Tag Archives: Veterans health care

The Next $10 Billion Chapter In The Veterans Administration Health Care Systems Development Saga

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VA New System

Editors’ Note:  The story herein on “FEDSCOOP” announces the latest trip on a decades- long road of efforts by the Veteran’s Administration to connect the  health care systems of the military with those of the VA and establish state of the art records keeping for veterans.  

This sole source, non-competitive, contract award to CERNER,  a commercial firm in lieu of in-house systems development  is a major change in approach from past efforts that have cost billions and led to shut downs and start overs. 

Having seen these types of government systems management challenges from the inside for over 4 decades I find myself sincerely doubting that both the scope and the price tag are final.   For historical perspective, please see: 

A VETERAN CONNECTS THE DOTS IN THE MILITARY AND VETERANS HEALTH CARE SYSTEMS MAZE   

Ken Larson

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“FEDSCOOP”

“The Department of Veterans Affairs announced Thursday that it has officially signed a contract with Cerner for a new electronic health record (EHR) system.

The inked contract is worth up to $10 billion over 10 years.

“With a contract of that size, you can understand why former Secretary [David] Shulkin and I took some extra time to do our due diligence and make sure the contract does what the President wanted,” acting Secretary Robert Wilkie said in a statement. “President Trump has made very clear to me that he wants this contract to do right by both Veterans and taxpayers, and I can say now without a doubt that it does.”

The new EHR will be “similar” to that used by the Department of Defense, which will allow patient data will be “seamlessly” shared between the two. This has been a major pain point with the Department’s current EHR, the Veterans Information Systems and Technology Architecture, or VistA.

Wilkie reiterated Shulkin’s comments, from March, that the VA will learn from some of the DOD’s challenges in deploying its new EHR, known as MHS Genesis, and will not fall prey to the same pitfalls, which have plagued early pilots of the system and led to a report calling it “neither operationally effective nor operationally suitable.”

“VA and DoD are collaborating closely to ensure lessons learned at DoD sites will be implemented in future deployments at DoD as well as VA,” Wilkie said. “We appreciate the DoD’s willingness to share its experiences implementing its electronic health record.”

“Signing this contract today is an enormous win for our nation’s Veterans,” Wilkie said. “It puts in place a modern IT system that will support the best possible health care for decades to come. That’s exactly what our nation’s heroes deserve.”

However big an announcement this may be, actual rollout of the new EHR will take time. At an event in January, former VA CIO Scott Blackburn told the crowd to expect another 10 years of VistA.”

https://www.fedscoop.com/va-ehr-cerner-10-billion-robert-wilkie/

 

 

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Sweeping $52 Billion Veterans Policy Bill Passed Overwhelmingly In The House

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Veterans Policy Bill

The Raymond G. Murphy VA Medical Center in Albuquerque, N.M., is shown on July 8, 2016. On Wednesday, House lawmakers passed a nearly $52 billion veterans policy package that includes an overhaul of VA community care programs and an expansion of veteran caregiver stipends. (Russell Contreras/AP)

“MILITARY TIMES”

“Overhauls outside medical care options for Department of Veterans Affairs patients, expands stipends for veteran caregivers and launches a review of the bureaucracy’s national footprint.

Despite the cost of the plan, the measure easily passed the chamber by a vote of 347-70 and has the blessing of the White House. It’s expected to move quickly through the Senate.”

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“Lawmakers have until the end of the month to finalize legislation, including new funding for the department’s controversial Choice program or risk disrupting health care for tens of thousands of veterans using the account.

House Veterans’ Affairs Committee Chairman Phil Roe, R-Tenn., dismissed concerns from critics about the scope and cost of the measure, particularly charges that the package is part of a slow erosion of VA responsibilities and services.

“Opponents of this bill will tell you, falsely, that it is aimed at eventual privatization of the VA health care system,” he said just before the vote. “That misconception is based on nothing but fear and rhetoric.

“A yes vote is a vote for access, for quality, for choice, for the long-term success and sustainability of the VA health care system, for caregivers and for veterans.”

Among the legislation’s opponents (all Democrats) was the committee’s ranking member, Minnesota Democratic Rep. Tim Walz, who voiced concerns that Republicans rejected proposals to exempt the costs from mandatory budget caps scheduled to take effect in coming years.

