Veterans' Benefits
VBA's Efforts to Implement the Veterans Claims Assistance Act Need Further Monitoring Gao ID: GAO-02-412 July 1, 2002The Veterans Claims Assistance Act of 2000 was passed in response to concerns expressed by veterans, veterans service organizations, and Congress over a 1999 decision of the U.S. Court of Appeals for Veterans Claims that held that the VA did not have a duty to assist veterans in developing their claims unless they were "well-grounded." The Veterans' Benefits Administration (VBA) has taken a number of steps, including issuing guidance, revising and supplementing this guidance based on questions raised by regional offices, and reinforcing the guidance based on the results of its accuracy reviews. Despite these efforts, VBA has found problems with consistent regional office compliance with the law. While taking steps to implement the act, VBA is also focusing on significantly increasing production and reducing the claims inventory to manage the slowdown in case processing. In fiscal year 2002, VBA plans to complete 839,000 claims to reduce its inventory to 316,000 claims.
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Director: Team: Phone:GAO-02-412, Veterans' Benefits: VBA's Efforts to Implement the Veterans Claims Assistance Act Need Further Monitoring
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United States General Accounting Office:
GAO:
Report to the Chairman and Ranking Member, Committee on Veterans‘
Affairs, U.S. Senate.
July 2002:
Veterans‘ Benefits:
VBA‘s Efforts to Implement the Veterans Claims Assistance Act Need
Further Monitoring:
GAO-02-412:
Contents:
Letter:
Results in Brief:
Background:
VBA‘s Efforts To Implement the VCAA Have Not Resulted in Full
Compliance with the Law:
VBA Is Focusing on Increasing Production, but Challenges Remain in
Improving Timeliness:
Conclusions:
Recommendation:
Agency Comments and Our Response:
Appendix:
Comments from the Department of Veterans Affairs:
Table:
Table 1: Changes in VBA‘s Workload of Rating-Related Claims, Fiscal
Years 1997 - 2002:
Figure:
Figure 1: Average Days to Complete Rating-Related Claims, Fiscal Years
1999 - 2003:
Abbreviations:
BVA: Board of Veterans‘ Appeals:
STAR: Systematic Technical Accuracy Review:
VA: Department of Veterans Affairs:
VBA: Veterans Benefits Administration:
VCAA: Veterans Claims Assistance Act of 2000:
[End of section]
United States General Accounting Office:
Washington, DC 20548:
July 1, 2002:
The Honorable John D. Rockefeller IV:
Chairman:
The Honorable Arlen Specter:
Ranking Member:
Committee on Veterans‘ Affairs:
United States Senate:
In November 2000, the Veterans Claims Assistance Act (VCAA) of 2000
[Footnote 1] was enacted to ensure that the Department of Veterans
Affairs (VA) assisted veterans claiming VA benefits. This legislation
was passed in response to concerns expressed by veterans, veterans
service organizations, and the Congress over a July 1999 decision of
the U.S. Court of Appeals for Veterans Claims, [Footnote 2] known as
the Morton decision, which held that the VA did not have a duty to
assist veterans in developing their claims unless they were ’well-
grounded.“ That is, enough information was provided for VA to determine
that the claim was plausible. The VCAA invalidated certain portions of
the Morton decision and obligated VA to assist veterans in the
development of their claims. According to VA‘s Veterans Benefits
Administration (VBA), the VCAA has significantly increased VBA‘s
workload in processing veterans‘ claims for VA disability compensation
and pension benefits because it decided to rework many of the 98,000
claims that had been denied under the Morton decision, review
approximately 244,000 claims that were pending at the time the VCAA was
enacted, and it added more time to the processing of new claims received
after the passage of the law.
VBA considers the VCAA‘s implementation a significant factor in the
recent growth of its inventory of compensation and pension claims
awaiting decisions. From the law‘s enactment to January 2002, the
inventory increased by more than three-quarters, to a peak of about
433,000 claims. Given the number of veterans whose claims are awaiting
decisions, you asked that we evaluate VBA‘s implementation of the
legislation. Specifically, you asked us to determine (1) what steps VBA
has taken to implement the legislation and (2) how VBA is managing the
slowdown in case processing.
To address the questions, we reviewed VBA guidance and regulations
pertaining to the implementation of the VCAA and analyzed workload and
productivity reports to identify changes since the enactment of the
VCAA. We also interviewed agency officials to discuss their efforts to
implement the VCAA. In addition, we visited five VBA regional offices
to review their implementation of the VCAA and how the law has impacted
their workload and claims processing production. The regional offices we
visited were in Montgomery, Alabama; Oakland, California; Buffalo, New
York; Winston-Salem, North Carolina; and Roanoke, Virginia. We focused
our work on VBA‘s disability compensation and pension programs, since
they account for most of the benefit claims in VA. We conducted our
review from September 2001 through May 2002 in accordance with
generally accepted government auditing standards.
