VA Tests New Automated System that Could Speed Up Claims Decisions

Department of Veterans Affairs officials are hoping a new automated system that helps render decisions on disability claims will accelerate the process and decrease the backlog of claims applications.

The automated system being considered by the VA has proven to shorten the disability claims review process from 100 days to two under certain circumstances and conditions, according to the agency.

A pilot run of the VA Automated Benefits Delivery System, launched in December, looked at claims filed by veterans seeking upgrades to their disability ratings for hypertension and cut 98 days from the process for those with complete files.

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VA officials said the program is part of a plan to address 260,000 current disability claims, including 59,000 that are older than 125 days and are considered backlogged.

"We saw an opportunity to look at our traditional disability claims process and see how we can better leverage the data we have ... to introduce business-process automation," explained Rob Reynolds, acting deputy undersecretary for the VA's Office of Automated Benefit Delivery, during a press conference with reporters Tuesday.

The system takes electronic or paper claims and uses algorithms to determine whether the file contains enough data and information to render a decision. It then weighs the information against the rules that govern disability claims and makes a recommendation whether to approve or disapprove the claim.

The system's recommendation is reviewed and validated by a rating veterans service representative. If at any time the system decides that more information is needed -- the veteran needs a comprehensive medical exam or more data is required to render a decision -- the claim is sent to a claims reviewer for traditional processing, Reynolds said.

"The algorithm is pulling the necessary data we need. The rater is the final decision maker," he said.

After the pandemic began, the number of backlogged claims rose from 70,000 to 211,000. While the VA reduced that to roughly 180,000 by mid-2021, the number grew again as veterans applied for benefits under an expansion of covered conditions, including illnesses related to Agent Orange and airborne pollutants.

VA Secretary Denis McDonough said Tuesday that the department has hired more than 1,000 new claims processors and plans to hire roughly 1,000 more by the end of spring. The department is paying its personnel overtime to process claims, and working with the National Personnel Records Center and National Archives to digitize records needed to make claims decisions.

The new automated system could further accelerate the process.

"The initiative has the potential to dramatically reduce the time it takes to process individually," McDonough said.

With the program proving successful for hypertension claims, the department is now building algorithms to assess other common conditions in veterans, including asthma, sleep apnea and prostate cancer, Reynolds said.

The goal is to add three new conditions per quarter, he said. But, Reynolds added, at no point in time will the decisions be left up to the system and the algorithms.

"We will ensure that our employees continue to supervise and validate the rules associated with the automation, the algorithms, to ensure that all statutory regulatory and procedural guidance are adhered to and [they] have the ultimate decision control for the process over the claim," he said.

The VA is anticipating that more post-9/11 veterans will be filing claims in the future. The department announced last August it planned to add three conditions -- asthma, rhinitis and sinusitis -- to the list of conditions fast-tracked for health care and disability compensation and is reviewing more illnesses as possibly related to exposure to burn pits and other pollution in deployed settings.

Decisions on several respiratory cancers and constrictive bronchiolitis are expected this year.

McDonough urged veterans thinking about filing a disability claim to do so, despite the backlog.

"Please, please submit your claims," McDonough said. "I promise you that we will stop at nothing to work through this backlog and get you timely access to the benefits."

– Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.

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