good afternoon everybody thank you for your patience we all please rise for the pledge allegiance i pledge allegiance to the flag of the united states of america through the republican stands one nation under god indivisible with liberty and justice for all welcome to the subcommittee on disability assistance in memorial affairs hearing on examination of the v a regional lambourn and we understand both will be called at any time so i'm sorry that you've been so patient already and you'll be asked to be patient again but sometime soon we'll have to burn across the street i just want to  say first of all that i welcome you all here in what's been a profoundly historic and important week for the nation and for our veterans over the last seven days the full committee convened a successful claim summit which brought many of you and othe r dozens of top veterans stakeholders together and from the summit came a lot of very useful information which we welcome and look forward to working with the v a and all the veterans groups to try to turn into action to solve the problems that are facing in a rare sunday session congress passed and president signed a sweeping health care reform package america's warriors the help heroes keep their homes active the cost of living increase for veterans the national guard employment protection act i won't go into detail on these things but this particular hearing will be about the star technical review system and we'll look at the accuracy assessing disability compensation and pension claims rating  and the disparity between accuracy in the different aros using this quality control tool should be able to focus attention on poorly performing aros and help the agency direct additional staff  training to the problem offices at the same time look at those who are the highest performing aros and find out what they're doing right star system was implemented in october of one thousand nine hundred eighty since f y two thousand and seven set for itself a goal of completing compensation claims ratings without error ninety percent of the time its long term strategy goal is ninety eight percent fortunately we're still far from achieving that goal o have people here from their agencies which have produced studies revealing issues that may be those impeding the efficiency and consistency of the star system and we're looking forward to hearing their testimony i'm personally troubled by g o s finding that the claims processing accuracy rate is particularly low in cases pertaining to p t s d and traumatic brain star system would look forward to hearing about these improvements and how we subcommittee a full committee in congress can help to fully understand star it's important to review the c and p rating system itself to assess the claim the application for disability systems must be developed a process that involves obtaining all necessary evidence to support the veteran's claim after development the claims of a rating service representative are b s ours herman if that disability is service connected and it signs a percentage rating that is intended to represent the average earning reduction a veteran with that condition would experience in a civilian occupation the veterans and notified of that decision for reopen claims the assigned diagnostic codes effect a veteran's overall combined percentage of disability the aros regional offices or using previously assigned codes along with their percentages in combination with the current assigned diagnostic code percentages to determine the combined level of disability once that claim is completed it is declared a product and the result that claim is cleared and the work read it is given to the regional office so a completed claim corresponding cleared and product is then subject to review by star reviewers being here for you in advance for your testimony and now i would like to recognize his opening statement well thank you mr chairman and thank you for waiting although i would have been happy for you to go ahead and start but i know as a of bipartisanship you wanted to wait so i thank you for that and i do apologize there was a misunderstanding between my staff and i thought that we were going to start after the first series of votes because i specifically asked that and once they found the mistake they notified me immediately not but i was two buildings away so i got here as quickly as i could but i know everyone's time here is extremely valuable and so i apologize it's totally the fault of me and my office chairman i want to like you welcome everyone to this hearing on department of veterans affairs star program throughout my tenure on this committee my fellow members and i have called for stronger accountability within the v a claims system for too long the primary focus has been on production and this is led to an error rate that is unacceptable i believe that the v a s greatest challenge the claims backlog is largely attributable to hasty decisions made without proper regard for accuracy the ramifications of this approach can be seen throughout the entire system therefore v a employee performance awards cannot be based entirely on production there must also be a valid measure of quality under the star program a statistically valid sample of rating decisions from various regional offices is reviewed for accuracy while this method may be useful for macro perspective it is not sufficient for ensuring individual accountability v a must be able to identify employees in need of individualized remedial training without this essential component of the quality assurance process will have perpetual problems in its claims system in the one hundred tenth congress this committee passed a provision that was included in the veterans benefits improvement act of two thousand and eight that required to conduct a study on the effectiveness of the current employee work credit system i believe the upcoming report along with the testimony that we will hear today will provide valuable feedback for the department to improve its quality assurance and accountability program i look forward to hearing from our witnesses today and i thank you all for your participation and mr chairman i thank you also and i office of the inspector general department of veterans affairs and daniel bertoni director disability issues with the government accountability office welcome to you both and your full written statements are entered in the record so operations division is committed to proactively reviewing the department's internal controls to identify weaknesses before they escalate into significant problems over the past two years my office has audited three components of the quality assurance program rating accuracy rating consistency and program although our written statement covers our work in all compensation rating accuracy and consistency we concluded that star process did not effectively dental and report errors and compensation claim rating decisions we projected that about seventy seven percent of claims were accurate as opposed to the reported accuracy rate of eighty seven percent this equated to approximately eighty eight thousand additional claims veterans monthly benefits may be incorrect we identified five areas needed to improve the star program agreed with all of our