Results in Brief:
VBA has taken a number of steps to implement the VCAA, including
issuing guidance, revising and supplementing this guidance based on
questions raised by regional offices, and reinforcing the guidance
based on the results of its accuracy reviews. Despite these efforts,
VBA has found problems with consistent regional office compliance with
the law. To VBA‘s credit, shortly after the enactment of VCAA, it
issued to its regional offices its first guidance on VCAA
implementation for new and pending cases. From December 2000 to
February 2001, VBA issued further guidance to clarify its original
guidance and respond to regional office questions. VBA also revised its
quality assurance system to reflect the new VCAA requirements and
capture data on their proper implementation. Despite VBA‘s efforts,
recent results from its quality assurance reviews indicate a
significant decrease in rating accuracy due, in large part, to improper
regional office implementation of VCAA requirements. To correct this,
VBA instructed regional office management to certify that all claims
processing employees have read and understand VCAA guidance. However,
VBA does not know the underlying reasons why regional offices are not
properly implementing the VCAA. Without understanding the root causes
of the errors, certifying that staff have read and understand the
guidance may not be enough for proper implementation.
While taking steps to implement the VCAA, VBA is also focusing on
significantly increasing production and reducing the claims inventory to
manage the slowdown in case processing. In fiscal year 2002, VBA plans
to complete about 839,000 claims to reduce its inventory to 316,000
claims.
VBA plans to eventually reduce its inventory to 250,000 claims to meet
the Secretary‘s timeliness goal of processing claims in an average of
100 days by the end of fiscal year 2003. [Footnote 3] Through the first
6 months of fiscal year 2002, VBA completed about 367,000 claims, and
its inventory was 412,000 claims. Although VBA has made some progress
in increasing production, meeting the fiscal year 2002 production and
inventory reduction goals will be challenging because VBA is relying on
staff to increase their productivity even more in the second half of
the fiscal year. Furthermore, as we noted in our April 2002 testimony,
[Footnote 4] cutting the time to process claims roughly in half to meet
the Secretary‘s timeliness goal of 100 days by the end of fiscal year
2003 depends on more than just increasing production and reducing
inventory. VBA continues to face difficult challenges we identified in
the past that can lengthen claims processing times, such as delays in
obtaining evidence.
This report contains a recommendation to the Secretary of Veterans
Affairs that he direct VBA to identify the causes of the VCAA-related
errors so that more specific corrective action can be taken if VBA
continues to experience significant quality assurance problems related
to the VCAA.
Background:
In its July 1999 Morton decision, the U.S. Court of Appeals for Veterans
Claims ruled that the VA did not have a duty to assist in developing
claims unless they were ’well-grounded“ as required by federal statute.
Prior to this court decision, VA policy was to assist claimants in
developing a well-grounded claim. This practice, however, was not
required by law, and VBA regional offices varied in the amount of
assistance they provided. The VCAA (P.L. 106-475), commonly referred to
as the ’duty to assist“ law, was enacted in November 2000. This law
repealed the requirement that claims be well-grounded and it obligated
VA to assist a claimant in obtaining evidence that is necessary to
establish eligibility for the benefit being sought.
VCAA requires VBA to take specific steps to assist claimants once they
have filed a complete claim for benefits. Specifically, the VCAA
requires VBA to: (1) notify claimants of the information necessary to
complete the application; (2) indicate what information not previously
provided is needed to prove the claim, and distinguish between the
portion of the information for which the claimant will be responsible
and the portion for which VA will be responsible; (3) make reasonable
efforts to assist claimants in obtaining evidence to substantiate
claimants‘ eligibility for benefits, including relevant records; and
(4) inform claimants when relevant records are unable to be obtained.
The VCAA also allowed for the re-adjudication of claims denied as not
well-grounded between the date of the Morton decision, July 14, 1999,
and the effective date of the VCAA, November 9, 2000. The act stated
that this rework could be done at the veteran‘s request or on VBA‘s
initiative. VBA decided to review all such claims and perform any
necessary work, such as sending additional notifications or making new
rating decisions.
The compensation program pays monthly benefits to veterans who have
service-connected disabilities (injuries or diseases incurred or
aggravated while on active military duty). The pension program pays
monthly benefits based on financial need to wartime veterans who have
low incomes and are permanently and totally disabled for reasons not
service-connected. [Footnote 5] VA expects to provide about $25 billion
in compensation and pension benefits in fiscal year 2002 to over 3
million veterans and their dependents and survivors.
Disability compensation benefits are graduated in 10 percent increments
based on the degree of disability from 0 percent to 100 percent.
