Veterans' Benefits
Quality Assurance for Disability Claims and Appeals Processing Can Be Further Improved Gao ID: GAO-02-806 August 16, 2002For fiscal year 2002, the Department of Veterans Affairs (VA) will pay $25 billion in cash disability benefits to 3.3 million disabled veterans and their families. Veterans who are dissatisfied with VA's 57 regional offices' decisions may file appeals with VA's Board of Veteran's Appeals. In about half of such appeals, the Board has either granted the benefits denied or returned the cases to regional offices for rework. Additionally, VA reported an accuracy rate of less than 70 percent for regional office disability decisions when it tested a new quality assurance program in fiscal year 1998. When the Board itself denies benefits, veterans may appeal to the U.S. Court of Appeals for Veterans Claims. In over half of these appeals, the Court has either granted the benefits denied by the Board or returned the decisions to the Board for rework. In fiscal year 1998, the Board of Veteran's Appeals established a quantitative evaluation program to score its decisionmaking accuracy and collect data to improve decisionmaking. The accuracy measure used by the Board understates its true accuracy rate because the calculations include certain deficiencies, such as errors in a written decision's format, which would not result in either a reversal or a remand by the Court. VA does not assess the consistency of decisionmaking across the regional office and Board disability adjudicators even though VA acknowledges that in many cases adjudicators of equal competence could review the same evidence but render different decisions. Although available evidence indicates that variations in decisionmaking occur across all levels of VA adjudication, VA does not conduct systematic assessments to determine the degree of variations that occurs for specific impairments and to provide a basis for determining ways to reduce such variations.
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United States General Accounting Office:
GAO:
Report to the Ranking Democratic Member, Committee on Veterans‘
Affairs, House of Representatives:
August 2002:
Veterans‘ Benefits:
Quality Assurance for Disability Claims and Appeals Processing Can Be
Further Improved:
GAO-02-806:
Contents:
Letter:
Results in Brief:
Background:
The Board Understates Its Accuracy and Does Not Capture Certain Data
for Improving Quality:
VA Does Not Systematically Assess Consistency of Decision Making:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Steps in the Disability Claims and Appeals Process:
Appendix II: Board of Veterans‘ Appeals Illustrations of Difficult
Judgments Resulting in Decision-Making Variations:
Appendix III: Comments from the Department of Veterans Affairs:
Tables:
Table 1: Board‘s Accuracy Rate Goals and Performance:
Table 2: Board‘s Quality Review Criteria:
Abbreviations:
SSA: Social Security Administration:
VA: Department of Veterans Affairs:
VBA: Veterans Benefits Administration:
[End of section]
United States General Accounting Office:
Washington, DC 20548:
August 16, 2002:
The Honorable Lane Evans:
Ranking Democratic Member:
Committee on Veterans‘ Affairs:
House of Representatives:
Dear Mr. Evans:
For fiscal year 2002, the Department of Veterans Affairs (VA) estimates
that it will pay about $25 billion in cash disability benefits to about
3.3 million disabled veterans and their families. When veterans submit
disability claims, VA‘s 57 regional offices make decisions to either
grant or deny the requested benefits. Veterans who are dissatisfied
with regional office decisions may file appeals with VA‘s Board of
Veterans‘ Appeals, and in about half of such appeals, the Board has
either granted the benefits denied by the regional offices or remanded
(returned) the cases to the regional offices for rework. Additionally,
VA reported an accuracy rate of less than 70 percent for regional
office disability decisions when it tested a new quality assurance
program in fiscal year 1998. As a result, we issued two prior reports
at your request on VA‘s system for measuring and improving the accuracy
of regional office decisions. [Footnote 1]
Recently, questions have arisen about the quality of Board decisions.
When the Board itself denies benefits requested by veterans, they may
appeal to the U.S. Court of Appeals for Veterans Claims. In over half of
such appeals, the court has either granted the benefits denied by the
Board or remanded the decisions to the Board for rework. As a result,
you now have asked that we examine VA‘s efforts to ensure the quality
of decisions made by the Board. Specifically, you asked that we assess
the effectiveness of VA‘s system for (1) measuring and improving the
accuracy of the Board‘s decisions and (2) determining the consistency
(extent of variation) in decision making across the spectrum of
regional office and Board disability adjudicators.
To address your request, we reviewed (1) data and documents of the
Board of Veterans‘ Appeals; (2) data and documents of the Veterans
Benefits Administration (VBA), the VA component responsible for the
operations of the 57 regional offices; (3) reports on studies of VA
disability claims processing conducted by the Veterans‘ Claims
Adjudication Commission, the National Academy of Public Administration,
and VA‘s Claims Processing Task Force; and (4) data reported by the
U.S. Court of Appeals for Veterans Claims on its disposition of
veterans‘ appeals. We also interviewed officials of the Board and VBA
about claims and appeals processing accuracy and consistency issues. We
conducted our review from October 2001 through June 2002 in accordance
with generally accepted government auditing standards.
Results in Brief:
In fiscal year 1998, the Board of Veterans‘ Appeals established its
first quantitative program to evaluate and score its decision-making
accuracy and to collect data to identify areas where the quality of
decision making needs improvement. The accuracy measure used by the
Board understates its true accuracy rate because the Board‘s accuracy
rate calculations include certain deficiencies, such as errors in a
written decision‘s format, which would not result in either a reversal
or a remand by the Court. In fiscal year 2001, if the Board had
excluded format deficiencies from its accuracy rate calculations, its
accuracy rate would have been 92 percent versus the reported rate of 87
percent. Even so, the Board‘s quality assurance program does not
capture certain data that potentially could further help improve the
quality of the Board‘s decisions. For example, the Board does not
record in its quality assurance database any information identifying
the specific medical issues involved in cases where a Board decision
was judged as being in error. Having such data could enhance the
Board‘s ability to target training needed for its decision makers.
VA does not assess the consistency of decision making across the
spectrum of regional office and Board disability adjudicators, even
though VA acknowledges that in many cases two adjudicators of equal
competence could review the same evidence but render different
decisions due to the difficult judgments often required in decision
making. The result is that variations may occur in the benefits
provided to veterans who have similar impairments and circumstances.
Even though available evidence provides indications that variations in
decision-making may occur across all levels of VA adjudication, VA does
not conduct systematic assessments to determine the degree of variation
that occurs for specific impairments and to provide a basis for
determining ways, if considered necessary, to reduce such variation.
