Veterans Benefits Administration: Clarity of Letters to Claimants
Needs to Be Improved (23-APR-02, GAO-02-395).			 
                                                                 
The Veterans Benefits Administration (VBA) provided $23 billion  
in monthly cash benefits to 3.2 million disabled veterans and	 
their families through its compensation and pension program in	 
fiscal year 2001. In the same year, VBA mailed 1.2 million	 
"notification" letters to veterans and their families, informing 
them of VBA's decisions on compensation or pension benefits	 
claims filed. VBA also sent 1.2 million "development" letters in 
fiscal year 2001 requesting information in order to make a	 
decision on claims. In 1995, VBA found that its notification and 
development letters failed to communicate adequately, and	 
launched an initiative, called Reader-Focused Writing, to improve
its written communications. In its letters, VBA clearly explained
some, but not all, of the key aspects that claimants needed to	 
understand. Beyond the lack of clarity in these letters, various 
writing deficiencies, such as sequencing and formatting problems,
reduced the value of VBA's letters. First, in many of its rating 
decision documents and development letters, VBA attempts to	 
achieve more than one objective and, in doing so, compromises	 
clarity for the reader. Second, although VBA's central office and
some regional offices have developed boilerplate paragraphs for  
letters and their attachments to increase consistency and	 
quality, some contain writing deficiencies. Third, some letters  
contain editorial mistakes and boilerplate language not adapted  
to the claimant's specific situation. Finally, VBA does not	 
systematically evaluate the clarity of its letters, identify	 
writing deficiencies, and provide timely feedback to help correct
problems. As a result, VBA lacks an organized process for	 
continuously improving the clarity of its letters.		 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-02-395 					        
    ACCNO:   A03123						        
  TITLE:     Veterans Benefits Administration: Clarity of Letters to  
Claimants Needs to Be Improved					 
     DATE:   04/23/2002 
  SUBJECT:   Claims processing					 
	     Compensation claims				 
	     Pension claims					 
	     Quality assurance					 
	     Veterans						 
	     Veterans benefits					 
	     Written communication				 
	     VA Systematic Technical Accuracy Review		 
	     System						 
                                                                 
	     VBA Reader-Focused Writing Program 		 


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GAO-02-395
     
Report to the Ranking Democratic Member, Committee on Veterans' Affairs,
House of Representatives

United States General Accounting Office

GAO

April 2002 VETERANS BENEFITS ADMINISTRATION

Clarity of Letters to Claimants Needs to Be Improved

GAO- 02- 395

Page i GAO- 02- 395 Letters to Claimants Need to Be Improved Letter 1

Results in Brief 2 Background 4 In Many VBA Letters, Certain Key Aspects
Were Clear but Others

Were Not 7 Multiple Factors Contribute to Deficiencies; Some Initiatives Are

Under Way, but an Evaluation System Is Needed 30 Conclusions 40
Recommendations 42 Agency Comments and Our Response 42

Appendix I Comments from the Veterans Benefits Administration 44

Appendix II Scope and Methodology 48

Appendix III GAO Contacts and Staff Acknowledgments 52 GAO Contacts 52 GAO
Acknowledgments 52

Tables

Table 1: Percentages of VBA?s Notification Letters That Were Unclear, by
Type 8 Table 2: Percentages of VBA?s Development Letters That Were

Unclear 21 Table 3: Writing Deficiencies That Obscured Development Letters?

Explanation of Actions That Claimants Should Take 23 Table 4: Status of VBA
Initiatives That Can Improve Clarity of

Letters and Attachments 31 Table 5: Similarity of Technical Language in
Medical Criteria from

the Schedule for Rating Disabilities and a Rating Decision Document 33

Figures

Figure 1: Compensation Letter That Clearly Stated the Decision 10 Figure 2:
Pension Letter That Did Not Clearly State the Decision 11 Contents

Page ii GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 3: Rating Decision Document That Clearly Summarized, Despite Medical
Terminology, the Reasons for the Decision 13 Figure 4: Compensation Letter
That Clearly Stated Financial

Information about the Claimant?s Benefits 16 Figure 5: Compensation Letter
Illustrating VBA?s Policy of

Communicating the Gross Benefit Amount 17 Figure 6: Compensation Letter in
Which the Date the Claimant Was

First Eligible for Benefits Was Unclear 18 Figure 7: Notification Letter
That Clearly Stated the Claimant?s

Rights and Responsibilities, Contact Information, and Other Benefits for
Which the Claimant Could Be Eligible 20 Figure 8: Development Letter That
Clearly Set Forth What VBA

Needed from the Claimant 22 Figure 9: Letter Attachment with Technical
Jargon and Lengthy

Sentences That Made It Difficult to Understand 26 Figure 10: Form That Was
Clear and Easy to Read 27 Figure 11: Respondents to the Customer
Satisfaction Survey Who

Appealed or Contacted VBA to Discuss a Decision on a Compensation or Pension
Claim 29

Abbreviations

RO regional office VBA Veterans Benefits Administration VA Department of
Veterans Affairs VCAA Veterans Claims Assistance Act

Page 1 GAO- 02- 395 Letters to Claimants Need to Be Improved

April 23, 2002 The Honorable Lane Evans Ranking Democratic Member Committee
on Veterans? Affairs House of Representatives

Dear Mr. Evans: In fiscal year 2001, the Department of Veterans Affairs?
(VA) Veterans Benefits Administration (VBA) provided more than $23 billion
in monthly cash benefits to approximately 3.2 million disabled veterans and
their families through its compensation and pension program. In the same
year, VBA mailed approximately 1.2 million ?notification? letters to
veterans and their families, informing them of VBA?s decisions regarding
claims that they had filed to receive compensation or pension benefits. VBA
also sent about 1.2 million ?development? letters in fiscal year 2001
requesting information that the agency needed to reach a decision on claims.
1 Because these letters serve as VBA?s official means of communicating its
decisions to claimants and requesting information to support claims, it is
important that the letters be clearly written and easy to understand.

In 1995, VBA found that its notification and development letters, among
other types of letters, failed to communicate adequately, and it launched a
still ongoing initiative, called Reader- Focused Writing, to improve its
written communications. Because of your concern about the current
understandability of VBA?s letters, you asked us to assess (1) the extent to
which VBA?s notification and development letters are understandable to the
reader and (2) the causes of any deficiencies and whether VBA has
implemented initiatives to correct these deficiencies.

1 We estimated the number of notification and development letters because
these numbers are not tracked. We based our estimate on the assumption that
most benefit decisions would generate, at a minimum, one notification and
one development letter. While some decisions might not require a development
letter and others could result in multiple notification letters, development
letters, or both, generally VBA will generate at least one notification
letter and one development letter for each decision. These estimates do not
reflect letters generated for certain types of activities, such as appeals
or special reviews. Neither do the estimates reflect the letters sent to
claimants to explain cost- of- living adjustments in their benefits or
acknowledging receipt of their claims.

United States General Accounting Office Washington, DC 20548

Page 2 GAO- 02- 395 Letters to Claimants Need to Be Improved

To address these issues, we analyzed a random sample of each of three types
of letters: (1) letters notifying claimants of original and reopened
compensation decisions, (2) letters notifying claimants of original and
reopened pension decisions, and (3) compensation and pension development
letters sent to claimants. 2 We selected these letters from VBA?s national
sample of cases. This sample was likely to have included both letters that
had been rewritten under the agency?s initiative to improve the quality of
its compensation and pension program letters, as well as letters that had
not been rewritten. We limited the sample of development letters to those
written in 2001, to assure that they were written after promulgation of a
new law, the Veterans Claims Assistance Act (VCAA). The VCAA defines VBA?s
duty to assist claimants in gathering evidence to support their claims.

We reviewed the letters against a set of decision rules that we had
developed for assessing letter clarity. We developed these rules in
consultation with writing consultants, taking into consideration VBA?s legal
and policy requirements for its notification and development letters.
Writing consultants verified that the decision rules were reliable for
assessing, and were a valid measure of, letter clarity. Writing consultants
also reviewed the clarity of standard forms commonly attached to VBA?s
letters.

We also interviewed officials at VBA?s central office and at 7 of VBA?s 57
regional offices (ROs), as well as representatives of veterans service
organizations. In addition, we reviewed VBA laws, regulations, and policies
on notification and development letters and VBA documentation on initiatives
to improve letter clarity. We conducted our work between March 2001 and
March 2002 in accordance with generally accepted government auditing
standards. For more details about our scope and methodology, see appendix
II.

In its letters, VBA clearly explained some, but not all, of the key aspects
that claimants needed to understand. In most of its notification letters,
VBA clearly stated the decision concerning claimants? entitlement to
benefits, claimants? responsibilities, their right to appeal, how they could

2 When a claimant submits an initial claim to VBA for compensation or
pension benefits, that claim is designated as an ?original? claim. Once the
original claim is decided, subsequent claims are called ?reopened? claims.
For example, claimants may submit reopened claims to request an increase in
benefits or reconsideration of a previous denial. Results in Brief

Page 3 GAO- 02- 395 Letters to Claimants Need to Be Improved

contact VBA for more information, and other benefits for which they might be
eligible. However, other key aspects that claimants needed to understand
were unclear. About half of VBA?s compensation letters did not clearly
explain pertinent financial information concerning the claimants? benefit.
Similarly, nearly 30 percent of compensation letters did not clearly explain
the reason for VBA?s decision regarding whether or not to award benefits.
Among the letters that did not clearly explain the reason for the decision,
many had legal and medical terminology in the attached rating decision
document that would be difficult for a layperson to understand. Further,
about 43 percent of the development letters did not clearly explain the
actions that claimants were to take to support their claims. Beyond the lack
of clarity in these key aspects of the letters, various writing
deficiencies, such as sequencing and formatting problems, reduced the
overall clarity of VBA?s letters. Unclear notification and development
letters confuse and frustrate claimants. As a result, claimants are more
likely to contact VBA to discuss or appeal the decision, adding to VBA?s
workload, or they may not pursue benefits to which they are entitled.

Four key factors contribute to deficiencies in VBA?s letters, and VBA has
initiated efforts to address some of these deficiencies. First, in many of
its rating decision documents and development letters, VBA attempts to
achieve more than one objective and, in doing so, compromises clarity for
the reader. For example, in its development letters, in attempting to
explain VBA?s new legal duties for assisting veterans in gathering evidence,
the agency obscures its request that the claimant provide information to
support the claim. Second, although VBA?s central office and some ROs have
developed boilerplate paragraphs for letters and their attachments to lessen
the time that employees spend in creating them and to increase consistency
and quality, some of these paragraphs contain writing deficiencies. Because
the unclear text is part of the boilerplate language, it appears in numerous
letters and their attachments that are mailed to claimants. VBA began taking
steps in the spring of 2001 to clarify the boilerplate language in the
national compensation and pension notification letters. It tested these
revised national letters and mandated their use by all ROs at the end of
2001, but the extent to which these letters are being used by the ROs is
unknown. Third, some types of writing deficiencies are caused by human
errors. These include editorial mistakes and boilerplate language not
adapted to the claimant?s specific situation. Finally, despite its efforts
to make its letters more understandable, VBA does not systematically
evaluate the clarity of its letters, identify writing deficiencies, and
provide timely feedback to help correct such

Page 4 GAO- 02- 395 Letters to Claimants Need to Be Improved

deficiencies. As a result, VBA lacks an organized process for continuously
improving clarity of its letters.