Eligibility and priority for other VA benefits and services such as
health care and vocational rehabilitation are affected by these VA
disability ratings. Basic monthly payments range from $103 for 10
percent disability to $2,163 for 100 percent disability. Generally,
veterans do not receive compensation for disabilities rated at 0
percent. About 65 percent of veterans receiving disability compensation
have disabilities rated at 30 percent or lower; about 8 percent have
disabilities rated at 100 percent. The most common impairments for
veterans who began receiving compensation in fiscal year 2000 were
skeletal conditions; tinnitus; auditory acuity impairment rated at 0
percent; arthritis due to trauma; scars; and post-traumatic stress
disorder.
Veterans may submit claims to any one of VBA‘s 57 regional offices. To
develop veterans‘ claims, veterans service representatives at the
regional offices request and obtain the necessary information to
evaluate the claims. This includes veterans‘ military service records;
medical examinations and treatment records from VA medical facilities;
and treatment records from private providers. Once claims are developed
and ’ready to rate,“ rating veterans service representatives (hereafter
referred to as rating specialists) evaluate the claimed disabilities
and assign ratings based on degree of disability. Veterans with
multiple disabilities receive a single, composite rating. For veterans
claiming pension eligibility, the regional office determines if the
veteran served in a period of war, is permanently and totally disabled
for reasons not service-connected, and meets the income thresholds for
eligibility.
If a veteran disagrees with the regional office‘s decision, he or she
can ask for a review of that decision or appeal to VA‘s Board of
Veterans‘ Appeals (BVA). BVA makes the final decision on such appeals
and can grant benefits, deny benefits, or remand (return) the case to
the regional office for further development and reconsideration. After
reconsidering a remanded decision, the regional office either grants
the claim or returns it to BVA for a final VA decision. If the veteran
disagrees with BVA‘s decision, he or she may appeal to the U.S. Court
of Appeals for Veterans Claims. If either the veteran or VA disagrees
with the court‘s decision, they may appeal to the U.S. Court of Appeals
for the Federal Circuit.
In fiscal year 1999, VBA implemented the Systematic Technical Accuracy
Review (STAR) system to measure the accuracy of its claims processing
for its rating-related work. Under the STAR system, VBA considers a
claim to have been processed accurately if the regional office
determines basic eligibility correctly, obtains all required medical
and nonmedical documentary evidence, decides service-connection
correctly, gives the correct rating to each impairment, determines the
correct payment amount, and properly notifies the veteran of the
outcome of his or her claim. If a claim has any errors in any of these
areas, VBA counts the entire claim as incorrect for accuracy rate
computation purposes. For the nation as a whole, VBA reported an
accuracy rate of 81 percent for fiscal year 2001. VBA‘s goal for fiscal
year 2002 is 85 percent, and its strategic goal is to achieve a
national accuracy rate of 96 percent by fiscal year 2006. Beginning
with fiscal year 2002, VBA has revised its accuracy measure to focus on
whether regional office decisions to grant or deny are correct. Prior
to this change, VA‘s accuracy rate included whether the decision to
grant or deny claims were correct and also included errors stemming from
procedural and technical issues, such as failure to include all the
documentation in the case file. This revision to VBA‘s quality assurance
program for compensation claims processing is consistent with
recommendations made by the VA Secretary‘s 2001 Claims Processing
Task Force. Issues related to benefit entitlement decisions would be the
basis for future revision based on clear and unmistakable error or would
result in a BVA remand if not otherwise corrected during the appeal
process.
VBA‘s Efforts To Implement the VCAA Have Not Resulted in Full
Compliance with the Law:
To implement the VCAA, VBA has issued guidance, obtained and responded
to regional office staff questions, conducted an informal review of
cases, and issued clarifying instructions based on the questions it
received and the results of its review. To better hold regional offices
accountable for proper implementation, VBA revised its quality assurance
system to reflect the VCAA requirements. However, recent quality reviews
show that VCAA requirements are not always being met. Though VBA does
not know the underlying reason why regional offices may not be meeting
VCAA requirements, it has attempted to correct the implementation
deficiencies by requiring regional office managers to certify that
staff had read and understand VCAA guidance.
On October 19, 2000, in anticipation of enactment of the VCAA, VBA
instructed regional offices to stop denying claims as not well-grounded
under the Morton decision. On November 17, 2000”8 days after the VCAA‘s
enactment”VBA issued its first VCAA implementation guidance and
rescinded guidance on implementing Morton. This guidance was provided
pending the revision of VA‘s adjudication regulations to conform with
the VCAA. [Footnote 6]
To clarify and supplement its initial guidance, VBA issued several other
guidance letters through February 2001. VBA supplemented this written
guidance with teleconferences and questions and answers posted on VBA‘s
Intranet site. This guidance covered the development and adjudication
of claims (1) denied as not well-grounded under Morton, (2) pending
when the VCAA was enacted, and (3) received after the law was enacted.
The guidance also covered the handling of appealed claims.
