VA Disability Benefits
Board of Veterans' Appeals Has Made Improvements in Quality Assurance, but Challenges Remain for VA in Assuring Consistency Gao ID: GAO-05-655T May 5, 2005The House Subcommittee on Disability Assistance and Memorial Affairs asked GAO to update a 2002 study to determine what VA has done to (1) correct reported weaknesses in methods used by the Board to select decisions for quality review and calculate the accuracy rates reported by the Board and (2) address the potential for inconsistency in decision-making at all levels of adjudication in VA, including VA's 57 regional offices and the Board. GAO said in 2002 that VA had not studied consistency even though adjudicator judgment is inherently required in the decision-making process, and state-to-state variations in the average disability compensation payment per veteran raised questions about consistency. In January 2003, in part because of concerns about consistency, GAO designated VA's disability program as high-risk.
The Department of Veterans Affairs (VA) has taken steps to respond to GAO's 2002 recommendations to correct weaknesses in the methods for selecting decisions by the Board of Veterans' Appeals (Board) for quality review and calculating the accuracy rates reported by the Board. Specifically, the Board now ensures that decisions made near the end of the fiscal year are included in the quality review sample, and the Board now excludes from its accuracy rate calculations any errors that do not have the potential for resulting in a reversal by or remand from the court. GAO found that the Board had not yet revised its formula for calculating accuracy rates in order to properly weight the quality review results for original Board decisions versus the results for Board decisions on cases remanded by the court. However, GAO believes correcting this calculation method will not materially affect the Board's reported accuracy rates. VA still lacks a systematic method for ensuring the consistency of decision-making within VA as a whole, but has begun efforts to understand why average compensation payments per veteran vary widely from state to state. These efforts include studies underway by VA's Office of Inspector General and the Veterans Benefits Administration, which oversees the operations of VA's regional offices. Some variation is expected since adjudicators often must use judgment in making disability decisions, but VA faces the challenge of determining whether the extent of variation is confined within a range that knowledgeable professionals could agree is reasonable.
GAO-05-655T, VA Disability Benefits: Board of Veterans' Appeals Has Made Improvements in Quality Assurance, but Challenges Remain for VA in Assuring Consistency
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Testimony Before the Subcommittee on Disability Assistance and Memorial
Affairs, Committee on Veterans' Affairs, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:30 a.m. EDT:
Thursday, May 5, 2005:
VA Disability Benefits:
Board of Veterans' Appeals Has Made Improvements in Quality Assurance,
but Challenges Remain for VA in Assuring Consistency:
Statement of Cynthia A. Bascetta, Director, Education, Workforce and
Income Security:
GAO-05-655T:
GAO Highlights:
Highlights of GAO-05-655T, a testimony before the Subcommittee on
Disability Assistance and Memorial Affairs, House Committee on
Veterans' Affairs:
Why GAO Did This Study:
The House Subcommittee on Disability Assistance and Memorial Affairs
asked GAO to update a 2002 study to determine what VA has done to
(1) correct reported weaknesses in methods used by the Board to select
decisions for quality review and calculate the accuracy rates reported
by the Board and (2) address the potential for inconsistency in
decision-making at all levels of adjudication in VA, including VA‘s 57
regional offices and the Board. GAO said in 2002 that VA had not
studied consistency even though adjudicator judgment is inherently
required in the decision-making process, and state-to-state variations
in the average disability compensation payment per veteran raised
questions about consistency. In January 2003, in part because of
concerns about consistency, GAO designated VA‘s disability program as
high-risk.
What GAO Found:
The Department of Veterans Affairs (VA) has taken steps to respond to
GAO‘s 2002 recommendations to correct weaknesses in the methods for
selecting decisions by the Board of Veterans‘ Appeals (Board) for
quality review and calculating the accuracy rates reported by the
Board. Specifically, the Board now ensures that decisions made near the
end of the fiscal year are included in the quality review sample, and
the Board now excludes from its accuracy rate calculations any errors
that do not have the potential for resulting in a reversal by or remand
from the court. GAO found that the Board had not yet revised its
formula for calculating accuracy rates in order to properly weight the
quality review results for original Board decisions versus the results
for Board decisions on cases remanded by the court. However, GAO
believes correcting this calculation method will not materially affect
the Board‘s reported accuracy rates.
