Veterans' Benefits: Promising Claims-Processing Practices Need to Be
Evaluated (Letter Report, 04/07/2000, GAO/HEHS-00-65).

Pursuant to a congressional request, GAO reviewed the Veterans Benefits
Administration's (VBA) claims processing procedures, focusing on: (1)
practices that individual regional offices believe have helped them
improve the accuracy of their disability decisions and remand rates; and
(2) VBA's efforts to evaluate and disseminate information on individual
regional office practices that hold promise for improving accuracy and
remand rates of regional offices nationwide.

GAO noted that: (1) the 55 regional offices responding to GAO's survey
reported a total of 238 practices that they believe have helped improve
the accuracy of their disability decisions and remand rates; (2) GAO
grouped these practices into four broad areas of focus: (a) efforts to
improve staff training, guidance, or accountability; (b) changes in
supervisory or staffing structure; (c) efforts to develop evidence
accurately and fully; and (d) efforts to communicate more effectively
with veterans; (3) while many practices were similar, the mix and number
of practices varied from office to office, and the regional offices
viewed some practices as more effective than others in improving
accuracy and remand rates; (4) however, the regional offices generally
had not conducted evaluations to demonstrate a link between a specific
practice and improvements in accuracy or remand rates; (5) similarly,
VBA has not systematically evaluated regional office practices to
identify best practices that hold the most promise for improving the
claims-processing performance of regional offices across the nation; (6)
in a 1995 report, GAO emphasized that VBA needed to systematically
evaluate the effectiveness of regional offices' claims-processing
practices to identify those that hold promise for improving the
performance of regional offices nationwide; (7) VBA took steps in 1997
to identify potentially promising practices, however, it has neither
followed up on this effort nor developed a system for evaluating
promising practices and disseminating the results to regional offices;
(8) regional office and VBA officials stated it would be beneficial if
VBA evaluated and identified best practices so that regional offices
could use their limited resources to try only the most promising
practices; and (9) VBA officials told GAO they are planning to develop a
system for evaluating promising practices but, to date, evaluation
efforts have been limited to a few initiatives related to VBA's efforts
to reengineer its business processes for adjudicating disability claims.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-00-65
     TITLE:  Veterans' Benefits: Promising Claims-Processing Practices
	     Need to Be Evaluated
      DATE:  04/07/2000
   SUBJECT:  Claims processing
	     Veterans disability compensation
	     Military benefits claims
	     Performance measures
	     Veterans benefits
	     Private sector practices
IDENTIFIER:  VA Systematic Technical Accuracy Review System
	     GPRA
	     Government Performance and Results Act

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GAO/HEHS-00-65

Appendix I: Scope and Methodology

18

Appendix II: Comments From the Department of Veterans
Affairs

19

Table 1: Regional Office Practices by Broad Area of Focus 7

Table 2: Summary of Types of Regional Office Practices 9

GPRA Government Performance and Results Act

SDN Service Delivery Network

STAR Systematic Technical Accuracy Review

VA Department of Veterans Affairs

VBA Veterans Benefits Administration

Health, Education, and
Human Services

B-282849

April 7, 2000

The Honorable Lane Evans
Ranking Minority Member
Committee on Veterans' Affairs
House of Representatives

Dear Mr. Evans:

In fiscal year 1999, the Department of Veterans Affairs (VA) paid about $21
billion in compensation and pension benefits to more than 3 million disabled
veterans and their dependents and survivors. Under the direction of the
Veterans Benefits Administration (VBA), 58 regional offices receive and
process veterans' compensation and pension disability claims. For many
years, VBA's disability claims processing has been the subject of concern
and numerous studies--particularly its outmoded processes and long waits for
claims decisions. As a result, VBA has been exploring ways to reengineer the
regional offices' business processes and improve their claims-processing
performance. More recently, the accuracy of regional office claims
processing has been the subject of concern and attention within VA and from
the Congress and veterans' service organizations. Such questions arose
because, in more than half the cases when veterans appealed regional
offices' decisions, the Board of Veterans' Appeals either reversed the
regional offices' decisions or remanded them to the regional offices for
further development and reconsideration.

