A publication of Vietnam Veterans of America, Inc. ®
An organization chartered by the U.S. Congress

February 2000/March 2000

Interview With Joseph Thompson,

Undersecretary For Benefits, Department Of Veterans Affairs

By Len Selfon, Director of Veterans Benefits

Joseph Thompson was confirmed Veterans Administration Undersecretary for Benefits in November 1997. Prior to that, he served as the director of the VA Regional Office in New York City. A native of Peekskill, N.Y., Thompson is a U.S. Air Force Vietnam veteran who began his VA career in 1975.

As Undersecretary, Thompson directs the Veterans Benefits Administration, through regional offices in every state, the District of Columbia, Puerto Rico, and the Philippines. He has responsibility for managing VA benefits to veterans and dependents, including education, home loan guaranty, compensation, pension, vocational rehabilitation, and life insurance.

VVA: You've been the Undersecretary for Benefits for several years now, and we'd like to know what your greatest challenge has been?

Joseph Thompson: I'd say the single greatest challenge is trying to revamp the agency. Trying to balance all this fundamental change with getting the work done at the same time is the single greatest challenge right now.

VVA: Would you describe your top three or four general goals or specific objectives that you'd like to accomplish?

Thompson: Two of them have very much to do with compensation and pension. One is: we have to make better decisions. Our error rate is way too high. We have put a more rigorous system of review in place. Where we used to say we made errors 3 percent of the time, now we say we're making them 30-something percent of the time. So trying to get the mistakes down to an acceptable number will be a continuing goal of mine. Anybody who replaces me will have to continue on in that vein.

Secondly--and this is fundamentally about compensation and pension--is changing the way we handle the claims themselves. Our business process of re-engineering is taking that old adjudication assembly line and replacing it with one where a veteran knows who he or she can speak to and the person spoken to knows what's going on in the claim.

The veterans, if they don't like the decision, understand their rights. If they do agree with it, they understand that, and we can go on from there. So trying to change that underlying, fundamental business process, which has been in place for a century or more, that's an ongoing goal.

There are two other things that apply across VA that are key for us. One is building training systems. We have not had good systems in place that are managed by Washington so that we can make sure that whether you walk into an office in Togus, Maine, or Albuquerque, New Mexico, you're going to get the same decision on the same issues. That training is key for us, and every spare dime we have goes into training.

VVA: Would you consider that the threshold for uniformity the VA is trying to accomplish?

Thompson: Absolutely. You can't guarantee uniformity in any way if you can't guarantee the training experiences people have. If the training is always a local function, then you're going to hear from somebody who learned it ten years ago from somebody who learned it twenty years before that. That's no way to manage a federal program. Training is key.

The other is information technology. I'm proud to say that the systems we use in regional offices, I worked on twenty years ago. I'm also ashamed to say they're still the ones that our folks have to use to pay claims to veterans. We must change the technology so that it's easier for our own employees and gives them more information to help veterans and makes it easier to make good decisions and provide information to veterans.

Those four things--reducing the error rate, changing the business process, building the learning systems, and changing the technology--are really keys. I'll be struggling with that everyday.

VVA: Those points seem very interrelated.

Thompson: Absolutely. They feed off each other. One drives the other. If one gets worse, it tends to make the others worse. If one gets better, you're right, it's a symbiotic relationship.

VVA: Last March, VVA submitted a petition to the Secretary with regard to presumptive service connection of hepatitis C. Would you comment on the status of the petition?

Thompson: We have put together a proposal to the Secretary to add presumptive service-connected conditions for hepatitis C. I was hoping to be able to give you a specific date, but my

estimation is that it will get approved by the Secretary.

We are not adopting some of the proposals, such as body piercing and tattooing, as being presumptive conditions. It would become ``Mission Impossible'' to figure out where tattoos were received and whether they had anything to do with the military. I think the exposure risks are probably fairly minimal in those kinds of things. Obviously, a transplant or a transfusion will put you at a high risk.

VVA: The Compensation and Pension Service has issued guidelines on hepatitis C that were pretty specific. A lot of individual adjudicators are not cognizant of these directions. They sort of put them aside somewhere, and they're not actually applying them. Would you describe what steps the C&P Service is taking to ensure better compliance with guidance letters and regulations?

