Faster Decisions, Stronger Outcomes: VA’s Work to Streamline the Disability Claims Backlog
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House Veterans' Affairs U.S. House of Representatives
Follow its sittingsMike Bost
It is important that we have a VA that leverages innovative technologies and approaches to improve outcome for our veterans today and tomorrow. I know we are all looking forward to hearing from Ms. Devlin. Ranking member, I now recognize you for your opening statement.
Mark Takano
Well, good morning. Thank you, Mr. Chairman. Good morning, everyone. Thank you for being here today as we examine the timeliness of VA disability claims decisions. Veterans need, want, and deserve a timely decision on their claims.
Access to earned benefits and care can mean the difference between financial stability and better health or a life of hardship. And I say that without exaggeration. So yes, it is welcome news that the disability claims backlog has returned to its pre-pandemic level.
But veterans also deserve an honest accounting of how we got here and why the backlog ballooned over the last few years. Now, the backlog did not materialize out of thin air, nor was its trajectory a mystery. It reflects two major events, and as you can see on this chart behind me, we hit a peak of roughly 425 claims in the summer of 2024. That's right here. And it's been, it's been trending downward ever since, a very dramatic trend downward.
But there are two prominent spikes that occurred before. The first spike is in the beginning of 2020, which is the, the pandemic. It was driven by the COVID pandemic, which no one could have predicted. The second is beginning in 2022, following the passage of the Honoring our PACT Act, and that second increase was not a failure, was not because of a failure or due to bureaucratic malfeasance or, as the chairman mentioned, some dysfunction. It was anticipated and intentional.
When President Joe Biden signed the PACT Act in 2022, the summer of 2022, the goal was not to suppress claims or to keep numbers low. The goal was just the opposite. VA accelerated implementation and surged resources to encourage veterans to come forward and file. Actually, the president, I think, actually signed some sort of executive action which made veterans, cohorts of veterans eligible sooner. And so, you know, what the actions of the, of the president and the secretary at that time meant was that it ensured that veterans could secure their date of claim and their place in line as quickly as possible.
In other words, the backlog increase reflected increased access. It reflected veterans finally getting into the system, many for the very first time after years of being shut out. Now, VA's own projections from October 2022 anticipated all this. Now, I have a second chart up here, and this was created by VA just after the passage of the PACT Act in August 2022, and it shows projections for claims inventory and backlogs based on the then-new law. And you can see a projected peak of about 450,000 backlog claims in October of 2023.
That's right here. And it drops to roughly 100,000 claims in February of 2025. Now, and this is the projection, but in the real, in real life, in the real world, you know, we get to 100,000 a few months after the projected date. Now, I remind you, this was a, a projection that was created by VA just after the passage of the PACT Act in August. All told, VA's projections were pretty accurate, albeit a shift to the right just a few months from what we saw in the real world.
Now, what we're seeing today, you know, the victory lap that's being touted in this hearing, is not the result of some extraordinary turnaround by the new administration. It's largely the system and hardworking VA employees performing as expected under the weight of expanded eligibility and long-overdue access.
Now that context matters especially as we hear VA boasting and taking credit for a trend that was already happening. But there's more to the story. There's growing concern about a distinct shift of emphasis to quantity over quality at the department. Processing speed has become the headline metric. But veterans do not experience the VA system as a metric.
They experience it as a decision that is either right or wrong from their perspective. If it is wrong, the consequences are significant, including a denial of a veteran's access to healthcare. So veterans deserve to know what the opportunity costs are of the department focusing solely on processing times. Now, I am confident in saying that veterans don't want partisan blame games, just as much as they don't want a partisan cheerleading session. Fortunately, the nakedly political backslapping session the majority has arranged today fails in that.
We have a single witness before us, the Department of Veterans Affairs. VA is hardly in a position to provide an independent assessment of its own performance. And what we are missing are key oversight voices like the Office of Inspector General and the Government Accountability Office who would be able to speak objectively about the quality of VA's claims processing work. Now, we are missing the voice also of the VA workforce who would be able to talk about the challenges of VA's increased emphasis on throughput and the toll that mass hirings and a return to mandatory overtime have taken. But most importantly, we're missing the voices of veterans themselves, either individually or collectively through their advocates in the veterans service organizations.
It's impossible to justify a hearing by this committee on VA's claims without including a single actual user of the system or the service officers who help veterans navigate it every day. We need to hear beyond the carefully honed talking points that VA is going to deliver today. We need to know what is actually happening on the ground from veterans and those service officers who are helping them navigate this complex process. We raised the need for other voices to be heard to the majority more than a month ago and sadly we were rebuffed. And so we're here today with only VA as our witness.
Nevertheless, we on our side are going to do our best to draw out what is actually happening with disability claims processing, beyond just how fast claims are moving. A quick decision is well and good, but if we're moving so quickly that errors are made, or if we're simply rushing to denials, there are downstream effects we must consider. Anecdotally but consistently we are hearing that claims processing errors are rising and denial rates are increasing. That, of course, is problematic. Premature or erroneous denials lead to more appeals where timelines are measured in years and not months.
So it is imperative that the Veterans Benefit Administration get it right the first time, because any delay in getting a veteran their earned benefits is a problem. It can lead to the denial of healthcare and needless suffering. We need to spend this committee's time finding solutions to the problems veterans face, not on engineering victory laps for the administration so that it can pat itself on the back for simply doing what it was supposed to do. Our responsibility remains the same. The question before us is not how fast claims are moving, but whether we are getting them right in the first place.
Unfortunately, the structure of today's hearing makes that harder to assess. We need a clear understanding of what is actually happening in claims processing, not just how quickly decisions are issued, but whether those decisions are accurate, durable, and fair to the veterans who depend on them.
Veterans deserve both speed and accuracy because one without the other is not success, it is simply delay in another uniform. Thank you, Mr. Chairman, I yield back.
Mike Bost
Thank you, Ranking Member, for your opening statement. As mentioned earlier, joining us today from the Department of Veterans Affairs is Ms. Devlin and Ms. Flynn. Thank you both for being here. I ask you to please stand and raise your right hand. Do you solemnly swear that the testimony you are about to provide is the truth, the whole truth, and nothing but the truth?
Thank you, let the record reflect that the witnesses have answered in the affirmative. Ms. Devlin, you are now recognized for five minutes to present the department's testimony.
Margarita Devlin
Chairman Bost, Ranking Member Takano, and members of the committee, thank you. It's good to see you all again, and thank you for the opportunity to be here to discuss VA's progress in reducing the disability claims backlog. I appreciate your unwavering commitment to veterans, service members, their families, and their survivors. Joining here with me to testify is Ms. Flint. She is the Deputy Under Secretary for Field Operations, so she's responsible for the entire field.
I want to start by saying that behind every claim waiting for a decision is a veteran or a survivor whose health, financial stability, or family situation depends on us getting this right. These are not just numbers. They're people who have already served this nation and deserve timely and accurate decisions. I am proud to report that under Secretary Collins' leadership, we have made historic progress. For the first time since May 2020, the backlog has fallen under 100,000, an achievement made possible through disciplined management and focused effort.
We reached this milestone really by combining three things. I'm going to start by naming those three: our people, our tools, and our technology, and a clear leadership focus on the areas where claims were stacking up. First, let me talk about our workforce. By the way, our workforce is about a little over half veterans themselves. Last year, VA completed a record-breaking 3 million compensation and pension claims, and this year we surpassed 1 million claims earlier than ever before.
Our employees drove that success. They reviewed records, they developed claims, they made complex decisions, and determined when medical exams were needed. They partnered closely with our contract exam vendors who completed more than 3 and a half million disability exams, and together we expanded access to exams in rural areas so that veterans could get the evidence needed no matter where they lived. All of this was done without sacrificing accuracy. Quality is now, as of the end of March, over 94%, the highest it's been in two years.
