VA: Veterans Claims Backlog Dips Below 100K But Won't Hit Zero

The Veterans Affairs Department's backlog of disability claims has dropped below 100,000 but it won't ever reach zero because of the way veterans seek care, says the head of the Veterans Benefits Administration.

Future claims exceeding the 125 days set for on-time decisions will more than likely be because of veteran's individual choices or outside agencies, not the VA's system, according to Under Secretary Allison Hickey.

"Zero for us is not an absolute zero," she said on Monday. "I don't want us to say, 'Too bad, we want to hit our 125 days! The heck with you! We're going!' That's not right and that's not the kind of culture and core values that we hold."

Hickey spoke with reporters during a telephone roundtable, during which she announced that the backlog -- once well over 600,000 claims -- had finally been brought down to fewer than 100,000. She credited the reduction to increased digitation of records, a new application system that emphasize electronic filings, and employees pulling mandatory overtime hours for the past three years.

But Hickey said the problem of claims going past 125 days without a decision won't disappear entirely, though the numbers will be manageable at perhaps 11 percent of new claims.

There are valid reasons that some claims will take longer than 125 days that have nothing to do with VA bureaucracy, Hickey said.

Examples include a veteran amending a claim already nearing the 125-day point, a veteran's preference for where or when to get a necessary physical, or a claim requiring information from the Defense Department.

Many times, she said, VA will be nearing completing of a claim application when the veteran decides to add a new medical condition.

"To the veteran, that means if they can get that on that [original] claim, they get the earlier effective date," and with it compensation starting from that date, she said.  If they file it as a new claim, they will get a later start date for compensation.

So adding it onto a nearly finished existing claim means action on the claim is going to run past 125 days.

"If you come in with something new on day 120, I can't be expected to produce a new medical issue and a result of that, that requires an exam, filing it in your medical records, making sure we've got it all, doing the rating, doing the evaluation to see if there's any additional resources to be added. You can't to do that in five days … It's more complicated than that," she said.

Older veterans who divide their time between different states may also account for claims going past 125 days.

If they have a preferred VA office they want to go to but will not in that part of the country until some future date, "I'm not gonna say, 'Sorry, pack it up, drive north or drive south and come see us because we're ready to do our claim.'"

Hickey said the VA will honor the veteran's wishes even if it means the claim slipping past 125 days.

There may also be a medical reason that an exam cannot be done within the 125 days, she said.

"I'm not going to make a pregnant veteran take a CT or MRI or an X-ray that would be harmful to her or to her baby while she's pregnant," Hickey said. "I'm going to wait until she's delivered that child and she's feeling she can come back and go through that exam."

Other veterans with claims live abroad. The VA does not pay to fly them to the U.S. for the exams and cannot expect them to pick up the costs, leaving the scheduling to the State Department and others, according to Hickey.

Claims filed in connection to radiation exposure during military service or to contaminants in the water at Camp Lejeune, North Carolina, she said, also will likely take longer than 125 days.

"There's too much burden of proof that the DoD has to do," she said. "I have to give the DoD more time on those and I don't' hold them to the same standard as all the rest of the claims."

The VA long dealt with claims exceeding 125 days, but until then-VA Secretary Eric Shinseki established the 125-day application-to-decision period there was no established backlog.

The VA originally said the backlog would be eliminated by Sept. 30, 2015, then to the end of the calendar year. Officials now maintain that no firm date was set, but offered only as a way to inspire the department.

--Bryant Jordan can be reached at bryant.jordan@military.com.