Part Two in a National Journal series on Veterans Affairs. Read Part One here.
Failure is an orphan—and there are few failures more toxic than those of the Department of Veterans Affairs.
The agency, ostensibly created to help veterans heal from the wounds of war, is plagued by a backlog of claims from soldiers seeking help, leaving them to wait months or even years for compensation.
There's consensus that the backlog is unacceptable, and President Obama's administration pledged to eliminate it by the end of 2015. But the agency—and the backlog—is getting new attention due to a spate of deaths at VA hospitals, and Republicans are attempting to pin the agency's failures squarely on the president.
Looking for a lone villain in the VA debacle, however, is a fool's errand. It's true that—despite holding the world's most powerful post for five years—Obama is yet to eliminate the long waiting times for veterans seeking help. Blaming him alone, however, is to ignore roots of the problem that stretch back decades before Obama took the Oval Office.
Instead, the sheen of shame over the VA's failures spreads across time and party affiliation. It stains the legacies of presidents as far back as John F. Kennedy and condemns past Congresses whose poor oversight allowed the problem to fester. The VA itself is also not without fault, as bureaucracy and intransigence let the agency deteriorate to the point the problem became nearly impossible to fix.
So who really broke the VA? In sum, it's a failure with many silent fathers.
Obama's experience with the VA is a testament to the danger of big promises—and high expectations.
He pledged to end the claims backlog while simultaneously making a string of moves that summoned a flood of new claims to the agency.
The administration made it easier for veterans to get compensation for both post-traumatic stress disorder and exposure to Agent Orange—a Vietnam War-era defoliant now tied to a long list of neurological disorders. Those moves extended help to long-suffering veterans, but they weren't matched by the VA reforms needed to adequately address the new claims. Agent Orange alone took up 37 percent of the Veterans Benefits Administration's claims-processing resources nationally from October 2010 to March 2012, according to a Government Accountability Office report.
And as claims soared during Obama's first years in office, so did wait times. In 2009, there were about 423,000 claims at the VA, with 150,000 claims pending for more than four months (the official wait time it takes a claim to be considered "backlogged"). By 2012, claims had exploded to more than 883,000—and 586,540 of those sat on the agency's backlog list.
The administration did request—and get from Congress—additional funding for the agency. The agency's budget totaled $100 billion in 2009. In 2014, it was up to $154 billion. But that money doesn't instantly transfer into an expanded capacity to meet veterans' needs: It takes approximately two years to fully train a claims worker; the blame for the staff crunch doesn't rest on Obama's shoulders alone.
The influx of claims has since fallen, and the backlog is greatly diminished—though there is controversy over how the administration has dealt with the claims. (For more on the administration's struggle to fix the VA, seePart One.)
"As a candidate, Barack Obama promised veterans the moon, but in many cases he hasn't delivered as president," said GOP Rep. Jeff Miller of Florida, the chairman of the House Veterans Affairs Committee. "VA's disability claims backlog grew to historic levels on his watch. … Candidate Obama promised the most transparent administration in history, but his VA is a case study in how to stonewall the press, the public, and Congress."
Miller's own branch of government, however, cannot claim clean hands.
The VA could be overhauled to better address the needs of modern veterans, including reforms to the way it processes claims, assesses the performance of its employees, and measures its overall performance. But putting many of those reforms in place would require an act of Congress—and thus far those haven't happened.
Instead, Congress has taken a more reactive approach. When incidents—such as the recent hospital deaths—capture public attention, lawmakers hold hearings where they berate agency officials with juicy sound bites they can later play back for their constituents. It's good political theater, but it's unclear that the payoff is anything other than political.
"Congress has been totally exasperated by the VA's inability to get on top of the problem for a long time," said Linda Bilmes, a senior lecturer in public policy at Harvard University's Kennedy School. "But they haven't been willing to really contemplate anything other than throwing more money at the problem."
Congress is taking some legislative steps now: The House is slated to vote this week on a VA accountability bill to make it easier to fire senior executives, and the latest VA funding bill banned bonuses to agency executives. But neither measure contains changes on the structural level.
And even when Congress has passed legislation aimed at improving the agency, its record of efficacy is mixed at best—especially in terms of eliminating the claims backlog.
In 2000, lawmakers passed the Veterans Claims Assistance Act. The law was signed by President Clinton and was, by all accounts, a well-meaning attempt to make it easier for veterans to get VA claims approved.
The law required that the VA tell a veteran what to do to prove a claim, help the veteran obtain necessary records, and inform the veteran when the VA could not obtain the information it needed. The law required the VA to retrieve the veteran's service medical records and provide exams when the VA did not have sufficient evidence to substantiate a claim.
But the law was ambiguous and left much open to interpretation, which had to be fought out in the courts. It wound up adding several additional layers of bureaucracy to an already clunky VA claims process without appropriating additional funds or human resources to manage the increased workload.
