Veterans' Benefits Claims

The Department of Veterans Affairs pays monthly compensation benefits to veterans with injuries or diseases incurred or aggravated while on active military duty and monthly pension benefits to wartime veterans who have low incomes and are permanently and totally disabled for reasons not connected to their service. The Veterans Benefit Administration's (VBA) new accuracy measurement system, deployed at the beginning of fiscal year 1999, indicates that it needs to give more attention to ensuring that the regional offices that process compensation and pension claims make correct decisions the first time so that veterans need not make unnecessary appeals or be unnecessarily delayed in receiving benefits. Compared with VBA's previous system, the new one focuses more on regional office decisions that are likely to contain processing errors, uses a stricter method for computing accuracy rates, provides more data on the performance of VBA's organizational levels, collects more data on processing errors, and stores more accurate review results in a centralized database for review and analysis. However, VBA could (1) further strengthen its ability to identify error-prone cases by collecting more detailed data on the human body systems, specific impairments, and deficiencies in medical evidence and examinations involved in disability claims, (2) implement a system for reviewing claims-processing accuracy that meets standards on separation of duties and organizational independence, and (3) keep Congress informed on its progress in establishing stricter employee accountability and developing more effective training for claims adjusters.

GAO noted that: (1) the new STAR system represents an important step forward by VBA in measuring the accuracy of compensation and pension claims processing; (2) compared with the previous system, STAR focuses more on RO decisions that are likely to contain processing errors, uses a stricter method for computing accuracy rates, provides more data on the performance of organizational levels within VBA, collects more data on processing errors, and stores more accuracy review results in a centralized database; (3) even so, VBA can further strengthen STAR's ability to identify error-prone cases and claims-processing weaknesses so that it can take corrective actions; (4) VBA needs to better pinpoint error-prone cases and weaknesses in the development of evidence by collecting more specific data on the types of medical characteristics and deficiencies in medical evidence that are most prevalent in incorrect decisions; (5) VBA can also better address vulnerabilities in the integrity of accuracy data; (6) STAR reviewers in ROs do not have sufficient separation of duties or adequate independence to meet government standards for internal controls or program performance audits; (7) these shortcomings raise concern about the integrity of STAR accuracy data, which are a key factor in the performance measurement system designed by VBA to meet the requirements of the Government Performance and Results Act (GPRA) of 1993; (8) while such system improvements are necessary, they alone are not sufficient for VBA to meet its goal for improving accuracy; (9) using the STAR pilot test's 64-percent accuracy rate as a baseline, VBA's goal is to achieve a 93-percent accuracy rate by fiscal year 2004; (10) VBA faces management challenges that it must address successfully in order to meet its accuracy improvement goal; (11) to do this, VBA recognizes that: (a) its newly implemented performance measurement system must hold program managers accountable for performance; and (b) the training program under development must effectively train the current RO workforce as well as the many new employees who will have to be hired in the coming decade to replace those who retire; and (12) it is too early to determine whether VBA's efforts to meet these challenges will be successful.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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