VA’s Dr. Paul Lawrence discusses benefits for Navy vets exposed to Agent Orange

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After a long argument, Congress and the Department of Veterans Affairs opted to grant benefits to Navy veterans whose ship duties during the Vietnam War might have exposed them to agent orange. The job of administering benefits fell to the Veterans Benefits Administration. Visiting Federal Drive with Tom Temin in studio to explain a program that got underway last month, the VA undersecretary for veterans benefits, Dr. Paul Lawrence.

Interview Transcript: 

Dr. Paul Lawrence: The president, on June 25th of last year signed the Blue Water Navy Act Vietnam Veterans Act to provide Agent Orange benefits to those folks who had been in the blue waters 12 nautical miles off the shore of Vietnam during the conflict. So if you’ve been exposed to Agent Orange and you have some of the conditions, now you can have access to both health care and benefits. So it resolves a long running dispute. What exactly was the Republic of Vietnam? The interesting thing about this law was once it was signed, the Secretary was allowed to stay it, pause it for six months while we got ready so that we could be ready on January 1st. There was a great deal of concern that wouldn’t be ready. But we were ready and we began granting on January 1st. We’ve been doing that now for a little more than six weeks. We’ve gotten about 18,000 claims. We’ve granted about 1000. You know, survivors benefits is real important. As you could imagine, a lot of veterans from Vietnam are older. They may have passed, for conditions perhaps. Their families can apply for benefits.

Tom Temin: I want to get to some of the issues concerned with how long ago that was. But before we do, is this anyone who can prove they were in the Blue Water Navy in ships that carried this material back and forth? Is that all that’s needed to be able to get these benefits.

Dr. Paul Lawrence: We will find your ship, so the veterans don’t have to prove they were there. They have to have the conditions, and they’re listed on our website VA.gov, search blue water. You can find the conditions. If you have conditions and you were in service off there, your record shows us where you were. We’ll find the ship you were on.  It’s not so much your ships carry the Agent Orange, it is that it made its way into the water, then the water made its way onto the ships. That’s the thinking.

Tom Temin:  I guess which can happen in literal waters. Things splash.

Dr. Paul Lawrence: That’s exactly right. The Agent Orange was actually carried by the Merchant Marines and distributed on the shore.

Tom Temin: So it was controversial in deciding whether it was a worthy benefit or not. But once decided, then your job is just to deliver it.

Dr. Paul Lawrence:  Once the laws passed, we execute at VBA, and that’s what we did. And just so you know, we’re very serious about this and deliberate, and we actually have benefits office in Manila. So it turns January 1st aired December 31st at about 11 o’clock in the East Coast time. That’s where we started granting benefits so that we could be, as you know, just prompt is we could had 200 people work in the continental United States on January 1st. Volunteered. We paid them, but we didn’t need mandatory overtime and I called the first recipient to tell them that he had been granted benefits under the new law.

Tom Temin: And is it only Navy?

Dr. Paul Lawrence: No. There’s Marines and other military personnel, but its primarily Navy because these were Navy ships.

Tom Temin: And just get to that distance in time issue, I heard a soon to be veteran the other day give a talk about PTSD and TBI that he experienced in the early days of Iraq, Special Forces. He’s about to muster out, and he’ll be one of your constituents pretty soon. But he mentioned how hard it is to find records and videos and so forth of things that happened in 2004 in that part of the world. You’re dealing with something 50 years ago now and as good as the military keeps records, how do you find all the ships?

Dr. Paul Lawrence: Actually, the ship logs wish plot, and they record where the ships were were actually kept at. NARA, the National Archives. And so we went and got them there. Every day someone would come take a reading. No GPS, right? This is the 60s. eight in the morning, noon time and eight o’clock in the evening where they were so we can see where the ships traveled, whether they were in the blue water or whether they were not. And that’s what we used to place you.

Tom Temin: That sounds incredibly painstaking. Case by case,

Dr. Paul Lawrence: Yes. So we had to eventually digitize, I think it was 28 million records/pictures and then transcribe a lot of information off them to build a tool. And that’s what we did in the six months as well as train and develop procedures. But this was really the big challenge of getting this. So now we can say, jeez, veterans, if you think you have a condition, we’ll find your ship. We can tell you whether you were in the blue water. Come apply for benefits. Let us help figure this one out.

Tom Temin: And how did you get that digitization done?

Dr. Paul Lawrence: With conversations with NARA and the Department of Defense. Both organizations leaned in. They understand the situation you can imagine. We had very good luck. The archivist, the head of NARA, is a Blue water Navy veteran. He understood completely. We had to promise to be careful with the records, but we were able to take them from NARA and bring them to a facility where a contractor promised with utmost care to help scan them, you know, put them  in plastic. So these sorts of things so that we do not lose him.

Tom Temin: You needed a contractor to do all that?

Dr. Paul Lawrence: It is an intense amount of work in a very short period of time under really demanding conditions.

Tom Temin: And these were paper records that had been written on in pencil?

