Veterans' Benefits: Improvements Made to Persian Gulf Claims Processing
(Testimony, 02/05/98, GAO/T-HEHS-98-89).
Pursuant to a congressional request, GAO discussed the Department of
Veterans Affairs' (VA) adjudication of veterans' claims for compensation
for undiagnosed illnesses that resulted from their service in the
Persian Gulf War, focusing on: (1) VA's efforts to improve Persian Gulf
claims processing; and (2) its effect on the readjudication of claims
previously denied.
GAO noted that: (1) VA has taken steps to help improve its processing of
Persian Gulf claims; (2) specifically, in July 1996, VA issued guidance
to help ensure that procedures for processing Persian Gulf claims are
followed by requiring claims processors to provide veterans with clear
and useful information regarding types of evidence that could be used to
support their claims; (3) such evidence includes records of medical
exams and time lost at work; (4) the guidance also requires claims
processors to properly consider these pieces of evidence and thoroughly
follow up on information that may support the claims; (5) also, to help
improve the timeliness of VA's actions on Persian Gulf claims, in May
1997, VA centralized the processing of those claims from 4 to all 58 of
its regional offices and began providing training to regional office
staff on processing the claims; (6) because VA only recently began some
of the initiatives to help improve the processing of Persian Gulf
claims, the full impact of the initiatives is uncertain at this time;
(7) however, GAO's follow-up review indicates that VA, for the most
part, has followed its procedures in readjudicating the previously
denied cases; (8) for example, in all the cases GAO reviewed, VA had
provided veterans with a written description of the types of evidence
Persian Gulf veterans could use to support their claims; (9) as a result
of VA's readjudication of denied claims completed to date, VA granted
benefits to about 8 percent of the veterans whose claims were previously
denied for undiagnosed conditions; and (10) benefits could include
compensation or medical care.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: T-HEHS-98-89
TITLE: Veterans' Benefits: Improvements Made to Persian Gulf
Claims Processing
DATE: 02/05/98
SUBJECT: Veterans
Veterans benefits
Veterans disability compensation
Claims processing
Military benefits claims
Disability benefits
Medical records
Claims settlement
IDENTIFIER: Persian Gulf War
Gulf War Syndrome
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Cover
================================================================ COVER
Before the Committee on Veterans' Affairs, House of Representatives
For Release on Delivery
Expected at 1:00 p.m.
Thursday, February 5, 1998
VETERANS' BENEFITS - IMPROVEMENTS
MADE TO PERSIAN GULF CLAIMS
PROCESSING
Statement of Stephen P. Backhus, Director
Veterans' Affairs and Military Health Care Issues
Health, Education, and Human Services Division
GAO/T-HEHS-98-89
GAO/HEHS-98-89T
(105756)
Abbreviations
=============================================================== ABBREV
GAO - General Accounting Office
VA - Department of Veterans' Affairs
VETERANS' BENEFITS: IMPROVEMENTS
MADE TO PERSIAN GULF CLAIMS
PROCESSING
============================================================ Chapter 0
Mr. Chairman and Members of the Committee:
We are pleased to be here today to discuss the Department of Veterans
Affairs' (VA) adjudication of veterans' claims for compensation for
undiagnosed illnesses that resulted from their service in the Persian
Gulf War. As you know, in November 1994, the Congress enacted
legislation allowing VA to pay compensation benefits to veterans for
Persian Gulf-related undiagnosed illnesses. In May 1996 we reported
deficiencies in VA's processing of the nearly 8,000 undiagnosed
illness claims VA had evaluated.\1 More specifically, we reported
that VA did not provide clear and useful information to veterans
about the types of evidence needed to support a claim. We also
stated that VA did not always provide veterans with required
assistance by obtaining relevant evidence for the claims. In
response to our report and concerns raised by others, VA made the
decision to readjudicate previously denied Persian Gulf claims
related to undiagnosed illness.
