Cutting Bureaucratic Tape to Bring Better Service to Veterans

Military men and women come from across the country to serve around the world – carrying out missions that protect homefront interests and safety. When they return, oftentimes they come home to a different world altogether.

The Vietnam War exposed service members to Agent Orange, a tactically deployed chemical used by the military against the Viet Cong, and some veterans later have dealt with cancer and Parkinson’s disease. In more recent wars, veterans of deployments to the Middle East have contracted any of nine infectious diseases – including malaria and Mycobacterium tuberculosis. And generally, veterans have always risked losing life as they know it, as those who do return might come back without the same physical capacities of sight, hearing or motor functions and many suffer from post-traumatic stress disorder (PTSD).

The Veteran Affairs Department (VA) attempts to ensure that upon reentering civilian life, veterans are welcomed with the “world-class benefits and services they have earned,” and it looks for ways to do so efficiently. For that reason, VA has embraced the Presidential Innovation Fellows (PIF) program, to speed up service delivery and ensure veterans receive personalized treatment from the VA.

“What we want is to make sure that when you walk into the VA, we know who you are,” said Nelson Colon, a Presidential Innovation Fellow detailed to the VA’s Office of the Chief Technology Officer.

The Problem With Disability Claims

One of VA’s most important responsibilities is the offering of benefits and compensation to soldiers who’ve borne disabilities for their service. To receive compensation, veterans submit an application detailing the extent of disabilities, and VA follows up by reviewing necessary records, offering medical examinations and assisting veterans in finding proof to back up their claims. The application, Form 21-526 EZ, can be accessed here.

On average, VA receives 1.7 million of these forms a year from veterans applying for disability compensation and related benefits. Sixty percent, or more than 1 million, are received in the mail. For veterans, the paperwork involved in these forms delays the time until they receive their benefits, and forms that are received in the mail are especially laborious. Veterans have to wait an average of 100 days for forms to be processed, and many forms can take far longer.

VA wants to follow up on benefits applications as quickly as possible, and in its era of digitization, forms submitted online can be processed through language-reading software. The forms submitted by mail, however, almost always have to be manually sorted, evaluated and logged before they can even be acted on, requiring significant costs and time from VA employees.

The department has used software to speed up the process for applications submitted by mail, digitizing the forms and then scanning them automatically to detect types of disability. With language recognition capabilities, software can recognize phrases such as “hearing loss” and classify the form appropriately.

Unfortunately, the program is very limited in scope – capturing just 1% of the applications submitted through mail, or 10,000 of 1 million – as it fails to account for misspellings and alternate phrasings or descriptions. Only 111 phrasings of disabilities are currently understood by the system, so if a veteran writes “difficulty hearing” instead of “hearing loss” or misspells a disease, then the form couldn’t be automatically processed and would need to be reviewed by a VA employee, even though the disability is apparent.

Fielding an Innovative Solution

VA has embarked on a mission to modernize, which has been advanced by thinking outside of the box and outside of VA headquarters – a rectangular ten-story building a block from the White House’s north lawn.

About a half mile away resides the General Services Administration (GSA), a familiar resource for VA information technology. Every year, GSA welcomes a class of Presidential Innovation Fellows and connects them with different departments and offices throughout the federal government for a yearlong sprint to tackle specific problems – a program of which VA is a primary benefactor.

The Presidential Innovation Fellows classes are designed to infuse innovation into the public sector from outside sources to offer a fresh approach to intractable challenges within the federal government, which is often maligned for getting too stuck in familiar ways of operating. The 12-month tenure of PIFs requires fellows to each carefully select a project that can be accomplished in a limited time frame.

VA Chief Technology Officer Charles Worthington is a PIF alumnus, and his office currently houses four fellows. There are another three fellows assigned to other offices within VA, Colon said.

After going through onboarding, Colon sat down with Worthington to discuss the VA’s modernization journey in general, and they decided to pursue a way to update the processing of disability forms for VA – a difficulty that had already been identified within the department.

