Product Description Appeals Application.docx

VA OIT BAM Product Line - Appeals RFI – Appeals Modernization Attachment A – Caseflow Baseline Requirements

1. Background If a Veteran or other beneficiary is unsatisfied with a benefits decision by the Department of Veterans Affairs, they are entitled to appeal to the Board of Veterans’ Appeals (Board). These appellants have various routes they can take to get a decision depending on their circumstances and preferences, including a legacy system and a modernized system; an expedited docket and a regular docket; and a direct appeal, an evidence submission appeal, and a hearing appeal. Last year, the Board handled more than 100,000 appeals of benefits decisions, and many other requests requiring administrative action.

To manage appeals and related requests, the Board depends on software systems that support several critical functions. Each of the hundreds of thousands of appeals contains hundreds to thousands of documents that must be individually reviewed and annotated while remaining isolated from other appeals to protect privacy. The Board must also schedule thousands of hearings by coordinating the availability of judges, hearing coordinators, representatives, regional offices, and appellants, while also accounting for the complexity of the appeals being scheduled together.

Other systems oversee intricate workflows that must be easily adjustable in response to judicially-mandated changes. For example, intake requests must be categorized according to business rules that evolve as new Court decisions are issued. The requests must also be routed to the appropriate processing queues. If an appellant requests a hearing, it must be scheduled and held—typically virtually—before the appeal can proceed. Many types of appeals also include multi‑step notification requirements that must be tracked and completed on time. Throughout an appeal, additional actions may arise, such as translation needs, responses to status inquiries, or handling requests for changes.

Ultimately, each appeal is reviewed by a staff attorney who drafts a decision for approval and signature by a Veterans Law Judge. This requires the use of another software tool to integrate the workflow application with Microsoft Word to generate the outline of the document along with a central repository of language snippets for common text fragments. Afterward, dispatch specialists prepare the final decision package, add the appropriate cover letters, and electronically send the decision to a print service to be sent to the appellant. A Board decision may result in a remand—requiring the Department of Veterans Affairs to correct an issue before issuing a new decision—a grant of benefits, or a denial. If any portion of the decision is a denial, the appellant may seek Board reconsideration or appeal to the Court of Appeals for Veterans Claims.

In addition to intake and workflow management, the Board’s software must also support:

• Integration with other VA systems and databases, including document storage systems, Veteran profile information systems, Veteran claims systems, and document mailing systems via different system APIs.

• Robust data management and reporting capabilities including with data extraction, transformation, and loading into external systems

The Board’s systems are used by approximately 1300 attorneys, 200 judges, 300 support staff, and 10,000 non-Board Department users. Access to status information and document downloads are also provided to approximately 20,000 Veteran representatives.

Incumbent Appeals Systems

Caseflow Caseflow is the Board of Veterans’ Appeals’ modern case management system designed to streamline appeals processing under the Appeals Modernization Act (AMA) and improve efficiency in document review. Hosted securely on AWS GovCloud, built using Ruby on Rails, and integrated with VBMS, Caseflow offers flexible hearing options, including in-person, video, and virtual tele-hearings, reducing travel burdens and expanding nationwide access for Veterans. Caseflow supports over 30,000 VA users and manages more than 475,000 active and dispatched appeals. Caseflow delivers measurable improvements in transparency, efficiency, and service delivery and empowers the Board to provide faster, more equitable decisions, and ensures timely participation for Veterans.

High level Caseflow features Caseflow is a lot of different things, and will continue to evolve over time

· Form/data intake

· A case/task management system for many distinct users & roles, inside and out of VA

· Creates tasks for other VA systems, too

· Hearing scheduler (across many of variables)

· Document viewer and annotator

· Appeal system of record - centralizes Veteran and appeal data from disparate source systems

· API that shares Veteran and appeal data to other systems, including VA.gov for Veterans themselves

VACOLS

VACOLS is a VA in-house developed product that is over forty years old, built using PowerBuilder, used to process legacy appeals and handle some AMA appeals.

Veterans Appeals Control and Locator System (VACOLS) is a client/server application used for tracking appeals and monitoring pending workloads programmed by the Board of Veterans’ Appeals. The system tracks legacy appeals that existed prior to the Appeals Modernization Act (AMA) passed in 2017 and continues to intake legacy appeals and a small subset of AMA appeals.

Interactive Decision Template (IDT) The IDT is a VA in-house developed Microsoft Word plugin that integrates with Caseflow, VACOLS, SharePoint, and other systems to create written correspondence and decisions on appeals at the Board. The IDT uses a flexible templating system for correspondence along with insertable Snippets of standardized text for sections of custom decisions to handle content validation, document lifecycle management, and mailing. Decisions on appeals are heavily customized to each individual, so although there is use of templates and reuse of some language, the individual attorneys and Judges typically make extensive changes and modifications to each and every decision using Word’s normal features. The IDT checks these changes to ensure that formatting and style guidelines are followed throughout the document.

2. Future requirement summary

The systems of the Board can be a singular system or multiple systems that integrate together where appropriate. Responses that replace only parts or individual systems are acceptable provided they can integrate with existing or other systems. The Board’s systems do not exist in isolation and must integrate with other systems in VA. At the highest level, the Board needs a workflow and docket management system; a document review and annotation system; a system for scheduling, holding, and transcribing hearings; a system for drafting correspondence and appellate decisions with custom and semi-prepared language options integrated with the docketing software and Microsoft Word; and a data operations system to integrate with existing business data and APIs, host the business data as a system of record, and reporting system.

The following high-level capabilities are generally required for a total “Appeals Processing System”

a. Appeal Request Intake capability that provides an ability to intake (establish) Appeal Requests into a system of record

b. Work Queue management capability that enables tasks to be assigned and completed by various users on established Appeal and Appeal-related requests

c. Appeal Request management capability that provides an ability to view and edit Appeal Request information and perform task management related to these requests

d. Judicial Hearings management capability that enables the processing, scheduling and post-hearing activities required of this capability

e. Appeal Decision drafting and finalization integrated with the Microsoft Word application

f. Appeal Dispatch and Request response capability

g. Follow-on Request capabilities that enable follow-on actions to be performed related to Appeals or other Requests

h. Quality Review capability that enables specific users to evaluate the accuracy and completeness of Requests

i. Document Review and evidence management capability

j. Capability to Integrate these system/s with various Department of Veterans Administration (VA) systems to process requests

k. Capability to provide Custom Workflows and Business Rules surrounding all of these major system functions

l. Ability to manage user and team accounts, including assignment of roles and access.

m. Management, storage and maintenance of data within the application, including data integrity

n. Users ability to generate custom reports & access to standard system reports

o. Ability to support compliance with applicable policies, regulations and standards

p. Identification, visibility, and processing of legacy appeals in accordance with applicable statutory and operational requirements.

q. Modern user interface providing efficient navigation and completion of system task

r. System generated and delivered notifications to users based on system events and actions

s. Artificial intelligence capabilities to support automation, insights and decision-making image1.png