Amid such concerns, you asked us to report on (1) practices that individual
regional offices believe have helped them improve the accuracy of their
disability decisions and remand rates, and (2) VBA's efforts to evaluate and
disseminate information on individual regional office practices that hold
promise for improving accuracy and remand rates of regional offices
nationwide. To address these issues, we met with VBA officials and reviewed
VBA program guidance, procedures, policies, and quality assurance data. We
also surveyed all regional offices and visited six of them to discuss their
practices in more detail. We did not evaluate the effectiveness of
individual practices, but discussed the benefits of these practices with
regional office and VBA headquarters officials. (See app. I for more
information on scope and methodology.) We conducted our review between May
1999 and February 2000 in accordance with generally accepted government
auditing standards.

The 55 regional offices responding to our survey reported a total of 238
practices that they believe have helped improve the accuracy of their
disability decisions and remand rates. We grouped these practices into four
broad areas of focus: (1) efforts to improve staff training, guidance, or
accountability; (2) changes in supervisory or staffing structure; (3)
efforts to develop evidence accurately and fully; and (4) efforts to
communicate more effectively with veterans. While many practices were
similar, the mix and number of practices varied from office to office, and
the regional offices viewed some practices as more effective than others in
improving accuracy and remand rates. However, the regional offices generally
had not conducted evaluations to demonstrate a link between a specific
practice and improvements in accuracy or remand rates.

Similarly, VBA has not systematically evaluated regional office practices to
identify best practices that hold the most promise for improving the
claims-processing performance of regional offices across the nation. In a
1995 report, we emphasized that VBA needed to systematically evaluate the
effectiveness of regional offices' claims-processing practices to identify
those that hold promise for improving the performance of regional offices
nationwide.1 VBA took steps in 1997 to identify potentially promising
practices; however, it has neither followed up on this effort nor developed
a system for evaluating promising practices and disseminating the results to
regional offices. Regional office and VBA officials stated it would be
beneficial if VBA evaluated and identified best practices so that regional
offices could use their limited resources to try only the most promising
practices. VBA officials told us they are planning to develop a system for
evaluating promising practices but, to date, evaluation efforts have been
limited to a few initiatives related to VBA's efforts to reengineer its
business processes for adjudicating disability claims. We recommend that VBA
establish timeframes for developing and implementing a formal plan for
evaluating and disseminating information on practices that hold promise for
improving the claims-processing performance of regional offices nationwide.

VBA formulates the policy and guidance followed by regional office staff who
develop and adjudicate veterans' compensation and pension claims. The
compensation program pays monthly benefits to veterans who have
service-connected disabilities (injuries or diseases incurred or aggravated
while on active military duty), based on degree of disability, regardless of
whether they are employed or have earnings.2 When it receives an initial
disability claim, the regional office must establish that the claim is well
grounded--that is, that there is evidence supporting a plausible case that
the veteran has a current disability that is related to a service-connected
impairment. If the claim is well-grounded, the regional office has a duty to
assist the veteran in fully developing the claim. After obtaining required
evidence, the regional office must evaluate the veteran's degree of
disability for each service-connected impairment and assign a percentage of
disability ranging from zero to 100 percent.

After the regional office notifies the veteran of its decision, the veteran,
if dissatisfied, can ask for a hearing before a regional hearing officer.
The veteran also can submit a Notice of Disagreement to the regional office
and file an appeal asking for a review of the decision by VA's Board of
Veterans' Appeals, which makes final decisions on behalf of the Secretary.
Veterans may appeal regional office decisions for a variety of reasons. For
example, a veteran may disagree with a regional office's ruling to deny a
compensation claim because his or her impairment is not service-connected;
or, even if the regional office grants the claim, the veteran may disagree
with the percentage of disability that the regional office assigns to his or
her impairment. (Overall, veterans appeal relatively few regional office
decisions--in fiscal year 1997, for example, they appealed 5.4 percent of
all initial decisions.) When deciding an appeal, the Board can grant or deny
benefits, or remand (return) the case to the regional office for further
evidentiary development and reconsideration. For remanded decisions, the
regional office completes the additional development and either grants the
claim or returns it to the Board for a decision.