My comments today will focus on information we have gathered at your
request on VA's efforts to improve Persian Gulf claims processing and
its effect on the readjudication of claims previously denied. Our
information is based on analyzing a statistical sample of the
approximately 11,000 undiagnosed illness claims that VA had initially
denied and is now readjudicating as well as discussions with
officials at VA headquarters and regional offices, and veterans
service organizations.
In summary, VA has taken steps to help improve its processing of
Persian Gulf claims. Specifically, in July 1996, VA issued guidance
to help ensure that procedures for processing Persian Gulf claims are
followed by requiring claims processors to provide veterans with
clear and useful information regarding the types of evidence that
could be used to support their claims. Such evidence includes
records of medical exams and time lost at work. The guidance also
requires claims processors to properly consider these pieces of
evidence and thoroughly follow up on information that may support the
claims. Also, to help improve the timeliness of VA's actions on
Persian Gulf claims, in May 1997 VA decentralized the processing of
those claims from 4 to all 58 of its regional offices and began
providing training to regional office staff on processing the claims.
Because VA only recently began some of the initiatives to help
improve the processing of Persian Gulf claims, the full impact of the
initiatives is uncertain at this time. However, our follow-up review
indicates that VA, for the most part, has followed its procedures in
readjudicating the previously denied cases. For example, in all the
cases we reviewed, VA had provided veterans with a written
description of the types of evidence Persian Gulf veterans could use
to support their claims. As a result of VA's readjudication of
denied claims completed to date, VA granted benefits to about 8
percent of the veterans whose claims were previously denied for
undiagnosed conditions. Benefits could include compensation and/or
medical care.
--------------------
\1 Veterans' Compensation: Evidence Considered in Persian Gulf War
Undiagnosed Illness Claims (GAO/HEHS-96-112, May 28, 1996).
BACKGROUND
---------------------------------------------------------- Chapter 0:1
Following the return of U.S. forces from the Persian Gulf region,
some veterans began exhibiting symptoms that could not be attributed
to known clinical diagnoses. At that time, section 1110 of title 38,
U.S.C., authorized VA to compensate for disabilities arising from
disease or injury incurred or aggravated in the line of duty during
military service. However, since many of the symptoms reported by
Persian Gulf veterans could not be attributed to a known disease or
injury, VA had no authority to compensate for them.
In response to the needs and concerns of Persian Gulf veterans, the
Congress enacted the Persian Gulf War Veterans' Benefits Act (P.L.
103-446, Nov. 2, 1994) to allow VA to pay disability compensation to
veterans who experienced undiagnosed illnesses. Some examples of
compensable conditions under this legislation include fatigue,
headaches, joint and muscle pains, and respiratory disorders. In
order to be compensated under this legislation, veterans must provide
objective evidence of a chronic disability. Objective evidence
includes medical information such as medical records from the
military, VA, or private physicians. Objective evidence also
includes nonmedical information such as records of time lost from
work and lay statements from persons such as family members or
friends who are knowledgeable about changes in the claimant's
physical appearance, physical abilities, and mental or emotional
attitude. Claimants must also prove that the undiagnosed illness is
chronic--present for 6 months or longer--and was either present
during service in the Persian Gulf or during the eligibility period.
Initially the eligibility period was defined as 2 years after a
veteran's departure from the Gulf. However, based on a consensus
within the veteran community concerning the adequacy of the 2-year
presumptive period and the continuing medical and scientific
uncertainty about the nature and causes of these illnesses, VA
extended the eligibility period to December 31, 2001.
STATUS OF VA'S EFFORTS TO
IMPROVE PERSIAN GULF CLAIMS
PROCESSING
---------------------------------------------------------- Chapter 0:2
Since our 1996 report, VA has taken a number of steps to improve its
processing of Persian Gulf claims. These steps include issuing
guidance to ensure that procedures for processing Persian Gulf claims
are followed, decentralizing claims processing to all 58 regional
offices to improve timeliness, and providing training on the
processing of Persian Gulf claims.