recommendations and just recently reported that all corrective actions were completed first the star reviewers did not identify some errors because they either did not thoroughly review available evidence or they in appropriately classified benefit entitlement errors as comments that did not count against the accurate second our management required regional offices to report quarterly on actions taken to correct errors but did not follow up to ensure that these offices actually took the corrective actions on comment excluded brokered claims from star review the officials told us that the  program primary focus was to assess and report rating accuracy each of the individual regional offices to regional offices are involved and brokered claims these officials believed it would be difficult to assign responsibility for rating accuracy on a brokered claim for the star reviewers did not ensure regional offices submitted all of the selected compensation claim ratings for review the offices did not submit about seven percent of the requested ratings for the twelve month period ending february two thousand and eight we reviewed a sample of these and submitted claims and identified a benefit entitlement error rate of approximately twenty two percent the star reviewers were not required to complete formal training on an annual basis in contrast the regional office  procedures to ensure the accurate and timely correction of errors identified by starr our analysis of one hundred errors found that regional office staff had not corrected twenty seven percent of without an effective and reliable quality assurance program maybe a leadership cannot adequately monitor performance necessary program improvement and ensure veterans receive accurate and consistent rating chairman good afternoon and please be here to discuss the department of veterans affairs efforts to improve the quality of disability decisions for years we've noted that claims processing challenges not only include making quicker decisions in reducing its claims backlog but also improving accuracy and consistency my statement today focuses on steps taken in response to recommendations from us and others to enhance quality assurance tools namely to systematic technical accuracy review or star program as well as other programs designed to address decisional consistency since starwars first implemented we have made numerous recommendations for improvement for example very early on we know that star reviewers lacked organizational independence because it also they also had claims processing duties and reported directly to regional managers who claims they may review our recommendations move to require organizationally independent star review or were precluded from making claims decisions in subsequent work we found that star sampling was insufficient to ensure the accuracy of disability pension decisions or findings by consolidating pension processing into three locations in establishing a separate star review for pension claims more recently we reported that v a is not using start to separately assess the accuracy of the benefits delivery of discharge in quick starts quickstart claims alternative processes for fast tracking v a disability compensation claims for active duty service members opted not to evaluate the extent to which staff are accurately developing and rating these claims although such information could better inform training in focus program monitoring efforts days offices of inspector general has also recommended changes to the star program which v a has begun to address including establishing minimum annual training karmas for reviewers mandating additional supervisory review of star reports sampling broker claims for accuracy in implementing more stringent procedures for conducting star reviews and finally the agency has begun to take steps to address deficiencies that both we in da inspector general have identified with his consistency review program which assessed the extent to which regional offices  individual raters may consistent decisions on the same claim we recommended that be a conduct systematic studies of impairment identified as having potentially inconsistent decisions and a fiscal year two thousand and eight be a did initiate  however last year the inspector general report of the v a had not fall through on its plans to conduct additional reviews which was attributed in part to insufficient star staffing resources the agency has since developed the consistency review strategy in is in the process of conducting fiscal u two thousand and ten reviews however these efforts have only recently begun and it is too early to assess their impact in despite various recommendations for improvement in actions to address them v has struggled over the years to improve the accuracy rate for disability compensation decisions which was eighty four percent into school year two thousand and twelve short of the a stated goal of ninety percent is attributed its inability to meet accuracy goals in part to the large numbers of newly hired personnel conducting claims development work in their general lack of training and experience we've also noted that human capital challenges associated with providing training to help new staff become more proficient will likely continu the near future and could impact quality thus it is important to continue to improve and maintain a robust quality assurance framework that not only support staff in their understanding of the very complex business of making timely accurate and consistent disability decisions but also ensure that all veterans receive the benefits they are legally entitled to over time vs newly implemented quality assurance initiatives have the potential to improve decisional accuracy and consistency if compliance with enhanced protocols procedures in standards is sustained however it's imperative that v a meet remain proactive in its quality assurance efforts going forward especially as aging veterans in more veterans from current conflicts had to be already substantial comment about his questions or yeah as i tell you mr chairman i'm going to waive my questions for the sake of time and just follow up in writing to the degree that we need further explanations so thank you thank you mr lambourn and i'll try to squeeze a few questions in here before we have to go across the street to vote this spin your i g report indicates that there are about two hundred three thousand claims where a veteran is and is receiving incorrect monthly benefits does this number reflect only veterans who are being underpaid i ask because it's important to know whether there is a systematic bias toward underpaying rather than overpaying better and what is your data suggests we found errors are report is the projected number based on our sample well that would be a good thing if you if you can call that from your data that would be good for us to know if it's tilted toward underpayment and how much i missed in your testimony right now we do overtime no follow up on selected reports to actually assess the effectiveness of corrective actions we always follow up with management to ensure that they can at least report to us what they have done thank you and your study observe that star reviewers do not identify some errors because they either