In February 2001, VBA issued guidance for the review of about 98,000
claims that regional offices had previously denied as not well-grounded
under Morton. VBA required regional offices to complete reviews of these
claims by October 1, 2001; it later extended this deadline to December
31, 2001. Where a new decision was required, [Footnote 7] regional
offices were to follow the VCAA guidance on notifications to veterans
and claims development. This included sending ’duty to assist“ letters
to veterans requesting any additional evidence the veterans may have to
substantiate their claims; developing any previously or newly
identified evidence; obtaining medical examinations, if appropriate;
and making a new rating decision. If the veteran did not respond to the
regional office‘s request for information within 60 days, VBA could
deny the claim again for lack of evidence. As of the end of March 2002,
VBA has completed about 81 percent of its reviews.
The areas in which VBA clarified and supplemented its initial guidance
included: (1) requesting VHA medical examinations and medical opinions;
(2) pursuing records from federal agencies and private providers; and
(3) notifying veterans, including requests for evidence, and
notifications that VBA was unable to obtain identified evidence. For
example, in response to staff questions about the criteria for
scheduling medical exams and requesting medical opinions, VBA advised
that medical exams should be scheduled unless it is absolutely clear
that no relation exists between the veteran‘s current disability and
military service. Also, in response to staff questions on what to do if
federal and private provider records are unavailable, VBA advised that
regional offices needed positive confirmation that federal records do
not exist. Regional offices also asked if they needed to develop all
claims denied under Morton as not well-grounded or simply re-rate the
claims without performing additional development. VBA responded that
for all such claims that required readjudication, VBA must develop the
claim in accordance with the VCAA‘s requirements. Furthermore, VBA
provided templates for VCAA development letters.
Veterans Service Organization (VSO) officials we spoke with at the
regional offices we visited expressed concerns about the clarity and
necessity of VCAA pre-decision notification letters. [Footnote 8] They
said that some veterans did not understand why they were receiving the
letters” particularly if they had already responded to previous VBA
letters requesting evidence. Also, the officials said that the letters
were not always clear and were often not tailored to the circumstances
of individual veterans‘ claims. We reported in April 2002 [Footnote 9]
that 43 percent of our sample of development letters did not clearly
explain the actions that claimants were to take to support their
claims. We recommended that VBA eliminate deficiencies in its
development letter to clarify the actions that the claimant should take
to substantiate a claim. In response to our recommendations, VBA agreed
to revise its development letter.
In an effort to assess the impact of VCAA on the outcome of claims and
to assess regional office compliance with VCAA, VBA conducted an
informal review in the summer and fall of 2001 of claims that had been
denied as not well-grounded under Morton. VBA found that its VCAA
implementation instructions had not been followed in some of the cases
it sampled. In particular, the letters notifying the veteran of
necessary evidence were not being sent in about 20 percent of the
cases. As a result of this study, VBA issued instructions in August
2001 that emphasized the need to follow the previous written guidance,
particularly the need to fully and completely develop claims. This
included providing notice to the veteran of any additional evidence
needed, pursuing records from federal agencies and private providers,
and obtaining medical examinations when needed to make a decision on
the claim. VBA noted that failure to take these actions would cause
STAR reviewers to find the claim to be in error and could serve as a
basis for BVA to remand the claim, if appealed.
To ensure accountability by regional offices and their claims processing
staffs for VCAA compliance, VBA has incorporated the requirements into
its STAR quality assurance review checklists. [Footnote 10] These
revised checklists” which began to be used to review claims decisions
made in October 2001”include two specific VCAA-related questions: (1)
Was VCAA predecision notice provided and adequate? and (2) Does the
record show VCAA compliant development to obtain all indicated evidence
(including a VA exam, if required) prior to deciding the claim?
Early fiscal year 2002 data show that benefit entitlement errors are
still occurring because of VCAA implementation errors. Of the STAR
sample of 830 rating-related decisions made from October 2001 through
January 2002, the overall accuracy rate”under VBA‘s new standard, which
focuses on the accuracy of the decision on entitlement to benefits
[Footnote 11] ”was 71 percent. VBA found that about half (142 of 288)
of the entitlement decision errors involved noncompliance with VBA‘s
guidance on the VCAA. [Footnote 12] Of these errors, 60 involved a pre-
decision notice that was not adequate or not provided at all and 82
showed that not all indicated evidence was obtained as required.
VBA considered the error rate for VCAA compliance to be significant
enough that in April 2002 it asked regional offices to ’retrain“ staff
on the VCAA guidance and certify that the staff have read and
understand the guidance, by the end of April 2002. As of May 7, 2002,
56 of the 57 offices had certified that their staff had read and
understand the guidance. Although ensuring that staff have read and
understand the guidance is a positive step, this may not be enough. VBA
had already issued a series of implementing guidance letters to answer
staff questions and to reinforce guidance prior to the STAR review.
However, the STAR review showed that regional offices continued to
experience problems with implementation. VBA has not determined the
reasons why the regional offices are not properly implementing the
VCAA.
