Manual evidence retrieval
Claims processors spent time locating and assembling information that already existed across VA health-data sources.
— CASE STUDY
Accelerating Veterans' disability claims with connected health data
theta. expanded VA’s Rapid Ready for Decision approach to PACT Act claims, connecting claims workflows with existing health data so eligible cases could move forward with less manual retrieval and fewer avoidable exams. The work paired product strategy, prototyping, secure integration, and iterative delivery around the needs of Veterans and claims processors.
customer
U.S. Department of Veterans Affairs (VA)
Contract Role
Subcontractor
Mission
Veterans benefits claims processing
Delivery Focus
Product expansion, health-data integration, and workflow automation
Capabilities
Discover & Define | Build & Integrate | Data & Intelligence
Mission Context
VA claims processors often had to search across systems for medical evidence and request additional exams even when relevant information already existed in VA records. PACT Act implementation increased both the volume and complexity of disability claims. theta. expanded the Rapid Ready for Decision approach so eligible claims could use existing health data more effectively, while also testing automation concepts for claims that did not fit the initial fast-path model.
Why it mattered
Every unnecessary handoff or repeated exam adds time and effort for Veterans and claims processors.
Every unnecessary handoff or repeated exam adds time and effort for Veterans and claims processors. The solution needed to improve speed without weakening privacy, security, decision quality, or the human review required for benefits determinations.
The Challenge
Use existing evidence to reduce avoidable claims friction
Rising claim complexity
PACT Act eligibility expanded the number and variety of claims moving through the process.
Sensitive, high-stakes data
Any automation had to protect Veteran information and fit established adjudication controls.
How theta. Delivered
A product path from existing evidence to faster decisions
Expanded the fast path
theta. identified PACT Act claim patterns that could use Rapid Ready for Decision workflows when the required evidence was available.
Connected health evidence
theta. integrated relevant information from VistA and the Corporate Data Warehouse into claims workflows, reducing avoidable manual retrieval.
Tested new automation concepts
theta. prototyped and evaluated approaches for claims outside the initial RRD model, turning promising concepts into product-ready increments.
Designed for scale
theta. used iterative product delivery to prepare successful patterns for broader claim types and higher processing volume.
Outcomes
More eligible claims could use existing evidence
theta. gave VA a stronger digital path for using existing evidence to move eligible disability claims toward a decision.
Broader ready-for-decision coverage
The RRD model was extended to PACT Act-related claim scenarios that could be supported by available health evidence.
Less avoidable retrieval work
Connected data sources made relevant medical information easier to bring into the claims process.
A scalable product foundation
Tested automation patterns gave VA a practical basis for expanding faster, evidence-driven processing.
Built for What Comes Next
Reusable patterns for additional claim types
The work established reusable integration and product patterns that can support additional claim types as VA continues to modernize the Veteran benefits experience.
Technical environment
Technology and delivery practices
Java, Python, XSLT, HTML, Groovy, Shell, GitHub, AWS, Docker, Helm, Kubernetes, Kafka, RabbitMQ, Gradle, and Datadog
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