Until the passage of the Veterans' Judicial Review Act in 1988, the Board's
decisions on veterans' appeals were not subject to judicial review. This act
established what is now called the U.S. Court of Appeals for Veterans Claims
and gave veterans the right to appeal the Board's decisions to the Court.3
Before the Court was established, the Board annually remanded 12 to 24
percent of the cases it reviewed back to the regional offices for rework.
However, since the Board's decisions became subject to review by the Court,
the Board has annually remanded about 31 to 51 percent of the cases back to
the regional offices.4 In recent years, the remand rate has been
declining--for the first 4 months of fiscal year 2000, the remand rate was
about 29 percent.

The Government Performance and Results Act of 1993 (GPRA) requires agencies
to clearly define their missions, set goals, and measure performance. Under
GPRA, agencies submit to the Congress (1) annual performance plans and (2)
annual reports on success in achieving program performance goals. In its
fiscal year 2000 performance plan, VA stated that one of its top priorities
is the improvement of the quality and timeliness of disability claims
processing.

Over the years, VBA has sought ways to improve program performance. For
example, in 1995, VBA published a concept report calling for reengineering
the business processes used for adjudicating disability claims. This effort
is still ongoing and includes, among other initiatives, implementing a case
management approach to claims processing, contracting for veterans' medical
examinations, and developing computer-based training modules. Also, VBA has
restructured its 58 regional offices into nine Service Delivery Networks
(SDN). The regional offices that compose each SDN are expected to
collaborate, provide mutual support, share resources, use team-based
principles, and share collective responsibility and accountability for the
SDN's overall performance of all assigned work.

In fiscal year 1999, VBA instituted a "balanced scorecard" approach to
measure program performance. Under this approach, VBA assesses performance
on the basis of five factors: claims-processing accuracy, claims-processing
timeliness, unit cost, customer satisfaction, and employee satisfaction and
development. The balanced scorecard gives more relative weight (25 percent)
to accuracy than to any other factor. In fiscal year 1999, VBA also
implemented a new accuracy measurement system, known as Systematic Technical
Accuracy Review (STAR). Using STAR, VBA calculated a national accuracy rate
of 68 percent (or a 32-percent error rate) for decisions requiring
disability ratings, which VBA views as the core workload of the compensation
and pension program. The STAR error rate includes incorrect regional office
decisions on whether to grant or deny claims, but it also includes errors
that stem from procedural and technical issues such as failure to (1)
include all required documentation in the case file, (2) compute payment
amounts correctly, and (3) properly notify veterans of their decisions.
Acknowledging the need to improve the accuracy rate, VBA's compensation and
pension program has set a goal of achieving 81 percent accuracy for its core
workload in fiscal year 2000. The long-term strategic goal is 96-percent
accuracy.

Performance

Our survey asked managers of all regional offices to identify practices they
believed had helped them improve their accuracy or reduce their remand
rates. In response, managers from 55 regional offices reported a total of
238 practices, which we grouped into four areas of focus (see table 1).

Table 1: Regional Office Practices by Broad Area of Focus

                                                        Practices reported
 Broad area of focus
                                                        Number  Percentage
 Efforts to improve staff training, guidance, or
 accountability                                         101     42
 Changes in staffing or supervisory structure or
 assignments                                            62      26
 Efforts to accurately and fully develop evidence       56      24
 Efforts to communicate effectively with veterans       19      8
 Total                                                  238     100

Source: GAO's survey of VBA regional offices.

In many instances, a specific practice reported by one regional office was
the same as or similar to a practice reported by one or more other regional
offices; however, the mix and number of reported practices varied widely
among the regional offices. For example, the number of practices identified
by individual regional offices ranged from zero to as many as 12. Because
there were similar practices within the four broad areas of focus, we
classified the 238 practices into 24 categories (see table 2).