This report contains recommendations to the Secretary of VA concerning
actions to improve VA‘s ability to better ensure the accuracy and
consistency of disability decisions made across the spectrum of decision
making in VA. In responding to a draft of this report, VA concurred
fully or in principle with our recommendations. However, although VA
agreed that consistency is an important goal, it did not fully respond
to our recommendation regarding consistency because it did not describe
how it will measure consistency and evaluate progress in reducing any
inconsistencies it may find. Instead, VA said that consistency is best
achieved through comprehensive training and communication among VA
components involved in the adjudication process and discussed efforts
underway to do so.
Background:
VA has two basic cash disability benefits programs. The compensation
program pays monthly benefits to eligible veterans who have service-
connected disabilities (injuries or diseases incurred or aggravated
while on active military duty). The payment amount is based on the
veteran‘s degree of disability, regardless of employment status or
level of earnings. By contrast, the pension program assists permanently
and totally disabled wartime veterans under age 65 who have low incomes
and whose disabilities are not service-connected. [Footnote 2] The
payment amount is determined on the basis of financial need.
VBA and the Board process and decide veterans‘ disability claims and
appeals on behalf of the Secretary. The claims process starts when
veterans submit claims to one of VBA‘s 57 regional offices. (See app. I
for the overall flow of claims and appeals processing.) By law,
regional offices must assist veterans in supporting their claims. For
example, for a compensation claim, the regional office obtains records
such as the veteran‘s existing service medical records, records of
relevant medical treatment or examinations provided at VA health-care
facilities, and other relevant records held by a federal department or
agency. If necessary, the regional office arranges a medical
examination for the claimant or obtains a medical opinion about the
claim. The regional office adjudicator then must:
* analyze the evidence for each claimed impairment (veterans claim an
average of about five impairments per claim);
* determine whether each claimed impairment is service-connected (VA
grants service-connection for an average of about three impairments per
claim);
* apply VA‘s Rating Schedule which provides medical criteria for rating
the degree to which each service-connected impairment is disabling
(disability ratings can range from zero to 100 percent, in 10-percent
increments);
* determine the overall disability rating that results from the
combination of service-connected impairments suffered by the veteran;
and;
* notify the veteran of the decision.
If a veteran disagrees with the regional office‘s decision, he or she
begins the appeals process by submitting a written Notice of
Disagreement to the regional office. During fiscal years 1999-2000, the
regional offices annually made an average of about 616,000 decisions
involving disability ratings, and veterans submitted Notices of
Disagreement in about 9 percent of these decisions. Veterans can
disagree with decisions for reasons other than the outright denial of
benefits that occurs, for example, in a compensation case when a
regional office decides an impairment claimed by a veteran is not
service-connected. The veteran also may believe the severity rating
assigned to a service-connected impairment is too low and ask for an
increase in the rating.
In response to a Notice of Disagreement, the regional office provides a
further written explanation of the decision, and if the veteran still
disagrees, the veteran may appeal to the Board. During fiscal years
1999-2000, about 48 percent of the veterans who filed Notices of
Disagreement in decisions involving disability ratings went on to file
appeals with the Board. In fiscal year 2001, VBA began nationwide
implementation of the Decision Review Officer position in its regional
offices. Now, before appealing to the Board, a veteran may ask for a
review by a Decision Review Officer, who is authorized to grant the
contested benefits based on the same case record that the regional
office relied on to make the initial decision. VBA believes this
process will result in fewer appeals being filed with the Board.
Located in Washington, D.C., the Board is an administrative body whose
members are attorneys experienced in veterans‘ law and in reviewing
benefits claims. The Board‘s members are divided into four decision
teams, with each team having up to 15 Board members and 61 staff
attorneys. Each team has primary responsibility for reviewing the
appeals that originate in an assigned group of regional offices. Board
members‘ decisions must be based on the law, regulations, precedent
decisions of the courts, and precedent opinions of VA‘s General
Counsel. [Footnote 3] During the Board‘s appeals process, the veteran
or the veteran‘s representative may submit new evidence and request a
hearing.
During fiscal years 1999 and 2000, for all VA programs, the Board
annually decided an average of about 35,700 appeals, of which about
32,900 (92 percent) were disability compensation cases. The average
appealed compensation case contains three contested issues. As a
result, in some cases, the Board member may grant the requested
benefits for some issues but deny the requested benefits for others.
During fiscal years 1999 and 2000, the Board in its initial decisions
on appealed compensation cases granted at least one of the requested
benefits in about 24 percent of the cases. In some instances, the Board
member finds a case is not ready for a final decision and returns (or
remands) the case to the regional office to obtain additional evidence
and reconsider the veteran‘s claim. During fiscal years 1999 and 2000,
respectively, the Board in its initial decisions on appealed
compensation cases remanded 38 percent and 34 percent of the cases.
[Footnote 4] After obtaining additional evidence for remanded cases, if
the regional office still denies the requested benefits, it resubmits
the case to the Board for a final decision.
If the Board denies benefits or grants less than the maximum benefit
available under the law, veterans may appeal to the U. S. Court of
Appeals for Veterans Claims. [Footnote 5] The court is not part of VA
and not connected to the Board. During fiscal years 1999 and 2000,
veterans filed appeals with the court in an estimated 10 percent of the
Board‘s decisions. Unlike the Board, the court does not receive new
evidence, but considers the Board‘s decision, briefs submitted by the
veteran and VA, oral arguments, if any, and the case record that VA
considered and that the Board had available. The court may dismiss an
appeal on procedural grounds such as lack of jurisdiction, but in the
cases decided on merit, the court may affirm the Board‘s decision (deny
benefits), reverse the decision (grant benefits), or remand the
decision back to the Board for rework. During fiscal years 1999 and
2000, the court annually decided on merit an average of about 1,800
appealed Board decisions, and in about 67 percent of these cases, the
court remanded or reversed the Board‘s decisions in part or in whole.
[Footnote 6] Under certain circumstances, a veteran who disagrees with
a decision of the court may appeal to the U.S. Court of Appeals for the
Federal Circuit and then to the Supreme Court of the United States.
The Board Understates Its Accuracy and Does Not Capture Certain Data
for Improving Quality:
In fiscal year 1998, the Board established the first quantitative
quality assurance program to evaluate and score the accuracy of its
decisions and to collect data to identify areas where the quality of
decision-making needs improvement. The accuracy measure used by the
Board understates its true accuracy rate because the Board‘s accuracy
rate calculations include certain deficiencies that would not result in
either a reversal or a remand by the court. Even so, the Board‘s
quality assurance program does not capture certain data that
potentially could help improve the quality of the Board‘s decisions.