VA still lacks a systematic method for ensuring the consistency of
decision-making within VA as a whole, but has begun efforts to
understand why average compensation payments per veteran vary widely
from state to state. These efforts include studies underway by VA‘s
Office of Inspector General and the Veterans Benefits Administration,
which oversees the operations of VA‘s regional offices. Some variation
is expected since adjudicators often must use judgment in making
disability decisions, but VA faces the challenge of determining whether
the extent of variation is confined within a range that knowledgeable
professionals could agree is reasonable.
Steps in the Veterans Disability Claims and Appeals Process:
[See PDF for image]
[End of figure]
What GAO Recommends:
This testimony updates actions VA has taken to implement
recommendations from the GAO‘s 2002 report, in which GAO recommended
that VA take steps to (1) correct the weaknesses in the Board‘s
sampling and accuracy rate calculation methods and (2) establish a
system for assessing the consistency of decision-making at all levels
of adjudication in VA, including VA‘s regional offices and the Board.
www.gao.gov/cgi-bin/getrpt?GAO-05-655T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cynthia A. Bascetta at
(202) 512-7101.
[End of section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me to discuss our work related to the efforts of
the Department of Veterans Affairs (VA) to assure the quality and
consistency of disability decisions. Assuring the quality and
consistency of VA's disability decisions is vital for assuring program
integrity and equitable decisions. As you know, in January 2003, we
designated VA's disability program, along with other federal disability
programs, as high-risk.[Footnote 1] In part, we designated VA's program
as high-risk because of concerns about consistency of decision-making.
Despite VA's efforts to provide training and enhance communication to
improve the consistency of decisions, we found indications of
inconsistency such as the wide variation among states in the average
compensation payment per veteran.
You asked us to update our 2002 report in which we found that the Board
needed to improve its quality review program.[Footnote 2] Specifically,
the Board needed to revise its sampling methods, the way it weighted
quality review results in its calculation of accuracy rates, and the
types of errors reported in the accuracy rates. In that report, we also
found that VA needed to take action to assure consistency of decision-
making within VA as a whole. Today I would like to highlight the steps
the Board has taken since our 2002 report and discuss VA's recent
efforts to address inconsistent decision-making. To update our 2002
report, we interviewed officials of and/or obtained pertinent
documentation from the Board and the Veterans Benefits Administration
(VBA), which oversees the operations of VA's 57 regional offices. We
obtained comments from Board officials on the updated information
contained in this testimony regarding the Board's quality assurance
system, and they agreed with this information. We did our work in
accordance with generally accepted government auditing standards in
April 2005.
In summary, we found that the Board has taken action to strengthen its
system for reviewing the quality of its own decisions, but VA still
lacks a systematic method for ensuring the consistency of decision-
making within VA as a whole. With respect to the Board, it has taken
steps to improve the sampling and accuracy rate calculation methods of
its quality review system and also to assure that serious errors are
not obscured by mixing them with less significant deficiencies.
Regarding consistency, VA still lacks a plan for an ongoing, systematic
assessment of decision-making consistency at all levels of adjudication
within VA. As we concluded in 2002, such an assessment is needed to
provide a foundation for determining acceptable levels of decision-
making variation and to reduce variations found to be unacceptable.
Although VA has much left to do regarding consistency of decision-
making, it has begun efforts to understand the reasons behind one
indication of inconsistency: the wide variations from state to state in
the average compensation payment per veteran. These efforts include
studies being done by VA's Office of Inspector General and VBA.
Background: The Disability Claims and Appeals Process:
VA's disability compensation program pays monthly cash benefits to
eligible veterans who have service-connected disabilities resulting
from injuries or diseases incurred or aggravated while on active
military duty. The benefit amount is based on the veteran's degree of
disability, regardless of employment status or level of earnings.
A veteran starts the claims process by submitting a disability
compensation claim to one of the 57 regional offices administered by
VBA (see fig. 1). In the average disability compensation claim, the
veteran claims about five disabilities. For each claimed disability,
the regional office adjudicator must develop evidence and determine
whether each disability is connected to the veteran's military
service.[Footnote 3] The adjudicator then applies the medical criteria
in VA's Rating Schedule to evaluate the degree of disability caused by
each service-connected disability, and then the adjudicator determines
the veteran's overall degree of service-connected disability.
