnosis, comorbidity or severity adjustments 
were used to explain this difference but could not com- 
pletely account for it. The fact that the residual differ- 
ence was slill highly significant supports the conclusion 



that the VA had a lower postoperative mortality rate for 
this procedure group than private hospitals. This was 
one of the most interesting findings to emerge from the 
postoperative mortality rale comparisons. The reason 
for the relative advantage enjoyed by the VA patient in 
this procedure group may be related to the relatively 
large volume of tKesc procedures and the experience of 
surgeons in VA hospitals." 
Postoperative mortality rates can only be used as a 



Table 4. SURGICAL PROCEDURES WITH SIGNIRCANT DIFFERENCES AFTER ADJUSTMENT- 
FORAGE, DIAGNOSIS, COMORBIDITY OR SEVERITY 



Procedure Group 

Death rate higher t\ VA hospitals 

Sulue ol iA:er 

Revision of gaslrK ar\astorTX)srs 

Smal'to-smaR nlestmal anaslomosts 

Appendectomy 

Redosue of postoperative disruption 
of apdomvial wal 
Death rale higher in pnvate hospitals 

Vascular bypass surgery (other than 
coronary artery) 

Portal systemic vervxjs shunt 

Esophageal surgery 



1434 
207 
1103 
3506 

819 



DMih 
Rata% 



2315 

1256 

2031 

143 

18 32 



4 50 
1780 
1070 



1835 

178 

2965 

20644 

168 



35946 
260 



Death 
Rale% 



1237 
3.37 

1160 
023 

357 



1158 
27 31 
18.37 



92 



284 Stremple and Others 



screening tool to tentatively identify circumstances af- 
fecting the quality of care rather than as a measurement 
of the quality of care itself'' Definitive evidence of defi- 
ciencies or strengths can only be established by a more 
focused review such as supplemental individual case 
chart review of actual care rendered by peer-group sur- 
geons."" 

The ICD-9-CM procedure code is not operation-spe- 
cific" and has considerable clinical overlap.""^' We 
found that suture of ulcer, code group 44.40-44.42, in- 
cluded gastric or duodenal ulcer sites and bleeding or 
perforation. Although the overall postoperative mortal- 
ity rate for perforated gastroduodenal ulcer is 6.6%, the 
mortality rate for gastric ulcer is 3.6 times higher than 
that for duodenal ulcer." Postoperative mortality for 
bleeding gastroduodenal ulcer is about 3 times higher 
than for perforation.^-' Because of the wide differences in 
postoperative mortality rates between gastric and duo- 
denal ulcer site and between perforation and bleeding, 
the rates for suture of ulcer, code group 44.40-44.42, 
contain too much clinical overlap to be meaningful 
without individual case chart review. 

We must also ask, then, if there are other differences 
between VA and private hospital patient populations or 
hospital characteristics that might account for the differ- 
ences in mortality rates." The uniqueness of a patient 
f)opulation is an important variable when inter-hospital 
system data are compared since each hospital system is a 
reflection of its patients and their diseases. Veterans who 
use VA hospitals have been reported to have less formal 
education and annual income than veterans who use pri- 
vate hospitals. They are more likely to be retired because 
of health reasons, to hve alone, to be unable to perform 
usual activity because of chronic health conditions, and 
to rate their health as poor.^^ 

Another difference is the longer lengths-of-stay in VA 
hospitals, which are likely to artificially increase the num- 
ber of postoperative deaths taking place within the 30- 
day period of hospitalization. Jencks et al." found a 25% 
higher inpatient mortality for four major medical condi- 
tions in New York than in California, which disappeared 
when 30-day total cumulative mortality was used to de- 
termine hospital-associated death rates. They suggested 
that the difference in inpatient mortality was an "arti- 
fact" of a 99.0% longer length-of-stay in New York than 
in California. 

The broad range of different surgical procedures and 
comparisons often based on extremely large samples 
from both data bases strongly support our principal find- 
ing that in-hospital postoperative mortality rates in the 
VA surgery program are similar to those found in many 
of the nation's private hospitals. 

When viewed from a statistical perspective, applicable 
when multiple significance tests are done, 1 1 3 two- 



tailed, and independent hypothesis tests at the 5% level 
would be expected to yield approximately 3 rejections in 
each tail even if all null hypotheses were simultaneously 
true. We observed five rejections in one tail and three in 
the other. From a statistical view, our results are consis- 
tent with random occurrence and suggest that there are 
no differences in postoperative mortality rates between 
the two medical care systems. 



Acknowledgments 

The authors thank the other members of the Surgical Advisory Com- 
mittee of the Office of Quality Management, Department of Veterans 
Affairs, Veterans Health Administration, VHA Central Office. Wash- 
ington, D.C. who were as follows. Chairman: J. Bradley Aust, M.D., 
Chairman, Department of Surgery, University of Texas, San Antonio. 
Members: Alden Harken, M.D.. Chairman, Department of Surgery, 
University of Colorado; Herbert Greenlee. M.D.. Loyola University 
Medical School; Paul Thomas, M.D., Chief of Staff, West Side VA 
Medical Center, William Henderson, Ph.D., Chief, Cooperative Stud- 
ies Coordinating Center, Hines VAMC. Maywood, Illinois; and Galen 
Barbour, M.D., Associate Chief Medical Director for Quality Manage- 
ment, Veterans Health Administration, Washington, DC. 



References 

1 . Ellwood PM. Shattuck Lecture: outcome management. A technol- 
ogy of patient experience. N Engl J Med 1988; 318:1549-1556. 

2. Roos LL, Fisher ES. Sharp SM, et al. Postsurgical mortality in 
Manitoba and New England. JAMA 1990; 263:2453-2458. 

3. Hollingsworth JW, Bendy PK. The role of Veterans Affairs hospi- 
tals in the health care system. N Engl J Med 1 990; 322: 185 1 - 1 857. 

4. Hadley J, Steinberg EP. Feder J. Compari.son of uninsured and 
privately insured hospital patients: condition on admission, re- 
source use. and outcome. JAMA 1991; 265:374-379. 

5. Smith CB. Wolcott M. Veterans health care: lessons for a national 
health care system. Ann Intern Med 1991; 1 15:907-909. 

6. Iglehart JK. Health Policy Report: the American health care sys- 
tem: introduction. N Engl J Med 1992; 326:962-967. 

7. Public Law 99- 1 66-December 3, 1985, Veterans Administration 
Health-Care Amendments of 1 985. Title II: Health Care Adminis- 
tration Sec. 204. Quality Assurance and Credentialing. 99 STAT 
941. 

8. Jencks SF. Dobson A. Refining case-mix adjustment: the research 
evidence. N Engl J Med 1987; 317:679-686 

9. Gonnella JS. Disease Staging Clinical Criteria: 3rd ed. Systemet- 
rics, Santa Barbara, CA: McGraw Hill Inc.. 1986. 

10. Fleiss JL. Statistical Methods for Rates and Proportions, 2nd ed. 
New York, NY: John Wiley and Sons Inc., 1981. 

1 1 . Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in 
the elderly. Am J Surg 1990; 160:291-293. 

1 2. Lau WY, Fan ST, Yiu TF, et al. Acute appendicitis in the elderly. 
Surg Gynecol Obstet 1985; 161:157-160. 

13. Lloyd SS, Kissing JP. Physician and coding errors in patient rec- 
ords. JAMA 1985;254:1330-1336. 

14. Green J, Wintfeld N, Sharkey P, et al. The importance of severity 
of illness in assessing hospital mortality. JAMA 1990; 263:241- 
246. 

15. Hannan EL, O'Donnell JF, Kibum H, et al. Investigation of the 
relationship between volume and mortality for surgical procedures 



93 



Postoperative Mortality in VA and Private Hospitals 285 

performed in New York stale hospitals. JAMA 1989; 262:503- 21. RutkowIM. General surgical operations in the United Slates. Arch 
510. Surg 1986; 121:1145-1148. 

16. Jencks SF. Daley J, Draper D, et al. Interpreting hospital mortality 22. SvanesC. Salvesen H, EspehaugB, etal. A multifactorial analysis 
data. The role ofdinical risk adjustment. JAMA 1988; 260:351 1- of factors related to lethality afler treatment of perforated gastro- 
3516. duodenal ulcer. Ann Surg 1989; 209:418^23. 

17. Dubois RW, Rogers WH, Moxley JH. et al. Hospital inpatient ^^ Brolin RE. StrempleJF. Emergency operations for upper gaslroin- 
morulity: is it a predictor of quality? N Engl J Med 1987; lestinal hemorrhage. Am Surg 1982; 48:302-308. 

317 1674-1680 ^*- ^^"^ ^' Kjakauer H, Kuhn EM, et al. Hospital charaaeristics 

18. MullinRL. Diagnosis related groups and severity: ICD-9^M. the „ and mortal.ty rates. N Engl J Med 1989;321:1720-1725. 

real problem. JAMA 1985; 254:1208-1210. " '^^"''^' ^' "^'f"'™'' ^' Pendergast JF, et al. Differences in 
.„ , ,,.,..>«. ^ ■ . J J.J patient characteristics between Veterans Administration and com- 

19. lezzon, LI Moskow,,2V^A.a,n,ca^overiap among medical d,ag- mun.ty hospitals. Med Ore 1987; 25:1099-1 104. 

nosu related groups. JAMA 1986; 225:927-929. 26. Jencks SF. Williams DK. Kay TL. Assessing hospital-associated 

20. Del Guercio LRM, Savino JA. Morgan JC. Physiologic assessment deaths from discharge data: the role of length of stay and comorbid- 
of surgical diagnosis-related groups Ann Surg 1985; 202:5 19-522. ities. JAMA 1988; 260:2240-2246. 



75-767 0-94-4 



94 



VETERANS ADMINISTRATION/PITTSBURGH CANCER INSTITUTE 
COLLABORATIVE LUNG CANCER EFFORTS 



Lung cancer is the leading killer among cancers In the United States, accounting for 
over 150,000 deaths in 1992. It is responsible for more deaths among women than 
breast cancer and more deaths among men than prostate cancer. It is unequivocally 
related to cigarette smoking with 85-90% of all cases occurring in current or former 
smokers. Additionally, the Department of Health and Human Services recently 
released a report indicating that a proportion of the lung cancers occurring in non- 
smokers is directly related to passive smoking. Despite recent trends demonstrating a 
leveling off and possible decrease in the annual incidence of lung cancer in men, the 
rapid increase in the rate of lung cancer among women has caused a continued rise 
in the total incidence of this disease as well as mortality. Unfortunately, treatment of 
lung cancer has been relatively unsuccessful with approximately 90% of all victims 
succumbing to this disease. The magnitude of this epidemic has been graphically 
illustrated by Dr. Nael Martini, of Memorial-Sloan Kettering Cancer Center, who 
compared the death rate from lung cancer to awakening each morning to discover, on 
the front page of the newspaper, that a Boeing 747 had crashed and all of the 
passengers on board had been killed. Unfortunately, this analogy actually 
underestimates the annual cost incurred and loss of life secondary to lung cancer 

As smoking is very prevalent among the Veterans Administration Hospital population, 
lung cancer is one of the leading admitting diagnoses at these hospitals. Furthermore, 
lung cancer is quite prevalent in the Pittsburgh area. Recent data reveal that the 
North Side neighborhood of Pittsburgh has the highest prevalence of lung cancer of 
any neighborhood in the country. We, in Pittsburgh, therefore see an extraordinarily 
large number of lung cancer patients at the Veterans Administration Hospital. 

Fortunately, the University of Pittsburgh Medical Center, through the Pittsburgh Cancer 
Institute, has designated lung cancer as one of its highest priorities in its recently 
issued 10 year strategic plan. This designation was spurred by the fact that the 
University of Pittsburgh was one of only four successful competitors for the 
designation as an NCI supported Specialized Program Of Research Excellence 
(SPORE) in lung cancer. This award recognizes the extraordinary depth and breadth 
of the cancer research, both clinical and basic, that is occurhng at the Pittsburgh 
Cancer Institute. Mark L. Levitt, M.D., Ph.D., is the Co-Principal investigator of the 
SPORE grant and is Director of the Lung Cancer Center for the Pittsburgh Cancer 
Institute. Additionally, he is a full time VA physician with a laboratory and office at the 
VA hospital. He is also a VA Merit Review funded investigator for his research into 
the role of induction of squamous differentiation as a possible new approach to the 
treatment of lung cancer. 

1 



95 



Dr. Levitt's efforts at the VA would be quite isolated in the absence of the University. 
As is the case for most serious researchers, a rich research environment with 
extensive collaborative opportunities is an absolute necessity for success. The VA 
alone is unable to provide such an environment, due to size constraints. However, its' 
affiliation with the University of Pittsburgh allows for the creation of a clinical and 
research environment that is stronger than either institution alone. Thanks to the 
collaboration, VA patients have at their disposal cutting edge experimental protocols 
for lung cancer which cannot be cured by conventional means. The Pittsburgh Cancer 
institute also supplies research nurses and data managers to assist in coordinating 
these protocols. In addition, thanks to the collaboration, the VA is a participant in the 
Eastern Cooperative Oncology Group (ECOG), one of the large National Cancer 
Institute sponsored cooperatives for clinical cancer research. This further enables the 
physicians at the Veterans Administration Hospital to offer the most advanced 
treatments to VA patients. 

While the VA Ment Review award pays for some of Dr. Levitt's research, other aspects 
of his research are supported through the SPORE grant and through direct funding 
from the Pittsburgh Cancer Institute As VA funding is limited, these other funds are 
important supplements to his research program, allowing the lung cancer research 
program at the VA to grow beyond the constraints that would be mandated by the VA 
budget. 

Additionally, the Divisions of Medical Oncology and Hematology of the Pittsburgh 
Cancer Institute also supply clinical staff to augment and diversify the attending staff 
at the VA. Furthermore, while the VA funds positions for two medical staff fellows to 
provide care on the consult service, the Department of Medicine has been allowing 
additional fellows to go to the VA to help take care of the enormous cancer load, 
much of it generated by lung cancer. On the other hand, the VA contributes to the 
University program by allowing for a more diverse patient population which creates a 
much better environment for research and training In addition, VA contributions to 
protocol accrual help to speed clinical research in areas such as lung cancer 

Thanks to the UniversityA/A collaboration. VA patients have access to many of the 
countries very best physicians - in all areas - including lung cancer Unquestionably, 
the key to attracting these physicians to the VA has been the research budget and the 
joint VA/University appointment. Considering the relatively low pay and the difficult 
working conditions created by the underfunding of the VA system, without these 2 
Items the VA would be sorely lacking for quality professional medical personnel. 
Maintenance and expansion of both the research budget and the UniversityA/A 
collaboration is essential to recruitment and retention of such physicians Certainly, in 
the absence of the research budget and the availability of the joint VA/University 
appointment Dr Levitt and the VA lung cancer research program would not be at the 
VA. In fact, it was the Department of Medicine at the University of Pittsburgh that 
recruited Dr. Levitt for this position. 



96 



Hopefully, with continued support from Congress and the Administration, the VA 
research budget and VA/University cooperation can continue to expand, hastening the 
day when lung cancer maybe cured and continuing to provide top notch medical care 
for veterans. 



Respectfully submitted. 



Mark L Levitt, M.D., Ph.D. 

Assistant Professor of Medicine and Surgery 

Director, Fellowship Program 

Division of Medical Oncology 

University of Pittsburgh 

Director, Lung Cancer Center 

Pittsburgh Cancer Institute 

c/o Montefiore University Hospital 

3459 Fifth Avenue, 7 Main North 

Pittsburgh, Pennsylvania 15213 

(412) 648-6575 



97 

Statement Of Ronald F. Conley 

National Executive Corrimitteeman (PA) 

The Air.erican Legion 

Before The Subcommittee On Oversight And Investigations 

Coirjnittee Of Veterans Affairs 

United States House Of Representatives 

University Of Pittsburgh 

Pittsburgh, Pennsylvania 

June 28, 1993 

Mr. Chairman And Members Of The Committee: 

The American Legion appreciates the opportunity to appear- 
before you and offer comments on the delivery of benefits 
and services by the Pittsburgh Regional Office of The Veterans 
Benefits Administration (VBA) . 

Mr. Chairman, we want to commend you for scheduling this 
hearing to examine the issues relating to the increasing backlog in 
claims pending in the Pittsburgh Regional Office and to seek 
possible solutions to this chronic problem. 

The American Legion National Veterans ana Rehabilitation 
Comrr.ission has testified in Washington, D.C. to tr:e rr.en^bers of the 
Sub -commit tee on Con-.?sr.53tion, Pension and Insurance concerning the 
Department of Veterans Affairs and the continuing dstcrioration in 
the quality and tirr.eliness of processing benefit clairr.s nationally. 

The American Legion has pointed out that the length of time 
and lack of care taken in processing benefit claims is creating an 
unnecessary dissei^vice to the veteran and his faxily. The entire 
time involved in processing claims in the Pittsburgh Regional 
Office is far greater than the national average. If you would 
compare the Pittsburgh Office with another division in similar 
size, you will find that it takes longer to process a claim in 
Pittsburgh. 

The decline in service provided by the Veterans Benefit 
Administration is graphically illustrated by the increases reported 
in the processing tine. The Department Of veterans Affairs 
reported nationally that claims for service connected disabilities 
in FY 1990 were completed in 151 days. In FY 1992, this time in- 
creased to 164 days and in FY 1993 it rose to 174 days. By 
comparison, in FY 1992 it took the Pittsburgh Regional Office 192 
days to complete similar claims and in September of 1992 it rose to 
221 days. The veterans Benefits Administration's stated processing 
time goal is only 106 days. it takes Pittsburgh 28 days longer 
than the national average and 86 days longer to complete a claim 
than the goal set by the veterans Benefit Ad.i;inistration. 

In FY 1990, Die claims were being conipleted in 94 days. In FY 
1992, it was taking 99 days and currently the time has increased to 
103 days. In the Pittsburgh Regional Office for FY 1992, the time 
for DIG claim completion was 125 days. I believe the goal set by 
the Department Of Veterans Affairs is 77 days. Therefore, it takes 
Pittsburgh 26 more days than the national average and 48 days 
longer than the goal set by the VA. Many more comparisons could be 
made substantiating the length of time it takes to assist the 
veterans in the Pittsburgh Regional Office; however, we want to 
keep our statement as illustiative and concise as possible because 
we realize you do have a full schedule. 

It is our firm belief that the number of days reported under 
the current work -related standards do not accurately reflect the 
total time required to complete the actual claims process. Months 
after the Regional Office has taken credit for claims certified, at 
least half of those claims have been subseciuently remanded back to 
the Regional Office because additional due process development and 
re -adjudication was necessary'. The Regional Office is not 
penalized because of unfinished work; the claims are merely added 
back to the pending workload, causing the veteran a longer delay in 
receiving his benefits. 



98 



The American Legion wiil continue to advise this committee to 
insure that veterans and their families receive the 
Congressionally -mandated monetary benefits to which they are justly 
entitled in a timely manner. 

We are deeply concerned about the length of time it is taking 
to process claims because not only does it cause the veteran and 
his family to suffer but it causes a morale problem among the VA 
employees. We hope that by addressing these problems, productivity 
will increase, a better sense of realism must be developed by the 
Veterans Administration in determining the.i r staffing and 
productivity goals for time elapsed for claims to be processed. 
The workload in Pittsburgh alone has increased 100.1% in 1992. 
This amounts to a larger workload in adjudications. Currently 
there are 25 adjudicators on the roster; however, there are less 
people working actually on claims. One is a Congressional liaison, 
one performs educational work and five are trainees. it is our 
firm belief that more adjudicators need to be hired and an ongoing 
educational and training program needs to be instituted. Not only 
does it take months to hire additional personnel but it takes a 
minimum of two years on the job before an individual has sufficient 
training and experience to become fully productive. The net result 
of inadequate staffing and training has resulted in more mistakes. 
The employees assigned to adjudication should do only adjudication. 

To assist the adjudicators in becoming more efficient, there 
is a need to modernize the computer and backup systems. Computer 
compatability between the Regional Office and the VA hospitals is 
a must and should be a nurt\ber one priority. 

It is imperative that VBA managers be able to accurately 
measure both the quantity of work accomplished and the quality of 
that work. By effective management techniques, procedural errors 
could be cut in half. A training program should be in place for 
those employees engaged in positions of decision -making authority. 
Quality MUST be the priority and standard by which the personal 
performance of adjudicators, supervisors and management personnel 
Is evaluated. 

The American Legion believes that by hiring additional 
adjudicators, updating the computer systems (especially between 

inter-agencies' facilities), proper training for all personnel 
including management, scrutinizing the work performed, and speeding 
up the processing of claims, veterans and their families will most 
certainly benefit. Claims processing time must be cut in half. 

Mr. Chairman, thank you for conducting this hearing. The 
American Legion will continue to monitor the situation in the 
Pittsburgh Regional Office along with the processing of claims and 
will also continue to make recorrjnendations to impiuve the service 
given to our veterans. 

This concludes our statement. We shall be happy to answer any 
questions you may have. 



99 



statement Of Charles A. Zsclir. 
Departmer.t Service Officer (?A) 
The American Legion 
Before The Subcomni t t ee On Oversight And Investigations 
Committee Of Veterans Affairs 
United States House Of Representatives 
University Of Pittsburgh 
Pittsburgh, Pennsylvania 
June 28, 1993 

Mr. Chairman And Members Of The Committee: 

QUALITY & TIMELINESS OF VETERANS BENEFIT DELIVERY 

When the Veterans Judicial Act of 1988 became law it indicated that 
the veteran would have his day in court. A great deal of activity 
was generated by reviewing past denials of claims, especially the ones 
reflecting combat exposure. A great number of claims were reopened 
upon declaration of a clear and unmistakable error. This meant that 
VA adjudicators would be forced to provide argument against the claimed 
error. It was our impression that the review would take place at the 
regional office level. 

The VA , however, insists that decisions made by its regional office that 
were upheld by the Board of Veterans Appeals are not subject to revision 
on the regional office level. Grave concern about the fairness of VA 
policy of not giving information about procederal and appelate rights 
when a VA adjudicator determines that the regional office does not have 
jurisdiction of claim based on clear and unmistakable error. It is 
believed that VA strategy was to preclude judicial review of as many 
clear and unmistakable error decisions as possible. 

The VA ' s hostile reaction to revision of decisions on clear and 
unmistakable error is understandable. It reflects the poor quality of 
decisions rendered, especially in claims involving combat exposure. 

The combat and the former Prisoner of War have very little administrative 
protection. Rating action of their claims are largely descr e t ionary . 
The Title 38 U.S. Code 1154, which in precise language instructs that 
pure credence be given to combat exposure claims. Denials are denoted 
by "absence of records" or the stressors under Post Traumatic Stress 
Disorder claims are not the correct type. 



100 



Little or no attention is given to combat exposure narratives which 
reflect the rigors of Prisoner of War exposure. Poor quality of 
rating practice is reflected upon claims which are filed when the 
veteran is still on active service. These claims were denied on 
the basis that no record of the claimed disability exists. These 
claims should have been given full adjudicative development as if it 
reflects an inservice clinical record. This poor quality of rating 
practice exists to this date. We have Prisoners of War being denied 
service connection for Post Traumatic Stress Disorder on the basis of 
no stressors. The adjudicators should realize that starvation each 
day for several months was and is stressful. Battle traumatisms which 
are recognized many years after discharge from service are not given 
the retroactive credit. Muscle group injuries are rated as scars, 
especially retained metal fragments. 

Timliness is very poor. One particular Prisoner of War claim is being 
held in limbo since 1983. Claims pending in excess of one year exist. 

Failure to provide important procedural protection was always and is an 
ongoing factor. An explanation of decisions in greater detail prevails. 
The resolution of the reasonable doubt doctorine, expecially in combat 
exposure claims is seldom applied. Expert medical opinions are refuted, 
both from the private and VA sector, especially claims dealing with 
stressors in a Post Traumatic Stress Disorder claim. 



Ninety percent of calls received by my office relate to inquiries on 
timliness of claims. 




Service OHicers: 

John M Emerick 
6072 Pleas*nt Street 
Finleyville. PA 15332 
412 348-5478 

Ken Curley 
221 Evalme Street 
Pinsburgh, PA 15235 
412 371 0625 



101 



AMERICAN DEFENDERS OF BATAAN & CORREGIDOR, INC. 

( INCLUDIWG ANY UNIT OF FORCE OF THF ACiATir c. r,r-r „ 

ARCHIPELACO. .AKE .^nS. MAB°rN^:srNrA^Nl"ou7^^'^J.^^..■.., 



Service OHice 

Room 415 . Federal Buildir^g 

10O0 Liberty Avenue 

Pittsburgh, PA 15222 

412-644-4808 

Coruultidon by Appointment 



June 17, 1993 



To Whom It May Concern: 

My name is Kenneth D. Curlpv t am „ xt ... ■ 

Officer and a Past Nation.T^A "^ ^ National Service 

s^^r?:e«rv£ "'t-™" "»"-".-'"- 

have been taking care of Pnw^f Regional Office, we 
was introduced in the 1980 's." ''"'" '^"''^^'^ ^^* ^^-^^ 

Sta?f'°;e''::re'aMe°to'' l^lt'' °' ^^^ ""^^^^-^^ 0"ice 

our POW poDulation Thill 5 ! J,- ^ ^^^^° seminars for 
the POW Tent itlementl ^^^^^ified and familiarized 

The Regional Office Staff also wa<; k^v in h^i • 
understand exactly what Public Law ^7^7 '^^^P'^g "« 
titfi'^'^^.^"^ clLms1or"bene%it: ^olhicre^ 'we're'^i;' 
a d^Iater's^reaJ to°l?^°^/^°^^^™ ^^^^ bere^in'^^^^tlCurgh 

was due in large part to thr"^ f "^ '° "^"^ ""i°°- ^hls 
large part to these dedicated professionals. 



Sincerely, 



Kenneth D. Curley "^ 

Past Nat'l. Commander 

ADBC 

Nat'l. Service Officer 



102 



STATEMENT OF 

WILLIAM J. REED, DEPARTMENT SERVICE OFFICER 

VETERANS OF FOREIGN WARS, DEFT. OF PENNSYLVANIA 

BEFORE THE 

HOUSE VETERANS AFFAIRS SUBCOMMITIEE 
ON OVERSIGHT AND INVESTIGATION 

WITH RESPECT TO 
EXAMINING DELIVERY OF VETERANS BENEFITS AND 
SERVICES BY THE PITTSBURGH REGIONAL OFFICE 
OF THE VETERANS BENEFITS ADMINISTRATION (VBA) 
AND RELATED ISSUES. 



THANK YOU FOR INVITING THE VETERANS OF FOREIGN WARS OF THE UNITED STATES 
(VFW) SERVICE OFFICE OF PITTSBURGH, PENNSYLVANIA TO PARTICIPATE IN THIS VERY 
IMPORTANT HEARING. OUR ORGANIZATION HAS A GREAT INTEREST IN HELPING THE VET- 
ERAN AND ALL THE PROCEDURES USED BY THE DEPARTMENT OF VKIERANS AFFAIRS WlIIUl 
WOULD AFFECT THE VETERAN. 

I BELIEVE WE CAN ALL AGREE THAT THERE ARE PROBLEMS WITH IN THE REGIONAL 
OFFICE IN PITTSBURGH WHICH MUST BE FACED AND AN ADEQUATE SOLUTION FOUND WITH 
OUT DISRUPTING THE ADJUDICATION PROCEDURE OF SAID OFFICE ANYMORE TIIAN IT HAS 
BEEN. WE FIND THAT ONE OF THE MAIN PROBLEI-IS IS IN THE TIMELINESS OF THE DEL- 
IVERY OF THE DECISIONS AND BENEFITS TO THE VETERAN/CLAIMANT. IN ALL FAIRNESS 
TO THE REGIONAL OFFICE IT MUST BE POINTED OUT THAT AT TIMES THE INDIVIDUAL 
VETERAN/CLAIMANT MAY BE RESPONSIBLE FOR SOME UNUSUALLY LONG DELAYS BY NOT CO- 
OPERATING WHEN REQUESTED BY THE ADJUDICATION SECTION. 