Such data include information identifying the specific medical issues
involved in cases where a disability decision was judged as being in
error. Having such data could enhance the Board‘s ability to target
training for its decision makers.
The Board Established Its First Quantitative Quality Assurance Program
in 1998:
On the basis of the results of the quality assurance program it
established in fiscal year 1998, the Board estimated that 89 percent of
its decisions were accurate (or ’deficiency-free“). Using these results
as a baseline, VA established performance accuracy goals for the Board.
One of the Board‘s strategic performance goals is to make deficiency-
free decisions 95 percent of the time. To calculate its estimated
overall accuracy rate, the Board does quality reviews of selected Board
decisions. [Footnote 7] We reviewed the Board‘s methods for selecting
random samples and calculating accuracy rates and concluded that the
number of decisions reviewed by the Board was sufficient to meet the
Board‘s goal for statistical precision in estimating its accuracy rate.
[Footnote 8] However, we brought to the Board‘s attention some issues
that caused the Board to fall short of proper random sampling and
accuracy rate calculation methods, such as not ensuring that decisions
made near the end of the fiscal year are sampled or that the results
from quality reviews are properly weighted in the accuracy rate
calculation formula. We do not believe the overall accuracy rate
reported by the Board for fiscal year 2001 would have been materially
different if these methodological issues had been corrected earlier;
however, if not corrected, these issues potentially could lead to
misleading accuracy rate calculations in the future. The Board agreed
in principle to correct these issues. As of June 2002, the Board had
not yet instituted corrective actions.
The Board‘s Actual Level of Accuracy Is Higher Than Reported:
According to VA‘s performance reports, the Board has come close but has
not achieved its annual interim goals for accuracy (see table 1).
[Footnote 9] However, in calculating its reported accuracy rates, the
Board includes deficiencies that are not ’substantive“”that is, they
would not be expected to result in either a remand by the court or a
reversal by the court. [Footnote 10] Consequently, the reported
accuracy rates understate the Board‘s level of accuracy that would
result if only substantive deficiencies were counted in the
calculation.
Table 1: Board‘s Accuracy Rate Goals and Performance (In percentages):
Accuracy Measure: Accuracy rate goal;
Accuracy rate, FY 1999: 90.5;
Accuracy rate, FY 2000: 91.5;
Accuracy rate, FY 2001: 90;
Accuracy rate, FY 2002: 91;
Accuracy rate, FY 2003: 92;
Strategic goal: 95.
Accuracy Measure: Reported performance (estimated);
Accuracy rate, FY 1999: 84;
Accuracy rate, FY 2000: 86;
Accuracy rate, FY 2001: 87;
Accuracy rate, FY 2002: [A];
Accuracy rate, FY 2003: [A];
Strategic goal: [A].
[A] No data available.
Source: VA budget submissions and performance plans, fiscal years 2000-
2003.
[End of table]
Under its quality assurance program, the Board‘s quality reviewers
assess the accuracy of selected decisions on the basis of six critical
areas (see table 2). One error (or deficiency) in any of these six
areas means that a decision fails the quality test. However, according
to the Board, all six areas would include certain deficiencies that are
not substantive. In particular, according to the Board, most
deficiencies in the ’format“ category are not substantive. In fiscal
year 2001, the format category accounted for about 38 percent of all
recorded deficiencies. At our request, the Board recalculated its
accuracy rate for fiscal year 2001, excluding format deficiencies, and
the resulting accuracy rate was 92 percent, as compared with the
reported accuracy rate of 87 percent. Excluding all other
nonsubstantive deficiencies presumably would have resulted in an even
higher accuracy rate. In contrast with the Board, beginning in fiscal
year 2002, VBA no longer includes nonsubstantive deficiencies in its
accuracy rate calculations; however, it continues to monitor them. VBA
took this action based on a recommendation by the 2001 VA Claims
Processing Task Force, which said that mixing serious errors with less
significant deficiencies can obscure what is of real concern.
Table 2: Board‘s Quality Review Criteria:
Criteria:
Six critical areas: Issues;
Criteria: Did the decision maker identify and address all issues that
were explicitly expressed in, or could be inferred from, the evidence?
Six critical areas: Evidence;
Criteria: Did the decision maker account for all evidence, including
the evidence in favor of and the evidence against the veteran‘s claim?
Six critical areas: Laws and regulations;
Criteria: Did the decision maker cite and set forth all applicable laws
and regulations?
Six critical areas: Reasons and bases;
Criteria: Did the decision maker fully and accurately coordinate the
facts (evidence) and laws and regulations with each other and clearly
explain how he or she reached the decision?
Six critical areas: Due process;
Criteria: Did the decision maker address all technical aspects of due
process such as accounting for jurisdictional problems, hearing
requests, and possible remand reasons?
Six critical areas: Format;
Criteria: Did the decision maker write the decision so that it meets
the basic requirements of format such as correct grammar, spelling,
decision structure, and requirements of statute?
Source: Board of Veterans‘ Appeals, 2002.
[End of table]
The Board‘s Quality Review Program Does Not Capture Certain Data That
Could Help Improve Quality:
The Board‘s quality review program subdivides the six critical areas
shown in table 2 into 31 subcategories. For example, if a quality
reviewer classifies an error as stemming from ’reasons and bases,“ the
reviewer must then indicate whether the error was due to misapplying
legal authority, failing to apply appropriate legal authority, using an
incorrect standard of proof, or providing an inadequate explanation for
the decision. This information is recorded in the Board‘s quality
review database, providing the Board with data that can be analyzed to
identify training needed to improve quality.
However, the Board does not record in its quality review database any
information on the specific issue that prompted the appeal (such as
whether a disability is service-connected) or the specific medical
impairment to which an error is related. For example, a quality reviewer
might find an error in a Board decision for an appeal that involved four
separate medical impairments”two for which the veteran had requested
service connection and two others for which he had requested a
disability rating increase. On the basis of information that the
quality review database currently captures, however, the Board could
not determine which of the four impairments the error was related to,
nor could the Board determine whether the error was related to a
request for service-connection or an increased disability rating.
This is not the case, however, for Board decisions remanded by the Court
of Appeals for Veterans Claims. For these cases, the Board maintains a
separate database with information on the reasons that the court remands
decisions back to the Board for rework. For each issue that the court
remands in a compensation case, the Board records in the database such
information as: (1) whether the issue involved a request for service-
connection or an increased rating, (2) the diagnostic code of the
impairment involved in each issue, and (3) the reason for the remand.
