VA Disability Benefits: Board of Veterans' Appeals Has Made	 
Improvements in Quality Assurance, but Challenges Remain for VA  
in Assuring Consistency (05-MAY-05, GAO-05-655T).		 
                                                                 
The House Subcommittee on Disability Assistance and Memorial	 
Affairs asked GAO to update a 2002 study to determine what VA has
done to (1) correct reported weaknesses in methods used by the	 
Board to select decisions for quality review and calculate the	 
accuracy rates reported by the Board and (2) address the	 
potential for inconsistency in decision-making at all levels of  
adjudication in VA, including VA's 57 regional offices and the	 
Board. GAO said in 2002 that VA had not studied consistency even 
though adjudicator judgment is inherently required in the	 
decision-making process, and state-to-state variations in the	 
average disability compensation payment per veteran raised	 
questions about consistency. In January 2003, in part because of 
concerns about consistency, GAO designated VA's disability	 
program as high-risk.						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-05-655T					        
    ACCNO:   A23497						        
  TITLE:     VA Disability Benefits: Board of Veterans' Appeals Has   
Made Improvements in Quality Assurance, but Challenges Remain for
VA in Assuring Consistency					 
     DATE:   05/05/2005 
  SUBJECT:   Decision making					 
	     Internal controls					 
	     Quality assurance					 
	     Quality control					 
	     Quality improvement				 
	     Veterans						 
	     Veterans benefits					 
	     Veterans disability compensation			 
	     Risk management					 
	     Appeals process					 

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GAO-05-655T

United States Government Accountability Office

GAO	Testimony Before the Subcommittee on Disability Assistance and
Memorial

Affairs, Committee on Veterans' Affairs, House of Representatives

For Release on Delivery

Expected at 10:30 a.m. EDT VA DISABILITY BENEFITS

Thursday, May 5, 2005

Board of Veterans' Appeals Has Made Improvements in Quality Assurance, but
                Challenges Remain for VA in Assuring Consistency

Statement of Cynthia A. Bascetta, Director, Education, Workforce and Income
Security

GAO-05-655T

[IMG]

May 5, 2005

VA DISABILITY BENEFITS

Board of Veterans' Appeals Has Made Improvements in Quality Assurance, but
Challenges Remain for VA in Assuring Consistency

                                 What GAO Found

The Department of Veterans Affairs (VA) has taken steps to respond to
GAO's 2002 recommendations to correct weaknesses in the methods for
selecting decisions by the Board of Veterans' Appeals (Board) for quality
review and calculating the accuracy rates reported by the Board.
Specifically, the Board now ensures that decisions made near the end of
the fiscal year are included in the quality review sample, and the Board
now excludes from its accuracy rate calculations any errors that do not
have the potential for resulting in a reversal by or remand from the
court. GAO found that the Board had not yet revised its formula for
calculating accuracy rates in order to properly weight the quality review
results for original Board decisions versus the results for Board
decisions on cases remanded by the court. However, GAO believes correcting
this calculation method will not materially affect the Board's reported
accuracy rates.

VA still lacks a systematic method for ensuring the consistency of
decision-making within VA as a whole, but has begun efforts to understand
why average compensation payments per veteran vary widely from state to
state. These efforts include studies underway by VA's Office of Inspector
General and the Veterans Benefits Administration, which oversees the
operations of VA's regional offices. Some variation is expected since
adjudicators often must use judgment in making disability decisions, but
VA faces the challenge of determining whether the extent of variation is
confined within a range that knowledgeable professionals could agree is
reasonable.

Steps in the Veterans Disability Claims and Appeals Process United States
                        Government Accountability Office

Mr. Chairman and Members of the Subcommittee:

Thank you for inviting me to discuss our work related to the efforts of
the Department of Veterans Affairs (VA) to assure the quality and
consistency of disability decisions. Assuring the quality and consistency
of VA's disability decisions is vital for assuring program integrity and
equitable decisions. As you know, in January 2003, we designated VA's
disability program, along with other federal disability programs, as
high-risk.1 In part, we designated VA's program as high-risk because of
concerns about consistency of decision-making. Despite VA's efforts to
provide training and enhance communication to improve the consistency of
decisions, we found indications of inconsistency such as the wide
variation among states in the average compensation payment per veteran.