We are making recommendations in this report to the Secretary of the
Department of Veterans Affairs to improve the clarity of VBA?s letters.
These recommendations include simplifying and clarifying the wording of the
letters in ways that facilitate claimants? comprehension and evaluating
letter clarity by obtaining periodic input from claimants, their
representatives, and staff who write letters. VA, in commenting on a draft
of this report, agreed with our conclusions and concurred with our
recommendations, and it detailed ongoing efforts and plans, including
timeframes, to implement the recommendations.

In the early 1990s, VBA learned through focus groups, surveys, and other
studies that the agency was not communicating adequately with claimants. The
agency also learned that lack of clarity in its letters was taking a toll on
its efficiency by generating unnecessary calls to its ROs for clarification
and creating unnecessary work on claims. To satisfy its customers and to
increase efficiency, VBA launched its Reader- Focused Writing Program in
1995 to create understandable communications throughout the agency by
focusing on what the reader needs to know. To better meet the needs of the
reader, Reader- Focused Writing seeks to design documents that adhere to
certain principles, including the following: (1) tell the reader the main
message up front, (2) use headings and group similar information in short
sections to help the reader find specific information, (3) use clear and
concise sentences that avoid jargon, and (4) use correct spelling, grammar,
and punctuation. VBA has taken a number of steps since 1995 to implement its
Reader- Focused Writing initiative and, as a result, was recognized by then
President Clinton as a leader in the governmentwide movement to use ?plain
language? in all written communications. For instance, a major step in
implementing Reader- Focused Writing involved training nearly all of VBA?s
employees in the basic principles of ReaderFocused Writing through courses
tailored to address the needs of particular positions, including VBA?s
veterans service representatives, who are generally responsible for
preparing notification and development letters for VBA?s compensation and
pension program.

VBA?s compensation and pension program provides monthly cash benefits to
eligible veterans and their dependents. In fiscal year 2001, approximately
2. 6 million beneficiaries received a total of $20.2 billion in disability
compensation benefits, and approximately 600,000 beneficiaries received $3.0
billion in disability pension benefits. The rules affecting Background

Page 5 GAO- 02- 395 Letters to Claimants Need to Be Improved

eligibility and benefit amounts in these programs can be complex. VBA pays
monthly compensation benefits, based on the degree of disability (from 0 to
100 percent), to veterans who have service- connected disabilities (injuries
or diseases incurred or aggravated while on active military duty). The
amount of basic benefits for veterans with no dependents ranges from $103 to
$2,163 per month, depending on the degree of disability. VBA pays monthly
pension benefits, based on financial need, to wartime veterans who have low
incomes and are permanently and totally disabled for reasons that are not
service connected. 3 For both types of benefits, additional amounts are paid
for dependents as well as for a range of special needs. Under certain
circumstances, claimants who are found to have a service- connected
disability or are eligible for pension benefits can also qualify for other
VA- provided benefits, including health care, employment support, and
educational assistance. For example, disability compensation is a gateway to
vocational rehabilitation and employment services for some veterans.

To obtain compensation or pension disability benefits, a claimant applies to
one of VBA?s 57 ROs. Upon receipt of a substantially complete claim, a
veterans service representative attempts to obtain the evidence required to
support the claim, which can involve creating and mailing a development
letter requesting the necessary information from the claimant or someone
else. If appropriate, an RO rating specialist subsequently analyzes the
evidence obtained, evaluates the claimed conditions to determine whether
they are service connected, and assigns a rating for the degree to which
each claimed service- connected condition is disabling. To assign the
rating, the rating specialist uses the Schedule for Rating Disabilities.
This schedule contains medical criteria and disability ratings associated
with the level( s) of severity for each condition.

To record the reasoning underpinning the decision, the rating specialist
prepares a rating decision document. This document is supposed to

3 To be eligible for pension benefits, in addition to having low income and
permanent and total disability, veterans must have 90 days or more of active
military service, at least one day of which was during a period of war.
Under the law, VA recognizes certain war periods. For example, the war
period for the Vietnam War is generally considered to be August 5, 1964,
through May 7, 1975. The war period for the Gulf War is considered to have
begun August 2, 1990, and is not yet recognized as having ended. Under the
Veterans Education and Benefits Expansion Act of 2001, enacted on December
27, 2001, veterans who are 65 years or older do not have to be permanently
and totally disabled to become eligible for pension benefits, as long as
they meet the other requirements for income and military service.

Page 6 GAO- 02- 395 Letters to Claimants Need to Be Improved

explain, for each claimed condition, VBA?s decision; the evidence considered
in reaching the decision; the evidence for and against the claim; and the
rationale for the decision, based on the facts and applicable legal
requirements. Once a decision on benefit eligibility is reached, a veterans
service representative creates a cover letter notifying the claimant of the
decision and attaches the rating decision document and necessary forms (e.
g., a form describing a claimant?s appeal rights). The letter package is
then mailed to the claimant. A copy of the letter and its attachments is
also mailed to the veterans service organization representing the claimant,
if the claimant has named one. If the claimant disagrees with the decision,
he or she can request a review by an RO decision review officer, who will
attempt to resolve the disagreement. If the claimant continues to disagree
with the decision, he or she may appeal the decision to VA?s Board of
Veterans? Appeals and subsequently to the Court of Appeals for Veterans
Claims, which is independent of VA. Finally, either the claimant or VA may
appeal a decision of the Court of Appeals for Veterans Claims to the Court
of Appeals for the Federal Circuit.

Legal, regulatory, and policy requirements govern the standards for
notification and development letters prepared in the ROs. Notification
letters should clearly state (1) the decision made; (2) the date the
decision is to be effective, the monthly rates payable to the claimant, and
any amounts to be withheld from the benefits; (3) the reasons for the
decision; (4) a claimant?s right to appeal the decision, including
procedures and time limits; and (5) any additional benefits to which the
claimant may be entitled. Standards for development letters follow the
tenets of the VCAA, which was signed into law on November 9, 2000. According
to the act, development letters are to advise claimants of any information
needed to substantiate their claims- including the information that
claimants are to submit in support of their claims, as well as that which
VBA is to obtain on the claimants? behalf. In addition, VBA policy requires
that these letters inform the claimant of the consequences for not
submitting the requested information within a specified time limit.

To create a letter, veterans service representatives select from a national
database certain boilerplate paragraphs that they can tailor to a particular
claimant by inserting an unlimited amount of free text. Some ROs have
adapted letters from the national database and created their own local
letter databases. Additionally, individual letter writers in the ROs have
created their own sets of letters by modifying the national and local
letters.

Page 7 GAO- 02- 395 Letters to Claimants Need to Be Improved

VBA?s ROs, which create the notification and development letters, face a
complex operating environment. According to the VA Claims Processing Task
Force, which was established by the Secretary in 2001 and which reviewed
VBA?s claims processing problems, VBA?s inventory of pending claims nearly
doubled, from about 350,000 to nearly 670,000 cases, between 1989 and August
2001. 4 Of the pending cases in August 2001, nearly 420,000 involved a
disability rating. 5 VBA wants to reduce this backlog of pending claims
involving a disability rating to 250,000 cases by September 2003. Over the
past decade, the average amount of staff time that it takes for VBA to
process a compensation claim has more than doubled. The task force
attributes VBA?s growing backlogs and increased processing time to a number
of factors. For example, veterans are filing increasingly complex claims,
with more disabilities per case than in the past and with disabilities that
are more difficult to evaluate, such as illnesses related to service in the
Gulf War. In addition, a number of legislative and regulatory changes, such
as VBA?s duty to assist claimants in gathering evidence to support their
claims, have added to the complexity of processing claims. Moreover, VBA has
recently hired a significant number of veterans service representatives and
rating specialists to fill vacancies left by a recent wave of retirements.
At the end of fiscal year 2001, about one quarter of veterans service
representatives and rating specialists had less than one year of experience
in their jobs. According to VBA, these new hires require intensive training
and on- thejob experience to achieve proficiency. 6

In its letters, VBA clearly explained some, but not all, of the key aspects
that claimants needed to understand. In most of its notification letters,
VBA clearly stated the decision concerning claimants? entitlement to
benefits, claimants? responsibilities, their right to appeal, how they could
contact VBA for more information, and other benefits for which they might be
eligible. However, other key aspects that claimants needed to

4 Department of Veterans Affairs, Claims Processing Task Force, Report to
the Secretary of Veterans Affairs (Washington, D. C.: 2001), p. 9. 5 Cases
that do not involve a disability rating include such cases as adjustments to
benefits resulting from income and dependency changes. Comparable data on
the number of pending cases involving a disability rating in 1989 are
unavailable.

6 For further information on VBA?s training program, see U. S. General
Accounting Office,

Veterans? Benefits: Training for Claims Processors Needs Evaluation, GAO-
01- 601 (Washington, D. C.: May 31, 2001). In Many VBA Letters,

Certain Key Aspects Were Clear but Others Were Not

Page 8 GAO- 02- 395 Letters to Claimants Need to Be Improved

understand were unclear in compensation letters. These included pertinent
financial information and the reason for VBA?s decision regarding whether or
not to award benefits. Further, about 43 percent of development letters did
not clearly explain the actions that claimants should take to support their
claims. Beyond the lack of clarity in these key aspects of the letters,
various writing deficiencies, such as sequencing and formatting problems,
reduced the overall clarity of VBA?s letters. Unclear notification and
development letters confuse and frustrate veterans. As a result, they are
more likely to contact VBA to discuss or appeal the decision, adding to
VBA?s workload, or they may not pursue benefits to which they are entitled.

Many of VBA?s notification letters were understandable in certain key
aspects. However, significant percentages of VBA?s notification letters were
difficult to understand in other key areas (see table 1).

Table 1: Percentages of VBA?s Notification Letters That Were Unclear, by
Type Percentages of letters that were

unclear Key aspects of VBA?s notification letters Compensation Pension

Decision concerning the claimant?s entitlement to benefits 5 15 Reason for
the decision 29 10 Financial information concerning the claimant?s benefit
52 a, b 7 b Claimant?s responsibilities and appeal rights and ways to
contact VBA for more information 4 6 Other benefits available to the
claimant 0 b N/ A c a The 95 percent confidence interval around this
estimate ranges from 37 to 67 percent.

b The percentage was based on only those letters in the sample that
contained the applicable information. c The sample of pension letters that
we reviewed included almost no letters that contained the

applicable information. Legend: N/ A = not applicable. Source: GAO?s review
of a national sample of letters.

The vast majority of letters- 95 percent of compensation letters and 85
percent of pension letters- clearly conveyed, in general, the decision
concerning the claimant?s entitlement to benefits. In comparison, VBA Some
Notification Letters

Did Not Clearly Communicate the Reason for VBA?s Decision or Financial
Information

Decision Concerning Entitlement

Page 9 GAO- 02- 395 Letters to Claimants Need to Be Improved

estimates that about 70 and 80 percent of their customers, respectively,
believe that VBA?s compensation and pension letters explained the decision
in a way that the reader could understand. 7 The letter in figure 1 provides
an example of a compensation decision covering nine separate conditions that
was particularly clear and easy to read, primarily because of the use of
simple lay language.

