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Mr. Chairman and Members of the Subcommittee:
On behalf of the 1.2 million members of the Disabled American Veterans (DAV), I am honored to appear before you today to discuss the effectiveness of the Department of Veterans Affairs (VA) training program for Veterans Benefits Administration (VBA) employees who process disability claims.
In line with our congressional charter, DAV's mission to "advance the interests, and work for the betterment, of all wounded, injured, and disabled American veterans" is as vital today as it has been throughout our 90 year history. In line with our core values of "Service, Quality, Integrity and Leadership," I am pleased to offer DAV's views regarding VBA's training program and its role in helping to reform the benefits claims process.
Although this is my first time testifying before Congress, it is not the first time that DAV has testified on the state of the VA benefits claims processing system. As my colleagues have stated countless times, but it bears repeating, the backlog of pending claims is not actually the problem; it is only a symptom of the larger problem: a broken veterans benefits claims processing system resulting in too many veterans waiting too long for decisions on claims for benefits that are too often decided incorrectly.
Unfortunately, the tremendous attention paid to the backlog and the understandable tendency to focus only on the number of claims pending -- many estimates put it over 1 million in total -- has led to an over-emphasis on production to the detriment of quality and accuracy. However, simply finding ways to increase production will result in more claims being decided wrongly, which only leads to notices of disagreement, appeals, remands and more appeals, further clogging up the system and exacerbating the existing problems.
The only sensible and long term to way to reform this system is to rebuild it in a way that focuses principally on getting claims done right the first time. This will require VBA to invest sufficient time and resources to build a new modern, paperless claims processing system. Although this path could potentially result in longer processing times during the transition and implementation of the new claims system, with proper training and quality control, processing times will shorten, error rates will drop, and the backlog will slowly but steadily decline and eventually disappear. We urge this Subcommittee to keep the pressure on VBA to stay true to this path and remain focused on quality and accuracy, not just the backlog.
Mr. Chairman, over the past year, VBA has been moving in this direction, launching dozens of new initiatives and pilot programs that could help to modernize the claims process. The most important of these is the Veterans Benefits Management System (VBMS), the new IT system that will serve as the backbone of the VA claims process. VBA recently announced that the first pilot of the VBMS will take place at the Providence, Rhode Island Regional Office beginning this November.
While we applaud the continuing progress of this essential IT system, and are pleased to see the first pilot is now scheduled, we continue to be disappointed that no veterans service organization (VSO) experts, nor any service officers from DAV or other VSOs, have been involved in the development of this system. Since more than half of all claims are represented by VSO service officers, we collectively offer a wealth of expertise that is essential to finding long term solutions, and we continue to stand ready to work with VBA in the further development of this system.
VBA also has more than four dozen other pilots and initiatives ongoing at various regional offices around the country. To fully benefit from all this experimentation, VBA must develop and implement an effective plan to analyze the results so that they can synthesize the best practices into a new claims process. Most importantly, VBA must resist the temptation to focus on those initiatives that provide only short term production increases, rather than enhance accuracy and quality, which must be one of the cornerstones of a 21st century claims process.
One of the other cornerstones is proper training of employees and managers involved in the processing of veterans claims for benefits. Having just come from the field after 17 years of working for DAV as a National Service Officer (NSO) and Supervisor in Louisville, Kentucky, Chicago, Illinois and New York City, I have seen firsthand many of the challenges facing VBA. I have been able to observe VBA's employees, learn about their training programs and hear from them what they believe works and what does not.
Having also had the benefit of DAV's extensive and life-long training programs, I'd like to provide an overview of DAV's on-the-job training program for new NSOs, and especially the Structured and Continued Training (SCT) program that all NSO's must continue throughout their careers at DAV. In our view, no other organization places more emphasis on training and its vital role in quality and accountability than DAV. While VBA and DAV necessarily have different training programs designed to meet similar but distinct needs, we believe there are lessons that could be applied from the DAV training program which could strengthen VBA's training program, and ultimately the claims process.