Dr. Paul Lawrence: You got it exactly right, all those years ago. So you know, approaching 50 for some of them. And there’s some 1800 ships.

Tom Temin: And VA staff is adequate to do the evaluations?

Dr. Paul Lawrence: That’s right. Adjudicating claims is something we do regularly. That’s our business. Adjudicating Agent Orange claims the things we’ve done before on the land and in the round water. This required some thinking about the location but it was somewhat similar. We had to hire more people and we had to train more people in some of the nuances of the law. But no, we’re ready for this.

Tom Temin: And what is the timeline for getting everyone processed or do they keep coming indefinitely?

Dr. Paul Lawrence: As long as people can apply. We’re on the communication campaign. Please apply for benefits if you think you’re eligible. I was just out talking to the Vietnam Veterans of America, VVA, here in Silver Spring and talking to them about getting the word out to this population. And they understand they’re old, average age is 73. We have to advertise in Reader’s Digest. The wife’s primarily have to be on the soap operas, because that’s what they’re watching, you know, we’re really challenging ourselves to figure out how we get the word out. And even to families, right? Dad could have died from these conditions. The kids now are eligible for benefits, or they can advocate for mom in this example.

Tom Temin: Are there any women involved?

Dr. Paul Lawrence: It was primarily men at this time, but there are small fractions of women.

Tom Temin: I wanted to ask you about Solid Start, the outreach program and what that’s all about, what the progress there is?

Dr. Paul Lawrence: So this fundamentally changes the way VA interacts with military service members as they become veterans in the first year. Part of what we do, and this was an executive order the president signed to begin to deal with suicide broadly across government is we are making phone calls to veterans in their first year. First phone call in the first 90 days, the next one in the first 6 months, and last one within 365 days and beginning to establish a relationship with VA. Letting them know we’re here to answer any question to provide information about the benefits they’ve earned as well. As you know, checking in on any mental health resource is they may need. What’s very exciting about this is the response rate in terms of people actually answering the phone is much higher than we thought, and many of the questions have so little do with mental health resources. More, how do I apply for benefits? How do I connect with the VA? So if you think of something you have a long term relationship with? Perhaps your pizza guy, don’t mean to be glib. You know, we want to reach out and say, This is your relationship with VA. Let’s get started on knowing that you are in her system now forever as a veteran.

Tom Temin: And do you call all veterans? Or what about those with less than honorable discharge.

Dr. Paul Lawrence: It’s the honorable discharge, people who would have access to benefits. But if you are in the dishonorable, you are welcome if you have mental issues to come to VA hospitals and we will give you care.

Tom Temin:  Because that’s a big gray area I think right now, in the eventual disposition of some of those cases where the behavior that resulted in the less than honorable could be, that’s not a VBA issue.

Dr. Paul Lawrence: I know that’s being re looked at for exactly the reasons you described. Times were different. Things were different. I know that’s always being thought about being reopened.

Tom Temin: Have you made any of the outreach calls personally?

Dr. Paul Lawrence: No. I have not. My deputy went the first day we began to do this in our contact centers. So she did it. She double jacked listening on the phone calls. Folks were very, very happy she had ‘I didn’t know I was eligible for these benefits’ and quite frankly, they found somebody who was sitting in his car rather distraught, not knowing what to do next. Not quite certain where they were going, but it was concerning. And this connectivity got him into the V A system, so it could be better. And the other thing, too, is think about, you know, you leave right away. Maybe things were great, But maybe sometime in the first year, things turn, and these phone calls are designed to just check in and so, you know, encourage veterans. If you do receive these phone calls, please take them. And even if everything’s fine, maybe it won’t be through the course of the year.

Tom Temin: Dr. Paul Lawrence is VA undersecretary for veterans benefits. In part two of my interview, we also discussed a program in which VBA staff phone new veterans to tell them what services they’re entitled to. I asked about the fact that in the age of runaway robo-calls. How do you get people to answer the phone?

Dr. Paul Lawrence: We observe this too. So the response rate isn’t 100% for exactly the reason you say people are suspect. So now we’ve gone and changed the caller ID, it says the Department of Veterans Affairs, so you can see it. But you’re right. We understand everybody’s very skeptical in this day and age, so we know that something to be worked through. Hence the reason we come to communicate about it on shows like yours to explain what a valuable thing this can be.

Tom Temin: You’ve been holding quarterly results meetings. What’s the highlights of the latest results on some of the mundane things that you do? Backlogs, appeals and all of that.

Dr. Paul Lawrence: Sure, that’s right. Once a quarter we report through a webcast, that’s a webinar. People can find it on YouTube, because we file it.  About a 20 minute broadcast of our quarter quarterly results, modeled after a private sector earning call, go through each of the eight business lines. So for the quarter just passed, the one that goes from October 1st through December 31st, which I just did a week or so ago, we reported what I call outstanding results by every business line. Every business line met or exceeded their targets, and we raised the targets at the end of the last fiscal year. We were doing so well. So ironically, our backlog in November reached an all time low. Was little more than 64,000. And your recall from 2013 it was 611,000.