Second, our technology and automation. By using new automated tools, we were able to streamline routine tasks and process claims more efficiently, ensuring that our experts, our employees, could focus on the decisions that require human judgment. We also worked closely with our federal records partners to ensure we receive documents needed to support these claims and move them more quickly through the process. And third, focused leadership and operational discipline. We made deliberate decisions, such as using overtime strategically and prioritizing high-impact workloads that allowed us to drive throughput where veterans were waiting the longest.
As a result, the average time to process a claim has dropped by 42% since January 2025, from 141 days to just 81 days. That's 60 fewer days a veteran has to wait for an answer. And this progress extends to survivors as well. The dependency and indemnity compensation inventory of pending claims has dropped by 67% and the backlog by 83%.
Mr. Chairman, this is not the finish line, but it is a strong foundation, one that positions us to keep driving the backlog down while maintaining the quality, accuracy, and care that veterans deserve. At the end of the day, every day we save brings a veteran or survivor closer to the benefits they've earned. Thank you for your support and for the opportunity to testify today. Ms. Flint and I look forward to your questions.
Mike Bost
Thank you, Ms. Devlin, for your opening statement, and everything will be in file in the records for the opening statement. We now want to go to questions. I'll recognize myself for five minutes. Ms. Devlin, can you describe how VA claims backlogs look now compared to the last several years one more time?
Margarita Devlin
Yes, thank you for the question. In January of 2025, it was over 264,000 veterans that were waiting over 125 days for a decision on their claim. And we are now under 100,000 as of this morning at about 83,000.
So you accomplished that by using what tools and what what program and what what plans did you use with your staff to get that done?
We we use a combination of things. In addition to our dedicated employees, our leadership focus on this ensured that we used our national work queue to drive the work to where the where we could be most productive. So the disability claims process includes a lot of development, and with our national work queue, we can drive the work to where the bottleneck might be. So a lot of times that's development. Our automated procedures help us get medical records more quickly.
One thing that we do for our veterans is if they have private medical records from a private physician or hospital, they don't have to go find those. Our automated systems, all they have to do is sign a release, and we will go get that, and much of that is received in an automated fashion. All of these these different things that we do to get federal records, to automate procedures that are that are administrative in nature, help the claim move through the process faster so that a decision maker can look at the claim and make that decision.
Mike Bost
Okay, faster is important, and we're glad we're getting them down, but also what do you have to put in place to make sure those decisions are accurate? Because quite often the conversation here is, okay, we can't just like the what OIG discovered, you can't do a four-minute job and think that that's accurate. So what is in the system to make sure it's accurate when you're doing it?
Margarita Devlin
That's a really great question. We focus very much on accuracy. That's it's also not by accident that we're at 94% accuracy now. So what we do, there's a feedback loop, and we get feedback from a lot of different a lot of different ways. One is through the Board of Veterans Appeals decisions.
We take a look at patterns and trends. We also look at the individual employee quality reviews and our national reviews to to determine whether there are certain areas where employees are making mistakes, and then we focus dedicated training on those areas. We do what we call quality training sprints, where we sort of stop everything and focus training on those areas where we find that we're seeing errors. We are very focused on making sure our veterans get the right decision as much as possible the first time.
Mike Bost
The the one claims processor that did the 80,000 in such a short period of time, what have you put in place to make sure that is not occurring throughout the system, and and what are the what are the stopgaps to stop that from occurring?
Margarita Devlin
Thank you for that question. We've put a few things in place. We have systems now that were not in place before to identify those employees that are producing at that high of a rate. And if they are producing above a certain rate, we are instituting additional quality review measures to make sure those employees' quality is where it needs to be.
We're going above and beyond with special focus reviews.
Mike Bost
Okay. Because because of the accusations that are obviously going to be made in the political world, what who does the oversight to say, okay, your accuracy is at this level? Is it you inside that make this decision on how accurate it is, or is there some oversight that's put in place that we know why it is that you get one accuracy rating prior and then the next one? So what's what's the stopgap there?
Margarita Devlin
And I can let Ms. Flint talk a little bit more to this, but we have several different quality review systems. So we have an in-process review, which is for the employees' direct feedback. These are things that happen while the claim is moving through the process so that if we find an error before that claim is completed, we can give the employee feedback, have that corrected before the decision is finalized. Then we have employee performance feedback. So these are quality reviews that go against their performance standards, and there's about three to five that get done per month, depending on the volume.
And then we have our national STAR quality review, which is done by our national headquarters. These are not people checking their own work. We have regional offices that are getting their work checked for quality by other regional offices or by our national team. They're not checking their own work.
Mike Bost
Okay. And I think this committee, regardless of the side of the aisle, we want to make sure, one, that these claims are processed at a timely manner, but they need to be accurate, and and that's the most important thing about having this hearing today is making sure that, you know, every every person out there believes their claim should be 100%. They they do. That's just the way a veteran is going to react to this. But you've got to be able to safeguard against, and you've got to do your fiduciary duty.
And I appreciate you being here today. With that, I'm going to turn the questions over to the ranking member.
Mark Takano
Thank you, Mr. Chairman. Ms. Devine, we hear consistently that denial rates for disability claims have been rising. That's true according to data from VA. Denial rates have rising have risen from roughly 35% in 2024 to 39% in 2026. Now, 4% may not sound like a lot, but when VA is processing several million claims a year, any percentage increase in denials represents tens of thousands of veterans who are denied access to crucial healthcare and benefits.
So, Ms. Devine, can you explain to the committee why denial rates have risen over the last five years?
Margarita Devlin
Thank you for the question. I'm not sure what data you're looking at, but I did look at the data on grant rates, and it has been consistently around 60 to 61% grant rate, with the exception of the two years right around the time PACT Act was implemented. So those two years, the grant rate did go up a bit to about 64 to 65%. And now we're in a in the place where some of those claims that we are still working on, which are in the backlog, are some of the more complicated claims that have a lot more evidence to review and to obtain to substantiate whether a disability condition exists.
Mark Takano
Okay. Well, moving on, Ms. Devine, according to VA data, in addition to denial rates rising, claim accuracy rates are currently below historical averages as well. Can you explain can you explain why that's going on?
Margarita Devlin
Thank you again for that. I've been really watching very closely the accuracy rates, and it's going up. And it's going up by design because we're focusing more on the error rates that we are seeing.
Mark Takano
Well, I'm reclaiming my time. I I'm not talking about that they've been going up. I'm talking about can you explain accuracy rates currently below historical averages? You I mean, yes, they are creeping up. That's not I don't dispute that, but but they're still below historical averages.
That's what I want you to explain.
Margarita Devlin
Respectfully, sir, they're higher than they've been in two years at 94%.
Mark Takano
Two years, but we're talking about previous years. I just explained over the last two years why we've seen claims, why there was a bulge. We had a pandemic and we also had this massive outreach to veterans to file claims. I mean, claiming a victory lap over that precipitous decline after VA was given all these resources, I mean, it's a bit rich. But we can look at the prior two or three years to kind of get a better sense of what's going on.
Margarita Devlin
Respectfully, sir, my concern is that veterans understand that the VA is here for them, that we respect them, and we want to take care of their benefits. And the purpose of putting the good news story out there is to gain their confidence.
Mark Takano
Okay, so you're not really responding to my question. I reclaim my time. You're not really responsive here. You state that the claim accuracy is improving, but I'm having trouble reconciling that with what is actually happening at the Board of Appeals. Now, the number of appeals is also increasing, partly because of increased denial rates.
But the number of times the board catches errors and sends a claim back to VBA to fix is also increasing. And that speaks to the quality deficit at VBA. Ms. Devlin, how can both of these things be true?
Margarita Devlin
Thank you for the question. The denial rates have not been going up, and in fact, we looked at the percent of disagreement with VA's decisions, and that has consistently over many years stayed at between 11 to 13% of our veterans who disagree with the decision they receive. 11% of a bigger number is a bigger number. So we are producing more claims, but the rate of disagreement is the same as it has been historically. It's not gone up.