VBA Is Focusing on Increasing Production, but Challenges Remain in
Improving Timeliness:
VBA is managing the slowdown in case processing by attempting to
significantly increase regional offices‘ rating decision production.
VCAA contributed to the slowdown in claims processing because VBA
reworked many claims based on the VCAA‘s new requirements and because
new claims must also be processed under these more time-consuming
requirements. VBA has set production and inventory goals for fiscal year
2002, which it believes will put it on track to reducing the average
time to process claims to 100 days by the end of fiscal year 2003.
Although VBA has made some progress in increasing production, it faces
challenges in meeting these production and inventory goals. Monthly
production will need to significantly increase in the second half of
the fiscal year if VBA is to meet its goal for the year. Even if VBA
achieves its production and inventory goals, it still faces additional
challenges to achieving its end of fiscal year 2003 goal of processing
claims in an average of 100 days.
VBA Attributes the Slowdown in Claims Processing in Part to VCAA:
VBA attributes a significant part of the increase in pending claims
inventory in fiscal year 2001, and the associated increase in claims
processing times, to the VCAA‘s impact. According to VBA, the VCAA
added to the inventory because of the need to rework many claims. VBA
also believes that VCAA will lengthen the processing time of new claims,
but could not quantify the extent. Several other factors, such as the
addition of diabetes as a presumptive service-connected disability for
veterans who served in Vietnam, the implementation of VBA‘s new claims
processing software, and the hiring and training of a large number of
staff, also impacted VBA‘s workload and production in fiscal year 2001.
Table 1: Changes in VBA‘s Workload of Rating-Related Claims, Fiscal
Years 1997-2002:
Fiscal year: 1997;
Rating-related compensation and pension claims, Received: 740,052;
Rating-related compensation and pension claims, Completed: 701,717;
Rating-related compensation and pension claims, End of year inventory:
213,193.
Fiscal year: 1998;
Rating-related compensation and pension claims, Received: 691,461;
Rating-related compensation and pension claims, Completed: 663,400;
Rating-related compensation and pension claims, End of year inventory:
241,254.
Fiscal year: 1999;
Rating-related compensation and pension claims, Received: 639,070;
Rating-related compensation and pension claims, Completed: 630,145;
Rating-related compensation and pension claims, End of year inventory:
250,179.
Fiscal year: 2000;
Rating-related compensation and pension claims, Received: 578,773;
Rating-related compensation and pension claims, Completed: 601,451;
Rating-related compensation and pension claims, End of year inventory:
227,501.
Fiscal year: 2001;
Rating-related compensation and pension claims, Received: 674,219;
Rating-related compensation and pension claims, Completed: 481,117;
Rating-related compensation and pension claims, End of year inventory:
420,603.
Fiscal year: 2002 first half;
Rating-related compensation and pension claims, Received: 358,895;
Rating-related compensation and pension claims, Completed: 367,476;
Rating-related compensation and pension claims, End of year inventory:
412,022.
Fiscal year: 2002 goal;
Rating-related compensation and pension claims, Received: 734,087;
Rating-related compensation and pension claims, Completed: 838,874;
Rating-related compensation and pension claims, End of year inventory:
315,586.
Source: Veterans Benefits Administration.
[End of section]
As shown in table 1, VBA received about 95,000 more claims and produced
about 120,000 fewer claims decisions in fiscal year 2001 than in the
prior fiscal year.
The VCAA contributed to VBA receiving more claims in fiscal year 2001
than the prior fiscal year. The VCAA required VA, if requested by a
veteran, to readjudicate claims that were denied as not well-grounded
under the Morton decision. It also allowed VA to readjudicate these
claims on its own initiative. VBA undertook a review of about 98,000
veterans‘ disability claims that it had identified as previously denied
as not well grounded. In addition, VBA had an inventory of about
244,000 rating-related claims pending when the VCAA was enacted in
November 2000. VBA decided to review these claims to ensure that VCAA
requirements were met. VBA had completed about 64,000 of these claims
as of April 29, 2002. [Footnote 13] In addition to the VCAA, VBA has
cited other factors as contributing to the increase in its claims
inventory. For example, the recent addition of diabetes as a
presumptive service-connected disability for veterans who served in
Vietnam has caused an influx of new disability claims. By the end of
fiscal year 2003, VBA expects to have received 197,500 diabetes claims.
The addition of new claims processing staff during fiscal year 2001 has
also temporarily hampered the productivity of experienced staff.
According to officials at some of the regional offices we visited,
experienced rating specialists had less time to spend on rating work
because they were helping train and mentor new rating specialists. The
learning curve and implementation difficulties with VBA‘s new automated
rating preparation system (Rating Board Automation 2000) also hampered
regional offices‘ productivity. [Footnote 14]
Furthermore, the VCAA has significantly impacted VBA‘s work processes.
According to VA officials, the most significant change is the
requirement to fully develop claims even in the absence of evidence
showing a current disability or a link to military service. Under
Morton, if a veteran could not provide enough information to show that
the claim was plausible, VBA could deny the claim as not well-grounded.
