VA Claim Processing Reform May Overwhelm Computer Systems - InformationWeek

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Healthcare // Analytics
08:00 PM

VA Claim Processing Reform May Overwhelm Computer Systems

The Claims Processing Improvement Act of 2010 calls for a modification to the current system for rating disabilities that will add greater complexity to computer tracking systems.

A proposed bill that would reform the way the Department of Veterans Affairs processes claims from disabled veterans, has been criticized as a bill that will add greater complexity to computer tracking systems, reallocate resources, and could open the door to legal action.

The Claims Processing Improvement Act of 2010 calls for a modification to the current system for rating disabilities, and directs the secretary of VA to conduct a four-year pilot program in six to ten regional offices using an alternative rating schedule that evaluates veterans afflicted with disabilities to their musculoskeletal system.

"VA does not support this section of the bill for several reasons," declared Michael Walcoff, acting under secretary for benefits in the Department of Veterans Affairs.

In his testimony last week before the Senate Committee on Veterans Affairs, Walcoff said the bill, which requires the VA to use the International Classification of Diseases (ICD) as adopted by the Secretary of Health and Human Services under the Social Security Act, could have a negative impact on the way the VA's benefits administration operates and maintains its computer systems.

An ICD assessment would focus on the impact of the disabilities to the musculoskeletal system, which affects the muscles, tendons, ligaments, bones, joints and associated tissues that move the body and maintain its form.

Specifically the IDC assessment would consider the frequency, severity, and duration of symptoms of the disability in rating the claim, but Walcoff said the VA doesn't support using the ICD to rate musculoskeletal disabilities because it will add greater complexity to the current claims processing system.

"While use of the ICD would provide more specificity in naming disabilities, its adoption in an alternative rating schedule would result in a far more cumbersome and complex system of ratings, particularly given the sheer number of ICD codes for musculoskeletal disabilities," Walcoff said.

Walcoff explained that the pilot program would require extensive efforts on the part of VA to "develop a comprehensive computer tracking system, draft detailed regulations governing the alternative rating schedule, and then train frontline adjudicators on the specifics of the new system all within an extremely short time period."

The acting under secretary for benefits also complained that the alternative rating modifications would divert VA resources from working on existing disability claims and appeals as well as the agency's transformation initiatives, while creating a new area of potential litigation with the end result being additional delay in the claims and appeals process, and an increase in the backlog.

Another issue of concern is that each veteran who participates in the pilot program would be assigned a single residual functional capacity rating for all limitations of the musculoskeletal system.

"This bill, on its face, would not treat veterans equally. This pilot program is only available to a select group of veterans based on their geographic location and it is possible that individuals rated under the pilot could potentially receive higher ratings than similarly situated veterans not in the pilot," Walcoff said. "This pilot program focuses on substantive changes, thus creating a potential equity issue."

Sen. Daniel Akaka, (D-HI) chairman of the Senate Veterans Affairs Committee, who introduced the bill last month, said there will be opportunities to discuss the bill before the committee considers the proposed legislation in early August.

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