Margarita Devlin
A clear and unmistakable error is when upon review we determine that the employee made a mistake of law or regulation in deciding the claim.
Mark Takano
Okay, so does VBA track those CUEs, that stands for clear and unmistakable errors, as part of its quality control process?
Margarita Devlin
Clear and unmistakable errors, yes. Well, we would track them for the purpose of feedback for the employee, but also to make sure we correct those errors for the veteran.
Mark Takano
Okay, and so if so, what is the trend line for the volume of that type of error?
Margarita Devlin
I don't have CUE data here. I don't know if Ms. Flint tracks that individually.
So you can't tell me if they're increasing or decreasing as of now.
Margarita Devlin
I can tell you that our errors in general are decreasing and our percentage of accuracy has been going up.
Mark Takano
But you can't tell me whether CUEs are increasing or decreasing. Just tell me that.
I don't have that data in front of me.
Mark Takano
You don't have the data. So you just said that. So these CUEs seem very much like the type of error that occurs when someone is rushing to get something done. Steps get missed, mistakes are made, and that's not something that can be solved with just training alone. So since you can't tell me what the trend line is, you know, I really can't get my question about whether we can cut down those rate of CUEs.
But I yield back, Mr. Chairman.
Derrick Van Orden
Thank you, Mr. Chairman. Ms. Devlin, thank you very much for coming. Can you tell me how the proposed reorganization and streamlining essentially of the chain of command is going to affect your ability to help our veterans and get these claims processed?
Margarita Devlin
Yes, sir, thank you for that question. The reorganization essentially streamlined our headquarters. Over the years, the headquarters had gotten very large. What we're trying to do is make sure that we're focusing the resources where the veteran receives the benefits, which is in the field. So streamlining the headquarters means less layers to go through for decisions to be made, for issues to rise to my level.
Speaker 9
Yes, because currently at the VA, everybody's got six bosses, Bob. I had a great meeting with our union folks in my office back in the district who work at the VA, and they're seeing improvements, but there needs to be continuous improvement.
So I wanted to pass that on to you. And I'm, you know, people have mixed feelings about certain unions, and I don't. A lot of these folks, you know, they're going to work and they're working very, very hard. And I'm really proud of them. That's from the administrative folks to the people processing these claims.
Now, I'm a veteran, I get all my healthcare through the VA. My friend, dear friend Morgan is also a veteran. Could you maybe just in a short period of time kind of wrap up for the folks here that have not served, what it actually means to get a disability rating? What happens? I retire, what happens?
Margarita Devlin
Thank you for that question. For our veterans who served, they might have had injuries while they were serving, they might have become ill, or they might have been exposed to toxic substances that resulted in them getting serious disability conditions like cancer. The disability claims process is such that we review that medical evidence and help them to get compensation for those disabilities and injuries that they will have for the rest of their lives.
What does that process look like?
Margarita Devlin
The veteran files a claim and they tell us which disability conditions they would like to claim for disability compensation. They provide us with information, and then we support them with our duty to assist by getting them medical exams if needed, collecting all the evidence and background information, and then making a decision that renders them a percentage of disability, which then results in a financial compensation for those percentages.
Derrick Van Orden
And the veteran doesn't have to do this by themselves. There's some of our outstanding veteran service organizations like the VFW, Disabled Veterans of America, the American Legion, and they do that pro bono whether or not you're a member of the organization or not, correct?
Yes, they do.
Derrick Van Orden
And have you found in the past that the VA has tried to impede our VSOs from being able to help veterans get their disability rating?
Margarita Devlin
Absolutely not. In fact, we now include them in our transition assistance program at the end of the course so that they can introduce themselves to the service members and tell them about their services and give them access immediately after the class.
Speaker 9
Excellent. If you were queen for the day, what would you do like right now to expedite this process?
Sir, I am not queen for the day.
You are today.
Margarita Devlin
But a lot of the things that we're already doing that we're going to continue to do more of involves more automation and continued focus on quality improvement and making sure our employees have the resources they need to do the best possible job because they care. They're mission-driven.
Speaker 9
I am going to translate that into English. You're going to get rid of four of the six bosses, Bob, and streamline the process by making sure that we understand that we're in 2026 and that automation and the implementation of artificial intelligence and the ability to focus very hard on what needs to get done, and that's the expedited, accurate adjudication of a veteran's disability claim happens in a much more rapid manner, right?
Representative Brownley.
Julia Brownley
Thank you, Mr. Chairman. So, thank you for being here. So this new system, the AI system or the automated systems in claims processing, how long has that been instituted? When did you institute it and how long has it been running?
Margarita Devlin
Thank you for that question. It's not brand new. It's been, it started years ago, and I'm sorry I don't have the exact year when we first started automated decision support, but we've accelerated the percentage of cases of disability conditions that can be assisted through the automated decision support. Remember that our employees are still making the decisions.
Julia Brownley
So is that saying you're using it more? You've had it for a long time, but you're using it more now than you were previously?
Margarita Devlin
No, it takes time and money to develop each piece, each component, and we have developed more of it so that we can do more support our decision makers with more disability conditions. It requires focused effort to create more of the automation.
Julia Brownley
So based on the system then you're not seeing it sounds to me like you're you're not seeing more denials for veterans based on this system. I'm just I know in private industry with insurance companies doing claims they also use an automated system to go through that and I continue to hear that those denials there are many denials that come in place. And so you know I think it's something that needs to be monitored very very closely because speed is great but quality is more important at the end of the day. And I just worry that we're trapping veterans in limbo that have to go to an appeals process which takes a really long time. I don't think that process has sped up as it as it probably should but it regardless veterans can be caught in limbo.
They are caught in limbo today between from a denial to an appeal and getting answers from that. Staff in my district office have tend to be receiving now more generic and unclear responses from VBA when assisting veterans with their disability claims. So without the information about estimated processing timelines details that are under review or documentation requirements that are outstanding it's extremely difficult for veterans in my district and I think across the country to know when they'll receive a decision. So my question is what steps are you taking to improve communication and engagement with veterans about the status of their outstanding disability claims?
Margarita Devlin
Thank you for the question. So I just want to clarify that our dis- our disapproval rates are not going up so we're not denying more veterans claims and we are expediting the lanes that we have for for disagreements the AMA lanes for higher level review and supplemental claims so that the claims process can be faster. And our people are making the decisions. The automation does not make any decisions and will not deny a claim. It simply puts everything together for the decision maker so that they can make the decision faster.
Julia Brownley
So okay I I would like to know more about that because it it certainly sounds as though I just don't understand when you talk about in your in your statement you talked about the leadership of the new secretary and the and as a consequence this process has improved and sped up and maintained quality all at the same time. But it just doesn't sound like I it sounds like you've got a perfect system going here and I just I can't believe that it is perfect and you probably will say it's not perfect. I get that. But you know what I want to hear from you is you know where are the points that we can still improve upon? Denials are denials and veterans are in limbo when they're denied.
So I'm wanting to hear some feedback from you in terms of what you're doing to in an ongoing basis continuous improvement on the system.
Margarita Devlin
I agree with you. Continuous improvement is a necessity. We will never sit back on our laurels and think that we're in a great place and we shouldn't continue to evolve in particular as it pertains to quality and accuracy. You asked about communication on the timeline because our claims are moving more quickly you know we're giving more feedback to veterans more quickly as well. And if we can decide some portion of the claim for a veteran we will decide that portion and start getting their compensation flowing even if there's another more complicated condition.
But also our our call center 1-800-827-1000 we will be able to give them a very specific status of their claim.
Julia Brownley
But my staff at home is just saying we're getting a generic response and you're not they're not getting that kind of detail to help you know in terms of communicating with our veterans to give them some sense of where the status is on their claim.
Margarita Devlin
Happy to work with you on any specific cases that you're that you're having issues with. We can look into them.
Yield back.