He also said that implementation of the massive veterans bill will fall to President Donald Trump’s administration, which “has been 40 days without a VA secretary” since the firing of VA Secretary Shulkin two months ago.

** VA Choice and community care

The legislation, dubbed the VA Mission Act, is the culmination of nearly a year of work on the contentious issue of VA community care.

More than one-third of all VA-funded medical appointments last year took place in offices outside the Veterans Health Administration, but administration officials have pushed for more access to private-sector doctors to increase options for veterans facing long waits or travel for federal care.

In 2014, lawmakers passed the VA Choice program with that same idea. The program handles around 30,000 outside medical appointments a day, but has come under fire from conservatives for being too restrictive and bureaucratic for veterans looking for options outside VA.

Last month, acting VA Secretary Robert Wilkie said the Choice program will run out of money by the end of this month. The VA Mission Act include $5.2 billion in bridge funding to keep that program running for another year, until it is consolidated with other department care programs.

That consolidation is expected to simplify and expand the rules for accessing outside care, but still keeping VA officials involved in veterans’ over health care plans.

It requires veterans become eligible for private-sector care options if VA does not provide adequate medical options for patients, including long travel times, long wait times or poor service ratings. It revises payment rates for community care to Medicare rates, to ease concerns about reimbursement for those visits.

It would also authorize two walk-in visits at local private-sector offices for any veterans who have used department health care services in the last two years. Those appointments may require a co-pay.

Critics of the plan — including federal unions — have said the changes are a major step towards privatizing VA health services by shifting billions of dollars from VA accounts to private companies. They’ve also accused the White House of working towards that goal, in an effort to hollow out VA.

But VA officials have defended the idea as modernizing VA operations, and acknowledging that the medical needs of millions of veterans cannot be shouldered by the department alone.

Numerous House Democrats, who in the past have warned about the privatization push, backed the new legislation, saying it strikes the balance between medical access and preserving the department.

** Caregivers and asset review

In order to attract that Democratic support, Republican House leaders added a dramatic expansion of the current VA caregivers stipend to the measure.

The issue has been a top priority of veterans organizations in recent years, since currently only caregivers of veterans from the post-9/11 era are eligible for monthly stipends through the department. The new proposal would expand that to veterans of all eras, first starting with pre-1975 veterans and later phasing in the remaining group over two years.

The obstacle in getting that expansion has been the cost. The Congressional Budget Office estimates that more than 41,000 caregivers could be added to the program over the next five years, at a cost of nearly $7 billion. But that bill is expected to rise even more in following years.

But the community care overhaul is expected to total more than three times that total by 2023, making it a more palatable concession in the context of the larger legislative package.

The asset review portions of the package resembles the framework of the Defense Department’s base closure and review commissions, although supporters have bristled at the comparison.

Under the plan, the president would establish a nine-member Asset and Infrastructure Review Commission, with representatives from veterans service organizations, the health care industry, and federal facility management.

The panel would meet in 2022 and 2023 to issue recommendations on “the modernization or realignment of Veterans Health Administration facilities.” That could include closing, reducing or expanding a host of VA health facilities across the country.

The cost of that work is unknown. Lawmakers have been reluctant to back new military base closing commissions because of controversies surrounding the 2005 round, which produced disputed savings totals.

But VA officials have repeatedly warned that their current footprint includes hundreds of outdated or obsolete facilities, and department administrators have severe restrictions on managing those locations. Roe said a “politically insulated process” is needed to fix that “massive and misaligned physical footprint” of VA.

The exterior of the Veterans Affairs Department hospital is shown in east Denver on Oct. 4, 2017. On Wednesday, House lawmakers approved a veterans legislative package which includes a review of department medical facilities and an overhaul of VA community care programs. (David Zalubowski/AP)
The exterior of the Veterans Affairs Department hospital is shown in east Denver on Oct. 4, 2017. On Wednesday, House lawmakers approved a veterans legislative package which includes a review of department medical facilities and an overhaul of VA community care programs. (David Zalubowski/AP)

** Veterans support

In advance of the House vote, 38 veterans groups issued a letter of support for the legislation, calling it “a major step towards … making improvements to and investments in the VA health care system, creating integrated networks so that veterans have access to care when and where they need it, and providing the further recognition and assistance to family caregivers of severely disabled veterans deserve.”