Thompson: We did put out very specific guidance to the regional offices in the form of policy letters. We've also held satellite training. We now have the ability to put the most knowledgeable people on our end of the satellite and bring together all the people in the regional offices without having to physically travel someplace. So that's been a great tool.

We've also developed a series of computer-based modules for training. It will ensure that people taking it get exposed to the same material, and that if you can use it locally at your own pace, you don't have to have everybody in the room at this hour to get this training.

It gives us the ability to insure that we're telling you and your partner on the other side of the United States that these are the rules for hepatitis C or these are the rules for Post-traumatic Stress Disorder.

And then at the back end of it is a more rigorous review of the decisions, which I think is the other part of it.

VVA: Is issue-specific training working?

Thompson: It's starting to. It takes time. One of my frustrations is that I always want everything done yesterday, and when you're dealing with eleven thousand people in dozens of locations, things just don't happen that quickly, unfortunately. I think we will have, when we're done, the best training in the federal government. We'll have people who know what the right thing to do is and are capable of doing it.

VVA: Can you tell us about the status of efforts to include diabetes melitis and other diseases that have not been linked to exposure to Agent Orange or dioxin under the service-connected presumption conditions?

Thompson: We got information from the Institute of Medicine last year. There were some statistical associations between diabetes and Agent Orange or dioxin exposure. The reports weren't that strong, and frankly, they weren't all that convincing. What we've done is ask the Institute of Medicine to take another review of this and perhaps go into a bit more depth.

VVA: One problem that is often encountered by our service representatives is the perception that the VA fails to expedite claims that have been remanded by the Board of Veterans Appeals. What plans do you have to speed up the claims process for veterans who have had their claims remanded for reconsideration?

Thompson: We were terribly slow in working remanded cases. Part of the pressure in the nineties was an attempt to reduce the cycle times for original claims, for first-time decisions, because the same people who worked those worked the remanded claims. If you devote all your resources to doing the front end of the business, you let that part of it go.

Over the last year we've made excellent progress. We've knocked down the total remands about 11 percent. But the old ones--the ones that are over two or four years old, have been reduced to somewhere around 45 percent for the over-two-year cases and 75 percent, close to that, for the over-four-year cases.

Because a case is old, doesn't mean we haven't looked at it in that period of time. Oftentimes we're involved in very, very complex evidence-gathering procedures. But sometimes we simply didn't pay as much attention as we should.

VVA: In terms of judicial review of veterans' claims, VVA has consistently advocated for full judicial review and also attorney representation at the regional office levels. Would you comment on whether you think the system has helped make the adjudication of claims more fair and consistent?

Thompson: I part company with you on the need for full judicial review, and this is why. The system for administering veterans' benefits is unique as far as I can tell in the federal government. The reason I say that is it doesn't treat the people coming to us as adversaries. We have no limitation on when you can file a claim.

There aren't many systems that give a 50-year or 70-year window if you want to file claims. There's no limit on the number of appeals you can make. There are thousands of advocates throughout the United States who will, for free, represent you before the United States government, and they're very expert in this business.

We have the duty--again, unlike almost any other system I can think of--to help you perfect your claim. We have an obligation to assist you in perfecting your claim. Then, finally, when the evidence is weighed, we must grant the benefit of doubt to the veterans.

 

My fear is you will begin to turn that into an adversarial process where it's the veteran's job to prove his claim, and it's our job to disprove it. And I would hate to see that happen. The system that's in place today is not perfect. It has flaws like any other system. I think on the balance, it does a good job for veterans.

VVA: So you think that the system, as it is, is adequate to protect the rights of veterans?

Thompson: I think so. And I think the Court is far more liberal and far more open than it's ever been. Despite the fact that the veteran population has been in decline since 1979, we now have more veterans receiving compensation than at any time in U.S. history. That speaks to something, and I think it speaks to the system, on balance, being fair and open.

VVA: It's been suggested that the VA could do a better job letting veterans know what and how you do your mandated work by means of a more assertive effort to get the word out. Would you comment on current efforts and plans for media outreach?

 

Thompson: This is a ``good news, bad news'' thing. The good news is the Transition and Assistance Program, which flowed out of the Gulf War, has been very successful. We put information out now to those who are about to get separated from the military in ways that are unprecedented. We're also looking to build the capability to allow them to file claims before they get out and make the decision.