Representative Luttrell.
Morgan Luttrell
Thank you, Mr. Chairman. Ms. Devlin, does VA create its own language models internally or is it outsourced?
Margarita Devlin
For language models, you mean for the automation, the AI-enabled automation? We have contract companies that help us with that.
How often is that updated?
Speaker 12
What's a regular basis? I'm going to dig in on you a little bit on this one. This one drives the point home to Mr. Takano and what Ms. Brownley are saying, if the language models aren't being updated at the speed of which technology is developed, the VA will obviously be lagging behind. And given where we are, if you're talking about artificial intelligence, machine learning injected into the VA system, if it isn't in a timely manner, I think this will decrease those kind of symptomatic issues that we're seeing with notifications.
Margarita Devlin
Yeah, so we have updates to the system on a regular basis. I'm going to say they're approximately about six to eight weeks that we get updates to the system for new automated decision support, new conditions...
Speaker 12
And all that information, okay, six to eight weeks, that seems, that's impressive that you say that because I'm trying in my mind to gather as much information as the VA brings in daily, aggregated or retrospective, and process that into a language model that would allow this system to update itself in six to eight weeks seems a bit aggressive.
Margarita Devlin
Well, the automated decision support is not just AI, right? It's rules-based processing that helps the employee have all the information in front of them to understand what they need and what they already have in the file without having to look through thousands of pages of medical records, right? So it's not making decisions on claims.
Speaker 12
Well, it's really helping. I think that what it does is it streamlines the process, puts that blue line right in the middle so the rater can see that in a clearer picture. If you can get kind of, I'd like to have like a breakdown on that if you don't mind, on kind of like what the timeliness is because I would, I'm going to speak freely with the committee, we are eagerly behind the injection of AI models into the system so our veterans get what they need in a timely manner. Fair enough?
Margarita Devlin
Yes, definitely technology is a huge part of how we continue to stabilize the system so that we're not always chasing a backlog but can focus on advancing the mission faster for veterans and enabling our employees to work on the more complex pieces of the work, which is really the decision-making.
Speaker 12
Where do we stand with information flow between the Department of Defense and Department of War, Department of Defense, excuse me, however you want to say it, Department of Defense, the VA, information flow from one service into the VA? The backlog, the system seems when it bogs down, we talk about National Work Queue, now I'm shifting gears on you, we talk about National Work Queue and the veteran's ability to hand-carry, I'm speaking for myself on this one, all of my information to the VA, hopefully I didn't miss anything. Okay, now the system itself is broken down in a way that there's no ceilings there, so to speak. Where are we with conversations, Department of War and the VA on complete information transfer from one site to the other?
Margarita Devlin
I will tell you the two secretaries have made a commitment to work together on this and the Secretary of War has committed to what we're calling sort of service treatment records at day zero. We want to be able to get all of them electronically.
Speaker 12
Is there a time frame on this? Don't say yes and just walk away with that. I'm that... I would like to hear, yeah, I know in six months on this day that will be set in stone and we are moving forward.
Margarita Devlin
So we're working on this in milestones. And the first milestone is to get a digital claim from the service member so that everything is digital, not just the service treatment records. So this month we are implementing a soft launch on a digital benefits delivery at discharge claim, meaning we're enabling both service members and VSOs, because a lot of service members want to work with a VSO, to submit the claim electronically. Because that then sets the stage for DOW to be able to submit the STRs electronically.
Speaker 29
And it takes the guesswork out of it. It lets the veteran know that, hey, my information is over.
Margarita Devlin
Exactly. We're trying to... we will avoid the situation where a service member's having to carry their medical records anywhere or scan them and upload them.
Speaker 12
Because once the veteran leaves the service, the service has their own thing. If I had to go back into the service and ask for my information, the service is not paying attention to me. I'm a name again, I'm not a number. I'm not an asset anymore. So having that take place before the veteran or service member moves into the veteran community is amazing.
The... as when it... I don't have time for that question. Mr. Chairman, I yield back. Thank you.
Maxine Dexter
Thank you, Mr. Chair, for holding this hearing and thank you also for being here and giving our... your testimony. I think we all understand we share a responsibility to ensure veterans are getting high-quality, timely benefit decisions. And as amazing as it sounds, I tend to trust but verify, so please bear with me. Um, we also had an opportunity to speak with local Oregon veteran service officers who made clear decision times are indeed that they are experiencing are improving, but countered to what we are hearing, their impression is that errors are increasing. And these are not just... you know, we haven't changed the number of veterans being served in our area.
So maybe it could just be that the absolute number processed are getting higher, as you made a point of earlier. But mistakes do delay access to care. So even if that were true, those mistakes still are something we should address. So my first question is, is it true you have fewer VA employees processing these claims? We've been told the answer's yes, but I just want to hear that for the record.
Margarita Devlin
Uh, we have had a little bit of attrition. Um, we're working on a strategic hiring plan to backfill some of those positions. But part of what we have to do is evaluate how everything has changed in our ecosystem with all the technology to make sure we put the employee resources in the right places.
Speaker 32
And we know that AI is threatening, you know, positions across all sectors. So this is obviously one where AI is being used. Um, we also know that when work is pushed faster with fewer employees, that oftentimes quality can be compromised. Um, this, as I said, is unacceptable. So, um, Ms. Devine, I want to also ground this in something we all understand.
Would you trust a physician who gave you a prognosis based on a quick Google search or AI tool?
Speaker 32
I would not either. And as a physician, I know technology can support good care, but it cannot replace good clinical training, expertise, and peer-reviewed evidence. Yet it seems that that is exactly the type of breakdown we are seeing. Veteran service officers raise serious concerns about VA decisions citing inappropriate sources. In some cases, determinations on disabilities included references to WebMD and Google searches in the actual letter being returned to the veteran.
I reviewed a claim where the VA explained a veteran's employability by stating, quote, "according to Google," followed by a quote, direct quote from language that certainly appears to be AI-generated content. And I have that here if we want to submit that for the record. That is not a standard. That is a system under strain. It is using artificial intelligence to do the work that these employees have done previously.
Speaker 38
And when staff are pushed to move faster without the resources and support they need, I do believe quality erodes and veterans are paying the price. So I'm going to ask directly, Ms. Devine, is this the level of quality veterans should expect?
Margarita Devlin
Um, that would be, I would like to look at that, actually, if you would submit that to us. And I'll let Ms. Flynn answer the question about employability and how an employee might use things like a Google search to understand the labor market for a specific veteran based on his or her specific background. That would not be an AI-generated action. That's an employee-generated action based on their individual use of systems available to them. We do not use AI for medical opinions or medical decisions or any decision-making.
Speaker 32
I mean, I have the exact quote from the letter. You attributed not working due to your service-connected disabilities, according to Google, in the letter. According to Google, quote, a person managing the conditions you described, and it has them, could thrive in various jobs with some adjustments. So this is literally quoting Google. And then there are literally quotes from WebMD.
I think that that, regardless of my skepticism around whether that is an accurate assessment, receiving that as a veteran certainly does not increase confidence. And so, I appreciate that you could walk through this, but I'm very conscious of my time. So I want to get to the quality review process, because 94% accuracy sounds amazing. Does that include veteran perceptions of the accuracy of the claims or VSOs or others?
Margarita Devlin
No, that would be based on our review of were procedures followed, were regulations followed, and was the decision right based on those requirements.
Speaker 32
And so I think that this is a self-fulfilling prophecy. If we're using AI-generated quality control measures, we have fewer people, you know, reviewing more claims. There has to be AI use looking over AI-generated decisions. I wonder where the actual peer review or quality review is coming in that is not automated.
Margarita Devlin
That's not automated. Our quality review systems are done by humans who are reviewing the regulations and the statutes and the quality of the work.
Margarita Devlin
It's a validated sample. I think it's three to five, Ms. Flynn? Three to five cases per month, is that correct?
Three to five cases?