Tom Temin: I was going to say that sounds like 90% based on what I remember.

Dr. Paul Lawrence: That’s exactly right. So, you know, this quarter, we processed claims faster than ever in our history.

Tom Temin: I know you did get some staff to add to that. But also there was a process changed to try to make it sort of rubber stamping everything one way or the other that you can always get rid of them overnight. But that’s not what you meant.

Dr. Paul Lawrence: No, no. We have quality indicators, so as we move faster, we want to make sure that the work still remains at a high level. And it is. So we’re, driving down the  appeals backlog that we handle. As well getting more positive outcomes for veterans. Getting our GI bill claims procesed  faster, so we think we’re making significant and real progress at VBA

Tom Temin: Now, at the departmental level, the Office of Information Technology recently released a year end report dealing with 2019 talking about customer service, modernizing and so on, and giving better applications deployed to veterans. Has some of that affected VBA and enhanced what you’re able to offer?

Dr. Paul Lawrence: Oh yes, we have a great relationship with OIT the CIO, I consider one of my closest collaborators. He really understands from a VBA perspective that we’re the customer and he’s in business to serve us. We meet at least once a week and talk about some of the challenges. He, of course, explains the dilemma we have with old systems and somewhat modest expectations I should have. But we work together, he’s always looking for what I call quarters from the couches to somehow figure out how we can get the things we need. But he doesn’t do anything short of performing miracles with a limited amount of IT money that’s available.

Tom Temin: Let’s talk about the unbanked veterans. This was a surprise to me that there are hundreds of thousands of veterans that don’t have a bank account, right?

Dr. Paul Lawrence: So in an effort to get folks out of the check writing business. There are still folks, however, who can receive their benefits, choose to receive their benefits through a check or having it put onto a debit card. And both of these make them susceptible for fraud and just frustration. I lost my check. Something happened. How do I get another one? Well, as you know, they’re issued by Treasury, not VA. That’s a level of frustration. This debit card if you’re unbanked and you go and to use it, they can charge you fees. So we’ve established a relationship with a series of banks. We call this program the Veteran’s Benefits Banking Program, VBBP. But if you just Google Veterans benefits or veterans bank, you will find this. There’s a series of banks and more joining this all the time, who will offer to veterans, and these are big, well known banks. FDIC insured, the whole nine yards. No cost checking account to veterans so they can have access to world class financial institutions to get them banked. They’ll avoid fraud and abuse. They’ll have all the checks we get. Quite frankly, what we hope is by interacting with the banks their financial literacy will increase. Can’t help but be in a branch and see all the products and the safeguards in place. So that’s really one of our plans for calendar or 2020.

Tom Temin: Other than, and I’m  making assumptions here that those without bank are on the poor and economically, is there any other demographic quality that characterizes those without banks?

Dr. Paul Lawrence: You know, that was my hypothesis, too, but it’s not necessarily true. It is related, we think, to the homeless problem because of all the reasons you can imagine. But there is a section of section that chooses to do this. So we’re trying to convince them not to do it. It wasn’t exactly what we thought.

Tom Temin: On the medical side of VA, one of the things they’re dealing with is the shortage of clinicians in rural areas. On the benefits side, is there any dichotomy in the ability to serve  city versus country.

Dr. Paul Lawrence: Now, of course, their footprint is bigger than ours, right? So we’re in 56 regional offices in a handful of sub offices around the country. But, as you know, their footprint is much larger. And doctors are in  demand nationwide. Medical professionals in general there’s a shortage everywhere in the cities we’re in, we’re often an employer of choice. So we are very lucky in that sense, especially in the middle part of the country. Where we experience some of the large metropolitan cities where we have offices, New York, Oakland, these type places. We notice that could be a problem to hire. But by and large, we’re pretty good. We’reso much smaller to the hospitals. We have 25,000 employees. We have openings, but many, many fewer

Tom Temin: In the medical area again, if you have telemedicine or you have to ship pictures and so forth X rays, MRI scans, tat takes a lot of bandwidth, which is not always there. But in VBA., I would think that you can do most of the transactions with people in rural areas over ordinary connections.

Dr. Paul Lawrence: Yeah, well, not quite, but you’re exactly right.We have a very active footprint. Our offices all around the country and in Manila. We have an active telework program and you could do much of your work remotely. And so, for example, when there were big office in Salt Lake City might have seen the news. Lots of snow probably can’t get to work. You can work from home. We won’t miss a beat.

Tom Temin: Final question. Any plans to add automation to pension claims and disability process?

Dr. Paul Lawrence: Oh, absolutely. One of our big challenges has really been to figure out that what the benefits of automation can be. We’ve sort of gone through by business line and looked at it. One of the last ones we really need to focus on is pension automation. So we started a project last fall, October 1st to do exactly that. So we’re in the middle of working with the CIO and the OIT team to figure out the resources that are available. We hope to have more on that later, but it is on our FY 20 list, so hopefully by the end of the summer will have some announcements in terms of what we’ve done and how much faster it could be.