The training program in VBA is basically a three-stage system, which requires new Veterans Service Representatives (VSRs) and Rating Veterans Service Representatives (RVSRs) to complete orientation training at their respective VA Regional Office (VARO). Next, they participate in a two- to three-week centralized or "Challenge" training course at VA's training academy in Baltimore, Maryland, which provides a basic introduction to job responsibilities. When they return to their respective VARO, new VSRs and RVSRs spend several more months in training, which includes completing a required curriculum by way of online learning known as the Training and Performance Support System (TPSS), as well as on-the-job training and/or instructor-led classroom training. It is our understanding there are currently eleven training modules in the TPSS, each consisting of multiple sections, and each with some testing requirements. Subjects range from very general orientation to more in-depth subjects such as how to utilize VBAs computer-based programs, medical terminology, how to review and interpret medical evidence, as well as understanding and applying the law and regulations when evaluating evidence and rendering decisions.
The assignment of supervised, individual case review is introduced later in the training program. While this initial training for new VSRs and RVSRs provides a sound core of knowledge, there seems to be imbalanced emphasis placed on production over training. DAV NSOs have been told by many VBA employees that meeting production goals is the primary focus, whereas training and quality is secondary. So, while we feel VBA's training program for new employees is sound, and while production is certainly important, productivity must not interfere with the training of new employees who are still learning their job.
Once these individuals have successfully completed their initial training, they begin their on-the-job-training (OJT) phase, in which they will be moved into productive roles in developing and rating cases with supervision. They will continue this OJT phase with mentoring and supervision, slowly increasing the number and complexity of cases until they are assigned a full case load approximately two years from their hire date.
From that point forward, they will have the same training requirements as all other experienced VSRs and RVSRs, which requires all employees to complete 80 hours of training annually, along with an additional 5 hours on VA's online Learning Management System (LMS) for cyber security and ethics. VBA's training is broken down to 40 hours of standardized training on VBA selected subjects and 40 hours of training on subjects selected by the VARO from the Core Technical Training Requirements (CTTR) and other subjects of their choosing.
In 2008, Congressed approved Public Law 110-389, the "Veterans' Benefits Improvement Act of 2008", which required VBA to develop and implement a certification examination for claims processors and managers. Now codified, 38 U.S.C. [Sec.] 7732A states:
(a) DEVELOPMENT OF CERTIFICATION EXAMINATION.--(1) The Secretary shall provide for an examination of appropriate employees and managers of the Veterans Benefits Administration who are responsible for processing claims for compensation and pension benefits under the laws administered by the Secretary.
(2) In developing the examination required by paragraph (1), the Secretary shall--
(A) consult with appropriate individuals or entities, including examination development experts, interested stakeholders, and employee representatives; and
(B) consider the data gathered and produced under section 7731(c)(3) of this title.
(b) EMPLOYEE AND MANAGER REQUIREMENT.--The Secretary shall require appropriate employees and managers of the Veterans Benefits Administration who are responsible for processing claims for compensation and pension benefits under the laws administered by the Secretary to take the examination provided under subsection (a).
However, almost two years later, there are still gaps in the implementation of this section. While tests have been developed and piloted for VSRs and RVSRs, additional tests need to be developed and deployed for Decision Review Officers (DROs) and supervisory personnel. None of these certification tests are mandatory, nor are they done on a continuing basis. It is our understanding that only when employees seek to move up to the highest GS-level for their position are they required to take and pass a one-time certification test. If they take but fail the test, they can simply remain in their current position and GS level. Moreover, VBA has no remedial training programs for employees that fail certification tests, nor are they required to re-take the test to show that they have mastered the skills and knowledge required to do their job.