LOOKING AT THE REGIONAL OFFICE STAFFING, RESOURCES, WORKLOAD AND WORK- 
ING CONDITIONS. BEING THAT THE ADJUDICATION SECTION HAS A WORKLOAD IIIAT CON- 
TINUES TO INCREASE INSTEAD OF BECOMING LESS, CAN HAVE AN ADVERSE AFFECT ON 
THE PEOPLE WORKING WIIH-IN SAID OPERATION, THUS CAUSING A MORALE PROBLEM 

WHICH AFFECTS THE PRODUCTION LEVEL AND QUALITY OF THE END PRODUCT. THIS 
I FEEL IS TAKING PLACE WITH IN THE AFOREMENTIONED SECTIONAT THE PRESENT 
AND NEEDS TO BE STOPPED. SECTION (ADJUDICATION) EXCELLENCE IS A FUNCTION 
OF HOW WELL THE SECTION IS STAFFED AND TRAINED. WE MUST LOOK AT ASSOCIATED 
PROBLEMS OF ATTRITION AND THE REALITY OF ADJUDICATION PERSONS OCCASIONALLY 
BEING CALL UPON TO WORK ON OTHER THAN STRICTLY ADJUDICATION PROBLEMS. 

I FEEL THAT THE APPROPRIATE SOLUTION TO THE PRESENT SITUATION WOULD BE 
TO REQUEST INCREASED FUNDINGS SUFFICIENT TO ENSURE ADEQUATE STAFFING TO PRO- 
CESS ALL CLAIMS IN A TIMELY AND ACCURATE MANNER, THUS CLEARING THE BACKLOG 
OF CLAIMS WHICH NOW EXISTS. 



103 



CHAPTER 427 • P.O. BOX 543 • BUTLER:pa"i 6003-0543 




Statement Of 



VIET|^te|;TERNS OF AME 



RICA 




House 



bcommi ttee On 

! V,- Pegional Office 



104 



What is the most important step the Pittsburgh VA Regional 
Office can take to improve its Outreach Program? 

A. What we feel is needed for the Outreach Program to be more 
effective is to use the local newspapers. The newspaper can inform 
the veteran when the Outreach Program is in town on certain days, 
where the veteran is to go to get help, and what papers the veteran 
will need to open their claims. 

Representatives from the Regional Office can make time available 
at most veterans service organizations at no cost to the Regional 
Office. This has the look that our government is trying to help 
all veterans and their families. At the same time the Outreach men 
can show the service officers the proper way of filling out quality 
claims submitted by veterans. 

Do you know why Adjudicators are only accepting physical 
examinations performed by Va physicians? 

A. By the Adjudicators not accepting outside physicians physical 
examinations and by passing or rejecting the claim, they get credit 
for a completed file. 

If the claim goes to the next level and they again reject the 
outside physicians examinations, they again get credit for a com- 
pleted file. 
If it goes to the third level and they accept the claim or again 

reject the claim without the outside physicians examination they 
again get credit for a completed file. Three steps, three credits, 
and one file. 



By accepting the outside physicians examinations and reports^ 
they now have a more complete file and can make a more logical 
adjudication on claims. 

Outside physicians are responsible to the patient, thereby 
giving more information in the patients file. The Va physicians are 
responsible to the Va. The unwritten Va rule is to put as little as 
possible in the patients file. 



105 




PARALYZED VETERANS 
OF AMERICA 
Zhanered by the Congress 
3f the United States 

STATEMENT OF 

JOSEPH A. KIREN, LEGISLATION DIRECTOR 

TRI -STATE CHAPTER 

OF THE 

PARALYZED VETERANS OF AMERICA 

BEFORE THE 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

OF THE 

HOUSE COMMITTEE ON VETERANS' AFFAIRS 

CONCERNING 

DELIVERY OF VETERANS BENEFITS AND SERVICES BY THE PITTSBURGH 

REGIONAL OFFICE OF THE VETERANS BENEFITS ADMINISTRATION 

JUNE 28, 1993 

Mr. Chairman and Members of the Subcommittee, it is an honor to 
appear here today on behalf of the Tri-State Chapter of the 
Paralyzed Veterans of America (PVA). The Tri-State Chapter 
appreciates your invitation to present testimony regarding the 
delivery of benefits and services by the Pittsburgh Regional Office 
of the Veterans Benefits Administration on issues touching veterans 
here, and across the country. 



SOI Eighteenth Street. N.W. Washington, DC 20006 
12021 USA-1300 Fax: 1202) 785-4452 TDD 800-795-4327 



106 



The delivery of benefits and services, and the issues of quality 
and timeliness, are at the very core of the relationship between 
the VA and the individual veteran. On one hand "justice delayed is 
justice denied," on the other hand "delay is preferable to error." 
Mr. Chairman, unfortunately, veterans today are getting the worst 
of both maxims: shoddy quality and unconscionable delays. This is 
true in Pittsburgh, and it is true over much of the country. 

The response time to veterans' claims for benefits is worsening at 
an alarming rate. In Pittsburgh it now takes an average of 220 
days for a decision to be reached on an original compensation 
claim, 127 days for an original pension claim, and 120 days for a 
reopened compensation claim. This phenomena is not recent, but has 
been many years in the making. We are faced with a situation where 
there is no timeliness and precious little quality. 

During the first quarter of fiscal year 1993, a total of 57.5% of 
Board of Veterans' Appeals (BVA) decisions were remanded back to 
the Pittsburgh Regional Office. This percentage is higher than the 
national average of 52.9%. These decisions are being remanded 
today for many of the same reasons they were remanded in 1988, 
including: 

poor original claims development within the [D]VA regional 
offices, inadequate medical examinations conducted by private 
or VA physicians, overworked adjudicators within both the 



107 



[D]VA and BVA, uncertainties regarding the resolution of 
highly complex cases like post-traumatic stress disorder or 
radiation exposure.... 1988 U.S.C. C.A.N. 3437. 

The Tri-State Chapter stands ready to assist Congress and the VA 
in fashioning fair and workable solutions to adjudication problems. 
We understand that oftentimes there are no easy solutions, but this 
is no reason to shrink from our responsibilities to our veterans. 

One solution, supported by some Veterans Service Organizations 
(VSOs), would be to amend Title 38 to allow one person Board of 
Veterans Appeals (BVA) decisions in all cases. We stand opposed to 
this. Only 4.8 percent of veterans who appeal to the BVA file a 
further appeal with the U.S. Court of Veterans Appeals. This means 
that for over 95 percent of veterans, the BVA is the final, full 
and complete review of their benefit claims. It is vital that this 
review be thorough and fair. PVA has no objection, and would 
support, single member allowances and remands. However, for a 
denial of benefits we believe that it is essential that a three 
member board decision be required so as to provide the veteran with 
a fair and equitable review. The institution of one member 
allowances and remands would still provide the BVA an opportunity 
to overcome some of their backlog and timeliness problems because 
a large majority of BVA's caseload presently results in an 
allowance or a remand. Furthermore, this would relieve that one 
member of the requirement for writing a complete BVA decision. 



108 



member of the requirement for writing a complete BVA decision. 

Pittsburgh has taken steps to deal with its backlog. Within the 
last 4 months the Regional Office has hired 6 new adjudicator 
trainees and is in the process of adding to the rating board staff. 
Unfortunately, it is a case of robbing Peter to pay Paul. By 
adding to the rating board they are stripping people from the 
authorization end, which will cause problems and further delay 
claims processing in the very near future. 

The need for proper case development is essential. This will 
decrease the percentage of remands. This can be accomplished by 
better training of existing personnel, and a temporary redeployment 
of other staff to decrease the present backlog that currently 
exists. PVA approves a temporary redeployment, but not to the 
extent of cannibalizing further the benefits delivery system. To 
do so would be to invite further delay into the process. 

The Tri-State Chapter supports the VBA's computer modernization 
project. The fact of the matter is that this step, long planned 
and long overdue, would improve the quality and timeliness of the 
Pittsburgh Regional office, and all other regional offices. The VA 
recognized seven long years ago that there was a need for a 
modernized benefits delivery system. The delay in instituting this 
program can be blamed on the GAO, which believes that this 
modernization program is premature. PVA is satisfied with the VA's 



109 



response to this GAO report, VETERANS BENEFITS; Acquisition of 
Information Resources for Modernization is Premature (GAO/ IMTEC- 
93-6), and their justifications for proceeding with the 
implementation of this program. We believe that it is time to move 
forward with this modernization program. 

Similarly, the VA computer system (Target) is not being fully 
utilized. It is essential that information be entered and it is 
essential that the information entered be correct. This is a 
simple thing that can be accomplished immediately that would have 
an impact on the intolerable delays that we are presently faced 
with. It would assist us and other VSOs in helping our members and 
fellow veterans in processing their claims. 

It is imperative that valid claims folders be built. This is 
essential to reaching the right decision the first time. Enough 
information must be supplied so that when a regional office 
adjudicator examines the entire folder he or she will have enough 
information readily available to render a correct decision, thereby 
saving time. 

The VA must institute a better system of case file management. 
Presently, all VA files are placed in a file room in a secured 
area. These files are removed for such matters as benefits 
determinations and for similar reasons. Each file is logged in and 
out. The problem with the current situation is that on any given 



110 



week there are over a hundred files found unaccounted for. They 
are not where the file log says that they are supposed to be. This 
can only cause further delays in an already dilatory system. 
Tighter controls must be implemented to better keep, and more 
accurately track, files as they are being worked on by VA 
personnel. This is not only a problem in Pittsburgh, it is a 
national problem as well. 

To relate a personal story as to one element of the Regional 
Office's attempts at outreach. I was sent a letter from the 
regional office to participate in a focus group. The reason for 
the focus group was to purportedly gather opinions on topics 
relating to the delivery of veterans benefits. When I arrived I 
was assigned to a group whose sole purpose was to critique a form 
produced by the VA on Income Verification Match. Everyone who 
attended took the time, and for many, experienced the considerable 
difficulties necessary to attend. They did this in order to have 
real input into the delivery of benefits. Instead of working 
together to find solutions, a real form of outreach, we critiqued 
a form. 

The regional offices and BVA's current work measurement standards, 
what is known as the "end product" method of assessing claims 
processing time and measuring job performance, must be changed. 
The method presently in place creates an environment in which high 
volume and low quality results are encouraged and rewarded. A 



Ill 



method that rewards and reinforces complete claims development, 
correct issue identification, and proper application of laws, 
regulations, procedures, and precedents should be developed. The 
method adopted should only grant credit once a "final" decision is 
reached and only after the appeals period has expired. 

Mr. Chairman and members of the committee, our veterans deserve 
better. They deserve prompt, efficient and fair resolutions to 
their claims for benefits, benefits earned by service to this 
country. They deserve a Regional Office that is helpful to the 
veteran and to his or her dependents, and they deserve to have this 
disgraceful delay in processing claims ameliorated. Mr. Chairman, 
and members of this subcommittee, we must not only be "speakers of 
words, but doers of deeds." As I stated previously, we here at 
the Tri-State Chapter stand ready to assist you in any way we can 
to fashion workable and fair solutions to the problems that exist 
here in Pittsburgh, and the problems that exist throughout this 
country. 

Thank you Mr. Chairman. I will be happy to answer any questions 
that you or members of this subcommittee might have. 



112 



PUBLIC HEARING TESTIMONY 

House Veterans AiTairs Subcommittee on Oversight & Investigations 

MR. THOMAS M. FITZGERALD, JR. 



June 28, 1993 
Pittsburgh, Pennsylvania 

A A A* Aftik 



Good morning. Members of Congress, colleagues and distinguished guests, I am 
here as a veteran who has had many concerns with the veteran community — in particular 
with unemployed and homeless veterans. As such, I have been privileged to work with 
what I feel is one of the finest veterans' organization, the Vietnam Veterans Leadership 
Program of Western Pennsylvania (VVLP). I have been honored to serve as the Board of 
Directors president for the past ten years and have therefore been personally involved with 
veterans who have experienced rnany problems. 

In brief, VVLP is the Greater Pittsburgh career advising und job placement 
assistance non-profit corporation for all unemployed, underemployed and homeless 
veterans of the U.S. military service. WLP was established by Vietnam Veterans to serve 
all veterans. With a full-time staff of eight professionals, VVLP provides employment 
search services for more than 700 veterans annually. Recently, WLP was named "Point 
of Light #753" for its work with corporate volunteerism. When VVLP opened its doors 
ten years ago, it was a fledgling organization operated by a small group of caring veterans 
who had a great desire to help their fellow unemployed veterans. This start up took place 
at a time when the Pittsburgh steel mills and factories were closing their doors. The 
unemployed veterans were the last hired when returning from Vietnam and were therefore 
the first laid off during the downsizing of Pittsburgh's manufacturing base. 

This group of caring veterans had the right ideas but not the organizational 
expertise to alone create a strong service base for local veterans. Many veterans' groups 
tried to help, but the actual creation of such an agency was very time consuming and 



113 



difiicult. As a member of the original WLP team, I can say that from the first support 
meeting, the Department of Veterans Affairs Regional Office (VARO) was present and 
has consistently stood beside us over the past ten years. 

During this time, WLP had received many different types of assistance from the 
VARO: veterans' direct and referred assistance, operational guidance, community 
relations in support of VVLP's efforts, veterans' employment assistance, and training 
facility space. The VARO has also consistently written letters of support for WLP 
government funding proposals and has participated in WLP fund raising events. Most 
notably, the VARO has already allocated valuable staff time and resources for the 
Pittsburgh STAND DOWN for homeless veterans. In particular, they have pledged 
assistance for proof of veteran status, veterans' benefits processing, and identification care 
construction for each homeless veteran and volunteer. 

If I may share my personal point of view, I have encountered many veterans with 
unique problems who are having difficulty with the Department of Veterans Affairs. 
When I became aware of their concerns, I have called the Regional Director, Mr. Harold 
Bushey, and the Assistant Director, Mr Gerry Serrino, and they have always personally 
reviewed these issues In all cases, the proper service was rendered or a very reasonable 
conclusion was reached 

1 also want to share that I work as an Allegheny County Homicide Detective. 
Through this position, I deal with many grieving and distressed families of homicide and 
suicide victims These victims' families are hard pressed and have many issues to deal 
with 1 have had many of these families ask for assistance with the VARO. Most of these 
families have never previously dealt with federal agencies and usually do not know where 
to begin. I have personally called the VARO for assistance, and they have always shown 
compassion and have rendered immediate services On behalf of these families, I would 
like to thank the Regional Office for being there when the families really needed 
something. 



114 



Testimony of Charles J. Lieberth 

Pennsylvajiia State Civil Service Commission 

Former Federal and State Official 

Former Chairman, Federal Executive Board of Western PA 

Presented to the House Veterans Affairs Subcommittee on 

Oversight cind Investigations. 

Public Hearing held in Pittsburgh, PA, June 28, 1993 



Members of Congress, staff and guests I appreciate this 
privilege to testify before your committee. Thank you very 
much. 

My comments will focus on the leadership, the extensive 
related activities, the tenacity of purpose on behalf of 
veterans and family, the broad network of veteran activities 
initiated, developed, and implemented, and the quality of 
service provided by Harold Bushey, Director of the 
Pittsburgh Regional Office, Department of Veterans Affairs. 
I will only highlight several of the special projects that 
we shared our efforts and concerns together. 

In the early 1970 's Mr. Bushey played the dominant role 
in conjunction with government agencies, the public and 
private employers, and the educational institutions in 
holding a series of Job Fairs and Educational Fairs to 
assist returning Vietnam Veterans. 

From 1967 on through the years. Director Bushey held 
the first and succeeding veterans telethons in the nation. 

We shared in the development of a Minority Business 
Opportunity Committee of the Federal Executive Board. The 
first minority owned and run bank was a major achievement 
in the early 1970 's. His confirming chairmanship has led to 
many projects, programs that benefited minorities - racial 
and gender. 

As PA Secretary of Labor & Industry I initiated the 
first high level state government conference on Agent 
Orange. Director Bushey provided exemplary" support and 
assistance. A major outcome was the first Herbicide 
Commission in PA. 

Director Bushey and I developed the Federal Education 
Center in Pittsburgh in the 1970 's for federal employees. 
Scores of employees improved their careers through 
certificate programs, as well as Bachelor's and Master's 
degrees. 

Director Bushey has served in a dominant role for over 
20 years as past Chairman and special project Chair and 
member of Western PA ASPA (American Society of Public 
Administration) . 



115 



Again when I served as Senior PA Administrator for 
Senator John Heinz, Director Bushey supported vigorously a 
special project. It was the Hire a Viet Vet Job Pledge 
Project in PA. 

It was a highly successful program resulting in the 
hiring of a thousand veterans. Bushey 's support and 
assistance continued when the project was picked up by 
Governor Thornburgh in his first term. 

In Pennsylvania^ five of Governor Thornburgh 's Outreach 
Offices for Veterans were implemented. Again Director 
Bushey was there with this support and assistance. 

As disaster in Pennsylvania, I recall that Harold 
Bushey was there with strong support, service and assistance 
as we coped with Hurricane Agnes devastation, the 1977 
Johnstown flood. 

Harold Bushey exemplifies leadership - the professional 
positives of a government official. He truly has been a 
highly recognized, admired and appreciated public servant 
and leader. 

In 1989 he was recognized by the American Society for 
Public Administration with its national award for 
excellence. Thru his service on the Boards of community 
service organizations, he has made the VA a leader in 
innovative programs. Pittsburgh has served as a national 
model with the VA and Commerce departments coordinating 
efforts thru the Federal Executive Board's Minority Business 
Opportunity Committee. This committee, which Mr. Bushey 
chairs, has served as a catalyst bringing together veterans, 
members of minority groups, government, and the private 
sector, assisting resulted in the Department of Commerce 
funding and staffing an office whose efforts Mr. Bushey 
coordinated. As a result, veterans have a small business 
program in this area second to none. 

I have referenced just a few, in fact, just a handful 
of a long public career achievements. If the past is 
prologue to the future - veterans will continue to be well 
served because of officials such as Harold Bushey. 

For 40 years I have been in public service. Fifteen of 
those years were in federal service. I can say with 
absolute candor and professional objectivity that Harold 
Bushey has been and continues to be the outstanding federal 
administrator in Western PA. 



116 



STATEMENT OF TREA GRAHAM 

BEFORE THE HOUSE VETERANS AFFAIRS/ 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 



JUNE 26, 1993 



Gentlemen / 

I appreciate the opportunity to be here today. The timeliness 
and responsiveness of the Department of Veterans ' Affairs in 
processing claims is a critical issue to our area's veterans, and 
I am grateful to you, Mr. Chairman, and Mr. Ridge, for taking the 
time to come to Pittsburgh today. 

For several years, I have served on Congressman Rick Santorum's 
Veterans' Affairs Advisory Board. This advisory group is 
composed of veterans and other interested individuals from the 
Pittsburgh area. While we come from a wide variety of 
backgrounds, we share a common commitment to the veterans of our 
area and a strong belief that individuals — through concerted 
action- -can change the way that our government serves us. 

I was Inspired to become involved in veterans issues as a result 
of the experiences of my husband, MSgt. David Graham of the 112th 
Security Police of the Pennsylvania Air National Guard. He is a 
veteran of the war in Vietnam, where he served as a Navy SEAL 
earning two Navy Crosses and a Purple Heart. Most recently, he 
served in Desert Storm. During the Gulf War, I was particularly 
frustrated in dealing with the various layers of bureaucracy 
which prompted me to help establish a support group at the Air 
National Guard Base for the families of servicemen and women. 
This support group was very successful in providing our families 
with the resources to deal with the long separation from our 
spouses, parents, and children serving in the Gulf War. 

After David returned from six months duty in the Persian Gulf, 
shifting my focus to the concerns of veterans seemed to be a 
logical next step. When I joined Congressman Sintorum's 
Veterans' Advisory Board, I was elected to participate with five 
other citizens in identifying veterans' benefits issues. We 
quickly discovered that timeliness in processing benefits claims 
was a serious concern. In the Pittsburgh region, for e^cAjnple, it 
was taking an average of eight months for a claim to be prepared 
so it could be processed. Our benefits committee decided to 
investigate why. 

Our committee's initial goal was to determine if the Pittsburgh 
Regional Office was performing on a par with other regional 
offices serving communities with similar caseloads. If problems 
could be Identified, we intended to work with Congressman 
Santorum and the VA to correct them. 



117 



During a meeting last year between the Congressman's Benefits 
Committee and William Byrnes, who at the time was the Chief 
Adjudication Officer, we examined VA statistics from a ten month 
period between October 1991 through July 1992 from the regional 
offices in Boston, Massachusetts, Jackson, Mississippi, Newark, 
New Jersey, and Little Rock, Arkansas. We compared these 
statistics with information from the Pittsburgh office. 

While timeliness seems to be a problem throughout the country, we 
learned that the Pittsburgh region had one of the poorest records 
of timeliness in virtually every category that we could evaluate. 
Working in cooperation with the regional office. Congressman 
Santorum, and the Congressman's staff, we sought changes. 

And Indeed, since last year, change has occurred. Mr. Bushey and 
his staff have been very helpful in lending their time and 
assistance. Since our study began. Director Bushey, recognizing 
the deficiencies, has implemented a comprehensive action plan for 
the improvement of claims processing timeliness. The first 
quarterly progress report, dated April 7th, which set forth a new 
strategy for the division, was recently presented to the 
Congressman's staff. In addition, I am pleased to acknowledge 
that the regional office has added the largest class of 
adjudication trainees ever. As of next month, the rating board 
will be expanded by two positions. 

As a direct result of these initiatives, timeliness comparisons 
that were conducted between October 1992 and last month 
illustrate that our regional office is moving in the right 
direction. While the national averages during this period 
remained the same or got worse, our timeliness by in large has 
improved. 

All this sounds great--indeed, it is great. However, it is 
important to remember that while these are all positive changes, 
the Pittsburgh regional office will have to continue its effort 
to improve the productivity level in adjudication. 

I say this for several reasons. The training of new adjudicators 
takes between 12 and 18 months. When trainee adjudicators are 
added, the training responsibilities fall on the present 
adjudicators. Also, when adjudicators are promoted to the rating 
board, it depletes the pool of experienced adjudicators. At this 
date, five of the new adjudicators have not yet completed their 
training and there are plans to promote two adjudicators to the 
rating board. Therefore, on paper, there may be 23 adjudicators, 
but in reality it will still take time for the Pittsburgh 
Regional Office to perform as if there were 23 fully trained 
adjudicators. 



118 



This situation is further complicated by a noticeable increase in 
workload, attributed to the downsizing of the military, last 
year alone, the Pittsburgh Regional Office had its pending 
workload increased from the year before by 27% compared to a 
national average increase of 15%. During a similar period, 
Pittsburgh's rating board workload increased by 100.1% compared 
to an increase of 46.4% nationally. 

As these facts reveal, the positive changes that have been 
implemented so far in the Pittsburgh Regional Office have not 
totally solved the problem. Simply put, even though the regional 
office has illustrated its commitment to improving timeliness in 
several ways since our study was initiated, there is still more 
to be accomplished. I was very happy to hear that Congressman 
Santorum's office was given assurances during a face to face 
meeting with the Director and his top management, as recently as 
last Wednesday, that the Adjudication Division would continue to 
be the region's number one staffing priority. The congressman's 
office was also assured that more adjudicators would be brought 
on board In the months to come. This is important because, even 
when the recently hired trainees are in place as full time 
adjudicators, our regional office will still lag behind other 
similarly sized regions in adjudication manpower. 

It is my hope that our efforts on the Veterans' Advisory Board 
have helped to focus attention on the need to improve the 
timeliness of the Pittsburgh Regional Office. We all share the 
belief that more can be done. In particular, we will suggest the 
following! 

1) That our regional office recruit experienced 
adjudicators from within the VA system to provide 
immediate assistance. 

2) That the Director consider delaying his selection of 
two senior adjudicators for the rating board until a 
sufficient number of trained adjudicators are in place. 

3) That the Pittsburgh Regional Office continue efforts to 
improve the efficiency of the office. One idea that has 
considerable merit would be a broader cross training of 
benefits counselors as adjudicators. 

Members of the Armed Forces served when our country needed their 
service. If they were asked to march, they marched. If they 
were asked to fight, they fought. These men and women did not 
respond to Uncle Sam's call to arms by saying "not right now, 
give me eight months." 

I think our country owes it to these veterans to return the 
courtesy and process their benefits claims in a timely fashion. 

Thank you, and I would be glad to answer any questions. 



119 




Department of Veterans Affairs 

Regional Office 
1000 Liberty Avenue 
Pinsburgh PA 15222 



April 7, 1993 



Director, C&P Service (214A) 
Department of Veterans Affairs 
Veterams Benefits Administration 
810 Vermont Avenue, N.W. 
Washington, DC 20420 



In Replv Refer To: 
311/21 



SDBJ: Quarterly Progress Report 



Enclosed is the first quarterly progress report based upon the action plan for 
improving claims processing timeliness that was submitted on January 13, 1993. 



HAROLD T. 
Director 



120 



Department of 
Veterans Affairs 



Memorandum 



April 7, 1993 

Acting Adjudication Officer 

Quarterly Progress Report 

Director 



In response to CO analysis of November 10, 1992 a claims processing timeliness 
improvement plan was implemented to address each out of line end product and 
establish a time table for improvement using realistic benchmarks to monitor 
improvement. The plan was submitted on Jauiuary 13, 1993, and quality 
benchmarks were establishea for March, June and September 1993. 



The following are division actual achievements since October 1992, 
to the established benchmarks. 

DIVISION IMPROVEMENT PLAN PERFORMANCE 



as con^ared 



^„"< 





Division 


Actual 


Achievement 




Benchmarks 


Goal M21-4 


EPS 


10/92 


11/92 


12/92 


. 1/93 


2/93 


3/93 


3/93 


6/93 


9/93 


106 =^ 


^-^10 


216 


238 


215 


234 


210 


203 


210 


190 


175 


120 


149 


141 


131 


135 


128 


110 


130 


115 


100 


82 


13 


63 


43 


44 


39 


36 


36 


45 


35 


25 


25 


140 


174 


127 


134 


110 


147 


96 


100 


85 


75 


68 


ISO 


74 


68 


58 


50 


45 


41 


60 


50 


40 


24 


155 


96 


41 


32 


48 


50 


41 


38 


35 


29 


19 


160 


48 


36 


36 


43 


43 


37 


33 


29 


29 


29 


"v '•' ^^° 


162 


172 


155 


139 


146 


143 


155 


130 


100 


77 


190 


115 


103 


85 


96 


76 


74 


90 


75 


60 


44 


290 


63 


63 


47 


64 


56 


50 


68 


61 


61 


61 


310 


98 


37 


74 


78 


98 


49 


80 


70 


60 


60 


320 


155 


132 


115 


98 


74 


67 


115 


76 


46 


46 


600 


91 


74 


98 


90 


90 


66 


72 


69 


65 


65 



121 



Page 2 

Quarterly Progress Report- 
By EOM March we achieved our benchmarks (current month) for 11 of the 13 end 
products measured. In March, end products 290 and 310 bettered goal as 
outlined in M21-4, while the benchmark for EP 155 and 160 were not met. EP 
155 was within 3 days of our March benchmark, while EP 160 was within 4 days. 
We are continuing to monitor our achievements and strive for a steady 
reduction in average days to complete each end product. 

Although actual achievement for EP 155 was 3 days over the March benchmark of 
38 days, it is substantially less than the 96 days average processing time for 
October 1992. Furthermore, a significcmt reduction has been made in the 
number of EP 155s pending over 30 days. Currently, there are 655 pending in 
all categories over 30 days, while in January there had been 1016 pending. 
For the past three months over 1000 EP l55's had been cleared each month. The 
unit chiefs are working ciosely with the adjudicators to resolve and clear the 
still pending 155 end products. Although in the short term it may negatively 
impact on processing timeliness, overall processing timeliness should improve 
by the next benchmark. 

For March, actual performance for EP 160 was 37 days as compared to the March 
benchmark of 33 days. This is a low volume EP with 218 pending on April 1. 
The unit chiefs are printing detail lists for this end product for the 
development (burial) clerks. The goal will be for the clerks to process these 
old cases by the end of the month. (Currently 123 of the 218 cases are over 
30 days old) . 