Table 2: Summary of Types of Regional Office Practices

Continued

      Types of regional office practices        Number of regional offices
                                                   reporting practicesa
 Efforts to improve staff training, guidance,
 or accountability
 Evaluate error data from STAR reviews, reviews
 of appeals/remands, or other case reviews      32
 Communicate directly with Board members or
 Court employees to clarify reasons for remands 15
 Provide information or training to staff on
 Court and Board decisions and other issues
 that affect claims processing development and  10
 ratings
 Include accuracy as an element in staffs'
 performance appraisals to ensure that          8
 processing quality standards are considered
 Establish a formal training coordinator
 position or related training function          6
 Develop a specific regional office emphasis on
 claims-processing accuracy as documented in
 local strategic plans and other management     4
 activities
 Require skills certification or other
 mandatory staff training                       3
 Require staff to participate in VBA conference
 calls that discuss the effect of Court         2
 decisions on claims processing
 Changes in staffing/supervisory structure or
 assignments
 Establish special unit or positions to process
 and/or analyze reasons for appeals/remands     37
 Establish other specialized teams or staffing
 assignments to focus on certain types of       6
 claims or issues
 Establish additional supervisory positions,
 reassign staff to fill existing supervisory
 positions, and/or redefine management          5
 responsibilities
 Establish additional rating specialist
 positions or reassign staff to fill existing   5
 rating positions
 Utilize case management principles to
 facilitate claims processing                   4
 Make temporary staff assignments to deal with
 claims backlogs                                4
 Efforts to accurately and fully develop
 evidence
 Communicate/interact with VA medical centers
 to ensure veterans' exams are performed in an  25
 accurate and thorough manner
 Use manual or automated checklists to track
 development/assure full development of         15
 veterans' claims
 Do special reviews to assure veterans' claims
 are fully and accurately developed             7
 Create new staff positions, such as rating
 analysts, responsible for ensuring veterans'   6
 claims are fully and accurately developed
 Coordinate with veterans service organizations
 and other entities to ensure veterans' claims  3
 are accurately and fully developed
 Efforts to communicate effectively with
 veterans
 Prepare pamphlets, brochures, letters, or
 other means to inform veterans about the
 claims process, evidentiary requirements, and  6
 how long it should take to process their claim
 Use reader-focused writing principles to
 generate standardized, user-friendly letters
 to veterans notifying them of the              6
 status/decision of their claim for benefits
 Make special efforts to contact veterans
 regarding the status of their appeals/remands  3
 Contact veterans via telephone to discuss
 evidentiary requirements and ensure accurate   2
 claims processing
 Redesign personal interview procedures to
 facilitate greater communication with          1
 claimants

aIn some cases, an individual regional office had more than one practice
that fell into a single practice category.

Source: GAO's survey of VBA regional offices.

Our survey results and visits to regional offices indicated that regional
offices generally had not conducted assessments of the effects of specific
practices on their accuracy and remand rates. As a result, the regional
offices' views on the benefits of specific practices were based primarily on
managers' observations or inferences, rather than evaluations that could
demonstrate a link between a specific practice and improvements in accuracy
or remand rates. Even so, we found that regional office officials regarded
some practices as being more helpful than others in improving accuracy and
remand rates. For example, 25 regional offices reported they were
communicating with VA medical centers to ensure that veterans' examinations
were performed accurately and thoroughly. Of these 25 offices, 28 percent
rated such practices as being among the most helpful in improving their
accuracy or remand rate. In contrast, 15 regional offices reported that they
used manual or automated checklists to track development or assure full
development of veterans' claims. Of these 15 offices, only 13 percent rated
such practices as being among the most helpful.

During our visits to regional offices, the managers highlighted some
specific practices that they believed had been critical in improving their
accuracy or remand rates. In all but one case, however, 10 or fewer regional
offices mentioned using practices similar to the ones highlighted by
regional offices we visited. The practices highlighted by these offices
include those discussed in the remainder of this section.

One practice highlighted is to provide information or training to staff on
Court and Board decisions and other issues that affect claims-processing
development and ratings (mentioned by 10 regional offices). One of the
offices we visited had prepared written directives for about 25 major
topics, such as well-grounded claims, effective dates, lay evidence, and
medical opinions. To formulate these directives, regional office management
relied on a variety of relevant legal authorities--including decisions by
the Court of Appeals for Veterans Claims, opinions of VA's Office of General
Counsel, VA's regulations, and legislation. Regional office management
synthesized these sources into a single directive for each topic. Providing
such guidance averts the need for regional office staff to individually
consult a multitude of sources, which could lead to errors and inconsistent
decisions. As changes occur in any legal authorities, regional office
management revises the directives to provide up-to-date guidance.