According to Board officials, being able to analyze the court‘s reasons
for remands by type of decisional issue and type of impairment enhances
the Board‘s ability to reduce remands from the court through appropriate
training.
VBA and the Board recognize that in some cases, different adjudicators
reviewing the same evidence can make differing judgments on the meaning
of the evidence, without either decision necessarily being wrong. In
such cases, VBA and the Board instruct quality reviewers not to record
an error. A hypothetical case provided by the Board furnishes an
example. In this case, a veteran files a claim in 1999 asserting he
suffered a back injury during military service but did not seek medical
treatment at that time. One of the veteran‘s statements says he injured
his back during service in 1951, but another says he injured his back
in 1953. An adjudicator may find that this discrepancy in dates
adversely affects the claimant‘s credibility about whether an injury
actually occurred in service, but the quality reviewer may consider the
discrepancy to be insignificant. Where such judgments are involved, the
Board‘s and VBA‘s quality review programs recognize that variations in
judgment are to be expected and are acceptable as long the degree of
variation is within reason. (App. II provides other examples of
difficult judgments that could result in decision-making variations and
explains VA‘s ’benefit-of-the-doubt“ rule.)
The Board and VBA, however, differ in their approaches to collecting
information about cases where this type of variation occurs. In such
instances, the Board‘s quality reviewers note why they believe an
alternative decision could have been made and send the explanation to
the deciding Board member. However, they do not enter any of this
information in the quality review database. In contrast, VBA recently
instructed its quality reviewers to enter such information in the VBA
quality review database, even though no error is recorded in the
database. VBA believes that by identifying and analyzing cases in which
quality reviewers believed the adjudicator‘s judgment was pushing
against the boundary of reasonableness, it potentially can identify
opportunities to improve the quality of decision making by improving
training.
VA Does Not Systematically Assess Consistency of Decision Making:
Even though evidence suggests decision making across regional office and
Board adjudicators may not be consistent, VA does not systematically
assess decision making consistency to determine the degree of variation
that occurs for specific impairments and to provide a basis for
identifying steps that could be taken, if considered necessary, to
reduce such variation. In its 2003 performance plan, VA acknowledged
that veterans are concerned about the consistency of disability claims
decisions across the 57 regional offices. In a nationwide comparison,
VBA projected in its fiscal year 2001 Annual Benefits Report that the
average compensation payments per disabled veteran in fiscal year 2002
would range from a low of $5,783 in one state to a high of $9,444 in
another state. According to a VBA official, this disparity in average
payments per veteran might be due in part to demographic factors such
as differences in the average age of veterans in each state. However,
this disparity in average payments per veteran also raises the
possibility that when veterans in the same age group submit claims for
similar medical conditions, the regional office in one state may tend
to give lower disability ratings than the regional office in another
state.
Indeed, in 1997, the National Academy of Public Administration reviewed
disability claims processing and said VA needed to identify the degree
of decision-making variation expected for specific medical issues, set
consistency standards, and measure the level of consistency as part of
the quality review process or through testing of control cases in
multiple regional offices. Furthermore, in 2001, VA‘s Claims Processing
Task Force said there was an apparent lack of uniformity among regional
offices in interpreting and complying with directives from VA
headquarters and that VA‘s regulations and the procedures manual for
regional offices were in dire need of updating. The task force
concluded that there was no reasonable assurance that claims decisions
would be made as uniformly and fairly as possible to the benefit of the
veteran. Even though such concerns and issues exist, VA does not
systematically assess the decision-making consistency of regional
office adjudicators.
Similarly, VA does not assess consistency between decisions made by
regional offices and the Board even though evidence suggests this issue
may warrant VA‘s attention. Because veterans may submit new evidence
during the appeals process, one might assume that the Board generally
grants benefits denied by regional offices due to the impact of such new
evidence. However, an analysis in 1997 of about 50 decisions in which
the Board had granted benefits previously denied by regional offices
yielded a different viewpoint. Staff from both VBA and the Board
reviewed these cases and concluded that most of these Board decisions
to grant benefits had been based on the same evidence that the regional
offices had considered in reaching their decisions to deny benefits.
The reviewers characterized the reason for the Board members‘ decisions
to grant benefits as a difference of opinion between the Board members
and regional office adjudicators in the weighing of evidence.
Furthermore, even in remanded compensation cases for which regional
offices have obtained new evidence in accordance with the Board‘s remand
instructions and then again denied the benefits, the Board generally has
granted benefits in about 26 percent of these cases after they have been
resubmitted for a final decision. This seems to indicate that, in these
particular cases, Board members in some way differed with regional
office adjudicators on the impact of the new evidence obtained by the
regional offices before resubmitting the remanded cases to the Board.
Available evidence also provides indications that the issue of
variations in decision making among the Board members themselves may
warrant VA‘s attention in studies of consistency. Historically, there
have been variances in the rates at which the Board‘s four decision
teams have remanded decisions to regional offices for rework. No
systematic study has been done to explain the variances in remand
rates. Board officials said that it is their perception that the remand
rates vary among the Board‘s decision teams because the quality of
claims processing varies among the regional offices for which each team
is responsible.
Similar concerns about consistency of claims adjudication in the Social
Security Administration (SSA) have prompted SSA to begin taking steps to
assess consistency issues in its disability program. As we reported in
1997, SSA‘s primary effort to improve consistency has focused on
decision-making variations between its initial and appellate levels.
[Footnote 11] To gather data on variations between these two levels,
SSA instituted a system in 1993 under which it selects random samples
of final decisions made by administrative law judges and reviews the
entire decisional history of each case at both the initial and
appellate levels. The reviewers examine adjudicative and procedural
issues to address broad program issues such as whether a claim could
have been allowed earlier in the process. Data captured through this
system have provided a basis for taking steps to clarify decision-
making instructions and provide training designed to improve
consistency between the initial and appellate levels. However, no
systematic evaluations have been done to determine the effectiveness of
these actions. In its January 2001 disability management plan, SSA said
that it needed to take further steps to promote uniform and consistent
disability decisions across all geographic and adjudicative levels.
[Footnote 12]
Conclusions:
Opportunities exist to improve the quality of the Board‘s reporting of
accuracy and decision making. The Board includes nonsubstantive
deficiencies in its accuracy rate calculation. By doing so, the Board
may be obscuring what is of real concern. In addition, the Board‘s
quality assurance database does not capture data on specific medical
disability issues related to the reasons for errors found in Board
decisions. Also, in contrast with VBA, the Board‘s quality assurance
program does not collect information on cases in which quality
reviewers do not charge errors but have differences of opinion with
judgments made by Board members. We believe that analysis of such data
could lead to improvements in quality through improved training or by
clarifying regulations, procedures, and policies.
