How the Veterans Benefits Administration is coping with PACT Act claims

The PACT Act, which became law in 2022, aims to help veterans who were exposed to toxins. Since June 3, it has sparked more than 625,000 new claims. For how the agency is dealing with the caseload, Federal Drive with Tom Temin spoke with Josh Jacobs, the Department of Veterans Affairs Undersecretary for Benefits.

Interview Transcript: 

Tom Temin And give us a sense, first of all, of who is handling these 625,000 claims? Is it the regular adjudication staff that was in place or did you have to staff up for this?

Josh Jacobs We’ve been actively increasing our staffing well before the PACT Act was enacted. In fact, prior to passage of the PACT Act in August of 2022, we started a 2000 person hiring campaign and we’ve increased our total workforce in VBA by about 20% over the last 18 months. And for the first time in our history, we’re now at over 30,000 employees. And the people who are doing the work are the claims processors, what we call the VSRs and the RVSRs who are helping develop the evidence and rate the cases. Just incredible employees and a very talented and hardworking workforce.

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Tom Temin Yeah. So they’re roughly equivalent to, say, administrative judges in other agencies.

Josh Jacobs It’s a slightly different we have administrative judges that do work in the Board of Veterans Appeals. These are claims processors. And they do hard work of identifying evidence and the military record and health records and working to make sure that we can make timely and accurate decisions for the veterans who’ve earned these benefits.

Tom Temin Yeah, they must be very patient people try to find out things from military records. And is there a dedicated staff for the PACT Act, or is everything blended into one big giant group of processors?

Josh Jacobs Our entire claims processing staff across the country is working PACT claims. We’ve actually received close to 680,000 PACT claims since the law was enacted, and we’ve processed more than 300,000 of those claims and we’ve been able to approve about 80% of claims that have a PACT contention. So what we’re finding is that the claims we’re receiving are taking up an increasing amount of the total inventory, about 45 to 50% of the total pending claims that we have, have at least one claim with a PACT contention.

Tom Temin So there could be claims with multiple contentions then.

Josh Jacobs Correct? We receive claims that receive anywhere it ranges. You can have some claims that have 10 to 20 different specific health conditions and then they’re going to be some with only a handful.

Tom Temin Dealing with veterans that go back to the Vietnam. I guess there are people from that era of the Vietnam era that are coming in under the PACT Act that would be a good example of people that might have multiple because there’s still the Agent Orange that you’re working through from several years ago and now the PACT Act. Fair to say?

Josh Jacobs Absolutely. One of the best things about the PACT Act is it’s expanding our ability to deliver benefits and health care to veterans who we haven’t been able to serve in decades. And so in the case of Vietnam veterans, we are now able to provide benefits to veterans who served in Vietnam or one of the other covered country locations who have hypertension. As you can imagine, there are a fair number of veterans of that age who have hypertension and so were able, for the first time ever, to provide benefits to those veterans. And so many of them may already be receiving other VA benefits for other service connected conditions, but for the first time are now coming in and being approved for hypertension.

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Tom Temin We’re speaking with Josh Jacobs. He’s the undersecretary for benefits at the Veterans Affairs Department. What kind of training is required for any claims processor? But the PACT Act, I mean, these laws, when you read them, they’re pretty complicated and there’s lots of codicils and we’re here two fours in them. I imagine there’s a pretty good training that’s required.

Josh Jacobs Absolutely. And particularly given the number of new employees that we’re bringing on board, we have a robust training for new employees that starts at their local regional office. It continues with our centralized training for all new employees, and then it follows them as they return back from that training to their regional office. It can take up to two years for a new employee to be fully proficient in processing claims. And for those employees who are more experienced, we have regular ongoing training. You can imagine the laws change, the policy changes, and so we need to make sure that our employees have the information, the resources that they need to keep up with all of those changes and to deliver timely and accurate decisions for the veterans that we’re privileged to serve.

