Veterans' Disability Benefits
VA Could Enhance Its Progress in Complying with Court Decision on Disability Criteria Gao ID: GAO-06-46 October 12, 2005To properly decide veterans' disability claims, the regional offices of the Department of Veterans Affairs (VA) must obtain all medical evidence required by law and federal regulations. To do so, in fiscal year 2004, the regional offices asked VA's medical centers to examine about 500,000 claimants and provide examination reports containing the necessary medical information. Exams for joint and spine impairments are among the exams that regional offices most frequently request, and in 2002, VA found that 61 percent of the exam reports for such impairments did not provide sufficient information for regional offices to make decisions complying with disability criteria mandated by the U.S. Court of Appeals for Veterans Claims in DeLuca v. Brown, 8 Vet. App. 202 (1995). In DeLuca, the court held that when federal regulations define joint and spine impairment severity in terms of limits on range of motion, VA claims adjudicators must consider whether range of motion is further limited by factors such as pain and fatigue during "flare-ups" or following repetitive use of the impaired joint or spine. Whenever VA regional offices ask VA medical centers to conduct joint and spine disability exams, the medical centers should prepare exam reports containing the information mandated in DeLuca. Congress asked that we determine VA's progress since 2002 in ensuring that its medical centers consistently prepare joint and spine exam reports containing the information required by DeLuca.
In summary, since 2002, VA has made progress in ensuring that its medical centers' exam reports adequately address the DeLuca criteria, but more improvements are needed. As of May 2005, the percentage of joint and spine exam reports not meeting the DeLuca criteria had declined substantially from 61 percent to 22 percent. Much of this progress appears attributable to a performance measure for exam report quality that VHA established in fiscal year 2004. However, a 22 percent deficiency rate indicates that many joint and spine exam reports still did not comply with DeLuca, and moreover, the percentage of exam reports satisfying the DeLuca criteria varied widely--from a low of 57 percent to a high of 92 percent among VHA's 21 health care networks. Further, VA's Compensation and Pension Examination Project (CPEP) Office has found deficiencies in a substantial portion of the requests that VBA's regional offices send to VHA's medical centers, asking them to perform disability exams. For example, the CPEP Office found in early 2005 that nearly one-third of the regional office requests for spine exams contained errors such as not identifying the pertinent medical condition or not requesting the appropriate exam. However, VBA has not yet established a performance measure for the quality of the exam requests that regional offices submit to medical centers.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-06-46, Veterans' Disability Benefits: VA Could Enhance Its Progress in Complying with Court Decision on Disability Criteria
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Report to the Ranking Democratic Member, Committee on Veterans'
Affairs, House of Representatives:
United States Government Accountability Office:
GAO:
October 2005:
Veterans' Disability Benefits:
VA Could Enhance Its Progress in Complying with Court Decision on
Disability Criteria:
GAO-06-46:
Contents:
Letter:
Appendix I: Briefing Section:
Appendix II: Comments from the Department of Veterans Affairs:
United States Government Accountability Office:
Washington, DC 20548:
October 12, 2005:
The Honorable Lane Evans:
Ranking Democratic Member:
Committee on Veterans' Affairs:
House of Representatives:
Dear Mr. Evans:
To properly decide veterans' disability claims, the regional offices of
the Department of Veterans Affairs (VA) must obtain all medical
evidence required by law and federal regulations. To do so, in fiscal
year 2004, the regional offices asked VA's medical centers to examine
about 500,000 claimants and provide examination reports containing the
necessary medical information. Exams for joint and spine impairments
are among the exams that regional offices most frequently request, and
in 2002, VA found that 61 percent of the exam reports for such
impairments did not provide sufficient information for regional offices
to make decisions complying with disability criteria mandated by the
U.S. Court of Appeals for Veterans Claims in DeLuca v. Brown, 8 Vet.
App. 202 (1995).
In DeLuca, the court held that when federal regulations define joint
and spine impairment severity in terms of limits on range of motion, VA
claims adjudicators must consider whether range of motion is further
limited by factors such as pain and fatigue during "flare-ups" or
following repetitive use of the impaired joint or spine. Whenever VA
regional offices ask VA medical centers to conduct joint and spine
disability exams, the medical centers should prepare exam reports
containing the information mandated in DeLuca. You asked that we
determine VA's progress since 2002 in ensuring that its medical centers
consistently prepare joint and spine exam reports containing the
information required by DeLuca.