Although the great majority of VBA?s pension letters clearly stated the
decision concerning the claimant?s entitlement to benefits, 15 percent of
the pension letters in our sample did not. Among the letters that we
reviewed that were unclear, in most cases, the statement of the decision in
the letter was inconsistent with that in the attached rating decision
document. Figure 2 illustrates such a case. In this instance, the
notification letter stated that VBA denied the claim for pension. However,
the rating decision document stated that entitlement to pension was granted.
Neither the notification letter nor the rating decision document explained
how the claimant could be entitled to a pension and at the same time be
denied it.

7 Data were provided by Surveys and Research staff, VBA Data Management
Office (from data presented in Department of Veterans Affairs, Veterans
Benefits Administration,

Survey of Veterans? Satisfaction with the VA Compensation and Pension Claims
Process: 2000 Summary Report [Washington, D. C.: 2001]). See appendix II for
a description of possible data limitations. Veterans responding to the
customer satisfaction survey would have evaluated letters written prior to
spring 2001, when VBA launched its initiative to improve the quality of its
compensation and pension program letters. In contrast, the samples of
letters that we reviewed were likely to have included some letters that had
been rewritten under the initiative.

Page 10 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 1: Compensation Letter That Clearly Stated the Decision A What Did We
Decide?

Commentary

The letter set forth VBA?s decision to deny the claim on nine separate
conditions. It was written in lay language (e. g., ?left ankle condition? or
?right shoulder pain?) and contained no

editorial mistakes. 1. Service connection for carpal tunnel syndrome,
bilateral

wrists is denied. 2. Service connection for residuals of right eye injury is

denied. 3. Service connection for shin splints is denied. 4. Service
connection for low back pain is denied. 5. Service connection for headaches
is denied. 6. Service connection for leg cramps is denied. 7. Service
connection for left ankle condition is denied. 8. Service connection for
exposure to asbestos as a result of

asbestos exposure is denied. 9. Service connection for right shoulder pain
is denied.

A A

Page 11 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 2: Pension Letter That Did Not Clearly State the Decision A

B A

B C

Why We Denied Your Claim

We cannot approve your claim for pension because your yearly family income
is $37,879.00. This amount exceeds the limit set by law of $18,405.00 for a
veteran with a wife with the aid and attendance allowance.

We have enclosed a copy of our Rating Decision for your review. It provides
a detailed explanation about our decision, including the evidence considered
and the reasons and basis for our decision.

1. Entitlement to pension is granted. 2. Entitlement to special monthly
pension based on the need for

aid and attendance is established effective June 14, 2001.

Commentary

The letter set forth the decision on the claim for pension. The claim was
denied because of income that exceeded specified limits.

The letter referred the claimant to the attached rating decision document
for an explanation of the decision.

To the lay reader, the statement of the decision in the attached rating
decision document seems to contradict VBA?s decision as stated in the
letter. The rating decision document stated that the claimant was entitled
to pension and to another ?special monthly pension.?

DECISION: C

A B C

Page 12 GAO- 02- 395 Letters to Claimants Need to Be Improved

Seventy- one percent of VBA?s compensation letters and 90 percent of its
pension letters clearly stated, in general, the reason for the decision. In
comparison, VBA estimates that 74 and 81 percent of its customers,
respectively, believe that VBA?s compensation and pension letters clearly
explained all of the reasons for the decision. 8 Figure 3 illustrates a
rating decision document from our sample that used nontechnical language to
explain how the facts of the case led to the decision. Despite the presence
of technical language in the recitation of the facts of the case and in the
criteria used to assign the degree of disability, this rating document
provided a brief, generally plain English summary of the reasons for the
decision that a layperson could understand.

Although the reason for VBA?s decision in most of these compensation and
pension letters was generally clear, nearly one- fifth of the compensation
letters included rating decision documents that contained editorial mistakes
or redundancies. Editorial mistakes included typographical errors, run- on
sentences, and sentence fragments, making the documents more challenging to
read. In addition, redundancies made the rating documents unnecessarily
lengthy. For example, a legal requirement- such as the VCAA provisions- was
listed for each of the multiple conditions, rather than being stated once
for all claimed conditions. Similarly, the rating documents sometimes
repeated language for each claimed condition that described the RO?s
attempts to obtain information from the claimant and the claimant?s failure
to respond to these attempts, when stating it once would have sufficed. In
one rating document, essentially the same paragraph- including the sentence
fragments embedded in it- was repeated 7 times throughout a 13- page
document.

8 See footnote 7. Reason for the Decision

Page 13 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 3: Rating Decision Document That Clearly Summarized, Despite Medical
Terminology, the Reasons for the Decision A

B Commentary

The facts of the case were written with medical terminology that would be
difficult for a layperson to understand. Similarly, the medical criteria
used to assign the degree of disability were written with medical terms.

In spite of the medical terms used in describing the facts and the criteria,
the document provided a simple, brief summary, written in lay language, of
the reasons for the decision.

VA examination notes no objective findings of loss of range of motion and
the veteran had flexion of 140 degrees and full extension. The patella was
hypermobile and there was a small prepateller effusion. There was no laxity
of the knee and no tenderness. Subjectively the veteran does state his left
knee is intermittently painful and gets stiff. He notices his knees are
symptomatic going up and down stairs with discomfort and stiffness. He has
had to limit such physical activities such as running. Patellofemoral
syndrome was diagnosed.

A B C

An evaluation of 10 percent is assigned under diagnostic code 5257 from
September 5, 2000. An evaluation of 10 percent is granted if the record
shows recurrent subluxation or lateral instability of the knee which is
slight. A higher evaluation of 20 percent is not warranted unless there is
evidence of moderate subluxation or lateral instability of the knee.

C Although the VA examiner did not give any objective findings of any
limitation of motion and flexion and extension were normal, the veteran
still is experiencing pain in left knee. The veteran does state that his
knee is intermittently painful and gets stiff. He also notices that he has
pain when going up and down stairs. He has limited his physical activities
such as running and avoids walking any long distances. Because of the
functional limitations due to knee pain, a 10 percent evaluation is
assigned.

A B C

Page 14 GAO- 02- 395 Letters to Claimants Need to Be Improved

While notification letters, in general, clearly stated the reason for VBA?s
decision concerning the claimant?s entitlement to benefits, 29 percent of
the compensation letters did not. Among the letters that were unclear, many
had legal and medical terminology in the rating decision document that would
be difficult for a layperson to understand. For example, one rating decision
document used highly technical medical language in attempting to establish
the reasons for a decision about inflammation of tendons in the wrist (De
Quervain?s Syndrome), as follows:

The evaluation of Post operative residuals, De Quervain?s Syndrome, right
wrist is increased to 40 percent disabling effective April 19, 2001. An
evaluation of 40 percent is assigned under diagnostic code 5214 from April
19, 2001. An evaluation of 40 percent is granted for any position of
ankylosis other than: palmar flexion, ulnar or radial deviation, or
favorable ankylosis in 20 to 30 degrees of dorsiflexion. A higher evaluation
of 50 percent is not warranted unless evidence demonstrates unfavorable
ankylosis of the wrist in any degree of palmar flexion, or with ulnar or
radial deviation. [Claimant name] experiences limitation of dorsiflexion to
10 degrees, which warrants assignment of the 40 percent evaluation. She does
not, however, experience unfavorable ankylosis in palmer [sic] flexion, or
with ulnar or radial deviation, which warrants the 50 percent evaluation.

Another rating decision document used the legalistic language illustrated
below in trying to explain why a case did not warrant a higher evaluation
than would be allowed by the rating schedule. In this paragraph, technical
jargon such as ?schedular evaluation,? ?extra- schedular evaluation,? and

?increased evaluation,? as well as such legalistic language as ?to render
impractical the application of the regular schedular standards,? would be
difficult for a lay reader to understand.

In exceptional cases where the schedular evaluations are found to be
inadequate, an extra- schedular evaluation may be approved, provided that
case presents such an exceptional or unusual disability picture, with such
related factors as marked interference with employment or frequent periods
of hospitalizations, as to render impractical the application of the regular
schedular standards. The veteran has not submitted evidence tending to show
this case presents such an exceptional or unusual disability picture as to
warrant an extra- schedular increased evaluation, and the veteran has made
no assertion to that effect. Accordingly, referral for an extra- schedular
increased evaluation is not warranted in this case.

Likewise, VBA officials in the agency?s central office and in the ROs, as
well as claimant representatives, told us that rating decision documents are
difficult for claimants to understand because of the highly technical
language. Officials in one RO, for example, told us that the RO received, on
average, between 8 and 15 calls per day from claimants about letters and
rating decisions. Several calls typically involved claimants? asking for
clarification of language in the rating decision, particularly about how VBA

Page 15 GAO- 02- 395 Letters to Claimants Need to Be Improved

had reviewed the evidence and reached the decision, as well as what other
evidence the claimant could submit to better substantiate the claim.

Forty- eight percent of compensation letters and 93 percent of pension
letters that contained financial information clearly conveyed, in general,
such information. Figure 4 provides an example of a compensation letter with
clear financial information. In this letter, the explanation of the payment
start date was consistent with the actual date given in the table, and the
letter clearly stated the reasons cited for the benefit.

However, in 52 percent of VBA?s compensation letters that contained
financial information concerning the claimant?s benefit, this information
was unclear. Among the letters that did not clearly explain the financial
information, 30 percent or more had one or more of the following
deficiencies:

 The way that financial information was communicated could make claimants
think that they would receive a larger payment than they would actually
receive. When notifying claimants of a decision that would result in a
retroactive change in benefits, several letters gave the new gross monthly
entitlement amount, less any withholding amounts (see figure 5). These
letters did not explain to claimants that to calculate their net retroactive
benefits, they must deduct from the gross amount the benefits that they had
already received at the preexisting rate. Veterans? representatives in the
two regions that we visited told us that presenting the gross benefit amount
without any explanation confused claimants, causing them to think that they
would receive a larger retroactive payment than they would actually receive.
However, several RO and central office officials with whom we spoke had not
found problems with this method of communicating the benefit amount to
claimants.

 Inconsistencies, contradictions, and incomplete information in VBA?s
compensation letters resulted in unclear statements of the date that the
claimant was first eligible for payment. Figure 6 provides an excerpt from a
typical example. In this letter, the general explanation of the payment
start date was not applicable to the particular case. As a result, the
payment start date that one would expect from reading this general
explanation was inconsistent with the actual date given in the letter.

 The explanations of how the benefit amount was computed were incomplete or
contradictory, contained convoluted language, or were simply missing. For
example, in one letter, the monthly rate of payment of benefits was
projected to decrease over the next three years without any explanation for
the decrease. Financial Information

Page 16 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 4: Compensation Letter That Clearly Stated Financial Information
about the Claimant?s Benefits A B

When Can You Expect Payment? Commentary

Payment was to begin the first day of the month following the

?effective date.? The effective date was generally the date that VBA
received the claim.

This claim was received on January 31, 2001. The actual payment start date
was established as February 1, 2001, as the claimant would expect.

The reasons cited for the benefit were clearly stated in lay language and
contained no editorial mistakes. Additionally, the reasons cited presented
no contradictions. Your payment begins the first day of the month following
your

effective date. Generally, your effective date is the date we receive your
claim. We made a decision on your claim for service connected disability
benefits received on January 31, 2001. Your monthly check amount is shown
below:

What Is Your Check Amount And Payment Start Date?