Another highlighted practice is to establish a special unit or positions to
process and/or analyze reasons for appeals and/or remands (mentioned by 37
regional offices). Two of the offices we visited had formed teams that
handled all appealed cases, including all decisions for which veterans had
submitted notices of disagreement, and all remanded decisions. These
regional offices reported that they believed their appeals teams had reduced
the remand rates because they became experts in meeting requirements for
submitting appealed cases to the Board, and they also could apply lessons
learned from analyzing the reasons for remanded cases. This viewpoint is
consistent with the results of a 1999 VBA study that, while not broad enough
to be conclusive, observed that the quality of appeals submitted to the
Board was consistently excellent for regional offices that had instituted
designated appeals teams.

A third highlighted practice is to establish specialized teams or staff
assignments to focus on certain types of claims or issues (mentioned by six
regional offices). One of the offices we visited had teams that specialized
by claim type, such as original claims and reopened claims. Another regional
office had staff who specialized in the most difficult rating issues, such
as post-war traumatic stress syndrome and Gulf War undiagnosed illnesses,
and the least frequently filed rating issues, such as radiation and mustard
gas. Both regional offices believed this approach had allowed staff to gain
sufficient expertise to process claims in their specialty more accurately
than otherwise could have been achieved.

A fourth highlighted practice is to create new staff positions, such as
rating analysts, responsible for ensuring veterans' claims are fully and
accurately developed (mentioned by six regional offices). Two of the offices
we visited had established new positions for developing and documenting the
evidence needed to make a fully supportable decision. One office had
identified inadequate development of evidence as a major contributing factor
in the increasing number of appeals by veterans. Therefore, the regional
office created a rating analyst position to specialize in developing three
types of claims that accounted for many appeals: post-traumatic stress
disorder, secondary service-connection claims, and individual
unemployability.

Although the regional offices reported many practices that they believe have
helped improve their accuracy or remand rates, VBA has not systematically
evaluated and disseminated information on practices that hold promise for
improving regional office claims-processing performance nationwide. While
VBA has taken steps to identify potentially promising practices, it has not
followed up on this effort and does not yet have a system for evaluating the
effect of such practices and disseminating the evaluation results to
regional offices. Regional office and VBA officials stated that it would be
beneficial if VBA evaluated and identified best practices so that regional
offices could focus their attention on trying only the most promising ones.
This is important because many regional offices reported that their ability
to try new practices is limited by factors such as insufficient number of
staff, lack of experienced staff, and high workload levels. VBA officials
recently acknowledged the need to develop a plan for systematic evaluation
of regional office practices in order to identify those that hold promise
for improving nationwide performance.

In a 1995 report, we emphasized that VBA needed to systematically evaluate
the effectiveness of claims-processing practices in regional offices in
order to identify those that hold promise for improving the performance of
regional offices nationwide. Since that time, VBA's evaluation efforts have
been limited to several initiatives related to the reengineering of its
business processes for adjudicating disablity claims, such as instituting
case management, using a paperless claims folder process, having regional
decision review officers review appeals, contracting for veterans' medical
examinations, and developing computer-based training modules. For example,
VBA's evaluation of the case management initiative includes its effect on
the balanced scorecard performance measures, including accuracy.

In 1997, VBA asked regional office and central office staff to submit
innovative practices affecting service and operations efficiency in all five
of VBA's business lines, including compensation and pension disability
claims.5 VBA issued a publication that catalogued the practices submitted
and established a website providing an electronic copy of this publication
on its internal network. Neither the publication nor the website has been
updated to include other practices. Moreover, VBA did not evaluate the
effect of the practices before issuing the publication. Also, as we found in
our survey and visits to regional offices, the regional offices themselves
generally had not conducted assessments of the extent to which a specific
practice affects accuracy or remand rates.