The Government Accountability Office (GAO) recently conducted a study (GAO-10-445, April 2010) to determine the appropriateness of training for experienced claims processors and the adequacy of VBA's monitoring and assessment of such training. Of particular interest are the GAO findings that experienced claims processors' had concerns with the training received; specifically the hours, amount, helpfulness, methods and timing of training. Likewise, as the GAO report points out, there is very little done by VBA to ensure the required training is completed or to assess the adequacy and consistency of the training, nor is the VA's LMS being utilized to the fullest extent to properly ascertain the total number of VSRs and RVSRs who have met the annual training requirement. In fact, data received indicated a dismal outcome of only one (1) VARO meeting the annual training requirement and nine (9) other VARO's with less than half meeting the annual training requirement. It is simply unacceptable to have only one VARO meeting the simple requirement of ensuring that all employees complete 80 hours of training. VBA must place greater emphasis on training by implementing stricter monitoring mechanisms for all VAROs and ensure that they are held accountable for failure to meet this minimal standard.
Mr. Chairman, when DAV speaks about training, we do not do so just as an interested stakeholder, but because DAV takes pride in the fact that we have the foremost training program and the largest National Service Officer program, representing almost 25 percent of all claims before VA. In 88 offices throughout the United States and in Puerto Rico, DAV employs a corps of approximately 250 NSOs who provide free representation to veterans and their families with claims for benefits from the VA, the Department of Defense and other government agencies. Last year alone, DAV NSOs worked tirelessly on behalf of nearly a quarter million veterans and their families in their claims before the VA, obtaining nearly $4.5 billion in new and retroactive benefits.
DAV NSOs function as attorneys-in-fact, assisting veterans and their families in filing claims for VA disability compensation and pension; vocational rehabilitation and employment; education; home loan guaranty; life insurance; death benefits; health care and much more. Outside of the office, DAV NSOs provide free services, such as information seminars, counseling and community outreach. NSOs also represent veterans and active duty military personnel before Discharge Review Boards, Boards for Correction of Military Records, Physical Evaluation Boards and other official panels.
The expertise required for the outstanding assistance provided by NSOs involves extensive training. It begins with a rigorous 16-month on-the-job training program, which provides the foundation for new trainees. Trainees are instructed by tenured supervisory NSOs with subject matter expertise. Throughout their training, progress and knowledge retention of the NSO is closely monitored through web-based testing and monthly evaluations. In addition to the training received in the office, NSO trainees must successfully complete academic instruction in Anatomy & Physiology, Medical Terminology, Composition and/or Legal Research & Writing, and Public Speaking, from an accredited college or university. The National Service staff at the National Service and Legislative Headquarters, administers and monitors the program, as well as the instructor's behavior and the progress of each NSO trainee.
Due to the intensity of the training in the first four months, NSOs trainees are ready for an individual caseload in their fifth month and must pass a comprehensive web-based examination every four months on the topics covered from that given period; an all-inclusive web-based examination for the entire training period is administered at the conclusion of the 16th month.
Beyond their initial training, all NSOs participate in a comprehensive SCT program designed to keep them up-to-date on changes to the laws and regulations affecting veterans' benefits. NSOs are required to pre-test and successfully complete 32 monthly training modules with post-testing on each.
DAV training-which includes all NSOs, Supervisors and Area Supervisors - is separated into two books, one for Adjudication and Appeals, and the other for the Schedule for Rating Disabilities. Each book contains 16 modules and NSOs are required to complete the workbook research, questions, and case studies each month. Training utilizes multi-media resources and is administered through an instructor-led classroom environment and individual workbooks.
At the end of each month, NSOs must successfully pass web-based testing in order to move forward in training. At the end of the 16 months a comprehensive 160 question web-based test must be passed in order to move forward to the second 16-month training period, which is delivered in the same manner as the first 16 month period. Once an individual successfully completes the entire 32 months of training, not only have NSOs gained a wealth of knowledge and become more proficient in their duties, they earn 12 college credits provided through the American Council on Education (ACE), which provides additional incentive for successful completion. DAV is the only veterans service organization to have a training program certified for college credit by ACE.
DAV's SCT is ongoing and it will continue throughout an individual's career at DAV. When an NSO completes the entire SCT program a new training cycle begins again, but with changes, updates and new information provided by DAV's national training staff. For example, an experienced NSO with 15 years of service will have completed the SCT training four times.