In conducting our research, we obtained pertinent information from and
interviewed officials of the Veterans Benefits Administration (VBA),
which manages VA's 57 regional offices; the Veterans Health
Administration (VHA), which has 21 health care networks that oversee
the operations of VA's 157 medical centers; and the Compensation and
Pension Examination Project (CPEP) Office, a national office jointly
established by VHA and VBA in 2001 to improve the disability
examination process. We assessed and determined that data from the CPEP
Office's quality reviews of medical center exam reports for the 10 most
frequently requested exams were reliable for the purposes of our work,
and we attended a December 2004 VA training conference aimed at
improving the ability of medical center clinicians to conduct and
report high-quality disability examinations. In addition, we
interviewed officials of Disabled American Veterans, The American
Legion, Paralyzed Veterans of America, and National Veterans Legal
Services Program. We conducted our review from November 2004 through
September 2005 in accordance with generally accepted government
auditing standards. After discussing our initial findings on DeLuca
with your office, your office asked that we furnish briefing slides
containing the information discussed. This letter conveys the requested
briefing slides.
In summary, since 2002, VA has made progress in ensuring that its
medical centers' exam reports adequately address the DeLuca criteria,
but more improvements are needed. As of May 2005, the percentage of
joint and spine exam reports not meeting the DeLuca criteria had
declined substantially from 61 percent to 22 percent. Much of this
progress appears attributable to a performance measure for exam report
quality that VHA established in fiscal year 2004. However, a 22 percent
deficiency rate indicates that many joint and spine exam reports still
did not comply with DeLuca, and moreover, the percentage of exam
reports satisfying the DeLuca criteria varied widely--from a low of 57
percent to a high of 92 percent among VHA's 21 health care networks.
Further, VA's CPEP Office has found deficiencies in a substantial
portion of the requests that VBA's regional offices send to VHA's
medical centers, asking them to perform disability exams. For example,
the CPEP Office found in early 2005 that nearly one-third of the
regional office requests for spine exams contained errors such as not
identifying the pertinent medical condition or not requesting the
appropriate exam. However, VBA has not yet established a performance
measure for the quality of the exam requests that regional offices
submit to medical centers.
To help ensure continued progress in satisfying the DeLuca criteria, we
recommend that the Secretary of Veterans Affairs direct the Under
Secretary for Health to develop a strategy for improving the
consistency of VHA's networks across the nation in meeting the DeLuca
criteria. We also recommend that the Secretary direct the Under
Secretary for Benefits to develop a performance measure for the quality
of the exam requests that regional offices submit to medical centers.
In written comments on a draft of this report, VA agreed with our
conclusions and concurred with our recommendations.
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 Chairman, House Committee on Veterans' Affairs; the Chairman and
Ranking Democratic Member, Senate Committee on Veterans' Affairs; and
the Secretary of Veterans Affairs. We will also make copies available
upon request. In addition, the report will be available at no charge on
GAO's Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please
contact me on (202) 512-7215 or bascettac@gao.gov. Contact points for
our Offices of Congressional Relations and Public Affairs may be found
on the last page of this report. Irene Chu, Assistant Director; Ira
Spears, Analyst-In-Charge; Joseph Natalicchio; and Walter Vance also
made key contributions to this report.
Sincerely yours,
Cynthia A. Bascetta:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Briefing Section:
VA Could Enhance Its Progress in Complying with Court Decision on
Disability Criteria:
Briefing for Staff of Representative Lane Evans:
Ranking Democratic Member:
House Committee on Veterans' Affairs:
* Objective;
* Background;
* Scope and Methodology;
* Key Findings;
* Conclusions;
* Recommendations.
Objective:
In 2002, the Department of Veterans Affairs (VA) found that about 61
percent of the joint and spine disability examination reports prepared
by VA medical centers did not provide the information required for VA's
joint and spine disability decisions to comply with DeLuca v. Brown, 8
Vet. App. 202 (1995). GAO was asked to determine the progress VA has
made since 2002 in ensuring that joint and spine exam reports prepared
by VA medical centers provide VA regional office claims adjudicators
with the medical information that DeLuca requires for disability
decisions.
Background:
To determine disability severity, VA claims adjudicators must use
medical criteria published in federal regulations. For certain
musculoskeletal disabilities, such as joint and spine impairments, the
regulations specify range-of-motion limitations that adjudicators must
use to determine severity.
However, the U.S. Court of Appeals for Veterans Claims held in DeLuca
that, in addition to the range-of-motion limitations specified in VA's
regulations, adjudicators also must consider any additional functional
limitations that may occur during "flare-ups" or following "repetitive
use" because of painful motion, weakened movement, excess fatigability
(or lack of endurance), or incoordination.