The other part, though, is that a lot of other things went by the wayside. One of them was outreach. We have not done what we need to do in terms of reaching out and letting special populations of veterans know what type of help is available to them.

I am glad to say that in our Compensation Pension Service, we've created a new position, Assistant Director for Outreach. We're going to put together some concerted efforts to reach out to special populations. I think the Internet and some of the high-tech tools will certainly get us into a lot more living rooms than in the past.

We also need to do the field work. There's no substitute for having a presence in a state. You have somebody who knows where the homeless shelters are, who knows where the meetings are. So we're going to push that more. We used to do a good job of that. We kind of let it go for a few years, and I'm going to make sure we get back into that business again.

VVA: We have had complaints from many of our service representatives that VA regional offices either lost claims files or lost evidence or documents contained in the files. Would you describe office automation plans and efforts?

Thompson: As anybody who has ever walked into a regional office knows, we live in a world of paper. We have under our direct jurisdiction about 22 million claims files. We have another 15 million in the archives. We add about 150 million pieces of paper a year to that system.

Clearly that has to change. The technology and computer capabilities have progressed to a point now where we shouldn't have to do business the way they did it in 1865.

One of our pilot projects--which is actually up and running here in the Washington regional office-- is taking all of this paper that comes in on a veteran's claim and putting it into an image system so that anybody who needs access to it and has a computer can get to it.

We were told that if we ever tried to index all of our information, we would be the largest image system in the world. So it's not a small task, but we think it's feasible. We think it will give much better service. The fact is, we have to do it.

I probably disagree with your original premise that we lose a lot of information. It certainly happens in any system this big. But it really is a tiny fraction. Often, there's a dispute about whether it ever really existed or whether it ever made it into the VA's possession. Nonetheless, we want to have all the evidence in front of us. So I think that imaging is clearly one solution.

VVA: Another problem our service representatives encounter is inadequate examinations conducted at the VA medical centers.

Thompson: This has been an issue for VA for as long as I go back in this agency, and that's the mid-seventies. I think we've done some important things to make it better. We put protocols out for the doctors to use so they clearly understand what it is we're looking for in the adjudication end of the business when we ask them to evaluate some condition.

We are contracting out exams with a third-party vendor. We found that's a good solution. It gives us a whole host of locations that are often more convenient for veterans to get to for the exams.

Although it had some growing pains, it's clearly a good product, so we keep pushing. That's the key for us: the exam. That's one of the single most important pieces of information we have right after the service medical records themselves. So we'll keep pushing.

VVA: VVA is concerned about service connection for breast cancer and service-connected mastectomies in terms of special monthly compensation and other diseases and conditions that specifically affect women veterans. Would you comment on what you're doing to work more closely with constituent groups to ensure the special needs and concerns of women veterans are met?

Thompson: Again, that's a combination of headquarters initiatives coupled with local initiatives, and both are necessary. We are doing a fair amount of training that is very specific to women veterans. And I think that's been helpful. I have my own advisory committee on women veterans' issues. They've been very, very involved.

They have the advantage of being tied into the local communities, and most of them have a background in claims, so they understand very well how the rating schedule affects evaluations of women veterans.

We've also put an emphasis on our local women veteran coordinators.

VVA: Switching to PTSD, you recently were filmed with a hostile journalist who claimed there is no such thing as PTSD. We saw the interview and were very impressed by the substance and tenor of your answers. Would you comment on the number of PTSD claims filed and granted, as well as the subject of PTSD claims in general?

Thompson: The whole issue of Post-traumatic Stress Disorder flowed from the post-Vietnam era work, done largely by Max Clelland, who was the VA administrator at the time. It was a simple recognition of the fact that you put people in harm's way, you put them under enough strain, and they're going to develop problems, sometimes lifelong problems.

The reporter in that 20/20 interview had people telling him, "Well, you're getting ripped off. VA can't really evaluate post-traumatic stress. And these guys are making up symptoms." I'm willing to concede anything's possible. People probably do either make up or exaggerate their symptoms.

But on the balance, the laws that apply to PTSD are good ones. And on balance, I think we make decisions in conformance with those laws. Congress recently made it easier for us to make the calls. It used to be you needed a stressor. We would go to great lengths to find stressors. And unless we agreed that it was a stressful, life-threatening event, you were often denied.