D D

C

We are paying you as a single veteran with no dependents. A B

D C A B

D C

Page 17 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 5: Compensation Letter Illustrating VBA?s Policy of Communicating the
Gross Benefit Amount B What Is Your Check Amount And Payment Start Date?

Your monthly check amount is shown below:

Commentary

A. ?Payment Start Date? was February 1, 2001, 4ï¿½ months prior to the date of
the letter, which was June 13, 2001. B. VBA assigned the claimant an
increased degree of disability (from 10 to 20 percent) for one condition. C.
As a result, the claimant?s benefits were increased retroactively to the
payment start date to reflect the difference between the amount the veteran
had been receiving and the newly established amount. ?Total Amount Granted?
referred to the newly awarded gross monthly entitlement amount.

D. The ?Amount Withheld? referred to special withholdings, such as military
retirement pay, deducted from the monthly entitlement amount. E. VBA
subtracted the amount withheld from the total amount granted to obtain the
?Monthly Check Amount.? Contrary to what the heading says, the ?Monthly
Check Amount? did not reflect the net monthly amount the claimant would have
actually received. To calculate that amount, the claimant must have deducted
from the ?Monthly Check Amount? the previous monthly benefit payments that
he or she had already received for the 4ï¿½ months prior to the date of the
letter.

A B

A D E C D E C

What Did We Decide?

We increased your service connected disability rating for the following
condition( s):

Page 18 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 6: Compensation Letter in Which the Date the Claimant Was First
Eligible for Benefits Was Unclear A When Can You Expect Payment?

Your payment begins the first day of the month following your effective
date. Generally, your effective date is the date we receive your claim.

B We made a decision on your claim for service connected disability benefits
received on October 2, 2000.

Commentary

Payment was to begin the first day of the month following the

?effective date.? The reader was told only that the effective date was
generally the date that VBA received the claim.

This claim was received on October 2, 2000. The claimant would therefore
conclude that payment would begin November 1, 2000.

However, the payment start date was established as June 1, 2000, with no
further explanation in the letter.

The rating decision document, to which the reader would typically turn only
after having read the multipage letter, showed that, in this case, the
effective date- May 22, 2000- was not the date that VBA received the claim.
The effective date, instead, was the date that VBA granted service
connection for a claimed condition.

A B

C C What Is Your Check Amount And Payment

Start Date?

Your monthly check amount is shown below:

D A B C

D DECISION:

1. Service connection for right knee condition is granted with an evaluation
of 10 percent effective May 22, 2000. . . . . .

D

Page 19 GAO- 02- 395 Letters to Claimants Need to Be Improved

Nearly all of VBA?s letters- 96 percent of compensation letters and 94
percent of pension letters- clearly explained, in general, a claimant?s
responsibilities and right to appeal VBA?s decision and how to contact VBA.
Claimant responsibilities include, for example, reporting changes in income
or dependents that could affect benefits. VBA?s letters generally used
simple, lay language to explain the rights, responsibilities, and contact
information, as illustrated in figure 7.

While the letters were generally clear in explaining claimant rights and
responsibilities and VBA contact information, nearly 30 percent of pension
letters and 17 percent of compensation letters did not provide a deadline
for filing an appeal of VBA?s decision, as required by VBA policy. 9
However, a form describing appeal rights- including the deadline for filing
an appeal- was attached to nearly all notification letters. In those
notification letters that mentioned a deadline for appealing, the deadline
always complied with the statutory requirement that an appeal be filed
within one year of the date of the notification letter.

VBA?s compensation letters that mentioned other benefits for which the
claimant might be eligible clearly explained, in general, these other
benefits, using lay terms. These benefits include, for example, medical,
educational, or vocational rehabilitation benefits. The letter in figure 7
(see the paragraphs labeled ?C?) illustrates VBA?s use of lay terminology in
explaining the benefits for which the claimant could be eligible.

9 The 95 percent confidence interval for the pension estimate ranges from 19
to 41 percent. Responsibilities, Appeal Rights,

and Contact Information Other Benefits Available

Page 20 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 7: Notification Letter That Clearly Stated the Claimant?s Rights and
Responsibilities, Contact Information, and Other Benefits for Which the
Claimant Could Be Eligible

A B

C D

E C If You Need Medical Care

You can receive free medical care for any service- connected disability. You
can apply for treatment at the nearest VA medical center. Take a copy of
this letter with you.

Are You Entitled To Additional Benefits?

You may be eligible for Department of Veterans Affairs (VA) vocational
rehabilitation. The enclosed VA Form 28- 8890 explains this benefit. To
apply, complete VA Form 28- 1900, and return it to this office.

E What You Should Do If You Disagree With Our Decision.

If you do not agree with our decision, you should write and tell us why. You
have one year from the date of this letter to appeal the decision. The
enclosed

VA Form 4107, ?Notice of Procedural and Appellate Rights,? explains your
right to appeal.

A How Do You Start Direct Deposit?

Your money may be deposited directly into your checking or savings account.
This is the safest and most reliable way to get your money. For more
information about Direct Deposit, please call us toll free by dialing 1-
877- 838- 2778.

D Do You Have Questions Or Need Assistance?

. . . If you have any further questions, call us toll- free by dialing 1-
800- 827- 1000. Our TTD number for the hearing impaired is 1- 800- 829-
4833.

If you call, please have this letter with you.

Commentary

This sentence clearly set forth contact information about directly
depositing the benefit amount.

This sentence clearly reminded the claimant of his or her responsibility to
report changes in the status of dependents. These two paragraphs clearly
explained that the claimant might be eligible

for medical and vocational rehabilitation benefits and how to apply for
these benefits. This paragraph clearly explained how claimants could contact
VBA for more

information. The final paragraph briefly highlighted the actions that
claimants could take if they disagreed with the decision, stating the one-
year deadline for appealing the decision and referring the claimant to an
attached form that details procedures for appealing.

C E A

D B B Are Your Dependents Included In This?

. . . Your payment includes an additional amount for your spouse, , and your
children, , , , and . Let us know right away if there is any change in the
status of your dependents.

Page 21 GAO- 02- 395 Letters to Claimants Need to Be Improved

About 43 percent of VBA?s development letters did not clearly explain the
actions that the claimant should take to support the claim. These letters
were generally clear, however, in explaining VBA?s actions in attempting to
obtain information to support the claim. (See table 2.)

Table 2: Percentages of VBA?s Development Letters That Were Unclear Key
aspects of VBA?s development letters Percentages of letters

that were unclear

Actions that claimant should take to support the claim 43 a Actions that VBA
would take or had taken in attempting to obtain information to support the
claim

13 b Source: GAO?s review of a national sample of letters. a The 95 percent
confidence interval around this estimate ranges from 30 to 56 percent.

b The percentage is based on only those letters in the sample that contained
the applicable information.

Fifty- seven percent of VBA?s development letters, in general, clearly
explained the actions that the claimant should take to support the claim.
For example, one easily understandable letter that we reviewed grouped the
actions that the claimant should take under a single heading, using simple,
lay language to describe these actions. Attachments to the letter listed the
more detailed information needed from the claimant. The letter also
clarified and simplified the description of the evidence needed to establish
that a disability was connected to military service (see figure 8). Many
Development Letters

Did Not Clearly Explain Actions That the Claimant Should Take

Actions That Claimant Should Take

Page 22 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 8: Development Letter That Clearly Set Forth What VBA Needed from the
Claimant A

A B C

Commentary

The first major section of the letter, following the introduction, focused
the reader's attention directly on a clear, crisp checklist of claimant
responsibilities.

The second section of the letter grouped the actions that VBA would take on
behalf of the claimant.

The description of the evidence needed to establish that a disability was
connected to military service was stated clearly and simply, using lay
language.

A B C

Page 23 GAO- 02- 395 Letters to Claimants Need to Be Improved

However, 43 percent of VBA?s development letters did not clearly explain the
actions that claimants should take to support their claims. Among the
letters that were unclear, half or more had one or more of the following
deficiencies: not grouping similar ideas, using convoluted language, and
raising unanswered questions. Table 3 describes each of these writing
deficiencies. In addition, in about 11 percent of development letters, a
description of the consequences for claimants? not responding in a timely
manner to VBA?s request for information was either incomplete or missing. A
claimant who does not realize the significance of VBA?s request might delay
in providing the needed information. Moreover, about one- third of
development letters did not ask the claimants to put their full name and VBA
file number on the information that they submitted to the agency. 10 If
claimants do not appropriately identify the documents that they submit,
these documents can be misfiled or lost, lengthening the time that it takes
to process the claim and increasing claimant frustration.

Table 3: Writing Deficiencies That Obscured Development Letters? Explanation
of Actions That Claimants Should Take Specific writing deficiency
Description of the writing deficiency

Similar ideas not grouped together Actions that the claimant should take
were frequently spread throughout the letter under multiple headings rather
than grouped together under a single heading. Therefore, the reader could
not go to a single section of the letter to determine what he or she should
do to comply with VBA?s request for information. Convoluted language used
Language describing the actions that the claimant should take was sometimes
legalistic

and awkward and thus difficult for a layperson to understand. Unanswered
questions raised Passages describing actions that the claimant should take
often raised questions that

were not answered. For example, in the four paragraphs that typically
described the evidence necessary to establish a disability?s connection to
military service, cumbersome sentence structure and legalistic wording
frequently made the paragraphs? content hard to grasp. This left the reader
confused as to the specific evidence needed to substantiate the claim.

In addition, the letters typically gave the claimant two very different
deadlines for submitting the needed information. The letter asked the
claimant to send the requested information within 60 days from the date of
the letter, but it also said that the evidence could still be received
within one year from the date of the letter. The differing deadlines raised
unanswered questions for a lay reader about the differences in the
consequences for not complying with each of the two deadlines.

Officials with whom we spoke in VBA?s central office and ROs also told us
that poor structure and use of legalistic language, among other factors,
made development letters difficult to read. For example, officials in
several ROs reported that development letters were unnecessarily long

10 The 95 percent confidence interval for this estimate ranges from 21 to 45
percent.

Page 24 GAO- 02- 395 Letters to Claimants Need to Be Improved

and complicated, causing confusion among veterans. Some RO and central
office officials with whom we spoke suggested simplifying and clarifying the
letters by placing the details in an attachment.

Eighty- seven percent of VBA?s development letters clearly explained, in
general, the actions that VBA would take or had taken in attempting to
obtain information on behalf of the claimant to support the claim. The
exemplary development letter in figure 8 clearly explained VBA?s actions.
For example, this letter grouped under a single heading, without redundancy,
the actions that VBA would take and explained these actions in simple lay
terms. However, while the majority of development letters generally clearly
explained VBA?s actions, many letters mentioned VBA?s actions throughout the
letter- sometimes mentioning the same actions repeatedly- making this aspect
of the development letters difficult to comprehend.

Beyond the lack of clarity of certain key aspects of VBA?s notification and
development letters, a variety of writing deficiencies made letters and
their attachments generally harder to understand. In many letters, the
ordering of ideas made it more difficult to grasp information quickly, and
in some instances, there were almost as many headings as sentences.
Moreover, certain standard forms attached to VBA?s letters contained writing
deficiencies similar to those that we found in the letters that we reviewed.