* Ensuring that joint and spine exam reports meet the DeLuca
requirements is important. Otherwise, a claims adjudicator may not
assign an appropriate severity rating for a veteran's condition.
* Under VA's quality review standards, a joint or spine exam report
satisfies the DeLuca "repetitive use" criteria if the exam report
indicates the extent, if any, and the number of degrees, if possible,
to which range of motion is additionally limited by pain, fatigue,
weakness, or lack of endurance following repetitive use. The additional
functional loss may be stated in terms of either degrees of loss of
motion or the additional percentage of loss of motion.
* Under VA's quality review standards, a joint or spine exam report
satisfies the DeLuca "flare-up" criteria if the report either states
the claimant does not experience any flare-ups or provides a
description of the flare-ups.
* The Veterans Benefits Administration (VBA) operates 57 regional
offices whose claims adjudicators develop required evidence and decide
disability claims.
* The Veterans Health Administration (VHA) operates VA's 157 medical
centers. VHA has organized these medical centers into 21 geographic
areas known as Veterans Integrated Service Networks (VISN). Each VISN
oversees the operations of the medical centers within its assigned
geographic area.
* To obtain the medical evidence required to make disability decisions,
VBA regional offices asked VHA's medical centers to perform about
500,000 disability examinations in fiscal year 2004. [NOTE 1]
* In 2001, the VA Claims Processing Task Force reported ongoing
concerns about the quality of the VBA-VHA disability examination
process.
* In 2001, VBA and VHA jointly chartered the Compensation and Pension
Examination Project (CPEP) Office to improve the disability examination
process.
NOTE:
[1] Because of workload issues at certain medical centers, 10 regional
offices use the services of a contractor to obtain disability
examinations.
* In 2002, after VA developed exam-specific quality indicators for the
10 most frequently requested disability exams, the CPEP Office did its
initial (baseline) review of VHA medical centers' disability
examination reports, including joint and spine exam reports. [NOTE 2]
* To assess quality, the CPEP Office uses 10 exam-specific indicators
to assess joint exam report quality and 11 indicators for spine exam
report quality. In both cases, two of the quality indicators address
DeLuca's repetitive use and flare-up criteria.
NOTE:
[2] The 10 exams that regional offices most frequently request are
audio (hearing), eye, feet, general medical, initial post-traumatic
stress disorder (PTSD), joints, mental disorders other than initial
PTSD and eating disorders, subsequent review of PTSD, skin (not scars),
and spine.
Scope and Methodology:
We interviewed or obtained information from officials of:
* VBA central office;
* VHA central office;
* CPEP Office, Nashville, Tenn.
* VHA VISN offices in Duluth, Ga; and Linthicum, Md.
* VHA medical centers in Baltimore, Md; and Birmingham, Ala.
* VBA regional offices in Atlanta, Ga; and Baltimore, Md.
We also interviewed officials of:
* Disabled American Veterans;
* The American Legion;
* Paralyzed Veterans of America;
* National Veterans Legal Services Program.
We attended a VA training conference for improving the ability of VHA
clinicians to conduct and report high-quality disability examinations.
* We assessed the CPEP Office's quality review data for the 10 most
frequently requested exams and found these data were reliable for the
purposes of our work.
* We conducted our review from November 2004 through September 2005 in
accordance with generally accepted government auditing standards.
Key Findings:
* VA has made progress since 2002 in ensuring that medical centers
prepare joint and spine exam reports satisfying the DeLuca criteria.
Much of this progress appears to be due to an overall performance
measure that VHA established for exam reports for the 10 most
frequently requested exams.
* However, many joint and spine exam reports still do not comply with
the DeLuca criteria, and VHA's 21 VISNs vary widely in the percentage
of exams that satisfy the DeLuca criteria.
* The CPEP Office has found that a substantial portion of regional
office requests for exams are inaccurate or incomplete.
VA Has Made Progress in Satisfying DeLuca Criteria:
* In its 2002 baseline review of disability exam report quality, CPEP
found that about 61 percent of VHA's joint and spine exam reports did
not contain the information required by DeLuca.
* However, by May 2005, the percentage of joint and spine exam reports
not containing the information required by DeLuca had declined
substantially from 61 percent to 22 percent. (See table 1)
Table 1: VHA's Performance in Satisfying the DeLuca Criteria:
[See PDF for image]
Source: CPEP.