do not thoroughly review available evidence they fail to identify the absence of necessary  medical information and sometimes they mis classify errors in a way that resulted in errors not being counted against the accuracy rate what do you believe can cure these deficiencies or is it a training issue alone i believe our recommendation in the report related to increased supervisory reviews on those issues certainly to ensure that comments that should be correct should be counted as errors were count you noted that in your testimony the star management required that regional regional offices report quarterly on actions taken to correct benefit entitlement errors but they did not require or follow up to ensure regional offices were actually taking correction corrective actions on the comments made by the star reviewers do you have any indication that v a has remedied this concern and what assurances that the bless you recommendation and as i alluded to in my oral and written testimony we look at this issue when we go on our regional office inspection and we do not always find that star errors have been actually  in the long run will be the that will be shown in the review of broker claims on the overall claims accuracy rate short term and long term  if i'm tony harris can you tell us no i can't tell yet we are conducting a national audit looking at the brokering or redistribution of claims program and two of the we are assessing the impact on the of claims processing and also how this could possibly impact accuracy well how the brokering problem program is being implemented in respect to accuracy so i don't at this point have any real solid projections are sampling that we did a year ago it's based on you know a sample of the broker claims are error rate at that time i guess i would  number but we understand it's lower than baltimore do you have have you already or do you have plans to try to identify what it is that the  moines office is doing that others maybe should be emulating or what it is that baltimore's doing it or wash is doing that or does should avoid or isn't it that simple or are there other factors i don't know that it's that simple we have not yet visited the des moines office on our benefit inspection we have however gone to baltimore and we do selected review of claims we're looking at specifically claims for p t s d we have looked at diabetes and also we look at broker client so our review of claims is not consistent necessarily with the star methodology and therefore the numbers are not directly comparable we did  find when we looked at the selected claims in baltimore they had about thirty eight percent accuracy on those type of selected claims we also found a number of management issues in baltimore and that they had had leadership vacancies and they also had had staff removed from the regular regional office operations to work on a disability pilot we felt that impacted their ability to  the accuracy rate itself i think one question might be variation might be due perhaps to quality of the review across the reasons we see lack of training folks who may not know completely the  rules of the game may be reviewing these claims and they may be sent in some regions and maybe you do want a more thorough job you know the reasons they may may not the other part is that there is some blame to lay on the regions in terms of quality i think you can't under under great regional management there are good managers out there who really embrace quality and it's ingrained at the staff they have they're doing innovative things in terms of training and where we have a reporter about the issues to this committee and regard to training and some best practice type things that are going on out there and also the ability to hire staff and keep staff and i think it's more difficult in certain areas than other especially some of the larger urban areas so  supervisors so i think it's a range of think it's a combination of things that sort of lead to this variance but i would also again hearken back to the quality of the reviews is it truly is it true that these two regions are entirely different sufficient and specific performance measures for assessing the accuracy of decisions b d d claims and you recommended that i consider options for separately estimating the accuracy of such decisions however v a asserted that the cost of sampling previous charge claims as part of star would outweigh the benefits if some subjected b d and quick start claims to star review could we make these programs better even better than they apparently are if so what staffing training or other resources you think would be needed i think the answer is yes there are two hundred fifty thousand an issue claims last year and b d d represented a little over fifty thousand so that's about twenty percent of the  claims coming into the into the pipeline so if you can make a difference there you can make a difference and the number the goal is to make b d claims an even larger part of initial claims the idea that it's it's not cost effective i don't know if i've seen enough to to agree to that v a did do some analysis for us but it was only on the cost side f t s space modification psystar they never did a sample of they never pull a sample of b say what did we get from this additional review so what's the return on investment on the on the other side it's not clear and i continue to believe that v a continues to process more claims outside the traditional process and these there re engineering processes there re engineering you know how they do work and i think they're using in many cases sort of stars more of a blunt interest instrument rather than using it we drill down into these specialized at this point what additional recommendations to you have for improving the star program i think there's a mixture here again there's there's program down design issues that they have to address but there's also management oversight i think the i g really hadn't and many of those  strongly surprised to hear that you have such an important program and had no training requirements and i was very surprised the fact that they haven't done that yet was something that they really need to move on a supervisor  view looking you know having another look at these cases before they're blessed or deemed to be correct it is very important it's part of their quality care it's process they need to build in some management controls and certainly training we have a lot of new staff and integrating the staff and making them put them in a position to be able to accurately assess claims he's going to take good management good supervisory review to sort of teach people as to you know what needs to be done so i think that's very than doubled the size of the quality assurance staff allowing it to increase the scope of quality assurance refuse to believe this additional staff has made a difference or are you of the opinion that staffing alone is insufficient to address deficiencies if you started to answer this question but that never hurts and if you staff up a program and you give folks the tools that they need to do the job they need to do it it could make a difference in that means again training them up and put him in a position to make a difference so the numbers will help but