In many letters, the sequence of ideas was out of order, and information of
greatest importance to the claimants was often not discussed first. This
ordering generally made letters more difficult to understand. For example,
two- thirds of VBA?s development letters did not state specific actions that
claimants should take to support their claims until at least the second page
of the letter. 11 In 14 percent of the letters, VBA did not provide this
information until the third or fourth page. 12 The specific request for
information from the claimant was generally preceded by information about
provisions of the VCAA, including a description of the act, VBA?s duty to
notify the claimant about needed information, and VBA?s duty to assist the
claimant in obtaining evidence. Also preceding the request for

11 The 95 percent confidence interval for this estimate ranges from 53 to 79
percent. 12 The 95 percent confidence interval for this estimate ranges from
7 to 25 percent. Actions That VBA Would Take

or Had Taken Variety of Writing Deficiencies Reduced Overall Clarity of
VBA?s Letters and Their Attachments

Page 25 GAO- 02- 395 Letters to Claimants Need to Be Improved

information was a multiparagraph description of the evidence needed to
establish that a disability was connected to military service.

RO officials with whom we spoke noted problems with the ordering of
information in VBA letters. Officials in one RO said that one of the most
frequent complaints received on that RO?s hot line involved claimants?
having to go through two or three pages of information before locating what
they were being asked to do. Officials in another RO questioned whether
claimants would actually take the time to read through the entire letter to
find out exactly what was being requested of them. We did find some VBA
letters that ordered ideas in a more logical manner. These letters were
easier to understand, because VBA placed first an explanation of what the
agency needed from the claimant, as shown in figure 8.

In addition to overall problems with sequencing, some letters categorized
information under too many headings. Sometimes only a single sentence
appeared below the heading. In one instance, a one- page letter contained 10
sentences that were broken down under 5 separate headings. On the other
hand, most letters contained headings in boldface that were, in general,
useful for breaking information down and enabling the reader to find
particular topics quickly. Figure 7, for instance, illustrates VBA?s use of
headings to group information about specific topics, such as ways to contact
VBA and other benefits for which the claimant might be eligible.

Finally, some VBA standard forms attached to the letters that we reviewed
contained writing deficiencies similar to those that we encountered in our
review of VBA?s letters. For example, some of the forms contained convoluted
language and technical jargon that made them difficult to understand. To
illustrate, figure 9- VA?s Form 21- 8760, which provides additional
information for veterans with military service- related permanent and total
disability- contained technical jargon, lengthy sentences, convoluted
language, and typographical errors that hindered clarity.

On the other hand, some forms were relatively easy to understand- for
example, the form explaining appeal rights that is shown in figure 10.

Page 26 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 9: Letter Attachment with Technical Jargon and Lengthy Sentences That
Made It Difficult to Understand Commentary

These sections used technical jargon (e. g., ?residuals

of organic disease;? ?as to preclude locomotion without resort to;?
?anatomical loss or loss of use of both hands?) that would be difficult for
a layperson to understand. Further, the structure of both sections- using
single lengthy sentences connected by the word ?or? to list a series of
alternatives- hindered clarity. Finally, typographical errors (e. g., ?50
percents? and lack of a dollar sign preceding ?38,000?) also reduced
clarity.

This lengthy sentence contained convoluted language. and

A A

SPECIALLY ADAPTED HOUSING Veterans who have a service- connected disability
entitling them to compensation for permanent and total disability due to:

(1) the loss, or loss of use of both lower extremities, such as to preclude
locomotion without the aid of braces, crutches, canes, or a wheelchair, or

(2) disability which includes (a) blindness in both eyes, having only light
perception, plus (b) loss or loss of use of one lower extremity, or

(3) the loss or loss of use of one lower extremity together with residuals
of organic disease or injury or the loss or loss of use of one lower and one
upper extremity which so affect the functions of balance or propulsion as to
preclude locomotion without resort to braces, crutches, canes or a
wheelchair;

may be entitled to a VA grant of not more than 50 percents, or up to a
maximum of 38,000, to pay part of the cost of building, buying or remodeling
a specially adapted house or to pay indebtedness on such homes already
acquired. Apply to the nearest VA office.

SPECIAL HOME ADAPTATION GRANT Veterans who have a service- connected
disability entitling them to compensation due to:

(1) blindness in both eyes with 5/ 200 visual acuity or less, or (2) the
anatomical loss or loss of use of both hands may be

entitled to a VA grant of not more than $6,500 to pay the cost of remodeling
a house in which they reside. Apply to the nearest VA office.

JOB COUNSELING AND EMPLOYMENT SERVICES A job and job training counseling
service program, employment placement service program, and job training
placement service program are available to a spouse of any veteran who has a
total disability permanent in nature resulting from a service- connected
disability or the spouse of a veteran who dies while disability so evaluated
was in existence.

B C A

B B C C

Page 27 GAO- 02- 395 Letters to Claimants Need to Be Improved

Figure 10: Form That Was Clear and Easy to Read A

D

An appeal is your formal request that the Board review the evidence in your
VA file and review the law that applies to your appeal. The Board can either
agree with our decision or change it. The Board can also send your file back
to us for more processing before the Board makes its decision.

How do I start my appeal? To begin your appeal, write us a letter telling us
you disagree with our decision. This letter is called your ?Notice of
Disagreement.? If we denied more than one claim for a benefit (for example,
if you claimed compensation for three disabilities and we denied two of
them), please tell us in your letter which claims you are appealing. Send
your Notice of Disagreement to the address at the top of our letter.

How long do I have to start my appeal? You have one year to appeal our
decision. Your letter saying that you disagree with our decision must be
postmarked (or received by us) within one year from the date of our letter
denying you the benefit. In most cases, you can?t appeal a decision after
this one- year period has ended. A

B C D

E F

B C

What happens if I don?t start my appeal on time? If you don?t start your
appeal on time, our decision will become final. Once our decision is final,
you can?t get the VA benefit we denied unless you either:

show that we were clearly wrong to deny the benefit or

send us new evidence that relates to the reason we denied your claim

Can I get someone to help me with my appeal to the Board? Yes. You can have
a veteran?s service organization representative, an attorney- at- law, or an
?agent? help you with your appeal. But you?re not required to have someone
represent you. It?s your choice.

Representatives who work for accredited veterans? service organizations know
how to prepare and present claims and will represent you. You can find a
listing of these orgranzations on the Internet at: http:// www. va. gov/
vso.

A private attorney or an ?agent? can also represent you. Your local bar
association may be able to refer you to an attorney with experience in
veterans? law. An agent is a person who isn?t a lawyer, but who VA
recognizes as being knowledgeable about veterans? law. Contact us if you?d
like to know if there is a VA accredited agent in your area.

CAN I GIVE VA ADDITIONAL EVIDENCE?

Yes. You can send us more evidence to support a claim whether or not you
appeal to the Board. If you want to appeal, though, don?t forget the one-
year time limit! E

F Commentary

Short sentences and lay language described what is essentially a legal
process. Potentially confusing technical terms were kept to a minimum.
However, where they were used (e. g., ?Notice

of Disagreement?), they were clearly defined. Questions used as headings
anticipated a reader?s questions and emphasized important points, such as
the consequences of not appealing on time. Emphasis was used to make
critical distinctions- in this

case, between the claimant?s letter disagreeing with VBA?s decision and
VBA?s letter denying benefits.

The reader was reminded of important procedural deadlines that the claimant
was responsible for meeting. In a series of alternatives, clarity was
achieved with

short sentences.

A B

C D E F

Page 28 GAO- 02- 395 Letters to Claimants Need to Be Improved

Clarity in VBA?s standard forms is important, because these forms serve
critical purposes. For example, they provide claimants with detailed
information about other benefits for which the claimants might be eligible.
The forms also request specific information- such as claimant income and net
worth- that is needed to support the claim.

Unclear letters confuse claimants and make them anxious, according to VBA.
Such letters also cause frustration and can affect the benefits that a
claimant receives. For example, if claimants do not understand VBA?s
development letters, they may not provide VBA with the information needed to
support their claims, claimant representatives told us. As a result, VBA may
delay processing the claimant?s application or may deny benefits because of
inadequate evidence. Moreover, if claimants do not understand the reasoning
that VBA used to reach its decision, they may not question an incorrect
decision and may therefore not receive the appropriate level of benefits.

Unclear letters can also have an adverse effect on VBA, requiring that staff
resources be diverted to rework claims or respond to additional inquiries
rather than to process claims and reduce VBA?s backlog. According to VBA?s
2000 national customer satisfaction survey, if notification letters and
rating decision documents do not explain the decision in a way that
claimants can understand, claimants are more likely to contact VBA to
discuss or appeal the decision, adding to VBA?s already heavy workload (see
figure 11). Survey respondents who understood VBA?s explanation of its
decision in the notification letter were less likely to appeal the decision
or contact VBA to discuss it than respondents who did not understand the
explanation. This was true regardless of whether the decision granted or
denied benefits. Of respondents who had been denied benefits, 34 percent of
those who did not understand the explanation of the decision appealed,
compared with 23 percent of those who understood the explanation. Even when
benefits were granted, 30 percent of those who did not understand the
explanation appealed, compared with 12 percent of the respondents who
understood. 13 Survey results were similar for respondents who contacted VBA
to discuss the decision: significantly more respondents who did not
understand the explanation of the decision contacted VBA,

13 VBA grouped under ?denied? those respondents whose entire claim was
denied. VBA grouped under ?granted? all respondents who replied that they
had been awarded benefits, even if benefits were less than respondents had
expected. Negative Consequences

May Occur for Both Claimants and VBA if Letters Are Unclear

Page 29 GAO- 02- 395 Letters to Claimants Need to Be Improved

regardless of whether they were granted or denied benefits, than did those
who understood the explanation.

VBA officials agree that processing appeals and responding to claimants
diverts employees from processing pending cases. These officials conclude
that any reductions in appeals or in the number of claimants who contact VBA
to discuss decisions would improve VBA?s productivity.

Figure 11: Respondents to the Customer Satisfaction Survey Who Appealed or
Contacted VBA to Discuss a Decision on a Compensation or Pension Claim

Note: These data reflect only the types of notification letters that we
reviewed as part of this study. See appendix II for a description of
possible data limitations.

Source: Department of Veterans Affairs, Veterans Benefits Administration,
?Effect of Clarity of Decision Letter on Percent Who Appealed or Who
Contacted VA to Discuss the Letter by Whether Their Claim was Granted or
Denied,? Survey of Veterans? Satisfaction with the VA Compensation and
Pension Claims Process: 2000 Summary Report (Washington, D. C.: 2001).

0 10

20 30

40 50

X Granted Denied Granted Denied Percentage

Filed appeals Contacted VBA to discuss the decision

Understood Did not understand

23 34

12 30

22 34

26 46

Page 30 GAO- 02- 395 Letters to Claimants Need to Be Improved

Four key factors contribute to deficiencies in VBA?s letters and their
attachments:

 Attempting to achieve more than one objective and, in doing so,
compromising clarity for the reader

 Using boilerplate paragraphs that contain redundancies and writing
deficiencies, such as technical terminology that is difficult for a
layperson to understand

 Through human error, making editorial mistakes and not adapting
boilerplate language to the claimant?s specific situation

 Not systematically evaluating letter clarity, not identifying writing
deficiencies, and not providing timely feedback to help correct such
deficiencies.