The list included the Veterans of Foreign Wars, Disabled American Veterans, Paralyzed Veterans of America, and Iraq and Afghanistan Veterans of America — all organizations that have repeatedly warned members about the threat of privatization to VA operations.

Denise Rohan, national commander of the American Legion, praised Wednesday’s vote as a critical step forward to “streamline and fund the Department of Veterans Affairs’ many community care programs, expand caregiver benefits to pre-9/11 veterans and their families, and review VA infrastructure holdings.”

The measure also received support from Concerned Veterans for America, which has close ties to the current White House and has argued against the privatization label in recent years.

“The Mission Act would go a long way towards resolving problems with the VA’s existing community care programs and stabilizing the VA’s health care system,” CVA Executive Director Dan Caldwell said in a statement. “We’re also encouraged that the MISSION Act mandates a long-overdue review of the VA’s infrastructure across the country.”

No timetable has been set for when the Senate may vote on the measure, but Senate Veterans Affairs Committee Chairman Johnny Isakson, R-Ga., said he hopes to take up the issue “without delay.”

In a gesture to colleagues, lawmakers changed the official name of the legislation to include Sen. John McCain, R-Ariz., Rep. Sam Johnson, R-Texas, and former Sen. Daniel Akaka, D-Hawaii. McCain and Johnson are both former prisoners of war, while Akaka (who died in April) was a longtime veterans advocate in his chamber.”

https://www.militarytimes.com/veterans/2018/05/16/sweeping-veterans-policy-bill-passed-overwhelmingly-in-the-house/

“Warrior Games” Help Veterans Adapt

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Warrior Games

“ARMY TIMES”

“Former Tech Sgt. Joshua Miller and Capt. Mitchell Kieffer, both medically retired, suffered significant injuries during their time in service. 

Those injuries led to a string of surgeries for both veterans and, ultimately, a choice: between reaching out to overcome those injuries or to isolate themselves.”



“Two Air Force veterans who were severely injured during their service, and who suffered from the “invisible wounds” of post-traumatic stress, said they had to overcome fear of the stigma sometimes associated with getting help ― and their own pride ― to recover from their wounds. 

The airmen talked about their roads to recovery during the Air Space Cyber Conference at National Harbor, Md., Monday.

Smith joined the Air Force in 2003 as an aircrew flight equipment specialist and served on active duty for 13 years.

During Combat Survival School, he was injured after being thrown into a culvert, which led to surgeries on both hips, his right shoulder and elbow.

When a friend suggested he join the Air Force Wounded Warrior Program, Smith hesitated because he felt his non-combat injuries didn’t warrant joining the program. He didn’t “fit the bill” of those wounded in combat, he said.


“I felt [the program] was really sacred and that I didn’t belong,” Smith told the audience.
“But everybody has a story. It doesn’t matter if it’s combat or non-combat related,” he said. “So many airmen are kind of afraid to go to their first camp because of what they’re struggling or dealing with,” Smith said.


Being around others who can relate to what you’re going through makes it easier to share your stories and your feelings, he said.


Kieffer, who was injured while on a voluntary deployment with the Army Corps of Engineers in 2011, echoed those sentiments.


“Whenever we go to these [Wounded Warrior] camps and events, we know we’re not going to be judged,” said Kieffer.


He was part of a convoy that was attacked by an improvised explosive device, rocket-propelled grenades and small-arms fire. He sustained seven broken vertebrae and had memory issues. Because of this, Kieffer is rated 100 percent disabled.


For both men, dealing with their physical injuries was difficult, but dealing with the unseen wounds of post-traumatic stress was also quite tough. Perhaps the biggest reason troops don’t want to admit their unseen wounds is pride, they said. Their initial reaction is not to seek help but to tough it out.


“That’s been the biggest issue I’ve seen and dealt with,” Kieffer said. Pride has held a lot of recovery back,” he said. “Stop letting pride affect you.


Becoming involved with Warrior Games was a transformative experience for both airman, they said. Kieffer was the 2015 and 2016 ultimate champion, which is based on five athletic categories. of competition.