DAV's SCT program is effective because it provides in-depth review of laws, regulations, VA M-21 and similar manuals, VA Fast Letters, Board of Veterans' Appeals practices, as well as opinions of the VA Office of the General Council and holdings from the US Court of Appeals for Veterans Claims. Moreover, the DAV SCT program delves deeply into the VA Schedule for Rating Disabilities (VASRD) by providing a meticulous breakdown of each anatomical system and correlating diagnostic codes and ratings. When dealing with the complexities of the VASRD, the SCTs accompanying CD-ROM collection, Special Monthly Compensation "slide rule" and case studies prove to be extremely useful throughout the NSOs career. In fact, there are many outside DAV who have benefited from our SCT program; this includes other VSOs and VA employees, as well as DoD Physical Evaluation Board members, who have utilized our SCT materials to enhance their knowledge.
DAV Recommendations for VBA's Continuing Training Program
Training Should Be Conducted at Regularly Scheduled Intervals in a Structured Format
VBA's failure to meet the hourly training requirements for its employees can be corrected by requiring greater structure to the training program with regularly scheduled training. Adequate time for training must be allowed in order for the employee to gain the maximum benefit of the training and improve their overall knowledge and skill. In order to accomplish this, VBA managers must ensure scheduled time for training is in place and that employees attend training. VBA's annual training should be structured and scheduled with consistency so employees can plan and prepare for training.
Although training time for employees is excluded from the calculation of their workload requirements and performance standards, it is clear that the pressure to produce creates disincentives for fully completing training. In GAO's survey for their report on training, 60 percent of experienced claims processors found it "difficult" to meet their annual training requirement due to their workload. VBA must find new ways to separate out time and space for employees to assist them in meeting their training requirements.
VBA Should Significantly Increase the Total Annual Hour Requirement for Continuing Training for All Employees
Given the complexities and duties of VSRs and RVSRs, more extensive training is necessary in order to gain the appropriate level of knowledge and skill to perform those duties with quality and accuracy. DAVs SCT training program is continuously ongoing and provides a constant learning environment for NSOs. Although NSOs are trained on virtually the same subjects as VSRs and RVSRs, NSOs are required to successfully complete 32 months of training about every three years, or approximately 400 hours a year, nearly five times the amount of training provided to VA claims processors. DAV also provides additional training on new and emerging issues that is outside the curriculum of the SCT training program, whereas VBA counts it as part of the 80-hour requirement. Annual training should not include emerging topics; this type of training should be provided separately and should vary each year depending on the number and complexity of the new and emerging issues.
We are not suggesting VBA match hour-for-hour DAV's training program, nor adopt the content verbatim. However, it is not possible for a claims processor to achieve the required proficiency level without significantly increasing the amount and intensity of training currently provided by VBA.
All VBA Employees, Coaches and Managers Must Undergo Regular Testing to Measure Job Skills and Knowledge, as well as the Effectiveness of the Training
Mandatory, regular and continuing testing programs for all VBA employees, supervisors and managers would serve several related purposes:
* It could be used to measure the proficiency and knowledge required for promotion or be used as a factor in determining other incentives;
* It could be used to identify subject matters or competencies that need required additional training of the test-taker;
* It could help evaluate the effectiveness of the training programs; and
* It could help identify weaknesses in the claims process that may require systemic improvements.
VSRs and RVSRs are currently required to complete 80 hours of annual training, but there is no testing to measure whether the material was understood or is being retained. Attendance is the main instrument used to verify if training is being completed, and even in that minimal measure VBA is failing miserably.
VBA has begun administering certification examinations for some employees; however, the examination is primarily being used for grade level increases, not for proficiency purposes. For example, if a VSR desires to elevate their grade level from a 10 to 11, they must pass a certification examination; however, they may opt out of the examination and remain at their current level. Conversely, if that same VSR fails the certification examination, there is no penalty and they may remain in their current position. A VBA employee also told DAV that a VSR "work around" to avoid taking a certification examination for a grade level increase would be for a VSR to apply for an RVSR position; if selected, the individual could be elevated from a grade level 10 to grade level 11 without the requirement of a certification examination.