VBA has initiatives underway to address some of these problems (see table
4). Multiple Factors

Contribute to Deficiencies; Some Initiatives Are Under Way, but an
Evaluation System Is Needed

Page 31 GAO- 02- 395 Letters to Claimants Need to Be Improved

Table 4: Status of VBA Initiatives That Can Improve Clarity of Letters and
Attachments Initiative Description Status Letters

Revisions of national compensation and pension program letters To make
letters more reader friendly,

VBA revised the paragraphs that are stored in a national database and used
by ROs to compose letters. Strong Prompts VBA created a software application

that provides a mechanism for selecting and inserting paragraphs from the
national database of revised paragraphs.

Begun in spring 2001, revisions of national compensation and pension
notification letters and new Strong Prompts technology were tested with some
ROs and made available for RO use at the end of 2001. Use of these revised
national notification letters was then mandated for all ROs. VBA has plans
extending into 2003 to revise other types of national compensation and
pension program letters. For example, VBA officials plan to clarify the
national development letter and incorporate the revised language into the
national database of paragraphs in the summer of 2002 at the earliest.

Rating Decision Documents

Improvement of rating decision document quality Training and guidance
materials VBA provided training and guidance

materials for rating specialists that, in part, were intended to encourage
them to eliminate redundancy and incorporate into the rating document a
brief layperson?s summary of the reasons for the decision.

The initiative, begun in 2000, was subject to a range of implementation
problems that limited the initiative?s success in enhancing clarity of the
rating document. These problems included not mandating that ROs provide a
layperson?s summary, not emphasizing clarity sufficiently in training, and
increasing workload pressures in ROs. Although training has ended, related
written guidance was distributed in May 2001. Review of rating decision
documents prepared for recently discharged claimants VBA reviewed rating
decision

documents to determine their sufficiency for notifying claimants of the
reason for the decision, among other objectives. This review was to
consider, in part, ways to prepare a rating document that explained the
decision clearly for all readers- especially laypersons- and was free of
professional jargon while meeting legal requirements.

The results of the review, which began at the end of 2001, are currently
being assessed.

Page 32 GAO- 02- 395 Letters to Claimants Need to Be Improved

Initiative Description Status

Revisions of rating schedule VBA updated the terminology and medical
conditions in the Schedule for Rating Disabilities. While improving clarity
was not a focus of this initiative, the initiative did involve removing
ambiguity and, with more recent regulations, explaining some medical terms
in lay language when this could be done briefly. Some medical terms and
concepts would require lengthy explanations, which VBA believes would be
better left to claimants? medical providers.

VBA has completed more than twothirds of this initiative and estimates that
it will not be finalized for another 2 years.

Simplification of legal terms VBA aimed to simplify and clarify legalistic
language embedded in a computer application used to create rating decision
documents.

This initiative focused only on a few less complex types of rating
decisions, such as whether to award benefits for specially adapted housing.
The initiative was temporarily suspended to redirect agency resources toward
reducing the backlog of pending cases. A task force is currently assessing
how to resume this process of simplifying language.

Forms

Revision of standard forms VBA revised standard forms to make them more
reader friendly. VBA revised the claimant?s appeal

rights form and is currently assessing how to go about rewriting the rest of
its standard forms.

In many of its rating decision documents and development letters, VBA
attempts to achieve more than one objective. In doing so, however, VBA may
compromise clarity for the reader. The rating decision document is intended
to serve two purposes. Its first purpose is to provide veterans with a
readily understandable explanation of the decision regarding their claims
for benefits. Its second purpose is to document the precise legal and
medical reason for the decision, which is especially important if the
claimant appeals the decision. If a claimant appeals a decision, the Board
of Veterans? Appeals and the Court of Appeals for Veterans Claims use the
rating decision document as a basis for their review. Because the rating
decision document is used in this legal process, regulation and court
precedents require that rating decision documents include certain key pieces
of information that can involve highly technical language.

For example, the rating decision documents must lay out the medical criteria
justifying the degree of disability assigned to a claim, as well as the
medical criteria for the next higher degree of disability. The criteria are
taken from VA?s Schedule for Rating Disabilities, which sometimes uses VBA?s
Attempt to Achieve

Multiple Objectives May Compromise Clarity; VBA Has Some Initiatives Planned
and Under Way to Improve Clarity

Page 33 GAO- 02- 395 Letters to Claimants Need to Be Improved

technical medical terminology. Additionally, rating decision documents must
include an evaluation of all relevant evidence and how this evidence
supports a particular decision on the claim. Because the documents must
discuss the evidence with reference to the medical criteria justifying the
degree of disability, this discussion is typically written with terminology
similar to that found in the criteria. Table 5 illustrates the similarity of
technical language in the Schedule for Rating Disabilities for heart
diseases to the language in a rating decision document that we reviewed in
our sample of letters.

Table 5: Similarity of Technical Language in Medical Criteria from the
Schedule for Rating Disabilities and a Rating Decision Document

Illustration of medical criteria for heart diseases, excerpted from the
Schedule for Rating Disabilities (38 CFR 4.104, July 1, 2001) Excerpt from a
typical rating decision

document taken from our sample

[For 30 percent degree of disability:]

?Workload of greater than 5 METs but not greater than 7 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac
hypertrophy or dilatation on electro- cardiogram, echocardiogram, or X-
ray.?

[Note:] ?One MET (metabolic equivalent) is the energy cost of standing
quietly at rest and represents an oxygen uptake of 3.5 milliliters per
kilogram of body weight per minute.?

?An evaluation of 30 percent is assigned if there is workload greater than 5
METs but not greater than 7 METs resulting in dyspnea, fatigue, angina,
dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on
electrocardiogram, echocardiogram, or Xray.

?One MET (metabolic equivalent) is the energy cost of standing quietly at
rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body
weight per minute.?

Some central office officials assert that the ability of rating specialists
to explain medical conditions in lay terms is necessarily limited because
the specialists lack in- depth medical training and physicians are not
available in all regional offices to assist them. As a result, in preparing
rating decision documents, rating specialists tend to repeat the language
used in regulations and medical reports. Because the reports of VA
physicians? medical examinations of claimants are now available in
electronic form, employees can now copy wording from these reports directly
into the rating document.

While rating decision documents may be used as legal documents by the Board
of Veterans? Appeals and the Court of Appeals for Veterans Claims, they are
also used to meet the needs of a vastly different audience- the claimant,
who is typically a lay reader. VBA regulations state that

Page 34 GAO- 02- 395 Letters to Claimants Need to Be Improved

claimants are entitled to notice of a VBA decision that affects their
benefits, including a clear statement of the reason, or reasons, for the
decision. The rating decision document is currently the primary means of
complying with the regulations and communicating the reasons for the
decision to the claimant. However, as our review of letters and their
attached rating decision documents showed, the reasons for the decision were
often unclear to lay readers. These documents did not provide a lay summary
explanation of the reasons for the decision.

Acknowledging that its rating decision documents need improvement, VBA is
working to assure that these documents provide the claimant with a clear
explanation of the reasoning used to reach the decision, while documenting
for the record the legal and medical reasons for the decision. For example,
one aim of VBA?s initiative to improve the quality of the rating decision
document was to train rating specialists to briefly summarize the reasons
for the decision in terms that a layperson could easily understand. However,
this initiative had limited success, owing to a range of implementation
problems explained in table 4. In a related initiative, the review of rating
decision documents prepared for recently discharged claimants, VBA has
reemphasized the importance of preparing high- quality rating decision
documents. In this initiative, VBA is considering how it can explain the
decision clearly for all readers, especially laypersons, while meeting legal
requirements. The results of this review, which was begun at the end of
2001, are currently being assessed. In addition, recent revisions of the
Schedule for Rating Disabilities include efforts to explain some medical
terms in lay language, but only when such explanations can be written
relatively briefly. Lengthier explanations are left for the claimants?
medical providers. Some of these revisions of the schedule have yet to be
published, so it is too early to know the extent to which they will affect
readability of the rating documents.

With the development letters, like the rating decision documents, VBA
attempts to serve two purposes and, in doing so, may compromise clarity for
the claimant. VBA sends development letters to claimants to request specific
information necessary to reach decisions on their claims. At the same time,
VBA uses the letter to meet its legal obligations under VCAA. VCAA requires,
among other things, that VBA notify claimants of any information that is
necessary to substantiate the claim. VCAA also requires VBA to distinguish
between the information that the claimant is to supply and the information
that VBA is to obtain on the claimant?s behalf. Our review of a sample of
development letters showed that in attempting to comply with its legal
duties, VBA obscured its explanation of the specific information needed from
the claimant to support the claim.

Page 35 GAO- 02- 395 Letters to Claimants Need to Be Improved

VBA acknowledges that improvements are needed to clarify the current
development letter, but improvement efforts are not yet under way.
Currently, VBA is focusing its energies on revising its national
compensation and pension program letters. As part of this effort, VBA
officials plan to clarify the national development letter?s language and
incorporate the revised language into the national database of paragraphs in
the summer of 2002, at the earliest.

VBA?s central office, as well as some ROs, have developed boilerplate
paragraphs for letters and the rating decision attachments to lessen the
time that employees spend in creating them and to improve their quality and
consistency. VBA has also developed a variety of standard forms to provide
detailed information to claimants regarding other types of benefits and to
obtain various types of information from claimants. Employees in ROs who
write letters may choose to attach these forms to the letters, as
appropriate.

Some boilerplate paragraphs and standard forms, however, contain writing
deficiencies that reduce clarity, such as convoluted language and highly
technical terminology. Because the unclear text is part of the standard
boilerplate language, it is replicated in numerous letters and attachments
that are mailed to claimants. Moreover, boilerplate paragraphs lack critical
information such as, in some notification letters, the deadline for filing
an appeal of VBA?s decision and, in some development letters, the
consequences for not responding in a timely manner to VBA?s request for
information.

VBA has begun to take steps to deal with boilerplate language problems.
First, in the spring of 2001, VBA began to simplify and clarify boilerplate
language in its national compensation and pension notification letters.
However, the extent to which these letters are being used by the ROs is
unknown. Second, as part of its Reader- Focused Writing effort, VBA
attempted to simplify legal terms embedded in the computer application used
to create a rating decision document. VBA did not attempt, however, to
simplify the legalistic language used for the more complicated rating issues
involved in deciding disability compensation and pension claims. Although
the initiative was temporarily suspended, a task force is currently
considering how to resume efforts to simplify the language. The agency also
recognizes the need for rewriting its standard forms according to reader-
focused principles. It has rewritten the form that describes a claimant?s
right to appeal a decision and is currently considering how to go about
rewriting the rest of its standard forms. Some Standardized

Paragraphs and Forms Contain Deficiencies; VBA Is Working on Resolutions

Page 36 GAO- 02- 395 Letters to Claimants Need to Be Improved

Boilerplate language contributes to the redundancy that we found in rating
decision documents. The computer application that VBA employees use in
creating rating decision documents automatically inserts boilerplate text
concerning the legal principle applicable to the decision for each claimed
condition. 14 This boilerplate text is automatically inserted for each
condition, even if the reason for the decision for each condition is the
same. In the same way, a rating specialist, when preparing a rating decision
document, may insert the same boilerplate text for each claimed condition.