“Any time you have the opportunity to tell your story, tell it,” said Chief Master Sgt. Nicole Johnson, chief of the Air Force Wounded Warrior Program. “Your story will help others tell theirs.”


http://www.armytimes.com/news/air-force-times/2017/09/18/letting-go-of-pride-air-force-vets-adapt-to-invisible-wounds/

VA Will Shift Medical Records To DOD’s “In-Process” Electronic Medical Records System

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Veterans Gaming the System

Image:  Military Times

Total Investment To Date Now Projected at Nearly $10 Billion

“MILITARY TIMES”

VA has already spent more than $1 billion in recent years in attempts to make its legacy health record systems work better with military systems.

The military’s health record system is still being put in place across that department, more than three years after the acquisition process began. The initial contract topped $4.6 billion, but has risen in cost in recent years.

Shulkin did not announce a potential price tag for the move to a commercial electronic health records system, but said that a price tag of less than $4 billion would likely be “unrealistic.”


“Veterans Affairs administrators on Monday announced plans to shift veterans’ electronic medical records to the same system used by the Defense Department, potentially ending a decades-old problematic rift in sharing information between the two bureaucracies.

VA Secretary David Shulkin announced the decision Monday as a game-changing move, one that will pull his department into the commercial medical record sector and — he hopes — create an easier to navigate system for troops leaving the ranks.

“VA and DoD have worked together for many years to advance (electronic health records) interoperability between their many separate applications, at the cost of several hundred millions of dollars, in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin said.

“While we have established interoperability between VA and DOD for key aspects of the health record … the bottom line is we still don’t have the ability to trade information seamlessly for our veteran patients. Without (improvements), VA and DoD will continue to face significant challenges if the departments remain on two different systems.”

White House officials — including President Donald Trump himself — hailed the announcement as a major step forward in making government services easier for troops and veterans.
Developing implementation plans and potential costs is expected to take three to six months.

But he did say VA leaders will skip standard contract competition processes to more quickly move ahead with Millennium software owned by Missouri-based Cerner Corp., the basis of the Pentagon’s MHS GENESIS records system.

“For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DOD did in its EHR acquisition process, to get our next generation EHR in place,” Shulkin said.

Shulkin for months has promised to “get VA out of the software business,” indicating that the department would shift to a customized commercial-sector option for updating the health records.

The VA announcement came within minutes of Trump’s controversial proposal to privatize the nation’s air traffic control system. The president has repeatedly pledged to make government systems work more like a business, and in some cases hand over public responsibilities to the private sector.

Shulkin has worked to assure veterans groups that his efforts to rely on the private sector for expertise and some services will not mean a broader dismantling of VA, but instead will produce a more efficient and responsive agency.

He promised a system that will not only be interoperable with DOD records but also easily transferable to private-sector hospitals and physicians, as VA officials work to expand outside partnerships.

Shulkin is expected to testify before Congress on the fiscal 2018 budget request in coming weeks. As they have in past hearings, lawmakers are expected to request more information on the EHR changes then. ”

http://www.militarytimes.com/articles/va-share-dod-electronic-medical-records-decision

 

 

New Website Competes VA Hospitals

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VA Competiton

Image:  “Cartoon Stock”

“MILITARY TIMES”

“WASHINGTON — The Department of Veterans Affairs wants its medical centers to compete over patients, and they’re launching a new online tool to make comparison shopping for health care easier.

The new “access to care” site, launched Wednesday but expected to be refined significantly over the next few weeks, will allow veterans to see how regional VA health centers stack up against each other on wait times, available services and customer satisfaction.

Poonam Alaigh, acting under secretary for health at the department, said the goal is to both increase transparency over the state of VA health services and provide veterans a way to better customize their own care.

Would-be patients willing to travel significant distances can find regional offices with shorter average wait times for primary and specialty care than nearby facilities. Individuals in metro areas can choose between sites based on customer response ratings.

“There’s competition now,” she said. “They’re going to start losing patients if they don’t start watching the patient experience piece.”

The site is the latest step in a three-year response to the 2014 VA wait-times scandal that forced the resignation of several senior department officials, including then VA Secretary Eric Shinseki.

Hospital administrators were found to have manipulated wait-time data to better meet department standards, and in some cases gain bonuses for facility improvements.