These claims must now be developed and evaluated under the expanded
procedures required by the VCAA. For example, officials at one regional
office we visited noted that they are requesting more medical
examinations than they did before the VCAA was enacted. Also, time can
be added in waiting for evidence. For example, VBA must make repeated
efforts to obtain evidence from federal agencies”stopping only when the
agency certifies that the record does not exist, or VBA determines that
further efforts to obtain the evidence would be futile.
VBA Is Focusing on Increasing Production to Address Its VCAA-Related
Slowdown:
VBA is addressing its claims processing slowdown by taking steps to
increase production and reduce its claims inventory. VBA believes that
it will be able to reduce its inventory to a level that will enable it
to process cases in an average of 100 days by the end of fiscal year
2003. Specifically, VBA has established an end of fiscal year 2002
inventory goal of about 316,000 claims. To meet this goal, VBA plans to
complete about 839,000 rating-related claims during the fiscal year.
The regional offices are expected to complete about 792,000 of these
claims. This level of production is greater than VBA has achieved in
any of the last 5 fiscal years”as shown in table 1, VBA‘s peak
production was about 702,000 claims in fiscal year 1997. However, VBA
has significantly more rating staff now than it did in any of the
previous 5 fiscal years. VBA‘s rating staff has increased by about 50
percent since fiscal year 1997 to 1,753. To reach VBA‘s fiscal year
2002 production goal, rating specialists will need to complete an
average of about 2.5 cases per day”a level VBA achieved in fiscal year
1999. VBA expects this production level to enable it to achieve its end-
of-year inventory goal of about 316,000 rating-related claims, which
VBA believes would put the agency on track to meet the Secretary‘s
inventory goal of 250,000 cases by the end of fiscal year 2003.
To meet its production goal, in December 2001, VBA allocated its fiscal
year 2002 national production target to its regional offices [Footnote
15] based on each regional office‘s capacity to produce rating-related
claims given each office‘s number of rating staff and their experience
levels. [Footnote 16] For example, an office with 5 percent of the
national production capacity received 5 percent of the national
production target. In February 2002, VBA revised how it allocated the
monthly production targets to its regional offices based on input from
regional offices regarding their current staffing levels. In allocating
the target, VBA considered each regional office‘s fiscal year 2001
claims receipt levels, production capacity, and actual production in
the first quarter of fiscal year 2002.
In March 2001, VBA allowed regional offices to suspend or alter several
VBA initiatives in order to increase production. Offices were allowed to
revert back to an early version of VBA‘s Rating Board Automation (RBA)
software for ratings where the new software (RBA 2000) was significantly
impeding productivity. In an effort to increase rating decision output
while VBA continued its training of new rating specialists, offices
were directed to have their decision review officers”who handle
veterans‘ appeals of regional office decisions”spend half their time
rating claims. Also, offices were given latitude to vary from VBA‘s
case management principles, under which claims processing teams handle
most types of claims, and realign staff to perform specialized
processing of certain types of claims.
To hold regional office managers accountable, VBA incorporated specific
regional office production goals into regional office performance
standards. For fiscal year 2002, regional office directors are expected
to meet their annual production target or their monthly targets in 9
out of 12 months. Generally, the combined monthly targets for the
regional offices increase as the year progresses and as the many new
rating specialists hired in previous years gain experience and become
fully proficient claims processors.
At the same time as it is expecting regional offices to complete more
claims, VBA has implemented two initiatives to expedite claim decisions
and supplement regional office capacity. In October 2001, VBA
established the Tiger Team at its Cleveland Regional Office to expedite
decisions on claims by veterans aged 70 and older and clear from the
inventory claims that have been pending for over a year. The Tiger Team
relies on 17 experienced rating specialists, complemented by a staff of
veterans service representatives. The Tiger Team also relies on
expedited access to evidence needed to complete claims development. For
example, VA and the National Archives and Records Administration
completed a Memorandum of Understanding in October 2001 to expedite
Tiger Team requests for service records at the National Personnel
Records Center (NPRC) in St. Louis, Missouri. Also, VBA and the
Veterans Health Administration (VHA) established procedures and
timeframes for expediting Tiger Team requests for medical evidence and
examinations.
As of the end of May 2002, the Tiger Team had completed about 10,000
claims requested from 49 regional offices. From December 2001 through
May 2002, the team‘s production exceeded its goal of 1,328 decisions per
month. According to Tiger Team officials, its experienced rating
specialists were averaging about 4 completed ratings per day. Officials
added that in the short term, completing old claims might increase
VBA‘s average time to complete decisions. VBA also established nine
Resource Centers [Footnote 17] to supplement regional offices‘ rating
capacity. The Resource Centers receive claims from nearby regional
offices that are ’ready to rate,“ but which are awaiting decisions.