As part of its previously described initiative to improve the quality of
rating decision documents, VBA has attempted to reduce some of the
redundancy in them. Guidance materials issued nationwide as part of this
initiative instructed ROs, when preparing rating decision documents, to
consider grouping the reasons for the decision for each claimed condition
when the reasons were the same. VBA?s guidance materials note, however, that
grouping the reasons for the decision is a cumbersome task. These materials
state that VBA might seek computer enhancements to make it easier for
employees to reduce redundancy. To date, however, VBA has not made any
computer enhancements that would ease the task of eliminating redundancy.

During the process of drafting a letter to a claimant or a rating decision
document, editorial mistakes and other writing deficiencies can result from
human error. Human error can occur when employees modify existing text or
insert original text, which they may do for a variety of reasons. For
example, boilerplate paragraphs may not be appropriate for every claimant?s
particular situation and may therefore have to be revised. In addition, an
employee will need to insert original text, such as medical conditions,
dates, dollar amounts, or other facts that are specific to the claimant.
Also, because they believe that some boilerplate paragraphs used to create
letters or rating decision documents contain writing deficiencies, employees
with whom we spoke in some ROs edit these paragraphs by inserting original
text, or they cut and paste from what they perceive to be clearer existing
text developed by other RO employees. Officials in one RO told us that this
process of modifying existing text and

14 VBA is currently using two different versions of a computer application
to create rating decision documents- the older Rating Board Automation (RBA)
and a newer version, called RBA 2000. Both versions created substantial
redundancy in some of the rating decision documents that we reviewed. Human
Error Contributes

to Some Writing Deficiencies; VBA?s Efforts to Improve Letters May Reduce
the Need for Human Intervention

Page 37 GAO- 02- 395 Letters to Claimants Need to Be Improved

inserting original text could result in editorial mistakes. Types of
editorial mistakes in the letters that we reviewed included typographical
errors, run- on sentences, and sentence fragments.

Workload pressures and an inexperienced new workforce can exacerbate writing
deficiencies related to human error. ROs are under pressure to reduce VBA?s
large backlog of pending claims. Additionally, according to VBA officials, a
significant portion of VBA?s veterans service representatives and rating
specialists are newly hired and need intensive training and on- the- job
experience to become fully proficient at creating and modifying letters and
rating decision documents. For example, rating specialists require about 2
years to become fully productive. The combined effect of many new hires and
a heavy workload can increase the potential for human error that can
contribute to writing deficiencies.

Writing deficiencies can also occur when a letter writer does not check the
relevance of the boilerplate language. It is ultimately the responsibility
of the employee to read the letter or rating document that he or she has
created and to revise or replace any text if it does not apply to the
claimant?s particular situation. However, according to some RO officials,
because of time pressures, employees do not take the time necessary to
review letters for writing deficiencies. The inconsistencies and incomplete
information that we found in some key aspects of the letters we reviewed-
such as the statement of VBA?s decision and the financial information
concerning a claimant?s benefits- suggest that the letters had not been
reviewed thoroughly for overall clarity.

VBA?s efforts to revise its national compensation and pension notification
letters may help to reduce the need for human intervention in letter
writing. For example, VBA has designed its revised national compensation and
pension notification letters to cover about 80 percent of possible claimant
situations that a letter might have to address. As a result, the need for a
veterans service representative to modify boilerplate paragraphs in letters
that are inappropriate for a claimant?s particular situation should
decrease. However, some human intervention will probably always be required,
even with the revised national notification letters, because these letters
cannot be written to cover all possible claimant situations.

In addition, VBA has developed the new Strong Prompts software application,
intended to make it easier for the veterans service representative in the
field to create a letter. With this application, a series of automated
commands guides a veterans service representative in the

Page 38 GAO- 02- 395 Letters to Claimants Need to Be Improved

process of creating a notification letter using the revised boilerplate
paragraphs. These commands prompt the veterans service representative to
select particular paragraphs or to insert specific information. VBA
officials expect that use of the new software application will reduce the
time needed to create a letter. If this productivity enhancement is
achieved, it could eventually help to reduce workload pressures that
contribute to mistakes.

Further, during the process of testing the revised national compensation and
pension notification letters with the ROs, VBA received feedback from the
ROs about how to improve the letters. The agency used this feedback to
improve the national letters as appropriate. Thus, some of the writing
deficiencies that veterans service representatives identified in the
previous national notification letters may have been eliminated through the
testing process, potentially reducing the perceived need for veterans
service representatives to modify the boilerplate paragraphs. However,
simply using the revised national letters will not eliminate human error. In
fact, RO officials warn that errors can result from excessive dependence on
automated tools for preparing letters without close review of how the
letters apply to claimants? specific situations.

VBA recognizes the importance of evaluating the clarity of its letters. For
example, the agency?s blueprint for its Reader- Focused Writing Program
acknowledged that ongoing evaluation of program effectiveness should be an
essential element of this initiative. 15 Moreover, the agency has some
systems in place to assess the clarity of its letters. However, these
systems are not adequate for helping VBA continuously monitor and improve
the clarity of its letters throughout the compensation and pension program.
Consequently, VBA will continue to miss opportunities to systematically
evaluate clarity, identify writing deficiencies, and provide timely feedback
to the responsible organizational component to help correct such
deficiencies.

VBA has a customer satisfaction survey that addresses some aspects of letter
quality, but this survey is not designed to be a tool for continuously
improving clarity of VBA?s letters. The annual Survey of Veterans?
Satisfaction with the VA Compensation and Pension Claims Process

15 Department of Veterans Affairs, Undersecretary for Benefits, Reader-
Focused Writing. Task Force on Simplified Communications (Washington, D. C.:
1995). VBA Lacks Systematic

Monitoring and Feedback to Identify and Correct Writing Deficiencies

Page 39 GAO- 02- 395 Letters to Claimants Need to Be Improved

measures various aspects of customer satisfaction for a random sample of
persons whose claims are pending or were recently decided. 16 Three
questions on the survey measure the extent to which notification letters
clearly explain the agency?s decision and the subsequent appeal process.
While responses to these questions provide broad information on overall
customer satisfaction with clarity of notification letters and their
attachments, they do not allow VBA to identify the root causes of specific
problems with clarity in its notification letters. Without this information,
VBA may not be able to develop effective solutions.

In addition to its customer service survey, the agency?s Systematic
Technical Accuracy Review Program includes a limited review of letters.
However, this system is intended primarily to assess overall claims
accuracy, not letter clarity. To assess accuracy of VBA claims, reviewers
evaluate a monthly sample of completed cases, including letters created as
part of the cases. The reviewers use formal guidelines that address such
accuracy issues as whether all claims issues were addressed; correctness of
the decision, effective dates, and payment rates; and whether the basis of
each decision was explained and all applicable evidence was discussed.
Reviewers also follow guidelines for assessing accuracy and completeness of
letters notifying claimants about the agency?s decision. Although the
guidelines were not designed to assess letter clarity in a comprehensive
fashion, they do address some dimensions of letter clarity such as
conciseness, logical sequencing, and consistency. They do not, however,
cover other important elements of clarity, such as the absence of technical
jargon, convoluted language, or redundancy. Moreover, the system is not
designed to obtain the opinions of claimants, their representatives, or VBA
employees who process claims with regard to specific letter clarity
problems. Yet, given the deficiencies that we encountered in our letter
review and the complaints about clarity that we heard from RO officials and
claimant representatives, such information is essential for identifying
writing deficiencies.

While VBA does not have a programwide mechanism for systematically
evaluating letter clarity, each RO is required to assess at least annually
various aspects of claims processing, including the quality of its locally
generated letters. On the basis of this assessment, each RO is to diagnose

16 Department of Veterans Affairs, Veterans Benefits Administration Survey
of Veterans? Satisfaction with the VA Compensation and Pension Claims
Process: 2000 Summary Report (Washington, D. C.: 2001).

Page 40 GAO- 02- 395 Letters to Claimants Need to Be Improved

potential problems and identify solutions. Our interviews with RO officials
indicated that there is variation in whether and how the ROs evaluate letter
clarity. For example, officials at two ROs told us that they review a sample
of a day?s outgoing letters every three months to assess writing
deficiencies. Additionally, one of these ROs reviewed its letters for
clarity semiannually with focus groups of veterans and their
representatives, although workload pressures resulted in recent reductions
in this effort. On the basis of claimant input obtained in this way, this RO
has made immediate improvements to its letters. Officials whom we
interviewed at another RO survey a sample of 10 claimants every week to
assess letter clarity, among other service issues, and invite comments. In
contrast to the emphasis placed by these ROs on evaluating letter clarity,
at another RO where we conducted interviews, the annual assessment of letter
quality does not focus on clarity but rather on accuracy.

VBA acknowledges the importance of evaluation. Prior to establishing its
Reader- Focused Writing Program, VBA used focus groups of veterans and
employees and a variety of ad hoc studies to assess the clarity of the
letters that it sent to claimants. However, its compensation and pension
program has more recently focused its efforts on revising its national
letters rather than on evaluating the clarity of the letters that the ROs
are generating. Without systematically evaluating the clarity of its
letters, VBA will not know if its revised national letters or other efforts
are improving letter clarity.

Given the environment in which VBA is operating- including large claims
backlogs, the inexperience of a significant portion of the workforce, and
complex laws and regulations- writing clear letters can be a daunting task.
Veterans and their families, as well as VBA itself, benefit when the agency
effectively conveys the information that it intends to communicate. Veterans
are entitled to compensation and other benefits for their military service-
related conditions and, in some instances, to pensions for conditions not
directly related to their military service. If veterans submit a claim for
benefits, it is reasonable for them to expect that they will be able to
understand what VBA decided and why.

To fulfill these expectations, it is imperative that VBA clearly convey in
its development letters what claimants must provide to support their claims.
Doing so at the outset could improve the chances of VBA?s making the
appropriate decision based on complete information, thus avoiding the
processing delays that could result from subsequent information requests. It
is also important that VBA provide claimants with a clear explanation of
Conclusions

Page 41 GAO- 02- 395 Letters to Claimants Need to Be Improved

the reasoning that the agency used to reach its decision. Unclear reasoning
can confuse and frustrate claimants and take a toll on VBA?s efficiency if
scarce staff resources must be diverted to rework claims. While explaining
the reasoning is challenging, VBA acknowledges that improvements are needed
and is working to clarify the rating decision documents. Some of the letters
that we read demonstrate that VBA can prepare rating decision documents that
clearly state the reasons for the decision in language that a layperson can
understand.

VBA has taken some steps to address the root causes of writing deficiencies.
In addition, its reader- focused initiative has been in the vanguard of the
plain- language movement in the federal government. However, without a
systematic mechanism for evaluating the clarity of its letters, VBA lacks a
means to position itself to continuously improve letter clarity. As a
result, VBA will continue to miss opportunities to identify writing
deficiencies in letters, diagnose their causes, and provide timely feedback
to guide corrective actions. Moreover, the agency will not have a way to
assess whether its initiatives are being implemented consistently and are
having the intended effect of improving letter clarity. Until VBA
systematically evaluates letter clarity, the agency cannot comprehensively
measure its performance in communicating clearly with claimants, assess its
progress in improving letter clarity, or hold itself accountable for making
such improvements. VBA already uses its Systematic Technical Accuracy Review
Program to partially assess the clarity of its letters. It could develop
this into a more comprehensive review to supplement its accuracy rate
computation or choose other ways to assess clarity. In deciding how to
proceed, VBA would need to balance the costs of evaluating clarity against
the benefits to claimants, and to VBA itself, of reducing the need to rework
claims.