again you had it's going to take time there's a learning curve and but over time i think it will be effective but you mr chairman we haven't done any specific work on the appeals process so i would prefer not to comment because no telling what i might say i would note however that you know the and rate involved remands involved other issues issues other than just whether the rating decision is accurate there could be procedural reasons for a man but i other than that i will leave that went to mister we have done work in that area not not very recently but i would say again there are there are a range of reasons why a case would be remanded back sometimes it's a matter of it's been so long that the parents change and parents are introduc other evidence has not been considered that should be so there's a lot of reasons but i think overall hearing what i've heard today with the i g report what we know in work that we've done in the past in terms of missing claims and how that could affect  rates i'd say the error rate i don't have a whole lot of faith in in the error rate or them sorry the x e rate of eighty four percent is probably some other lower figure but i don't know what that is twice as many cases are being reviewed two hundred forty cases per per year how many total cases were decided by the regional offices last year and it's a sample of twenty cases per month per r o sufficient should this sample be larger particularly ferraro's that process a larger number of claims unfortunately don't have the number of total cases but any time you can ramp up the numbers numbers is going to make your the project ability of what you  do more rigorous are concerned again as with the current system that start tends to be used more as a blunt instrument to account for accuracy of all claims in regard to that regardless of varied business processes more and more we see these claims being processed through these process should include some kind of quality assurance whether it's it's continuous or a snapshot or a limited investment without doing that you waste a lot of time you don't know what you're getting for your money and you might end up where you don't want to be at the the day i think failure to build any regular or limited investment quality assurance into any of these alternative processes is a failure of management and we've noted along the way these varied again  which case they're being decided where the keyway star review was not sufficient in our view to get a good sense of how accurate and consistent many claims are thank you mr tony and ms finn meyer grateful for your testimony and we may have further questions for you that we will send you in writing we now have a series of votes called on the floor so we'll ask  welcome again and thank you for your patience the subcommittee on disability assistance memorial affairs will now resume its hearing on the star review  making the grade and our second panel thank you for joining us again ronald b abrams join executive director national veterans legal services program john l wilson assistant national legislat director disabled american veterans kelly national legislative director of am bats and in cedar plock assistant director veterans affairs and rehabilitation commission of the american legion the but thank you mr chairman i have some good news was just met with hundreds of service officers for the legion and purple heart and i'm happy to tell you that when they talked to me they said star does catch errors they do order the v a to fix them and there is some training based on the errors called by starr however based on the same comments of these service officers and our own personal experience we find that the training based on the error is called by starr is not generally doing the job the the errors still continue and the emphasis is still on production in the regional offices and the l s p believes that the quality of the regional office adjudications is much worse than what is reported by the v a and all you have to do if you want to look at it as an independent check is look at the statistics produced by the board twenty evaluations of mental conditions and make raw or reason out of them the rating schedule is not applied on a consistent basis i'm not going to go over the stats you will have them i will say that the results of what we do with the american legion and we've done over forty quality checks in regional offices we find that the quality is much worse in many instances claims are denied in a premature manner or benefits are not paid at the proper rate because the regional office was more concerned about claiming credit and reducing the backlog than taking the time to d d valid and analyze the claim properly star shows about a sixteen percent we're finding over thirty percent are in general here are some of the are that we've found that you should know about assignment of erroneous low ratings for service connected mental conditions erroneous denial of claims for service connection for mental conditions failure to consider thirty eight us eleven fifty four b the combat veteran statute erroneous denials the claims for individual employability failure to consider pre  opinion sometimes doctors are not the right questions and that leads to a litany of problems based on that we ask that the v a work measurement system be altered so that quality pro pro duction and timeliness are concepts that really drive the system that's the most important thing you need to change that to make any of that would also like a quality control with teeth and an independent  the veterans benefits claims process will require training and accountability to elements central to producing quality results for veterans continues to struggle with the quantity of claims with quality training and accountability taking a back seat primary quality assurance program is a star program the star program canadan of three types of errors benefit and title not decision documentation on notification and administrative the star program was evaluated by the v a reviews quantity over quality in the area that is supposed to ensure quality of at least a technical nature the need for a quality control program as an adjunct to the star quality assurance program can also be  the board of veterans appeals the court of appeals or veterans claims could yield a valuable information on trends and causes of errors this data could be incorporated into a robust proper analysis of such data would provide management and employees understood strategies for improvements are put in place on the other hand does require aros to develop corrective action plans if they do not reach strategic goals for production inventory and timeliness this paradigm must be fli believe it is important to have this accuracy fall within a three percent margin of error therefore amvets request that oh i g conduct a follow up to the two thousand and nine report to ensure v b age gap solutions are productive in the oh i g continue to conduct periodic reviews of star to ensure the program reaches and maintains that three percent margin of error mr chairman this concludes my remarks and i'll be happy to answer any questions that you have thank you m spock thank you mr chairman and members of the committee on behalf of the american legion