Speaker 40
Yes, at the national level. At our national quality, they statistically valid sample to get a national quality number is three to five individual quality reviews per employee.
Three to five total?
Per employee per month.
Okay. My time's up, I yield back.
Thank you. Representative Barrett, you are recognized for five minutes.
Shaun Barrett
Thank you, Mr. Chairman. Ms. Devine, Ms. Flynn, thank you for being here today and appreciate the insight into how we are able to reduce the claims backlog that veterans have experienced. I know that's been a legacy from previous administrations and previous Congresses and appreciate the efforts to reduce that claims backlog. Obviously, you know from hearing from other members and hearing from veterans just how serious that is when a veteran is waiting and chronically anticipating the resolution of a claim. I've had that happen personally and I know others who have as well, where time will go on and a review takes place and, you know, veterans can go on the VA app and see kind of where they are in that process and the steps will sometimes go backward instead of forward as process goes on.
One question I had for you is as we see the claims backlog diminish, are we seeing an increase in appeals or are we seeing an overall reduction in claims that are not, or rather that are fully adjudicated and finalized post-appeal as well?
Margarita Devlin
We're not seeing an increase in the appeal rates. It's been consistent around 11 to 13% of our veterans disagree with a decision that we made on their claim.
They then have access to different procedures, right, that they can choose. A lot of times they'll choose the supplemental claim lane because they might realize that if they had submitted additional evidence it might change the decision. In that case, our grant rate's about 35% of supplemental claims get granted. So that sometimes that additional evidence was just missing in the in the initial decision. They can also access the higher level review, which really takes the the decision that was made by one person, one employee, and has a second more senior employee reviewing the the decision.
And our grant rate's a little lower than the 35% there. But those processes are not taking a long time either. So the processing time is approximately is very similar to the initial claim.
Shaun Barrett
And do those higher level review and supplemental claims, do those count in the, I guess, statistical capture of appeals or are those not considered an appeal until a more formal appeal is granted?
Margarita Devlin
They're considered appeals under AMA. And then we still have some legacy appeals that we're still working through.
Shaun Barrett
And the the lengthy appeals, are those those are the ones that are a more formal appeal, not a higher level review or a secondary claim submission, is that correct?
Margarita Devlin
They're all formal appeals. The legacy ones are before the AMA went into law.
Shaun Barrett
Okay. Okay. And then I know we've talked a lot about AI, the use of that. Certainly there's a lot of rightful concern in various different areas that AI touches on, whether it's in veterans benefits or other aspects of American life as we all kind of digest how this is going to affect all of us. Um, one thing I just wanted to ascertain from both of you today is that in the circumstance that the VA is using AI for the for the use of of claims processing and things of that sort, is there a human in that process that is reviewing anything before a veteran's claim would be denied or can AI simply sweep through that and, you know, dismiss a claim on its face or would a human be involved in in a process in that chain?
Margarita Devlin
There is no artificial intelligence in our systems that makes a denial decision. Everything gets presented to a human claims processor to make a decision. We a couple things I'd like to say about this. So first of all, we are assessing the quality of the automation to make sure that that's functioning properly and our employees have a method of reporting to us when they're seeing something that's not quite right so that we can fix it. The employee decides whether the automated information presented to them is enough or not enough.
And so they are looking at that and and ultimately making the decision on the claim or pushing back and saying I need additional information as part of duty to assist.
Shaun Barrett
And could a AI assistant tool that the VA uses say yes, you have the appropriate documentation either from a Department of Defense physician or an outside physician, you have this presumptive condition diagnosis and it could it could almost take that and say all of these things are met by this standard that we have and the the human claims representative would then quickly review that, but it could also work in a way that could approve or or help to approve an expedited claim, is that equally or is it only being used to detect fraudulent or denial basis for for a claim?
Margarita Devlin
It's actually detecting everything in the file that that claims processor must review to make a decision. So it will look at things like if the veteran served in the Navy, were they within 12 nautical miles of certain areas to qualify for certain presumptives. It'll look for what were their dates of service and be able to put that all together. So what the employee is seeing is screens that present to them, this has been satisfied, this piece has been satisfied. We've got the DD-214, we've got the length of service, we've got presumptive exposure, we've got a disability diagnosis for this condition.
Oh, no, it thank you for that question.
It presents it all to them and then shows them what's missing. So it might say, well, for these conditions, we've got everything you need, you can go and grant the claim. For this condition, you're missing something. We might need to go do a medical exam because we don't have a current diagnosis. Ultimately, the employee is in the driver's seat in every single claim decision.
Thank you. Thank you, Mr. Chairman.
Speaker 28
Before I recognize our next member, all members need to be advised that there's a protest going on on the second floor of the Cannon. If you're moving from building to building, you might want to avoid that. The police are, the Capitol Police are dealing with that right now. Representative Ramirez, you're recognized for five minutes.
Delia Ramirez
Thank you, Chairman, from the great state of Illinois and ranking member from the great state of California. We're being fair this morning. Look, all jokes aside, we have a responsibility in committee to provide oversight of the VA's processes, especially the processes that the VA is using to address its disability claims backlog. As we've been discussing the backlog, I would be remiss not to mention that the speed at which claims are processed cannot come at the sacrifice of the quality of service to our veterans. That can't ever be compromised.
And simply reducing the backlog for the sake of saying that the backlog is reduced at the expense of accurate and successful outcomes for veterans is not, in fact, putting our veterans first and it's certainly not honoring our veterans' service. As my colleagues are well aware, one of my primary concerns in this administration has been its commitment to reducing the federal workforce and dismantling the VA. Secretary Collins has made good on that commitment, has shrunk the workforce through RIFs, and he'll continue to do that work through the reorganization that he is leading. In July 2024, after the robust hiring of new claims processors as a result of the PACT Act, VBA ended its posture of mandatory overtime with a few exceptions for certain types of claims. This was a relief to a burnt workforce that had been torn apart by twin pressures: one, the COVID pandemic, and then the other, which was the increase in PACT Act claims.
When we fast forward to May 2025, after losing thousands of claims processors through the deferred resignation program, the voluntary early retirement, and outright firings, VBA realized they had a capacity problem and then they reinstated the mandatory overtime at a rate of about 25 hours per month, if I'm not mistaken. So, Ms. Devlin, is the May 2025 mandatory overtime policy still in place?
Margarita Devlin
Thank you for the question. I would like to point out, and I'll answer your question, that our quality is going up. We are focusing on quality. And yes, we did institute mandatory overtime. It depends, we're really focusing the...
So it's still on now? You still have it?
Speaker 22
We do not have mandatory overtime right now today. And Ms. Flint can talk about the number of hours that we are focusing on overtime right now.
Cheryl Flint
Can you tell me how many hours then, just for the record, that we have right now in overtime?
Speaker 26
Yes, ma'am. We have several categories of VSRs who are working 20 hours of mandatory overtime as of April, VSRs who do non-rating work and a couple of other missions. And we have one group of VSRs who do MST who are working eight hours.
Delia Ramirez
So let me follow up to that. And whether it's Ms. Flint or Ms. Devlin who answers this question, has VBA analyzed the effects of mandatory overtime on the quality of the claims? Have you done some analysis on that already as you've made some reorganizations on this overtime?
Speaker 23
The work that we perform in overtime is part of our overall workload. And so the any quality questions would flow naturally as part of our normal quality process.
Delia Ramirez
But you've been intentional about conducting analysis on the impact of quality of overtime in the quality of claims. You've done that work and if you've done that work, not just because people are doing the work, what were the results of that?
Speaker 23
We didn't, we don't make a distinction between the work that's done on overtime and work that's done, I'll say, on straight time.
Delia Ramirez
So you haven't really analyzed the effect of mandatory overtime. We have not analyzed the effect of mandatory overtime. So let me follow up on that. Ms. Devlin, has VBA analyzed the effect on worker burnout and or retention or attrition as a result of its resumption of mandatory overtime? Have you done that analysis?