If a veteran disagrees with the adjudicator's decision on any of the
claimed disabilities, the veteran may file a Notice of Disagreement. If
the regional office is unable to resolve the disagreement to the
veteran's satisfaction, the veteran may appeal to the Board.[Footnote
4] A veteran can dispute a decision not only if the regional office
denies benefits by deciding that an impairment claimed by the veteran
is not service-connected. Even for a claimed impairment found to be
service-connected, the veteran may dispute the severity rating that the
regional office assigns to the impairment and ask for an increase in
the rating.
During fiscal years 2003 and 2004, respectively, the regional offices
made about 715, 000 and 598,500 decisions involving disability
compensation claims. According to VBA, during fiscal years 2003 and
2004, respectively, veterans submitted Notices of Disagreement in about
13.4 and 14.5 percent of all decisions involving disability ratings,
and of the veterans who filed Notices of Disagreement, about 34.9 and
44.4 percent went on to submit appeals to the Board. Assisted by 240
staff attorneys, the Board's 52 veterans law judges decide veterans'
appeals on behalf of the Secretary. The Board has full de novo review
authority and gives no deference to the regional office decision being
appealed. The Board makes its decisions based on only the law, VA's
regulations, precedent decisions of the courts, and precedent opinions
of VA's General Counsel. During the appeals process, the veteran or the
veteran's representative may submit new evidence to the Board and
request a hearing.
Figure 1: Steps in the Disability Claims and Appeals Process:
[See PDF for image]
[End of figure]
In fiscal year 2004, for all VA programs, the Board decided about
38,400 appeals, of which about 94 percent (35,900) were appeals of
disability compensation cases that contained an average of 2.2
contested issues per case. In any given case, the Board might grant the
requested benefits for one issue but deny benefits for another. In some
instances, the Board may find that a case is not ready for a final
decision and return (or remand) the case to VBA for rework, such as
obtaining additional evidence and reconsidering the veteran's claim. If
VBA still does not grant the requested benefits after obtaining the
additional evidence, it returns the case to the Board for a final
decision. Of the appeals involving compensation cases decided during
fiscal year 2004, the Board reported that it granted requested benefits
for at least one issue in about 18 percent of the cases, denied all
requested benefits in about 23 percent of the cases, and remanded about
58 percent of the cases to VBA for rework.[Footnote 5]
Effective February 22, 2002, VA issued a new regulation to streamline
and expedite the appeals process. Previously, the Board had remanded
all decisions needing rework directly to VBA's regional offices. The
new regulation, however, allowed the Board to obtain evidence, clarify
evidence, cure a procedural defect, or perform almost any other action
essential for a proper appellate decision without having to remand the
appeal to the regional office. It also allowed 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. According to the Board, this change in the
process reduced the time required to provide a final decision to the
veteran on an appeal, allowed regional offices to use more resources
for processing initial claims rather than remands, and virtually
eliminated multiple remands on the same case to the regional offices.
However, in May 2003, the U.S. Court of Appeals for the Federal Circuit
held that the Board could not, except in certain statutorily authorized
exceptions, decide appeals in cases in which the Board had developed
evidence.[Footnote 6] As a result, VA established a centralized Appeals
Management Center within VBA in Washington, D.C., to take over evidence
development and adjudication work on remands.
If the Board denies requested 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, an independent federal court. Unlike
the Board, the court may not receive new evidence. It considers only
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. In cases decided on merit (cases not dismissed on
procedural grounds), the court may (1) reverse the Board's decision
(grant contested benefits), (2) affirm the Board's decision (deny
contested benefits) or (3) remand the case back to the Board for
rework. Of the 3,489 cases decided on merit during fiscal years 2003-
2004, the court reversed or remanded in part or in whole about 88
percent of the cases. 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 Has Taken Steps to Improve Its Quality Assurance Program:
The Board of Veterans' Appeals has taken action to strengthen its
internal system for reviewing the quality of its own decisions.
Specifically, the Board has taken steps to improve its quality review
system's sampling methodology and to avoid obscuring serious errors by
mixing them with less significant deficiencies. We found, however, that
the Board still needs to revise its formula for calculating accuracy
rates in order to avoid potentially misleading accuracy rates.