In our survey, the regional offices indicated that they consider direct
contacts with other regional offices to be useful ways to learn about each
others' practices. Such direct contacts come about through regional office
working relationships within an SDN, and through regularly scheduled
meetings with regional offices in other SDNs. The regional offices also
establish informal relationships when, for example, staff from various
regional offices meet at training courses and workgroups. VBA also has
established two "communities of practice" on internal network websites that
regional offices can use to informally share information about efforts to
enhance their staffs' technical skills and develop teamwork. Such
information sharing, though desirable, does not provide any way for regional
offices to obtain information on practices that have been shown through
systematic evaluations to hold the most promise for improving the
performance of regional offices nationwide.

According to staff in VBA's Office of Field Operations, VBA recently began
efforts to establish an Operations Center website that would include
information on best practices. VBA intends to evaluate practices before
posting information about them on the website. VBA officials also told us
that their evaluations would assess the effect of a practice on all of the
performance measures outlined in the balanced scorecard, including accuracy.
However, VBA is in the initial stages of its effort to develop this plan,
and has not yet established a timeframe for developing and implementing an
evaluation plan; according to Office of Field Operations staff, the effort
to develop a plan still has to address such fundamental questions as the
following:

ï¿½ How will ideas with quantifiable documentation that they improve
operations be identified?

ï¿½ What entity will evaluate the ideas?

ï¿½ How can ideas be best communicated, including their strengths, weaknesses,
and implementation considerations?

ï¿½ How can the information be kept current?

ï¿½ How will VBA develop evaluation skills?

Evaluation of potentially beneficial practices (such as some of those
reported by regional offices) is needed to help regional offices focus their
attention on the most promising. In a significant number of survey
responses, regional offices reported that their ability to try new practices
is hindered by large workloads, the need for more staff, and their current
staff's inexperience. Some regional office and VBA officials stated that
evaluation of practices by VBA would enable regional offices to devote their
energies and limited resources to trying only the most promising practices.
Also, the manager of VBA's reengineering effort stated that the most
effective practices should be considered for incorporation into the
reengineering effort.

While VBA has taken some steps to identify potentially promising practices,
it has neither followed up on this effort nor developed a system for
evaluating such practices and disseminating the results to regional offices.
While regional offices reported a variety of practices that they believe
have helped improve their claims-processing performance, regional office and
VBA officials agreed that it would be beneficial if VBA evaluated and
identified best practices so that regional offices could use their limited
resources to try only the most promising practices. Although VBA officials
told us they are in the initial stages of planning a system for evaluating
promising practices, VBA had not established specific timeframes for
developing and implementing such a plan.

To help ensure that VBA proceeds expeditiously, we recommend that the
Secretary of Veterans Affairs direct the Under Secretary for Benefits to
establish timeframes for development and implementation of a formal plan for
evaluating and disseminating information on practices that hold promise for
improving the claims-processing performance of regional offices nationwide.
The Secretary should also consider including information on goals for and
results of disseminating information on promising practices in the annual
reports submitted under GPRA.

In commenting on our draft report, VA generally agreed with our
recommendations. (The text of VA's letter appears as app. II.) While VA
agreed that VBA historically has not had good mechanisms for capitalizing on
best practices, VA stated it is committed to improving this situation and
believes that VBA is well on its way to developing good systems to do so. VA
also commented that our report did not fully address VBA's current
initiatives, such as its business process reengineering efforts. While we in
fact did discuss VBA's initiatives, our work focused on potential best
practices that regional offices developed on their own, apart from
initiatives directed by VBA.

Regarding our recommendation to establish timeframes for developing a plan
for evaluating and disseminating best practices, VA said that VBA has
prepared a draft procedure for receiving, evaluating, and disseminating best
practices. While the draft plan is not specific about the criteria or
analysis that will be used to identify best practices, it is a step in the
right direction that should, when finalized, enhance VBA's potential for
improving performance through the widespread adoption of best practices.
With respect to our recommendation to include in its annual GPRA reports
VBA's efforts to disseminate information on best practices, VA said that VBA
was considering adding a section to its GPRA submission to the Department.
If this information is included in VA's annual reports, it should heighten
awareness of best practices and the importance of agency-wide implementation
of them.