Margarita Devlin
We do look at the attrition numbers and I just want to point out that claims processors were not allowed to elect into the deferred resignation program or VERA, so our attrition has not changed from historic levels of attrition. We are working on a strategic hiring plan and as we mentioned earlier, because of automation efforts, the employees that we need might be in different categories of employees and we want to make sure that we do avoid burnout by making sure that we are resourced in the proper way in our new ecosystem that we're operating in.
Margarita Devlin
So we're looking at our pay files, we're looking at production, we're looking at quality. There's a lot of different things that we're, where the automation is helping the most, where we still need more human intervention in the development process. We will always need humans for decision makers.
Delia Ramirez
Absolutely. I want to make sure you, we have that on the record. Look, there's a couple questions that I want to follow up with you because it's not consistent with some of the reports that I have here. But just as I wrap up in these last 15 seconds, it is important to make sure that we are clear that the speed of processing claims does not equate in quality of the processing of the claims and I want to make sure that that is always a priority. And automation overtime alone are not long-term sustainable solutions for addressing the backlog.
We all know that to truly honor our veterans, it's service with action. We have to ensure that the VA is in fact fully staffed and that our processes do not sacrifice quality. So I do want to follow up with you on some of these systems. Thank you, with that I yield back.
Mariannette Miller-Meeks
Thank you very much, Mr. Chair. Ms. Devlin, has the VA utilized overtime to help alleviate the claims backlog?
Yes, ma'am, we have.
Mariannette Miller-Meeks
And does the VA see this as a long-term strategy for combating future surges and backlogged claims?
Margarita Devlin
Backlog, or sorry, overtime is a good surge capacity assistant. It is not something that we would want to rely on for sustenance of the backlog.
Yes, that's correct.
Mariannette Miller-Meeks
And then how do we ensure that the VA is not continuously playing a game of catch-up?
Margarita Devlin
I'm glad you asked that question. So we are getting to a point now where we can seek more balance and by continually to develop more of the automation, we can continue to focus our employees on the hard work of making decisions and advocating for our veterans. By doing so, we will get into more of a steady state where we would be able to then handle surges using things like overtime but not rely on it on a day-to-day basis.
Mariannette Miller-Meeks
And you've done a remarkable job catching up, so hopefully that can, we can get the rest of the VA in scheduling to do the same. Is it the case that quality has declined? Some people say because of the technology that you're using, quality has declined and some people are suggesting that the work is rushed by claims processors and is it correct to assume that claims that take longer are better quality?
I.E. if it takes more time, does that actually ensure that it's greater quality?
Margarita Devlin
Thank you for the question. Our quality has actually continued to improve. We're doing what we call quality sprints where we sort of ask everybody across the country to focus training on specific areas where we've seen error trends. And no, a claim taking a longer time just means a veteran has to wait longer. It doesn't mean it's going to be a better claim.
The automation doesn't make decisions. It does pull the information together so that the claims processor can not only get to a decision faster but can also see is there anything missing in this claim and get to that point faster and understand what is missing so that we can then go out and get it for the veteran to help them get a decision faster.
Mariannette Miller-Meeks
Yeah and I will say that I have heard from veterans in my district about the time. That's a greater complaint often. I've also heard some speculation that board appeals might increase due to faster processing, so this gets back to the quality issue. Has that been the case and is that a fair assumption?
Margarita Devlin
That's not the case. Our disagreement rate with our decisions has maintained pretty steady around between 11 and 13 percent. That has not changed historically even with the immense amount of production that we've done. I will say, and I've said this before, 11 percent of a bigger number is a bigger number, but when you look at the rate of disagreement, it's maintained consistency.
Mariannette Miller-Meeks
Thank you for that. And you've already mentioned some of the things that you're doing to ensure quality and level of success. So broader question, how should we be thinking about success? Is backlog reduction the right metric? And if not, do we need a more complete picture of system performance?
I'll just ask both of you.
Margarita Devlin
I appreciate that question. No, I would love to get to a place where we're not constantly talking about backlog. We are approaching a sort of an equalizing moment in time for the Veterans Benefits Administration where we can start achieving more balance. That is part of what we've been doing with focusing more and more on quality and these quality sprints and we're talking about what more training needs to happen and making sure that our automation efforts are adopted by employees because employees ultimately make the decision on whether the automation has given them everything that they need or not. So we are monitoring that for quality and then we're looking at strategic hiring and determining how we can make sure our employees are trained for the most complex decision making, you know, because we're always going to need human decision makers.
So how do we put them in the right places and how do we evolve our processes to adapt to all of these tools that we have at our disposal now that we didn't have before?
Mariannette Miller-Meeks
Well I can just tell you as a 24-year Army veteran we really appreciate the fact that the backlog is being reduced and that claims are being handled in a more expeditious way but still with that human touch and human oversight. So thank you so much and Mr. Chair I yield back.
Mike Bost
Thank you. The gentlelady yields back. Representative Kennedy you're recognized for five minutes.
Speaker 18
Thank you Chairman. First of all, I have a couple of quick questions. Talk about mandatory overtime. Do you need congressional approval for that mandatory overtime?
Margarita Devlin
Sir we get approval for the funding in the budget through the President's budget.
Speaker 14
But specific to mandatory overtime for the workforce, do you need congressional approval?
Speaker 20
So the VA is saying that you're making progress on reducing the backlog determinations. Obviously that's important to ensuring our veterans have the care they need, but as has been mentioned a number of times here, speed does not equal success. And the VA's data that I'm looking at says that there is an 83 percent claim accuracy rate. Is that accurate?
Our current accuracy rate is 94 percent as of the end of March.
Speaker 15
94 percent issue level accuracy, but 83.31 percent claims based accuracy. Is that correct?
Cheryl Flint
Yes, that is correct. VA went to an issue-based quality because that gives us a level of detail about what's actually happening in the claim so we can hone in on the things that are important to veterans. A claim-based score sort of masks what the real challenges are because if you get one wrong, the whole thing is wrong. And so we started focusing more on issue-based quality because we believe that's a much better indicator of actual quality.
Speaker 20
So, a couple things to that point. So you are no longer using claim-based accuracy whatsoever?
Speaker 20
According to your own data that on your website, the issues level accuracy upwards of 94%, but still lower than it was just a year ago. And while you've made progress in the last couple of months, it's still lower than it was a year ago. That also means that there are determinations in errors that are not simply numbers. These are delayed treatments, these are unmanaged pain, worsening health outcomes for our veterans. I just have a couple of constituents that have been impacted by this.
In a number of documented cases in my own district, a couple that I'll mention here, one for mental health, another for palliative care. And while their appeals are pending, there are many that are not receiving treatment. So does the VA track for what happens to veterans medically while their claims are under appeal?
Margarita Devlin
So, I just want to address the question about quality. The 94% is the highest it's been in two years. So we've steadily gone up in two years, not down. We can grant whatever claim conditions we can grant while the other conditions are being appealed, which can give the veteran access to care in the VA medical centers while they're waiting on certain decisions to be made by the board.
Speaker 20
Okay, thank you. First of all, I'm looking at data from your Veterans Affairs website that shows the 12-month accuracy issues level was at 95.91% at the end of March and now it is at 93.95%. So that shows me that there is a decrease. But to back to the question about following and tracking our veterans, if in fact they are appealing a case that they were denied care, are we following to make sure that they are taken care of medically?
Margarita Devlin
So if your question is if the disability rating was denied for a specific condition and while that denial is being appealed, do we check to see if that veteran can receive treatment for that specific condition, we would not because it would be predicated on their ability to get a grant for that, which would mean they would have to substantiate that they have the diagnosis and it's connected to service. But my earlier point was if they're already rated 50, 60% for other conditions, they can receive VA healthcare even while they wait for another decision on a separate condition to be decided.
