This is the second post of a seven-part blog series that chronicles and attempts to dissect and explain the recent and growing issues and challenges negatively affecting the U.S. Department of Veterans Affairs.
Why Has VA Fallen So Far in the Eyes of So Many?
Many factors contributed to the current state of affairs of VA. However, in my view, there are four primary reasons:
- Resources have not kept up with the workload.
- VA’s goals have been unrealistic, and its metrics need to be revised.
- Inaccurate data; inadequate information technology.
- VA’s culture, including a lack of accountability.
On the healthcare side, a number of factors have caused the workload to dramatically go up. First, to a certain extent, VA became a victim of its own reputation. As word got out that VA had the world’s best healthcare system, demand for VA’s services naturally increased and veterans were funneled into the system causing an increase in patients.
The United States’ invasion of Iraq and Afghanistan resulted in approximately 2.5-million veterans being deployed there; some for as many as five tours. As you may expect, a new generation of veterans began seeking assistance from VA. Many of them only survived the war because of advances in medical care. But, they were left with egregious injuries that required a high degree of care.
In 2009, VA initiated an aggressive outreach program. It brought many veterans back into VA’s healthcare system. This program, coupled with the fact that Vietnam veterans were aging and in greater need of healthcare, added more patients to VA’s rolls.
Changing views regarding mental health also caused veterans to finally come forward and seek treatment for PTSD and other mental conditions.
Healthcare Demand Increase for the VA
These are only a few of the reasons why VHA has often become overwhelmed. Listed below is a table that shows how the number of people receiving access to VA has increased during the past many years.
As you can see, since FY2001, the total number of patients seen by VHA has increased by 56%, even though the total number of living veterans has declined by 17%.
On the benefits side, many of the factors impacting upon VHA, as described above, plus the ones shown below, have contributed to a dramatic rise in VBA’s workload. For example:
- In 2001, the Veterans Claims Assistance Act added extra steps to the claims process. It increased the length of time it takes to develop and adjudicate a claim.
- In 2004, a court decision required that more than 62,000 claims be deferred; many for longer than 90 days.
- In 2006, Haas v. Nicholson expanded the presumption of exposure to Agent Orange. This resulted in additional claims requiring resolution.
- In 2008, VA reopened 488,000 claims for disability benefits and revised its rating process for traumatic brain injury.
- In 2009, Secretary Shinseki added B-cell leukemia and ischemic heart disease as presumptive conditions associated with Agent Orange.
The Secretary also relaxed the stressor verification requirements for certain veterans claiming Post-Traumatic Stress Disorder.
Additional factors that added to the VBA’s workload include:
- Slower economic growth
- An increase in the average number of medical conditions claimed by veterans
- Improved access to benefits through the VA/DoD pre-discharge programs.
As a result, the number of claims received by VBA increased 24% over four years, from 888,000 in 2008 to 1.1 million in 2012 (per VBA’s website.) This does not take into account the number of claims that needed to be reworked as a result of various court decisions and other influencers.
The point of outlining many of the reasons why VA’s workload has grown so significantly, and, thus, contributed to its current problems, is to illustrate that none of them were under the control of VA’s senior executives. Moreover, VA’s senior executives had little, if any, control over the resources they received to address these workload challenges.
Increase in Veterans Affairs Employees
To be fair, in response to these workload challenges, the number of VA employees has steadily risen as shown below:
However, there are several points you should be aware of that impacted upon VA’s ability to meet its healthcare and benefits workload:
- VA did not really ramp up its workforce until 2008, years after we invaded Iraq and Afghanistan and several key court decisions were issued. Given that many of VA’s positions are highly technical in nature and take years to learn, the agency was way behind the eight ball in preparing for and coping with many of its workload challenges.
- During this period, most of the Class of ‘74 left, meaning many of VA’s most experienced employees and senior executives from the Vietnam era departed, resulting in the loss of an enormous amount of institutional knowledge.
- While VHA’s budget has increased significantly, many of those increases have been directed for “earmarked” purposes and were not within the discretion of local directors to allocate to where they saw the greatest need. In other words, during the past decade, many VHA directors have felt that VA Central Office has been telling them both what to accomplish and how to accomplish it while holding them accountable for results for which they had limited control.
- The same goes for VBA. For example, for many years, VBA had a policy of “bleeding” (aka intentionally withholding resources) what they deemed to be less productive offices. While they eventually reversed this policy, it had an adverse impact on the affected regional offices, many of who are today still paying the price for this policy.
The point is that many VA facilities, through no fault of their own, have been understaffed to varying degrees. In the process, they also have had far too much authority stripped away.
This statement was confirmed in an internal VA audit, which among other things reported that the imposition of the 14-day standard on the field “before ascertaining the resources required and its ensuing broad promulgation represented a failure of leadership.”
An independent White House review also pointed out that VA, particularly VHA needs additional resources. Moreover, Congress supported this view in its bill to reform VA by adding approximately $12 billion in emergency funds to boost the hiring of doctors, nurses and other medical personnel. That budget also allowed for the private medical care of veterans under certain circumstances.
The same holds true for VBA. For example, during the past few years, many of its employees have been required to work 20 hours of mandatory overtime per month. Despite this, the backlog is still way too high.
Let’s be clear about this: Understaffing does not in any way justify the abuses that have been uncovered. However, in order to help preclude future abuses and to provide better service to America’s veterans, VA must address the underlying resource issues that contributed to its current problems.
So, why has VA been understaffed for so long? Some of it is certainly the continuing national deficit. However, a major part of the reason is that VA has not been honest with Congress, which provides VA with its annual budget.
As long as VA gives Congress and the public the impression that it is doing better than it really is, Congress will continue to provide it with resources that are inadequate. I will address the topic of improper reporting later in this blog series.
About Stewart Liff
Stewart Liff is an HR and visual performance management expert and leading author on managing and transforming government agencies, as well as president of Stewart Liff & Associates. He is also the author of a new book 98 Opportunities for Improving Management in Government, as well as Managing Government Employees and co-author of A Team of Leader and Seeing is Believing.
Go now to download a free chapter from my book A Team of Leaders: Empowering Every Member to Take Ownership, Demonstrate Initiative, and Deliver Results. Get a deeper knowledge today about how you can put into play a better way to get your business on the path to success.
 Erin Bagelman, The Number of Veterans That Use VA Health Care Services: A Fact Sheet, Congressional Research Services, June 3, 2014
Per the VA Claims Backlog Working Group March 2014 Report
 Per Chris Edwards, Number of VA Employees, The Cato Institute, May 28, 2014
 Department of Veterans Affairs Access Audit System Wide Review of Access Results of Access Audit Conducted May 12, 2014 to June 3, 2014
 Review was prepared by Rob Nabors and Sloan Gibson and was dated June 27, 2014