You asked us to update our 2002 report in which we found that the Board
needed to improve its quality review program.2 Specifically, the Board
needed to revise its sampling methods, the way it weighted quality review
results in its calculation of accuracy rates, and the types of errors
reported in the accuracy rates. In that report, we also found that VA
needed to take action to assure consistency of decision-making within VA
as a whole. Today I would like to highlight the steps the Board has taken
since our 2002 report and discuss VA's recent efforts to address
inconsistent decision-making. To update our 2002 report, we interviewed
officials of and/or obtained pertinent documentation from the Board and
the Veterans Benefits Administration (VBA), which oversees the operations
of VA's 57 regional offices. We obtained comments from Board officials on
the updated information contained in this testimony regarding the Board's
quality assurance system, and they agreed with this information. We did
our work in accordance with generally accepted government auditing
standards in April 2005.

In summary, we found that the Board has taken action to strengthen its
system for reviewing the quality of its own decisions, but VA still lacks
a systematic method for ensuring the consistency of decision-making within
VA as a whole. With respect to the Board, it has taken steps to improve
the sampling and accuracy rate calculation methods of its quality review
system and also to assure that serious errors are not obscured by mixing

1GAO, High-Risk Series: An Update, GAO-03-119 (Washington, D.C.: January
2003).

2GAO, Veterans' Benefits: Quality Assurance for Disability Claims and
Appeals Processing Can Be Further Improved, GAO-02-806 (Washington, D.C.:
Aug. 16, 2002).

  Background: The Disability Claims and Appeals Process

them with less significant deficiencies. Regarding consistency, VA still
lacks a plan for an ongoing, systematic assessment of decision-making
consistency at all levels of adjudication within VA. As we concluded in
2002, such an assessment is needed to provide a foundation for determining
acceptable levels of decision-making variation and to reduce variations
found to be unacceptable. Although VA has much left to do regarding
consistency of decision-making, it has begun efforts to understand the
reasons behind one indication of inconsistency: the wide variations from
state to state in the average compensation payment per veteran. These
efforts include studies being done by VA's Office of Inspector General and
VBA.

VA's disability compensation program pays monthly cash benefits to
eligible veterans who have service-connected disabilities resulting from
injuries or diseases incurred or aggravated while on active military duty.
The benefit amount is based on the veteran's degree of disability,
regardless of employment status or level of earnings.

A veteran starts the claims process by submitting a disability
compensation claim to one of the 57 regional offices administered by VBA
(see fig. 1). In the average disability compensation claim, the veteran
claims about five disabilities. For each claimed disability, the regional
office adjudicator must develop evidence and determine whether each
disability is connected to the veteran's military service.3 The
adjudicator then applies the medical criteria in VA's Rating Schedule to
evaluate the degree of disability caused by each service-connected
disability, and then the adjudicator determines the veteran's overall
degree of serviceconnected disability.

If a veteran disagrees with the adjudicator's decision on any of the
claimed disabilities, the veteran may file a Notice of Disagreement. If
the regional office is unable to resolve the disagreement to the veteran's
satisfaction,

3The Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, (2000)
requires VBA to assist claimants who have filed a complete claim for
benefits. Specifically, VBA must: (1) notify claimants of the information
necessary to complete the application; (2) indicate what information not
previously provided is needed to prove the claim and distinguish between
the portion of the information for which the claimant will be responsible
and the portion for which VA will be responsible; (3) make reasonable
efforts to assist claimants in obtaining evidence to substantiate
claimant' eligibility for benefits, including relevant records; and (4)
inform claimants when relevant records are unable to be obtained.

the veteran may appeal to the Board.4 A veteran can dispute a decision not
only if the regional office denies benefits by deciding that an impairment
claimed by the veteran is not service-connected. Even for a claimed
impairment found to be service-connected, the veteran may dispute the
severity rating that the regional office assigns to the impairment and ask
for an increase in the rating.

During fiscal years 2003 and 2004, respectively, the regional offices made
about 715, 000 and 598,500 decisions involving disability compensation
claims. According to VBA, during fiscal years 2003 and 2004, respectively,
veterans submitted Notices of Disagreement in about 13.4 and 14.5 percent
of all decisions involving disability ratings, and of the veterans who
filed Notices of Disagreement, about 34.9 and 44.4 percent went on to
submit appeals to the Board. Assisted by 240 staff attorneys, the Board's
52 veterans law judges decide veterans' appeals on behalf of the
Secretary. The Board has full de novo review authority and gives no
deference to the regional office decision being appealed. The Board makes
its decisions based on only the law, VA's regulations, precedent decisions
of the courts, and precedent opinions of VA's General Counsel. During the
appeals process, the veteran or the veteran's representative may submit
new evidence to the Board and request a hearing.

4In response to a Notice of Disagreement, the regional office provides a
further written explanation of the decision, and if the veteran still
disagrees, the veteran may appeal to the Board. Before appealing to the
Board, a veteran may ask for a review by a regional office Decision Review
Officer, who is authorized to grant the contested benefits based on the
same case record that the regional office relied on to make the initial
decision.

Figure 1: Steps in the Disability Claims and Appeals Process

In fiscal year 2004, for all VA programs, the Board decided about 38,400
appeals, of which about 94 percent (35,900) were appeals of disability
compensation cases that contained an average of 2.2 contested issues per

case. In any given case, the Board might grant the requested benefits for
one issue but deny benefits for another. In some instances, the Board may
find that a case is not ready for a final decision and return (or remand)
the case to VBA for rework, such as obtaining additional evidence and
reconsidering the veteran's claim. If VBA still does not grant the
requested benefits after obtaining the additional evidence, it returns the
case to the Board for a final decision. Of the appeals involving
compensation cases decided during fiscal year 2004, the Board reported
that it granted requested benefits for at least one issue in about 18
percent of the cases, denied all requested benefits in about 23 percent of
the cases, and remanded about 58 percent of the cases to VBA for rework.5

Effective February 22, 2002, VA issued a new regulation to streamline and
expedite the appeals process. Previously, the Board had remanded all
decisions needing rework directly to VBA's regional offices. The new
regulation, however, allowed the Board to obtain evidence, clarify
evidence, cure a procedural defect, or perform almost any other action
essential for a proper appellate decision without having to remand the
appeal to the regional office. It also allowed the Board to consider
additional evidence without having to refer the evidence to the regional
office for initial consideration and without having to obtain the
appellant's waiver. According to the Board, this change in the process
reduced the time required to provide a final decision to the veteran on an
appeal, allowed regional offices to use more resources for processing
initial claims rather than remands, and virtually eliminated multiple
remands on the same case to the regional offices. However, in May 2003,
the U.S. Court of Appeals for the Federal Circuit held that the Board
could not, except in certain statutorily authorized exceptions, decide
appeals in cases in which

5The statistics in the Board's annual reports do not reflect all cases in
which at least one issue is remanded or denied because the Board reports
appeals outcomes on the basis of individual cases rather than individual
issues within each case. To do this, the Board counts "case" dispositions
using the following hierarchy: (1) allowed, (2) remanded, (3) dismissed,
and (4) denied. Under this hierarchy, if any issue or part of the appeal
is allowed, the entire case is counted as an allowance, regardless of
whether any other issue in the case is remanded or denied. If no issue or
part of the appeal is allowed, but part is remanded and part is denied,
the case is counted as a remand. If no issue or part of the appeal is
allowed or remanded, but part is dismissed and part is denied, the case is
counted as a dismissal. A case is counted as denied only when all issues
or parts of the appeal are denied.

  The Board Has Taken Steps to Improve Its Quality Assurance Program

the Board had developed evidence.6 As a result, VA established a
centralized Appeals Management Center within VBA in Washington, D.C., to
take over evidence development and adjudication work on remands.

If the Board denies requested benefits or grants less than the maximum
benefit available under the law, veterans may appeal to the U. S. Court of
Appeals for Veterans Claims, an independent federal court. Unlike the
Board, the court may not receive new evidence. It considers only the
Board's decision; briefs submitted by the veteran and VA; oral arguments,
if any; and the case record that VA considered and that the Board had
available. In cases decided on merit (cases not dismissed on procedural
grounds), the court may (1) reverse the Board's decision (grant contested
benefits), (2) affirm the Board's decision (deny contested benefits) or
(3) remand the case back to the Board for rework. Of the 3,489 cases
decided on merit during fiscal years 2003-2004, the court reversed or
remanded in part or in whole about 88 percent of the cases. Under certain
circumstances, a veteran who disagrees with a decision of the court may
appeal to the U.S. Court of Appeals for the Federal Circuit and then to
the Supreme Court of the United States.

The Board of Veterans' Appeals has taken action to strengthen its internal
system for reviewing the quality of its own decisions. Specifically, the
Board has taken steps to improve its quality review system's sampling
methodology and to avoid obscuring serious errors by mixing them with less
significant deficiencies. We found, however, that the Board still needs to
revise its formula for calculating accuracy rates in order to avoid
potentially misleading accuracy rates.

6In Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d
1339 (Fed. Cir. 2003), the Court held that allowing the Board-which is
VA's "appellate tribunal" for deciding appeals of denials of veterans'
benefits claims-to consider additional evidence without having to remand
the case to the agency of original jurisdiction (regional office) for
initial consideration and without having to obtain the appellant's waiver
was contrary to the requirement of 38 U.S.C. S: 7104(a) that "[a]ll
questions in a matter which . . . is subject to decision by the Secretary
shall be subject to one review on appeal to the Secretary." Section
7104(b) does not permit the reconsideration of a claim disallowed by Board
in the absence of new and material evidence as required by 38 U.S.C. 5108;
however the regulation in question resulted in the veteran's not being
able to object effectively to any of the additional evidence obtained by
the Board until after the Board had weighed the evidence and decided the
appeal, therefore not permitting the veteran to explore effectively a
basis for "one review on appeal to the Secretary" with respect to the
additional evidence obtained by the Board.

During our 2002 evaluation, we reviewed the Board's methods for selecting
random samples of Board decisions and calculating accuracy rates for its
decisions. We found that the number of decisions reviewed was sufficient
to meet the Board's goal for statistical precision in estimating its
accuracy rate.7 However, we pointed out some Board practices that might
result in misleading accuracy rates. These practices included not ensuring
that decisions made near the end of the fiscal year were sampled and not
properly weighting quality review results in the formula used to calculate
accuracy rates. At the time of our 2002 report, the Board had agreed in
principle to correct these practices.

We found in our most recent work that the Board took corrective action in
fiscal year 2002 to assure that decisions made near the end of the fiscal
year were sampled. The quality review program now selects every 20th
original decision made by the Board's veterans law judges and every 10th
decision they make on cases remanded by the court to the Board for rework.
However, we found that the Board had not revised its formula for
calculating accuracy rates in order to properly weight the quality review
results for original decisions versus the results for decisions on
remanded cases. We determined that, even if this methodological error had
been corrected earlier, the accuracy rate reported by the Board for fiscal
year 2004 (93 percent) would not have been materially different. However,
to avoid the potential for reporting a misleading accuracy rate in the
future, corrective action needs to be taken, and the Board agreed to
correct this issue in the very near future.

In our 2002 evaluation, we also found that the Board included
nonsubstantive deficiencies (errors that would not be expected to result
in either a remand by the court or a reversal by the court) in calculating
its reported accuracy rates. We concluded that the reported accuracy rates
understated the level of accuracy that would result if the Board, like
VBA, counted only substantive deficiencies in the accuracy rate
calculation.8

7The Board's intention is that VA can have 95 percent confidence that the
Board's true accuracy rate is no more than 5 percentage points higher or
lower than the estimated accuracy rate.

8At that time, the Board's quality reviewers assessed decision accuracy on
the basis of six areas: issues, evidence, laws and regulations, reasons
and bases, due process, and format. One error (or deficiency) in any area
meant that a decision failed the quality test. However, according to the
Board, all six areas included certain deficiencies that are not
substantive. According to the Board, most deficiencies in the "format"
category were not substantive, such as errors in grammar, spelling, or
decision structure.

VBA had ceased counting nonsubstantive deficiencies in its error rate
after the VA Claims Processing Task Force said in 2001 that mixing serious
errors with less significant deficiencies could obscure what is of real
concern. Similarly, we recommended that the Board's accuracy rates take
into account only those deficiencies that would be expected to result in a
reversal or a remand by the court. In fiscal year 2002, the Board
implemented our recommendation.

Also, during the course of our 2002 evaluation of the quality review
program, we brought to the Board's attention the governmental internal
control standard calling for separation of key duties and the governmental
performance audit standard calling for organizational independence for
agency employees who review and evaluate program performance. These issues
arose because certain veterans law judges who were directly involved in
deciding veterans' appeals were also involved in reviewing the accuracy of
such decisions. The Board took corrective actions during our review in May
2002 to resolve these issues so all quality reviews from which accuracy
rates are determined are done by persons not directly involved in deciding
veterans' appeals.

In 2002, we also found that the Board collected and analyzed
issue-specific data on the reasons that the Court remanded decisions to
the Board in order to provide feedback and training to the Board's
veterans law judges; however, the Board did not collect issue-specific
data on the errors that its own quality reviewers found in decisions of
the Board's veterans law judges. We recommended that the Board revise its
quality review program to begin collecting such issue-specific error data
in order to identify training that could help improve decision quality. In
April 2005, the Board said it did not implement this recommendation
because it believes the benefits would be too limited to justify the
substantial reprogramming of the data system that would be required to
collect issue-specific data. The Board also pointed out that the
issue-specific data captured for court remands have not proved to be as
useful as it had expected in identifying ways to provide training that
could reduce court remands.

VA Faces Challenges Adjudicator judgment is an inherent factor in deciding
disability claims,

and it introduces the potential for variation in the process. Part of in
Measuring assessing inconsistency, as we recommended in 2002, would
include Consistency But Has determining acceptable levels of variation for
specific types of disabilities.

In late 2004, in response to adverse media reports, VA initiated its first
Recently Initiated study of consistency. Such studies are the first step
in determining the Studies degree of variation that occurs and what levels
of variation are acceptable.

Adjudicator Judgment Results in Inherent Variation in Decisionmaking

Adjudicators often must use judgment in making disability decisions.
Judgment is particularly critical when the adjudicator must (1) assess the
credibility of different sources of evidence; (2) evaluate how much weight
to assign different sources of evidence; or (3) assess some disabilities,
such as mental disorders, for which the disability standards are not
entirely objective and require the use of professional judgment. In such
cases, two adjudicators reviewing the same evidence might make differing
judgments on the meaning of the evidence and reach different decisions,
neither of which would necessarily be found in error by any of VA's
quality reviewers.

For example, in an illustration provided by the Board, consider a
disability claim that has two conflicting medical opinions, one provided
by a medical specialist who reviewed the claim file but did not examine
the veteran, and a second opinion provided by a medical generalist who
reviewed the file and examined the veteran. One adjudicator could assign
more weight to the specialist's opinion, while another could assign more
weight to the opinion of the generalist who examined the veteran.
Depending on which medical opinion is given more weight, one adjudicator
could grant the claim and the other could deny it. Yet, a third
adjudicator could apply VA's "benefit-of-the-doubt" rule and decide in
favor of the veteran. Under this rule, if an adjudicator concludes that
there is an approximate balance between the evidence for and the evidence
against a veteran's claim, the adjudicator must decide in favor of the
veteran.

In the design of their quality review systems, VBA and the Board
acknowledge the fact that, in some cases, different adjudicators reviewing
the same evidence can make differing, but reasonable, judgments on the
meaning of the evidence. As a result, VBA and the Board instruct their
quality reviewers that when they review a decision, they are not to record
an error merely because they would have made a different decision than the
one made by the adjudicator. VBA and the Board instruct their quality
reviewers to not substitute their own judgment in place of the original

adjudicator's judgment if the adjudicator's decision is adequately
supported and reasonable.

Another example provided by the Board demonstrates how adjudicators must
make judgments about the degree of severity of a disability. VA's
disability criteria provide a formula for rating the severity of a
veteran's occupational and social impairment due to a variety of mental
disorders. This formula is a nonquantitative, behaviorally oriented
framework for guiding adjudicators in choosing which of the degrees of
severity shown in table 1 best describes the claimant's occupational and
social impairment.

Table 1: VA's Medical Criteria for Evaluating the Degree of Occupational
and Social Impairment Due to Mental Disorders

Disability Degree of occupational and social impairment as rating (in
characterized in VA's medical criteria percent)

                              Totally impaired 100

Deficient in most areas such as work, school, family relations, judgment,
thinking, or mood

Reduced reliability and productivity

Occasional decrease in work efficiency and intermittent periods of
inability to perform occupational tasks

Mild or transient symptoms that decrease work efficiency and ability to
perform occupational tasks only during periods of significant stress, or
symptoms can be controlled by continuous medication

Not severe enough to interfere with occupational or social functioning or
to require continuous medication

Source: Board of Veterans' Appeals and VA's Schedule for Rating
Disabilities.

Similarly, VA does not have objective criteria for rating the degree to
which certain spinal impairments limit a claimant's motion. The
adjudicator must assess the evidence and decide whether the limitation of
motion is "slight, moderate, or severe." To assess the severity of
incomplete paralysis, the adjudicator must decide whether the veteran's
paralysis is "mild, moderate, or severe." The decision on which severity
classification to assign to a claimant's condition could vary in the minds
of different adjudicators, depending on how they weigh the evidence and
how they interpret the meaning the of the different severity
classifications.

Consequently, it would be unreasonable to expect that no decision-making
variations would occur. But it is reasonable to expect the extent of
variation to be confined within a range that knowledgeable professionals
could agree is reasonable, recognizing that disability criteria are more

objective for some disabilities than for others. For example, if two
adjudicators were to review the same claim file for a veteran who has
suffered the anatomical loss of both hands, VA's disability criteria state
unequivocally that the veteran is to be given a 100 percent disability
rating. Therefore, no variation would be expected. However, if two
adjudicators were to review the same claim file for a veteran with a
mental disability, knowledgeable professionals might agree that it would
not be out of the bounds of reasonableness if one adjudicator gave the
claimant a 50 percent disability rating and the other adjudicator gave a
70 percent rating. However, knowledgeable professionals might also agree
that it would be clearly outside the bounds of reasonableness if one
adjudicator gave the claimant a 30 percent rating and the other, a 100
percent rating.

VA Began Studying Decision-making Consistency in December 2004

Although the issue of decision-making consistency is not new, VA only
recently began to study consistency issues. In a May 2000 testimony9
before the House Subcommittee on Oversight and Investigations, Committee
on Veterans' Affairs, we underscored the conclusion made by the National
Academy of Public Administration in 199710 that VBA needed to study the
consistency of decisions made by different regional offices, identify the
degree of subjectivity expected for various medical issues, and then set
consistency standards for those issues. In August 2002, we drew attention
to the fact that there are wide disparities in state-to-state average
compensation payments per disabled veteran, and we voiced the concern that
such variation raises the question of whether similarly situated veterans
who submit claims to different regional offices for similar conditions
receive reasonably consistent decisions. In January 2003, we reported that
concerns about consistency had contributed to GAO's designation of the VA
disability program as high-risk in 2003. Again, in November 2004, we
highlighted the need for VA to develop plans for studying consistency
issues.

Most recently, in December 2004, the media drew attention to the wide
variations in the average disability compensation payment per veteran in
the 50 states and published data showing that the average payments varied
from a low of $6,710 in Ohio to a high of $10,851 in New Mexico. Reacting

9GAO, Veterans Benefits Administration: Problems and Challenges Facing
Disability Claims Processing, GAO/T-HEHS/AIMD-00-146 (Washington, D.C.:
May 18, 2000).

10National Academy of Public Administration, Management of Compensation
and Pension Benefits Claim Processes for Veterans, (Washington, D.C.:
August 1997).

to these media reports, in December 2004, the Secretary instructed the
Inspector General to determine why average payments per veteran vary
widely from state to state. As of February 2005 the Office of Inspector
General planned to use data obtained from VBA for all regional offices to
identify factors that may explain variations among the regional offices.

In March 2005, VBA began a study of three disabilities believed to have
potential for inconsistency: hearing loss, post-traumatic stress disorder,
and knee conditions. VBA assigned 10 subject matter experts to review
1,750 regional office decisions and plans to complete its analysis of
study data in mid-May 2005, develop a schedule for future studies of
specific ratable conditions, and recommend a schedule for periodic
follow-up studies of previously studied conditions.

In our 2002 report, we recommended that VA establish a system to regularly
assess and measure the degree of consistency across all levels of VA
adjudication, including regional offices and the Board, for specific
medical conditions that require adjudicators to make difficult judgments.
For example, we said VA could create hypothetical claims for certain
medical conditions, distribute the claims to multiple adjudicators at each
decision-making level, and analyze variations in outcomes. Such a system
would identify variation in decision making and provide a basis to
identify ways, if considered necessary, to reduce variation through
training or clarifying and strengthening regulations, procedures, and
policies.

Although VA agreed in principle with our recommendation and agreed that
consistency is an important goal, it commented that it would promote
consistency through training and communication. We support such efforts
but still believe VA needs to directly evaluate and measure consistency
across all levels of adjudication. Otherwise, VA cannot determine whether
such training and other efforts are directed at the causes of
inconsistency and whether such efforts actually improve consistency.

In our November 2004 report,11 we found that VBA's administrative data was
insufficient to analyze inconsistency because we could not reliably use
the data to identify decisions made after fiscal year 2000, identify the
regional offices that made the original decisions, or determine
serviceconnection denial rates for specific impairments. However, in
October

11GAO, Veterans Benefits: VA Needs Plan for Assessing Consistency of
Decisions, GAO-05-99 (Washington, D.C.: Nov. 19, 2004).

2004, VBA completed its implementation of a new nationwide data system,
known as Rating Board Automation (RBA) 2000. VA said this new system could
reliably collect the types of data needed to perform the analyses we
sought to do. Therefore, we recommended that the Secretary of Veterans
Affairs develop a plan, and include it in VA's annual performance plan,
containing a detailed description of how VA intended to use data from the
new RBA 2000 information system. We recommended that VA conduct systematic
studies of the impairments for which RBA 2000 data reveal indications of
decision-making inconsistencies among regional offices. VA concurred with
our recommendation. Because the new RBA 2000 data system had been recently
implemented, we acknowledged that VA could not implement such a plan until
it accumulated a sufficiently large body of data under the new system. In
our judgment, at least one year of data would be needed to begin such a
study.

While we believe the studies recently begun by the Office of Inspector
General and VBA are positive steps forward in addressing consistency
issues, the RBA 2000 data system, if found to be reliable, can provide VA
with the data needed to proactively and systematically target specific
impairments that have the widest variations in decision-making outcomes
among the regional offices and focus VA's efforts to study reasons for
variations on those impairments. Building in such analytical capability to
augment its quality assurance program would help enhance program integrity
and better assure that veterans' disability decisions are made fairly and
equitably.

Mr. Chairman, this concludes my remarks. I would be happy to answer any
questions you or the members of the subcommittee may have.

Contact and For further information, please contact Cynthia A. Bascetta at
(202) 5127101. Also contributing to this statement were Irene Chu, Ira
Spears,Acknowledgements Martin Scire, and Tovah Rom.

Related GAO Products

Veterans Benefits: VA Needs Plan for Assessing Consistency of Decisions.
GAO-05-99. Washington, D.C.: November 19, 2004.

High-Risk Series: An Update. GAO-03-119. Washington, D.C.: January 2003.

Veterans' Benefits: Quality Assurance for Disability Claims and Appeals
Processing Can Be Further Improved. GAO-02-806. Washington, D.C.: August
16, 2002.

SSA and VA Disability Programs: Re-Examination of Disability Criteria
Needed to Help Ensure Program Integrity. GAO-02-597. Washington, D.C.:
August 9, 2002.

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