By Chris Adams
As American soldiers stream home from Iraq and Afghanistan, what was a war on the battlefield has become a war for benefits. And the agency responsible for handling those benefits is the embattled, overwhelmed, and often-dysfunctional Department of Veterans Affairs.
At McClatchy Newspapers (as well as Knight Ridder, acquired in 2006), we’ve been tracking the VA and its efforts to provide benefits to America’s former soldiers for about eight years. We sometimes cover it as a beat but more often we look to the VA as a vast data warehouse: a place that tracks millions of veterans and billions of dollars, and one that constantly struggles to do so.
In those billions of dollars are stories of individual veterans – of former soldiers who have waited years to have a disability compensation case resolved, of young Iraq veterans struggling with post-traumatic stress disorder but unable to easily access mental health care, or of elderly widows who could get a VA pension due to their husbands’ service but don’t even know the pension exists.
For reporters, analyzing any VA data you can get your hands on helps find the stories that best illustrate the big trend emerging from the numbers.
In 2005, for example, Knight Ridder colleague Alison Young (now a reporter at USA Today) and I wrote a story about the extensive waits veterans experienced because their disability claims were sent back again and again and again for re-hearings. The numbers, based on an analysis of VA appeals data, showed that 13,700 veterans had died the previous decade while their cases were in the appeals process. Berlie Bowman was one of them.
A North Carolina man who had gone to Vietnam in 1967, Bowman developed PTSD over a lifetime that included 30 jobs; his first disability claim, in 1971 for “nerves,” was denied, as was his second, in 1995.
By 2004, after a half dozen different decisions, he finally won his claim. But by then his health was failing from advanced pancreatic cancer. His check for back benefits – the $53,784 the VA should have paid him over the years but hadn’t – was in the process of being cut when Bowman died. No check was ever sent.
Need some shoe leather to go with your data
Stories like those came from a mixture of data analysis and old fashioned shoe-leather reporting. Much of the traditional work – talking with veterans’ groups, reading court dockets, listening to the confused veterans or their widows who call in – is pretty basic: the more calls you make, the greater your chance of hitting pay dirt.
The data analysis was something different. Most of the data I requested from VA had never been used by journalists before; medical researchers regularly make use of VA health system data to analyze which treatments work and which don’t. But giving that information over to a journalist didn’t come easy for the VA. We’ve had our share of FOIA skirmishes with the agency, although it has gotten more open in recent years.
In fact, Knight Ridder in 2004 was forced to sue the VA to turn over many of its data files, as well as paper records on how the VA oversees the nonprofit organizations that assist veterans. We eventually got our information – as well as a hefty bill for the legal fees necessary to win our case.
Over the past several years, I’ve filed a few dozen FOIA requests with the VA. It’s vitally important to get it to the right division – the FOIA officer for the VA health system is different than the FOIA officer for the VA benefits system, for example.
I have rarely had success asking the VA to find information for me – i.e., asking a question that would require they go and essentially research and present information that might not readily be available on one book or one database. But if I know the exact database – the precise name of the database; as well as the name, location, and phone number of the person who maintains that database – I’ve increasingly had luck in getting data requests filled.
The VA health system has one document called the “Corporate Databases Monograph” (2011 version, PDF) lists dozens of databases and their uses inside the VA system. It was from that document that I zeroed in on health-system data to request. It gives you much of detail you need to craft a smart FOIA request.
The VA lends itself to both national stories and strong local pieces. While the VA headquarters is a couple blocks from the White House, the VA’s work really happens far outside Washington – at the collection of regional offices (which handle disability compensation) and hospitals and clinics (which handle health care).
The structure leads to plenty of rankings and other comparisons, by state, hospital, or region. The efficiency in the regional offices is particularly scattershot; wait times and errors by regional office, for example, vary widely. At one time, the waiting time to have an appeal decided in some regions was 100 days and in others, 1,400 days. The VA says it is correcting these problems. But the VA has been saying that for 15 years.
Here’s what you need to know about mining data at the VA, and how to turn the numbers into stories for your readers or viewers.
The VA is really two different agencies:
- The Veterans Health Administration oversees the health system
- The Veterans Benefits Administration manages the disability compensation system.
Each spends more than $50 billion a year. But while they report to the same secretary, they have different leaders, different cultures, different reputations, and – most important for reporters – different FOIA offices and data policies.
The Veterans Benefits Administration (the VBA) has at times had a dysfunctional, secretive FOIA office resistant to releasing information, and indeed hasn’t gotten many requests to do so over the years.
The Veterans Health Administration, by contrast, has more of a culture that respects data, regularly works with medical researchers and economists to quantify the great amount of information it maintains, and until recently had one of the best FOIA officers I have ever experienced.
Expect significant FOIA battles.
In dealing with the VBA, we faced FOIA requests that were not logged in, that were routed from office to office, or that were simply ignored. Perhaps that’s par for the course among federal agencies. But you must plan accordingly.
- Spend time before making a request to determine the office or person who actually maintains the information in question and give as detailed a roadmap as possible in your FOIA letter to pinpoint where your information resides.
- Keep detailed logs of when you make a FOIA request and follow up regularly – every few weeks or so — for status updates. You can expend mental energy griping about how long things are taking, but on some level you’re at their mercy, so it’s usually best to file your FOIA and then switch your focus to another story.