We recognize that VBA is trying to address other high- priority issues,
namely, reducing the backlog and shortening lengthy processing times, a
long- standing problem. These issues are extremely important and deserve the
immediate attention that they are getting. However, communicating clearly
with claimants is an integral part of the solution and needs to be
addressed. The Secretary of the Department of Veterans Affairs estimates
that VBA?s pending workload will be under control by September 2003. At that
time, VBA needs to start holding itself accountable for communicating
clearly to claimants. In the meantime, to position itself to do this, the
agency needs to develop a systematic mechanism that will enable it, on an
ongoing basis, to assess the effectiveness of initiatives to improve letter
clarity.

Page 42 GAO- 02- 395 Letters to Claimants Need to Be Improved

As VBA proceeds with its initiatives to improve the clarity of its letters,
we recommend that the Secretary of the Department of Veterans Affairs direct
the Undersecretary for Benefits to take the following steps to enhance the
effectiveness of these efforts:

1. Eliminate writing deficiencies in the national development letter to
clarify the actions that the claimant should take to substantiate a claim.
Once the letter is rewritten, before mandating its use by the ROs, test its
clarity with claimants, their representatives, and employees who process
claims in the ROs.

2. In continuing VBA?s efforts to improve rating decision documents, write
succinctly, clearly, and in lay terms the reasons for its decisions to grant
or deny benefits.

3. Expand the Systematic Technical Accuracy Review Program or choose other
ways to systematically evaluate whether letters (including their
attachments) are clear to the claimant. The evaluation method should include
obtaining periodic input on letter clarity from claimants, their
representatives, and employees who process claims. Use the results of this
evaluation to continuously improve letters by identifying writing
deficiencies and providing timely feedback to enable the responsible entity
(e. g., central office or ROs, as appropriate) to take corrective actions.
In September 2003, when VBA projects that its large inventory of backlogged
claims will be reduced, the agency should formally measure letter clarity
and hold itself accountable for improved clarity.

The Department of Veterans Affairs provided written comments on a draft of
this report. These comments are reprinted in appendix I. The agency agreed
with our conclusions and concurred with our recommendations, noting that, in
seeking to enhance quality of service to veterans, improving the quality of
its communications is a critical element. The agency also detailed steps
that it is planning or has under way, including timeframes, to implement the
recommendations.

As agreed with your office, we will make no further distribution of this
report until 10 days after its issue date, unless you publicly release the
contents earlier. At that time, we will send copies of this report to the
Honorable Anthony J. Principi, Secretary of the Department of Veterans
Affairs; appropriate congressional committees; and other interested parties.
We will make copies available to others on request. The report will also be
available on GAO?s home page at www. gao. gov. Recommendations

Agency Comments and Our Response

Page 43 GAO- 02- 395 Letters to Claimants Need to Be Improved

If you or your staff have any questions regarding this report, please call
me at (202) 512- 7101 or Shelia Drake, assistant director, at (202) 512-
7172. Staff acknowledgments are listed in appendix III.

Sincerely yours, Cynthia A. Bascetta Director, Education, Workforce, and

Income Security Issues

Appendix I: Comments from the Veterans Benefits Administration Page 44 GAO-
02- 395 Letters to Claimants Need to Be Improved

Appendix I: Comments from the Veterans Benefits Administration

Appendix I: Comments from the Veterans Benefits Administration Page 45 GAO-
02- 395 Letters to Claimants Need to Be Improved

Appendix I: Comments from the Veterans Benefits Administration Page 46 GAO-
02- 395 Letters to Claimants Need to Be Improved

Appendix I: Comments from the Veterans Benefits Administration Page 47 GAO-
02- 395 Letters to Claimants Need to Be Improved

Appendix II: Scope and Methodology Page 48 GAO- 02- 395 Letters to Claimants
Need to Be Improved

To assess letter clarity, we analyzed a random sample of each of three types
of letters (including the letter attachments) generated by the Veterans
Benefits Administration?s (VBA) compensation and pension program: (1)
letters notifying claimants of original and reopened compensation decisions,
(2) letters notifying claimants of original and reopened pension decisions,
and (3) compensation and pension development letters sent to claimants. 1 We
selected these types of letters because they reach a large number of people,
have the potential for affecting VBA?s productivity if they are unclear, and
are relatively complex. Moreover, the compensation and pension notification
letters convey important information about claimants? eligibility for
benefits and about changes in their benefit amounts that can significantly
affect their future income. The types of letters that we selected account
for about 36 percent of notification and development letters sent by VBA?s
compensation and pension program. 2

We selected each of our three samples of letters from a national sample of
cases that VBA collects for its Systematic Technical Analysis Review
Program. VBA draws this sample each month from the cases involving a
disability rating that are completed in each of VBA?s nine service delivery
networks during the month. 3 After we had accounted for missing cases and
letters, our three samples comprised the following:

 Ninety- seven compensation letters selected from VBA?s sample of cases
that were closed in June 2001.

 Seventy- two pension letters comprising VBA?s entire sample of pension
cases that were closed in both June and July 2001. (VBA?s sample of cases
closed in June 2001 was not large enough to yield an adequate number of
letters.)

 Seventy- three development letters drawn from our sampled compensation and
pension cases that were closed in June 2001, as described above, and written
in 2001. Because the Veterans Claims Assistance Act (VCAA) was

1 Our selected compensation and pension categories do not include letters
notifying survivors of benefits following the death of the claimant, such as
death pensions. 2 As mentioned earlier, the estimates of the number of VBA?s
compensation and pension letters do not reflect letters generated for
certain types of activities, such as appeals or special reviews. Neither do
they reflect the letters sent to claimants explaining cost- ofliving
adjustments in their benefits or acknowledging receipt of their claims.

3 In addition to original and reopened compensation and pension cases, cases
involving a disability rating include appeals. Cases that do not involve a
disability rating include adjustments to benefits due to income and
dependency changes. Appendix II: Scope and Methodology

Appendix II: Scope and Methodology Page 49 GAO- 02- 395 Letters to Claimants
Need to Be Improved

signed into law on November 9, 2000, letters written in 2001 were more
likely to reflect the law?s requirements than were letters written before
2001. The development letters that we selected were those substantive
development letters that were first sent to claimants after they had filed a
claim for benefits. Thus, our development letter sample did not include the
letters sent subsequently to claimants or others to request particular
items, such as a signature on a form, that were missing from the claim
files.

Because we followed a probability procedure based on random selections, our
sample is only one of a large number of samples that we might have drawn.
Since each sample could have provided different estimates, we express our
confidence in the precision of our particular sample?s results as 95 percent
confidence intervals (for example, ï¿½7 percentage points). These are the
intervals that would contain the actual population values for 95 percent of
the samples that we could have drawn. This means that there is a 95 percent
likelihood that each of the confidence intervals in this report will include
the true values in the study population. Unless otherwise noted, all
percentage estimates from the letter review have sampling errors (confidence
intervals) whose upper and lower bounds are not more than 10 percentage
points higher or lower than the estimated percentage.

We used VBA?s legal and policy requirements for its notification and
development letters as the basis for identifying the aspects of a letter
that should be clearly conveyed to claimants. For the notification letters,
these were

1. VBA?s decision concerning the claimant?s entitlement to benefits, 2. the
reason for VBA?s decision, 3. the financial information concerning the
amount of benefits to which

the claimant is entitled, 4. the claimant?s responsibilities and appeal
rights and ways to contact

VBA for more information, and 5. other benefits that might be available to
the claimant. Moreover, we based our assessment of VBA?s development letters
on the premise that they would clearly explain

Appendix II: Scope and Methodology Page 50 GAO- 02- 395 Letters to Claimants
Need to Be Improved

1. the actions that the claimant should take to support the claim and 2. the
actions that VBA would take or had taken in attempting to obtain

information to support the claim. To review our samples of letters, we
developed a set of decision rules in consultation with writing consultants
and incorporated these rules into a data collection instrument to assess
letter clarity. 4 For each aspect of a letter, our decision rules defined
specific types of writing deficiencies- for example, jargon, contradictory
or incomplete information, or convoluted language- that reduced
understandability. The consultants used their professional opinion to judge
whether the decision rules were a valid measure of letter clarity. To verify
that these rules could be reliably applied to assess letter clarity, the
consultants and our GAO team used the rules to review examples of VBA
letters and identify writing problems. We then verified that the results of
our reviews were consistent among all reviewers. Similarly, throughout the
process of assessing the sampled letters for clarity, we used a systematic
method of review to help assure that we were consistently applying the
decision rules.

In general, we used a two- staged process to assess whether VBA?s letters
were clear. First, we determined what, if any, writing deficiencies were
present for a key aspect of the letter. Second, we determined whether the
writing deficiencies- if such existed- made the letter unclear for that
aspect. An aspect of a letter could have multiple writing deficiencies, but
unless the deficiencies were sufficient to make the meaning unclear to the
reader, we would judge that aspect of the letter to be clear.

As part of our methodology, to identify questions that were pertinent to
this study, we reviewed the questionnaire used by VBA to survey its
customers in its 2000 Survey of Veterans? Satisfaction with the VA [Veterans
Administration] Compensation and Pension Claims Process. For the relevant
questions, VBA?s Surveys and Research staff provided us with special data
results based on the 2000 survey. This survey data may have some
limitations, however. The response rate to the VBA 2000 survey was 62
percent. Because VBA did not conduct a nonresponse follow- up analysis to
determine whether there was a difference between those individuals who
responded to the survey and those who did not, the survey

4 Additionally, the writing consultants assessed the clarity of VBA?s
standard forms that were commonly attached to the sampled letters.

Appendix II: Scope and Methodology Page 51 GAO- 02- 395 Letters to Claimants
Need to Be Improved

results may reflect an unknown level of bias. VBA believes that the sampling
errors of estimates from their 2000 national customer service survey that
are cited in this report do not exceed 3.4 percentage points.

To assess the underlying factors contributing to writing deficiencies in
VBA?s letters and any initiatives to correct these deficiencies, we
interviewed officials at VBA?s central office and at seven regional offices
(RO), as well as claimant representatives. We selected the seven ROs because
they reflected a range in the understandability of the ROs? letters from the
claimants? perspective, according to VBA?s customer satisfaction survey, and
because of their geographic dispersion. Moreover, we discussed writing
deficiencies in VBA?s letters during interviews with claimant
representatives on VCAA implementation, as part of another GAO study.

We also reviewed VBA laws, regulations, and policies on notification and
development letters and VBA documentation on initiatives to improve letter
clarity. We conducted our work between March 2001 and March 2002 in
accordance with generally accepted government auditing standards.

Appendix III: GAO Contacts and Staff Acknowledgments

Page 52 GAO- 02- 395 Letters to Claimants Need to Be Improved

Cynthia A. Bascetta, (202) 512- 7101 Shelia Drake, (202) 512- 7172

In addition to those named above, Barbara Bordelon, Patrick diBattista,
Tamara Harris, John Smale, James Wright, and Paul Wright made key
contributions to this report. Appendix III: GAO Contacts and Staff

Acknowledgments GAO Contacts GAO Acknowledgments

(130031)

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