In July 1996, VA issued guidance that clarified its procedures for
processing Persian Gulf claims. For example, the guidance identified
the importance of using a standard letter for all claims involving
undiagnosed illnesses of Persian Gulf veterans informing the veterans
of the types of evidence that could be used to support a claim. The
guidance also discussed the importance of nonmedical evidence, such
as lay statements, in deciding a claim and in determining the
duration and severity of the illness.
In addition, the guidance discussed the importance of obtaining all
evidence, including medical and nonmedical statements. For instance,
if a veteran's lay statement describes the year the condition arose,
but the month is not specified and that information is necessary for
a successful resolution of the claim, VA staff should attempt to
obtain this missing information.
With the additional readjudication workload imposed on the initial
four regional offices, VA found the operations of those offices
increasingly strained. Thus, in May 1997, VA decided to decentralize
the processing of Persian Gulf claims and began redistributing
undiagnosed illness claims from the 4 offices to VA's 58 regional
offices. VA officials said that the purpose of VA's decision to
decentralize the processing of Persian Gulf claims was to give better
service to claimants, reduce the workload created by the
readjudication, and improve the timeliness of claims resolution.
While there may be advantages to the decentralization, there may also
be disadvantages. VA officials and veterans service organization
representatives said that advantages include more rating specialists
being available to process the claims, a faster VA response to
inquiries, and immediate access for claimants and their veterans
service representatives to claim files and claim processors if the
claim file is located at the regional office. The officials and
representatives said that the disadvantages include the loss of
expertise as a result of using staff less experienced in processing
Persian Gulf claims, an increase in average claims processing time
while the new staff are trained and become familiar with processing
Persian Gulf claims, and the potential for inconsistency because of
the vastly increased number of regional offices processing the
claims.
VA officials said that the redistribution of claims has resulted in
an unequal distribution of cases and backlogs in some regional
offices. While some regional offices have received few additional
Persian Gulf claims, others have received over 600 claims. For
example, one adjudication officer said that decentralization had
caused a slowdown in all claims processing in his office.
As a part of VA's decentralization effort, in late May 1997, VA began
preparing each regional office to process undiagnosed illness claims.
To accomplish this, VA developed a variety of methods to train and
assist rating specialists as they processed claims. Specifically,
shortly after the claims were redistributed, VA sponsored a satellite
broadcast to all regional offices to discuss rating issues for
Persian Gulf claims. Following the broadcast, VA conducted a 2-day
training conference to reinforce the information provided in the
broadcast. Following the conference, additional training was
provided in each VA area--eastern, central, southern, and western.
Attendees from this and the 2-day conference then trained staff in
their regional offices. In addition to classroom training, VA
created a team of experts referred to as the Rapid Response Team.
The members of this team are available to respond to questions or
address any Persian Gulf issue. Moreover, VA's central office
conducts weekly conference calls with regional office staff to share
information obtained through the Rapid Response Team and to address
issues or concerns. Rating specialists and adjudication officers we
spoke with at the regional offices said that, generally, the training
was effective and they felt comfortable as they began processing
undiagnosed illness claims. (See the appendix for details about the
training and assistance provided to regional claims processors.)
VA FOLLOWS PROCEDURES IN
READJUDICATING CLAIMS AND
GRANTS ADDITIONAL APPROVALS
---------------------------------------------------------- Chapter 0:3
In our 1996 report, we found that VA did not adequately implement its
claims processing procedures. Specifically, VA did not always inform
the veterans of the type of evidence needed to support undiagnosed
illness claims, nor did it always attempt to obtain all medical and
nonmedical evidence identified by claimants, including lay
statements. Our analysis of a statistical sample of readjudicated
claims showed that VA has followed its processing procedures during
the readjudication of undiagnosed illness claims.
On the basis of our analysis of readjudicated cases, we found that,
for the most part, VA provided veterans with information on the types
of evidence needed to support undiagnosed illness claims and followed
up on medical and lay statements. Specifically, in all cases, VA
provided the veteran with a written description of the types of
evidence Persian Gulf veterans could use to support their claims.
