Robert Chisholm: Welcome to the CCK podcast. My name is Robert Chisholm. I am joined today by Brad Hennings from Chisholm Chisholm and Kilpatrick, as well as EJ McQuade and Mark Ramos who work for the Regional Office in Providence, Rhode Island. Welcome, everyone. In here, today, we are going to be discussing sort of a year in review with the VA, what are some of the challenges have been, what are some of the success has been, and then we are going to talk a little bit about what to look forward to in 2021. So EJ, I would like to start with you. Obviously, the biggest challenge has been navigating the COVID-19 pandemic. Can you talk a little bit about that and let us know how VBA, the Veterans Benefit Administration, has handled it here locally and nationally if you can comment as well?
EJ McQuade: Thank you, Robert. I will start at the national level and then break it down towards locally, what we are doing here at the Providence Regional Office. At the national level, the biggest impact– well, lots of big impacts as a result of COVID-19, but specifically as it pertains to disability compensation, appeals activities, and all sorts of rating and non-rating activities for VBA, the largest challenge has been overcoming the inability to conduct in-person exams for really the majority of the spring and summer. Fast forward to the fall and where we are at now, VBA has very much restored exam capabilities and functionality. We have moved away from VHA performing any type of C&P exam with the exception of very rare circumstances and have shifted to an all contractor compensation and pension exam providers nationwide. This has provided VBA and VHA with some much-needed flexibility for VHA to redirect clinical type staff to all the new needs as a result of COVID-19. For VBA, it has given us a lot of flexibility to better meet the needs of our veterans, specifically after we were unable to conduct any type of in-person C&P exam during the first six, seven months of COVID-19. The other piece there is, of course, telehealth has taken on a whole new look for VA both for clinical type purposes as well as for compensation and pension exams. We are doing more exams and delivering more service, health services to veterans through telehealth and through things like acceptable clinical evidence type reviews to better meet the needs of veterans and to ensure that we are still processing claims as COVID-19 has provided so many unique challenges to the veteran community, not only access of care but of course, financial stressors and this is a lot of what is allowing VBA to work through any sort of backlog that has been created during the course of COVID-19.
EJ: The big headlines for VBA at the national level for anything appeal related and disability compensation has been related to exams. It has really been related to exams and VBA is very proud of the fact that we have taken multiple steps to work beyond that and really the big so what for listeners is the shift to contract exam providers and VHA is no longer in the C&P business at the national level. I will just use the caveat, Robert, of you know, with very rare exceptions, maybe a veteran who would be in some sort of in-patient type capacity that might be an exception. Right on the heels of that, I will also say obtaining records has been another unique challenge, and VBA and the Providence Regional Offices is in intricate part of this through some of our records research innovative activities, but the Federal Records Archives or the FARCs have had very limited workforce as a result of COVID-19, so the obtaining of federal records for claims processing, any sort of appeal activity has been impacted. VBA has put together several workgroups and brought on multiple contractors and is now leveraging technology to better obtain those records that would have traditionally been through our federal archives. So not as big of a challenge as exams, but certainly a very unique challenge that has been presented as a result of COVID-19 has been VBA’s ability to obtain federal records that are stored at any sort of federal records archive. So again, the Providence Regional Office had kind of moved to a little more of a local discussion and has multiple innovative technologies that we have championed, we are very proud of. We are supporting several different workgroups and work efforts to better modernize our records retrieval and records research activities, and thus far we have made a major improvement with any sort of claim that was awaiting federal records at the national level. So very, very exciting there.
EJ: Bring it down a little bit more local but certainly a national issue has been VBA’s ability to meet veterans face-to-face, essentially in person or public contact operations that would also include any sort of hearing conducted by the Board of Veterans Appeals and any sort of Vocational Rehabilitation– I am sorry, Veteran Readiness and Employment, VR&E, formerly Vocational Rehabilitation and Employment has been rebranded as Veteran Readiness and Employment. A lot of those case management activities took place face-to-face and what has happened, Robert, is one, COVID has impacted different parts of the country very differently. We do have, on a national level, multiple Regional Offices that have been and continue to be closed, and really what is happening is the building, the federal building, is closed and I will use the Cleveland Regional Office, the Detroit Regional Office as examples of those where the building is closed and you have other Regional Offices like Providence where although we are closed to the public at this current time, the building itself is open. The building is actually open and we have other federal agencies who are meeting with the public. But again, much like telehealth, the solution here has been leveraging technology. VR&E was well-positioned and had been doing a lot of virtual type engagements with any veteran who was participating in VR&E. The Board of Veterans Appeals, BVA, has made a major shift to virtual hearings as well. However, most Regional Offices are able to accommodate any sort of in-person hearing and do that safely and consistent with CDC guidelines. Certainly, that is the case in Providence. We have not had a need to but we are ready and able to conduct any type of BVA hearing if it would be required.