By comparison, DAV NSOs engaged in the SCT program are trained and tested each month, concluding with a comprehensive 160 question web-based test at the end of the SCT program. Likewise, NSO supervisors have the flexibility to implement additional testing, which is often the case depending on the complexity of the SCT material, or with emerging topics, such as a particular CAVC case or VA Fast Letter.
DAV takes our commitment to disabled veterans, their families and survivors very seriously; and in order to provide competent, proficient representation, training is vital. Our goal is to deliver the most relevant material and information to an individual, monitor their progress through testing, and hold managers and NSOs accountable for completing the training, while increasing their competency and proficiency to perform their duties. We believe there is absolutely no way for VBA to accurately assess its training or measure an individual's knowledge, understanding or retention of the training material without regular testing. It is important, however, that all testing and certification be applied equally to both employees and to the people who supervise and manage them.
VBA Must Aggregate the Results of all Employee Testing, Coaches Reviews, Quality Assurance and Quality Control Programs and Regularly Analyze this Data to Develop New Training Curriculum and Claims Process Improvements
Training and quality control are interrelated and should be part of a continuous improvement program, both for employees and for the claims process itself. Quality control programs should identify areas and subjects that require new or additional training for VBA's employees; better training programs for employees and managers should improve the overall quality of VBA's work.
VBA has mountains of data about the quality and accuracy of work performed under the current system that comes from the Systematic Technical Accuracy Review (STAR) program, "coaches" reviews of employees, Inter-Rater Reliability (IRR) reviews and employee certification testing. However, there is currently no process or system that is capable of aggregating or analyzing this data to spot error trends or breakdowns in the claims process that need improvement or additional training of employees or managers. The new VBMS system should include the capability to aggregate and analyze the data from the results of all employee and manager training, testing, IRR, STAR and Coaches reviews. Such analysis can then be used to modify training programs and the claims process itself to reduce errors.
Training Must Be a Shared Responsibility of Both VBA Employees and Managers, and VBA Must Provide Accountability and Incentives for Successfully Completing Training
Successful completion of training must be an absolute requirement for every VARO and must be a shared responsibility of both employees and management. Managers must be held responsible for ensuring that training is offered and completed by all of their employees. However it is also the responsibility, as well as part of the performance standard, for employees to complete their training requirements. Managers must provide employees with the time to take training and employees must fully and faithfully complete their training as offered. Neither should be able or pressured to just "check the box" when it comes to training.
Training is essential to the professional development of an individual and tied directly to the quality of work they produce, as well as the quantity they can accurately produce. In fact, a senior VA official recently told DAV that new employees who just completed training were receiving some of the highest marks for quality and accuracy. One explanation is that new employees are more accountable for the quality of their work because they are more closely reviewed, have recently been trained and are up-to-date on the latest information.
Mr. Chairman, DAV believes wholeheartedly in the vital role of training and the primacy of quality over quantity. We believe the only way that VBA can make any tangible and lasting gains towards decreasing the backlog will be by producing better quality decisions the first time. As we have said over and over again, the claims backlog is not the problem; rather it is a symptom of a much larger problem: the failure to accurately process claims. One of the keys to solving this problem is training. VBA must undergo a cultural change that focuses on the accountability of managers and employees to ensure the training is being accomplished on time and with consistency.
At DAV, accountability for training and quality is present at every level and tied directly to performance reviews and monetary increases of employees as well as supervisors and managers. VA must infuse the same level of accountability within its VAROs, and they will be most successful if they adopt a "carrot and stick" approach which can be done both through performance standards ("the stick") and by linking training requirements to advancement, bonuses and awards ("the carrot"). This simple change could be a catalyst to producing better quality decisions for veterans and their families. We urge VBA to be firm in holding managers and employees to a much higher level of accountability in ensuring that training requirements are being met.
Mr. Chairman, that concludes my testimony and I would be happy to respond to any questions the Committee may have.
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