Michael C. Vudragovich 




122 



Department of Veterans Affairs 

Regional Offic* 
1000 Liberty Avenue 
Pittsburgh PA 15222 



January 13, 1993 



In Reply R«f«r To: , 
Director, CtP Service (214A) 311/21 

'Departatenc of Veterans Affairs 

Veterans Benefits Administration 

810 Vermont Avenue, N.W. 

Washington, DC 20420 

SUBJ: Action Plan for Ii^provement of Claias Procassing TlmelinaBS 

This is in response to the Central Office Analysis of the Adjudication 
Division dated November 10, 1992, and to our letter to Eastern Area of 
October 22, 1992, submitting an action plan for in^rovement of overall claims 
processing timeliness. 

This revised plan is being suboiitted after discussions with Mi-ke Bratz during 
and after his recent help visit to the office December 1-3, 1992. We 
appreciate his efforts and the insights provided while he was here. We intenc 
to build upon ideas discussed when he was here, to closely monitor, enhance 
and niodify the plan as necessary during the coming year. 



Signed by 

HAROLD T . BOSHEY ' 

Director 



123 



°ZTZ%tL Memorandum 

Oaw January 8, 1993 

From Adjudication Officer 

Suoi Systeaatic Aaalyaia of Operations - Claias Prcxrassing TiaeliiiesB 

To Director 

Assistant Director 

TOPIC : Processing Timeliness 

REFERENCES : M21-4, Chapter 4, Claims Processing Timeliness 

aACKGROOND : On October 19, 1993, an SAO on Claims Processing Timeliness was 
completed because of a slippage in timeliness within the Adjudication 
Division. CO Staff Analysis of the Adjudication Division of November 10, 
1992, directed the formation of an overall claims processing timeliness 
improvement plan to address the timeliness of each out-of-line end product and 
CO establish a timetable for improv emen t using realistic benchmarjcs to monitor 
progress. 

To assist in this process, Mike Bratz, Chief, Field Operations Staff, visited 
our station on December 1-3, and provided suggestions and guidance on the 
formulation of a plan. 

DESCRIPTION OF RgviSW : This review describes divisioi manageaent's plan to 
improve average processing time for each end product. Timeliness has slipped 
due to the variables outlined below to the point that 11 end products (130, 
150, 155, 170, 190, 290, 600, 140, 180, 310, and 320) are reportable under the 
standard in effect on October 1, 1991 (K21-4, Par. 4.07). Additionally, none 
of the end products bettered the new timeliness goals outlined in M21-4, 
Chapter 4. 

FINDINGS : Effective October 1, 1992, average days to complete is the guide 
Adjudication managers must use both to measure the success of their direction 
of the claims adjudication process and to identify areas where action to 
improve timeliness must be initiated. 

The following variables have impacted upon the adjudication division's 
timeliness during the past year: 

- The concentration on worlcing claims pending over 180 days to the detriment 
of worJting newer cases. 

- Dealing with the impact cf Che 43 "Desert Storm" scud missle attack 
cases . Both Senator Specter and Congressmar. Murt.*ia had these cases reviewed 
by Central Office. There were several field hearings, and the Director 
personally met with Congressman Murtha in Washington on these cases. Each 
case has been reviewed numerous times during this period. These cases are 
still controlled in the Adjudication Officer's Office, and receive special 
handling by the division Desert Storm Team. 



124 



SAO - Timalinass 

Page 2 

January 8, 1993 



- Sines' Fabruaxy we l^ve alao experienced critical peraonnel losses in the 
Adjudication Division. One senior adjudicator and two joumeynan adjudicators 
left govemoient service; another journeyman adjudicator went on maternity 
leave. This had an adverse impact on our ability to ccoplete the number of 
claims we would like to have coo^leted in order to Iceep our timeliness under 
better control. To balance these personnel losses, we have recently hired an 
adjudicator and will shortly be filling two career ladder adjudicator 
positions internally. The adjudicator on maternity leave has returned on a 
part -time basis effective December 13, 1932. 

- In May, the division participated in the VBA time management study. This 
was the second year the division was involved in this study. 

- Software problems with AMIE. At present we have only two useable ports 
for eight development clerks and management to access the five VAMCs in our 
jurisdiction. This has impacted on the morale and efficiency of our 
development clerks. It appears, however, that approval will b« shortly coming 
to change to a PC based AMIB system, giving us four ports for AMIS access. 

For analysis, division managers are cccnparing the adjudication division's 
cumulative average days to complete each of thirteen (13) end products from 
October 1992 against both National average days to cooiplete the same end 
products and against the FT 1993 goal for that end product (H21-4, Par. 4.02, 
Table 1) . ' The following table describes our comparison: 

AVERAGE DAYS TO COMPLETE 

£P VMS 



110 


216 


120 


149 


130 


63 


140 


174 


150 


74 


155 


96 


160 


48 


ISO 


162 


190 


115 


290 


63 


310 


98 


320 


155 


600 


91 


CONCLUSIONS : 


The divis: 



NATIOHAL AVERAGE 


n ?3 «>fti. 


174 


106 


122 


82 


37 


25 


1-03 


68 


37 


24 


25 


19 


33 


29 


119 


77 


66 


44 


49 


61 


66 


60 


63 


46 


6S 


N/A 



The division average processing days exceeds both National 
Average and FY 93 Goal in each end product compared. National average 
processing days substantially exceeds FY 93 Goal in each end product. 



125 



SAO - Timalinasa 

Page 3 

January 8, 1993 



RSCOMMBHDATIONS : Division managers decided to approach the goals in U21-4, 
Chapter 4,' increaentaily. Initially, our plan vas to ccom within 10% o£ the 
RDPC average for each end product, as the RDPC average was readily available. 
After discussion with Mike Bratz, and now with the availability of the 
National Average on DOORS, our goal is to achieve the National Average for 
each end product as outlined below. Our desire is to show steady and 
continuous ii!f>rovement in achieving this goal over the coming year. 

Division Actual Achievement H>nrhmj^Tir^ Goal M21-4 

E£a 9/92 10/92 11/92 12J22. 2121 6/93 9/93 

110 221 216 238 215 210 190 175 106 



120 


141 


149 


141 


131 


130 


115 


100 


82 


130 


54 


63 


48 


44 


45 


35 


25 


25 


140 


116 


174 


127 


134 


100 


85 


75 


68 


150 


64 


74 


68 


58 


60 


50 


40 


24 


155 


66 


96 


41 


32 


38 


35 


29 


19 


160 


44 


48 


36 


36 


33 


29 


29 


29 


180 


160 


162 


172 


155 


155 


130 


100 


77 


190 


99 


115 


103 


85 


90 


75 


60 


44 


290 


84 


68 


63 


47 


68 


61 


61 


61 


310 


83 


98 


87 


74 


80 


70 


60 


60 


320 


116 


155 


132 


115 


115 


76 


46 


46 


600 


101 


91 


74 


98 


72 


69 


65 


65 



Our plan is to achieve goal in 12 of the. 13 end products listed within one 
year with the exception of EP 110. As end product 170 will becoae a work 
credit only, it will not be included in the plan. 

We will monitor our achievements monthly, and strive for a steady reduction in 
average days to complete each end product in order to show contiiiucus 
improvement . 

Benchmarks shown will be the actual achievement for the month. This method 
was suggested by Mike Bratz. As we strive for our goals on a monthly basis, 
the cumulative averages will ultimately come down. 

In arriving at the benchmark figures, division management considered the 
number of pending claims already over their goal and the impact of upcoming 
projects that have already started to arrive. In order to encourage our 
employees to strive for improvement in our timeliness, we wanted to set 
realistic benchmarks that were achieveable with the hope that we could do 
better thaxi them in seme end products. 

Because of the number of end product llOs pending over 180 days (321, or 30.7V 
of total pending) we do not anticipate achieving goal during this year. 
Average processing time for this E? was 216 days m October 238 days in 
November a.^d 215 days in December. 

Dntil these cases are worked down upon receipt of necessary records, we do net 
anticipate a dramatic improvement in ti.Tieliness to complete this end product. 



75-767 0-94-5 



126 



SAO - Timeliness 

Page 4 

January 8, 1993 



Although is^rovetnenc in proceasing timeliness for December was noted for 10 of 
the 13 neasured IPs, we believe that the current benchmarks are challenging 
but achievable considering the ounber of cases in each SP category already 
over goal. 

The attached N-10 screen of 1-4-93 shows the total nuaiber of cases already 
over 180 days and over goal. 

Several suggestions discussed during the recent help visit are either in the 
process of or have already been ia^lenanted. 

Effective Janviary 11, 1993, all education cases (TD 00-99) will be specialized 
with one individual, with baclcup support. A standardized OISP procedure has 
been implemented (copy attached) which should ensure better control and 
tracJcing of claims. Regarding the software problems with AMIS, contact has 
been made with JacJc McCoy at the Winston-Salem Regional Office. Ultimately, 
we were referred to Kevin Cosley who J.s involved with AlIIB at VACO. He is 
exploring a potential solution utilizing a PC based systea. 

He are currently reviewing the adjudicator performance standairds and the 
division WIPP User Plan and will be maXing appropriate changes to best utilize 
our available staffing (both supervisory and non- supervisory) in order to 
achieve our timeliness benchmarlcs and goals in the shortest timeframes as can 
reasonably be expected. 



127 



wio 






WORK IN PROCSS.r ': 


•TATUS 






01 


-04-93 










PI" 


TTiBnpQH 


















if-.) 


(3) 


(C) 


(D) 


(E) 


(F) 


<i3) 






AVEFIAQE 


AVEr:Aei£ 














OVER 




DIVISION 


CONTROL 


DfityZ 


00-14 


15-30 


31-60 


61-90 


91-130 


181-360 


360 


EPC 


TOTAL 


DAYS 


PENDING 


DAYS 


DAY? 


DAYS 


DAYS 


DAYS 


DAYS 


DAY* 


110 


10-*5 


6 


162 


13 


64 


99 


132 


416 


253 


6.-5 


120 


2264- 


9 


122 


64 


221 


384 


347 


788 


410 


52 


130 


492 


S 


89 


27 


75 


107 


37 


145 


■ 50 


1 


135 


29 


2 


122 


5 


3 


1 


1 


3 


11 





140 


107 


.■3 


112 


2 


11 


20 


18 


41 


13 


2 


IT'O 


5?i 


8 


50 


.33 


lie 


143 


!00 


l-»3 


JA 





154 


i'fil 


:; 


1 ?■? 





3 


3 


173 


47c 


797 


■ ^7 


If'li 


1902 


1 


52 


!6e 


716 


5!:- 


242 


200 


61 


4 


loO 


313 


7 


64 


33 


■55 


76 


39 


65 


14 


1 


1^5 


17 


14 


107 


1 


1 


1 


5 


7 


2 





170 


1307 


20 


211 


17 


35 


137 


163 


304 


3<52 


214 



TOTAL 96 70 361 1355 1484 1312 2590 2039 499 

END PRODUCT CODE EPC TYPE TERMINAL DIliIT RANSE COLUMN DETAIL 

cV.P 00 THr.U 99 



NEXT SCREEN 



YOU HAVE REQUESTED MOPE THAN 11 EPCS. HIT ENTES TO CONTINUE 



■^ORK IN PROCErS STATUS 01-04-93 
?ITTS5UR'=H 

(A) i.B) <C) (D) '.El 'F) '.S> 

AVERAGE AVERAGE OVER 

DIVISION CONTROL DAYS 00-14 15-30 31-60 61-90 91-180 181-360 360 

TOTAL DAYS PENDING DAYS DAYS DAYS DAYS DAYS DAYS DAYS 

3 68 5 6 5 

5 163 11 12 5? 35 123 109 17 

7 ■16 13 26 75 61 147 53 ? 

7 91 10 22 yi 34 55 16 1 

•? 95 22 62 67 ■sO 104 46 3 

1 65 6 15 I'J li 10 3 

2 !04 8 13 -iO 15 61 8 - 
'5 



173 


16 


174 


360 


180 


384 


1 90 


176 


290 


3i-i 


293 


55 


310 


148 


314 


n 


320 


95 



r\([. icor.ijc 



'Ji.i Hfi"E rS'.-'UErTEi' i'lOPE THAN 11 Ef<:-: 





■i J7 


lT5i 1797 15'*4 


3120 2; 




"VFE 


"ERMINhL-M'SIT ?:^r-'r.E 


CCLU?"M 


.;.; 


!^p 


00/TrRU 99 





128 



WlO 



EPC 
500 
510 
600 
630 
632 
633 
634 
c'rO 
6'?2 
c-?3 
694 



DIVISION 

TOTAL 





239 

318 







56 

1? 

1 

1 



i')Of=:K IN PROCES'c. STmTUS 
PITTSBURLiH 



AVERASE AVERAGE 
CONTROL DAYS 
DAYS PENDINQ 
n 

2 63 
15 634 





172 

■?4 



iTAL ir?42 

END PROriiJCT CODE 



00-14 

DAYS 





25 



EPC TYPE 



15-30 
DAYS 




53 



31-60 

DAYS 





61-30 91-130 131-360 

DAYS DAYS DAYS 





34 47 13 

7 10 39 

n 



OVER 

360 

DAYS 



255 





1603 136? 1533 
TERMINAL DI'SIT RANLiE 


3272 235t. JV .' 
COLUMN DETAIL 


00 THRU 9? 


NEXT rCREHM 



rOU HAVE REQUESTEr. MOPE THAN 11 E=CS. HIT ENfER TO CONTINUE 



DIVISION 
TOTAL 



AVERAiSE AVERACiE 
CONTROL PAY? 
DAYS PENDING 



K IN PRi 


0CES3 STATUS 








PIT 


TSBURCiH 
(3) (C) 


(D) '-^l 


(r) 


C.i.' 
OVER 


00-14 

DAYS 




15-30 31-60 

DAYS DAYS 




61-90 91-130 

DAYS DAYS 

2 


131-360 
DAYS 



360 
DAYS 




129 



WORK IN FROCESf STATU? 















PI 


'TSei.-^GH 






















(A) 


(B) 


(C) 


<D.> 


(£) 


(F) 


< G < 








AVERAGE 


AVERAGE 


^ 














OVER 




DIVISION 


CONTROL 


DAYS 


00- 


14 


15-30 


31-60 


61-90 


91 -ISO 


1S1-36C 


360 


EPC 




TOTAL 


DAYS 


PENDING 


DAYS 


DAYS 


DAYS 


DAYS 


DAYS 


DAYS 


DAYS 


200 




5 


6 


31-« 
















1 


'-> 


2 


210 




3 


5 


146 







n 





1 


1 


1 





215 




3 


1 


34 




1 





2 














220 




30 


6 


70 




1 


5 


11 


4 


3 


1 





2?0 




30 


13 


92 




3 


3 


9 


2 


? 


5 





240 




11 


4 


126 




2 





3 


1 


1 


3 


1 


250 




2<: 


10 


SO 




3 


6 


6 


■j 


A 


1 


I 


260 




100 


■^ 


74 




6 


17 


32 


l? 


•8 







270 




3 


s 


303 



















3 





273 




































274 




































TOTAL 


211 








16 


31 


63 


30 


43 


24 


4 




END 


PRODUCT 


CODE 


EPC TYPE 




"ERMINAL 


DiLiIT 


RANGE 


COLUMN 


DETAIL 










-•3'. 






00 


THRU 99 









NEXT SCREEN 



YOU HAVE REQUESTED MORE THAN 11 EPC?. HIT ENTEP TO CONTINUE 



WORK IN PF0CES9 STATUS 01-04-93 
PITTS5UPGH 

(A) O) (C) <D) (£) (r) CG) 

AVERAGE AVERAGE OVER 

DIVISION CONTROL DAYS 00-14 15-30 31-60 61-90 91-130 lSl-360 360 



EPC 


TOTAL 


2-50 


47 


290 


2 



DAYS 



PENDING DAYS 
93 3 



DAY^ 



DAY 



DAYS 



DAYS 
12 



DAYS 



DAYS 





:.>IINAL MGIT 



.■-TA'a 



130 



Department of Memorandum 

Veterans Affairs 

0*m- Dccwnb«r 10, 1992 

From: Adjudication Officer 

Sut>i: scaodardizad DISF ProcsduxBS 

'''■ All Adjudication Personnel 



1. In order to track the various stages of pending claims, the attached 
steuidardized DISP acronyms will be used to reflect the current status of these 
claims. Standardization of DISP procedures and acronyms for adjudication 
actions will benefit our regional office as a whole. Ose of these codes will 
provide anyone reviewing pending claims more information regarding their 
status. Hopefully, this will result in a reduction of VAIs and requests for 
claims folders . 

2. Since our main concern is the latest stage of adjudication action of these 
pending claims, it will no longer be necessary to DISP the claims folder baclc 
to files. 

3 . Tha attached standardized acronyms will be used anytime a Target e nmm s n d 
is processed which results in an input in the disposition field cm the S99 
Target screens. Enter the acronym in the 'RCOTG' field on the S99 screen. If 
more than one acronym can be used, enter the code which best describes the 
action being taken. 

4. If a VA Form is used for development, use the last three or four digits, 
as appropriate, prefixed with the letter "0". Any form in current use may be 
designated. Only the attached acronyms and not any unlisted combination of 
letters and/or digits should be used. 




iTrector's Office 
VSD 
VRiC 
All Service Organizations 



131 



STAHDARDIZgP DTy p nr- 



03101 • Service verification 

ODC - Death certificate 

ODCVA - Death certificate requested from \~ 

OTRAD - Transportation costs 

OFBIL • Funeral bill 

0F6C • Facts and circumstances 

OIMFH - Initial funeral hooe receipt 

OTGST - Latter of testamentary 

OSKR - Service Medical Records 

COMPBITSATIOB/PPISIOB 



Strict Tnfnnr1■^^n^ 

03101 - Service verification, pay grade, se-. 
OSm - Service raedical records 
OSGO • Discovered medical records (Surgeon 
DDTYA - Duty assignments verification, all t 

DA Form 20, Navy pages 
ODRX - Defense Nuclear Agency verification 
OF&C - Facts fc circuaiatancea 
OESG - Information fron Army t Joint Servic 

Support Group pending 
OSTRS - FTSD stressors - letter to vet 
ORADD - Radiation exposure development - let' 
013S5 - Information needed to reconstruct mec 
0137S - Information needed to verify aulitar-. 

WllJMl Pev«lcip»mt 



02S07 - Examination requested 

07131 - Request from VAMC (other than hospita 

outpatient treatment records) 

QAAME - A&A medical evidence 

QAAST - Statement from vet requesting aid t a 

OHRA - Hospital records - Altoona 

OHRB - Hospital records - Butler 

OHRB - Hospital records • Erie 

OHRHD - Hospital records - Highland Drive 

OHRDD - Hospital records - Oniversity Drive 

OPMKD - Private medical doctor's statement rec 

OR£CT - Recent treatment 

OHLPC - Helpless child 



132 



COMPgWSATIOH/PKMSION 

Dependency 

0£86c- - 21-686C (Declaxatiao of Haxital Status t Dependent) 

0674 • Request for school approval 

0674b - Certification of school attendance (674 suboitced before 

beginning date of classes) 

OMC - Marriage certificate 

OBC - Birth certificate 

OADOP - Adoption decree 

ODV - Deemed valid letter to claimant 

OCOHB - Continuous cohabitation 

ODDV - Divorce decree (s) • veteran 

ODDS - Divorce decree (s) - spouse 

ODDB • Divorce decree (s) - both 

OSSNA - Social security nuoibers - all 

OSSNV - Social security number - veteran 

OSSNS - Social security number - spouse 

OSSNC - Social security mabers - children 

OAFPO - Development on apportionment 



Income /Kxpenses 



0527 - 21-527 (form requesting income, net worth ( employment) 

ORBTP - 21 -651a to Retired Pay Center 

OINCM - Income requested fzam claimant 

ODBP$. - Dependent (s) ' inco— 

OEST$ - Estate development ($1,500 rule) 

ONW - Net Worth 

OSSLV - Social security award letter - veteran 

OSSLS - Social security award letter - spouse 

OSSIA - Social security award letter • all dependents 

OTPQY - Third p2Lrty query fVA request to social security) 

OUHE - Unreimbursed medical expenses 

OFARH - F2Lnn income developsMnt 

ORENT - Rental income development 

OELEC - Xn^jroved pension election 

ONH - Nursing home statement 

OCONT - Vet's contributions to dependent (s) support 

OMNHR • Medicaid Nursing Home Reduction 



General /Other 



0592 - Fiduciary requested 

OACRP - Accident report from police 

OINCP - Due process for incompetence 

OPROP - Proposal to terminate or reduce prior to due process 

ODUEP - Due process 

OFS - Field exam requested 

OCLTH - Clothing allowance sent to prosthetics 

OIU - Individual unemployability 

OJAIL - Ltr to prison officials (felony determination) 

OFREE - Ltr to obtain release date (vet .and/or prison) 

ONME - Develop for new and material evidence 

03SSI - Beneficiary supplemental security income 



133 



EDOCATIOH 

02384 - Chapter 106 eligibility (NOSE) 

06YR - Six -year obligation 

03101 • Service verification 

OBC - - Birth certificate 

OSSN • Social security number 

OMITC - Mitigating circumstances 

OPRCR - Prior credit requested 

OOSAT - Unsatisfactory progress 

Iffi ' KKNA L RCXmWG 



ORBxx - Claim sent to rating board 

OADJ - Claim coming out of rating board and routed to an adjudicator 

ODC - Unit Chief 

OSC - Section Chief 

QAAO - Assistant Adjudication Officer 

OAO - Adjudication Officer 

ODENT - Dental Drawer 

OBVA - File sent to BVA, Washington, D.C. 



134 



SUBMITTED TO 

Subcommi C tee on Oversight and Investigations 

U.S. House of Representatives 

Comniittee on Veterans' Affairs 

335 Cannon House Office Building 

Washington, DC 20515 



TESTIMONY 

June 28, 1993 

Jack S. Ehrhardt, MSW/ACSW 

Psychotherapist /Team Leader 

Vet Center 

1000 State Street 

Suite 1 & 2 (Lobby) 

Erie, PA 16501 



135 



Gentlemen it is of the utmost importance that I 
tell you I am very honored to be asked to testify 
today before this Congressional Committee as a 
citizen, a professional, and more importantly as a 

veteran whom deeply aDDrpr^a^oe 

pj-y appreciates my country and all 

that it offers me and my family. 



136 



In opening, let me say that my testimony today is based on twenty-four 
years experience with the Veterans Administration; as a 100% 
service-connected veteran, an out-patient psychiatric social worker 
(1982-1985), as Team Leader of the Erie Vet Center ( 1 985-present ) , and as a 
researcher for the Rural Working Group of Readjustment Counseling Service 
(1991-present) . So, my experience is that of patient, line staff worker, 
program manager, and researcher. 

After being wounded in 1968 with one year of recovery in a naval hospital I 
converted my military disability retired pay into VA compensation, was 
treated at the out-patient clinic at the Federal Building, and the VA 
Hospital University Drive. 

Patient experiences in the Department of Veterans Affairs hospitals have 
been mostly good; however, not as modern and well staffed as my patient 
experiences in the private sector. As was stated, I have received all my 
benefits via the Pittsburgh Regional Office. My approach during the time I 
sought benefits was aggressive; and therefore, 1 have been able to achieve 
most of my goals. There were times of bureaucratic bungling which resulted 
in frustration and anger; however, bureacratic bungling exists in other 
government agencies as well as in the private sector. 

Frustration and anger got to a higher level at the VA because I had a 
strong feeling they were supposed to help. This feeling exists in all 
veterans, particularly the service-connected and those whom feel they 
should be service-connected. This same frustration and anger is now 
directed toward me as the VA employee expected to provide service. 

1 would like to turn my comments to that which are hopefully analytical and 
not critical, constructive and not destructive, and being as pro-active and 
directed toward quality 1 can. 1 will now speak to the last eleven years 
as social worker and Team Leader and how I view the Regional Office. 

From this view point, problems at the Regional Office are not any one 
person or department, but a system problem that has its root in lack oJ_ 
resources; in terms of personnel and varied expertise and in the 
adjudication claim review process and rating process. In short, there are 
too many claims of different types being fed into an overloaded system that 
doesn't have enough circuits to receive, assimilate, and service the need 



137 



-2- 



of the input (which in this case is the number of veterans seeking claims). 
This overload not only causes difficulty for the Regional Office, but also 
a ripple effect that goes through the system at the Medical Center, Vet 
Centers, other parts of the health care system, the individual veterans 
life, and the social and family systems with which he interacts. 

In terms of knowledge on Post Traumatic Stress Disorder, the veterans whom 
already have a low tolerance for stress and other psycho-social problems 
(ie. unemployment, family dysfunction, and medical difficulty) are more 
severely effected. They also tend to act out more and be more demanding. 

At times, probably because of case overload, cases don't appear to get full 
review or have all the information needed to adjudicate the claim properly. 
At the Vet Center we render as much assistance to the veterans as time 
allows, in hopes of cutting the load of the Regional Office. More time 
might be spent looking at how the disability has impacted the individuals 
life on a case-by-case basis, and how it impacts the veteran in 
relationship to the industrial index. New resource personnel in 
adjudication and claims review may need additional training in 
medical-clinical and occupational expertise. 

A few brief times it has been rumor mill discussion that Jack Ehrharflt 
thinks every veteran has Post Traumatic Stress Disorder and is a bleeding 
heart for all veterans. Let me address that by saying, I am indeed a 
strong advocate for all veterans, particularly my clients. It is my duty 
as a VA employee and professional therapist adhering to the N.A.S.W. code 
of ethics and to the VA code of ethics, to care for those who have bore the 
battle. I will continue to do so as best 1 can; but in cooperation not 
competition with other components of the Department of Veterans Affairs. 

The reality is that our most recent statistics indicate that out of the 
1,A39 Vietnam Era veterans we have seen at the Vet Center, only 265 have 
been diagnosed as having Post Traumatic Stress Disorder and only 
approximately one-half of those have claim work. This is lower that the 
NVVRS and the national average. 

In closing, I must say that 907. of our interaction with the Regional Office 
is positive. We refer hundreds of calls to their toll free number, get 
many of our forms and publications through their resources, and have active 
communication with all departments. A Vocational Rehab counselor is 



75-767 0-94-6 



138 



-3- 



sCationed at the Vet Center several days per month, providing excellent 
service. A recent successful cooperative effort by the Vet Center, VAMC, 
and Regional Office, produced a well attended and highly effective Town 
Meeting. For the first time, I had the opportunity to meet Mr. Bushy and 
members of his staff. A line of communication has been opened and the 
results are already positve for the veterans of Northwestern Pennsylvania. 

We are looking toward planning other Town Meetings in the rural 
Northwestern Pennsylvania interior and toward more cooperation in the 
future. The Vet Center, being the first line of contact with so many of the 
veterans of all eras, hopefully will be able to continue to observe, 
analyze, assist, and cooperate in providing America's most important 
citizens with quality and timely service, just as they have given us at 
Normandy, Inchon, Khe Sanh, and the Gulf. 

Again, Thank you for allowing me the opportunity to share my views. 



139 

SUMMARY STATEMENT OF 

HAROLD T. BUSHEY 

DIRECTOR 

VA REGIONAL OFFICE, PITTSBURGH, PA 

BEFORE THE 

HOUSE VETERANS AFFAIRS COMMITTEE 

ON OVERSIGHT AND INVESTIGATIONS 



JUNE 28, 1993 
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: 

I AM PLEASED THAT YOUR SUBCOMMITTEE'S CONCERN FOR SERVICE 
TO VETERANS BRINGS YOU TO PITTSBURGH TO LOOK AT THE OPERATIONS 
OF A REGIONAL OFFICE. I APPRECIATE THIS OPPORTUNITY TO TAKE 
YOU THROUGH THE MYRIAD OF DECISIONS AND PROBLEMS WE FACE AND 
HOW WE ARE DEALING WITH THEM. 

THE NEED AND CONCERN TO REDUCE GOVERNMENT SPENDING HAS HAD 
ITS IMPACT UPON THE DEPARTMENT OF VETERANS AFFAIRS AS WELL AS 
OTHER GOVERNMENT AGENCIES. IT HAS LEFT OUR REGIONAL OFFICES 
WITHOUT SUFFICIENT NUMBERS OF TRAINED PERSONNEL AND RESOURCES 
TO CARRY OUT A WORKLOAD WHICH HAS RISEN DRAMATICALLY IN SIZE 
AND COMPLEXITY. ADDITIONAL BENEFITS, DUE PROCESS LEGISLATION 
AND JUDICIAL REVIEW HAVE HELPED VETERANS BUT AT THE SAME TIME 
SLOWED THE CLAIMS PROCESS RESULTING IN A BACKLOG OF UNWORKED 
CASES OF MAJOR PROPORTIONS. 