Alaigh dismissed concerns about the new public comparison site creating similar incentives for dishonesty, saying the focus is on accountability and public awareness. And she said unrelated to the site, VA has implemented new data-monitoring algorithms to detect similar manipulation in the future.

But she acknowledged the site will highlight “the good and bad” of current facility performance.

For example, on the site now, visitors can track wait times for new patient primary care appointments for every VA facility in the greater Phoenix area, the center of the 2014 scandal. For the VA clinic in nearby Anthem, Arizona, the average wait is 11 days. For the clinic in Casa Grande south of the city, it’s 56 days.

“I want to use this to help build accountability,” she said. “I don’t want this to be a punitive thing. It also has to be a tool for us to redirect resources to needed areas.”

The site also includes comparisons of standardized health data to other regional, non-VA hospitals, although only a small number of VA sites are currently listed. Alaigh said more will be added in coming weeks.

So will a feedback button for veterans to ask questions about facility offerings and better contact information to help veterans contact medical centers. Alaigh called the site “rushed” and “far from perfect” but said officials wanted to get the available data in veterans hands as quickly as possible.

VA officials for years have promised both better access to medical treatments at department clinics and better customer service throughout the agency, but have received mixed reviews on the work so far from veterans groups and lawmakers.

http://www.militarytimes.com/articles/va-website-medical-care-access-competition

 

 

VA Boosts Budget to Tackle Outstanding Healthcare Claims from Vets

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“MILITARY.COM”

“The Veterans Affairs Department is requesting a budget of $182 billion next year, a nearly $20 billion funding increase designed in part to tackle outstanding health care claims from veterans.

The proposed spending plan unveiled on Tuesday includes nearly $103.6 billion for mandatory programs such as disability compensation and pensions, and more than $78 billion in discretionary funding — mostly for health care.

VA Secretary Bob McDonald, who is scheduled to testify Wednesday before Congress on the budget request, said the agency now has “one of the greatest opportunities in its history to transform the way it cares for our veterans.”

McDonald says the funding will expand health care options to veterans across the country, continue efforts to end chronic veteran homelessness and further reduce the backlog on first-time claims and also on appeals.

Claims appeals, which have increased over the past six years as the VA put more resources and manpower into tackling the first-time claims backlog, is being targeted next year with more money and personnel.

The budget proposes $156.1 million and 922 full time employees for the Board of Appeals, up from about $110 million for a staff of 680 personnel in 2016.
The department’s spending plan marks the last one that President Barack Obama will submit as his second term ends next year and amounts to about double what it was in 2009 when he was sworn in.

After the White House released the budget details, Rep. Jeff Miller, R-Florida, a Republican from Florida and the chairman of the House Veterans Affairs Committee, released a rundown of recent and longstanding department problems, from cost overruns on construction projects to employees not being held accountable for poor performance and alleged wrongdoing.

“I will fight to ensure VA has the resources it needs, but given the complete lack of accountability for the department’s string of past financial failures, this budget request will receive every bit of the scrutiny it is due,” he said in a statement.

The department budgeted $68.6 billion for health care. Of that amount, more than $12 billion is slated to deliver health care to vets in their community.
Another $8.5 billion is for long-term care; $7.8 billion for mental health programs; $1.6 billion to reduce veteran homelessness; $1.5 billion to treat veterans ill with hepatitis C; $601 million for treating spinal cord injuries and $284 million for traumatic brain injuries, according to budget documents.

The VA expects to spend $725 million for caregivers.

To improve claims processing, the VA is continuing to invest in technology, earmarking $180 million to the Veterans Benefits Administration to enhance its electronic claims system and $143 million to the Veterans Claims Intake Program to continue converting older, paper records, including health records, into digital images and data.

The backlog in first-time claims — those not acted on within 125 days of filing — has been reduced from its 2013 peak of 611,000 to about 82,000, McDonald said last month.

Unlike other parts of the federal budget, Congress has authorized the VA to include funding requests one year in advance. As a result, the department included 2018 funding figures that totaled about $174 billion, including $104 billion in mandatory programs, a $1.5 billion increase from the 2017 request, and $470 billion in advance appropriations, an boost of about $300,000 from next year’s amount.”

http://www.military.com/daily-news/2016/02/09/va-boosts-budget-to-tackle-outstanding-healthcare-claims-vets.html

 

VA Sued for Delays of 2 Years in Providing Veterans With Health Records

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VA Claims“MILITARY DOT COM”

“A veterans’ organization and a public advocacy group filed suit in federal court on Monday against the Veterans Affairs Department, claiming the agency has kept some veterans waiting longer than two years for records needed to apply for benefits.