i would like to say that the start program is a potentially effective tool that if used in a more effective manner could really a deal with the accuracy issues it's refreshing to see that in the oh i g report from march two thousand and nine that the issues that identified v a concurred with and has recently reported that they are  making the changes to correct those the american legion would recommend three points which could help enhance the efficiency of star and the ability for it to be effective the first point is to create an aggregate record of all of the errors that are reported through star so that it can be analyzed the second point would be to use the collected data to develop a targeted training program and the third point would be to have regular outside impartial oversight of the process going back elaborate on the first part the errors are being reported back to the aros however to the best of our knowledge there is no one consolidated effort to aggregate these these mistakes common errors and deficiencies that are being noted if you combine this with common errors and deficiencies noted from the board of veterans appeals the appeals management center and the court of appeals for veterans claims you can develop an overall picture both on a regional office level perhaps even on a team level but more importantly on a national level of what the common errors within v a are and you can use that to determine where to devote the resources to improve accuracy with the n b a that leads directly into point number two targeted training the we have reports and when we have spoken to v a employees on the american legion quality review visits to regional offices it is noted and v a notes that when star identifies problems they reported back to the teams and the coaches for correction involved however if you can notice a national trend if you can notice the consistently v a is experiencing problems with say red rating mental health disorders or improperly asking for exams then this can be set into a targeted training program so that v is getting the most use possible out of their eighty to eighty five hours of mandated training that it's going to correct the areas that you need corrected if you take a math test and you realize you're having problems with binomial equations then you need to go back and do some extra work on binomial equations the next time you take that math test to get it right this is exactly the same sort of thing the v a could use this aggregate data to accomplish and the third point that i want to make is about outside oversight third party oversight in the recent report this morning that was published in the federal register on the oh i g investigation of togaf maine one of the things that was pointed out twenty five percent of the stars were not corrected in accordance with v b a policy and two examples that are listed here started it constructed the regional office to inform a widow that her child could be entitled to d c benefits there's no evidence in the claims folder showing staff inform the widow of this potential entitle furthermore the r o staff irania fully informed starr that they corrected the error secondly star instructed the r o to send a notification letter for a burial claim to the proper claimant while the staff informed star that they corrected the error they did not send the revised heir to the proper claimant so clearly and this is not new that we've seen in the reports of the l i g of the various specific regional offices even if starr's capturing the areas they're not necessarily being followed up on which is why you need third party oversight you need somebody to go in and double check that they're crossing the i's dotting the t's and correcting these errors v a has a potentially very effective tool here and we want them to be able to use it effectively and with the three points that we believe will be effective to create an aggregate of that information that can be searched for trends to use those trends to target the training and to add outside oversight we believe that this can be an effective tool for v a thank what the american legion is proposing here is to have some national training that targeted two national areas of fish n c however within the individual aros there there are different training staff within the individual aros and so when they notice something that's within their particular obvious office obviously they have some initiative to direct the training on their own however we're talking about here is when you're identifying a national problem that a consistent number or even a regional problem that aros in a certain area are deficient in performance on a certain aspect such as applying the mental health disability schedule or properly sending out a notice then it is important to have at the national training specifically craft training that will address the issues that are that are noted and that's why it's important to actually have a method for capturing that that takes into account not only star but also as i said there needs to be a method for for capturing the errors that are being seen at the appeals management center that are being seen at the board of veterans appeals and that are being seen at the court and if you combine those four elements are the amc the b v a and the ca v c then you actually have a big picture the picture from you know three thousand feet of what's going on and you can create the targeted training that's going to be more effective thank you and just one more question here you suggest incentives for bonuses in the management of the aros are driven by quantity rather than quality how would you change the incentive structure to help encourage the accuracy the quality of claims there is taking the one point that addresses accuracy however it does not substantially impact the bonus structure the vast of it is driven by timeliness or quantity of claims and what the american legion has maintained for a long time time is that the work credit system needs to be addressed we have proposed although are open to other proposals the idea that work credit not be counted until a claim is finally adjudicated so that you can determine that it was correctly done every step of the way that may be a more complicated system however some system that takes into account the accuracy of the claim in counting the credit for that work rather than simply that the claim was passed along to another desk needs to be implemented as the system stands right now where you're counting people on three and a half claims a day rather than three and a half correctly done claims a day that's that's where you're running into the problem if you start counting them on accurately and effectively completed claims and then that's when a is going to be in a situation where the incentive is to get the claims done right and not to get a large number of claims done thank you mr kelly and your testimony and that's a search that the star program should be expanded to ensure that specific programs such as speedy and specific conditions can be tracked for anomalies that occur so that improvement strategies and specific training complete be implemented  that's the benefits of such changes to not surpass the cost of these measures do you concur with that position and if