We evaluated how well the Manchester VARO accomplishes its mission. We found the staff accurately addressed entitlement to mental health treatment for Gulf War veterans. They were generally effective in processing traumatic brain injury and herbicide-related claims, correcting errors identified by internal reviews, as well as ensuring Systematic Analyses of Operations were timely and complete, and proper handling claims-related mail. However, the VARO lacked accuracy in processing some disability claims. Inaccuracies in processing temporary 100 percent disability evaluations occurred when staff did not schedule required medical reexaminations. Overall, VARO staff did not accurately process 18 (26 percent) of 68 disability claims we reviewed. Management did not have mechanisms in place to timely process competency determinations. Further, outreach to homeless shelters and service providers was not always effective.