From October 2001 through May 2002, the Resource Centers had completed
about 22,000 ratings. The Tiger Team and Resource Centers are expected
to complete 47,000 claim decisions in fiscal year 2002; as of the end
of May 2002, they had completed about 32,000 decisions.
VBA‘s ability to achieve this increase in production, and reduction in
inventory, depends on (1) increasing productivity of new claims
processing staff over the second half of fiscal year 2002 and (2)
receipts being consistent with projected levels. VBA‘s monthly goals
for fiscal year 2002 assume that its large number of new rating
specialists will become more productive, with additional experience and
training, as the fiscal year progresses. However, VBA lacks historical
data on the productivity of staff by experience level. Meanwhile,
receipts of new claims must not exceed VBA‘s projections. VBA received
about 359,000 rating-related claims–-about 3,000 fewer than projected–-
in the first half of fiscal year 2002. However, an unexpected surge in
receipts could mean that, even if VBA achieved its production goal for
the fiscal year, it might not meet its inventory goal. External factors
beyond VBA‘s control, such as the decisions made by the U.S. Court of
Appeals for Veterans Claims, could affect VBA‘s workload and its
ability to make sustained improvements in performance.
As stated in our April 2002 testimony, even if VBA meets its production
and inventory goals, it still faces challenges in meeting its 100-day
goal. Improving timeliness depends on more than increasing production
and reducing inventory. VBA continues to face some of the same
challenges that we identified in the past that can lengthen claims
processing times. For example, VBA needs to continue to make progress
in reducing delays in obtaining evidence, ensuring that it will have
enough well-trained staff in the long term, and implementing
information systems to help improve claims processing productivity.
Figure 1 shows that VBA will need to cut average processing time from
224 days to 100 days by the end of fiscal year 2003. This is less than
half its fiscal year 2002 goal and 65 days less than its fiscal year
2003 goal. VBA officials noted that the link between increasing
production and improving timeliness is not clear. Thus, the officials
could not show how meeting VBA‘s production and inventory goals would
result in a specific level of timeliness improvement. Given this
uncertainty, it is possible that VBA could meet its fiscal years 2002
and 2003 production and inventory goals but not meet the 100-day goal.
Figure 1: Average Days to Complete Rating-Related Claims, Fiscal Years
1999-2003:
[See PDF for image]
This figure is a vertical bar graph depicting the following data:
Average Days to Complete Rating-Related Claims, Fiscal Years 1999-2003:
Fiscal year: 1999;
Average days: 166.
Fiscal year: 2000;
Average days: 173.
Fiscal year: 2001;
Average days: 181.
Fiscal year: 2002 (first half);
Average days: 224.
Fiscal year: 2002;
Average days: 208 (goal).
Fiscal year: 2003;
Average days: 165 (goal).
Fiscal year: 2003 (last quarter);
Average days: 100 (goal).
Source: Veterans Benefits Administration data.
[End of figure]
Conclusions:
To its credit, VBA has taken a number of steps over the last year and a
half to provide guidance to its regional offices on the proper
application of the VCAA requirements for both new and pending veterans‘
claims. However, despite VBA‘s efforts, results from VBA‘s quality
assurance reviews indicate a decrease in rating accuracy due to
regional office noncompliance with VCAA requirements. In an effort to
improve rating accuracy, VBA recently instructed regional office
management to ensure that all claims processing employees read and
understand VCCA-related guidance. But, VBA may need to do more than
verify that claims processors have read and understood the VBA
guidance. In the past, we have noted that VBA needs better analysis of
case-specific data to identify the root causes of claims processing
problems and target corrective actions. If VCAA-related accuracy
problems continue, VBA will need to determine the underlying causes for
the improper implementation as part of its continuing efforts to
monitor proper implementation of the VCAA. Without proper
implementation of VCAA, some veterans may not receive the benefits to
which they are entitled by law.
Recommendation:
If VBA continues to experience significant problems with implementing
the VCAA, we recommend that the Secretary of Veterans Affairs, direct
the Under Secretary for Benefits to identify the causes of the VCAA-
related errors so that more specific corrective actions can be taken.
Agency Comments and Our Response:
We received written comments on a draft of this report from VA (see
app. I). In its comments, VA concurred with our recommendation that if
VBA continues to experience problems with implementing the VCAA, VBA
identify the causes of the VCAA-related errors so that more specific
corrective actions can be taken.
We will send copies of this report to the Secretary of the Department of
Veterans Affairs, appropriate congressional committees, and other
interested parties. We will also make copies available to others on
request. In addition, the report will be available at no charge on the
GAO Web site at [hyperlink, http://www.gao.gov].
If you or your staff have any questions regarding this report, please
call me at (202) 512-7101 or Irene Chu, Assistant Director, at (202)
512-7102. In addition to those named previously, Steve Morris, Corinna
Nicolaou, Martin Scire, and Greg Whitney made key contributions to this
report.