THERE IS CURRENTLY A 557,000-CASE BACKLOG IN COMPENSATION 
AND PENSION CLAIMS ACROSS THE COUNTRY. DESPITE THE EXTENSIVE 
USE OF OVERTIME, INNOVATIVE CLAIMS PROCESSING, AND OTHER 
MEASURES TO REDUCE THE PENDING BACKLOG, IT HAS BEEN PROJECTED 
THAT THE WORKLOAD WILL BALLOON TO NEARLY 900,000 CASES BY THE 
EITO OF FISCAL YEAR 1994. 

I WISH WE COULD SAY THE SOLUTION TO OUR PROBLEM LIES IN 
FUNDING. IF THAT WERE SO, I WOULD SIMPLY SAY GIVE US THE 
RESOURCES AND WE WILL DO OUR JOB. WE ALL KNOW THE SOLUTION IS 
NOT THAT SIMPLE. THE PRESIDENT AND CONGRESS EACH YEAR HAVE TO 
DEVELOP A BUDGET THAT ADDRESSES THE NATIONAL DEBT AND PROVIDES 
FUNDING FOR WORTHY PROGRAMS SUCH AS VETERANS BENEFITS 
PROGRAMS. ISSUES SUCH AS, "DO WE INCREASE TAXES?, WHICH 
PROGRAMS DO WE CUT?, AND WHAT WILL BE THE IMPACT?" ARE NOT EASY 
ONES TO ADDRESS. OUR REGIONAL OFFICE DIRECTORS ARE FACED WITH 
SIMILAR DECISIONS BECAUSE THE IMPACT OF YOUR DECISIONS 
TRANSLATES INTO OUR BUDGETS. OF MAJOR SIGNIFICANCE IS THAT 



140 



FUNDED STAFFING LEVELS RARELY EQUATE TO THE NUMBERS NECESSARY 
TO ACCOMPLISH OUR PROJECTED WORKLOAD. THEN, WE HAVE TO ADDRESS 
QUESTIONS SIMILAR TO THOSE YOU DO. 

A GOOD ILLUSTRATION OF OUR PROBLEM IS THE RELATIONSHIP 
BETWEEN THE WORKLOADS OF OUR VETERANS SERVICES DIVISION WHICH 
ANSWERS INQUIRIES AND ASSISTS VETERANS IN FILING CLAIMS, AND 
OUR ADJUDICATION DIVISION WHICH PROCESSES COMPENSATION, 
PENSION, AND EDUCATION CASES. THE MORE CLAIMS WE HAVE, THE 
GREATER NUMBER OF INQUIRIES WE HAVE RELATIVE TO THEIR STATUS. 
IF WE CONCENTRATE OUR RESOURCES IN CLAIMS PROCESSING, THEN WE 
HAVE LESS STAFF AVAILABLE TO RESPOND TO BENEFIT INQUIRIES, AND 
WE EXPERIENCE LOST CALLS AND DELAYS IN INTERVIEWS AND INQUIRY 
RESPONSES. EMPHASIS IN VETERANS SERVICES RESULTS IN LESS 
CLAIMS PROCESSED AND GENERATES MORE INQUIRIES. AS THE DIRECTOR 
AND MANAGER OF THE REGIONAL OFFICE, IT IS MY RESPONSIBILITY TO 
MAKE THESE RESOURCE DECISIONS IN THE MOST EFFECTIVE MANNER. 

SINCE THE PURPOSE OF THIS HEARING IS TO REVIEW HOW WELL WE 
MEET THE NEEDS OF THE VETERANS FROM THIS AREA, I WOULD LIKE TO 
HIGHLIGHT SEVERAL OF OUR ACCOMPLISHMENTS, SOME OF WHICH HAVE 
RECEIVED NATIONAL RECOGNITION. 

IN CONCERT WITH THE AMERICAN LEGION AND THE VAMC- HIGHLAND 
DRIVE, WE WERE THE FIRST OFFICE IN THE COUNTRY TO CONVERT A VA 
PROPERTY INTO A HOME FOR HOMELESS VETERANS. IT SERVES AS A 
NATIONAL MODEL, AND WE CONTINUE TO LEAD THE WAY WITH THREE 
FACILITIES OPERATING SUCCESSFULLY IN OUR JURISDICTION AND A 
PROSPECTIVE FOURTH CURRENTLY BEING DISCUSSED. 

EMPLOYING TOTAL QUALITY MANAGEMENT (TQM) PRINCIPLES, WE 
HAVE BEEN ABLE TO PROVIDE IMPROVED TELEPHONE SERVICE - EXPANDED 
ACCESS AND REDUCED MISSED CALLS - AND BY USING AN INNOVATIVE 
COMBINATION OF VETERANS CLAIMS EXAMINER AND VETERANS BENEFITS 
COUNSELOR POSITIONS, WE HAVE SIGNIFICANTLY IMPROVED OUR INQUIRY 
RESPONSE RATE TO WHERE IT IS CURRENTLY BETTER THAN THE NATIONAL 
STANDARD. 

OUR WORK WITH THE DESERT STORM VETERANS WAS REVIEWED DURING 
A FIELD HEARING AND AT BRIEFINGS OF LOCAL CONGRESSMEN AND 
SENATORS. THE QUALITY OF SERVICE PROVIDED TO THE DESERT STORM 
VETERANS AND THEIR FAMILIES RECEIVED NATIONAL RECOGNITION. 

IN FEBRUARY 1993 WE HAD A SEMINAR FOR CONGRESSIONAL 
DISTRICT OFFICE STAFF PERSONNEL REVIEWING OUR PROCEDURES AND TO 
ASCERTAIN HOW WE MIGHT IMPROVE SERVICES. THERE WERE NO 
COMPLAINTS OR SUGGESTIONS FOR IMPROVEMENT BUT, RATHER, WE WERE 
COMMENDED FOR THE SERVICE WE PROVIDE. 



141 



MORE RECENTLY, WE HAVE INITIATED A SERIES OF TOWN MEETINGS 
LITERALLY BRINGING THE REGIONAL OFFICE TO POPULATION CENTERS 
REMOTE FROM PITTSBURGH TO NOT JUST PROVIDE INFORMATION ABOUT 
BENEFITS BUT TO DISCUSS PROBLEMS WITH VETERANS WHETHER IT BE 
THE EXPLANATION OF A LETTER OR PROCESS OR HOW WE MIGHT ASSIST 
THEM. 

WE CURRENTLY HAVE STARTED STAFF TRAINING IN HOW TO CONDUCT 
FOCUS GROUPS, A PROCESS IN WHICH WE WILL BRING IN VETERANS AND 
SOLICIT THEIR VIEWS ON HOW WE CAN IMPROVE SERVICES. 

WHILE WE TAKE PRIDE IN THESE ACCOMPLISHMENTS, WE RECOGNIZE 
THAT THERE ARE NEEDS FOR IMPROVEMENT IN OTHER AREAS. A CRUCIAL 
AREA OF CONCERN FOR EVERY REGIONAL OFFICE IS THE ADJUDICATION 
DIVISION. OUR MAJOR WORKLOAD AND, PERHAPS, MOST CRITICAL 
FUNCTION - THE PROCESSING OF DISABILITY COMPENSATION, PENSION, 
AND EDUCATION BENEFIT CLAIMS - IS DONE IN THIS DIVISION. 

CLAIMS PROCESSING HAS BEEN INFLUENCED BY THREE IMPORTANT 
DEVELOPMENTS: CHANGES IN DUE PROCESS REQUIRED BY THE SEMENCHUK 
COURT DECISION; CLAIMANT NOTIFICATION PROVISIONS OF PUBLIC LAW 
101-237, WHICH REQUIRE A STATEMENT OF THE REASONS FOR ADVERSE 
DECISIONS AND A SUMMARY OF THE EVIDENCE; AND THE COURT OF 
VETERANS APPEALS. IRONICALLY, THESE ACTIONS DESIGNED TO ASSIST 
VETERANS HAVE, IN FACT, FREQUENTLY PROLONGED PROCESSING TIMES. 

THE FULL IMPACT OF JUDICIAL REVIEW WAS NOT APPARENT AT THE 
REGIONAL OFFICE LEVEL UNTIL LATE 1991. BEFORE THE ADVENT OF 
THE COURT, BVA REMANDED ABOUT 18% TO 20% OR 8,000 TO 9,000 OF 
ITS CASES EACH YEAR FOR REGIONAL OFFICE ACTION. THE BVA REMAND 
RATE HAS NOW REACHED 52%. 

IT HAS BEEN ESTIMATED THAT IT NOW TAKES AT LEAST 25% LONGER 
TO PREPARE A RATING DECISION OR A DETAILED STATEMENT OF THE 
CASE FOR THE VETERAN WHO APPEALS SUCH DECISIONS. SIMILARLY, 
NEW "DUTY TO ASSIST" GUIDELINES REQUIRE CLAIMS EXAMINERS TO 
DEVELOP AND REVIEW ALL RECORDS CITED BY THE CLAIMANT, NO MATTER 
HOW REMOTELY THEY MAY BE RELATED TO THE ISSUE UNDER REVIEW. 
COMMUNICATIONS WITH CLAIMANTS ARE MORE FREQUENT AND GREATLY 
MORE DETAILED, TAKING 12% TO 13% LONGER TO COMPLETE. 

VA MUST NOW MAKE EFFORTS TO SECURE THE PERSONAL MEDICAL 
RECORDS OF VETERANS AND TIMEFRAMES HAVE BEEN ESTABLISHED WHICH 
GOVERN HOW LONG WE WAIT BEFORE PROCEEDING TO FURTHER DEVELOP 
THE CASE; THESE ACTIONS CAN TYPICALLY DELAY A FINAL 
DETERMINATION BY AS MUCH AS 120 DAYS. THE COURT OF VETERANS 
APPEALS (COVA) HAS HAD SIGNIFICANT IMPACT ON CLAIMS 
PROCESSING. COVA DECISIONS HAVE REQUIRED EXPANDED, MORE 



142 



COMPLEX RATING DECISIONS WHICH THOROUGHLY DISCUSS THE EVIDENCE 
AND REASONING USED TO REACH THE DECISION. 

ADDITIONALLY, AUTHORIZATION PERSONNEL ARE NOW REQUIRED TO 
PROVIDE A MUCH MORE DETAILED RESPONSE TO CLAIMANTS ESPECIALLY 
WHEN ADDRESSING THE BASIS FOR ANY DENIAL. THE CHANGES MADE ARE 
GOOD, BUT IT MUST BE RECOGNIZED THAT THEY ADD TO THE TIME 
NECESSARY TO PROCESS A CASE. VA COMPENSATION AND PENSION 
SERVICE NATIONWIDE STATISTICS INDICATE AN ORIGINAL COMPENSATION 
CLAIM IN OCTOBER 1991 TOOK AN AVERAGE OF 145.4 DAYS TO 
PROCESS. THE AVERAGE PROCESSING TIME FOR THIS SAME CLAIM IN 
MAY 1993 IS 191.2 DAYS. 

THESE ISSUES ALONG WITH NUMEROUS SPECIAL PROJECTS SUCH AS 
SOCIAL SECURITY AND INTERNAL REVENUE WAGE MATCHES, THE 
PROMINENCE AND EFFORT GIVEN TO DESERT STORM CASES, CHANGES IN 
STAFFING, AND COMPLEXITIES OF WORKLOADS, HAVE COMBINED TO DRAIN 
RESOURCES WHICH WOULD OTHERWISE BE DEDICATED TO NORMAL CLAIMS 
PROCESSING AT THE PITTSBURGH REGIONAL OFFICE. 

THE EFFECT ON OUR OPERATIONS WAS NOTICED IN JANUARY 1992 
WHEN IT WAS OBSERVED THAT OUR TIMELINESS IN PROCESSING CLAIMS 
HAD INCREASED, AND WE WERE NOT IN THE ACCEPTABLE RANGE OF A FEW 
KEY END PRODUCTS {I.E.; TIME TO PROCESS NEW CLAIMS, REOPENED 
CLAIMS, ETC.). INITIALLY, WE ATTRIBUTED THE DIFFERENCES TO THE 
NATIONAL TIMELINESS PROBLEM CAUSES PREVIOUSLY MENTIONED, 
EMPHASIS ON DESERT STORM, AND OUR EMPHASIS ON CLEARING OUT OLD 
CASES. (THE TIMELINESS FIGURE REFLECTS THE AVERAGE AGE OF THE 
CASES COMPLETED SO IF YOU ARE EMPHASIZING OLD CASES, AVERAGE 
PROCESSING TIME WOULD BE HIGH.) BY APRIL WE HAD A QUARTERLY 
REPORT SHOWING THE BEGINNING OF A TREND AS THE DISPARITY 
BETWEEN LOCAL AND NATIONAL FIGURES WIDENED. OUR PROBLEMS HAD 
BECOME COMPOUNDED BY THE LOSS OF KEY STAFF AMONG OUR CLAIMS 
EXAMINERS. EMPHASIS WAS PLACED ON TRAINING OF CORRESPONDENCE 
AND DEVELOPMENT CLERKS AS WELL AS NEW CLAIMS EXAMINER 
TRAINING. BY SEPTEMBER, WE WERE LOOKING FOR NEW WAYS TO 
ADDRESS THE TIMELINESS PROBLEM, AND WE HAD KEY STAFF VISIT THE 
NEW YORK REGIONAL OFFICE TO REVIEW SOME INNOVATIVE DEPARTURES 
THEY HAD MADE FROM THE TRADITIONAL WAYS OF DOING THINGS. WE 
TALKED TO COMPENSATION AND PENSION SERVICE PERSONNEL AS TO WHAT 
HAD WORKED ELSEWHERE AND, MOST IMPORTANTLY, TO OUR OWN 
EMPLOYEES TO SECURE THEIR IDEAS AS TO HOW TO DO OUR JOB 
BETTER. WHAT CAME OUT OF THIS WAS A DEPARTURE FROM TRADITIONAL 
WAYS OF DOING THINGS WHERE IT MAKES SENSE (I.E.; VETERANS 
CLAIMS EXAMINERS LOCATED IN THE VETERANS SERVICES DIVISION TO 
WORK SIMPLE CASES ON THE SPOT WHICH DO NOT REQUIRE 
DEVELOPMENT) ; EMPLOYEE INVOLVEMENT AND COMMITMENT TO AN 
IMPROVEMENT PLAN DEVELOPED IN CONJUNCTION WITH OUR C&P SERVICE; 



143 



THE POSTING OF PROGRESS CHARTS PROMINENTLY DISPLAYED IN THE 
ADJUDICATION DIVISION FOR ALL TO SEE; AND, MOST IMPORTANTLY, 
PROGRESS . 

WHILE THE QUALITY OF OUR WORK NEVER SUFFERED AS EVIDENCED 
BY VACO QUALITY REVIEWS AND APPEAL RATES THAT ARE BETTER THAN 
THE NATIONAL AVERAGE, WE HAVE SEEN IMPROVEMENTS IN MONTHLY 
TREND DATA THAT ARE ENCOURAGING. FURTHER EVIDENCE OF THE 
IMPROVEMENT AT THE PITTSBURGH REGIONAL OFFICE CAN BE SEEN IN 
THE REDUCTION OF PENDING WORKLOAD. SINCE OCTOBER 1992 THROUGH 
THE BEGINNING OF JUNE THIS YEAR, WE HAVE BEEN ABLE TO REDUCE 
OUR PENDING WORKLOAD BY OVER 3,000 CASES. DURING THE SAME 
TIMEFRAME, THE PENDING WORKLOAD NATIONALLY HAS DECREASED BY 
ONLY 700 CASES. 

THE PITTSBURGH REGIONAL OFFICE HAS DEMONSTRATED IMPROVEMENT 
FROM OCTOBER 1992 TO MAY 1993. OF THE 13 MEASURED END 
PRODUCTS, THE TOTAL NUMBER OF CLAIMS PENDING DECREASED FOR 10 
OF THESE EPS FROM OCTOBER TO MAY. THE NUMBER OF CLAIMS PENDING 
OVER THREE MONTHS FOR 12 OF THE EPS DECREASED AND ONE STAYED 
THE SAME DURING THIS PERIOD OF TIME. THE NUMBER OF CLAIMS 
PENDING OVER SIX MONTHS ALSO DECREASED FOR 12 OF THE EPs. THIS 
DECLINE IN PENDING CLAIMS IN ALL AGE CATEGORIES INDICATES 
MANAGEMENT'S IMPROVED EMPHASIS ON THE CLAIMS ADJUDICATION 
PROCESS . 

AS OUR CLAIMS EXAMINER TRAINEES GAIN MORE EXPERIENCE, WE 
EXPECT TO SEE AN EVEN GREATER POSITIVE IMPACT ON PROGRESS, AND 
WE INTEND TO AGGRESSIVELY PURSUE OUR PLAN T^ND ACHIEVE OUR 
STATED OBJECTIVES. 

I WANT TO THANK YOU FOR THE OPPORTUNITY TO TESTIFY BEFORE 
YOUR SUBCOMMITTEE, AND I WILL BE HAPPY TO ANSWER ANY QUESTIONS 
YOU MAY HAVE. 




144 



Department of Veterans Affairs 

Regional Office 
1000 Liberty Avenue 
Pittsburgh PA 15222 



June 3, 1994 

In Reply Refer To; 

Commitcea on Veterans Affairs 311/00 

ATTN: Pam Parker 
335 Canon HOB 
Washington, DC 20515 



Dear Ms. Parleer: 

I am writing in response to our telephone conversation of June 2, 1994. 
relative to the number of adjudicators (Vetereois Claims Examiners) we had 
in 1979 as opposed to 1993. Our records show wa had 50 adjudicators in 
1979 as opposed to 44 in 1993 . 

Although the number of adjudicators was reduced by only six over the four 
year period, that number does not truly reflect the impact of the 
budgetary constraints on claims processing. During the same period, we 
were forced to reduce the number of clerical personnel in our 
Adjudication Division from 49 to 30 clerks. This accounts for nearly 40% 
(19 of 49) of our clerical staff in the division which worked directly in 
the development and processing of claims. These claims processing tasks 
which were previously performed by clerical personnel are now done by 
adjudicators. The end result is we have fewer adjudicators with less 
time to make much more complex decisions. 

Ovpr the past year, we have continued to shift resources from other 
divisions to the adjudication activity to meet workload demands. Though 
we have actually lost personnel stationwide, we have added six claims 
examiners to the Adjudication Division. This staffing has come at the 
expense of stripping staff from other needed operations to meet the 
priorities of the high nationwide pending workload in claims processing. 

Our office has continued to improve productivity and timeliness of 
processing since the hearing through innovation, employee involvement, 
and maximizing the efficient use of personnel. I feal I can confidently 
say that our office compares favorably to others, and wa anticipate being 
one of the best in the near future. Tables illustrating the changes in 
staffing as of June 30, 1979, June 30, 1993, and currently June l. 1994 
are provided on Attachments 1 and 2 . 



145 



VARO Pittsburgh 



Page 2 . 



Chairman Evans made it apparent the purpose of the hearing was 

constructive and to find ways of improving service to veterans not only 

m Pittsburgh but across the country. Needless to say, you were an 

invaluable part of conveying that meaaage. Please advise me if we can be 
of further assistance. 

Sincerely, 



f HAROLD T.^USH: 
Direc 




Attachments 



146 



VARO Pittsburgh 
Attachment 1 



ivru-rrmTrATTON STAFFIWG 

(June 30, 1919 - June 30, 1993) 



f:/30/79 6/30/93 



Claims Examiners (Adjudicators) 
Clerical (claims development) 
Total 



50 
49 
99 



44 
30 
74 



147 



VARO Pittsburgh 
Attachment 2 

ADJUDICATIOM STAPFIHG 

(Juna 30, 1979 - Current Date) 

6no/l9 6/30/93 6/1/94 

Claims Examiners (Adjudicators) 50 44 5 

Clerical (claims devel<^>ment) 49 30 28 

Total 99 74 78 



148 




S 




A M V E T S 

NATIONAL 
HEADQUARTERS 
4647 Forbes Boulevard 
Lanham, iMarvland 
20706-9961 

TELEPHONt 301-459-9600 
FAX 301-459-7924 
FTS 8-344-3552 



AMVETS Statement for the Record 
before the 



House Veterans Affairs Subcommittee 

on 

Oversight and investigations 



ERVING 
WITH 
PRIDE regarding 



Department of Veterans Affairs Adjudication 

of 

Claims for Veterans Benefits 



June 28, 1993 



i 



149 



Mr. Chairman, thank you for this opportunity to present testimony on the challenges 
of improving VA's compensation and pension adjudication. 

Veterans receive compensation to offset loss of income due to service-connected 
disabilities. Many suffer sigruficant employment handicaps beyond what is compensated by 
the VA and others are totally disabled and are unable to augment their VA checks with 
outside income. Totally disabled, non-service connected VA pensioners must also rely upon 
the nation's generosity to live with a minimum of dignity. 

The claims deli very system cannot and will not be fixed until this body and the 
administration admit to the total disaster a decade of under funding and under staffing has 
created. It is time to finally provide the resources that will enable the VA delivery system to 
adapt rapidly to emerging social and technological challenges, thus better-serving veterans and 
the country. Perhaps the single most important recommendation in this year's Independent 
Budget is the increase of 2013 FTEE for Veterans Benefit Administration (VBA). Simply put, 
there is no other way to significantly and rapidly reduce the backlog in claims. Therefore, 
AMVETS whole-heartedly supports the FTEE increase called for in the Independent Budget 
because waiting six to twelve months for action on a claim is unacceptable. And to assure 
veterans of timely claims adjudication, AMVETS supports legislation that would mandate a 
maximum reasonable processing time for a claim after which benefits would be granted on an 
interim basis. Today, the backlog in claims exceeds 600,000, and is expected to continue its 
rapid growth unless there is an increase in resources devoted to reducing that number. This 
is a prime example of the need to fund the costs of delivering benefits - including personnel 
costs - from mandatory spending accounts. 

You have asked us to bring concrete ideas to the table today on how to fix the system. 
The really easy answers are more people and more money as stated earlier, and in the end, 
these must be considered to achieve meaningful improvements. But there are also 
management actions to augment some of the obvious fixes. AMVETS would like to suggest 
that a Total Quality Management approach to designing the adjudication system offers many 
solutions that would let VA work smarter, not harder. First, the adjudication process should 
be viewed as a production system that uses resources to produce a quality final product. In this 
case, the product is a final decision that accurately awards or denies benefits. More on how 
to define a final decision in a moment. 



150 



The production system must be designed from throughout with a high quahty product 
as the ultimate goal. To begin, the system designers must consider the resources that will be 
available to accomplish that goal. VA's resources in this case are its employees, facilities and 
equipment, data, the claimant, and the VSO service officers and political strength. A systems 
engineer would design the system, put it into operation, stress the system to identify the weak 
component in the system, fix the component and stress the system again. As we have described 
previously, the weakest component in the system has been identified as the regional office, and 
that is where the resources should be devoted. 

Statistics indicate the greatest need for additional personnel, technology and training 
is at the regional office to compensate for the increased workload due the effects of staff cuts, 
inadequate automation, insufficient training, rulings by the Court of Veterans Appeals and an 
increased demand for benefits. 

Because of the increasing complexity of the adjudication process, VA estimates that it 
takes about two years to become a fully qualified adjudicator. Therefore the system designers 
must lay out a personnel program that addresses that complexity and assigns a grade sufficient 
to attract well-educated and educable personnel to fill the positions. The personnel structure 
must reflect an opportunity to advance within the adjudication system and not encourage 
qualified adjudicators to move to other divisions within VA or the goverimient. AMVETS 
suggests universal testing similar to that employed by the military to identify those who excel 
in the intricacies of adjudication and who merit promotion based on their technical knowledge, 
quality and quantity of work as well as leadership and management abilities. It takes good, 
competent people to deliver services in an efficient and accurate manner. Adjudication has 
become a much more complex process requiring a higher level of skill and insight. Therefore, 
VA should consider increasing the GS ratings of adjudication personnel to attract and retain 
competent employees. VA must also develop performance standards that reward quality as 
well as quantity of work and redefine the standards by which cases are tracked through the 
system to accurately reflect adjudication times. VA must cease judging production on the 
mere movement of a claim from one desk to another. 

Training programs must be designed to accommodate new hires as well as current 
employees. Supervision of new personnel is especially critical, and supervisors must be held 
accountable for the progress of those under their guidance. 



151 



It is also imperative that office automation be designed to allow VBA computers to 
interface with VHA computers to access all relevant records in a veteran's file to help speed 
adjudication and treatment. Improved automation will shorten the adjudication process. 
AMVETS suggests some form of on-line computerized help for adjudicators similar to those 
found in commercial computer programs. This would offer a way to keep adjudicators up-to- 
date on changes in regulations due to the latest decisions by the Court of Veterans Appeals 
or legislation. The on-line help system would provide an index of adjudication topics and 
complete explanations and guidance on implementation. If implemented properly, all 
adjudication staff would have instant access to the most recent information needed to process 
claims. This would also increase productivity by eliminating thousand of hours spent posting 
regulation changes and assuring uniformity of reference materials. Emerging artificial 
intelligence (AI) technologies also offer large productivity improvements, by reducing training 
requirements and records collection and analysis. 

AMVETS also suggests some form of administrative triage to screen the more difficult 
cases from relatively easy decisions. That would allow VA to apply the minimum resources 
needed to a given case and would integrate the caseload into the training process. VA must 
also do a thorough analysis of its information requirements to determine the absolute 
minimum data needed to make a decision on a claim. 

Perhaps consideration should be given to utilizing adjudicative personnel in some type 
of split shift configuration, i.e. half of the division would report to work four hours before the 
current normal work day - the other half of the staff would report two hours after the normal 
start-up time, thus ending the work day two hours after the normal office hours. This 
configuration would provide six hours of uninterrupted productivity. The hours that overlap 
with all of the regional office staff could be used for training and other day-to-day operational 
necessities. Also of interest would be the potential for using recently retired, knowledgeable 
adjudicators on a contract basis during the extra hours when they could be provided with all 
the needed resources. A further option would be to contract uith a professional services firm 
to provide specialists to assist in the adjudication process similar to the way DoD contracts for 
help on procurement programs. We are sure that reasonable accommodations, adjusted office 
hours, contract retirees and/or professional services firms all offer the means to reduce the 
si^e of the claims backlog. 



152 



The transfer of records from the military services to VA is often a very time consuming 
process. AMVETS applauds the Army's decision to send separating soldier's medical records 
directly to the VA and we urge the Congress to mandate that the other services do likewise as 
a means to shorten the adjudication process. 

Statistics for the Board of Veterans Appeals (BVA) illustrate the problem facing VBA. 
Since the advent of the Court of Veterans Appeals (CVA), the BVA has struggled under a 
heavier caseload, as have the Regional Offices, due to the actions of the Court. BVA 
operating statistics show a 43% decline in decision per FTEE, a 26% drop in total decisions 
and steadily rising remand rates now in excess of 50%. The Independent Budget for 1993 
estimates that left unresolved, BVA response time will approach 550 days! Clearly only 
additional employees can help BVA dig out of the hole. (This is in no way offered as criticism 
of the Court, which we absolutely support. Rather it is intended to show the dire conditions 
facing the adjudication divisions.) Likewise, the performance numbers for the Pittsburgh RO 
illustrate the problem. BVA decided 262 Pittsburgh appeals as of April 28, 1993. Of those, 
BVA allowed 18.3%; (VA-wide average = 15%), denied 30.5% (VA-wide average = 31.8%) 
and remanded 49.6% (VA-wide average = 51.4%). In other words, the Pittsburgh RO is 
correct in less than 1/3 of the cases appealed to BVA. While AMVETS concedes that many 
of the remanded cases will be denied, the sheer volume of remands indicates a serious 
problem that must affect the overall quality rates of the RO. We reiterate that VA must adopt 
a work credit system that rewards only qualiiy performance, helps to identify those needing 
further training or dismissal and provides an accurate picture of the workload. This must be 
complemented by adequate staff and improved automation. 

