รายละเอียดกระทู้

http://www.wsj.com/articles/automated-system-often-unjustly-boosts-veterans-disability-benefits-1431387826 Reduction of VA staff input allows more patients to exaggerate symptoms By DANIEL HUANG An effort by the Department of Veterans Affairs that aimed to speed the processing of disability-benefits applications also loosened controls that prevent veterans from exaggerating symptoms to receive more money, say current and former VA employees. A software system introduced in 2012 that automates veterans’ disability levels for compensation relies almost solely on a patient’s self-reported ailments, the employees say, even in the face of contradictory information. Automated System Often Unjustly Boosts Veterans’ Disability BenefitsWhile the new system reduced paperwork and increased output, it limited the information that the VA’s employees who determine compensation eligibility and dollar amounts—called raters—can consider, according to these employees. The result, raters contend: a more inaccurate process that approves higher levels of disability than veterans’ military records, medical histories and other evidence might show—in some cases increasing payments to veterans by thousands of dollars a month. The process, they maintain, also ignores stated VA rules in which claims must be evaluated “in light of the whole recorded history.” Senior VA officials counter that the software system still relies on raters’ expertise to determine the accuracy of claims. They say it is designed to facilitate, but not replace, that process. Raters “have every right to change if there is other evidence in the file,” one official said. Increased disability levels—the degree to which a veteran is considered impaired from earning a normal living—is partly why costs in the VA benefits branch have surged 65% to nearly $65 billion in 2014, from the end of 2011. Approved veterans also are receiving compensation for more diagnosed problems: averaging 4.3 disabilities each in 2013, up from 3.9 in 2011. The VA expects to pay out nearly $72 billion in benefits in 2015, according to the agency. Of course, many soldiers returning to civilian life are entitled to benefits and depend on the payments to get by. Conflicts in Iraq and Afghanistan sent waves of troops into combat who are now transitioning back from service, driving much of the growing cost in disability payments. As awareness of the physical and mental conditions suffered by those in the military has grown in recent years, so has the range of disabilities approved for compensation. A veteran’s path to disability benefits begins primarily with a VA doctor or psychologist interviewing the vet and filling out a questionnaire from his or her responses. The form for mental-health disorders, for example, allows the doctor to select symptoms such as “anxiety” and “impaired judgment.” Physicians also might include their own observations and assessments, and are encouraged to review the veterans’ service records and medical histories to inform their diagnoses. But some employees said doctors, faced with an overload of claims, often don’t have the time to incorporate their own assessments. Some physicians also said they are instructed to record symptoms at the patient’s word. “Regardless of our objective observations, we’re required to check off all the symptoms the veteran says,” said Gail Poyner, a psychologist who conducts disability examinations for the VA in Oklahoma City. That information is passed along to a rater, who inputs it into the software. Here’s the hitch: The software calculates the level of disability—from zero to 100%—solely on the vet’s symptoms from the questionnaire. It doesn’t consider any additional comments the rater may have included. The more severe the impairment, the more money the vet receives. Mark Adams, 64 years old, who reviewed disability claims at the Wichita Veterans Affairs Regional Office in Kansas for more than two decades before retiring in 2012, said he conducted an experiment shortly after his office adopted the new software. Selecting a mental-health case at random, he entered into the computer only the vet’s reported symptoms. Less than three minutes later, the program gave him a 70% disability evaluation. Mr. Adams then deleted the result and started over, this time spending an hour feeding the computer the vet’s reported symptoms and five narrative pieces of evidence from the claims file, including medical treatment records that “did not support the severity of symptoms.” The computer instantly returned the same 70% rating. Without the software, Mr. Adams estimates that a human rater would have determined the vet was only 30% disabled. “Moving checked boxes from one place to another,” he said of his work under the new system. “A monkey could do it.” Raters ultimately have the ability to override the computer’s recommendation, say senior VA officials, who declined to comment on specific cases. Current and former VA raters, however, say they are encouraged—sometimes even pressured—to transcribe symptoms into the program exactly as received. Some say efforts to override the program’s recommendation because of inadequate or conflicting evidence are met with pushback from supervisors or error notifications. In one claim reviewed by The Wall Street Journal, a veteran admitted to his VA psychologist that he was capable of working, but preferred to “do nothing but watch TV movies or play video games” and “use marijuana all day every day.” While these details were described in the examiner’s comments, the computer program—considering only the reported symptoms on the claim—returned a 70% rating for post-traumatic stress disorder. When the rater evaluating the case overrode the program’s recommendation and denied the claim, he received an error call. Due to an additional technicality, the veteran ultimately was granted a 100% disability rating. He currently receives more than $3,100 a month from the VA. The VA declined to comment, citing privacy. Because overrides are flagged and sent directly to the VA’s central office, raters said they have an incentive to follow the program’s recommendation at the risk of attracting complaints. VA officials said overrides are reported to locate defects and identify further training opportunities. Last year, raters overrode less than 2% of the 1.4 million rating decisions completed with the new software, according to a VA spokeswoman. Since June 2013, the VA has been implementing a program to automatically feed symptoms from questionnaires directly into the computer program, bypassing raters altogether. As of last month, 37 questionnaires for varying disabilities have been enabled with this function. A VA spokeswoman said that even with the additional automation, raters can add new data to the computer system when necessary. Write to Daniel Huang at dan.huang@wsj.com