Signed by:
Cynthia A. Bascetta:
Director:
Education, Workforce, and Income Security Issues:
[End of section]
Appendix: Comments from the Department of Veterans Affairs:
The Secretary Of Veterans Affairs:
Washington:
June 21, 2002:
Ms. Cynthia A. Bascetta:
Director:
Education, Workforce, and Income Security Team:
U. S. General Accounting Office:
441 G Street, NW:
Washington, DC 20548:
Dear Ms. Bascetta:
This responds to your draft report, Veterans' Benefits: VBA's Efforts
to Implement the Veterans Claims Assistance Act Need Further Monitoring
(GAO-02-412). The Department of Veterans Affairs (VA) agrees with your
conclusion that, despite the steps taken by the Veterans Benefits
Administration (VBA) to provide guidance to its regional offices,
reviews indicate a persistent problem in rating accuracy.
VA concurs with your recommendation to identify the causes of errors
related to the Veterans Claims Assistance Act (VCAA) to ensure that VBA
implements specific corrective actions. As you mention in the report,
in a continuing effort to rectify this emerging error trend, VBA issued
a letter in April 2002 (VBA Letter 20-02-12, Decrease in Rating Quality
Related to Implementation of the Duty-to-Assist Provisions) requiring
regional office directors to certify that affected employees read and
demonstrate an understanding of the guidance provided in the letter. It
is too early to analyze the effect of the "retraining" effort required
by VBA's letter. However, by the end of FY 2002, VBA will review a
significant sample of work completed subsequent to this retraining.
Those results will allow VBA to evaluate the effectiveness of this
effort. If an unacceptable number of VCAA-related errors persist, VBA
will identify the underlying causes based on the latest data. The
Department is committed to correcting these shortcomings and will
continue its efforts to effectively implement VCAA.
Thank you for the opportunity to comment on your draft report.
Sincerely yours,
Signed by:
Anthony J. Principi:
[End of section]
Footnotes:
[1] Public Law 106-475, Nov. 9, 2000.
[2] Morton v. West, 12 Vet. App. 477 (1999).
[3] VBA measures processing time from the date the claim was received
to the date on which VBA issued a decision on the claim.
[4] U.S. General Accounting Office, Veterans‘ Benefits: Despite Recent
Improvements, Meeting Claims Processing Goals Will Be Challenging, GAO-
02-645T (Washington, D.C.: Apr. 26, 2002).
[5] Veterans who are 65 years or older do not have to be permanently
and totally disabled to become eligible for pension benefits, as long
as they meet the other requirements for income and military service.
[6] VA published its proposed regulations on April 4, 2001, and its
final regulations on August 29, 2001.
[7] A new decision was not required if VBA had already readjudicated
the claim, and the claim was (a) granted or (b) denied on the merits
after being fully developed.
[8] The pre-decision notice (also known as a development letter) is a
notification sent to the claimant requesting any information, not
previously provided that is necessary to substantiate the claim.
[9] U.S. General Accounting Office, Veterans Benefits Administration:
Clarity of Letters to Claimants Needs to Be Improved, GAO-02-395
(Washington, D.C.: Apr. 23, 2002).
[10] Under STAR, regional offices submit samples of claims each month
to be reviewed. Decisions are reviewed for accuracy and conformance
with VBA‘s standards. Feedback is provided to the regional offices. VBA
has two STAR checklists: one for rating decisions and one for
’authorization“ decisions, which do not require ratings.
[11] The two VCAA questions in the rating checklist are included in the
criteria for determining entitlement accuracy.
[12] A decision may have more than one error on the STAR checklist.
[13] VCAA also impacted VBA‘s appeals workload. For example, prior to
enactment of VCAA about 30 percent of appealed regional office
decisions were remanded (returned) back for additional work by the
Board of Veterans‘ Appeals. According to VBA, the VCAA led to an
increase in the remand rate to about 50 percent during fiscal year
2001.
[14] Rating Board Automation 2000 is a system designed to assist rating
specialists in preparing rating decisions on claims.
[15] VBA had initially established production targets in March 2001 for
April through December 2001. The target was to complete 52,000 rating-
related claims per month that would allow VBA to reduce its inventory
by 1 percent per month.
[16] In determining regional office production capacity, VBA officials
told us that they considered the various experience levels of regional
office rating specialists. For example, rating specialists with 6
months to 1 year of experience are expected to rate half as many claims
as rating specialists with more than 2 years of experience. A rating
specialist with 1 to 2 years of experience would be expected to rate
three-quarters as many claims as a rating specialist with over 2 years‘
experience.
[17] The Resource Centers are located at the regional offices in San
Diego, California; St. Petersburg, Florida; Togus, Maine; St. Louis,
Missouri; Muskogee, Oklahoma; Philadelphia, Pennsylvania; Columbia,
South Carolina; Seattle, Washington; and Huntington, West Virginia.
[End of section]
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