not why veterans are waiting and deserve to have done accurately you point out that not only is training for b b a raider's needed but sometimes retraining is needed to reteach key lessons based on updated procedures in the ten years since starr's establishment the v a has yet to surpass a ninety percent rating accuracy with that in mind do you think that the star review team needs to be retrained to make sure that they're correctly employing the star quality control system putting a lot of pressure on individuals again to do a lot of work in a little bit of time i think making sure that they have the right resources and they're trained properly and retrain if you start seeing deficiencies is absolutely time to get back  managers in the regional office can claim work that's a disincentive if you give the managers the incentive to do it right because you're going to reward them with work  they're going to courage their work to do it right the workers will work to what their managers want them to do as do post office workers and patent office workers and you've read about the problems with those groups set the system up so that what the managers want is what we want quality adjudication then we could also reward people who do good work and plenty of that but instead of just plenty of that work that's not enough that's a good way to make people do the right thing and get benefits probably to our veterans which was what this committee intended to in the legislation we passed into thought we we we certainly support that we were happy that we did it and we anxiously await the response as do we  do you have such bias that you can come up with the if you want we have plenty of cases where not only the regional office but the board of veterans appeals did not claim even though the veterans met the requirements in the diagnostic code to get the higher evaluation fact we had one i just trained on it yesterday where we scre we're level there and we have other instances but i have to go back through files and go over them and if they're public i can share them i would appreciate i'm sure the committee  would mr wilson in your testimony you indicate that the primary problem with the current accountability system is that v b employees are not usually held responsible for their errors and what specific way would you rather well generally speaking although certainly has an error rate that's unacceptable but it does measure the process itself it tells you what the result of that process will provide it does that what it does not provide however is a  quality you do not have a quality control program where you can look at this process dissect its part and evaluate it to determine whether this process is giving me the product that i need that process that it will be needed something  inspections and deliverable peer reviews of the quality of the work done at the end of the day that work by coaches is on an all in on an occasional basis unfortunately something that would require particular review and of the aggregate roll that up also take a look at a national level to provide opportunities for training folks for various regional offices or individual employees and that would also be tied into the kinds of compensation packages it would be provided alternatives or should we should pursue pursue this and keep going down the road that they are currently on it's important initiative and i'd like to respond for the record to the question  we range from a high in des moines of ninety two point three four percent accuracy to a low in baltimore sixty nine point three three in washington lower than that although we don't have a number we did not find such a high quality of work it was better than some offices but not at ninety two percent in my experience i do not really trust the statistics except to note that they are generally worse than what are reported i say that because i've seen that over thirty six years however some offices in rural areas attract a higher level of worker and we don't talk about that a lot but working for the a in new york with the kicker to get a little more money doesn't give you the same quality of life as working in des moines so one of the problems is attracting higher level of worker in the regional office also a smaller office tends to be on top of things a little more the worst office we found was st peter the largest one it was a disaster in my view right there about two thirds of the way down the list here but not all the way about i'm only looking at what we actually found and since i did a lot of  's a personality that comes out in each one of these are and in that there's a culture and we need to figure out how can we get everybody to to look at things the same way  localized training on certain issues that that have been identified is a true problem for that one area need to be identified but there needs to be national standardized training throughout to ensure that everybody's thinking from the from the same book and and everybody's moving forward and with the same thought in mind thank you mr playing well the simple answer that you would want to do in a case like that is figure out a way to clone  iowa if that's your top performing thing and replicate it everywhere else but as mr abrams pointed out you don't necessarily have the same base the same resources the same workload at every regional office and so there are going to be flux fluctuations we agree completely on what you have to address in the in the pool of workers that you can attract with the salaries that are that are there for v a obviously any employment is great in a difficult economy but people want to be competitive and then they want to be in a position to do that and in some areas where the cost of living is much higher it it's less attractive and so that's difficult and we don't talk about that a lot but it is something that's there and that is there to consider the nationally standardizing training and having a good solid means of national analysis to see hey how do we replicate the the iowa results in other offices is there a way to condense that put it into a training package and get that to every place else that's what you're dealing with but also in each regional office there's different staff there's different management they're all trying to do the same task but you have a different climate in each one the accuracy rates that we've seen have been fairly consistently when the american legion does quality reviews have been fairly consistently in the twenty five to thirty three percent range of error which is and that's an across the board sort of average which is below obviously what the star averages are finding and  you look across the board then something like ninety two percent may be optimistic although you should still consider that that's better than what a number of others are doing so in addition to finding out where you're seeing the deficiencies are also look for where you're seeing the strengths are and use that in your in your training programs to again like we said create targeted training create training that's targeting what you know is both positive and negative about your organization and to correct those bradley g mazed the director of compensation pensions service for the benefits administration u s department