Defense

VA Paperless Claims System ‘Spontaneously’ Shuts Down

pling/Shutterstock.com

The Veterans Affairs Department’s $491 million paperless claims processing system frustrates examiners with “spontaneous system shutdowns,” Sondra McCauley, VA deputy assistant inspector general for audits and evaluations, told a hearing of the House VA Committee.

McCauley said 25 staffers in the in the Houston, Newark and Milwaukee regional offices of the Veteran Benefits Administration told the IG that the Veterans Benefits Management System, or VBMS, also has latency problems that have slowed downloading of medical documents.

Nextgov reported on Jan. 4 that sluggish response times on VBMS made it difficult for claims examiners to perform simple actions on veteran claims files, such as search, update, save or retrieve.

McCauley told the hearing on Wednesday that VBMS mislabeled electronic evidence in claims files and mixed up evidence in the file of one veteran with that of another veteran. Such malfunctions, she said, force users to rely on older systems to process claims.

VA completed  installation of VBMS in all 56 VBA regional offices in June. However, McCauley said, VBA has only one VBMS pilot site with “the capability to process claims from initial application through review, rating, award, to benefits delivery.”

VBMS, key to VA Secretary Eric Shinseki’s goal to elimination of the massive claims backlog by 2015, is ill-suited to handle complex claims -- those involving multiple medical conditions -- well, due to the limitations of its design, an official of the Paralyzed Veterans of America told the hearing.

VBMS is a rules-based system that lacks the “human interaction to fully understand the circumstances of a specific injury,” Sherman Gillums Jr., associate executive director for Veterans Benefits at the PVA told the hearing.

“Unfortunately, rules-based systems treat all veterans the same and can be flawed by imperfect rulemaking and application,” Gillums said. He said the numerous issues faced by veterans with “with catastrophic injuries create a complex set of outcomes that cannot be easily reconciled by logic-based systems that cannot appreciate nuance in disability assessment.”

Calculators in rules-based systems historically have failed to compute the right ratings for people with multiple issues, Gillums said.  This type of decision analysis uses decision trees that attempt to enable the rater to simplify and resolve complex questions, Gillums said. “This technique, however, can be problematic when the analysis involves highly qualitative assessments that are reduced to binary choices,” he said.

Experienced claims examiners, not algorithms, “best factor in the nuances of special monthly compensation and areas of subjective interpretation that can lead to an incorrect decision,” Gillums said.

(Image via pling/Shutterstock.com)

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// April 15