And, in nearly all cases, VA attempted to obtain all medical and
nonmedical records. Table 1 shows the percentages of cases in which
VA followed its procedures in the readjudication of Persian Gulf
undiagnosed illness claims.
Table 1
Percentages of Cases in Which VA
Followed Procedures in Readjudicating
Persian Gulf Undiagnosed Illness Claims
% of
cases
in
which
proced
ure
was
follow
Claims processing procedure ed
-------------------------------------------------------------- ------
VA provided claimant a letter describing evidence to support a 100
claim
VA tried to obtain medical records identified by the claimant 96
VA tried to obtain nonmedical records identified by the 100
claimant
----------------------------------------------------------------------
For the claims included in our sample where VA's readjudication
process was complete, we estimate that 8 percent resulted in veterans
receiving benefits for undiagnosed conditions, although previously
they had been denied those benefits.\2 These veterans are now
receiving compensation or free medical care, or both, for their
conditions. In our sample of readjudicated claims, we found that two
major factors account for most of the denied claims. About 34
percent of the cases were denied because physicians were able to
diagnose the condition. These cases were then assessed under
different compensation requirements. Another 36 percent of the cases
were denied for lack of objective evidence to support a claim.
--------------------
\2 Sampling errors range from + 6 to + 16 percentage points at the
95-percent confidence level.
CONCLUSIONS
---------------------------------------------------------- Chapter 0:4
The Congress enacted the Persian Gulf War Veterans' Benefits Act to
allow VA to pay disability compensation to veterans suffering from
undiagnosed illnesses attributed to their service in the Persian
Gulf. As we reported in 1996, VA had not properly followed its
procedures to adequately inform and assist veterans in processing
their claims for Persian Gulf-related undiagnosed illnesses. In
response to our report and concerns raised by others, VA has taken
steps to help improve its processing of claims for Persian Gulf
undiagnosed illnesses. VA's issuance of clearer guidance on its
processing procedures appears to have resulted in claims processors
following the procedures. In addition, to help improve the
timeliness of VA's actions on Persian Gulf claims and better serve
claimants, VA decentralized processing of Persian Gulf claims from 4
to 58 regional offices and began training claims processors in
handling Persian Gulf undiagnosed illness claims. Because VA only
recently began these efforts, their impact is yet to be determined.
-------------------------------------------------------- Chapter 0:4.1
Mr. Chairman, this concludes my prepared statement. I will be glad
to answer any questions you or Members of the Committee may have.
TRAINING AND OTHER ASSISTANCE
PROVIDED TO REGIONAL CLAIMS
PROCESSORS
==================================================== Appendix Appendix
-- On May 29, 1997, VA provided a satellite broadcast to its
regional offices that primarily discussed rating issues for
Persian Gulf claims. VA stated that the broadcast was the first
in a series of initiatives that the Compensation and Pension
Service plans to undertake to prepare claims processors in each
regional office for processing Persian Gulf claims.
-- On June 2, 1997, VA conducted a 2-day training conference that
expanded on the training provided in the May broadcast. Each
regional office sent one representative (usually a hearing
officer or rating specialist) to the training. The
representatives were responsible for going back to their
regional offices to train other staff that would be working on
Persian Gulf cases.
-- After the June training, additional training was provided in
each VA area that focused on using examples of actual cases to
show how they should be processed. For example, the staff from
the Louisville regional office conducted training for regional
offices in the central area on June 4. The southern area
training was conducted by staff from the Nashville regional
office for 3 days at the end of June.
-- Claims processors also received less formal training through
participation in weekly national conference calls and
interaction with the Rapid Response Team, a team of experts
created by the VA central office to address questions or issues
raised by claims processors. Every Wednesday, the VA central
office holds a conference call with all regional offices.
During these calls, knowledgeable staff members address any
Persian Gulf-related issue.
*** End of document. ***