It also makes no sense to return a faulty product to the beginning of the assembly line 
for correction of a defect. If at all possible, the defect should be fixed on the spot and save the 
administrative cost and time of transferring the product between bureaucracies. 

In closing Mr. Chairman, it is important to retain economic fairness for our most 
deserving veterans while decreasing the adjudication times. There is a crisis in the timely 
delivery of benefits and it is time for bold and decisive action. We ask this committee to 
consider the recommendations contained in the FY 94 Independent Budget for the 
Department of Veterans Affairs as a reasonable approach to funding VA. We believe that a 
common sense approach coupled with sufficient resources can solve the adjudicadon problem. 
That concludes our statement. 



153 
WRITTEN COMMITTEEE QUESTIONS AND THEIR RESPONSES 

QUESTIONS ASKED BY REP, TOM RIDGE 
PITTSBURGH FIELD HEARING 
JUNE 28, 1993 

1. Q.- DO YOU FEEL THAT THOSE CLAIMS FOR POST-TRAUMATIC STRESS SYNDROME ARE BEING 

ADJUDICATED FAIRLY? ANSWER— NO! 1 1 ARE THERE AN INORDINATE NUMBER BEING 
DENIED? ANSWER — YES ! ! '. A cross section check indicates ]k denials for 
PTSD. These claims are supported by medical diagnosti cation. One of 
these is a former prisoner of war. 

2. Q..- WHAT DO YOU FEEL ARE THE MAJOR PROBLEMS AT THE VA REGIONAL OFFICE WITH 

RESPECT TO TIMELINESS AND QUALITY OF CLAIMS PROCESSING? IN YOUR OPINION, 
WHAT IMPROVEMENTS DOES THE REGIONAL OFFICE NEED TO MAKE? 

A.- THE MAJOR PROBLEM IS A COMPLETE DEPARTURE OF CREDENCE TO THE AFFIRMATIVE 
ASPECTS OF A CASE. THESE FACTORS ARE IGNORED OR INDICATED AS CUMULATIVE 
AND THAT THEIR ACTION WAS SUSTAINED BY THE BVA. DUE PROCESS WHICH EQUATES 
EVIDENCE DOESN'T EXIST. TIMELINESS IS RELATED TO THE POOR QUALITY OF 
RATING PRACTICE. 

REGARDING IMPROVEMENTS AT THE REGIONAL OFFICE LEVEL, AT THIS POINT OF TIME, 
I'M VERY ANGRY. WE NEED NEW FACES WITH PROPER CONCEPTS. THE "HARD LINERS" 
ARE GUILTY OF COUNTLESS TRANSGRESSIONS. THEY SHOULD BE LET GO AS THEY ARE 
STILL RATING CASES WITH COMPLETE DISREGARD TO DUE PROCESS. 

3. Q.- ARE YOU AWARE OF ANY PERSONNEL PROBLEMS AT THE VARO IN PITTSBURGH WHICH 

MIGHT INTERFERE WITH THE PROCESSING OF CLAIMS IN A TIMELY AND ACCURATE 
MANNER? 

A.- THE ADJUDICATION OFFICER WILL TELL YOU, "I CAN'T TELL THE RATING BOARD 
WHAT TO DO". THE RATING BOARD WILL TELL YOU, "APPEAL IT", KNOWING FULL 
WELL THAT 90% OF THE APPEALS ARE RUBBER STAMPED, SUSTAINING THE RATING 
ACTION. THE RATING BOARDS ARE IMBUED IN THE IMMUNITY FACTOR AND DO AS 
THEY PLEASE. THEY SHOULD BE SUBJECT AND RESPONSIBLE FOR THE ENORMOUS 
VIOLATIONS. I DON'T BELIEVE THEY'LL EVER CHANGE. 

^. Q.- IN YOUR OPINION, WHAT IS THE RELATIONSHIP BETWEEN MANAGEMENT AND CLERICAL 
ASSISTANTS, ADJUDICATORS AND RATING SPECIALISTS WITHIN THE VA REGIONAL 
OFFICE IN PITTSBURGH? 

A.- LACK OF DIRECTION. 

5. Q.- ACCORDING TO OFFICIALS AT THE VA CENTRAL OFFICE, THE PITTSBURGH VA REGIONAL 

OFFICE HAS IMPROVED ON TIMELINESS SINCE OCTOBER OF 1992. HAVE YOU NOTICED 
ANY ACTUAL IMPROVEMENT IN THE AREA OF TIMELINESS SINCE OCTOBER? 

A.- YES, ON ONE CLAIM FOR DIC. IT CAME THROUGH IN A COUPLE OF WEEKS; HOWEVER, 
THIS IS A FLASH IN THE PAN. THEY ARE STILL IN THE DOLDRUMS WITH 1991 & 
1992 CASES. 

6. Q.- ON PAGE ONE OF YOUR PREPARED STATEMENT, YOU EXPRESSED GRAVE CONCERN ABOUT 

THE VA'S POLICY OF NOT GIVING INFORMATION ABOUT PROCEDURAL & APPELLATE 
RIGHTS. PLEASE EXPLAIN WHAT YOU MEAN. 

A.- WITH THE SURGE OF CLAIMS UNDER A CLEAR AND UNMISTAKABLE ERROR DUE TO THE 
VETERANS JUDICIAL ACT OF 1988, THESE CLAIMS WERE CANCELLED ON THE PREMISE 
THAT THE CLEAR AND UNMISTAKABLE ERROR WAS SUSTAINED BY THE BVA AND COULD 
NOT BE REOPENED. PROCEDURAL AND APPELLATE RIGHTS WERE DENIED. A CROSS 
CHECK OF OUR FILES INDICATES VIOLATIONS OF DUE PROCESS IN 15 CLAIMS. 
THESE ARE COMBAT EXPOSURE AND POW CLAIMS. I'M CERTAIN THAT A CAREFUL 
REVIEW WILL YIELD MANY MORE OF THESE VIOLATIONS. 



FROM: CHARLES A. ZEGLIN 

DEPARTMENT SERVICE OFFICER 
THE AMERICAN LEGION 



154 



REPLY TO 
QUESTIONS ASKED BY REP. TOM RIDGE 
PITTSBURGH FIELD HEARING 



JUNE 28, 1993 jSt 






TO: LANE EVANS, CHAIRMAN 

Subcoimiittee on Oversight 
and Investigations 



1. YOUR WRITTEN STATEMENT REFERS TO THE INCREASED WORKLOAD OF ADJUDICATORS 
WHICH HAS CAUSED A MORALE PROBLEM AFFECTING THE PRODUCTION LEVEL AND 
QUALITY OF DECISIONS. WHAT WOULD YOU RECOMMEND BE DONE TO CORRECT THE 
MORALE PROBLEM AMONG ADJUDICATORS? DOES THIS LOW MORALE IMPACT 
DIRECTLY ON HOW THEY TREAT INDIVIDUAL VETERANS? 

ANSWER : TO CORRECT THE MORALE PROBLEM IT IS SUGGESTED THAT ADDITIONAL 
PEOPLE BE TRAINED AND PLACED IN THE ADJUDICATION SECTION TO EASE THE 
WORKLOAD THAT IS NOW PLACED UPON THE PEOPLE IN THIS SECTION. OVER 
LOADING OF WORK WILL CAUSE STRAIN, PRESSURE AND TENSION, THUS CAUSING 
THE MORALE OF THE PEOPLE TO DROP. 

DUE TO THE FACT THAT A FEW PEOPLE HAVE BEEN ADDED TO THE 
SECTION, THERE HAS BEEN IMPROVEMENT SHOWN WITHIN THE PAST SIX (6) TO 
EIGHT (8) MONTHS. 

THE MORALE PROBLEM DOES NOT SEEM TO HAVE A DIRECT AFFECT ON 
HOW THE INDIVIDUAL VETERAN IS TREATED, EXCEPT IN THE FORM OF TIME- 
LINESS OF THE DELIVERY OF THE DECISIONS AND BENEFITS TO THE VETERAN. 
IT IS FELT THAT THE PEOPLE DO HAVE A TRUE FEELING FOR THE PROBLEMS 
OF THE VETERAN. 

2. DO YOU FEEL THAT THOSE CLAIMS FOR POST-TRAUMATIC STRESS SYNDROME ARE 
BEING ADJUDICATED FAIRLY? ARE THERE AN INORDINATE NUMBER BEING DENIED? 

ANSWER : IT IS FELT THAT THE POST-TRAUMATIC STRESS SYNDROME CLAIMS ARE 
BEING ADJUDICATED AS FAIRLY AS POSSIBLE. IN MANY CASES IT IS FOUND 
THAT THE CLAIM IS DENIED DUE TO THE LACK OF A STRESSOR AND THE VETERAN 
FAILS TO PRODUCE EVIDENCE OF A STRESSOR WHEN REQUESTED. THEREFORE IT 
IS FELT THAT THERE IS NOT AN INORDINATE NUMBER OF POST-TRAUMATIC STRESS 
SYNDROME CLAIMS BEING DENIED. 

3. WHAT DO YOU FEEL ARE THE MAJOR PROBLEMS AT THE VA REGIONAL OFFICE WITH 
RESPECT TO TIMELINESS AND QUALITY OF CLAIMS PROCESSING? IN YOUR 
OPINION, WHAT IMPROVEMENTS DOES THE REGIONAL OFFICE NEED MAKE? 

ANSWER : WITH RESPECT TO TIMELINESS AND QUALITY OF CLAIMS PROCESSING, 
I PERSONALLY FEEL THAT AS PREVIOUSLY STATED THE WHOLE PROBLEM IS THE 
LACK OF A SUFFICIENT NUMBER OF PEOPLE TO PROCESS THE WORKLOAD. AS 
STATED IN ANSWER NUMBER ONE (1) THERE HAS BEEN AN IMPROVEMENT SHOWN 
WITHIN THE PAST SIX (6) TO EIGHT (8) MONTHS. 



155 



SHEET 2 OF 2 



4. ARE YOU AWARE OF ANY PERSONNEL PROBLEMS AT THE VARO IN PITTSBURGH WHICH 
mem INTERFERE WITH THE PROCESSING OF CLAIMS IN A TIMELY AND ACCURATE 
MANNER? 

ANSWER : BEING IN THE POSITION I AM, I AM NOT AWARE OF ANY PERSONNEL 
PROBLEMS WHICH MAY EXIST WITHIN THE VARO PITISBURGHWHICH COULD INTERFERE 
WITH THE TIMELY AND ACCURATE MANNER IN WHICH THE CLAIMS ARE PROCESSED. 

THE TIMES THAT I MUST MAKE CONTACT VHTH ANY OF THE VARO 
PERSONNEL, I HAVE RECEIVED PROMPT AND COURTEOUS ATTENTION TO THE 
PROBLEM THAT I PRESENT. 

5. IN YOUR OPINION, WHAT IS THE RELATIONSHIP BETWEEN MANAGEMENT AND CLERICAL 
ASSISTANTS, ADJUDICATORS, AND RATING SPECIALISTS WITHIN THE VA REGIONAL 
OFFICE IN PITTSBURGH? 

ANSWER : IN MY OPINION AND FROM MY OWN OBSERVATION, I FEEL THERE IS A 
GOOD RELATIONSHIP BETWEEN MANAGEMENT AND THE CLERICAL ASSISTANTS, AD- 
JUDICATORSAND RATING SPECIALISTS WITHIN THE PITISBURGH VA REGIONAL 
OFFICE. 

6. ACCORDING TO OFFICIALS AT THE VA CENTRAL OFFICE, THE PITTSBURGH VA 
REGIONAL OFFICE HAS IMPROVED ON TIMEUNESS SINCE OCTOBER OF 1992. HAVE 
YOU NOTICED ANY ACTUAL IMPROVEMENT IN THE AREA OF TIMELINESS SINCE 
OCTOBER? 

ANSWER : IN MY OPINIO THERE HAS BEEN AN IMPROVEMENT IN THE TIMELINESS 
WITHIN THE PAST SIX (6) TO EIGHT (8) MCWIHS. IT SEEMS THAT DECISIONS, 
AWARD LETTERS AND OTHER INFORMATION CONCERNING CLAIMS IS MOVING IN A 
MORE TIMELY MANNER THAN IT HAS FOR QUITE SOME TIME. 



WILLIAM J. REED 
DEPARTMENT SERVICE OFFICER 
VETERANS OF FOREIGN WARS 



156 




PARALYZED VETERANS 
OF AMERICA 
Chartered by the Congress 
of the United States 



RESPONSES TO QUESTIONS PRESENTED BY THE 

HONORABLE THOMAS J. RIDGE 

AT THE PITTSBURGH, PENNSYLVANIA FIELD HEARING 

JUNE 28, 1993 



1. What do you believe is the reason, or reasons, that the 
VARO in Pittsburgh has a higher than average claims 
processing time? 



Pittsburgh has, in the past, suffered from inadequate staffing 
and poor management. Changes have been initiated to increase 
staffing, and new management personnel will soon be in place. 
The VA and the Pittsburgh Regional Office are to be commended for 
these changes and their efforts to improve service. 

The steps taken at the Pittsburgh Regional Office are in the 
right direction, but they alone will not solve these problems. 
Help is required from VA Central Office in the form of increased 
personnel authorization, improved management systems, and better 
equipment . 

It is important to stress that longer claims processing time is a 
deplorable situation, and a situation that must be remedied. We 
must also remember that efficiency and quality should be viewed 
as twin goals of the entire VA effort. 



2. In your written testimony, you state one of the reasons for 
Pittsburgh's higher than average remand rate is due to poor 
original claims development. Can you explain in more detail 
why you feel the claims are not being developed properly? 



Prior to the advent of the Court of Veterans Appeals, the VA, 
including the Pittsburgh Regional Office, developed cases in a 
perfunctory manner. Policies and procedures for adequate 

801 Eighteenth Street, N.W.. Washington, D.C. 20006 {202} USA-1300 Fax: (202) 785-4452 



157 



development of claims were in some instances not complied with in 
a satisfactory fashion, and in some instances they were ignored. 
There was no effort to accomplish the thorough and complete 
development now required by the decisions of the Court. 

Since the advent of the Court, many earlier deficiencies have 
become increasingly patent. First and foremost of these 
deficiencies is the lack of adequate training of the personnel 
responsible for developing claims. Today, training in claims 
development requires a thorough knowledge of claims development 
procedures. This necessitates a continual updating of 
development requirements as Court decisions are rendered and 
changes are mandated to comply with these decisions. The need 
for timely dissemination to the Regional Offices of changing 
development requirements cannot be over-emphasized. 

New personnel have been hired to assist in claims development. 
These personnel require a period of training before they can 
become effective. Once their training has been completed we 
should witness some improvement in claims development at the 
Pittsburgh Regional Office. 

Inadequate claims development is not solely the fault of the 
Pittsburgh Regional Office. The delays in processing claims may 
also produce cases which no longer meet the criteria for properly 
developed claims as the result of interim Court decisions. As a 
result, claims reaching the Board of Veterans' Appeals may no 
longer be adequately developed and must therefore be remanded 
back to the Regional Office to begin anew. 

PVA National Service Officers receive extensive training in the 
requirements of appropriate claims development. These officers 
seek to submit to the Regional Office adjudication staff claims 
which are either fully developed for adjudication or contain the 
information necessary for completion of the development process. 



158 



In instances where the development is solely in the hands of the 
VA, there is nothing the Service Officer can do to assure that 
the claim is developed appropriately. An example of this 
situation is when the VA examination needed to rate a case is 
inadequate and the rating board refuses to obtain another 
examination . 



3. Your written statements alludes to overworked adjudicators. 
What can be done to correct this problem? Does this impact 
on the quality of service a veteran receives? 



Adjudicators are indeed overworked. They face an overwhelming 
number of cases which require disposition. One attempt to reduce 
this backlog has been to increase production quotas. These new 
quotas have been achieved at the expense of quality. PVA 
believes that any production quota system must reward quality 
claims development as well as efficiency, and not just reward 
paper shuffling. If claims are developed correctly, this will 
necessitate fewer remands and assist in decreasing the enormous 
backlog of claims that presently exist. 

Another method to alleviate the backlog of cases has been the 
institution of overtime. This adds to the stress the 
adjudicators are already experiencing and causes more morale 
problems and less efficiency. This does indeed affect the 
quality of service a veteran receives. 

The Pittsburgh Regional Office has added six new adjudicators. 
It takes time, however, to train these people. It will be some 
time before they are effectively integrated into the adjudication 
staff. Unfortunately, these six new adjudicators come at the 
expense of the authorization end of claims processing and this 
will cause problems and further delay down the road. 



159 



Do you feel that those claims for post-traumatic stress 
syndrome are being adjudicated fairly? Are there an 
inordinate number being denied? 



"Post-traumatic stress disorder" (PTSD) is a specific mental 
disorder recognized in the American Psychiatric Association, 
Diagnostic and Statistical Manual of Mental Disorders , Third 
Edition (DSM-IIIR). The manual sets forth the medical criteria 
which must be met for the diagnosis to be applied. PVA National 
Service Officers are not aware of an inordinate number of claims 
for PTSD being denied. PVA does not see any difference in the 
adjudication of claims for PTSD than for other chronic diseases 
or injuries. 



What do you feel are the major problems at the VA Regional 
Office with respect to timeliness and quality of claims 
processing? In your opinion, what improvements does the 
Regional Office need to make? 



The major problems at the VA Regional Office are the same as 
those facing almost all other VA Regional Offices. There needs 
to be a commitment by the VA to both quality and efficiency in 
claims processing. More personnel need to be assigned to this 
important aspect of the VA's mission, but not to the extent of 
further cannibalizing the benefits delivery process. The VA must 
make a commitment to increase the training given to those 
involved in the process, as well as faster dissemination of 
necessary information and quicker adherence to Court of Veterans 
Appeals decisions. Finally, there must be a strong commitment on 
behalf of the VA to the individual veteran and a commitment to 
assist the veteran as he journeys through what can seem to be, at 
times, a maze-like bureaucracy. 



160 



Are you aware of any personnel problems at the VARO in 
Pittsburgh which might interfere with the processing of 
claims in a timely and accurate manner? 



There are inevitable personnel problems in any large 
organization. There have been recent personnel changes in 
Pittsburgh, most notably a new Adjudication Officer. We at the 
PVA look forward to working with this new officer, and we await 
any changes that might be instituted by this personnel change. 



7. In your opinion, what is the relationship between management 
and clerical assistants, adjudicators, and rating 
specialists within the VA Regional Office in Pittsburgh? 



The relationship between personnel is no different than that 
found at other large Regional Offices. PVA believes that the new 
adjudication officer should be given the opportunity to improve 
any of the current personnel problems now outstanding. PVA 
believes it is more important to look toward the future than to 
look to the past. Along this vein we await with anticipation any 
constructive changes that might be instituted in the near future. 



According to Officials at the VA central office, the 
Pittsburgh VA Regional Office has improved on timeliness 
since October of 1992. Have you noticed any actual 
improvement in the area of timeliness since October? 



While there has been an improvement in timeliness, much still 
remains to be done. The back log of claims awaiting processing 
remains staggeringly high and many deserving veterans are 
suffering because of this. 



161 



iyet€rari& o/\Jun£ricay 




CHAPTER 427 



P.O. BOX 543 



BUTLER, PA 16003-0543 



Chairman 

Subcommittee on Oversight 
and Investigations 



Question: What Is the most important step the Pittsburgh 
VA Regional Office can take to improve its Outreach Program? 

Answer: Notification of vhere Outreach Programs are being 
held , notification of time, and notification of a particular 
session of that Outreach Program. 

At the present time, the Outreach Program from the Pittsburgh 
Regional Office is invisible. We know they have the Outreach 
Programs, but we don't know where or when. The Regional Office 
could contact the County Service Officer and let him know where 
the Outreach Program is going to be held. 

The Veterans Organizations would in most cases be willing 
to open their doors at no cost to the Outreach Program in their 
own facilities throughout the entire region of Pittsburgh and 
the surrounding communities. 

The Veterans Organizations would also have in most cases, their 
Service Officers there to assist the veteran and their families 
in the proper ways to fill out the claim forms currantly used 
throughout the Va system. 

If the Service Officer conducting the Outreach Program was 
out one day a month, for a full day at each location, he could 
service the people. It should be the primary job of the Outreach 
Program. 

By doing this in this manner, we believe it would speed up 
all claims filed at this time. It would also show the veterans 
and their families that our government does care. 



Sincerely , 



;/ 




162 




Service OHicers: 

John M. Emerick 
6072 Pleasant Street 
Fmlevville, PA 15332 
412 348 6478 

Ken Curley 
221 Evaline Street 
Pinsburgh, PA 15235 
412-371 0625 



AMERICAN DEFENDERS OF BATAAN & CORREGIDOR, INC. 



( INCLUDIMG ANY UNIT OF FORCE OF THE ASIATIC FLEET. PHILIPPINE 
ARCHIPELAGO. WAKE ISLAND. MARIANNA ISLAND. AND DUTCH EAST INDIESI 



JUL 2 01993 

CONGRESSMAN LANE EVANS 

CHAIRMAN 

SUBCOMMITTEE ON OVERSIGHT 

AND INVESTIGATIONS 

335 CANNON HOUSE OFFICE BUILDING 

WASHINGTON , D . C . 20515 



Service Office 

Room 415 ■ Federal Building 

1000 Liberty Avenue 

Pittsburgh, PA 15222 

412-644-4808 

Coruultadon by Appoincmenc 



DEAR CONGRESSMAN EVANS 



JULY 16, 1993 



QUESTIONS ASKED BY REP. TOM RIDGE 
PITTSBURGH FIELD HEARING 
JUNE 28,1993 

1. DO YOU FEEL THAT THOSE CLAIMS FOR POST TRAUMATIC STREEE SYNDROME 
ARE BEING ADJUDICATED FAIRLY? ARE THERE ANY INORDINATE NUMBERS BEING 
DENIED? 

A. NO, THERE IS LITTLE OR NO CONSIDERATION OR UNDERSTANDING OF POST 
TRAUMATIC STRESS SYNDROME , THERE ARE A SIZABLE NUMBER OF VETERANS WHO 
ARE NOT BEING CONSIDERED FOR P.T.S.S. 

2. WHAT DO YOU FEEL ARE THE MAJOR PROBLEMS AT THE REGIONAL OFFICE WITH 
RESPECT TO TIMELINESS AND QUALITY OF CLAIM PROCESSING? 

IN- YOUR OPINION, WHAT IMPROVEMENT DOES THE REGIONAL NEED TO MAKE? 

A, MORE OPEN MINDEDNESS AND A CLEARER UNDERSTANDING OF THE VETERANS NEEDS 
B^ THE ADJUDICATORS AND RATING SPECIALIST. 

3f^. ARE YOU AWARE OF THE PERSONNELL PROBLEMS AT THE VARO IN PITTSBURGH 
WHICH MIGHT INTERFERE WITH THE PROCESSING OF CLAIMS IN A TIMELY AND 
ACCURATE MANNER? 



A. I WAS NOT AWARE OF ANY PERSONNELL PROBLEMS, BUT I DO KNOW THAT WITH THE 
FUNDS BEING CUT THE WAY ARE AT THE REGIONAL OFFICE, THERE ARE NOT ENOUGH 
RATING SPECIALIST TO HANDLE THE WORK LOAD FAST ENOUGH. 



163 




Service OHicari: 

John M. Emerick 
6072 Pleas*ni Street 
Finleyville, PA 15332 
412 348 5478 

Ken Curley 
221 Evalcne St/eet 
Pinsburgh. PA 15235 
412 371 0625 



AMERICAN DEFENDERS OF BATAAN & CORREGIDOR, INC. 

( INCLUDING ANY UNIT OF FORCE OF THE ASIATIC FLEET. PHILIPPINE 
ARCHIPELAGO. WAKE ISLAND. MARIANNA ISLAND. AND DUTCH EAST INDIES) 



Service Offica 

Room 415 • Fe<)«r»l Building 

1000 LibertY Avenue 

Pinsburgh, PA 15222 

412-644-4808 

Coiuultaooa by Ap^iacmcnt 



4. IN YOUR OPINION WHAT IS THE RELATIONSHIP BETWEEN MANAGEMENT AND 
CLERICAL ASSISTANTS, ADJUDICATORS, AND THE RATING SPECIALIST WITHIN THE 
VA REGIONAL OFFICE IN PITTSBURGH? 

A.IWAS NOT AWARE OF ANY FRICTION BETWEEN MANAGEMENT AND STAFF, BUT IF THERE 
WHERE OR IS, IT SHOULD NEVER HAVE INTERFERED WITH THE PROCESSING OF CLAIMS 
OR INTERFERED WITH THE VETERANS RECEIVING A FAIR RATING FOR THE INJURIES 
THEY RECEIVED WHILE IN THE SERVICE OF THEIR COUNTRY. 

5. ACCORDING TO OFFICIALS AT THE VA CENTRAL OFFICE, THE PITTSBURGH VA 
REGIONAL OFFICE HAS IMPROVED ON TIMELINESS SINCE OCTOBER 1992, HAVE YOU 
NOTICED ANY ACTUAL IMPROVEMENT IN THE AREA OF TIMELINESS? 

A. YES, BUT WITH THE VETERANS OF DESERT STORM PLUS THE VETERANS FROM ALL 
OF THE OTHER WARS, THE IMPROVEMENT IS NOT AS SUFFICIENT AS WE WOULD LIKE 
TO SEE. 

6.' your statement discussed the success of the p . . w . program at the 
pittsburgh va regional office. do you have any suggestions as to what 
that office can do to achieve the same rate for other type of benefit 
ciJaims? 

j.what is needed is better understanding and better interpretation of 
the public laws that can benefit all veterans. 

for some reason the interpretation is not adequate enough to benefit 
all veterans. 



SINCERELY , 

KENNETH D. CURLEY ,>! . S .0 . -P .N .C . -A .D. B.C . 
221 EVALINE STREET 
PITTSBURGH, PA. 15235 



164 

Congressman Ridge to Veterans' Affairs Advisory Board 

QUESTIONS ASKED BY REP. TOM RIDGE SUBSEQUENT TO THE 

VA COMMITTEE FIELD HEARING IN PITTSBURGH ON JUNE 28, 1993. 

AUGUST 16, 1993 

REMARKS 

Our benefits committee began its investigation into the 
timeliness question because of a WIPP List (Exhibit A) was 
brought to our attention. We decided that to evaluate 
timeliness, we needed to compare regions that were similarly 
sized to Pittsburgh. We believed that this would be the only 
fair way to determine were problem areas existed. We requested 
the WIPP Lists from these regions from the VA itself through the 
Congressional Liaison office. They provided us with Exhibits B, 
C, and D. As you will note, these documents are not the WIPP 
Lists that we requested. 

Exhibits B and C were sent to the Directors office not 
directly to our Committee the VA in Washington, D.C. These two 
exhibits were presented to our Committee by Director Bushey's 
staff along with Exhibit D. Our committee was told that the VA 
staff needed to interpret the information for us. 

QUESTIONS AND ANSWERS 

1. PLEASE EXPLAIN IN FURTHER DETAIL THE COMPONENTS OF THE 
COMPREHENSIVE ACTION PLAN FOR THE IMPROVEMENT OF CLAIMS 
PROCESSING TIMELINESS. 

A. The committee recommended that the adjudication positions be 
advertised throughout the VA to attract experienced candidates. 
Since the hearing, it has been made clear to us that this will 
not be done. We think experienced adjudicators would give a 
"shot in the arm" to the staff, and relieve the "too many 
trainees to too few adjudicators" syndrome. Even if there was a 
temporary assignment of 2-6 months, this would provide at least 
some relief. Presently there are 20 adjudicators: 6 first class 
trainees, 3 second class trainees, 10 experienced adjudicators, 
and 1 person who is assigned full time to education claims. A 
couple of these 10 adjudicators will be assigned to authorizer 
slots leaving 2 less adjudicators until these slots are filled. 
We recommend that if 2 people are promoted, 2 people should be 
immediately put in the positions of adjudicators. Otherwise, you 
are back to square one and more crisis management. 

B. We recommended a delay in the promotions of 2 trainees to the 
Rating Board. This was declined, the Director's staff said that 
this was not a viable idea. We also recommend stronger 
supervision to fully utilize the 8 hour day. There is obvious 
slacking by a number of the employees of this division. 