Furthermore, because variations in decision making are to be expected
due to the difficult judgments that adjudicators often must make, one
must ask the questions: For a given medical condition, how much
variation in decision making exists and does the degree of variation
suggest that VA should take steps to reduce the level of variation? VA,
however, does not assess variation in decision making. None of the
quality review efforts of either VBA or the Board are designed to
systematically assess the degree to which veterans with similar medical
conditions and circumstances may be receiving different decisional
outcomes or to help identify steps that could reduce such variation if
necessary. Without ongoing systematic assessments of consistency across
the continuum of decision making, VA cannot adequately assure veterans
that they can reasonably expect to receive consistent treatment of
their claims across all decision-making levels in VA.
Recommendations for Executive Action:
We recognize that our recommendations will have to be implemented
within the context of VA‘s current major efforts to reduce a large and
persistent backlog of disability claims and appeals and to reduce the
average processing time. Nevertheless, we believe it is critical that
VA take the necessary steps to support improvements in training and in
regulations, procedures, or policies that could enhance the quality of
disability decision making across the continuum of adjudication and to
help provide adequate assurance to veterans that they will receive
consistent and fair decisions as early as possible in the process.
Indeed, maintaining and improving quality should be of paramount
concern while implementing a major effort to reduce backlogs and
processing time.
Accordingly, we recommend that the Secretary of VA direct the Chairman
of the Board of Veterans‘ Appeals to:
* Revise the quality assurance program so that, similar to VBA, the
calculation of accuracy rates will take into account only those
deficiencies that would be expected to result in a reversal of a Board
decision by the U.S. Court of Appeals for Veterans Claims or result in a
remand by the court.
* Revise the Board‘s quality assurance program to record information in
the quality review database that would enable the Board to
systematically analyze case-specific medical disability issues related
to specific errors found in Board decisions in the same way that the
Board is able to analyze the reasons that the court remands Board
decisions.
* Monitor the experience of VBA‘s quality assurance program in
collecting and analyzing data on cases in which VBA‘s quality reviewers
do not record errors but have differences of opinion with regional
office adjudicators in the judgments made to reach a decision. If VBA
finds that the analysis of such data helps identify training that can
improve the quality of decision making, the Board should test such a
process in its quality assurance program to assess whether it would
enable the Board to identify training that could improve the quality of
Board decisions.
We also recommend that the Secretary direct the Under Secretary for
Benefits and the Chairman of the Board of Veterans‘ Appeals to jointly
establish a system to regularly assess and measure the degree of
consistency across all levels of VA adjudication for specific medical
conditions that require adjudicators to make difficult judgments. For
example, VA could develop sets of hypothetical claims for specific
medical issues, distribute such hypothetical claims to multiple
adjudicators at all decision-making levels, and analyze variations in
outcomes for each medical issue. Such a system should provide data to
determine the degree of variation in decision making and provide a
basis to identify ways, if considered necessary, to reduce such
variation through training or clarifying and strengthening regulations,
procedures, and policies. Such a system should also assess the
effectiveness of actions taken to reduce variation. If departmental
consistency reviews reveal any systematic differences among VA decision
makers in the application of disability law, regulations, or court
decisions, the Secretary should, to the extent that policy
clarifications by VBA cannot resolve such differences, direct VA‘s
General Counsel to resolve these differences through precedent legal
opinions if possible.
Agency Comments and Our Evaluation:
We received written comments on a draft of this report from VA (see app.
III). In its comments, VA concurred fully or in principle with our
recommendations. With regard to our first recommendation, VA said that
the Board intends to revise its quality review system to count only
substantive errors for computational and benchmarking purposes but will
continue to track all errors. On the basis of VA‘s comments, we also
modified the report to accurately reflect the standard of review
employed by the U.S. Court of Appeals for Veterans Claims in reviewing
Board decisions. With regard to our second recommendation, VA said that
it would use its Veterans Appeals Control Locator System to gather
information on case-specific medical disability issues related to
specific errors found in Board decisions. VA questioned our basis for
concluding that tracking such information will yield useful data for
improving the adjudication system. As stated in the draft report, we
based our recommendation on the fact that the Board has already
concluded that such information is beneficial for analyzing the reasons
for remands from the Court of Appeals for Veterans Claims. With regard
to our third recommendation, VA said representatives of the Board and
VBA will meet so that a system may be established for the Board to
access and review VBA‘s methodology for assessing, reporting, and
evaluating instances of ’difference of opinion“ between the quality
reviewer and the decision maker.
In its comments, VA concurred in principle with our fourth
recommendation. VA agreed that consistency is an important goal and
acknowledged that it has work to do to achieve it. However, VA was
silent on how it would measure consistency for specific medical
conditions that require adjudicators to make difficult judgments.
Instead, VA described the kinds of actions underway that it believes
will generally reduce inconsistency. While we support these efforts, we
maintain that without a way to evaluate and measure consistency, VA
will be unable to determine the extent to which such efforts actually
improve consistency of decision-making across all levels of VA
adjudication now and over time. Neither will VA have information needed
to identify ways to reduce decision-making variations for specific
medical conditions, if considered necessary.
As agreed with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days
after its issue date. At that time, 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 upon request. In addition, the report
will be available at no charge on the GAO Web site at [hyperlink,
http://www.gao.gov].
If you have questions about this report, please call me on (202) 512-
7101 or Irene Chu on (202) 512-7102. Other key contributors were Ira
Spears, Steve Morris, Patrick diBattista, and Mark Ramage.
Sincerely yours,
Signed by:
Cynthia A. Bascetta:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Steps in the Disability Claims and Appeals Process:
Illustration of the estimated disposition of 100,000 hypothetical
compensation claims:
Veterans Benefits Administration: 57 Regional Offices Decide Claims and
Notify Veterans of Decisions (estimated disposition of 100,000
compensation claims filed with regional offices):
1. Veterans either agree with regional offices decisions or take no
further action in 90,880 cases.[A]
2. Veterans submit Notices of Disagreement to regional offices in 9,120
cases. In 3,657 of these cases, veterans go on to file appeals with the
Board.[A]
Board of Veterans' Appeals: Board Members Review Regional Office
Decisions Appealed by Veterans (estimated disposition of 3,657
compensation cases appealed to Board)[B]:
3. Board remands 1,311 cases to regional offices to develop further
evidence and reconsider their decisions (Board remands 211 of these
cases twice).[C]
4. Board grants at least one requested benefit in 1,153 cases (Board
makes 269 of these grants after regional offices resubmit remanded
cases).[D]
5. Board denies all benefits in 1,956 cases (Board makes 494 of these
denials after regional offices resubmit remands).[D]
6. Regional offices obtain more evidence but deny requested benefits in
839 cases and resubmit these cases to the Board for a final decision
(of the 211 remanded twice, regional offices deny benefits in 135 and
resubmit them to Board).[D]
7. Regional offices obtain more evidence and grant requested benefits
in 339 cases (47 of these 339 grants occur after the second remand).
