[Congressional Record Volume 145, Number 47 (Wednesday, March 24, 1999)]
[Extensions of Remarks]
[Pages E548-E549]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  INTRODUCTION OF H.R. 1214--DEPARTMENT OF VETERANS AFFAIRS VETERANS' 
              CLAIMS ADJUDICATION IMPROVEMENT ACT OF 1999

                                 ______
                                 

                            HON. LANE EVANS

                              of illinois

                    in the house of representatives

                       Wednesday, March 24, 1999

  Mr. EVANS. Mr. Speaker, for years our Nation's veterans who submitted 
a claim to the Department of Veterans Affairs (VA) for benefits 
associated with their military service, particularly service-connected 
disability compensation, have been forced to contend with a VA claims 
adjudication process which has been both too slow and too inaccurate. 
Too often the adjudication of a veterans' claim has taken not days, not 
weeks, not months, but years.
  Recent information suggests that after waiting years for a decision, 
one out of three veterans may find that the decision made by VA was 
wrong. Untimely and inaccurate decision-making by the VA, and 
particularly the Veterans Benefits Administration (VBA), have been twin 
problems which have plagued veterans, veterans service organizations 
and Members of Congress who have sought to assist their veterans 
constituents.
  While experience clearly indicated otherwise, VBA consistently 
reported that the quality of its work was nearly error free as measured 
by VBA. Between 1993 and 1997, VA was reporting an accuracy rate of 
97%. This was unfortunately like the fox not only guarding the hen 
house, but also keeping the inventory of hens.
  To his credit, the Under Secretary of Veterans Benefits, Mr. Joe 
Thompson instituted, on a trial basis, a new system for measuring the 
quality of the claims adjudication work performed by VBA. This new 
quality measure, the Strategic Technical Accuracy Review (STAR) was 
tested and used operationally in 1998.
  STAR use has been focused on claims submitted by veterans which 
require the VA to rate the claim, make a determination as to whether a 
medical disability is service-connected or non-service-connected and 
determine the degree of disability manifest. Using the STAR 
methodology, the accuracy of various actions taken during the 
adjudication process are used to determine if the case was correctly or 
incorrectly decided. A case is either all right or all wrong. Using 
STAR, the accuracy rate was 64%--less that two out of three claims were 
correctly decided.
  While STAR has provided a more realistic assessment of the quality of 
VA claims adjudication, STAR does not currently meet generally accepted 
governmental standards for independence and separation of duties. 
Reviews of regional office decisions are made by persons who are also 
decision makers. There is not sufficient staff provided for reviewing 
enough cases to make statistically valid accuracy determinations at the 
regional office level. In order to pinpoint errors, it is important to 
be able to identify regional offices which have specific high or low 
accuracy rates and to ascertain the reasons for discrepancies between 
regional offices.
  In addition to the problems documented by the STAR report, VBA is 
facing the impending

[[Page E549]]

retirement of experienced senior staff and several years of staff 
reductions which have impeded VBA's ability to resolve increasingly 
complex cases in a timely and accurate manner.
  One measure of quality, the percentage of decisions appealed to the 
Board of Veterans Appeals (the Board) which are either reversed or 
remanded back to the regional offices for further work, is particularly 
disturbing. During fiscal year 1998, 17.2% of the appealed decisions 
were reversed outright by the Board. An additional 41.2% of the appeals 
were remanded for further action by the regional offices. Another 
measure of accuracy is the integrity of data relied upon by the VBA. 
During 1998, the VA Inspector General issued a report finding that data 
entered into the VBA computer system was being manipulated to make it 
appear that claims were processed more efficiently that was actually 
occurring.
  Problems are not confined to the Compensation and Pension Service. In 
reviewing VA's compliance with statutory financial requirements, the 
General Accounting Office (GAO) noted that VA's home loan program was 
unable to perform routine accounting functions and had lost control 
over a number of loans which were transferred to an outside loan 
company for continued loan servicing. VA was not able to obtain an 
unqualified audit opinion as a result of these deficiencies. On 
February 24, 1999, VA's Inspector General reported that the $400 
million vocational rehabilitation program was placed at high risk after 
the Quality Assurance Program for that services was discontinued in 
1995.
  Because of the fundamental importance of accurate and effective 
claims processing and adjudication by VA regional offices, and the need 
for effective oversight of regional office claims processing and 
adjudication by the Veterans' Benefits Administration, in July of 1997, 
I requested the GAO to review the quality assurance policies and 
practices of the VBA. On March 1, 1999, GAO issued its report which 
determined that further improvement is needed in claims-
processing accuracy. In particular, GAO has determined that VBA's 
quality assurance activities do not meet the standards for independence 
and internal control.

  To assure that VBA's internal quality assurance activities meet the 
recognized appropriate governmental standards for independence, I have 
introduced H.R. 1214, which provides for the establishment within VBA 
of a quality assurance division which comports with generally accepted 
government standards for performance audits. In addition, my Additional 
and Dissenting Views and Estimates submitted to the Budget Committee 
for VA's fiscal year 2000 budget requests additional funding for 250 
full time employees for VBA. It is my intention that if additional 
staff funding is provided, some of the additional staff be used to 
adequately staff this program.
  While VBA has made some improvements by developing an accuracy 
measurement which focuses on VA's core benefit work--rating claims for 
benefits--further improvements are needed in claims processing. 
Currently, there is no formal division within VBA devoted to providing 
the policy and program oversight necessary to assure quality and 
accuracy of claims processing The possible consequences of this for 
both veterans and taxpayers is troubling.
  In fiscal year 2000, the VA will pay over $22 billion dollars in 
monetary benefits to veterans. Yet only nine full-time employees are 
allocated to STAR to oversee the quality of the claims adjudication 
process. Without a mandated program of quality assurance, which meets 
generally accepted governmental auditing standards for program 
performance audits, impartial and independent oversight of the quality 
of claims adjudication decisions will not be assured.
  With the establishment of independent oversight of the quality of 
claims adjudication decisions, veterans can have more confidence in the 
decisions made by VA and the number of claims which are remanded 
because of the poor quality of claims adjudication will be reduced. 
With better initial decisions and fewer remands for re-adjudication, 
veterans will receive a quicker and a more accurate response. More 
claims will be adjudicated correctly the first time. This will not 
occur overnight, but without an independent oversight of the quality of 
claims adjudication decisions it may never exist.
  The ``Veterans' Claims Adjudication Improvement Act of 1999'', H.R. 
1214, will help address these problems. It changes the way decisions 
concerning claims for compensation and pension, education, vocational 
rehabilitation and counseling, home loan and insurance benefits will be 
reviewed and evaluated. Employees who are independent of decision 
makers will be devoted to identifying problems in the decision-making 
process. By identifying the kinds of errors made by VA personnel, VBA 
managers will be able to take appropriate action. Hopefully, remand 
rates can be significantly reduced and veterans will find that VA makes 
the right decision the first time the claim is presented.
  We cannot expect any improvement in the timeliness of claims 
adjudication unless the barriers to quality decision making are 
identified and addressed in a systemic fashion. Our nation's veterans 
deserve to have their claims for VA benefits decided right the first 
time. By enacting H.R. 1214, Congress can help put the VA claims 
adjudication process on the right track. Our veterans deserve no less. 
I strongly urge my colleagues to support the ``Veterans' Claims 
Adjudication Improvement Act of 1999'' and for Congress to give this 
measure quick and favorable consideration.

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