[End of table]
To improve disability exam report quality, including satisfying the
DeLuca criteria, VA has done the following:
* VHA required medical centers in 2002 to develop quality improvement
plans for exams and exam reports for the 10 most requested exams,
including joint and spine exams.
* CPEP distributed musculoskeletal exam training videos and other
resource materials in 2002 and 2004.
* CPEP sponsored national training conferences in 2003 and 2004 that
included training on the DeLuca criteria.
* Via satellite broadcasts, VHA conducted training on DeLuca for its
medical centers in 2004, and VBA, for its regional offices in 2005.
VA also did the following to improve joint and spine disability exam
report quality:
* To focus attention on the DeLuca criteria, CPEP has published monthly
DeLuca performance statistics for each of VHA's 21 VISNs since October
2003.
* VBA instructed regional offices in 2004 to send back to the medical
centers any musculoskeletal exam reports not adequately addressing the
DeLuca criteria.
In addition, CPEP and VA's Office of Information developed and
distributed software during 2004 and 2005 that provides medical centers
with automated templates for clinicians to use in conducting and
reporting disability exams, including joint and spine exams.
* The templates provide a guided and structured approach for conducting
exams and entering the results at a computer workstation. Using the
templates is optional.
* CPEP believes the templates can help ensure that clinicians do not
omit necessary exam information, such as for the DeLuca criteria.
* CPEP is conducting a study in which medical center clinicians use a
selected template routinely in order to gather data on the costs and
benefits of using the templates.
Finally, in fiscal year 2004, VHA established a performance measure for
the quality of exam reports for its VISN directors. This performance
measure for exam report quality takes into account a VISN's combined
performance on all of the 10 most frequently requested exams. For
fiscal years 2004 and 2005, VHA defined fully successful performance as
when 64 percent of the exam reports prepared by a VISN's medical
centers satisfy at least 90 percent of the CPEP quality indicators.
The two VISNs we visited told us they had included this performance
measure in the performance plans of the directors for the medical
centers in their VISN.
Since VHA instituted the exam report quality performance measure, the
combined quality of exam reports for the 10 most frequently requested
exams has improved broadly, indicating that the performance measure may
have been a catalyst for improvement. (See table 2.)
Still, it should be noted that because the performance measure applies
to a VISN's combined performance on all 10 types of exam reports, poor
performance on one exam type could be masked in the overall average
performance statistic if performance on another exam type is
sufficiently high to allow the VISN to still meet the fully successful
definition of performance.
Table 2: Number of VISNs Meeting the Fully Successful Definition for
the Combined Exam Report Quality of the 10 Most Frequently Requested
Exams:
Time period: 1st quarter-fiscal year 2004;
Number of VISNs that achieved the fully successful standard: 0.
Time period: 4th quarter-fiscal year 2004;
Number of VISNs that achieved the fully successful standard: 15.
Time period: 3rd quarter-fiscal year 2005;
Number of VISNs that achieved the fully successful standard: 21.
Source: CPEP.
[End of table]
If a joint or spine exam report fails on both of the DeLuca criteria
(flare-ups and repetitive use), the exam report automatically fails the
quality review-that is, it does not pass at least 90 percent of the
exam-specific quality indicators.
As a result, the exam report quality performance measure provides an
incentive for VISNs and their medical centers to focus on satisfying
the DeLuca criteria because, to optimize the chance to be rated as
fully successful on combined performance for all 10 of the most
frequently requested exams, VISNs and their medical centers must pay
attention to the quality of all 10 exam types, including the joint and
spine exams that are subject to the DeLuca criteria.
More Improvement Needed in Satisfying DeLuca Criteria:
As of May 2005, 22 percent of joint and spine exams still did not
satisfy the DeLuca criteria. Also, as of May 2005, VA found a large
degree of inconsistency in the extent that the 21 VISNs satisfied the
DeLuca criteria. Among the 21 VISNs, the percentage of joint and spine
exam reports satisfying the DeLuca criteria ranged from a low of 57
percent to a high of 92 percent. (See table 3.)
It should be noted that within a given VISN, an individual medical
center's performance in meeting the DeLuca criteria may be lower than
the combined average DeLuca performance for all the medical centers in
that VISN. Therefore, in the VISN that had 57 percent of its joint and
spine exams meeting DeLuca criteria, an individual medical center
within that VIN may have had less than 57 percent meeting the DeLuca
criteria.
Table 3: Percentage of Each VISN's Joint and Spine Exams Satisfying the
DeLuca Criteria as of May 2005:
VISN number: 1;
Percentage meeting DeLuca criteria: 57.