During our 2002 evaluation, we reviewed the Board's methods for
selecting random samples of Board decisions and calculating accuracy
rates for its decisions. We found that the number of decisions reviewed
was sufficient to meet the Board's goal for statistical precision in
estimating its accuracy rate.[Footnote 7] However, we pointed out some
Board practices that might result in misleading accuracy rates. These
practices included not ensuring that decisions made near the end of the
fiscal year were sampled and not properly weighting quality review
results in the formula used to calculate accuracy rates. At the time of
our 2002 report, the Board had agreed in principle to correct these
practices.
We found in our most recent work that the Board took corrective action
in fiscal year 2002 to assure that decisions made near the end of the
fiscal year were sampled. The quality review program now selects every
20th original decision made by the Board's veterans law judges and
every 10th decision they make on cases remanded by the court to the
Board for rework. However, we found that the Board had not revised its
formula for calculating accuracy rates in order to properly weight the
quality review results for original decisions versus the results for
decisions on remanded cases. We determined that, even if this
methodological error had been corrected earlier, the accuracy rate
reported by the Board for fiscal year 2004 (93 percent) would not have
been materially different. However, to avoid the potential for
reporting a misleading accuracy rate in the future, corrective action
needs to be taken, and the Board agreed to correct this issue in the
very near future.
In our 2002 evaluation, we also found that the Board included
nonsubstantive deficiencies (errors that would not be expected to
result in either a remand by the court or a reversal by the court) in
calculating its reported accuracy rates. We concluded that the reported
accuracy rates understated the level of accuracy that would result if
the Board, like VBA, counted only substantive deficiencies in the
accuracy rate calculation.[Footnote 8] VBA had ceased counting
nonsubstantive deficiencies in its error rate after the VA Claims
Processing Task Force said in 2001 that mixing serious errors with less
significant deficiencies could obscure what is of real concern.
Similarly, we recommended that the Board's accuracy rates take into
account only those deficiencies that would be expected to result in a
reversal or a remand by the court. In fiscal year 2002, the Board
implemented our recommendation.
Also, during the course of our 2002 evaluation of the quality review
program, we brought to the Board's attention 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 veterans law judges who
were directly involved in deciding veterans' appeals were also involved
in reviewing the accuracy of such decisions. The Board took corrective
actions during our review in May 2002 to resolve these issues so all
quality reviews from which accuracy rates are determined are done by
persons not directly involved in deciding veterans' appeals.
In 2002, we also found that the Board collected and analyzed issue-
specific data on the reasons that the Court remanded decisions to the
Board in order to provide feedback and training to the Board's veterans
law judges; however, the Board did not collect issue-specific data on
the errors that its own quality reviewers found in decisions of the
Board's veterans law judges. We recommended that the Board revise its
quality review program to begin collecting such issue-specific error
data in order to identify training that could help improve decision
quality. In April 2005, the Board said it did not implement this
recommendation because it believes the benefits would be too limited to
justify the substantial reprogramming of the data system that would be
required to collect issue-specific data. The Board also pointed out
that the issue-specific data captured for court remands have not proved
to be as useful as it had expected in identifying ways to provide
training that could reduce court remands.
VA Faces Challenges in Measuring Consistency But Has Recently Initiated
Studies:
Adjudicator judgment is an inherent factor in deciding disability
claims, and it introduces the potential for variation in the process.
Part of assessing inconsistency, as we recommended in 2002, would
include determining acceptable levels of variation for specific types
of disabilities. In late 2004, in response to adverse media reports, VA
initiated its first study of consistency. Such studies are the first
step in determining the degree of variation that occurs and what levels
of variation are acceptable.
Adjudicator Judgment Results in Inherent Variation in Decision-making:
Adjudicators often must use judgment in making disability decisions.
Judgment is particularly critical when the adjudicator must (1) assess
the credibility of different sources of evidence; (2) evaluate how much
weight to assign different sources of evidence; or (3) assess some
disabilities, such as mental disorders, for which the disability
standards are not entirely objective and require the use of
professional judgment. In such cases, two adjudicators reviewing the
same evidence might make differing judgments on the meaning of the
evidence and reach different decisions, neither of which would
necessarily be found in error by any of VA's quality reviewers.
For example, in an illustration provided by the Board, consider a
disability claim that has two conflicting medical opinions, one
provided by a medical specialist who reviewed the claim file but did
not 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 assign more weight to the opinion of the generalist who
examined the veteran. Depending on which medical opinion is given more
weight, one adjudicator could grant the claim and the other could deny
it. Yet, a third adjudicator could apply VA's "benefit-of-the-doubt"
rule and decide in favor of the veteran. Under this 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.