Some of the seven veterans named in the suit have been waiting 25 months for records that should have been turned over to them within 20 days, according to the lawsuit.

“Veterans who have been injured and disabled in combat should not be forced to wait months or years to receive their records from the VA so they can apply for disability benefits,” Bart Stichman, co-founder and co-executive director of National Veterans Legal Services Program, said in a statement.

The complaint asks the U.S. District Court for the District of Columbia to find that the VA has unreasonably delayed providing the records and to order the VA to produce them within 20 days.

The veterans requested their VA health records in order to apply for special combat disability compensation benefits or for a rating increase, according to NVLSP and advocacy group Public Citizen.

Plaintiffs in the lawsuit are Army veterans George Ball of Palm Beach Gardens, Florida; Malik Biel of Elizabethtown, Kentucky; William Herndon of Mancos, Colorado; and Juan Rodriguez of Miami, Florida; Marine Corps veteran David B. Stringer of Crozet, Virginia; Navy veteran Jeffrey L. Wooden of Wapiti, Wyoming; and Air Force veteran Charles Hoffman of Aurora, Colorado.

Rachel Clattenburg, an attorney for Public Citizen, said the lawsuit “is about ensuring that our country keeps its promise to its service men and women, and their families.”

If the VA is unable to meet its 20-day delivery time for the records, the agency is supposed to contact the veteran to say when the records will be provided, according to the two groups. If the VA denies releasing copies of the files, it is supposed to give the veteran an explanation for denial, the groups said.

The requested records would detail veterans’ periods of service, circumstances of their separation, letters from the VA regarding decisions to deny or grant benefits, explanations for any rating already granted, service medical records and personnel files.

Five of the seven veterans named in the lawsuit requested their records in order to apply for Combat-Related Special Compensation. This program is for combat-disabled military retirees who, by law, have their monthly retirement docked by the amount of the disability compensation they were awarded.

Congress established the tax-free special compensation as a workaround to the law so that eligible retirees would get the benefit of their full retirement pay and disability compensation. These five have so far waited between 308 and 803 days for their records, according to NVLSP and Public Citizen.

The lawsuit over the records request delay comes as the VA continues to wrestle down its longstanding backlog of disability claims. That backlog — made up of first-time claims not acted on within 125 days — was more than 600,000 in 2013 but is now below 200,000, according to the department.

VA Secretary Bob McDonald said the department is on track to end the backlog by the end of 2015.

Some veterans groups believe the VA hopes to do that, in part, by slowing the rate of new claims applications by requiring new claims be filed on standard forms. NVLSP, The American Legion, Veterans of Foreign Wars and other organizations argue that many older veterans do not have access to computers to get the forms and would have difficulty filling them out.

The VA, by mandating the new system, effectively ended the informal filing system by which a veteran could initiate a claim — and establish the start date — simply by writing a letter of intent to do so. The VA says its new system also enables a veteran to reserve a start date before fully completing an application.

But NVLSP, the Legion, VFW, the Military Order of the Purple Heart, AMVETS and the Vietnam Veterans of America filed suit against the VA in March for going over to the new system.

Attorney Douglas J. Rosinski of Veterans Justice Group in Columbia, South Carolina, also filed a suit challenging the new system last November.

The other veterans named in the lawsuit requested their records in order to apply to the Physical Disability Board of Review for rating increases. One has been waiting about 20 months and the other nearly two years, according to the complaint.

The disability review board was established by Congress after it found that more than 77,000 injured soldiers, sailors, Marines and airmen separated because of injury or medical reasons between 2001 and 2009 “may have been lowballed on disability ratings by the military and, therefore, denied the benefits to which they were entitled,” according to NVLSP and Public Citizen.

About 25 percent of veterans applying to the review board are awarded a higher disability rating and retirement benefits, they said.”

http://www.military.com/daily-news/2015/04/20/va-sued-for-delays-in-providing-veterans-with-health-records.html