C. We suggested broader cross training of benefits counselors as 
adjudicators . 



I 



165 



2. WHEN YOU WERE CONDUCTING YOUR STUDY, DID YOU FIND ANY 
MANAGERIAL PROBLEMS AT THE PITTSBURGH REGIONAL OFFICE? 

For the entire adjudication process, we recommend a careful 
look at the performance review process so inefficiency is brought 
to light. We have some reason to believe that management 
personnel who exhibit a lack of leadership shares the blame for 
poor performance. While this has been addressed recently by the 
Director and his staff, it is still evident today that poor 
performance is directly related to poor timeliness. 

3. DO YOU FEEL THAT THE DELIVERY OF BENEFITS AT THE VA REGIONAL 
OFFICE IS ACCEPTABLE IN TERMS OF ACCURACY AND PROMPTNESS OF 
DECISIONS? 

No, we do not believe that the delivery of benefits is 
acceptable at this date. Our committee believes the processing 
time is still in excess of 12 months. When we began our 
investigation, the WIPP List said initial disability compensation 
claims had a seven month processing time, and that figure was 
considered conservative. 

Accuracy is at a minimum. Unfortunately, 50% of the cases 
in our regional office are overturned by the hearing officer. 
This indicates poor and inadequate preparation by VA personnel 
prior to the case reaching the hearing officer. Some of this can 
be attributed to poor examinations conducted by the VA hospitals. 
Examination inadequacies should have been recognized by rating 
board specialists. Also, these same specialists have 
consistently failed in their responsibility to note when all 
necessary evidence is not part of the veterans folder. 

4 . WHAT DO YOU FEEL ARE THE MAJOR PROBLEMS AT THE VA REGIONAL 
OFFICE WITH RESPECT TO TIMELINESS AND QUALITY OF CLAIMS 
PROCESSING? IN YOUR OPINION, WHAT IMPROVEMENTS FOES THE REGIONAL 
OFFICE NEED TO MAKE? 

We see several problems. Among our concerns are: 
timeliness, poor management, insufficient staff, splintered 
attention to task, and morale affected by overload (Saturday 
overtime has been approved for every Saturday since January, give 
or take a few weekends). The committee does not recommend an 
increase in the present budget and resources. The Director must 
keep his pledge to make adjudication his #1 priority. Please 
refer to the quality of claims processing (see above), and also 
Exhibit E. 

5. ARE YOU AWARE OF ANY PERSONNEL PROBLEMS AT THE VARO IN 
PITTSBURGH WHICH MIGHT INTERFERE WITH THE PROCESSING OF CLAIMS IN 
A TIMELY AND ACCURATE MANNER? 

It is the committee's opinion that the Director in this 
regional office has not yet made the adjudication process his #1 



166 



priority. Without this adjudication process as the hub, the 
entire regional office shows a lack of productivity. Which 
creates a domino effect. In our view, personnel priorities 
should focus on the adjudication process. 

Recently, the adjudicator that is assigned to solely act as 
a congressional liaison, got so far behind that another 
adjudicator had to be taken off his regular duty and assigned to 
work on the congressional backlog. Not only is the regional 
office having trouble servicing the VETERAN in a timely fashion, 
but it seems to be having trouble servicing the Congress of the 
United States as well. We believe the most important goal of the 
VA is to serve the veteran in a timely manner without causing 
undue hardship to the veteran. 

6. IN YOUR OPINION, WHAT IS THE RELATIONSHIP BETWEEN MANAGEMENT 
AND CLERICAL ASSISTANTS, ADJUDICATORS, AND RATING SPECIALISTS 
WITHIN THE VA REGIONAL OFFICE IN PITTSBURGH? 

Management verses adjudication division: first of all there 
is a poor relationship, there is no support for department heads. 
When decisions are made at the Division level they are 
consistently not supported by the Directors office thus making 
them ineffectual. See page 16 of Inspector General's report. 

There is much evidence that the Director has been there so 
long that this alone transfers into some clout. The regional 
office is very in-bred. There are several husband/wife pairs 
that have protected themselves by the tag-team method. Morale is 
a serious problem. 

7. ACCORDING TO OFFICIALS AT THE VA CENTRAL OFFICE, THE 
PITTSBURGH VA REGIONAL OFFICE HAS IMPROVED ON TIMELINESS SINCE 
OCTOBER OF 1992. HAVE YOU NOTICED ANY ACTUAL IMPROVEMENT IN THE 
AREA OF TIMELINESS SINCE OCTOBER? 

NONE - The staff has worked almost every Saturday for a 
year. Timeliness is not up to par. 

The Committee is grateful for an opportunity to share the 
results of our investigation with your committee. 

Sincerely, 



Trea Graham Steve Dennison 

Member, Benefits Committee Chairman, Benefits Committee 

The Benefits Committee is one of 5 Committees that comprise 
Congressman Santorum's Veterans' Affairs Advisory Board. 



167 



Memorandum 

To: Harold T. Bushey 

Director, Pittsburgh V.a. Regional Office 
From: Rick S&ntorum 

Congressman, 18th District of PA 
Re: Information discussed during our meeting on 14 May 93 
Date: 8 June 93 

Please note that the following data was accumulated by 
members of my Veterans' Affairs Advisory Board, specifically 
merabera of my Benefits Committee. I would respectfully request 
that your office review the following information thoroughly and 
make any necessary corrections. 

Keith Schmidt, my Veterans' Affairs Coordinator, will be in 
touch with your offics vsr'/ soon to determine a date when both of 
us will be available for a follow-up meeting. 

My Benefits Committee compared 5 similarly sized districts: 

1) Pittsburgh 

2) Boston 
3} Jackson 

4 ) Newark 

5) Little Rock 

The following is a breakdown of the total number of Rating 
Board personnel and Adjudicators in each refien: 



a*ting Board Adjudicators 



1) 


Pittsburgh 




r — • 


n 


r. 


Boston 


n 


PLUS 1 Doctor 


3) 


Jackson 


11 


PLUS 2 Doctors 


29 


4) 


Newark 


9 




27 


5) 


Little Rock 


11 




27 



* Please note that Pittsburgh numbers are as of the date of 
this memo, but all other regions reflect their numbers as of 
February 1, 1993. 

Pittsburgh and Little Rock Include one Doctor each as part 
of their Rating Board count. 

It is also Important to note that our regional office 
includes Trainees In our total number of Adjudicators; the other 
four regions studied do not include Trainees In their count. 

Of the five regions, only Jackson and Pittsburgh count a 
Congressional Liaison as part of their Adjudication total. 

The following is a breakdown of the 23 Adjudicators in the 
Pittsburgh regional office: 

Authorlzers - 4 

Ploskon, Ayuyang, Moody and Farrell 



168 



Full-time Adjudicators - 9 

Boykins, Menefes, Szczepaniak, Malloy, McQuaide, 

Feather, Mosko, Gonzales and Prevost 
Full-time Education Adjudicator - 1 

Taylor 
Trainees - 9 

l8t class: Forbes, Bair, Kruper, Nalepa, Scott and 
wintermute 

2nd class: Heiser, Olsen and Moore 

Although my Benefits Committee unanimously agrees that 
everyone in Adjudication is giving 100%, the division is still 
significantly understaffed. The Committee contends that the 
staffing concerns naturally affect both productivity and 
timeliness. Based upon their interaction with Adjudication 
personnel, the Committee also believes that the heavy workload 
has had a serious impact on morale. 

Increase in workload, 1992: 

1) Pittsburgh 100.1% 

2) Boston 17.0% 

3) Jackson 23.1% 

4) Newark 22.7% 

5) Little Rock 178.4% 

Please note that, although Little Rock had almost twice as 
much increase as Pittsburgh, they had fewer rating cases pending. 
As of 1/29/93, Pittsburgh had approximately 100 more cases 
pending. Additionally, Little Rock had over 300 fewer cases over 
6 months old. Pittsburgh had 280 cases over 6 months old as of 
1/29/93. Consequently, Adjudicators worked nearly weekend since 
the beginning of the year. 

* 63.2% of cases from Pittsburgh that go before a hearing 
officer. The Board of Veterans in D.C, or are remanded were 
overturned in 1991/1992. 

56.8% - Boston 

42.5% - Little Rock 

My Committee has also brought to my attention that two full- 
time V.A. employees are assigned to "MBOC". Assuming that this 
is correct, does this have an impact on your overall budget or 
personnel ceiling? 

I would also like to discuss with you at our next meeting 
the possibility of having Veterans' Benefits Counsellors cross- 
trained with Adjudication personnel. It is my understanding that 
this idea was considered once before but was never implemented. 

Thank you for your continued cooperation with regards to my 
Benefits Committee's study of the Adjudication division. 



169 



IN DIRECTOR'S MAILBOX 8/12/92 



The Taible below shows timeliness for cocpleted claims for the ten 
month period from October 1, 1991, through July 31, 1992, for five of 
the largest Adjudication divisions, five of the smallest Adjudication 
divisions, four Adjudication divisions similar in size to the 
Pittsburgh Adjudication division (including Pittsburgh) axid the 
National averages. Timeliness is represented by the average of 
monthly data showing the time in days to complete the claim. For 
example the TaJole shows the Boston Adjudication division completed 
original compensation claims in an average of 199 days for the period 
shown. 



FIVE LARGEST ADJUDICATION DIVISIONS AND NATIONAL AVG. 



TYPE OF 


















CLAIM 


STL 


, PETE . 


ATLANTA 


WACO 


MUSKOGEE 


ST 


LOUIS 


NATIONAL 


Original Comp 




130 


178 


152 


147 




114 


160 


Reopened 




79 


110 


107 


87 




60 


99 


Original DIC 




69 


96 


114 


85 




77 


99 


Orig Pension 




98 


132 


120 


106 




80 


114 



FIVE SMALLEST ADJUDICATION DIVISIONS 



TYPE OF 












CLAIM 


SIOOX FALLS 


HONOLULU 


WILMINGTON 


WRJ* 


ANCHORAGE 


Original Comp 


176 


199 


171 


126 


, 172 


Reopened 


110 


160 


126 


72 


129 


Original DIC 


116 


122 


101 


66 


76 


Orig Pension 


101 


137 


133 


88 


91 



White River Junction, VT 



FOUR ADJUDICATION DIVISIONS SIMILAR 70 AND INCLUDING PITTSBURGH 



TYPE OF 












CLAIM 


PITTSBURGH 


NEWARK 


JACKSON 


BOSTON 


LITTLE ROCK 


Original Comp 


192 


159 


168 


199 


190 


Reopened 


121 


94 


97 


124 


107 


Original DIC 


125 


75 


89 


124 


118 


Orig Pension 


154 


111 


102 


144 


139 



NOTE: THE DATA SHOW ONLY ONE ASPECT OF PERFORMANCE EVALUATION, 
TIMELINESS AND DO NOT REFLECT OTHER ASPECTS 'OF CLAIMS PROCESSING, 
SUCH AS QUALITY AND PRODUCTIVITY, WHICH ALSO MUST BE CONSIDERED WHEN 
EVALUATING A STATION'S TOTAL PERFORMANCE. 



GHARTUNG:glh 8/10/92 214 



WANG 020eB 



75-767 0-94-7 



170 



WIPP LISTING 
VAPO PPOCESSIKG TIMES AS OF June 1992 



END PRODOCT CESCHIPTION PROCESSING TIME 

110 Initial Disability Compensation Claims 7 Months 

120 Kon-Original Claims 5 Months 

130 Dependency Claims for CSP "I Months 

140 Original Death (C&P) Claims 4 MohtHs 

150 Income, Estate & Election Under New Law 2 Months 

160 Burial & Accrued Claims 2 Months 

170 CiP Notices of Disagreement 5 Months 

180 Initial Disability Pension Claims 5 Months 

190 Original Death Pension Claims 3 Months 

200 Original Education 5 Month 

210 Re-Entrance & First Change of Program 5 Month 

220 Mitigating Circumstances 1 Month 

230 , Dependency Claims 1 Month 

240 Unsatisfactory Progress 1 Month 

270 Education Notice of Disagreement 2 Month 

280 Second Change of Program 1 Month 

290 Eligibility Determinations 1 Months 

295 Eligibility 3 Months 

310 Future Examinations & DnempliSyability 3 Months 

320 Bospital/OPT Reports - Para 29 & 30-^ 4 Months 

330 Reviews - Regulatory 4 Procedural 1 Month 

400 Letters of Explanation 1 Month 

500 Special Correspondence 1 Month 

680 & 690 New Legislation - CO Reviews 3 Months 

960 Dependency Reviews 1 Months 



171 



As of 9-30-92 



Station 


No. of Rating 
Board Meirbers 


No. of 1 % of Ttotal ' 
Ai;judicatars I Workload 'Output 


% of C&P 
Vforklcad Output 


% of Educ 
Vtorkload Outou 


Pittsburgh 


9 


21 


1.31 


1.49 


0.53 


Newark 


9 


27 1 1.63 


1.38 


0.53 


Jackson 


11 


31 ; 1.94 


2.20 1 0.30 


Boston 


11 


30 


1 1-- 


1.73 


0.80 



Little Rock 



Note : As of 2-1-91 (Pre-Desert Storm) , there were 20 adjudicators on duty at 
VARO Pittsburgh, PA. 



172 





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174 



AVERAGE DAYS TO COMPLETE (Monthly) 



ev 


VtiSD 


Nacional 


VARO 


National 


GQA 




SEP 


SEP 


OCT 


OCT 




110 


221 


174 


216 


174 


106 


120 


141 


122 


149 


122 


82 


130 


54 


34 


63 


37 


25 


140 


116 


102 


174 


103 


68 


150 


64 


47 


74 


37 


24 


155 


66 


27 


96 


25 


19 


160 


44 


32 


48 


33 


29 


170 


94 


99 


90 


87 


29 


Lao 


160 


116 


162 


119 


77 


190 


99 


66 


115 


66 


44 


290 


84 


43 


68 


49 


61 


310 


83 


65 


98 


66 


60 


320 


116 


63 


155 


63 


46 


600 


101 


6S 


91 


68 


Pent 



AVERAGE DAYS TO COMPLETE (FYTD) 



EP 


VARO 


National 


VARO 


National 




SEP 


SEP 


OCT 


OCT 


110 


199 


164 


216 


174 


120 


128 


105 


149 


122 


130 


49 


33 


63 


37 


140 


130 


99 


174 


103 


150 


58 


36 


74 


37 


155 


52 


26 


96 


25 


160 


45 


32 


48 


33 


170 


84 


89 


90 


87 


180 


154 


115 


162 


119 


190 


94 


64 


115 


66 


290 


94 


44 


68 


49 


310 


87 


67 


98 


66 


320 


107 


60 


155 


63 


600 


106 


70 


91 


68 



46 

Pending 



COMMENTS: Effective October 1, 1992, the average days to complete is the 
guide used to monitor the general effectiveness of adjudication claims 
processing and identify out of line situations. Guidance is provided in 
M21-4, Chapter 4 . 



Because of the emphasis being placed on completing old cases, division 
management anticipates average days to complete to increase before starting to 
improve . 



175 



Questions Asked by Rep. Tom Ridge 

Pittsburgh Field Hearing 

June 28, 1993 

To Thomas M. Fitzgerald, Jr. - WLP: 

1. Do you feel that those claims for Post-Traumatic Stress Syndrome are being 
adjudicated fairly? Are there an inordinate number being denied? 

We at the Vietnam Veterans Leadership Program of Western Pennsylvania, Inc. 
(WLP) are not actively involved in the adjudication of (Post Traumatic Stress Disorder) 
PTSD claims In fact, all of our work in this area is done on a referral basis with either the 
VARO or a veterans service organization Most of the WLP information regarding 
adjudication of PTSD or any other type of veteran benefit claim is received directly from 
WLP veteran clients Some of our clients say that too many claims are being denied and 
that the needs of veterans afflicted with PTSD are not being addressed Other clients, 
however, say that too many veterans are being diagnosed with PTSD to fulfill the program 
continuation needs at the local VAMC psychiatric facility's PTSD program (i e , to justify 
its existence) 

2. What do you feel are the major problems at the VA Regional OITice with 
respect to timeliness and quality of claims processing? In your opinion, what 
improvements does the regional office need (o make? 

From WLP client responses, major VARO concerns include poor staff morale 
and the consequent negative effects on quality customer care, poor record keeping, and, 
seemingly non-interest from management in creativity Again, from WLP client 
responses, needed improvements include customer service training for VARO staff. 

3. Are you aware of any personnel problems at the VARO in Pittsburgh which 
might interfere with the processing of claims in a timely and accurate manner? 

From WLP client responses, poor VARO staff morale has a negative efTect on 
quality customer care No noted situations or named personnel were mentioned in these 
client responses. 

4. Ill your opiiiiuii, niiui i.s illc rtrii>tiuiisiii;j uiriwccil iiiuii;ig«.'ir.cni aiiJ liLi'ica! 

assistants, adjudicators, and rating specialists within the VA Regional OfTice in 
Pittsburgh? 

WLP staff members do not generally work with the VARO staff but rather deal 
primarily with veteran clients Therefore most of the feedback from the VARO is 
generated from these very clients, and WLP does not have solid information on VARO 
management/staff working relationships 



Continued .... 



176 



5. According to ofTicials at the VA Central OfTice, the Pittsburgh VA Regional 
Office has improved on timeliness since October of 1992. Have you noticed any 
actual improvement in the area of timeliness since October? 

WLP veteran client responses reflect no noticed differences in VARO timeliness 
issues since October of 1992. Please keep in mind, however, that WLP is involved with 
veteran employment issues and is not directly involved with veteran benefit claim issues. 
Due to this emphasis, a longer time period (i.e., longer than since October, 1992) would 
be need for the WLP office to recognize this change. This particular question may be 
best directed to veteran service organizations, since these are the organizations which deal 
directly with veteran claims. 

6. Has any employee of the Pittsburgh VARO ever explained to you as to why 
they have a lower than average allowance rate for PTSD claims? 

No. Please keep in mind, however, that the WT^P staff has no opportunity or 
reason to talk with VARO employees regarding this issue. 



Respectfully submitted. 




Thomas M. Fitzgerald, Jr. 

Immediate Past President - 

Vietnam Veterans Leadership Program 

of Western Pennsylvania, Inc. (WLP) 

August 30, 1993 



TMF/jj 



177 



QUESTION ASKED BY REP. TOM RIDGE 

PITTSBURGH FIELD HEARING 

JUNE 23, 1993 

TO CHARLES LIEBERTH: 

YOU HAVE HEAR MUCH TODAY ABOUT THE PROBLEMS PITTSBURGH VARO 
HAS WITH CLAIMS PROCESSING. GIVEN THE SUCCESS WHICH YOU INDTCATE 
THAT OFFICE HAS HAD IN OTHER AREAS, WHAT DO YOU BELIEVE CAN BE 
DONE TO IMPROVE THE TIMELINESS AND QUALITY OF CLAIMS PROCESSING? 

In response to the above Question, let me expand on the sunaestion I made in ny 
testimony at the recent field hearinq in Pittsburnh. 

It seens to ne, Sasea on experience ana observation, that a sionificant amount of 
claims nrocessina can be attributed to the difficultv of validatina, documentino and 
authenticatino a claim. A claimnant bases his claims on memory, military records 
which mav or may not exist, or witnesses who cannot be located and other reasons. 

The sunaestion I would make and repeat is that at the time of discharae, counseling 
and Drocessina a soecial form should be develooed. 

This form would be utilized bv the counselor and the information to be orovided bv the 
"about to be" discharaed person. This information to be orovided would include the 
statements bv the oerson as to sickness/iniurv, date, olace, nature of accident, 
witnesses and such other pertinent facts. 

Copies would become part of the oerson's militarv record; coov orovided to the nerson; 
coov given to veteran's ornanization of choice (VF!-), AL, DAV). 

This data would assist considerably in claims processing and adiudication. 



178 



QUESTIONS ASKED BY REP. TOM RIDGE 

PITTSBURGH FIELD HEARING 

JUNE 28, 1993 



RESPONSE RESPECTFULLY SUBMITTED BY 

JACK S. EHRHARDT, MSW/ACSW 

TEAM LEADER, VET CENTER (222) 



1. DO YOU FEEL THAT THOSE CLAIMS FOR POST-TRAUMATIC STRESS SYNDROME ARE 
BEING ADJUDICATED FAIRLY? ARE THERE AN INORDINATE NUMBER BEING DENIED? 

In response Co the first part of question one (1), I would say that given 
the resources available to the individuals rating the cases, that they are 
adjudicated fairly. However, I would say it's not a fair shake for the 
veteran because of the time element involved and the tremendous burden of 
proof that is placed on the veteran, such as detailed information on where 
the stressor event occurred and details about location, personnel, and 
geography that are often difficult events for the veteran to recall because 
of repression and suppression of those very memories as a coping mechanism 
for PTSD. 

PTSD is very difficult to work with in treatment and claims process. It is 
a complex disorder and very difficult in the legal sense (ie., claims 
process, court defense, etc.). Thus, claims are not adjudicated fairly for 
PTSD because they require more time and resources than are available to 
give the veteran a fair shake for his service. 

It has been stated that the Pittsburgh Regional Office has the lowest rate 
of PTSD adjudicated in the veterans favor in the nation. This may need to 
be addressed further. 

2. WHAT DO YOU FEEL ARE THE MAJOR PROBLEMS AT THE VA REGIONAL OFFICE WITH 
RESPECT TO TIMELINESS AND QUALITY OF CLAIMS PROCESSING? IN YOUR OPINION, 
WHAT IMPROVEMENTS DOES THE REGIONAL OFFICE NEED MAKE? 

As I stated in June, problems at the Regional Office are not any one person 
or department, but a system problem that has its root in lack of resources; 
in terms of personnel and varied expertise and in the adjudication claim 
review process and rating process. In short, there are too many claims of 
different types being fed into an overloaded system that doesn't have 
enough circuits to receive, assimilate, and service the need of the input 
(which in this case is the number of veterans seeking claims). This 
overload not only causes difficulty for the Regional Office, but also a 
ripple effect that goes through the system at the Medical Center, Vet 
Centers, other parts of the health care system, the individual veterans 
life, and the social and family systems with which he interacts. 

From my vantage point, the improvements needed at the Regional Office would 
include more human resources and more training for those personnel. Field 
offices such as the Vet Centers could be a tremendous asset to the claims 
process and the Regional Office, if they were additionally staffed and 
trained to work with the veterans and the claims process. This might 
include assisting the veteran in packaging the claim, etc. 

3. ARE YOU AVv'ARE OF ANY PERSONNEL PROBLEMS AT THE VARO IN PITTSBURGH WHICH 
MIGHT INTERFERE WITH THE PROCESSING OF CLAIMS IN A TIMELY AND ACCURATE 
MANNER? 

Only in one (1) instance did I encounter an individual that appeared to be 
inappropriate. That individual is no longer working in the claims process 
and is under indictment for fraud related to the claims process. 



I 



179 



4. IN YOUR OPINION, WHAT IS THE RELATIONSHIP BETWEEN MANAGEMENT AND 
CLERICAL ASSISTANTS, ADJUDICATORS, AND RATING SPECIALISTS WITHIN THE VA 
REGIONAL OFFICE IN PITTSBURGH? 

I could not comment on this, since I am not closely involved in the 
day-co-day management of the Regional Office. I would say that their 
relationship with us has improved a great deal recently and that a 
cooperative effort is producing a much better result for both us and them 
and most importantly those who served. 

5. ACCORDING TO OFFICIALS AT THE VA CENTRAL OFFICE, THE PITTSBURGH VA 
REGIONAL OFFICE HAS IMPROVED ON TIMELINESS SINCE OCTOBER OF 1992. HAVE YOU 
NOTICED ANY ACTUAL IMPROVEMENT IN THE AREA OF TIMELINESS SINCE OCTOBER? 

There has been some improvement since October 1992. We still have a long, 
long, way to go to be an adequate and timely service for the veteran (as 
was stated in June 93 by one of the hearing attendees). We put 500,000 men 
in the Gulf along with all their supplies and equipment i.i a matter of 
months, and completed the mission in several months. It will take most 
veterans three (3) times that amount of time to have their claims come to a 
final disposition. 

6. HAS ANY EMPLOYEE OF THE PITTSBURGH VARO EVER EXPLAINED TO YOU AS TO WHY 
THEY HAVE A LOWER THAN AVERAGE ALLOWANCE RATE FOR PTSD CLAIMS? 

- Only that resouces are limited - 



180 

Chairman Evans to Harold Bushey, Director, VARO, 
Pittsburgh, PA 

QUESTIONS SUBMITTED BY 

HONORABLE LANE EVANS, CHAIRMAN 

SUBCOMMITTEE ON OVERSIGHT i, INVESTIGATIONS 

COMMITTEE ON VETERANS' AFFAIRS 

DELIVERY OF VETERANS BENEFITS (. SERVICES 
BY THE PITTSBURGH REGIONAL OFIFCE AND RELATED ISSUES 

JUNE 28, 1993 
1. HOW CAN THE PITTSBURGH REGIONAL OFFICE, "WORK SMARTER, NOT HARDER"? 



We have identified several ways to work smarter and not harder. One 
which we feel will have major impact is the adoption of Total Quality 
Nanagenent principles into the operation of the regional office. Through 
the use of TQM, the people actually performing the duties and who are 
most familiar with the operations are involved in resolving the problems 
and Improving work processes. We use intradivisional task teams to look 
at problems which cross division lines and attempt to foster a regional 
office perspective as opposed to a division or employee perspective in 
resolving problems. 

Support divisions without direct program responsibility have been 
carefully scrutinized to make them as lean as possible. Through these 
efforts, we have been able to affect more efficient manpower utilization 
by moving personnel to the Adjudication Division. We have reassigned six 
employees from other areas of the regional office to the Adjudication 
Division resulting in the addition of six claims examiner (adjudicator) 
positions. We will continue to monitor workloads and staff for m a xi mum 
utilisation. 

We are also looking at non-traditional ways of doing work. A good 
example of which is the training of Veterans Benefits Counselors to 
perform "select" adjudicator duties which do not require a great deal of 
training but allows us to process routine cases expeditiously. The 
establishment of a Special Processing Unit for congressional Inquiries 
which will eventually handle our Veterans Assistance Inquiries is another 
example. The use of personnel from other program areas who would be 
available on a short term basis to do development work relative to claims 
processing is being explored. Follow-up calls to secure information 
needed to process the claim and review of the claims folder to ensure 
that all necessary information has been secured prior to processing are 
two areas which show promise. We are looking at the possible use of 
Veterans Benefits Counselors assisting in case development and further 
down the line at the assignment of case managers to ensure better control 
of processing. 



IDENTIFY THE STEPS OR ACTIONS WHICH THE PITTSBURGH REGIONAL OFFICE CAN 
TAKE TO IMPROVE THE QUALITY OF VETERANS' BENEFITS CLAIMS ADJUDICATION 
(QUICKER DECISION-MAKING WITH FEWER PROCEDURAL AND SUBSTANTIVE ERRORS) 
WITHOUT A CORRESPONDING REDUCTION IN THE QUALITY OF ANY OTHER SERVICE 
PROVIDED BY THE PITTSBURGH REGIONAL OFFICE. 

The following are some of the steps or actions the regional office can 
take to improve the quality of claims adjudication: 

- Explore further specialization of functions within the division. 

- Broaden the scope of standardization of procedures. 

- Further review and refine work flow processes to identify and eliminate 
unnecessary delays and inefficiencies. 

- Expand the emphasis on the identification of training needs, and the 
development of programs to meet those needs. 

- Explore the use of telephone contacts and FAX transmissions to obtain 
and confirm evidence from claimants to expedite claims processing. 



181 

IDENTIFY THE ACTIONS TAKEN BY THE PITTSBURGH REGIONAL OFFICE TO REDUCE OR 
ELIMINATE UNNECESSARY DELAYS IN THE PROCESSING OF BENEFIT CLAIMS, AS 
REPORTED BY THE OFFICE OF INSPECTOR GENERAL. 