In the design of their quality review systems, VBA and the Board
acknowledge the fact that, in some cases, different adjudicators
reviewing the same evidence can make differing, but reasonable,
judgments on the meaning of the evidence. As a result, VBA and the
Board instruct their quality reviewers that when they review a
decision, they are not to record an error merely because they would
have made a different decision than the one made by the adjudicator.
VBA and the Board instruct their quality reviewers to not substitute
their own judgment in place of the original adjudicator's judgment if
the adjudicator's decision is adequately supported and reasonable.
Another example provided by the Board demonstrates how adjudicators
must make judgments about the degree of severity of a disability. VA's
disability criteria provide a formula for rating the severity of a
veteran's occupational and social impairment due to a variety of mental
disorders. This formula is a nonquantitative, behaviorally oriented
framework for guiding adjudicators in choosing which of the degrees of
severity shown in table 1 best describes the claimant's occupational
and social impairment.
Table 1: VA's Medical Criteria for Evaluating the Degree of
Occupational and Social Impairment Due to Mental Disorders:
Degree of occupational and social impairment as characterized in VA's
medical criteria: Totally impaired;
Disability rating (in percent): 100%.
Degree of occupational and social impairment as characterized in VA's
medical criteria: Deficient in most areas such as work, school, family
relations, judgment, thinking, or mood;
Disability rating (in percent): 70%.
Degree of occupational and social impairment as characterized in VA's
medical criteria: Reduced reliability and productivity;
Disability rating (in percent): 50%.
Degree of occupational and social impairment as characterized in VA's
medical criteria: Occasional decrease in work efficiency and
intermittent periods of inability to perform occupational tasks;
Disability rating (in percent): 30%.
Degree of occupational and social impairment as characterized in VA's
medical criteria: 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;
Disability rating (in percent): 10%.
Degree of occupational and social impairment as characterized in VA's
medical criteria: Not severe enough to interfere with occupational or
social functioning or to require continuous medication;
Disability rating (in percent): 0%.
Source: Board of Veterans' Appeals and VA's Schedule for Rating
Disabilities.
[End of table]
Similarly, VA does not have objective criteria for rating the degree to
which certain spinal impairments limit a claimant's motion. The
adjudicator must assess the evidence and decide whether the limitation
of motion is "slight, moderate, or severe." To assess the severity of
incomplete paralysis, the adjudicator must decide whether the veteran's
paralysis is "mild, moderate, or severe." The decision on which
severity classification to assign to a claimant's condition could vary
in the minds of different adjudicators, depending on how they weigh the
evidence and how they interpret the meaning the of the different
severity classifications.
Consequently, it would be unreasonable to expect that no decision-
making variations would occur. But it is reasonable to expect the
extent of variation to be confined within a range that knowledgeable
professionals could agree is reasonable, recognizing that disability
criteria are more objective for some disabilities than for others. For
example, if two adjudicators were to review the same claim file for a
veteran who has suffered the anatomical loss of both hands, VA's
disability criteria state unequivocally that the veteran is to be given
a 100 percent disability rating. Therefore, no variation would be
expected. However, if two adjudicators were to review the same claim
file for a veteran with a mental disability, knowledgeable
professionals might agree that it would not be out of the bounds of
reasonableness if one adjudicator gave the claimant a 50 percent
disability rating and the other adjudicator gave a 70 percent rating.
However, knowledgeable professionals might also agree that it would be
clearly outside the bounds of reasonableness if one adjudicator gave
the claimant a 30 percent rating and the other, a 100 percent rating.
VA Began Studying Decision-making Consistency in December 2004:
Although the issue of decision-making consistency is not new, VA only
recently began to study consistency issues. In a May 2000
testimony[Footnote 9] before the House Subcommittee on Oversight and
Investigations, Committee on Veterans' Affairs, we underscored the
conclusion made by the National Academy of Public Administration in
1997[Footnote 10] that VBA needed to study the consistency of decisions
made by different regional offices, identify the degree of subjectivity
expected for various medical issues, and then set consistency standards
for those issues. In August 2002, we drew attention to the fact that
there are wide disparities in state-to-state average compensation
payments per disabled veteran, and we voiced the concern that such
variation raises the question of whether similarly situated veterans
who submit claims to different regional offices for similar conditions
receive reasonably consistent decisions. In January 2003, we reported
that concerns about consistency had contributed to GAO's designation of
the VA disability program as high-risk in 2003. Again, in November
2004, we highlighted the need for VA to develop plans for studying
consistency issues.
