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Office of Budget

Fiscal Year 2005 Performance and Accountability Report
Published November 15, 2005

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GAO4. IMPROVING VETERANS' DISABILITY PROGRAM: A HIGH-RISK AREA

4A. Timeliness and Accuracy

VA faces continuing challenges in improving its veterans' disability program. Although some progress has been made, VA is still far from meeting its timeliness goal. GAO made, and VA concurred with, recommendations on ways to improve the timeliness and accuracy of disability claims decisions and compensation.

VA's Program Response to GAO4A:

Please see VA's Program Response to OIG2B for a response to the timeliness of claims processing.

VBA continues to use the national Systematic Technical Accuracy Review (STAR) process to gauge accuracy of claims processing. National training efforts use STAR error trend analyses, and regional office-specific training is offered during site visits. VBA continues to work with VHA through the Compensation and Pension Examination project office to improve accuracy of compensation and pension examinations and requests.

VBA remains committed to moving from an older technology base to a modern claims processing environment (Modern Award Processing) via the series of applications developed as part of VETSNET.

VA is involved in discussions with DoD and other federal institutions to improve timeliness by reducing delays in their areas. For example, VBA is obtaining information from the Center for Unit Records Research and has interfaced with the imaged Official Military Personnel Files for the Army, Navy, and Marine Corps via the VA Personnel Information Exchange System and the Defense Personnel Records Image Retrieval System. In addition, VA is working with DoD's new data-centric system, Defense Integrated Military Human Resources System, which will be used by all branches of the military to manage personnel and pay information.

4B. Consistency of Claims Decisions

VA needs to address concerns about possible inconsistencies in disability claims decisions made by its 57 regional offices and better report and use the data on the accuracy of its decisions.

VA's Program Response to GAO4B:

VA concurred with the recommendations GAO outlined in the November 2004 report, Veterans Benefits: VA Needs Plan for Assessing Consistency of Decisions.

VBA is in the process of examining data and data sources, including data collected from the Rating Board Automation (RBA 2000) system, for development of ongoing systemic reviews for possible inconsistencies. VBA developed a detailed plan to identify inconsistencies in decision-making.

In March 2005, a working group of subject-matter experts identified elements needed to measure specific rating criteria for given medical conditions. The working group formulated tools to review and assess a stratified sample of cases consisting of grant or denial of service-connected disabilities, evaluation assigned to hearing loss, and evaluation assigned to limitation of range of motion of the knee. VBA also examined the granting or denial of service-connected disabilities for post-traumatic stress disorder (PTSD) as part of the pilot review. PTSD is one of the more subjective and difficult conditions to evaluate. Therefore, development and testing of a tool to assess evaluation assigned to PTSD will occur after VBA has drawn from lessons learned in the pilot review.

The working group reviewed cases to validate the tools, and consistency measures were documented so that corrections could be made. VBA will incorporate the process and tools used for measuring consistency into the national quality review process (the Systematic Technical Accuracy Review) for the purpose of monitoring potential inconsistencies.

Every 2 to 3 years, VBA will conduct a thorough and targeted review on each of the identified disability areas that pose consistency challenges. These reviews will be done on a rotating basis so that targeted disability areas are subject to complete review over time.

To improve the quality and consistency of he adjudicative process, VBA will continue to conduct individual and joint training involving the Board of Veterans' Appeals, the Office of General Counsel, and VHA. VBA is actively reviewing and revising its Schedule for Rating Disabilities to replace ambiguous rating criteria with more objective rating criteria.

4C. Staffing Level Justification

In addition, VA needs to provide more transparency in its justification for staffing levels in the disability compensation and pension program and use better staff attrition data and analysis in its workforce planning. VA concurred with GAO's recommendations to improve various aspects of its workforce planning.

VA's Program Response to GAO4C:

VA's planning documents will include more detailed information on areas that impact incoming and completed workload (claims complexity, productivity levels, legislative and regulatory changes to veterans benefits, etc.).

4D. Program Transformation and Modernization

VA, along with the Social Security Administration, should take the lead in examining the fundamental causes of program problems and seek both management and legislative solutions to transform their programs so that they are in line with the current state of science, medicine, technology, and labor market conditions.

VA's Program Response to GAO4D:

Congress passed legislation in 2003 to create a commission (the Veterans' Disability Benefits Commission) to study the appropriateness of VA disability and death benefit programs and to provide recommendations for change to Congress and the President. The Commission held its first meeting on May 9, 2005, and has 15 months to issue its final report to Congress. In addition to public testimony, the Commission will receive input from other organizations, including the Institute of Medicine and DoD. Sound strategic planning and execution along with the Commission's recommendations will guide any necessary realignment.