The following actions have been vmdertaken as reported to the IG 
regarding improvement of claims processing timeliness: 

In February 1993, the regional office Automated Medical Information 
Exchange (AMIE) System was converted from Wang Office to a PC based 
application which runs faster and smoother. This has given the 
development clerks better access to the VA Medical Centers (VAMCs) in our 
jurisdiction. This and other joint actions with the VA Medical Centers 
have resulted in improved efficiencies in the areas of comnunication and 
medical processing, achievements which Secretary Brown has noted in his 
recent conments as an indication of the cooperative spirit that exists 
within the Department of Veterems Affairs. 

A plan has been devised to redistribute the developoient clerk work. The 
GS-5 clerks are responsible for all activity on EP 160 (burial claims), 
for initial claims establishment to completion of claim. They are also 
responsible for all development on original claims (EP 110 
(compensation), EP lAO (service-connected death), EP 180 (nonservice 
connected pension), EP 190 (nonservice connected death pension). This 
allows the more experienced clerks to do the development for Service 
Medical Records (SMRs), and service verification, while allowing the GS-^t 
clerks to do all other development actions. Closer supervisory Work In 
Progress (WIPP) reviews will also ensure more timely follow-ups. 

The responsibility of printing completed AMIE examinations has been given 
to one GS-3 file clerk. In addition to printing the examinations, he 
associates them with the claims folders, and refers them to the rating 
board, thus relieving the developoient clerks of these duties. 

Senior adjudicators have been reviewing all original pension claims, EP 
180 and EP 190, and making initial eligibility determinations regarding 
income and qualifying wartime service. This reduces or eliminaLes 
unnecessary development by the rating board and other authorization 
personnel. 

A screening table was established in February for all cases being 
referred to the rating boards. At this jxjint a rating board specialist 
reviews cases, and inmediate rating board development is undertaken; 
examinations are scheduled; cases are certified to the Board of Veterans 
Appeals (BVA); quick rating actions are identified; and only those cases 
that appear ready to rate are referred. This is resulting in more timely 
development and follow-ups. 

In January 1993, one claims examiner was assigned primary responsibility 
for the processing of all education cases in the regional office. This 
has relieved the other adjudicators of this responsibility, and allowed 
them more time to process compensation and pension cases. 

The development clerks have been given standardized checklists to 
temporarily place in claims folders and to use as a guide in the 
development of cases. A standardized DISP procedure has also been 
established to allow for easier monitoring and control of pending cases 
by supervisors. The standardized DISP procedures were implemented in 
December 1992. At that time, training was completed on both the DISP 
procedures and the checklist. In November 1992, the correspondence 
clerks received training on Circular 20-92-2'*, which dealt with the 
receipt of service medical records from the Service Medical Records 
Center (SMRC). They had also received training on Word Processing and 
E-mail procedures. 

In January, both development and correspondence clerks received training 
on the recent circular pertaining to environmental hazards encountered 
during Desert Storm. Correspondence clerks were instructed in the proper 
procedures to E-mail confirmation of cases to the Louisville Regional 
Office, and the generation of Wang letters to claimants. 



182 

Training is an ongoing process. The Quality Control and Training 
Specialist (QCTS) has been directed to closely monitor initial 
development and conduct additional training where appropriate. He also 
utilizes E-mail and meetings to disseminate instructions and 
clarifications to changes in circulars, directives, etc. 

Adjudication supervisory personnel have been instructed in the necessity 
to follow the current Work-in— Progress (WIPP) User Plan, to do reviews on 
a timely basis, and to annotate their results. Unit Chiefs are taking a 
more "hands on" approach to directing work by daily review of WIPP 
screens, and completing WIPP reviews in an effort to ensure a smoother 
movement of claims. 

The Acting Adjudication Officer samples the Section Chief and Hearing 
Officer reviews to ensure they are being done. Likewise the 
Authorization Section Chief ensures Unit Chief reviews are being 
completed. Findings are validated by a mstnagement analyst from the 
Director's Office. 

3. THE OFFICE OF INSPECTOR GENERAL (OIG) RECENTLY REPORTED PITTSBURGH 
REGIONAL OFFICE, "ADJUDICATION DIVISION PERSONNEL OFTEN RECORDED 
INACCURATE DATA IN THE WORK-IN-PROCESS (WIPP) SUBSYSTEM". 

WHAT ACTIONS HAVE BEEN TAKEN TO CORRECT THIS PROBLEM? 

The QCTS has conducted specific training for the correspondence clerks 
on the correct method of recording data into the WIPP Subsystem. To 
ensure this recording is being accomplished properly, the supervisors are 
more closely examining the accuracy of the WIPP data as part of the 
regularly scheduled quality reviews. Moreover, the correspondence clerks 
responsible for the input of this data have had their work standards 
revised to reflect more rigid quality controls. 

PLEASE PROVIDE EVIDENCE THAT THE ACTIONS TAKEN TO CORRECT THIS PROBLEM 
HAVE BEEN SUCCESSFUL. 

The QCTS has reported a reduction in the inaccuracies detected dtirlng 
scheduled quality reviews, and recent feedback from first-line 
supervisors also indicates that correspondence clerks are recording data 
more accurately. In addition, feedback from Veterans Services Division 
personnel working with Veterans Assistance Inquiries and routine 
telephone inquiries, indicates improved accuracy and reliability from the 
WIPP Subsystem. 



U. PLEASE EXPLAIN THE FAILURE OF RESPONSIBLE ADJUDICATION DIVISION PERSONNEL 
TO BE AWARE OF EVIDENCE REQUIREMENTS AND FOLLOWUP PROCEDURES, 

During the time frame cited by the IG, the development clerks were 
confronted with high pending workloads, and attempting to learn the AMIE 
system. It is not so much the clerks did not know what to do, but felt 
pressured to reduce work on hand, and therefore employed shortcuts in 
development not authorized by management nor consistent with manual 
requirements . 

WHAT ACTIONS HAVE BEEN TAKEN TO ELIMINATE THESE PROBLEMS? 

The QCTS has been closely monitoring initial development and has 
conducted additional training where appropriate. He also utilizes E-Mail 
and brief meetings to give instructions, and clarifications to either 
manual or circular changes. 

The development clerks now have a standardized checklist to ensure that 
all evidence is requested. The senior claims examiners have also been 
reviewing all pension cases for Income and wartime service. All cases 
referred to the rating board are sent to one point where one rating 
specialist undertakes immediate board directed development. 



183 

PLEASE PROVIDE EVIDENCE THE ACTIONS TAKEN TO CORRECT THESE PROBLEMS HAVE 
BEEN SUCCESSFUL. 

Timellnees in claims processing has improved to the point that for June 
1993 the Adjudication Division was at or better than the national average 
for 10 of the 13 measured end products. In addition, the total number of 
cases pending in WIPP on 7-20-92 was 11,817. Effective 10-5-92, the 
start of FY, there were 12,174 cases pending which have been reduced to 
9,894 on 7-19-93. 

THE OFFICE OF INSPECTOR GENERAL RECOMMENDED PITTSBURGH REGIONAL OFFICE 
ADJUDICATION DIVISION RESOURCES BE REDIRECTED TO SPEEDUP REQUESTS FOR 
EVIDENCE AND TO PROVIDE MORE PROMPT FOLLOWUP. 

IDENTIFY THE ADJUDICATION DIVISION RESOURCES WHICH HAVE BEEN REDIRECTED, 
AS RECOMMENDED BY THE OFFICE OF INSPECTOR GENERAL, AND EXPLAIN HOW THESE 
RESOURCES HAVE BEEN REDIRECTED. 

In Febriiary 1993, the regional office AMIE System was converted from 
WANG Office to a PC based application which runs faster and smoother. 
This has given the developoient clerks better access to the VAMCs in our 
jurisdiction. 

A plan has been devised to redistribute the development clerk work. The 
GS-5 clerks are responsible for all activity on EP 160, for initial 
claims establishment to completion of claim. They are also responsible 
for all development on original claims (EP 110, 140, 180, 190). This 
will allow the more experienced clerks to do the development for SMRs, 
and service verification, while allowing the GS— 4 clerks to do all other 
development actions. Closer supevisory WIPP reviews will also ensure 
more timely follow-ups. 

Consideration is also being given at the present time to have the more 
experienced GS-5 clerks do all development on EVA remands. 

The responsibility of printing completed AMIE examinations has been given 
to one GS-3 file clerk. In addition to printing the examinations, he 
associates them with the claims folders and refers them to the rating 
board, thus relieving the development clerks of these duties. 

Since January 1993, the senior adjudicators have been reviewing all 
original pension claims, EP 180 and EP 190, for income and appropriate 
wartime sevice. This is done prior to referral to the rating board or 
authorization for further action. 

A screening table was established in February for all cases being 
referred to the rating boards. At this point a rating board specialist 
reviews cases, and imnediate rating board developotent is undertaken, 
examinations are scheduled, cases are certified to BVA, quick rating 
actions are identified, and only those cases that appear ready to rate 
are referred to the rating boards. In the long run, this will result in 
■ore timely development and follow-ups. 

In January 1993, one claims examiner was assigned primary responsibility 
for the processing of all educational cases in the regional office. This 
has relieved the other adjudicators of this responsibility, and allowed 
them more time to process compensation and pension cases. 

On June 24, 1993 a clerk was reassigned to the correspondence activity as 
part of the effort to reduce average control time. 

DESCRIBE THE RESULTS OF THIS REDIRECTION OF ADJUDICATION DIVISION 
RESOURCES. 

Since the Central Office survey of March 1992, authorization backlog has 
been reduced from over 5,000 cases to approximately 2,400 cases pending. 
Development clerk backlog has also been reduced. With this reduction in 
backlog, the development clerks are able to do more timely initial 
developoient and follow-up requests. 

Claims processing timeliness has improved both in the areas of 
compensation and pension cases, as well as education. 



184 

DESCRIBE THE KNOWN TRAINING NEEDS OF PITTSBURGH REGIONAL OFFICE 
ADJUDICATION DIVISION PERSONNEL. 

There is an ongoing need for training in the Adjudication division. 
There are always changes in procedures, projects, the enactment of new 
legislation. Court of Vetereins Appeals decisions and computer 
enhancements, which all impact on the adjudication division etnd its 
ability to process and handle claims. There is also a need to continue 
training for. the new trainee adjudicators and new rating board members. 

DESCRIBE CURRENT PLANS TO SATISFY THESE TRAINING NEEDS. 

- Training on new issues occurs whenever new circulars, court decisions, 
or manual changes are issued. 

- Refresher training is conducted as necessary based on individual 
feedback, and as needs are identified on either station or individual 
Statistical Quality Control. 

- The rating boards and Hearing Officers attend the monthly Court of 
Veterans Appeals Hotline. The Rating Board Section Chief also holds 
meetings to discuss court cases, or other issues of relevance to the 
rating boards. 

- The adjudication division has a special training unit for new 
adjudicators. Over the years, the work of adjudicators has become more 
complex, and it takes approximately two years to become fully trained. 
All new adjudicators attend the three week basic adjudicator training at 
the VBA Training Academy. Thereafter, they continue their training in 
the training unit, learning to work progressively difficult and complex 
claims. Employees having difficulties with certain types of cases may 
voluntarily attend training unit classes. Employees whose work shows 
deficiencies in quality will have a training program developed for them 
which may include one on one training, attendance at training unit 
classes or a combination thereof. This approach has proved very 
beneficial. 

- The two new rating specialists will be attending a 1 week seminar for 
new rating specialists in Augtist at the VBA Training Academy. 
Thereafter, one rating specialist and one Hearing Officer will be 
responsible for their training. The rating board physician will assist 
in the training, as well as the Rating Board Section Chief and Assistant 
Adjudication Officer. 

HOW MANY PITTSBURGH REGIONAL OFFICE PERSONNEL HAVE RECEIVED SUFFICIENT 
CROSS-TRAINING SO THAT PERSONNEL FROM OTHER DIVISIONS CAN EFFECTIVELY 
ASSIST WITH ADJUDICATION OF CLAIMS AS NEEDED? 

While cross-training of personnel offers the office greater flexibility 
and employees a greater sensitivity or understanding of the purpose of 
their work, it also has certain drawbacks. The cross training for highly 
technical positions requires considerable time of both the trainer and 
trainee. For instance, it is generally accepted that it takes two years 
to train a new employee to become a fully trained adjudicator. If 
individuals are trained and do not work in the claims examination process 
they will not be familiar with changes in benefit laws and their 
application and will also need refresher training in processing. 

We have cross trained employees to perform select duties that would 
relieve adjudication personnel to perform more complex duties. Some 
examples are: 

- the use of approximately six clerks and typists from other divisions to 
process Eligibility Verification Requests; and 

-the VBC/VCE initiative where more simple, routine processing of 
documents cein be done in the Veterans Services Division. 



185 

7. PLEASE EXPLAIN THE FAILURE OF SUPERVISORS TO REVIEW CLAIMS PENDING AS 
LONG AS 590 DAYS, AS REPORTED BY THE OFFICE OF INSPECTOR GENERAL, 

The GIG noted that a claim or case on the WIPP list was pending for over 
590 days without proper annotation to indicate it was reviewed and the 
reason it had not been worked. Cases are reviewed by Unit Chiefs after 
90 days. Section Chiefs after 180 days, the Assistant Adjudication 
Officer after 270 days and the Adjudication Officer sifter one year. 
Because of the large numbers of claims pending, proper annotation of the 
files may not have been made. However, review of WIPP lists shows that 
these are currently being annotated as proof that the reviews are 
completed. 

DESCRIBE THE ACTIONS TAKEN BY THE PITTSBURGH REGIONAL OFFICE TO INSURE 
ALL PENDING CLAIMS ARE ADEQUATELY REVIEWED IN A TIMELY MANNER BY 
SUPERVISORY PERSONNEL. 

Adjudication supervisory personnel have been instructed of the necessity 
to follow the current WIPP User Plan, to do reviews on a tijnely basis, 
and to annotate their results on the WIPP lists and in the claims 
folders. Unit Chiefs are taking a more "hands on" approach to directing 
work by daily review of WIPP screens, and completing WIPP reviews in an 
effort to ensure a smoother movement of claims. 

The Acting Adjudication Officer samples the Section Chief and Hearing 
Officer reviews to ensure they are being done. Likewise the 
Authorization Section Chief ensures Unit Chief Reviews are being 
completed. Findings are validated by a management analyst from the 
Director's Office. 

8. PLEASE EXPLAIN THE FAILURE OF REGIONAL OFFICE PERSONNEL TO DETECT THE 
DEFICIENCIES IN PITTSBURGH REGIONAL OFFICE NOTIFICATION LETTERS AS 
REPORTED BY CENTRAL OFFICE. 

During the March 1992 station survey VACO reviewed a nianber of 
notification letters and found deficiencies in several. They also noted 
that while authorization actions overall reaain acceptable both local and 
central office quality reviews have noted this deficiency. 

To correct this, the senior adjudicators were advised to review 
notification letters more closely prior to authorization of cases. Unit 
Chiefs and the QCTS are paying closer attention to notification letters 
on their reviews, and the QCTS provides individual training or 
instructions to personnel whose letters are deficient. With the 
introduction of the WANG WP System the adjudicators now are able to take 
the discussion paragraph from a rating decision and Include it in their 
notification letters. This gives the claimant a better understanding of 
the decision. 

9. THE PITTSBURGH REGIONAL OFFICE HEARING OFFICER ALLOWANCE RATE IS HIGHER 
THAN THE NATIONAL AVERAGE. 

DOES INADEQUATE DEVELOPMENT AND ADJUDICATION OF BENEFIT CLAIMS BY 
PITTSBURGH REGIONAL OFFICE PERSONNEL CONTRIBUTE TO THIS HIGHER ALLOWANCE 
RATE? 

No. Inadequate developoient and adjudication of benefits claims do not 
contribute to the higher grant rate. 

IF NOT, PLEASE IDENTIFY THE FACTORS RESPONSIBLE FOR THE HIGHER ALLOWANCE 
RATE. 

A total of 26 regional offices have a grant rate higher than the 
national average. Over the last several years, the grant rate as well as 
the rate of development has increased nationally, due in part to the 
impact of the Court of Veterans Appeals, and current guidelines on 
testimony, procurement of evidence, and duty to assist. 



Grant/development rates 



Pgh 



FT 93 






2 QTRS 




FY 92 


grant 


development 


grant developnent 


50.8 


69.2 


45.7 60.5 


35.5 


56.5 


33.4 47.1 



FY 91 
grant development 
48.3 69.3 



Natl 35.5 56.5 33.4 47.1 26.4 46.8 



186 

Oftentimes new evidence is presented to the hearing officer at the time 
of the hearing which was not available to the ratings board when they 
made their decision. The statistics also reflect the sensitivity and 
compassion of the hearing officers who are able to talk to the veterans, 
address their needs, and draw out additional data and information that 
may be beneficial to a claim. While there may be some instances where 
further development would have been desirable, the greater proportion of 
development and grants are due to the face to face meetings, and the 
opportunity to discuss with a veteran his or her claim. 

10. COURT OF VETERANS APPEALS DECISIONS HAVE BEEN CITED AS ONE FACTOR 
CONTRIBUTING TO PITTSBURGH REGIONAL OFFICE HIGH REMAND RATE. 

HAVE COURT OF VETERANS APPEALS DECISIONS DISPROPORTIONATELY AFFECTED THE 
PITTSBURGH REGIONAL OFFICE? IF SO, PLEASE EXPLAIN. 

COVA decisions have not disproportionately affected the Pittsburgh 
regional office remand rate. Certainly, the remfind rate has had £tn 
impact on timeliness both locally and nationally. This was noted in 
testimony by then Deputy Secretary Principi in testimony before the House 
Veterans Affairs Committee on 3-18-92. He indicated that before the 
advent of the Court EVA remanded 18-20% of cases each year to the 
regional offices. The EVA remand rate in 1992 was 52%. The remand rate 
for the first three quarters of FY 93 is 47.3% nationally and 45.6% for 
this office. 



11. PLEASE IDENTIFY THE RECENT STEPS WHICH HAVE BEEN TAKEN TO IMPROVE THE 

DEVELOPMENT OF BENEFIT CLAIMS BY THE PITTSBURGH REGIONAL OFFICE AND GIVE 
THE DATE FOR EACH OF THESE ACTIONS. 

In February 1993, the regional office ANIE System was converted from 
Wang Office to a PC based application which runs faster and smoother. 
This has given the development clerks better access to the VAMCs in our 
jurisdiction. 

Since January 1993, the Adjudication division has acquired five new 
adjudicator trainees. As part of their training, they will be given 
instructions on evidence requirements, and the development of cases. 

A plan was devised to redistribute the development clerks work. The GS-5 
clerks are responsible for all activity on EP 160, for initial cesting to 
completion of claim. They are also responsible for all development on 
original claims (EP 110, 140, 180, 190). This allows the more 
experienced clerks to do the development for SMRs, and service 
verification, while allowing the GS-4 clerks to do all other development 
actions. Closer supervisory WIPP reviews will also ensure more timely 
follow-ups. This was implemented on May 3, 1993. 

The responsibility of printing completed AMIE examinations was given to 
one GS-3 file clerk in Febrtiary 1993. In addition to printing the 
examinations, he associates them with the claims folders, and refers them 
to the rating board, thus relieving the development clerks of these 
duties. 

Since January 1993, the senior adjudicators have been reviewing all 
original pension claims, EP 180 and EF 190, for income and appropriate 
wartime service. This is done prior to referral to the rating board or 
iiuthorization for further action. 

A screening table was established in February for all cases being 
referred to the rating boards. At this point a rating board specialist 
reviews cases, eind immediate rating board development is undertaken, 
examinations are scheduled, cases are certified to EVA, quick rating 
actions are identified, and only those cases that appear ready to rate 
are referred to the rating boards. In the long run, this will result in 
more timely development and follow-ups. 



187 

The development clerks have been given standardized checklists to 
temporarily place in claims folders and to use as a guide in the 
development of cases. A stardardized DISP procedure has also been 
established to allow for easier monitoring and control of pending cases 
by supervisors. The standardized DISP procedures were implemented in 
December 1992. At that time, training was completed on both the DISP 
procedures and the checklist. In November 1992, the correspondence 
clerks received training on Circular 20-92-24, which dealt with the 
receipt of service medical records from SMRC. They had also received 
training on Word Processing and E-mail procedures. 

In jEmuary, both development and correspKjndence clerks received training 
on the recent circular pertaining to environmental hazards encountered 
during Desert Storm. Correspondence clerks were instructed in the proper 
procedures to E-mail confirmation of cases to the Louisville Regional 
Office, and the generation of WANG letters to claimants. 

PLEASE PROVIDE EVIDENCE THE ACTIONS TAKEN TO IMPROVE THE DEVELOPMENT OF 
BENEFIT CLAIMS BY THE PITTSBURGH REGIONAL OFFICE HAVE BEEN SUCCESSFUL. 

Success can be measured by the fact that pending workload is decreasing, 
that the total number of old cases has decreased since last fall, and 
that timeliness of measured CS.P end products is improving to the point 
that in June the Adjudication Division was at or better than the national 
average for 10 of the 13 measured end products. We are continuing to 
strive to improve and will make every effort to do so. 

12. HOW HAVE VETERANS BENEFITED FROM BEING ABLE TO NEGOTIATE THE INTEREST 
RATE ON VA HOME LOANS? 

We recently submitted repwrt of loan activity under PL 102-547 to VA 
Central Office regarding our experience with negotiated rates. For the 
period of November 1, 1992 thru April 30, 1993, 326 loans were closed 
under the jurisdiction of the Pittsburgh Regional Office. Of these 
loans, 27 were cash-out refinancings, 57 were interest rate reduction 
refinancings and 139 were to first-time homebuyers. 

A ten percent statistical sample revealed one 7. OX loan in which the 
veteran paid no points; fifteen 7.5X loans in which the veteran paid no 
points; five 8.01 loans in which the veteran paid no points; one 8.01 
loan in which the veteran paid a portion of the one point which was 
charged; two 8. OX loans in which the veteran paid the one point that was 
charged; and seven loans over 8. OX interest in which the veteran paid no 
points. 

This sample seems to suggest that veterans have been able to obtain VA 
financing with negotiated interest rate arrangesents which are favorable. 

13. WHAT PERCENT OF ELIGIBLE VOCATIONAL REHABILITATION PROGRAM APPLICANTS 
QUIT THE PROGRAM BEFORE FINDING AND MAINTAINING A SUITABLE JOB? 

Based on recent reports, 77 per cent of the veterans the Pittsburgh 
Regional Office enters into a rehabilitation plan do not complete the 
program. This compares favorably with the national average which 
indicates that 91.5 per cent of the veterans who enter a rehabilitation 
plan never complete it. 

WHAT SPECIFIC STEPS HAVE AND ARE BEING TAKEN BY THE PITTSBURGH REGIONAL 
OFFICE TO REDUCE THE DROPOUT RATE AMONG PARTICIPANTS IN THE VOCATIONAL 
REHABILITATION PROGRAM? 

1. Establish a T(jn team to identify ways to improve the number of 
veterans who are rehabilitated by the Pittsburgh Regional Office. 

2. Provide more timely counseling intervention and assistance with 
Chapter 31 applicants. 

3. Place an emphasis on starting the placement into suitable employment 
process from the point of initial contact with the veteran and sustaining 
this throughout the rehabilitation process. 

4. We are using the COIN TAR 6013 report which identifies important 
client data to identify and motivate those clients who have been placed 
in an interrupted status. 



188 

DESCRIBE THE RESULTS OF THESE ACTIONS. 

The most recent Total Program Management Report, a Central Office 
Vocational P.ehabilitation and Counseling Service document, recorded 
improvement in the effectiveness of our employment placement rate. It 
shows we placed 10 out of 12 veterans who were considered job ready into 
suitable employment. This indicates we are becoming more effective in 
both identifying veterans who are job ready, and placing them in suitable 
employment. 

14. FOCUS GROUPS HAVE BEEN IDENTIFIED AS AN ACCOMPLISHMENT OF THE PITTSBURGH 
REGIONAL OFIFCE. DESCRIBE IN DETAIL WHAT HAS BEEN ACCOMPLISHED? 

The Pittsburgh Regional Office was chosen to host, as well as 
participate in, a Focus Group Training program which was jointly 
sponsored by our Eastern Area Office and Veterans Assistance Service. 
Two station personnel received this training and are now qualified to not 
only facilitate focus group discussions, but also provide training for 
additional employees. On July 28, 29 and 30, they conducted training for 
7 additional employees who normally have personal contact with veterans 
in the course of their activities. We now have a cadre of trained 
personnel to actuate our action plan to conduct a series of focus groups 
for veterans and their families in our jurisdiction. 

WHAT ADDITIONAL FOCUS GROUPS ARE PLANNED? WHY? 

We intend to conduct our first actual focus group in September of this 
year at the Regional Office training facility which is centrally located 
and readily accessible to public transportation. Subsequent meetings are 
planned to be held on a quarterly basis, and may be scheduled in other 
population centers throughout our jurisdiction based on the findings from 
our focus group volunteer questionnaires. 

The Total Quality Management Sub-Council will use the findings secured 
from the focus group meetings, in conjunction with the objectives of our 
station TQM plan, to direct the activities of task teams, sind when 
appropriate, to directly modify processes and procedures to meet 
identified customer needs. 



189 

QUESTIONS TO VARO BY REP. TOM RIDGE 

SUBCOMMITTEE ON OVERSIGHT i, INVESTIGATIONS 

PITTSBURGH FIELD HEARING 

JUNE 28, 1993 



1. PLEASE EXPAND ON YOUR WORKLOAD MEASUREMENT STANDARD. WHAT IS A 
"WORK CREDIT"? SHOULD THE STANDARD BE CHANGED: AND, IF SO, HOW? IF 
NOT, WHY NOT? 

We understand your question as a request for a basic clarification 
of the method by which time is credited for working differing types 
of claims. We employ an End Product system to identify these work 
unite and assign time credit. We define 35 specific types of C&P 
claims by these End Products. Each End Product has a time value 
associated with it. For example: a completed original compensation 
claim (EP 110) is assigned a work unit credit of 5.68 hours; a 
completed income issue (EF 150) is assigned work unit credit of 1.31 
hours; a completed Eligibility Verification Report issue (EP050) is 
assigned work credit of .19 of an hour. Each End Product is 
assigned work unit credit based on the findings of an annual work 
rate study conducted in a sampling of regional offices. The studies 
are intended to capture the time necessary to complete the different 
types of actions. 

The current work unit system provides a realistic measure of the 
amount of time required to complete the differing types of claims 
and is also a sound measure of the work produced. Since it is 
reviewed annually, it reflects changes in processing efforts 
necessitated by judicial determinations and legislative 
requirements . 

2. IF THE WORKLOAD MEASUREMENT STANDARD WERE CHANGED, HOW WOULD IT 
IMPACT ON THE TIMELINESS AND QUALITY OF CLAIMS PROCESSING? 

Changing the current work rate standard should, in and of itself, 
theoretically have no impact on timeliness or quality indicators 
since the intent of work rate measurement is to reflect existing 
time costs for each type of claim. 

3. IN THE SUMMARY OF SUGGESTIONS MADE AS A RESULT OF THE MARCH 1992 
SURVEY OF YOUR REGIONAL OFFICE, ONE WAS TO PROVIDE ALL DEVELOPMENT 
CLERKS WITH REFRESHER TRAINING ON WORKLOAD MANAGEMENT TO INCLUDE 
SCREENING OF INCOMING CASES AND DATE OF CLAIM PROCESSING. IS THIS 
SUGGESTION BEING IMPLEMENTED? 

Yes, caseload management and screening are extremely important. 
The Quality Control and Training Specialist has assisted the 
individual developoient clerks on a one-on-one basis in screening 
techniques and caseload management. The Unit Chiefs also work with 
the individual clerks to assist them in organizing their work. 



I*. HOW OFTEN DO YOU RE-EXAMINE VETERANS TO ASCERTAIN WHETHER THEIR 
SERVICE-CONNECTED CONDITION SHOULD BE RE-RATED? 

The criteria for re— examining veterans is outlined in 38 C.F.R. 
3.327. These guidelines are followed by the regional office. 
Re— examinations are requested whenever VA determines there is a need 
to verify either the continued existence or the current severity of 
a disability. Generally, if a re-examination is required it will be 
scheduled not less than two years nor more than five years within 
the judgment of the rating board, unless another timeframe is 
elsewhere specified (e.g., myocardial infarction, joint 
replacements, etc.). Not all cases require re-examination. 