of veterans veterans affairs accompanied by ed mimic noddle deputy director of compensation pension service of the your full written statement has already made a part of the hearing record and so feel free to abridge it or add to it whatever you'd like to do it five minutes mr ma mr chairman thank you for providing me this opportunity to discuss the veteran's benefits administration's quality assurance program in a positive effect it has on the processing of veterans disability claims and joining me today let me just say before i get into that let me that i agree completely with with virtually every panelist that's been up here that quality must be at the core of our philosophy for serving veterans we there's no question about that the subcommittee has indicated a special interest in our systematic technical accuracy review program however i want to emphasize that star is only one of forty years of our multifaceted national the assurance program the star component focuses on claims processing accuracy while the other three components address regional office oversight rating consistency and special focus reviews along with the star program components collaborate to ensure high quality and consistent decisions for veterans star is the quality assurance component that focuses on claims processing accuracy star reviews are focused on outcomes for veterans rather than specific processes by which the outcomes are reached star reviews evaluate the quality of the rating decision product that v b a provides for veterans it is from the veterans perspective that there is an expectation that we understand the claim we evaluate it accurately and fairly and provide proper compensation under the law the purpose of star reviews is to ensure that rating decision outcomes meet these expectations the star program incorporates review of three types of work claims that usually require rating decision authorisation work that does not generally require rating decision and  a determination of benefit entitlement accuracy for rating and authorization work utilizes a structured checklist to ensure all issues were addressed claims assistance was provided and the decision was correct accuracy results are calculated on the results of the benefit entitlement reviews star findings provide statistically valid accuracy results at both the regional office and national level d b a continues to focus on expanding  improve and improving the star program in two thousand and eight the star staff was consolidated in nashville which provided space for expansion and allowed aggressive recruitment for more staff since then stars completed an extensive expansion effort more than doubling the staff and increasing the sample size to obtain a statistically valid sample at the regional office level in two thousand and ten quality review of fiduciary cases was also transferred to nashville during fiscal year two thousand and nine a little over twenty thousand cases were reviewed under the program the targeted number of cases for review in two thousand and ten is thirty seven thousand nine hundred thirty two the star sample was expanded in two thousand and nine to include a review of brokered work completed by v a s resource centers and tiger team and sampling was increased for the pension management centers to allow measurement of pension entitlement decisions ongoing reviews of the disability evaluation system cases and appeals management center cases became part of the monthly compensation quality sample in fiscal year two thousand and nine the v b a quality assurance program has undergone significant change over the past several years and has become more comprehensive by expanding the type and breadth of cases reviewed but we've knowledge this is a journey that we're on and we look forward to working with our stakeholders continue to continuously improve our quality assurance program mr chairman thank you for the opportunity to provide you an update on our accomplishments at this hearing and with that i'll be glad to answer as numbers are growing numbers of staff are growing numbers of claims being brought in by the new diseases that are service connected automatically not to mention the returning  taken or are considering taking regarding sprint since baltimore washington given the disparity between their accuracy rate under your evaluation and the more successful i mean i would just guess that maybe nashville is rated near the top because star is based there is that is that a correct assumption but what is there something under way already to try to bring baltimore and washington up well the first of all tackle that last one i don't think it hurts that we have our our quality assurance operation in nashville it's although it's not actually in the regional office but in nashville  you had a director who i understand is going to be retiring soon but brian coralie who came up through the system understanding the program  education process and someone who was very dedicated i know personally very dedicated in training and focusing on developing his workforce and he knew the value of developing that workforce because that in the end would would reap long term reward and so while you may have to pay the price early on to train these that this has to be a philosophy and i echoed that and i'm not suggesting that involved more they don't have that philosophy or they do what i am saying that what we have to do what the service has to do is help shine a light on areas where there are deficiencies star helps do that star you've got that array of the quality by offices but we also do site surveys and we've gone into baltimore on site a site visit and we've highlighted some areas that they need to focus their attention on and we work closely with our operations  through our office of field operations we share this information with them and then the expectation is that the management team will execute on these recommendations and so that's how this process works and we've provided that information and i believe that they have set about executing a plan for addressing these deficiencies that we've identified and it's resulted i believe in a lower quality rating  a keep records of how performance has changed or improved with new leadership that the our rose for instance in new york i know serves my constituents in the hudson valley and other new york regional veteran recently had a new director appointed and i'm curious if well currently in this ranking has the fifth lowest accuracy rating is that changing if you had time yet to ascertain whether the  t the way we're organized as as me being the head of the policy component in v b a i'm i r our program goes in and takes a look and identifies these these gaps and we work closely with that operations component to then come back and rectify those deficiencies the my understanding is the director just reported there so i think it might be too early for us to tell that you know whether some of the countermeasures that she has put in place are beginning to to reap some some benefit to have accuracy ratings for the previous year two thousand  we do and it's a twelve month cumulative accuracy score so it's looking back at the twelve month cumulative number and we've gotten those numbers going back historically yes i think