As agreed with your office, we plan no further distribution of this report
until 30 days from its date of issue, unless you publicly announce its
contents earlier. We will then send copies of this report to the Chairman of
the House Committee on Veterans' Affairs, the Secretary of the Department of
Veterans Affairs, other congressional committees, and others who are
interested. We will also make copies available to others upon request. If
you have questions about this report, please call me at (202) 512-7101 or

Irene P. Chu, Assistant Director, at (202) 512-7102. Other major
contributors to this report were Ira B. Spears, Steve D. Morris, Paul C.
Wright, and Deborah L. Edwards.

Sincerely yours,
Cynthia A. Bascetta
Associate Director, Veterans' Affairs and
Military Health Care Issues

Scope and Methodology

To identify claims-processing practices that the Veterans Benefits
Administration (VBA) regional offices believe have helped them improve their
accuracy and remand rates, we sent a survey questionnaire to 57 regional
offices, of which 55 responded.6 To examine reported practices and related
issues in more detail, we visited six responding regional offices: Columbia,
South Carolina; Milwaukee, Wisconsin; Montgomery, Alabama; New York, New
York; Oakland, California; and Waco, Texas. While we did not attempt to
evaluate the effectiveness of individual practices that regional offices
reported, we discussed the benefits and limitations of practices with
officials of the regional offices we visited and VBA headquarters.

The six regional offices we visited were judgmentally selected to provide a
mix of offices based on a combination of factors, including remand rates,
Service Delivery Network (SDN) affiliation, geographic location, and
workload level. We did not use technical accuracy rates produced under
Systematic Technical Accuracy Review (STAR) as a factor in selecting
regional offices because VBA has not yet ensured that the STAR system
provides reliable accuracy rates for each regional office. As we reported in
1999, VBA reviews samples of cases from each SDN and is able to produce
accuracy rates with reasonable statistical precision for each SDN and the
nation as a whole; however, VBA does not review enough cases from each
regional office to produce accuracy rates for each office with reasonable
statistical precision.7 Instead, each regional office does self-reviews of
its work to produce its own accuracy rate. Because the rigor and standards
of the regional offices' self-reviews could vary from office to office, VBA
is reviewing for each office a limited number of cases that the office has
already self-reviewed in order to gauge the reliability and consistency of
regional office accuracy rates. Although this process will not enable VBA to
validate regional office accuracy rates with reasonable statistical
precision, VBA believes it will provide a reasonable indicator of regional
office accuracy rate reliability. At the time of our review, VBA had not
completed enough reviews to reach firm conclusions about regional office
accuracy rate reliability.

Comments From the Department of Veterans Affairs

(105774)

Table 1: Regional Office Practices by Broad Area of Focus 7

Table 2: Summary of Types of Regional Office Practices 9
  

1. Veterans' Benefits: Better Assessments Needed to Guide Claims Processing
Improvements ( GAO/HEHS-95-25, Jan. 13, 1995).

2. The pension program pays monthly benefits--based on financial need--to
wartime veterans who have low incomes and are permanently and totally
disabled for reasons not service-connected.

3. If dissatisfied with the Court's decision, either the veteran or VA may
appeal the decision to the Court of Appeals for the Federal Circuit.

4. Not every remand indicates that the regional office made an error. For
instance, remands can result from changes in regulations that occur after an
appealed case is sent to the Board.

5. In contrast with our survey's focus on practices that helped improve
accuracy and remand rates in the compensation and pension program, VBA's
1997 study focused on practices related to "service and operations
efficiency" improvements in all of VBA's programs--the compensation and
pension, loan guaranty, education, vocational rehabilitation, and insurance
programs. Based on its survey, VBA issued a publication, entitled "Best
Practices," which catalogued a combined total of 191 practices for its five
programs.

6. Although VBA has an office in Cheyenne, Wyoming, this office reports
administratively through the Denver regional office, and for the purposes of
accuracy measurement, the Cheyenne office is treated as part of the Denver
regional office. Therefore, we sent a survey questionnaire to the Denver
regional office only.

7. Veterans' Benefits Claims: Further Improvements Needed in
Claims-Processing Accuracy (GAO/HEHS-99-35 , Mar. 1, 1999).
*** End of document. ***