Speaker 20
Well, what's clear to me today is that the VA's progress on processing time is real, but it doesn't represent a full picture of our veterans' experience on health outcomes within the system, which is the most important data point that the VA needs to be measuring. And so a delayed decision is delayed treatment and a system that can't measure those outcomes can't fix them. So we've clearly got a lot of work to do. I am being respectful of time, Chairman, I'll yield back.
General Bergman, you're recognized for five minutes.
Jack Bergman
Thank you, Mr. Chairman. Ms. Devlin, it's good to see you again. Let me begin by saying I appreciate the progress that Secretary McDonough and the VA have made on the claims backlog. This is real progress, and veterans deserve to see more of it. But that progress also makes us step back a bit and ask how the system got so backed up in the first place.
In my view, part of the answer is pretty simple. When claims are incomplete on the front end, the whole system slows down because you've got redos in there to get it right so it can begin to be processed. That means more delay, more rework, more frustration for veterans trying to get access to the benefits that they've earned. We all want to protect veterans from bad actors. Make no mistake, bad actors are never going to get a chance to mess up our veterans.
We need to continue to move forward, but we ought to make sure that veterans can still get legitimate help in understanding the process and putting forward complete claims the first time to reduce the failure rate, if you will, and speed up the decisions. If we want faster, better decisions, then the front-end piece truly does matter. So, Ms. Devlin, how does the completeness of claims submitted to the VA impact the claims processing time and the VA's ability to render a fast decision?
Margarita Devlin
Thank you for the question. You know, we have a lot of our veterans who work with VSOs or other accredited agents, and it does help them to sort of navigate the system. We are working on making the application process more simple for veterans so that it's not as complex. But certainly, if the veteran submits a claim with all of the non-government evidence that they have available to them, private medical records and such, it would certainly make the process go faster. However, we are still moving fairly quickly even if it's not a complete claim because we can get an exam for them through one of our exam vendors or through VHA quickly.
Jack Bergman
You are, and I because I know you are deeply into this and you're doing it for the right reasons. We can all seek to do better on whatever our role is, whether it's the diagnosis, the process, all of that. So we all have a commitment, it's part of our mission to be better on the front end so to lead to better outcomes. Would you agree that it is a false choice to claim consumer protection requires restricting lawful advisory services?
Margarita Devlin
Sir, I can't speak to the statute that covers accreditation and that's not my area of expertise on what's allowable by law.
Jack Bergman
Okay. Well, I'm going to switch gears here for a moment. It is my understanding that the VA started a pilot program in August of 2023 to better leverage technology to expedite acceptable clinical evidence exams, and it started producing disability benefits questionnaires earlier this year. Is it correct that this pilot has now completed over a thousand reviews to date and that they are being generated with over a 99% accuracy rating?
Margarita Devlin
Yes, the initiative has completed over a thousand DBQs. The quality was 97.9%. And I just want to clarify the AI puts everything together, but a clinician is actually rendering the acceptable clinical evidence decision.
Jack Bergman
No, this is about using the tools you have available to you for better clinical outcomes, better acceptance rates, better benefits created, etc. And in my last minute here, there also are being generated, reviewed, and signed by appropriate medical reviewers all within a 72-hour timeframe.
Jack Bergman
Okay, what is the normal time limit for other providers outside of this pilot? So you got the control group and then everybody else. What are we talking about as far as 72 hours?
Margarita Devlin
Yeah, it's definitely longer. It takes, you know, we can do some exams fairly quickly, but on average it's 25 days to get an exam in person. Our exam vendors can also do acceptable clinical evidence exams. I don't have that number separate for that.
Jack Bergman
Okay, well, the point is we know that if everybody puts their mind to this and their energy behind it, we can do better for the veterans, for the companies trying to do the right thing to help the veterans and to help the Veterans Administration. And with that, Mr. Chairman, I yield back. Oh, and I would like to, before I yield, Mr. Chairman, I ask unanimous consent to insert Rep. Amo's opening statement into the record.
Jill Morrison
Thank you, Mr. Chairman, and thank you, Ms. Devine and Ms. Flint, for being here today and for your service to VBA. I think we all agree that our veterans deserve to have their disability claims decided in an efficient, transparent, and fair manner. Ms. Devine, as a physician myself, I want to begin by asking you about an issue we've been hearing about related to the disability exam process. I look forward to hearing more from you about how VBA can strengthen both the speed and quality of its claims processing. We've heard that software incompatibility between VA and C&P examiners have prevented the examiners from properly receiving a veteran's medical records.
As you know, this type of disconnect can lead to exam deficiencies, which in turn can lead to an incomplete or insufficient disability benefits questionnaire, which of course can result in a claim being unfairly denied. How is VBA addressing this issue and working with its contractors to ensure software compatibility?
Speaker 46
Thank you for the question. I'm not aware of any major disconnect between those two systems. As you mentioned, it is important that our examiners have access to the information that we have about the veteran, but I can take a look at that and get you an answer on that.
Jill Morrison
I would appreciate that. Thank you so much. And as you know, Ms. Devine, the National Work Queue is intended to evenly distribute work between regional VBA offices who pass that work on to claims processors. However, we've heard from claims processors that the system's not always assigning them enough work during the day. In fact, some of these employees have had to solicit work from their supervisors.
Are you aware of this problem and what are you doing to fix this reported breakdown in the process?
Cheryl Flint
Ma'am, I can answer that question. Thank you for it. NWQ does in fact distribute the work as you mentioned. It distributes the work right now to the regional office and then the regional office distributes it to the employee. We just had some upgrades to NWQ that we believe in the future where if there is a situation where an employee feels that they want more work, they can go to NWQ and pull that down themselves.
Right now, if that's the situation, they are able to go to their supervisors who can get that work for them, but a chronic not having enough work is, we have a lot of work, so.
Cheryl Flint
No, they can't. They can pull from their regional office queue. So the NWQ sends work to the regional office, then the regional office decides about who gets what.
They have their own sort of days of work from the queue that they can access.
Cheryl Flint
Not always. In some cases, since it's a national system, what we don't want are people going in and sort of picking the cases that they want. It disrupts the flow of things and it may be not allowing us to strictly do first in, first out processing of claims. So we discourage that. There are of course emerging cases where we need to go get a case, but by and large this distribution system, which in the old system you could only do once a day, in the newer system we hope we can do multiple distributions.
But we don't want folks kind of going into NWQ without... yeah, it causes some challenges.
Jill Morrison
Understood. I want to end by turning to the use of artificial intelligence, a point of interest I think for all of us. AI obviously offers immense potential to streamline claims processing, but it's essential that these tools are implemented with strong guardrails and transparency to be sure that they're being used responsibly and effectively. While we all want veterans to get their claims processed as soon as possible, I'm sure you would agree, Ms. Devlin, that it's essential that claims are adjudicated fairly and accurately. Could you share a list of all the current and planned AI use cases?
Margarita Devlin
Thank you for the question. AI is both an enabler for the business process supports that I mentioned earlier, the decision support. The use case we're looking at right now is the one that takes and looks at every piece of evidence inside the case to determine if all the medical information that's necessary is already there. So a lot of veterans already have medical evidence that they're giving us, right, between their service treatment records, their private treatment records. And what we're trying to do is make sure we're not unnecessarily sending them to a medical examiner when we already have all the information we need.
When I go to the regional offices and I talk to VSOs, that's one of the concerns they've raised to me. We know there's enough evidence in the file, why are we making the veteran go to an exam? So this use case will use AI to determine if all the evidence is there so we don't need an exam, or if there's enough evidence there but we still need a clinician to basically render an opinion, and that would be the acceptable clinical evidence. That's the use case we're looking at now to try and reduce unnecessary exams, but we'll still do an exam when necessary.
Speaker 51
So it's pretty comprehensive, the use case. Can you, and this has come up already, but I think we all just want to hear it loud and clear on record, can you guarantee that there will always be a human making the final decision on a claim?