VISN number: 2;
Percentage meeting DeLuca criteria: 84.
VISN number: 3;
Percentage meeting DeLuca criteria: 78.
VISN number: 4;
Percentage meeting DeLuca criteria: 80.
VISN number: 5;
Percentage meeting DeLuca criteria: 86.
VISN number: 6;
Percentage meeting DeLuca criteria: 92.
VISN number: 7;
Percentage meeting DeLuca criteria: 83.
VISN number: 8;
Percentage meeting DeLuca criteria: 86.
VISN number: 9;
Percentage meeting DeLuca criteria: 67.
VISN number: 10;
Percentage meeting DeLuca criteria: 76.
VISN number: 11;
Percentage meeting DeLuca criteria: 72.
VISN number: 12;
Percentage meeting DeLuca criteria: 75.
VISN number: 15;
Percentage meeting DeLuca criteria: 79.
VISN number: 16;
Percentage meeting DeLuca criteria: 92.
VISN number: 17;
Percentage meeting DeLuca criteria: 85.
VISN number: 18;
Percentage meeting DeLuca criteria: 87.
VISN number: 19;
Percentage meeting DeLuca criteria: 81.
VISN number: 20;
Percentage meeting DeLuca criteria: 69.
VISN number: 21;
Percentage meeting DeLuca criteria: 73.
VISN number: 22;
Percentage meeting DeLuca criteria: 64.
VISN number: 23;
Percentage meeting DeLuca criteria: 71.
Note: VA had 22 networks until January 2002, when it merged Networks 13
and 14 to form a new network, Network 23.
Source: CPEP.
[End of table]
Many Regional Office Exam Requests Are Deficient:
Since early 2004, CPEP has done monthly reviews of exam requests that
regional offices submit to medical centers, and CPEP has found that
many requests are inaccurate or incomplete. For example, of the spine
exams requested during the second quarter of fiscal year 2005, 32
percent of the exam requests had at least one error such as:
* not identifying the pertinent condition, * not requesting the
appropriate exam,
* not providing clear or useful information in the remarks section of
the request,
* not identifying the specific joint or part to be examined, or:
* not explaining instances in which the exam request contained no
telephone number for the veteran who was to be examined.
VBA told GAO it may consider establishing a performance measure for the
quality of exam requests after CPEP modifies its software so that when
CPEP finds an error in an exam request, the regional office would be
able to obtain via VA's intranet the identity of the case involved,
study the error, and learn from the mistake.
In July 2005, CPEP said it would soon complete software modifications
that will make case-specific exam request error information available
to regional offices via VA's intranet.
Conclusions:
Although the percentage of joint and spine exam reports that do not
satisfy the DeLuca criteria declined substantially from 61 percent in
2002 to 22 percent at the end of May 2005, more improvement is needed
to further reduce the more than one-fifth of these exam reports not
meeting the DeLuca criteria. Also, more improvement is needed to reduce
wide variations in performance on the DeLuca criteria; among the 21
VISNs, the percentage of deficient exam reports ranged from a low of 8
percent to a high of 43 percent.
The ability of medical centers to provide exam reports containing the
information that regional offices need in order to make accurate
disability decisions is negatively affected when regional offices
submit inaccurate or incomplete exam requests. Although CPEP has found
that many exam requests are deficient, the lack of a performance
measure for exam request quality means regional offices do not have the
same incentive for improvement that medical centers have had since VHA
instituted the performance measure for exam report quality.
Recommendations:
To help ensure continued progress in satisfying the DeLuca criteria, we
recommend that the Secretary of Veterans Affairs direct the Under
Secretary for Health to develop a strategy for improving consistency
among the VHA VISNs in meeting the DeLuca criteria. For example, if
performance in satisfying the DeLuca criteria continues to vary widely
among the VISNs during fiscal year 2006, VHA may want to consider
establishing a new performance measure specifically for joint and spine
exams. Also, if the CPEP Office's study of the costs and benefits of
the automated exam templates supports their use, VHA could require that
its medical centers use the automated templates for joint and spine
exams.
We also recommend that the Secretary direct the Under Secretary for
Benefits to develop a performance measure for the quality of exam
requests that regional offices send to medical centers. This measure
could be implemented as soon as the CPEP Office is able provide
regional offices with case-specific exam request deficiency data via
VA's intranet.