8. Veterans withdraw or regional offices close 209 cases (28 of these
209 withdrawals or closures occur after second remand).[E]
9. Veterans appeal 307 cases to U.S. Court of Appeals for Veterans
Claims.[F]
U.S. Court of Appeals for Veterans Claims: Court Reviews Board
Decisions Appealed by Veterans (estimated disposition of 307
compensation cases appealed to the court)[F]:
10. Court dismisses 74 cases on procedural grounds.
11. Court affirms Board decisions in whole in 77 cases (all requested
benefits denied).
12. In whole or in part, Court reverses Board decisions (grants
requested benefits) or remands Board decisions in 156 cases.[G]
13. Veterans appeal 25 Court decisions to the U.S. Court of Appeals for
the Federal Circuit.
14. The Board or the regional offices grant or deny benefits in the
cases remanded by the court.[H]
Note: We did not include claims and appeals data for fiscal year 2001
in the basis for estimating the disposition of the 100,000 cases
because of anomalies related in whole or in part to the implementation
of the Veterans Claims Assistance Act of 2000. These fiscal year 2001
anomalies included a substantial increase in the regional offices‘
inventory of claims to be completed and substantial increases in the
proportion of appeals remanded by the Board and the Court. See 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).
[A] The estimated disposition by VA‘s regional offices of the 100,000
claims (in boxes 1 and 2) is based on data for claims involving
disability ratings for fiscal years 1997 to 2000. During those years,
veterans submitted Notices of Disagreement in about 9 percent of the
regional office decisions and went on to file appeals with the Board in
about 40 percent of the cases in which they had submitted such notices.
[B] Decisions appealed by veterans to the Board reach one of the
following dispositions before veterans can appeal to the U.S. Court of
Appeals for Veterans Claims: the Board makes an initial decision to
grant or deny requested benefits (boxes 4 and 5); the regional office
grants requested benefits in cases remanded by the Board for further
development and reconsideration (box 7); the Board grants or denies
benefits in remanded cases that regional offices resubmit to the Board
because the regional offices denied the requested benefits after
developing further evidence (boxes 4 and 5); the veteran withdraws his
or her appeal while the case is in remand status at the regional office
(box 8); or the regional office closes the case while in remand status
because the veteran fails to respond to requests for information needed
for the appeal to proceed (box 8). Therefore, the estimated disposition
the 3,657 appealed cases is accounted for in boxes 4, 5, 7, and 8
(1,153 + 1,956 + 339 + 209 = 3,657).
[C] The estimate of 1,311 remanded cases (in box 3) is based on Board
data for fiscal years 1999 and 2000.
[D] On the basis of Board data for fiscal years 1999 and 2000, in its
initial decisions on appealed compensation cases, the Board: (1)
granted at least one of the requested benefits in about 24 percent of
the cases, (2) denied all requested benefits in about 40 percent of the
cases, and (3) remanded about 36 percent of the cases to regional
offices for rework. After obtaining the additional evidence required by
the Board for remanded cases, the regional offices granted requested
benefits in about 22 percent of the remanded cases and denied requested
benefits in 64 percent of the cases. After regional offices resubmitted
denied cases to the Board for a final decision, the Board granted at
least one of the requested benefits in about 26 percent of the cases,
denied all benefits in about 49 percent, and remanded about 25 percent
once again to regional offices for further rework. For this
illustration, we assumed that the Board did not remand a case more than
two times.
[E] On the basis of Board data for fiscal years 1999 and 2000,
appellants withdrew about 13 percent of remanded compensation cases
while at the regional offices, and the regional offices closed less than
1 percent of the remanded cases because appellants did not respond to
requests for information needed to proceed with the appeal.
[F] The estimate of 307 cases appealed to the U.S. Court of Appeals for
Veterans Claims (in box 9), the court‘s estimated disposition of these
307 cases (in boxes 10, 11, 12), and the estimated number of decisions
appealed to the U.S. Court of Appeals for the Federal Circuit (in box
13) are based on fiscal years 1999 and 2000 data from the court‘s
annual reports.
[G] The court‘s annual reports did not disaggregate data on reversals
and remands. According to the Board, the court reversed Board decisions
in whole or in part in only about 1.6 percent of the cases during
fiscal years 1999 and 2000.
[H] The Board did not have any data that would provide a basis for
estimating the number of grants and denials made by the Board or
regional offices in cases remanded by the court (in box 14).
Source: Prepared by GAO using data from VBA, Board of Veterans‘
Appeals, and the U.S. Court of Appeals for Veterans Claims.
[End of illustration]
[End of section]
Appendix II: Board of Veterans‘ Appeals Illustrations of Difficult
Judgments Resulting in Decision-Making Variations:
Adjudicator‘s task: Assessing credibility of sources of evidence;
Examples of difficult judgments: To be granted benefits for post-
traumatic stress disorder, a veteran‘s claim must have credible
evidence that a stressor occurred during military service. Assume the
record shows a claimant served in Vietnam as a supply specialist, and
he identified mortar attacks as a stressor. Reports prepared by his
military unit in Vietnam indicate a single enemy mortar attack occurred
where the claimant was stationed. The claimant‘s testimony was vague
about the number and the time of the attacks. One adjudicator may rely
on the unit‘s reports and conclude the claimant engaged in combat and
is entitled to have his lay statements accepted without further
corroboration as satisfactory evidence of the in-service stressor.
Another adjudicator may conclude that the claimant is not credible as
to exposure to enemy fire and require other credible supporting
evidence that the in-service stressor actually occurred.
Adjudicator‘s task: Evaluating and assigning weight to evidence;
Examples of difficult judgments: Assume an appeal for either service
connection or a higher disability rating has two conflicting medical
opinions, one provided by a medical specialist who reviewed the claim
file but did not actually examine the veteran and a second opinion
provided by a medical generalist who reviewed the file and examined the
veteran. One adjudicator could assign more weight to the specialist‘s
opinion, while another could find the generalist‘s opinion to be more
persuasive. Thus, depending on which medical opinion is given more
weight, one adjudicator could grant the claim and the other deny it.