“We chose this machine learning project, and I think that one was mainly because I’ve worked on the whole process of developing software from building the models, building the containers, taking that into production,” Colon said. “I had a really good idea of how long that would take, so I was confident that we could do that in less than a year.”

Colon partnered with Bennett Gebken, a VA employee within the Veterans Benefits Administration who came up with a solution in his own time on a personal laptop. However, lacking a developer or data scientist background, he’d been unable to apply his model to VA’s Form 526-EZ conundrum.

Coming from the private sector, Colon had most recently worked for Microsoft, developing machine learning products, and a cybersecurity startup, working with natural language processing.

The previous language processing program in VA, that picked up on 1% of submissions, was to be replaced by a machine learning solution that Colon, Gebken and a small team worked on, benchmarked for 70% recognition of the different disabilities. By identifying disabilities from root words and classifying them, the team’s invention would save the VA $20 million if it ran at 70% accuracy.

Putting It In Motion and Completing the Bigger Picture

With the timeline in place, Colon’s team had to get started on the project quickly. The first step was to analyze the language, which involved cleaning up data and applying the right labels to ensure that words people wrote down could be understood and sorted.

“It’s actually one of the things I enjoy the most,” Colon said. “I think it’s sort of like playing with a puzzle, you know. You start playing around and trying to figure out how can I make this better.”

After considering different language patterns, Colon and company needed to actually code the software. They incorporated VA employees who handled the application programming interface (API) and development sides of the solution – enabling machine learning and natural language processing capabilities that Colon built into programs. By teaching the software to recognize language roots and misspellings, the classification and processing workload could be automated.

The team then went about piloting the solution, and the first model reached 70% accuracy, the expected outcome for the project as a whole. Not resting on its laurels, the team then added more methods and protocols for analyzing language to obtain higher accuracy with its model.

After starting the project in January 2019, just six months in, the final solution reached its final test. The team’s run-through during the last stage of development returned 92% accuracy, meaning that VA should save more than the $20 million leadership hoped for and veterans will have to spend less time waiting for the processing of benefits forms.

What’s Next?

Making use of the PIF program is just one way that VA has targeted modernization and accessibility. In 2014, VA hospitals were the center of TV headlines for reportedly long wait times that resulted in the deaths of veterans. Colon’s project is one way that VA is lowering barriers to access.

VA Secretary Robert Wilkie targeted customer experience as his No. 1 priority for 2019. A new VA website, centered around customer experience, has increased the number of online health applications by 50 percent, officials said in January.

VA has also been exploring ways to connect struggling veterans to help through social media, Keita Franklin, National Director of Suicide Prevention for VA, said in January at the AFCEA Health IT Summit. With the deployment of artificial intelligence software, social media language that hints at self-harm or suicidal thoughts can be brought to the attention of suicide prevention professionals.

Of 20 veterans who die by suicide every day, 14 are not under VA care, Franklin said. Getting veterans access to VA systems is one of the most important steps to helping those who are struggling with mental health. Mental health resources for veterans are available here.

These efforts culminate in a departmentwide strategy of accessibility and modernization – one that Colon’s project is just a small part of.

But he’s connected with the mission on a deeper level. Colon said that he came into government with an expectation of stagnancy within the workforce. Six months in, he views it very differently.

“I thought I was going to come in, and I was going to have to fight my way through things and that I was going to encounter a lot of resistance to get things going,” Colon said “And then I got to VA, and I realized that everyone wants to provide better services. Everyone wants to do better. And it’s just sometimes people have great ideas, but they don’t know how to move them forward, which was the case with Bennett Gebken.”

Working in government, Colon said, is his way of giving back. Half a year in, he hopes to have his public sector career extended, staying at VA longer than the promised year to help further transformation efforts and deliver services to veterans.

As his natural language processing program matures, he is also updating VA’s veteran database and supporting the cybersecurity desk, trying to shield veterans from fraud. Colon credited the PIF program for putting him in a position to make an immediate difference in the public sector.

“I would love to stay with the VA, and if that’s the case that I get to stay, that would be great,” Colon said. “But if I don’t, then I would like to have some time to train someone to keep updating this and keep looking after this project.”

Photo Credit: VA / Flickr