you could you provide the committee please with changes in the directors different aros within the last two years and any correlation that you see in terms of the accuracy before and after the new management talking about in terms of incentives and disincentives to try to encourage the higher accuracy performers and maybe just incentivize those who are not producing the same rate of accuracy well one thing i would say is that accuracy is in the performance plan for for every individual that's involved in the claims process from the director right down to the claims examiner who's developing the claim to the r v s r rating the claim every one of those decision makers and the managers in that process every one of those employees has a critical component related to accuracy so the assertion that that we somehow don't value accuracy isn't borne out by what we measure individual's performance on it is production as well but if there's equal weight in the performance plan for all of those employees for accuracy i appreciate that and i and i note that it's a complicated thing that is not just explained by any one factor for instance you do have  areas where it may be easier to extract do the cost of living in a center building one can achieve on a given salary just as with air traffic controllers or doctors in the in the private medical field and other areas there's all the other on or moving factors notwithstanding we need to which i believe we need to try to motivate people to to try to get up to where do you know if the mine is in fact there are we to get more des moines here so are you looking at or have you already made any changes in the way bonuses are  chairman i'm not involved in the in the and i'm making the assumption you're talking about at the senior leadership level i'm not involved in that in the process by which the bonuses are determined even for for the journey level employee that's processing this work quality is a core component of their performance plan and i know when i was in cleveland as the director or previously in milwaukee that if somebody was was failing to achieve their their performance plan target for quality and then they were not that counted against in the mix with respect to who is going to get performance awards because we valued quality so if we look at if we if we look at offices that are that are not performing as well we would see lower year end bonuses or performance awards mr chairman because i have not been involved in that process that's when i take for the record i'll try to find out  if you can find out for us that would be good is it safe to conclude since atlanta chicago to new york l a and baltimore are all near the bottom of the list that accuracy levels are driven down by volume that mr abrams made some points about smaller stations it's easier to to control your workload i think that's a valid observation but we also know there's evidence that larger stations can successfully manage that workload it makes it it can be more challenging because you've got a lot more work coming through there you have a lot more employees that you have to manage and even though the span of control at the at the  about the challenges in hiring and retaining a good workforce and as you point out most of those are significantly urban cities and we recognize that is a challenge for us to retain a workforce not that we can't do it but it is sometimes easier in your smaller stations or stations or states like muskogee who is a very large office for us but we are able to retain a very strong workforce that's exactly that's precisely why we built out our quality assurance operation in nashville because we were having a challenge in recruiting and retaining employees at that grade level here in the washington d so we've made a decision we're going to move that part of our operation to nashville as well because we are achieving more success there and we went to said going to happen we have an announcement on a street right now for employees part of that operation in nashville so soon as we can get through the hiring process will will begin that transition just like we did for the reviewer's we move that from washington tinted you please provide us with if you if you have it  other branches of government that are doing the same thing be for the same reasons and it would be helpful to us to know that he reports that the star quality control system was hindered by the v a s exclusion of brokered claims from star indication that recently you have embraced this recommendation and begun to review those claims what impact do you believe a review of the broker claims will have on the overall accuracy rate well we're reporting it now we started that for cases worked in april and right now the nation national accuracy rate for brokers work is seventy seven percent for the tiger team at seventy eight and when you factor that into the national numbers i think it stays the same at eighty three percent is that correct so that's the you know right now given the sample it it's not impacting the overall nationwide accuracy rate but i think the fact that we are looking at this work now is important because it means that folks that are promulgating decisions out of our resource centers know that there's the possibility you're going to have your case selected for review at the national level how do you explain the difference between star comments on a claim and issues identified as errors can you do or what are you doing to ensure that all issues are correctly identified as errors or comments well when we select our sample we are we are sampling claims that have been completed over one month period previous to the month that we're doing the reviews and the sample is driven by the end product control that is associated with the work that was done and the way we set our system up as we're doing the review for th claim that was at issue associated with that control but sometimes during the course of a review we might find where we missed something but it's not associated with the claim that is subject to the review and so will annotate that is a comment rather than call an error on the claim that is subject to the review in this particular review and so  what the i g commented on was that for error calls where we're saying you made a benefit entitlement err on that particular claim we were requiring a second level review but in those reviews where there was no error associated with that claim but we noted a comment we were not requiring a second level review and so we concurred with the we said that we need to have the second level review not just on those cases where we call a benefit entitlement error but also in those situations where we found something in the record that warranted a comment and we've implemented that so that was something that we agreed with with regions which according to you i g are actually maybe as much as ten percent below what these numbers show and i realize you know you're dealing with a very complicated situation but each veteran is also dealing with a very complicated situation that they may not have the resources to deal with so i know you understand the seriousness of this and the committee does also you and all the witnesses will have and members of the committee will have five days to