Yet, a third adjudicator could find both opinions to be equally
probative and conclude that VA‘s ’benefit-of-the-doubt“ rule requires
that he decide in favor of the veteran‘s request for either service-
connection or a higher disability rating. Under the benefit-of-the-
doubt rule, if an adjudicator concludes that there is an approximate
balance between the evidence for and the evidence against a veteran‘s
claim, the adjudicator must decide in favor of the veteran.
Adjudicator‘s task: Applying subjective standards in VA‘s Rating
Schedule;
Examples of difficult judgments: The Rating Schedule does not provide
objective criteria for rating the degree to which certain spinal
impairments limit a claimant‘s motion. The adjudicator must assess the
evidence and draw a conclusion as to whether the limitation of motion
falls into one of three severity categories: ’slight, moderate, or
severe.“ Similarly, in assessing the severity of incomplete paralysis,
the adjudicator must draw a conclusion as to whether the veteran‘s
incomplete paralysis falls into one of three severity categories: ’mild,
moderate, or severe.“ In each case, each severity category in itself
encompasses a range of severity, and the judgment as to whether a
claimant‘s condition is severe enough to cross over from one severity
range into the next could vary in the minds of different adjudicators.
The Rating Schedule provides a formula for rating the severity of a
veteran‘s occupational and social impairment due to a variety of mental
disorders. However, the formula actually is a nonquantitative,
behaviorally oriented framework for guiding adjudicators in making
judgments and drawing conclusions as to which of the following
characterizations best describes the degree to which a claimant is
occupationally and socially impaired: (1) totally impaired; (2)
deficient in most areas such as work, school, family relations,
judgment, thinking, or mood; (3) reduced reliability and productivity;
(4) occasional decrease in work efficiency and intermittent periods of
inability to perform occupational tasks; (5) mild or transient symptoms
that decrease work efficiency and ability to perform occupational tasks
only during periods of significant stress or symptoms can be controlled
by continuous medication, and (6) not severe enough to interfere with
occupational or social functioning or to require continuous medication.
Source: Board of Veterans‘ Appeals.
[End of table]
[End of section]
Appendix III: Comments from the Department of Veterans Affairs:
The Secretary Of Veterans Affairs:
Washington:
July 31, 2002:
Ms. Cynthia A. Bascetta:
Director, Veterans Health and Benefits Issues:
Education, Workforce and Income Security Team:
U.S. General Accounting Office:
441 G Street, NW:
Washington, DC 20548:
Dear Ms. Bascetta:
The Department of Veterans Affairs (VA) has reviewed your draft report,
Veterans' Benefits: Qualify Assurance for Disability Claims and Appeals
Processing Can Be Further Improved (GAO-02-806). VA appreciates that
the General Accounting Office (GAO) supports VA's efforts at
maintaining and improving quality while implementing a major effort to
reduce backlogs and processing time of benefits claims.
VA concurs with GAO's recommendations that the Board of Veterans'
Appeals (BVA) (a) revise its calculation of accuracy, (b) revise its
recording of data, and (c) monitor the Veterans Benefits
Administration's (VBA) experience with recording data as to difference
of opinion between the decision maker and the quality reviewer. VA also
concurs in principle with GAO's recommendation to establish a system to
regularly assess and measure the degree of consistency of adjudication
decisions. The Department agrees consistency is an important goal.
However, VA believes this is best achieved through comprehensive
training and communication among VA's components involved in the
adjudication process.
The enclosure provides detailed comments to each of GAO's
recommendations. Thank you for the opportunity to comment on your draft
report.
Sincerely yours,
Signed by:
Anthony J. Principi:
Enclosures:
Enclosure:
The Department Of Veterans Affairs Comments To GAO Draft Report,
Veterans' Benefits: Quality Assurance for Disability Claims and Appeals
Processing Can Be Further Improved (GAO-02-806):
GAO recommends that I direct the Chairman of the Board of Veterans'
Appeals to:
* Revise the quality assurance program so that, similar to VBA, the
calculation of accuracy rates will take into account only those
deficiencies that would be expected to result in a reversal of a Board
decision by the U.S. Court of Appeals for Veterans Claims due to clear
and unmistakable error or result in a remand by the Court.
Concur in Principle - The Board intends to revise its quality review
system to count only substantive errors for computational and
benchmarking purposes, but continue to track all errors. It is
considering excluding the category of "format" errors from the
calculation of its accuracy rate, at least as an interim measure. On
page 8 of its draft report, GAO cites this as raising BVA's accuracy
rate for FY 2001 from 87 percent to 92 percent and providing a more
useful assessment of BVA's decision accuracy. Since the Board has
accumulated the underlying data for past years, it can recalculate past
years' performance on this basis, and thereby continue to provide a
solid basis for benchmarking BVA's quality.
However, the Court does not reverse the Board on the basis of clear and
unmistakable error. As GAO's characterization of the standard of review
by the Court is erroneous, VA cannot concur with the recommendation as
stated.
* Revise the Board's quality assurance program to record information in
the quality review database that would enable the Board to
systematically analyze case-specific medical disability Issues related
to specific errors found In Board decisions in the same way that the
Board is able to analyze the reasons that the Court remands Board
decisions.
Concur - Implementing this recommendation would fall within the
capabilities of VA's Veterans Appeals Control Locator System (VACOLS).
In order to accomplish this, the Board will consult with IT staff to
determine the technical feasibility of doing so and then develop a
specific implementation plan. Nevertheless, VA questions the report's
basis for concluding that such tracking will yield useful data for
improvement of the adjudication system, as GAO provides no empirical
data to support its assertion that this would be a valuable exercise.
* Monitor the experience of VBA's quality assurance program in
collecting and analyzing data on cases in which VBA's quality reviewers
do not record errors but have differences of opinion with regional
office adjudicators in the judgments made to reach a decision. If VBA
finds that the analysis of such data helps identify training that can
improve the quality of decision-making, the Board should test such a
process in its quality assurance program to assess whether it would
enable the Board to identify training that could improve the quality of
Board decisions.
Concur - Representatives of the Board and VBA will meet so that a
system may be established for the Board to access and review VBA's
methodology for assessing, reporting, and evaluating instances of
"difference of opinion" between the quality reviewer and the decision
maker.