[End of slide presentation]
[End of section]
Appendix II: Comments from the Department of Veterans Affairs:
THE DEPUTY SECRETARY OF VETERANS AFFAIRS:
WASHINGTON:
SEP 23 2005:
Ms. Cynthia A. Bascetta:
Director:
Education, Workforce and Income Security Issues:
U. S. Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear Ms. Bascetta:
The Department of Veterans Affairs (VA) has reviewed the Government
Accountability Office's (GAO) draft report, VETERANS' DISABILITY
BENEFITS: VA Could Enhance Its Progress in Complying with Court
Decision of Disability Criteria; (GAO-06-46). The Department agrees
with GAO's conclusions and concurs with its recommendations. The
enclosure details VA actions and plans to implement GAO's
recommendations.
VA appreciates the opportunity to comment on your draft report.
Sincerely yours,
Signed by:
Gordon H. Mansfield:
Enclosure:
Enclosure:
Department of Veterans Affairs (VA) Comments to Government
Accountability Office (GAO) Draft Report, VETERANS' DISABILITY
BENEFITS: VA Could Enhance Its Progress in Complying with Court
Decision of Disability Criteria (GAO-06-46):
To help ensure continued progress in satisfying the DeLuca criteria,
GAO recommends that the Secretary of Veterans Affairs direct the Under
Secretary for Health to develop a strategy for improving consistency
among the VHA VISNs in meeting the DeLuca criteria. For example, if
performance in satisfying the DeLuca criteria continues to vary widely
among the VISNs during fiscal year 2006, VHA may want to consider
establishing a new performance measure specifically for joint and spine
exams. Also, if the CPEP Office's study of the costs and benefits of
the automated exam templates supports their use, VHA could require that
its medical centers use the automated templates for joint and spine
exams.
Concur in Principle - While it is agreed that more consistency among
Veterans Integrated Service Networks (VISN) in complying with the
DeLuca disability criteria in determining joint and spine impairment
severity is indicated, VA believes that it is premature at this point
to devise a new strategy to accomplish that goal. There is ongoing
evidence of consistent compliance improvement in results generated by
the Veterans Health Administration (VHA) VISN director performance
measure for quality of exam reports, which VHA plans to strengthen and
refine. Program managers in VHA's Compensation and Pension Exam Program
(CPEP) and in its Office of Patient Care Services will continue to
carefully monitor data trends throughout the first half of fiscal year
2006 to identify the need for intervention and/or new strategic
approaches. In addition, VHA will provide this report to all VISN
offices for further review and follow-up action with individual medical
facilities requiring focused attention.
GAO also recommends that the Secretary direct the Under Secretary for
Benefits to develop a performance measure for the quality of exam
requests that regional offices send to medical centers. This measure
could be implemented as soon as the CPEP Office is able to provide
regional offices with case-specific exam requests deficiency data via
VA's intranet.
Concur - A standardized review of examination requests was initiated
through the CPEP office in 2004 using the same quality indicator
approach used for assessment of quality of examination reports.
Initially, the 17 request indicators were a compilation of content and
process assessments with substantive and non-substantive indicators
carrying the same weight and, therefore, not an effective tool for
performance quality measurement. As GAO reports, this initial
assessment tool unduly skewed the accuracy results of exam requests as
noted in the original request baseline study results.
In August 2005, the Veterans Benefits Administration (VBA) revised the
request indicators to clearly establish six request-quality performance
indicators that assess the accuracy of the content of the exam request.
Six additional indicators focus on the request process and will be
tracked for quality monitoring purposes but will not be included in VBA
regional office performance indicators.
Use of the revised indicators to assess examination request quality
began in August 2005, and first-month results will be available later
in September 2005. Due to the significant revision of the request-
performance assessment tool, review results will need to be collected
for at least 6 months in order to obtain an accurate baseline of
regional office request quality prior to the establishment of a
baseline for performance measurement purposes.
In September 2005, CPEP will make available a Request Level Scoring
Reporter Web link that will provide access to claim-specific request
review information for each regional office.
[End of section]
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441 G Street NW, Room LM
Washington, D.C. 20548:
To order by Phone:
Voice: (202) 512-6000:
TDD: (202) 512-2537:
Fax: (202) 512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: www.gao.gov/fraudnet/fraudnet.htm
E-mail: fraudnet@gao.gov
Automated answering system: (800) 424-5454 or (202) 512-7470:
Public Affairs:
Jeff Nelligan, managing director,
NelliganJ@gao.gov
(202) 512-4800
U.S. Government Accountability Office,
441 G Street NW, Room 7149
Washington, D.C. 20548:
