Veterans' Disability Benefits: Claims Processing Problems Persist
and Major Performance Improvements May Be Difficult (26-MAY-05,  
GAO-05-749T).							 
                                                                 
The Chairman, Committee on Veterans' Affairs, U.S. Senate, asked 
GAO to testify on the current state of VA's disability claims	 
process and factors that may impede VA's ability to improve	 
performance. For years, the claims process has been the subject  
of concern and attention within VA and by the Congress and	 
veterans service organizations. Many of their concerns have	 
focused on long waits for decisions, large claims backlogs, and  
the accuracy of decisions. Our work and recent media reports of  
significant discrepancies in average disability payments from	 
state to state have also highlighted concerns over the		 
consistency of decision-making within VA. In January 2003, GAO	 
designated federal disability programs, including VA's		 
compensation and pension programs, as a high-risk area because of
continuing challenges to improving the timeliness and consistency
of its disability decisions, and the need to modernize programs. 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-05-749T					        
    ACCNO:   A25326						        
  TITLE:     Veterans' Disability Benefits: Claims Processing Problems
Persist and Major Performance Improvements May Be Difficult	 
     DATE:   05/26/2005 
  SUBJECT:   Accountability					 
	     Claims processing					 
	     Disability benefits				 
	     Performance management				 
	     Program evaluation 				 
	     Program management 				 
	     Strategic planning 				 
	     Veterans benefits					 
	     Veterans disability compensation			 
	     Performance measures				 

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GAO-05-749T

                 United States Government Accountability Office

GAO Testimony

Before the Committee on Veterans' Affairs, U.S. Senate

For Release on Delivery

Expected at 2:00 p.m. EDT VETERANS' DISABILITY

May 26, 2005

BENEFITS

  Claims Processing Problems Persist and Major Performance Improvements May Be
                                   Difficult

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

GAO-05-749T

[IMG]

May 26, 2005

VETERANS' DISABILITY BENEFITS

Claims Processing Problems Persist and Major Performance Improvements May Be
Difficult

                                 What GAO Found

The Department of Veterans Affairs (VA) continues to experience problems
processing veterans' disability compensation and pension claims. These
include large numbers of pending claims and lengthy processing times.
While VA made progress in fiscal years 2002 and 2003 in reducing the size
and age of its inventory of pending claims, it has lost some ground since
the end of fiscal year 2003. For example, pending claims increased by
about one-third from the end of fiscal year 2003 to the end of March 2005.
Meanwhile, VA faces continuing questions about its ability to ensure that
veterans get consistent decisions across its 57 regional offices. GAO has
highlighted the need for VA to study the consistency of decisions made by
different regional offices, identify acceptable levels of decision-making
variation, and reduce variations found to be unacceptable. Also, reacting
to media reports of wide variations in average disability benefit payments
from state to state, the Secretary of Veterans Affairs instructed VA's
Inspector General in December 2004 to determine why these variations were
occurring.

Several factors may impede VA's ability to make significant improvements
in its disability claims processing performance. Recent history has shown
that VA's workload and performance is affected by factors such as the
impacts of laws and court decisions affecting veterans' benefit
entitlement and the claims process, and the filing behavior of veterans.
These factors have affected the number of claims VA received and decided.
Also, to achieve its claims processing performance goals in the face of
increasing workloads without significant staffing increases, VA would have
to rely on productivity improvements. GAO believes that fundamental reform
might be necessary to achieve more dramatic gains in performance.

Rating-Related Claims Pending at End of Period, Fiscal Year 2000 through
March 2005

Claims pending (in thousands)

450 421

400

350

300

250

200

150

100

50

0

2000 2001 2002 2003 2004 2005 First half

                      Pending over 6 months Total pending

Source: VA data.

                 United States Government Accountability Office

Mr. Chairman and Members of the Committee:

I am pleased to be here today to discuss claims processing issues in the
Department of Veterans Affairs' (VA) disability compensation and pension
programs. Through these programs, VA provided almost $30 billion in cash
disability benefits to more than 3.4 million veterans and their survivors
in fiscal year 2004. For years, the claims process has been the subject of
concern and attention within VA and by the Congress and veterans service
organizations. Many of their concerns have focused on long waits for
decisions, large claims backlogs, and inaccurate decisions. Our work and
recent media reports of significant discrepancies in average disability
payments from state to state has also highlighted concerns over the
consistency of decision-making within VA. In January 2003, we designated
modernizing federal disability programs as a high-risk area, in part
because of VA's continuing challenges to improving the timeliness and
consistency of its disability decisions.

You asked us to discuss the current state of VA's disability claims
process and factors that may impede VA's ability to improve performance.
My testimony today draws on numerous GAO reports and testimonies on VA's
compensation and pension claims-processing operations. (See related GAO
products.) To update our work, we reviewed recent claims processing
performance data, VA's fiscal year 2006 budget justification, and VA's
fiscal year 2004 Performance and Accountability Report. We did not perform
independent verification of VA's data. We conducted our work in May 2005
in accordance with generally accepted government auditing standards.

In summary, VA continues to have disability claims processing problems.
For example, as of the end of March 2005, rating-related claims1 were
pending an average of 119 days, 8 days more than at the end of fiscal year
2003, and far from its strategic goal of 78 days. During the same period,
the rating-related inventory grew by about 86,000 claims to a total of
about 340,000 claims. While VA has improved the accuracy of its decisions
to 87 percent in fiscal year 2004, it is still below its strategic goal of
96 percent in fiscal year 2008. Further, we have identified concerns about
the consistency of decisions across VA's regional offices. VA has begun

1Rating-related claims are primarily original claims for disability
compensation and pension benefits, and reopened claims. For example,
veterans may file reopened claims if they believe their service-connected
conditions have worsened.

Background

studying one indicator of inconsistency, the wide variations in average
payments per veteran from state to state, in response to adverse media
coverage.

We identified factors that may impede VA's ability to improve its
disability claims processing performance. The impacts of laws, court
decisions, and the filing behavior of veterans can significantly affect
VA's ability to decide claims, as well as the volume of claims received.
Also, VA's ability to improve the productivity of its claims processing
staff may affect its ability to improve performance. More dramatic gains
in timeliness and inventory reduction might require fundamental changes in
the design and operations of VA's disability programs.

VA's disability compensation program pays monthly benefits to veterans
with service-connected disabilities (injuries or diseases incurred or
aggravated while on active military duty) according to the severity of the
disability. Also, VA pays dependency and indemnity compensation to some
deceased veterans' spouses, children, and parents and to survivors of
service members who died on active duty. The pension program pays monthly
benefits based on financial need to wartime veterans who have low incomes,
served in a period of war, and are permanently and totally disabled for
reasons not service-connected (or are aged 65 or older). VA also pays
pensions to surviving spouses and unmarried children of deceased wartime
veterans.

When a veteran submits a claim to any of VA's 57 regional offices, a
veterans service representative (VSR) is responsible for obtaining the
relevant evidence to evaluate the claim. Such evidence includes veterans'
military service records, medical examinations and treatment records from
VA medical facilities, and treatment records from private medical service
providers. Once a claim is developed (i.e., has all the necessary
evidence), a rating VSR, also called a rating specialist, evaluates the
claim and determines whether the claimant is eligible for benefits. If the
veteran is eligible for disability compensation, the rating specialist
assigns a percentage rating based on degree of disability. Veterans with
multiple service-connected disabilities receive a single composite rating.
For veterans claiming pension eligibility, the regional office determines
if the veteran served in a period of war, is permanently and totally
disabled for reasons not service-connected (or is aged 65 or older), and
meets the income thresholds for eligibility. A veteran who disagrees with
the regional office's decision for either program can appeal sequentially
to

VA's Board of Veterans' Appeals (BVA), the U.S. Court of Appeals for
Veterans Claims, and the U.S. Court of Appeals for the Federal Circuit.

In January 2003, we designated modernizing VA's disability programs, along
with other federal disability programs, as high-risk. We did so, in part,
because VA still experiences lengthy processing times and lacks a clear
understanding of the extent of possible decision inconsistencies. We also
designated VA's disability programs as high-risk because our work over the
past decade found that VA's disability programs are based on concepts from
the past. VA's disability programs have not been updated to reflect the
current state of science, medicine, technology, and labor market
conditions.

In November 2003, the Congress established the Veterans' Disability
Benefits Commission to study the appropriateness of VA disability
benefits, including disability criteria and benefit levels. The commission
held its first public hearing in May 2005.

Problems in Claims Processing Continue

VA continues to experience problems processing veterans' disability
compensation and pension claims. These include large numbers of pending
claims and lengthy processing times. While VA made progress in fiscal
years 2002 and 2003 in reducing the size and age of its inventory of
pending claims, it has lost some ground since the end of fiscal year 2003.
As shown in figure 1, pending claims increased by about one-third from the
end of fiscal year 2003 to the end of March 2005, from about 254,000 to
about 340,000. During the same period, claims pending over 6 months
increased by about 61 percent from about 47,000 to about 75,000.

Figure1: Rating-Related Claims Pending at End of Period, Fiscal Year 2000
through March 2005

Claims pending (in thousands)

450 421 400

350

300

250

200

150

100

50

0

2000 2001 2002 2003 2004 2005 First half

Pending over 6 months Total pending

Source: VA data.

Similarly, as shown in figure 2, VA reduced the average age of its pending
claims from 182 days at the end of fiscal year 2001 to 111 days at the end
of fiscal year 2003. Since then, however, average days pending have
increased to 119 days at the end of March 2005. This is also far from VA's
strategic goal of an average of 78 days pending by the end of fiscal year
2008. Meanwhile, the time required to resolve appeals remains too long.
While the average time to resolve an appeal dropped from 731 days in
fiscal year 2002 to 529 days in fiscal year 2004, close to its fiscal year
2004 goal of 520 days, but still far from VA's strategic goal of 365 days
by fiscal year 2008.

Figure 2: Average Days Pending for VA Compensation and Pension
Rating-Related Claims, Fiscal Year 2000 through March 2005

Days pending

                                    182 174

Stategic Fiscal year goal

2000 2001 2002 2003 2004 2005 First half

Source: VA data.

In addition to problems with timeliness of decisions, VA acknowledges that
the accuracy of regional office decisions needs to be improved. While VA
reports2 that it has improved the accuracy of decisions on rating related
claims from 81 percent in fiscal year 2002 to 87 percent in fiscal year
2004-close to its 2004 goal of 90 percent. However, it is still below its
strategic goal of 96 percent in fiscal year 2008.

VA also faces continuing questions about its ability to ensure that
veterans receive consistent decisions-that is, comparable decisions on
benefit entitlement and rating percentage-regardless of the regional
offices making the decisions. The issue of decision-making consistency
across VA is not new. In a May 2000 testimony3 before the Subcommittee on
Oversight and Investigations, Committee on Veterans' Affairs, House of
Representatives, we underscored the conclusion made by the National

2We are currently reviewing the reliability of VA's claims processing
accuracy data.

3GAO, Veterans Benefits Administration: Problems and Challenges Facing
Disability Claims Processing, GAO/T-HEHS/AIMD-00-146 (Washington, D.C.:
May 18, 2000).

Academy of Public Administration in 19974 that VA 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. We noted 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.5 We concluded that VA needed to
systematically assess decision-making consistency to provide a foundation
for identifying acceptable levels of variation and to reduce variations
found to be unacceptable. Again, in November 2004, we highlighted the need
for VA to develop plans for studying consistency issues.6 VA concurred in
principle with our findings and recommendation in the August 2002 report
and agreed that consistency is an important goal and acknowledged that it
has work to do to achieve it. However, VA was silent on how it would
evaluate and measure consistency. Subsequently, VA concurred with our
recommendation in the November 2004 report that it conduct systematic
reviews for possible decision inconsistencies.

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 VA's own 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 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.7 Also, VA's Veterans Benefits Administration
began another study in March 2005 of three disabilities believed to have
potential for inconsistency: hearing loss, post-traumatic stress disorder,
and knee conditions. VA assigned 10 subject matter experts to review

4National Academy of Public Administration, Management of Compensation and
Pension Benefits Claim Processes for Veterans (Washington, D.C.: Aug.
1997).

5GAO, Veterans' Benefits: Quality Assurance for Disability Claims and
Appeals Processing Can Be Further Improved, GAO-02-806 (Washington, D.C.:
Aug. 16, 2002).

6GAO, Veterans Benefits: VA Needs Plan for Assessing Consistency of
Decisions, GAO-05-99 (Washington, D.C.: Nov. 19, 2004).

7On May 19, 2005, the Office of Inspector General issued the report of its
review of state variations in disability compensation payments. Department
of Veterans Affairs Office of Inspector General, Review of State Variances
in VA Disability Compensation Payments, Report No. 05-00765-137
(Washington, D.C.: May 19, 2005).

1,750 regional office decisions. After completing its analysis of study
data, VA plans to develop a schedule for future studies of specific
ratable conditions and recommend a schedule for periodic follow-up studies
of previously studied conditions.

Several factors may impede VA's ability to make, and sustain, significant
improvements in its claims processing performance. These include the
potential impacts of laws, court decisions, and the filing behavior of
veterans; VA's ability to improve claims processing productivity; and
program design and structure.

Factors That May Impede VA's Ability to Improve Claims Processing
Performance

Laws, Court Decisions, and Filing Behavior of Veterans Impact Workload and
Performance

Recent history has shown that VA's workload and performance is affected by
several factors, including the impacts of laws and court decisions
expanding veterans' benefit entitlement and clarifying VA's duty to assist
veterans in the claims process, and the filing behavior of veterans. These
factors have affected the number of claims VA received and decided. For
example, court decisions in 1999 and 2003 related to VA's duty to assist
veterans in developing their benefit claims, as well as legislation in
response to those decisions, significantly affected VA's ability to
produce rating-related decisions. VA attributes some of the worsening of
inventory level and pending timeliness since the end of fiscal year 2003
to a September 2003 court decision that required over 62,000 claims to be
deferred, many for 90 days or longer. Also, VA notes that legislation and
VA regulations have expanded benefit entitlement and as a result added to
the volume of claims. For example, presumptions of service-connected
disabilities have been created in recent years for many Vietnam veterans
and former Prisoners of War. Also, VA expects additional claims receipts
based on the enactment of legislation allowing certain military retirees
to receive both military retirement pay and VA disability compensation.

In addition, the filing behavior of veterans impacts VA's ability to
improve claims processing performance. VA continues to receive increasing
numbers of rating-related claims, from about 586,000 in fiscal year 2000
to about 771,000 in fiscal year 2004. VA projects 3-percent increases in
claims received in fiscal years 2005 and 2006. VA notes that claims
received are increasing in part because older veterans are filing
disability claims for the first time. Also, according to VA, the
complexity of claims, in terms of the numbers of disabilities claimed, is
increasing. Because each disability needs to be evaluated, these claims
can take longer to complete. VA plans

to develop baseline data on average issues per claim by the end of
calendar year 2005.

Ability to Improve Productivity May Affect Future Performance Improvements

In November 2004, we reported that to achieve its claims processing
performance goals in the face of increasing workloads and decreased
staffing levels, VA would have to rely on productivity improvements.8
However, its fiscal year 2005 budget justification did not provide
information on claims processing productivity or how much VA expected to
improve productivity. VA's fiscal year 2006 budget justification provides
information on actual and planned productivity, in terms of rating-related
claims decided per direct full-time equivalent (FTE) employee, and
identifies a number of initiatives that could improve claims processing
performance. These initiatives include technology initiatives, such as
Virtual VA, involving the creation of electronic claims folders;
consolidation of the processing of Benefits Delivery at Discharge (BDD)
claims at 2 regional offices; and collaboration with the Department of
Defense (DOD) to improve VA's ability to obtain evidence, such as evidence
of in-service stressors for veterans claiming service-connected
Post-Traumatic Stress Disorder.

It is still not clear whether VA will be able to achieve its planned
improvements. VA's fiscal year 2006 budget justification assumes that it
will increase the number of rating-related claims completed per FTE from
94 in fiscal year 2004 to 109 in fiscal year 2005 and 2006, a 16-percent
increase. For fiscal year 2005, this level of productivity translates into
VA completing almost 826,000 rating-related decisions. Midway through
fiscal year 2005 VA had completed about 373,000 decisions.

Program Design and Program design features and the regional office
structure may constrain Regional Office Structure the degree to which
improvements can be made in performance. For May Limit Performance
example, in 1996, the Veterans' Claims Adjudication Commission9 noted

that most disability compensation claims are repeat claims-such
asImprovements claims for increased disability percentage-and most repeat
claims were from veterans with less severe disabilities. According to VA,
about

8Veterans' Benefits: More Transparency Needed to Improve Oversight of
VBA's Compensation and Pension Staffing Levels, GAO-05-47 (Washington,
D.C.: Nov. 15, 2004).

9Veterans' Claims Adjudication Commission, Report to Congress (Washington
D.C.: Dec. 1996).

65 percent of veterans who began receiving disability compensation in
fiscal year 2003 had disabilities rated 30 percent or less. The Commission
questioned whether concentrating claims processing resources on these
claims, rather than on claims by more severely disabled veterans, was
consistent with program intent.

In addition to program design, external studies of VA's disability claims
process have identified the regional office structure as disadvantageous
to efficient operation. Specifically, in its January 1999 report, the
Congressional Commission on Servicemembers and Veterans Transition
Assistance10 found that some regional offices might be so small that their
disproportionately large supervisory overhead unnecessarily consumes
personnel resources. Similarly, in its 1997 report, the National Academy
of Public Administration found that VA could close a large number of
regional offices and achieve significant savings in administrative
overhead costs.

Apart from the issue of closing regional offices, the Commission
highlighted a need to consolidate disability claims processing into fewer
locations. VA has consolidated its education assistance and housing loan
guaranty programs into fewer than 10 locations, and the Commission
encouraged VA to take similar action in the disability programs. In 1995
VA enumerated several potential benefits of such a consolidation. These
included allowing VA to assign the most experienced and productive
adjudication officers and directors to the consolidated offices;
facilitating increased specialization and as-needed expert consultation in
deciding complex cases; improving the completeness of claims development,
the accuracy and consistency of rating decisions, and the clarity of
decision explanations; improving overall adjudication quality by
increasing the pool of experience and expertise in critical technical
areas; and facilitating consistency in decisionmaking through fewer
consolidated claimsprocessing centers. VA has already consolidated some of
its pension workload (specifically, income and eligibility verifications)
at three regional offices. Also, VA has consolidated at its Philadelphia
regional office dependency and indemnity compensation claims by survivors
of servicemembers who died on active duty, including those who died during
Operation Enduring Freedom and Operation Iraqi Freedom.

10Report of the Congressional Commission on Servicemembers and Veterans
Transition Assistance (Washington, D.C.: Jan. 14, 1999).

Concluding Observations

GAO Contact and Acknowledgments

VA has had persistent problems in providing timely, accurate, and
consistent disability decisions to veterans and their families. To some
extent, program design features that protect the rights of veterans have
also increased the complexity of and length of time needed to process
their claims. In addition, expanding entitlements have increased VA's
workload as more veterans file claims. As a result, major improvements in
disability claims processing performance may be difficult to achieve
without more fundamental change. We have placed VA's disability programs
on our high-risk list along with other federal disability programs.
Modernizing its programs would give VA the opportunity to address many
longstanding problems. At the same time, VA could integrate any changes to
disability criteria and benefit levels that the Veterans' Disability
Benefits Commission may propose. This is important because significant
changes in the benefits package and disability criteria are major factors
affecting VA's disability claims process and its claims processing
performance.

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

For further information, please contact Cynthia A. Bascetta at (202)
5127215. Also contributing to this statement were Irene Chu, Martin Scire,
and Greg Whitney.

Related GAO Products

VA Disability Benefits: Board of Veterans' Appeals Has Made Improvements
in Quality Assurance, but Challenges Remain for VA in Assuring
Consistency. GAO-05-655T. Washington, D.C.: May 5, 2005.

High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January 2005.

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

Veterans' Benefits: More Transparency Needed to Improve Oversight of VBA's
Compensation and Pension Staffing Levels. GAO-05-47. Washington, D.C.:
November 15, 2004.

Veterans' Benefits: Improvements Needed in the Reporting and Use of Data
on the Accuracy of Disability Claims Decisions. GAO-03-1045. Washington,
D.C.: September 30, 2003.

Department of Veterans Affairs: Key Management Challenges in Health and
Disability Programs. GAO-03-756T. Washington, D.C.: May 8, 2003.

Major Management Challenges and Program Risks: Department of Veterans
Affairs. GAO-03-0110. Washington, D.C.: January 1, 2003.

Veterans' Benefits: Claims Processing Timeliness Performance Measures
Could Be Improved. GAO-03-282. Washington, D.C.: December 19, 2002.

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

Veterans' Benefits: VBA's Efforts to Implement the Veterans Claims
Assistance Act Need Further Monitoring. GAO-02-412. Washington, D.C.: July
1, 2002.

Veterans' Benefits: Despite Recent Improvements, Meeting Claims Processing
Goals Will Be Challenging. GAO-02-645T. Washington, D.C.: April 26, 2002.

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

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