WHAT IS YOUR PROCEDURE FOR RATING THE RESULTS OF THOSE 
RE-EXAMINATIONS? 

The procedures for rating these cases are no different than for 
other cases. The rating board reviews the examination results along 
with the evidence in the claims folder and makes a determination 
whether there has been improvement, worsening, or no change in the 
veteran's condition. 



190 

5. WHAT PERCENTAGE OF YOUR ADJUDICATION PERSONNEL ARE TRAINEES? 

Ten percent of adjudication personnel are trainees: five 
adjudicator trainees eind two rating specialist trainees. 

WHAT ARE THE AVERAGE YEARS OF EXPERIENCE OF YOUR ADJUDICATORS? 

The average years of experience of adjudicators is seven years. 

HOW MANY ACTUAL EMPLOYEES ARE DEDICATED TO THE ADJUDICATION OF 
CLAIMS? 

Adjudication of claims encompasses decisions made by adjudicators, 
senior adjudicators, rating specialists; development done by 
development clerks; claims establishment and transfers done by 
correspondence clerks ; mail and claims folders being pulled by the 
files activities; hearings being conducted and decisions being made 
by hearing officers; and reviews being done by supervisors. 

The actual number of employees dedicated to the adjudication of 
claims is as follows: 14 fully trained adjudicators who process 
claims; five trainee adjudicators; four burial clerks, and four 
senior adjudicators who authorize the work of the adjudicators and 
burial clerks. All three unit chiefs authorize work due to the 
recent promotion of two senior adjudicators to the rating board. In 
addition, there are eight fully trained rating specialists, two 
rating board trainees, amd two hearing officers, all involved in 
decision making. To support these activities, there are five GS-4 
correspondence clerks and three GS-A development clerks. 

6. HAVE YOUR ADJUDICATOR TRAINEES ATTENDED THE ADJUDICATION ACADEMY IN 
BALTIMORE? 

The five adjudicator trainees have all attended the VBA Training 
Academy in Baltimore for the three week course offered new 
adjudicators. 

7. WHAT IS YOUR PERSONNEL TURNOVER AMONG CLERICAL POSITIONS? 
ADJUDICATORS? RATING SPECIALISTS? 

Personnel turnover rate for period 7-1-92 to 6-30-93 is as follows: 

Rating Board - 11.1% 

Adjudicators - 8% 

Clerical - 5% 

8. HOW MANY STAFF POSITIONS (ADJUDICATORS) HAVE YOU LOST SINCE 1979 DUE 
TO VA BUDGET CUTBACKS? 

In 1979, there were a total of 30 adjudicators, as opposed to 25 at 
present. This includes senior adjudicators, adjudicators, and 
trainees. 

9. DO ALL OF YOUR RATING SPECIALISTS KNOW WHAT THE 3 ELEMENTS OF A PTSD 
CLAIM ARE? 

All rating board members are thoroughly familiar with the 
requirements for a PTSD claim. 38 C.F.R. 3.304(f) provides that 
service connection for PTSD requires medical evidence establishing a 
clear explanation of the condition, credible supporting evidence 
that the claimed inservice stressor actually occtirred, (i.e. 
verifiable stressor), and a link established by medical evidence, 
between current symptomatology and the claimed inservice stressor. 
They are also familiar with the criteria in the Diagnostic and 
Statistical Manual of Mental Disorders-DSM-III-R . the provisions of 
Adjudication Manual M21-1, Part VI, Par. 7.46, and 38 C.F.R. , Part 
4, (4.125 - 4.132). 



191 

10. ARE YOUR ADJUDICATORS CONTACTING CLAIMANTS BY PHONE TO OBTAIN 
NECESSARY INFORMATION WHICH WOULD OTHERWISE REQUIRE A WRITTEN 
REQUEST? 

This has been done on a limited basis because of the heavy 
workloads. However, we are expanding this process by establishing a 
development unit in our Veterans Services Division utilizing staff 
from other program areas, available on a short-term basis, to do 
development work relative to claims processing. Typical duties will 
include follow-up calls to secure information needed to process 
claims, i.e., items omitted on VA Form 21-526 (original application 
form for compensation and pension). 



11. IN THE MARCH 1992 SURVEY, IT WAS NOTED THAT TIMELINESS WAS VARIABLE 
BUT ALWAYS WITHIN A RANGE OF ACCEPTABLE-TO-GOOD. WHAT DO YOU 
CONSIDER AN ACCEPTABLE-TO-GOOD TIMELINESS RANGE? 

At the time of the on-site survey, claims processing timeliness was 
measured by a system entirely different from the current average 
days to complete system (in effect since October 1, 1992). Under 
the previous system we monitored the percentage of cases completed 
for each of I'* key End Products against a three level measure that 
included goal, standard, and reptortable levels. Pittsburgh's 
processing timeliness achieved the stfmdard in all but one or two of 
the key End Products for three Central Office staff analyses 
preceding the survey. This achievement in processing timeliness at 
that time was considered to be in the acceptable to good range. 

HOW DOES THAT COMPARE WITH THE NATIONAL AVERAGE? 

Overall timeliness, at that time, compared favorably with the 
national average. 

12. WITHIN YOUR FILES ACTIVITY, IT WAS NOTED IN THE 1992 MARCH SURVEY 
THAT YOU ACTIVELY SEEK TO USE "WORK-STUDY" AND "STAY-IN-SCHOOL 
LABOR". PLEASE EXPLAIN. 

The Stay-in-School program has as its major objective the 
employment of needy students so that they can resume or continue 
their educations without interruptions caused by financial 
pressure. In 1989, we initiated our participation in the 
Stay-in-School program in order to meet the needs of our 
Adjudication Division for additional manhours to handle the heavy 
workloads and backlogs in the Adjudication Files Activity. While 
stay-in-school students are paid from station funds, they do not 
count against station ceiling. The station generally has had 
sufficient funding to support the program. Students are paid the 
hourly wage for a grade GS-3, step 1. Students are employed on an 
intermittent basis, giving us additional funding flexibility. We 
average 5 to 10 students employed at any given time. 

The Veteran Student Work Study Program is an educational benefits 
program for veterans going to school. VA can employ such students 
at Federal minimimi wage to assist in clerical aspects of claims 
processing at schools and on station. Students do not count against 
station personnel ceiling or operating expenses. Salary funding is 
through the benefits program. Students can work up to 1100 hours in 
a one year period. We employ an average of about 60 students at any 
given time within the Western Pennsylvania area. Placement priority 
is given to the file activity in our Adjudication Division. 



13. WHAT IS THE PURPOSE OF THE WEEKLY "MASS SEARCH" FOR FILES? 

The weekly "mass search" for files is the method used to associate 
all types of mail with the respective claims files. This mail may 
include documents or evidence necessary to complete action on a 
claim. For prompt and accurate claims processing, items such as 
medical evidence, income or dependency documentation received during 
the week need to be combined with their respective claim files. 



192 

lA. WITH THE EXCEPTION OF BURIAL CASES, WHAT OTHER TYPES OF CASES DO 
DEVELOPMENT CLERKS HANDLE? WHAT ARE THEIR GS RATINGS? 

The development clerks are responsible for the development of all 
claims. They make requests for service medical records, service 
verification, development for remands, private medical evidence or 
hospital reports. In addition they utilize the AMIE System to 
schedule VA examinations, request outpatient treatment reports 
(OPTRs), hospital reports, and the exchange of beneficiary 
information with the VAMCs. 

The GS— 5 development clerks have the additional responsibility for 
burial claims, EP 160. They also do the development on all original 
claims, EP 110, 140, 180, 190. 

The GS-4 development clerks do not have responsibility for burial 
claims. As needed, both process eligibility verification reports. 

15. IN ACCORDANCE WITH THE RECOMMENDATION MADE BY THE MARCH 1992 SURVEY, 
HAVE YOU IMPLEMENTED AN ENHANCED REVIEW OF NOTIFICATION LETTERS TO 
ENSURE DUE PROCESS REQUIREMENTS? 

Enhanced reviews of notification letters have been undertaken to 
ensure claimants are afforded proper due process in decisions. The 
senior adjudicators have been reviewing notification letters more 
closely, and these letters are monitored on quality control checks. 
Enhanced word processing capability now allows the adjudicators to 
place the discussion paragraph of rating decisions in their 
notification letters. This provides a more in depth and 
comprehensive notification to claimants. 

16. PLEASE EXPLAIN WHAT EP-600 OR PREDETERMINED NOTICE CASES ARE? 

Whenever VA proposes to reduce, suspend or terminate a running 
compensation, pension, or DIG award, VA must send the beneficiary 
advance, written notice of the proposed action unless the decision 
to reduce, suspend, or terminate is based solely on written, 
factual, unambiguous information as to income, net worth, dependency 
or marital status provided by the beneficiary (or the beneficiary's 
fiduciary or representative) with knowledge or notice that such 
information will be used to calculate benefits and the legal 
standards applied to the information are numerical in nature. The 
written notice is called a predetermination notice. 

Payments must be continued for at least 60 days after the date of 
notification to allow time for the beneficiary to submit evidence 
showing that the proposed action should not be taken. This 60 day 
period is called the predetermination period. During the 
predetermination period, the case is controlled by EP 600. 

17. WHAT IS YOUR "NO-SHOW" RATE FOR BOARD OF VETERANS' APPEALS FIELD 
HEARINGS? 

The Regional Office does not have Jiny statistics for the "no show" 
rate for the Board of Veterans Appeals Field Hearings, i.e., 
hearings held by members of the Board of Veterans Appeals during 
their annual visit to the regional office. However, it is very rare 
that a claimant does not show up for this type of hearing. 

The Hearing Officer "failed to show" rate for the first two quarters 
of FY 1993 was 8.7% locally vs 10.3% nationally. 

18. HOW TIMELY ARE DECISIONS BY THE US COURT OF VETERANS APPEALS BEING 
MADE AVAILABLE TO YOUR OFFICE? 

COVA decisions are initially reviewed by the Judical Review Staff 
of the C&P Service. Each month the CScP Service provides assessments 
of COVA cases that have been reviewed. CStP Service then conducts a 
monthly Judicial Review Conference Call where recent decisions are 
explained £md discussed. 



193 

DO YOU HAVE THE BENEFIT OF SEEING THE ENTIRE DECISION? 

The regional office subscribes to West's V pi-^rgti s Appeals Reporter , 
so complete copies of decisions are made available to the regional 
office each month. 

19. HOW WOULD YOU ITEMIZE THE NUMBER OF MULTI-CONDITION 

SERVICE-CONNECTED CLAIMS YOU ARE NOW RECEIVING? ARE THEY THE 
MAJORITY OF YOUR NEW CASELOAD? 

The vast majority of original claims for service connected 
compensation are multiple issues. Rarely does the office receive a 
claim for only one issue. The disabilities claimed may include 
symptoms, acute conditions, as well as chronic conditions. 
However, all of these issues must still be reviewed, and addressed 
in the rating decision. 

ARE THEY PRIMARILY FROM DESERT STORM VETERANS? 

They are not primarily from Desert Storm veterans, but from all 
veterans being recently discharged. 



20. WHAT IS YOUR REMAND RATE FROM THE BOARD OF VETERANS' APPEALS? 





Remand 


Rate 




Pgh 




National Average 




27. 7X 




29. 7X 


FY 91 


50. 4t 




50. 5X 


FY 92 


45. 6X 




1*7. 3X 


FYTD 93 



WHAT TYPE OF CLAIMS ARE BEING REMANDED? 

The Board of Veterans Appeals is remanding all types of claims, 
from those involving grants of service connection, to claims for 
increase, or death claims. The remands generally direct the 
regional office to seek to obtain additional evidence froo veterans 
or claimants, private physicians and hospitals, VAMCs, and service 
departments. At the same time remands often include requests for 
one or more specialist examinations after all other developoient is 
completed. Two recent remands included a request for the regional 
office to obtain the court transcript from a criminal court case in 
Florida over 10 years ago, and a second directed the regional office 
to obtain private medical records from a physician, or the 
physicians' next of kin, or the physician who took over the 
practice. 

WHY IS YOUR TOTAL REMAND RATE HIGHER THAN THE NATIONAL AVERAGE? 

Although during the first quarter of FY 93 our remand rate was 
higher than the national average, it is now less than the national 
average, and has consistently been less than the national average on 
an annual basis. 

21. THE OTHER SIX REGIONAL OFFICES WHICH HAVE BEEN DESIGNATED TO 
PARTICPIATE IN THE CENTRAL OFFICE'S PROJECT KNOWN AS VBC/VCE 
PLANNING INITIATIVE HAVE ALREADY SUBMITTED PLANS TO THE CENTRAL 
OFFICE FOR CONSIDERATION. WHY HAS IT TAKEN YOUR OFFICE SO LONG TO 
EXECUTE A PLAN TO IMPROVE YOUR CLAIMS PROCESSING TIMELINESS AS PART 
OF THIS PLANNING INITIATIVE? 

Not only has the Pittsburgh VA Regional Office submitted its plan 
for the WBC/VCE Initiative to Central Office for consideration, but 
has received approval and has implemented the plan. A re(>ort 
prepared by the Central Office VBC/VCE Committee dated June 7, 1993 
includes a status report of the seven regional offices, which along 
with Pittsburgh, are actively participating in the VBC/VCE 
initiative. In that status report we stated that Pittsburgh is 
testing combining selected VBC/VCE duties at the RO as well as at a 
VA Medical Center. The test at the RO has been in effect since 
January 10, 1993, when a fulltime VBC/VCE was added to the staff in 
VSD. He performs normal VBC duties during peak periods and uses his 
adjudication expertise in the Veteran Assistance Inquiry (VAI) 
resolution unit the remainder of the time. Whenever possible. 



194 

adjudication actions are completed in VSD. Adjudication 
supervisory staff maintain control over this area, performing 
authorization and quality review functions. The VBC/VCE has 
averaged more than 90 award actions per month over the past four 
months. We are very pleased with the process in that all parties 
benefit. The veteran/beneficiary is provided a faster resolution to 
his or her problem, the Veteran Services Division is able to control 
VAIs better and gets the satisfaction of better public service. At 
the same time. Adjudication personnel are freed from considerable 
VAI processing thereby making more time to concentrate on normal 
claims processing. 

Additionally, a supervisory VBC has been given adjudication computer 
conmand access to process all EVRs that are completed for claimants 
who are seen in the Personal Interview Unit. This action expedites 
this routine adjudication function eind again provides more time for 
adjudication staff to devote to other claims processing. 

The initiative to establish a VBC/VCE at a VA Medical Center is 
still being developed. We are currently testing locally the 
hardware and software required to give that employee the computer 
access necessary to function effectively as a VBC/VCE. Before the 
end of the current fiscal year we expect to have the hardware and 
software installed at the medical center and to have the VBC/VCE 
properly trained to use that system. 

22. HAS YOUR REGIONAL OFFICE EVER HAD A SURVEY CONDUCTED BY AN OUTSIDE 
ENTITY? IF SO, WHEN WAS IT DONE? 

All surveys have been conducted by Department of Veterans Affairs 
entities. 

23. WHEN YOU REVISED YOUR CORRESPONDENCE CLERK STANDARDS IN ORDER TO 
ADDRESS THE ELEMENT OF QUALITY, AS RECOMMENDED BY THE IG, WHAT DID 
THAT ACTUALLY INVOLVE? 

The revised standard contains a critical element entitled "Quality" 
which provides for review of 300 CEST actions by the Unit Chief 
during the evaluation year. The supervisor also examines the 
Pending Issue Files (FIFs) for accurate, complete data; including, 
but not limited to date of claim. Powers of Attorneys (POAs), 
address. Beneficiary Identification and Records Locator System 
(BIRIS) data and use of audit trail stamp. The Quality of CEST 
actions is fully satisfactory if it is in control for 2%-3X 
achievement during the performance period. (This means that there 
can be no more than Ih inaccurate or incomplete PIFs for a fully 
satisfactory rating) The Performance Plan also contains a statement 
that failure to meet and sustain the standard in any critical 
element will be unacceptable performance and will result in a 90 day 
performance improvement plan. 

The revised standard also contains more explicit, tighter controls 
on CESTing within the 7 day standard established in M21-1, on 
permanent transfers to and from other ROs and on updating the Appeal 
Tracking System through the NDT screen. 

2A. WHAT IS THE STATUS OF THE IMPROVEMENT PLAN TO ADDRESS THE OVERALL 
CLAIMS PROCESSING TIMELINESS ISSUE? 

The Adjudication division continues to be making progress in 
improving claims processing timeliness. Through EOM June, our 
timeliness benchmarks were achieved for 11 of 13 measured end 
products. Total number of cases pending has declined, as well as 
the total number of cases pending over 6 months old. For the month 
of June we are at or better than the National Average for 10 of the 
13 measured end products. 



195 

25. WHAT ACTIONS HAVE YOU TAKEN TO TIGHTEN UP YOUR INTERNAL CONTROLS 
DESIGNED TO MINIMIZE CLAIMS PROCESSING DELAYS AS RECOMMENDED BY THE 
IG IN HIS REPORT OF JUNE 4, 1993? 

Adjudication supervisory personnel have been instructed in the 
necessity to follow the current WIPP User Plan, to do reviews on a 
timely basis, and to annotate their results. Unit Chiefs are taking 
a more "hands on" approach to directing work by daily review of WIPP 
screens, emd completing WIPP reviews in an effort to ensure a 
smoother movement of claims. 

The Acting Adjudication Officer samples the Section Chief and 
Hearing Officer reviews to ensure they are being done. Likewise the 
Authorization Section Chief ensures Unit Chief Reviews are being 
completed. Findings are validated by a management analyst from the 
Director's Office. 

26. ARE YOUR CORRESPONDENCE CLERKS WELL TRAINED IN THE HANDLING OF 
CLAIMS RELATED TO ENVIRONMENTAL HAZARDS? IF SO, WHEN DID THEY 
RECEIVE SUCH TRAINING? 

The correspondence clerks are well trained in the handling of 
claims related to environmental hazards. In January, 1993, they 
received training on the circular pertaining to environmental 
hazards. They were instructed on the proper procedures to send 
confirmation of cases to the Louisville RO and the sending of 
letters to claimants. 

27. DOES THE CURRENT CLAIMS BACKLOG CAUSE ANY UNDUE PRESSURE TO MEMBERS 
OF THE RATING BOARD? 

The current backlog does put pressure on the rating boards, as well 
as affecting the other elements of the Adjudication division. 
Employees strive to do good work, but become overwhelmed and 
frustrated with the backlog of cases. They feel the pressure of 
learning new procedures, doing special projects, dealing with COVA 
decisions, and at the same time working cases and reducing backlogs. 

Employees volunteer for overtime to assist in reducing backlogs. 
However, this tends to overwork people. It is an indication of our 
employees coomitment that in spite of the fact that some earn less 
on overtime than on regular time, they still volunteer to work. 
Employees do take pride in their work. 

HAVE THERE EVER BEEN ANY PROBLEMS WITH ANY PARTICULAR RATING BOARD 
MEMBER? IF SO, PLEASE EXPLAIN. 

It is normal under the pressures caused by the heavy pending 
workload that some problems have surfaced. Typically, these 
problems result from frustration and burnout from the escalating 
rating board workload, continual overtime, and the desire to do good 
work, but seeing no light at the end of the tunnel. We have put 
employees on performance improvement plams, and provided appropriate 
counseling so that they were able to improve their performance to a 
satisfactory level. 

28. WHAT STRUCTURED PLAN HAS BEEN IMPLEMENTED FOR TQM? WHO ARE YOUR 
TEAM LEADERS AND WHAT ARE THEIR SPECIFIC AREAS OF RESPONSIBILITY? 

The Director, Assistant Director, and Loan Guaranty Officer have 
been involved in the structuring and implementation of TQM in the 
Eastern Area. Mr. Bushey serves on the Eastern Area Training 
CoiBBittee. Mr. Serrino served on the Eastern Area TQM Steering 
Coimnittee responsible for providing guidance and support to the 16 
stations in the Eastern Area relative to TQM implementation. He 
also served as an instructor assisting other offices in the 
development and implementation of a quality plan. Mr. Rueter, the 
Loan Guaranty Officer, has recently been trained as an examiner for 
the Eastern Area and will be involved in assessing TQM progress at 
offices. 



196 

The regional office Quality Council is comprised of the Director, 
Assistant Director, Personnel Officer and Quality Coordinator, and 
is responsible for overall station TQM policy deployment and 
resource allocation. The Quality Council directs the development 
and implementation of the station TQM plan. They designed and 
implemented procedures to acquaint top managers with the tools of 
the TQM problem— solving procedure and to implement TQM at the 
regional office level. The Quality Council is responsible for 
developing mechanisms for ensuring that successful solutions are 
disseminated and implemented throughout the regional office. 

The Sub-Council is comprised of the Assistant Director, Division 
Chiefs and Management Analysts, and is responsible for disseminating 
policy, cross-functional team management, and coordinating 
training. The Sub-Council develops the station TQM Plan, in 
conjunction with the Director, including the mission, vision, 
fundamental objectives, detailed objectives, and initiatives. 

Division Lead Teams are comprised of Division Chiefs, Assistant 
Division Chiefs and selected supervisors. They are responsible for 
team assignments within their respective divisions. They provide 
support and resources within division control and act as liaison 
with the Sub-Council for resources, etc., as needed. 

The TQM Coordinator serves as a point-of -contact between the 
regional office and Area Office. The Coordinator role is also a 
liaison function between functioning teams and the Quality Council. 
The Coordinator is responsible for facilitating implementation of 
the TQM process and maintaining various TQM records . Other 
responsibilities include: assessing TQM training needs and 
arranging for such training; keeping the Quality Council and 
Director advised of progress of the various teams; ensuring that two 
or more teams are not working on the same problem or work process; 
and serving as a link with all divisions and supporting supervisors. 

A quality plan for fiscal 1993 containing the station's mission and 
vision statements, fundamental objectives, detailed objectives and 
initiatives was developed and implemented as part of the total TQM 
process. All employees received a copy of the plan and a thorough 
explanation of the methods used to actuate each element. 

The five division chiefs, or acting division chiefs, of the larger 
operating divisions are team leaders of their respective lead teams, 
while three support services were combined to form one lead team: 

Adjudication - Michael Vudragovich, Acting Adjudication Officer 
Administrative - George Burgess, Chief Administrative Division 
Loan Guaranty - Carl Rueter, Loan Guaranty Officer 
VSD - James Mareino, Acting Veterans Services Officer 
Vocational Rehabilitation & Counseling - Tracy Alton, VR&CO 
Support Services - Harry Feather, Senior Management Analyst 

In addition, the following personnel are team leaders of functional 
and task teams with standard team leader authority and 
responsibility for controlling and directing team activities; their 
names, titles, £uid areas of improvement are included: 

Tracy Alton, VRS.C Officer - Recognition Incentives 

Barry Feather, Senior Management Analyst - Improve Timely Completion 

of Veterans Assistance Inquiries 

Marleen Forsythe, Vocational Rehabilitation Specialist - Number of 

Rehabilitated Veterans 

Robert Gracie, Supervisor of Fiduciary and Field Exam Unit - 

Telephone Lost Call Rate 

Douglas Mildner, Loans Service Representative - Impact of Telephone 

and Personal Interviews 

Suzanne O'Hanlon, Assistant Chief, Administrative Division - 

Division Training ProgrEmi 

William Thomas, Personnel Officer - Station Training 

Nicholas Vrcic, Management Analyst - Station Communication 



197 

29. IN OTHER FIELD OFFICES AROUND THE COUNTRY, THE SPU IS LOCATED 
IMMEDIATELY WITHIN THE DIRECTOR'S OFFICE. WHERE IS YOUR SPU 
LOCATED? AT WHAT GRADE LEVEL ARE YOUR SPU EMPLOYEES? DO THEY HAVE 
THE AUTHORITY TO BRING PROBLEMS TO THE ATTENTION OF THE ADJUDICATION 
DIVISION? 

The aBGignnient of responsibility for responding to Congressional 
inquiries varies from office to office. Some offices have developed 
congressional units or special processing units and some have not. 
In some offices all congressional inquiries are handled in the 
Office of the Director, Veterans Services Division or Adjudication. 
Essentially, there is no standardized procedure for handling 
congressional inquiries. Prior to creating the Special Processing 
Unit (SPU) in October 1992, all inquiries, both telephonic tmd 
written, were received and placed under control in the Director's 
office. Telephone inquiries were referred to the Veterans Services 
Division for response while written inquiries were referred to the 
Adjudication Division for appropriate action and response. At the 
Pittsburgh VA Regional Office we established a special processing 
unit (SPU) for the purpose of centralizing responses to 
congressional inquiries and other special correspondence. Control 
of all incoming inquiries is maintained in the Office of the 
Director via an automated Congressional Tracking System. The 
inquiries are forwarded immediately to the SPU for appropriate 
action and response. The Director's office monitors the tracking 
system to insure responses are prepared timely. The Director's 
Office and respective Division Chief reviews responses to insure 
they are responsive and all appropriate action has been taken. The 
SPU is located in the Veterans Services Division. The SPU consists 
of one journeyman VBC (GS-9) and a journeyman claims examiner 
(GS-9). A backup has been designated for each of the assigned 
individuals. Members of the SPU have access to the adjudication 
division to resolve adjudicative actions that are outside their 
level of expertise. In especially complicated cases, members of the 
SPU can bring the case to the attention of the Adjudication Officer 
or directly to the attention of a member of the Director's staff. 

30. WHAT EXPERIENCE IS YOUR NEW ADJUDICATION OFFICER BRINGING TO THE 
JOB? HOW EFFECTIVE DO YOU FEEL HE WILL BE IN TACKLING THE CLAIMS 
ADJUDICATION DELAY PROBLEM? 

A major asset which our new Adjudication Officer brings is his 
experience. He began his career as a file clerk in the 
Administrative Division and worked his way up through clerical and 
technical positions in Adjudication before advancing to management 
positions. Having occupied alniost all the positions he supervises 
gives him a better understanding of the processes and the concerns 
of the position occupants. In the evenings, Mr. Burks secured both 
a bachelors degree and graduate credits to augment his experience 
with formal training in managenent. 

We feel Larry Burks will be very effective as our Adjudication 
Officer. His selection came only after an arduous screening process 
during which we spoke to the Directors and Adjudication Officers at 
the facilities where he worked. In each and every instance, we were 
advised that he was technically sound, employees want to work for 
him, and he has excellent rapport with service officers. The latter 
has been confirmed by two of our service officers who referenced 
their counterparts at facilities where he worked. Mr. Burks is a 
disabled Vietnam Era veteran who has demonstrated a concern and 
sensitivity for veterans' needs. His management style and record 
have proved to be very effective at each of the facilities where he 
worked. We feel he will be a valuable addition to the station 
managemen t s taf f . 

Those aspects of our timeliness problems within the control of the 
Adjudication Officer and regional office will be addressed 
effectively. Mr. Burks will not be able to address the national 
problems brought about by COVA precedent setting decisions causing 
BVA remands, the due process delays brought about by law, and 
problems in securing service medical records which are beyond his 
control. However, we will compare favorably with other Regional 
Offices. The progress we are making with our action plan in terms 
of timeliness will continue at an even more active pace once he is 
on board. 



^.nfZ?^ ^^^L'C LIBRARY 

,3 , Iff lillilll 

198 3 9999 05983 184 



31. WHAT KIND OF MORALE PROBLEMS EXIST WITHIN YOUR REGIONAL OFFICE DUE 
TO THE PRESSURES OF THE CURRENT CLAIMS BACKLOG? 

The current claims backlog has had both positive and negative 
effects on morale. The nature of our work requires an integrated 
workflow process within the Regional Office. As a result, a claims 
backlog presents pressures in varying degrees to other operating 
elements. Employees are sensitive to veterans needs and feel a 
sense of frtistration in that they can not do more to meet those 
needs. We have had a good response to overtime but we are seeing 
burnout of some employees as a result of the stress in their work 
environment. The development and implementation of an action plan 
which employees can identify with, and the posting of progress 
charts prominently displayed within the division so that employees 
can see the impact of their efforts has had a positive effect 
(charts show how our timeliness compares with the national average 
in processing actions). 

o 



ISBN 0-16-044453-5 



9 '780160"444531 



90000