Most recently, in December 2004, the media drew attention to the wide
variations in the average disability compensation payment per veteran
in the 50 states and published data showing that the average payments
varied from a low of $6,710 in Ohio to a high of $10,851 in New Mexico.
Reacting to these media reports, in December 2004, the Secretary
instructed the Inspector General to determine why average payments per
veteran vary widely from state to state. As of February 2005 the Office
of Inspector General planned to use data obtained from VBA for all
regional offices to identify factors that may explain variations among
the regional offices.
In March 2005, VBA began a study of three disabilities believed to have
potential for inconsistency: hearing loss, post-traumatic stress
disorder, and knee conditions. VBA assigned 10 subject matter experts
to review 1,750 regional office decisions and plans to complete its
analysis of study data in mid-May 2005, develop a schedule for future
studies of specific ratable conditions, and recommend a schedule for
periodic follow-up studies of previously studied conditions.
In our 2002 report, we recommended that VA establish a system to
regularly assess and measure the degree of consistency across all
levels of VA adjudication, including regional offices and the Board,
for specific medical conditions that require adjudicators to make
difficult judgments. For example, we said VA could create hypothetical
claims for certain medical conditions, distribute the claims to
multiple adjudicators at each decision-making level, and analyze
variations in outcomes. Such a system would identify variation in
decision making and provide a basis to identify ways, if considered
necessary, to reduce variation through training or clarifying and
strengthening regulations, procedures, and policies.
Although VA agreed in principle with our recommendation and agreed that
consistency is an important goal, it commented that it would promote
consistency through training and communication. We support such efforts
but still believe VA needs to directly evaluate and measure consistency
across all levels of adjudication. Otherwise, VA cannot determine
whether such training and other efforts are directed at the causes of
inconsistency and whether such efforts actually improve consistency.
In our November 2004 report,[Footnote 11] we found that VBA's
administrative data was insufficient to analyze inconsistency because
we could not reliably use the data to identify decisions made after
fiscal year 2000, identify the regional offices that made the original
decisions, or determine service-connection denial rates for specific
impairments. However, in October 2004, VBA completed its implementation
of a new nationwide data system, known as Rating Board Automation (RBA)
2000. VA said this new system could reliably collect the types of data
needed to perform the analyses we sought to do. Therefore, we
recommended that the Secretary of Veterans Affairs develop a plan, and
include it in VA's annual performance plan, containing a detailed
description of how VA intended to use data from the new RBA 2000
information system. We recommended that VA conduct systematic studies
of the impairments for which RBA 2000 data reveal indications of
decision-making inconsistencies among regional offices. VA concurred
with our recommendation. Because the new RBA 2000 data system had been
recently implemented, we acknowledged that VA could not implement such
a plan until it accumulated a sufficiently large body of data under the
new system. In our judgment, at least one year of data would be needed
to begin such a study.
While we believe the studies recently begun by the Office of Inspector
General and VBA are positive steps forward in addressing consistency
issues, the RBA 2000 data system, if found to be reliable, can provide
VA with the data needed to proactively and systematically target
specific impairments that have the widest variations in decision-making
outcomes among the regional offices and focus VA's efforts to study
reasons for variations on those impairments. Building in such
analytical capability to augment its quality assurance program would
help enhance program integrity and better assure that veterans'
disability decisions are made fairly and equitably.
Mr. Chairman, this concludes my remarks. I would be happy to answer any
questions you or the members of the subcommittee may have.
Contact and Acknowledgements:
For further information, please contact Cynthia A. Bascetta at (202)
512-7101. Also contributing to this statement were Irene Chu, Ira
Spears, Martin Scire, and Tovah Rom.
[End of section]
Related GAO Products:
Veterans Benefits: VA Needs Plan for Assessing Consistency of
Decisions. GAO-05-99. Washington, D.C.: November 19, 2004.
High-Risk Series: An Update. GAO-03-119. Washington, D.C.: January
2003.