GAO also recommends that I direct the Under Secretary for Benefits and
the Chairman of the Board of Veterans' Appeals to jointly establish a
system to regularly assess and measure the degree of consistency across
all levels of VA adjudication for specific medical conditions that
require adjudicators to make difficult judgments. For example, VA could
develop sets of hypothetical claims for specific medical issues,
distribute such hypothetical claims to multiple adjudicators at all
decision-making levels, and analyze variations in outcomes for each
medical issue. Such a system should provide data to determine the
degree of variation in decision-making and provide a basis to identify
ways, if considered necessary, to reduce such variation through
training or clarifying and strengthening regulations, procedures, and
policies. Such a system should also assess the effectiveness of actions
taken to reduce variation. If departmental consistency reviews reveal
any systematic differences among VA decision-makers in the application
of disability law, regulations, or court decisions, the Secretary
should, to the extent that policy clarifications by VBA cannot resolve
such differences, direct VA's General Counsel to resolve these
differences through precedent legal opinions if possible.
Concur in Principle - VA agrees that consistency is an important goal,
and the Department has work to do to achieve it. However, VA believes
improved consistency is best achieved by comprehensive training and
communication among the VA components involved in the adjudication
process. There are significant individual and joint training efforts
underway in BVA, VBA, the Office of General Counsel, and the Veterans
Health Administration to improve the quality and consistency of the
adjudication process. For example, VBA is using the national Systematic
Technical Accuracy Review (STAR) to promote quality and consistency. In
the near future, VBA will conduct Systematic Individual Performance
Assessments (SIPA) for all its employees. In addition, VBA's national
training program, including its computer-based Training and Performance
Support Systems (TPSS) program, provides a uniform approach toward
training new employees. Finally, the creation of specialized teams in
the Claims Processing Improvement (CPI) model, coupled with changes to
the Rating Schedule, will undoubtedly provide more consistent decisions
through repetition in dealing with specific medical conditions.
[End of enclosure]
[End of section]
Footnotes:
[1] U.S. General Accounting Office, Veterans‘ Benefits Claims: Further
Improvements Needed in Claims-Processing Accuracy, GAO/HEHS-99-35
(Washington, D.C.: Mar. 1,1999), and Veterans‘ Benefits: Quality
Assurance for Disability Claims Processing, GAO-01-930R (Washington,
D.C.: Aug. 23, 2001).
[2] Veterans age 65 or older do not have to be permanently and totally
disabled to become eligible for pension benefits, if they meet the
income and military service requirements.
[3] According to VA, precedent opinions of the General Counsel are
legal opinions that interpret court decisions, laws, or regulations.
These opinions may apply such an interpretation to a certain set of
facts, or they may be used to implement an interpretation of law
consistently across VA. To the extent precedent opinions may contain any
statements of VA policy, such policy statements are not binding on the
Board merely because they appear in a precedent opinion. General
Counsel precedent opinions also are binding on regional office
adjudicators.
[4] Effective February 22, 2002, a new VA regulation allows the Board
to obtain evidence, clarify evidence, cure a procedural defect, or
perform most any other action essential for a proper appellate decision
without having to remand the appeal to the regional office. It also
allows the Board to consider additional evidence without having to
refer the evidence to the regional office for initial consideration and
without having to obtain the appellant‘s waiver. Under this new
regulation, the Board expects that the proportion of appeals remanded
to regional offices will decline to about 12 percent. For those cases
that previously would have been remanded to regional offices, the Board
provides information to VBA on the reasons for actions taken by the
Board itself under this new regulation, such as obtaining new evidence
or clarifying evidence.
[5] Before appealing to the court, a veteran may ask the Board itself
to review any previous Board decision on the basis of ’clear and
unmistakable error.“ During fiscal years 1999 and 2000, the Board
revised a total of only 23 of its decisions due to clear and
unmistakable error. VA regulations state that clear and unmistakable
error is a specific and rare kind of error, of fact or law, that when
called to the attention of later reviewers compels the conclusion, with
which reasonable minds could not differ, that the result would have been
manifestly different if not for the error. Generally, either the
correct facts, as they were known at the time, were not before the
Board, or the statutory and regulatory provisions in effect at the time
were not correctly applied.
[6] The court‘s Annual Reports did not disaggregate data on remands and
reversals, but according to the Board, the court reversed Board
decisions in whole or in part in only about 1.6 percent of the cases.
[7] During our review, we brought to the Board‘s attention certain
issues regarding the compliance of its quality assurance program with
the governmental internal control standard calling for separation of
key duties and the governmental performance audit standard calling for
organizational independence for agency employees who review and
evaluate program performance. These issues arose because certain Board
members who were directly involved in deciding veterans‘ appeals were
also involved in reviewing the accuracy of such decisions. Effective
May 2002, the Board took corrective actions to resolve these issues;
now, all quality reviews from which accuracy rates are determined are
done by persons not directly involved in deciding veterans‘ appeals.
[8] The Board‘s goal is that VA can have 95 percent confidence that the
Board‘s true accuracy rate is no more than 5 percentage points higher
or lower than the estimated accuracy rate.
[9] The Government Performance and Results Act of 1993 requires VA, as
well as other federal agencies, to clearly define its mission, set
goals, measure performance, and submit to the Congress annual
performance plans and annual reports on its success in achieving
program performance goals.
[10] The court may set aside the Board's findings of fact that are
"clearly erroneous." A finding is clearly erroneous when, although
there is evidence to support it, the reviewing court on the entire
evidence is left with the definite and firm conviction that a mistake
has been committed. If there is a plausible basis in the record for the
Board's factual determinations, the court cannot overturn them, even if
it might not have reached the same determinations.
[11] U.S. General Accounting Office, Social Security Disability: SSA
Must Hold Itself Accountable for Continued Improvement in Decision-
Making, GAO/HEHS-97-102 (Washington, D.C.: Aug. 12, 1997).
[12] Since 1994, SSA has recognized the need to focus more attention on
the agency‘s overall quality assurance program; however, SSA had made
little progress in this effort as of early 2002. Since then, the
Commissioner of SSA has appointed a senior manager for quality who
reports directly to the Commissioner and who is responsible for
developing a proposal to establish a quality-oriented approach to all
SSA business processes. See U.S. General Accounting Office, Social
Security Disability: Disappointing Results from SSA‘s Efforts to
Improve the Disability Claims Process Warrant Immediate Attention, GAO-
02-322 (Washington, D.C.: Feb. 27, 2002) and Social Security
Disability: Efforts to Improve Claims Process Have Fallen Short and
Further Action is Needed, GAO-02-826T (Washington, D.C.: June 11,
2002).
[End of section]
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