Jennifer Kiggans
There will always be a human making the final decision on a disability claim.
Thank you, Chairman Bost, and thank you also Ranking Member Takano for bringing us here today. Thank you, Ms. Devlin and Ms. Flint, for presenting yourself and to here to be ready to answer questions. Veterans deserve quick and timely responses, and while the reduction in disability claims backlog seems promising, it is not a reality for all veterans. Some of my very own constituents are still waiting to receive response from the VA, a response. I would be remiss if I did not share their stories.
Very reassuring. Thank you, ma'am. With that I yield back. Thank you, Mr. Chair.
Dr. Kiggans, you're recognized for...
Jennifer Kiggans
Last July, a constituent of mine opened a case with her dad within my office. Her dad Vincent, a Vietnam War veteran, was terminally ill and suffering from dementia. The constituent wanted to expedite her father's case to the VA due to his illness. As of today, this case is still sitting in the regional office and the last update we have received from the VA was in September of last year. The veteran unfortunately has passed away in December.
Ms. Devlin, is the VA not prioritizing claims for terminally ill veterans?
Margarita Devlin
I'm so sorry to hear about that veteran's passing and we want to make sure we take care of the survivor. We do prioritize claims, in particular for terminally ill veterans, and we have other prioritization categories. Sometimes claims can take a long time because we're having a hard time finding the evidence that's needed to substantiate the claim. But if you can give me that information after the hearing, we're happy to make sure we can take care of the survivors in their time of loss.
Jennifer Kiggans
Thank you for that answer, and we'll get you that case and hopefully we'll find out why it is that this has languished for as long as it has.
The next case I wanted to bring to your attention is a story of my constituent Christine. Her father George served in the Air Force and the Army. George died a year after applying for VA benefits in 2016. He died without getting a rating. Now George's daughter has been handling his VA claim for her mother, a surviving spouse and substitute claimant.
His wife has endured 10 long years of denials and appeals. For years the VA has repeatedly asked for evidence that has either been proven unobtainable or had already been provided. Despite all the evidence she has sent, the VA has offered no reasonable explanation as to why the evidence is insufficient for granting George's claim. This 10-year wait is not unique to George, as I understand it. This happens far too often for far too many of our Vietnam veterans.
Ms. Devlin, just last month, reported to my caseworker that a higher-level review had been denied and so the family is appealing the case to the Board of Appeal. The family attorney has informed the caseworker and the daughter Christine, if they go to the Board of Appeals, they can expect a two-to-five more year wait. After a decade, does this seem like a reasonable timeframe under the duty to assist?
Margarita Devlin
Thank you for the question. I can't speak to the timeliness of the board. The board doesn't fall under VBA, but the legacy system did historically take several years. That's the reason the Appeals Modernization Act was put into place to provide faster lanes of decision-making for these reviews. Also happy to take a look at that case if you can give me the details afterwards.
We're happy to look into it to see and make sure that everything's moving as it should.
Jennifer Kiggans
Thank you. I will get that case over to you. In conversations with service officers, we hear that one of the often-repeated claims processing errors is the mislabeling of third-party medical evidence. Is that what you have also found? Is this report to us accurate?
And it's in the context of the use of AI to pull these claims together. It certainly raises a further concern about how the AI is working, or the system in general, for putting these claims together is working when you hear these sorts of stories. Now they're anecdotal. Have you heard this and what can you offer us on that issue?
Cheryl Flint
Yes, ma'am. We are very conscious of exam errors and things like that. We want to make sure that we are addressing any kind of error trends that we see. I've not heard that, sir, as a trend, but I will say that our automated decision support tool, one of the benefits of that is that it looks at the entire record and so it would be more difficult for information like that to not be a part of the veteran's claim.
Jennifer Kiggans
I just, and just getting to I guess my own AI question in the time I have left. Have you reviewed the AI systems that you're working to ensure that the data they're gathering is accurate? Anybody who's used any of these systems will know, lawyer make a mistake and you get case citations that are not there. But have you reviewed the architecture of the AI systems you're using to ensure that they are actually bringing all the claim information and claim data together and that they're not either leaving things out because they've mischaracterized it, because it's going to impact the decisions about the benefit percentage to the individual veteran? Has this internal review or auditing of the AI system been undertaken?
Cheryl Flint
Yes, sir, it has. In fact, as mentioned before, the AI tool gathers the information into an automated decision support tool. At that point, when that system was put out to the field, there was lots of testing. People who actually needed that information were a part of verifying that this was information was correct. And as Ms. Devlin said, even if it isn't, that decision maker has the opportunity to go out and get the information or go find the information he or she needs to support the veteran's claim.
So those tools have been tested, have been field tested, they continue to be tested to ensure that they are providing what we need, but there's also the opportunity for that decision maker to go get the information that may not be on that support tool.
Mark Takano
Chairman yields back. On behalf of the committee, I want to say thank you to your testimony here today, and I'm going to ask the ranking member for any closing remarks he might have.
Yes, Mr. Chairman. I do have closing remarks. I want to just say the witness has stated that according to her that denial rates are not rising, but according to the data that VA actually sent to the minority as per our request, the rates are rising. In 2024, denial rates were 34.8%. In 2025, now these are comp claims grant and denial rates that I'm quoting.
In 2024, the rates were 34.8%. In 2025, it was 38.2%. And so far in 2026, it is 38.8%. I don't know how the witnesses can reconcile what she stated with what we see here in the data that VA provided. I hereby submit this for the record with the unanimous consent.
Mark Takano
Mr. Chairman, our job is a co-equal branch of government is to provide oversight and act as a check on the other branches of government. And by coming here today to cheerlead the administration and not dig deeper, we simply abdicate our responsibility to provide true, meaningful oversight. It is a disservice to the issue at hand and to the veterans I know we care deeply about. What we do here is critically important. We do no one any good by overlooking legitimate procedural claims that leave our veterans in difficult positions in favor of politically convenient talking points.
I am glad that the backlog is down to pre-pandemic levels. Honestly, I'm glad about that. But just as I'm glad that the PACT Act and other presumptives created new access. We all should be pleased that more veterans are getting VA healthcare and benefits, but celebrating successes cannot be where our work ends. We owe it to our veterans and survivors to pull the curtain back, to get the real story, and to advocate for change that makes the system better for them.
But the time we have to do that in this room, in this committee, and in Congress is precious. And so we cannot waste it with shallow, throwaway hearings that barely move beyond the press releases and backslapping. I know that we agree about making the programs that support veterans work better for them. We agree on that, but using the valuable time we have in this way does not instill in me the confidence that we truly can work towards that noble goal together. So yes, the backlog is down, but many more veterans and survivors are still out in the cold.
I just read you the statistics about the denial rates. Many are still dying of cancer without service connection. The veterans of the Nevada Test and Training Range have a list of the fallen that continue to grow.
Those who have experienced sub-concussive impacts, blast injury, and infertility are still waiting to get the care and benefits that they've earned. So while we congratulate VA for taking credit for the sunrise, let us not forget that so many others are fighting on, fighting on borrowed time for their benefits and for the benefit of those they leave behind. I hope that we can keep those people at the center of this discussion and not the administration. I yield back.
Mike Bost
Gentleman yields back, and I just want to say thank you again for your attendance here today. And I do think this hearing was vitally important. You did give the, we did give you the opportunity to one, talk about the fact that the backlogs are down, which is vitally important, but also how it is that your accuracy on these claims is being done correctly. And we all work diligently on both sides of the aisle to try to make sure that you're doing your job for our veterans, and we thank you for that. But I also want to thank the ranking member for holding his position as the loyal opposition and making sure no credit is given to the administration at any time.
So we want to thank you for that. On behalf of the committee, I want to say again to the witnesses and members here today, I look forward to working with you to address issues facing us in the future. To complete the written statements of today's witnesses will be entered into the hearing record. I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extenuous material in the record. Hearing no objection, so ordered.
The hearing is now adjourned.