"So the situation wasn't getting better; it just added another forum that made it harder to get things done," said Sherman Gillums, an associate executive director with Paralyzed Veterans of America. "We attribute a lot of the early trouble—not the current backlog, but early trouble—to this, because it created an institutional laziness or institutional inefficiency and made that a part of the culture at the VA. People just accepted claims sitting around a long time because they had to do all of this other stuff.
"So if there is a snowball in all of this, I would say that's the little tiny thing that would eventually become the avalanche," he said.
President George W. Bush
The Bush administration sent troops to Iraq and Afghanistan, but when those troops came home injured, the Defense Department failed to adequately communicate it to the agency tasked with helping them.
Early on, the department was publicly counting only about a third of the casualties stemming from the War on Terror. That was because the Department was only counting servicemen and women immediately targeted in the department's wounded-in-action statistics. That accounting method left out those who were not targeted but were wounded nonetheless, such as troops injured when they were riding two trucks back from one that was hit by a roadside bomb, or those hurt in training or transportation.
The underreporting made it more difficult for the VA to prepare for the coming influx of requests for help. The poor sharing of information—including medical records—between the two agencies has long been a bone of contention, and it remains a challenge (albeit one that is improving) to this day.
"It's not surprising, really, that the VA ended up being poorly prepared for what happened, given the way that they were planning," said Harvard Kennedy School's Bilmes. "There was absolutely a lack of planning, a lack of capacity for planning. ... They didn't know what hit them. They were completely overwhelmed."
Additionally, the VA's claims-processing time skyrocketed early in the Bush years. In 2002, it took the VA an average of 224 days to complete claims, as compared with 166 days in 1999.
While the agency was hampered by plenty of external factors, it is hardly an innocent victim. Agency leadership allowed its problems to fester and its infrastructure to crumble.
For example, the VA did not have a digital way to process claims nationwide until 2013, instead relying on an inefficient paper filing system. By comparison, the IRS rolled out its electronic filing system across the country—albeit with some problems—in 1990.
It's just one area where the agency was too slow to react to changes in the world around it.
Even by the mid-2000s, several years after 9/11, the VA was using out-of-date claims projections it had based on injury estimates that used assumptions from older wars. Due to medical advances, many service members who would have died from their injuries in past wars are now being saved. That means fewer deaths, but it also means more wounded veterans, a development the agency failed to anticipate and was slow to adapt to.
And agency leaders at times failed to request the funding needed to do their duty.
In 2005, under VA Secretary Jim Nicholson, after originally denying its fiscal predicament, it came out that the VA faced a $3 billion shortfall in funding for veterans health care. The situation required emergency supplemental funding from Congress.
"There was a leadership attitude that was not aggressive in pushing back against whatever administration, … or even quietly going to Congress and saying we need more people," said Gerald Manar, national veterans service deputy director at the Veterans of Foreign Wars and a former 30-year VA employee.
Kennedy to Nixon to George H.W. Bush—and every president in between
In many ways, the Obama administration is paying for the negligence of past administrations, dating all the way back to President John F. Kennedy, who authorized the decade-long use of Agent Orange in Vietnam.
But it wasn't just Kennedy. Under President Johnson, Agent Orange was the dominant chemical used during the war. President Nixon halted its use, but a long line of presidents either refused to acknowledge the damage done or failed to address it.
President Carter's VA created the Agent Orange registry, where veterans who were worried about potential side effects could be examined. But four years later, a GAO report found that 55 percent of respondents felt that the VA's Agent Orange examinations either weren't thorough or they received little or no information on what long-term health impacts exposure could cause.
And President Reagan's legacy includes a damning congressional report from 1990 that found: "The Reagan administration had adopted a legal strategy of refusing liability in military and civilian cases of contamination involving toxic chemicals and nuclear radiation. ... The Federal Government has suppressed or minimized findings of ill health effects among Vietnam veterans that could be linked to Agent Orange exposure."
Progress has been slow. Vietnam veterans won a major victory under President George H.W. Bush when Congress passed legislation allowing the VA secretary to make certain diseases, including Hodgkin's disease and non-Hodgkin's lymphoma, "presumptive" to Agent Orange exposure. This means that the VA automatically assumes the diseases are related to the defoliant that the veterans encountered during their military service, making it easier for them to collect disability payments.
The government's long-standing failure to address the damage done to veterans by Agent Orange mirrors the larger failure of the VA. It spans generations and party affiliations, and every effort to fix it comes with unintended consequences.
"This goes across party lines," said Ronald Abrams, the joint executive director with the National Veterans Legal Services Program, and a former VA official who has worked on veterans claims cases for 40 years. "Democrats and Republicans have allowed this festering sore to continue."
Coming Soon: What Would It Take to Really Fix the VA?
(Image via Flickr user qnr)