Veterans' Benefits: Quality Assurance for Disability Claims and Appeals
Processing Can Be Further Improved. GAO-02-806. Washington, D.C.:
August 16, 2002.
SSA and VA Disability Programs: Re-Examination of Disability Criteria
Needed to Help Ensure Program Integrity. GAO-02-597. Washington, D.C.:
August 9, 2002.
Veterans Benefits Administration: Problems and Challenges Facing
Disability Claims Processing. GAO/T-HEHS/AIMD-00-146. Washington, D.C.:
May 18, 2000.
FOOTNOTES
[1] GAO, High-Risk Series: An Update, GAO-03-119 (Washington, D.C.:
January 2003).
[2] GAO, Veterans' Benefits: Quality Assurance for Disability Claims
and Appeals Processing Can Be Further Improved, GAO-02-806 (Washington,
D.C.: Aug. 16, 2002).
[3] The Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475,
(2000) requires VBA to assist claimants who have filed a complete claim
for benefits. Specifically, VBA must: (1) notify claimants of the
information necessary to complete the application; (2) indicate what
information not previously provided is needed to prove the claim and
distinguish between the portion of the information for which the
claimant will be responsible and the portion for which VA will be
responsible; (3) make reasonable efforts to assist claimants in
obtaining evidence to substantiate claimant' eligibility for benefits,
including relevant records; and (4) inform claimants when relevant
records are unable to be obtained.
[4] 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. Before
appealing to the Board, a veteran may ask for a review by a regional
office 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.
[5] The statistics in the Board's annual reports do not reflect all
cases in which at least one issue is remanded or denied because the
Board reports appeals outcomes on the basis of individual cases rather
than individual issues within each case. To do this, the Board counts
"case" dispositions using the following hierarchy: (1) allowed, (2)
remanded, (3) dismissed, and (4) denied. Under this hierarchy, if any
issue or part of the appeal is allowed, the entire case is counted as
an allowance, regardless of whether any other issue in the case is
remanded or denied. If no issue or part of the appeal is allowed, but
part is remanded and part is denied, the case is counted as a remand.
If no issue or part of the appeal is allowed or remanded, but part is
dismissed and part is denied, the case is counted as a dismissal. A
case is counted as denied only when all issues or parts of the appeal
are denied.
[6] In Disabled American Veterans v. Secretary of Veterans Affairs, 327
F.3d 1339 (Fed. Cir. 2003), the Court held that allowing the Board--
which is VA's "appellate tribunal" for deciding appeals of denials of
veterans' benefits claims--to consider additional evidence without
having to remand the case to the agency of original jurisdiction
(regional office) for initial consideration and without having to
obtain the appellant's waiver was contrary to the requirement of 38
U.S.C. § 7104(a) that "[a]ll questions in a matter which . . . is
subject to decision by the Secretary shall be subject to one review on
appeal to the Secretary." Section 7104(b) does not permit the
reconsideration of a claim disallowed by Board in the absence of new
and material evidence as required by 38 U.S.C. 5108; however the
regulation in question resulted in the veteran's not being able to
object effectively to any of the additional evidence obtained by the
Board until after the Board had weighed the evidence and decided the
appeal, therefore not permitting the veteran to explore effectively a
basis for "one review on appeal to the Secretary" with respect to the
additional evidence obtained by the Board.
[7] The Board's intention 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.
[8] At that time, the Board's quality reviewers assessed decision
accuracy on the basis of six areas: issues, evidence, laws and
regulations, reasons and bases, due process, and format. One error (or
deficiency) in any area meant that a decision failed the quality test.
However, according to the Board, all six areas included certain
deficiencies that are not substantive. According to the Board, most
deficiencies in the "format" category were not substantive, such as
errors in grammar, spelling, or decision structure.
[9] GAO, Veterans Benefits Administration: Problems and Challenges
Facing Disability Claims Processing, GAO/T-HEHS/AIMD-00-146
(Washington, D.C.: May 18, 2000).
[10] National Academy of Public Administration, Management of
Compensation and Pension Benefits Claim Processes for Veterans,
(Washington, D.C.: August 1997).
[11] GAO, Veterans Benefits: VA Needs Plan for Assessing Consistency of
Decisions, GAO-05-99 (Washington, D.C.: Nov. 19, 2004).