EJ: The more traditional public contact, face-to-face, walk-in traffic that would occur, Robert, what providence has done and many Regional Offices is we have adopted and implemented the Waitwhile technology. I really want to, for any listener, encourage you to familiarize yourself with Waitwhile, any veteran advocate to really encourage participation. Waitwhile is an off-the-shelf type of technology, very similar and consistent with what you would be using if you were scheduling a reservation at a restaurant and what this is doing, Robert, more than anything else is that it is driving the behavior that is going to allow for a safe one-to-one, maybe not in person but still face-to-face virtually or voice-to-voice virtually where we can accommodate the needs of veterans who either want to or need to ask questions on a one-to-one basis. Essentially, Waitwhile is the scheduling platform or the scheduling software that is doing it. It is very simple. There is no PII, there is no requirement for Social Security numbers or claims file numbers or dates of birth or anything like that. It is very similar to just a cell phone or an email and then an appointment is set up where right now that would be virtually. It would still be one-to-one, but it would be in a virtual setting, but in the future would be how we are going to be scheduling a face-to-face meeting in the office here in Providence, whether at the Regional Office or in our space at the Medical Center.
EJ: So I really wanted to emphasize the implementation of Waitwhile here locally, many Regional Offices have made this shift. We have had great support from our vets, from our partners in the community, to encourage folks to use Waitwhile so that we can provide that one-to-one interaction, one-to-one support, and make sure that we are allotting the appropriate amount of time and ensuring that the veteran experience is a positive one. So those are really the key points I wanted to stress, Robert. I also wanted to share that VBA’s mantra for fiscal year ’21 is faster, better together. Our undersecretary, Dr. Paul Lawrence, has been a champion in this initiative since the start of the fiscal year. We have multiple, faster, better together initiatives underway in all aspects of VBA operations. I talked about a few of them today, Compensation and Pension Exams, records retrieval, and one-to-one interactions, public contact type interactions, veteran engagements that we have been able to leverage technology to put back in place so they can be conducted safely both for the veterans and for our VA Workforce.
Robert: EJ, thank you very much for that overview. That was very helpful. Before I pivot to Mark I wanted to go to Brad for a second and just say, Brad, what EJ described as some of the challenges both in terms of exams and record retrieval seems to echo what we have experienced representing veterans. If you just want to comment a little bit about challenges that we faced trying to get records and exam schedule during the early part of the pandemic.
Bradley Hennings: Yes. Thanks, Robert. We have been having all of those similar challenges and we have experienced exactly what EJ has talked about. You know, everybody, it is a resource issue and there are just not as many people working in those archives and so it has really been challenging for us to get things as well. What we have really been encouraging our clients to do is to either if they had medical evidence on the room to give it to us and we can give it to VA. We encourage them, if they are comfortable, to attend evening examinations in person or either via telemedicine when VA was doing that, and if they are uncomfortable, to just let them know that and we will wait a little bit longer, but we have been trying everything we can think of to try to expedite those cases. It just a tough situation as it has been for everybody over the last nine months.
Robert: Mark, if I could pivot to you. You have been working at the VA for more than a few decades if I am not mistaken, and I do not think there is a year like 2020, is there anything you would like to add? Sort of a longitudinal view of what it was like this year as a long-term employee?
Mark Ramos: Well, certainly I have seen a lot of changes. The big difference between then and now obviously is the technology and EJ talked about that. With all of the issues that he brought up they all have a local aspect, and engaging with claims processors in the office remotely is different but when claims process is do recognize that there is a bottleneck with direct retrieval for a particular claim that we are working on, I can often leverage my contacts and my network with the contractors, especially emergent cases or cases maybe a bit old, maybe there is a homeless veteran involved, maybe there is veteran involved, I can usually leverage my network to at least expedite the search for the records that are needed. I have contacts with the contractors at our central office and they have been extremely helpful in those handfuls of instances where that kind of intervention was really necessary for the good of the veteran. So, certainly, technology enters into that and they fielded tools to us to expedite that handling of requests for records. I can also speak to the networking aspect. Again, in the agency, you make a lot of friends, you make a lot of connections, certainly, the Congressional Delegation knows that if they have that veteran that just really needs some TLC to get a C&P exam. We had one instance this year where the contracted exam was just too far for the veteran to travel in his current medical condition and working with the good folks who are still– there is still a C&P presence over at Davis Park, they do not a lot of it but in this particular instance the examiner actually traveled to the veterans home and conducted the exam because it had to be done in-person. I mean that is a rare instance but it also shows you how agile we can be when pressed, and certainly, we want to be responsive to those opportunities when they present themselves. I guess the big difference is the fact that, yes, we are a part, a necessity, and I get that, but we are still trying to do our best to help claims processors do the best job they possibly can, and I know, I have had so many interactions with them since we have been in this posture where they know, they pick their spots, it is not that they are bothering– not bothering, I should not use the word but they are not pinging me incessantly, they are picking the appropriate spots, they know when they run up against something that really they cannot overcome and they are looking for assistance to do that. So I can usually steer them and give them a path toward that. So the technology and the ability to engage with people using technology like this have been invaluable.