They changed the law and I think put some important codicils in there and said, "Look, if the guy's got a Combat Infantryman Badge, if he's got a valor medal, don't beat it to death. That's a stresser. Don't go any further than that unless you have something to the contrary to indicate that.'' And that's made life easier for us.

There are about a hundred and something thousand guys receiving PTSD benefits. There are 25 million veterans in the United States. So this media sensationalism that you've got this program where millions of people are abusing it, the facts belie that.

I think stress reactions to combat are as old as mankind. I don't think you can put a large number of people in harm's way and not have some folks suffer some things that will give them problems forever.

It was easy for me to defend what we were doing with the reporter, although if you saw the report, my 50 seconds of rebuttal time didn't sound particularly impressive.

 

VVA: Would you agree that a diagnosis of PTSD, based on a non-combat related stresser, would be just as warranted as a diagnosis based on war-related illnesses?

Thompson: Absolutely. You don't have to be in combat to feel stress. I worked in a bomb dump. I felt like this was kind of threatening, and I was nowhere near a combat zone. Bombs are pretty uncaring whether they blow up in America or whether they blow up in Asia.

Obviously, I think that women can have sexual assault experiences. It doesn't need to be exclusively related to combat.

VVA: Would you please describe for us current efforts that are under way to assist homeless veterans as a matter of Veterans Benefits Administration policy and what's being done to insure that the staff at the regional office levels and other locations are actually implementing those policies on a consistent basis?

Thompson: We work closely with the hospital system, obviously. We come in contact with veterans, for benefit purposes, who we know need medical care, and they have them in the hospitals, and they know oftentimes that they may be eligible for pension compensation. So most times, we follow the hospital systems on homelessness. But this is one of those areas on outreach where I don't think we're doing as much as we can and should.

VVA: You had a tough assignment as the director of the VA regional office in New York City before becoming the Undersecretary for Veterans Benefits. We know that they're both tough, high-pressure jobs. You seem to be thriving on the pressure, and we were interested in knowing why you seek and accept these types of pressure-producing positions?

Thompson: To be honest with you, I don't feel that they're that high-pressured. I mean, I'm doing what I love to do. I have spent most of my adult life in this arena. I love helping veterans. I love making a difference. You get nudged from thousands of directions, but I do think that's part of the job. As long as you accept the fact that you're open to criticism and that you're going to have to find a million flaws wherever you look, if you can accept that as part of your world, then I don't think it's that big a deal. I enjoy it.

VVA: Is there any one particular accomplishment of which you're most proud, and any one particular frustration that you've experienced here as the undersecretary?

Thompson: In general, I think the thing that I'm happiest about in the last two years has been the ability to restore some positive sense within the agency that we do good things, that we're on the right track, that we value our employees, and that we value our mission. I think that's the best part of what's happening. I think the communications that we have with all the stakeholders is much, much better than it was.

Like us or hate us, I don't think many people say they don't know what we're doing or that we're hiding the truth or that we don't tell you what's going on. We put a lot of effort into making sure that everybody understands what we're doing and why. And I think that's been a success.

I think the thing that frustrates me the most is I'm an impatient person. I wanted everything done yesterday or the day before that. I'm dealing with complex systems, and it's a large bureaucracy. I always want to get these things done immediately. There is so much to do that I want to try to make sure that everything gets done. So that's the frustrating part, but that's part of my personality and not the job itself.

It's a wonderful job. But every position I've held in VA has been enormously rewarding. The government never pays as much money as you might be able to make in other occupations. But I know when people come into this agency from the outside, and they see what we do, I'm telling you that they're envious.

We're the ones who've been entrusted by American citizens to help veterans. That's our mission, and it's a great one.

As a Vietnam veteran, I'm delighted to appear in your magazine. It concerns me that every media story about Vietnam veterans always comes from a negative slant, seemingly.

There are people who came home from Vietnam who needed help that we have an obligation to help. But there are also plenty of people who got on with their lives and have been wonderfully successful. Tell that story, too. Tell the story that two of the big four presidential campaign candidates today are Vietnam veterans.

That gets lost, and they always want to portray us as either criminals or victims or both.

Recognize that some folks need help, and we'll help them, and then recognize that some folks have done well.

So I'm delighted to speak to an audience who can appreciate the full range of experiences of Vietnam veterans and understand there's good and there's bad, and there's mostly a whole bunch of good that doesn't get told.

 

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