Tom Temin And do you feel that they are backed by a pretty decent case management system, an online way that they can make sure they can rapidly retrieve a veteran’s records if they call back this type of thing?

Josh Jacobs Absolutely. You know, if you had asked me that question ten years ago, I would say maybe not. But this is an organization that transformed from a paper bound process where the floors were literally buckling under the weight of all the paper that constituted the claims process, to an organization that is now primarily electronic. And so we have a system called the Veterans Benefits Management System that enables us to process claims and distribute it more efficiently. And we’re adding to that by creating new automated decision support tools that provide our employees with greater access to efficiencies that make their job easier. And so we’re in the early stages of that, but we’re continuing to modernize and improve our technology.

Tom Temin And what has the PACT Act done to the backlogs?

Josh Jacobs Well  the great thing about the PACT Act is that it’s enabling us to serve millions more veterans. And as anticipated, we’re seeing an increase in the number of claims. We’ve received almost 700,000. We have anticipated the growth in demand. We’ve been able to hire up, and thanks to that early hiring and training, as well as the process improvements in technology, we’re delivering more benefits to more veterans than at any other time in our history. But the inventory is increasing, the backlog is increasing. And as we’ve projected from the very beginning, we anticipate it’ll increase over the next year or so before we’re able to bring it down to a healthy, steady state.

Tom Temin What is your metric for turning around a given claim and how close are you coming to that on average so far?

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Josh Jacobs So we define a claim to be in the backlog if it takes more than 125 days. And right now, our average days to complete is slightly longer than that. But we want to make sure as we pursue timely decisions, we’re also making the right decision the first time. So in some cases, it may require us more time to identify and develop the evidence that’s required to deliver an accurate decision. So we don’t want to sacrifice quality for speed, and there’s always going to be that tension. The other thing I would say is we made a decision to start processing PACT Act claims on January 1st, even though the law was passed in August. And that was the right decision because we had to develop some regulatory guidance that provided policy. We didn’t wait 18 to 24 months for regulations. We had to develop the training. But it did enable us. It did allow us to to start processing those claims as early as possible. But there were a cohort of claims that we simply had to wait. And so that has also distorted the total average processing time.

Tom Temin Is there a way to I guess maybe, for lack of a better word, triage the claims that are coming in? I mean, a lot of the cases, especially with the PACT Act, have to do with respiration of a individual. And if someone says, look, I’m five days away from being on a ventilator versus someone that says, well my five mile time has fallen 20%. There’s a big difference there. Would one say maybe be looked at sooner rather than the other one?

Josh Jacobs Absolutely. We have a process to prioritize claims. So, for instance, if a veteran has a terminal illness or a financial hardship or is homeless, over the age of 85, as well as certain other conditions, we move those claims to the top of the list for priority claims processing. We want to make sure that veterans who are in dire need of the support and the benefits that they’ve earned get them as quickly as possible based on the individual circumstances.

Tom Temin And one other question that you might have implied earlier, just to be accurate, VA mentions that it serves X number of veterans in a given year, and there are so many veterans in the United States, these are known numbers. Has this increased the total population that you’re serving? That is, people came in because of the PACT Act that might not have been in the rolls for VA ahead of this.

Josh Jacobs We’re beginning to see more veterans who are pursuing VA benefits in health care that have not previously. And part of the reason we are actively trying to get the word out about the PACT Act is to reach more veterans who are not connected to VA. Either they have never wanted to apply or they applied and were previously denied. Maybe they heard a bad story. And so we are actively trying to get the word out. Let veterans know about these incredible benefits and health care and and encourage them to apply. And we want to either earn veterans trust or return it so that we can care for them as well as they have cared for this country.

Tom Temin And a final question Are Pact Act benefits available to those that are less than honorable discharge but above the level of dishonorable?

Josh Jacobs Yeah, we have a process to review specific discharge conditions and so eligibility depends on a variety of conditions. So if you’ve got questions about that, you can work with a local veterans service organization or you can call us at 1-800-myVA 411 to ask any questions and pursue your individual case.

 

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