Robert: Thank you, Mark. Brad, did you have a follow-up comment?
Brad: Yes, just I agree with everything that Mark said. We think it is great with all that is going on, and just to talk more generally that although it has been difficult in terms of doing development, one of the silver linings in all of this is that the number of appeals that have been able to push forward and worked, that were already developed, it has really been at a record-breaking pace for both VBA and the Board of Veterans Appeals. So that has been the silver lining, that cases are ready to move on to the next step they have been able to move on because there has been less development and so less work is able to be done. So in those cases, more work is able to be done on some of the appeals cases and cases that have been [inaudible] for a while.
Robert: And I think that is a really good point. It has been our experience this year in talking to other practitioners around the country that represent veterans that the appeals have been moving forward both on the legacy front and frankly on the AMA front as well, which has been, as Brad said, a silver lining in this process. I hate to ask the next question, EJ, but I would be remiss if I did not. There is going to be, by all appearances after yesterday, a change in the administration, a new president will be coming in. That means there will be a new Secretary of Veterans Affairs coming in and a new team at the top and how does that impact what you do locally here in Providence and how do you see the impact nationally? If that is not too difficult a question to sort of answer.
EJ: No, happy to answer. I really do not see much changing for us here in Providence and we are largely all about disability compensation as we have two large disability compensation missions in our veteran’s service center which covers Rhode Island and Southeast Massachusetts, the Cape and the Vineyard, and that area, and then our disability rating activity site for VA’s Integrated Disability Evaluation System or IDES where we process claims for the Navy, Marine Corps, Air Force, and now Coast Guard as well. I will share with everybody that IDES continues to be one of VA’s good news stories. It is really our one and only truly joint program with DoD where we actually both own different aspects of the process. It is something that both departments, both Department of Defense and VA hold up as an accomplishment and continues to be a success story. I will say that certainly, right now, IDES is very much impacted by COVID and specifically on the Department of Defense side or DoD where I do forecast and see some changes there as you are going to see changes within DoD as well as a result of a new administration. There is no easy way to solve some of these problems. The discharging a service members has become very complex with COVID-19 restrictions, specifically, anybody going through a medical discharge and some of the same challenges, in-person exams, health restriction, CDC guidelines, and much like with VA, different parts of the country are impacted differently and parts of the country that may be initially were not impacted as significantly by COVID-19 now have been and that includes any sort of major military installation that is located there. So right now, it is really more of a nationwide problem, as were early on, it was just specific military installations. But for us here at the Providence Regional Office, our mission will continue. I do expect there to be legislative changes and new initiatives that will come out of any sort of administrative change. [inaudible; connection lost].
EJ: A lot of our agency performance metrics we have both met and exceeded, all of those critical elements for the last two or three years. Technologically we are very well-positioned and had been in a virtual posture or a telework posture for a couple of years leading up to COVID, and then specifically staffing-wise, Robert, VA has really benefited from a very healthy budget and a lot of resources to meet the needs of an ever-changing veteran population whose needs are always changing, certainly with COVID-19 that continues to occur. But staffing-wise, I think both VHA and VBA are very well-positioned. VHA, obviously, with carrying on its fourth mission as a result of a global pandemic I think there will continue to be a lot of changes there and I think some very real challenges for VA, as so many of our facilities– and when I say VA, I mean really the health administration because so many of our facilities are old and if you look here throughout New England, both Southern and Northern New England, I mean, the average age of most of these buildings is sixty, seventy years old, and with the new COVID requirements, that is going to present a lot of unique challenges for VA and that is something that I think the new Administration will absolutely be very, very focused on. But for VBA, I think we are well-positioned and some business lines that I think will be getting looked at closely to make sure that we are meeting the new needs of COVID, education, things like GI Bill, loan guarantee, we do not perform those functions here in Providence as we are mostly about disability compensation and Veteran Readiness and Employment. But we will, as always, be remaining flexible and pride ourselves on being a good news story at the local level, but right now, where I would say a lot of our unique challenges are pointed towards our really towards our IDES mission. Again, that is something very specific to only two Regional Offices but is a challenge right now for both VA and DoD to meet the needs of any service member discharging through a medical discharge.
Robert: Well, EJ, thank you very much for joining us. Mark, thank you for joining us as well today. We appreciate the look back and the look forward from 2020 to 2021. It is December 15th, 2020 today, and people are starting to get vaccines around the country so there is reason to be optimistic for that reason as well. And Brad, thank you for joining us today and have a good day everyone.
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