The VA is a vast data warehouse.
At its core, the VA exists to give veterans checks or, in the health system, medical care. So it maintains vast collections of data. And it does a huge amount of sorting and ranking and analyzing data itself.
Among the most important databases we have used:
- The Comp and Pen Master File is the record of each veteran disability claim, detailing region, disability and the “rating” (a severity indication, from 0 to 100); there are dozens of other fields. This was the most pivotal, and also the hardest to get, as the VA was extremely hesitant to give it up. It’s more than 3 million records, and growing rapidly. (Search a McClatchy database of that data, by zip code or state).
- Monday Morning Report, which details the current backlog of cases and is updated each week. It’s a pivotal source to look for workload trends.
- Annual Benefits Report, which is put out each year by the VBA. It details a wealth of information about disabilities and other benefits, broken down by state. Our best stories took these easily getable indicators and, after obtaining the raw data underlying them, refined them in far more meaningful ways. Just spend time poking around the VA’s website – you’ll find plenty of interesting things.
- The health system has several research institutions around the country affiliated with VA hospitals and local med schools. One main site includes a link to the various centers and their research. One center deals with the cost of VA health care, and has a lot of research on what treatments and hospitals are cost effective (the Health Economics Resource Center).
- VACOLS is the appeals database and is handled by the quasi-independent Board of Veterans’ Appeals (part of VA but with its own authority). This database showed a case’s start date, end date, regional office, and resolution, among dozens of other fields. Most cases go through multiple appeals – they are appealed, sent back to the regional office, decided again, get appealed again, get sent back… Thousands of cases linger for between 5 and 10 years, during which time many of the elderly veterans die.
- The Pending Issue File showed all claims now in the works, as well as the regional office and type of claim. It was pivotal for showing how long claims were taking, particularly since delays vary widely by region and by type of claim.
- National Survey of Veterans – Conducted every five or six years, this is a wide-ranging survey that gets into veterans’ disabilities, incomes, etc. The most recent survey questioned 11,000 people.”. If you are having problems, the VA’s survey department has sometimes been helpful.
- Medical patient files – Those include the MedSAS and DSS files, which track patient visits (or “clinical stops”) and expenditures. These are massive files (tens or hundreds of million records per fiscal year), and are generally used only by medical researchers. But they can allow for in-depth breakdowns of the care given by location.
- Vital Signs database – This database details hospital-by-hospital statistics: average wait time for mental health patients, average wait time for orthopedic patients, percentage of patients who had certain tests conducted, etc. It’s very detailed, but there are limitations on what sorts of comparisons can be made. Also, the VA’s inspector general has reported in the past that waiting time data is manipulated and unreliable
My most recent veterans’ story used many of these resources, often for the third or fourth time since I began covering veterans’ issues. My analysis of the compensation database showed a wide spread from region to region in the awarding of PTSD and other disability claims. The data also pinpointed hotspots across the country where PTSD and other disabilities were a particular problem. Among the veterans returning from Iraq and Afghanistan, one hot zone was the tiny town of London, Ky.
There, I talked with the families of local soldiers who had died in Iraq or Afghanistan, and with the veterans who survived but would live with mental or physical reminders for the rest of their lives. My story was their stories. The numbers and the data provided a backbone to the story, but it was the humans who told the tale.
New to the beat, or tackling the VA for the first time? Here is how I would start:
- Read the VA Performance and Accountability Report. This is an annual document that shows every aspect of the VA’s operations as well as all of its goals – how it wants to decrease waiting times and infection rates, or increase accuracy and outreach. This is a valuable document that gets little attention from the media but can provide a wealth of story ideas.
- Find local veterans service organizations. These groups – state veterans’ agencies, non-profits such as the American Legion – provide service and fellowship to veterans, and also help them file claims with the VA. It’s the best way to get an outsider’s perspective, and to find local experts. You can search for service organizations or their representatives here.
- Look for reports from the VA’s inspector general. The IG office produces dozens of reports a year, some on broad national issues and others on individual VA hospitals or regional offices. Anybody covering the VA beat should regularly check the IG’s web site. Follow @VetAffairsOIG on Twitter.
- Look for cases at the U.S. Court of Appeals for Veterans’ Claims. This federal court is not part of the VA but specializes in hearing appeals that came from VA decisions. The decisions are posted online, and it is a great way to see the issues – and the delays – that veterans often face.
- Defense Casualty Analysis System troop casualty data, by operation and theater.
- Geographic Distribution of VA Expenditures (See data below). Annual VA spending data at the county, congressional district and state level. Includes compensation and pension; education and vocational rehabilitation and employment; insurance and indemnities; construction and related costs; general operating expenses and related costs; loan guaranty; and medical expenditures. From 1996 through 2011.
- Other data from National Center for Veterans Analysis and Statistics. Numerous historic and current charts, tables and downloadable data on spending, population, benefits, etc.
- Veteran’s Administration data via data.gov.
- VA spending in 2012 on prime contracts, subcontracts, grants and loans via USASpending.gov.
- VA social media directory (including local medical centers).
- Directory of key VA web sites.
- Definitions of VA acronyms and abbreviations (PDF).