Testimony Before the Subcommittee on 

Disability Assistance and Memorial 

Affairs, Committee on Veterans' Affairs, 

House of Representatives 

United States Government Accountability Office

GAO

For Release on Delivery 

Expected at 10:30 a.m. EDT 

Thursday, May 5, 2005 VA DISABILITY BENEFITS

Board of Veterans' Appeals 

Has Made Improvements in 

Quality Assurance, but 

Challenges Remain for VA 

in Assuring Consistency 

Statement of Cynthia A. Bascetta, Director, 

Education, Workforce and Income Security 

GAO-05-655T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

www.gao.gov/cgi-bin/getrpt?GAO-05-655T.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cynthia A. 

Bascetta at (202) 512-7101. 

Highlights of GAO-05-655T, a testimony 

before the Subcommittee on Disability 

Assistance and Memorial Affairs, House 

Committee on Veterans' Affairs 

May 5, 2005

VA DISABILITY BENEFITS 

Board of Veterans’ Appeals Has Made 

Improvements in Quality Assurance, but 

Challenges Remain for VA in Assuring 

Consistency 

The Department of Veterans Affairs (VA) has taken steps to respond to 

GAO’s 2002 recommendations to correct weaknesses in the methods for 

selecting decisions by the Board of Veterans’ Appeals (Board) for quality 

review and calculating the accuracy rates reported by the Board. 

Specifically, the Board now ensures that decisions made near the end of 

the fiscal year are included in the quality review sample, and the Board 

now excludes from its accuracy rate calculations any errors that do not 

have the potential for resulting in a reversal by or remand from the court. 

GAO found that the Board had not yet revised its formula for calculating 

accuracy rates in order to properly weight the quality review results for 

original Board decisions versus the results for Board decisions on cases 

remanded by the court. However, GAO believes correcting this 

calculation method will not materially affect the Board’s reported 

accuracy rates. 

VA still lacks a systematic method for ensuring the consistency of 

decision-making within VA as a whole, but has begun efforts to 

understand why average compensation payments per veteran vary widely 

from state to state. These efforts include studies underway by VA’s Office 

of Inspector General and the Veterans Benefits Administration, which 

oversees the operations of VA’s regional offices. Some variation is 

expected since adjudicators often must use judgment in making disability 

decisions, but VA faces the challenge of determining whether the extent 

of variation is confined within a range that knowledgeable professionals 

could agree is reasonable. 

Steps in the Veterans Disability Claims and Appeals Process 

The House Subcommittee on Disability 

Assistance and Memorial Affairs asked 

GAO to update a 2002 study to 

determine what VA has done to 

(1) correct reported weaknesses in 

methods used by the Board to select 

decisions for quality review and 

calculate the accuracy rates reported 

by the Board and (2) address the 

potential for inconsistency in decisionmaking at all levels of adjudication in 

VA, including VA’s 57 regional offices 

and the Board. GAO said in 2002 that 

VA had not studied consistency even 

though adjudicator judgment is 

inherently required in the decisionmaking process, and state-to-state 

variations in the average disability 

compensation payment per veteran 

raised questions about consistency. In 

January 2003, in part because of 

concerns about consistency, GAO 

designated VA’s disability program as 

high-risk.

What GAO Recommends

This testimony updates actions VA has 

taken to implement recommendations 

from the GAO’s 2002 report, in which 

GAO recommended that VA take steps 

to (1) correct the weaknesses in the 

Board’s sampling and accuracy rate 

calculation methods and (2) establish a 

system for assessing the consistency of 

decision-making at all levels of 

adjudication in VA, including VA’s 

regional offices and the Board.
Page 1 GAO-05-655T 

Mr. Chairman and Members of the Subcommittee: 

Thank you for inviting me to discuss our work related to the efforts of the 

Department of Veterans Affairs (VA) to assure the quality and consistency 

of disability decisions. Assuring the quality and consistency of VA’s 

disability decisions is vital for assuring program integrity and equitable 

decisions. As you know, in January 2003, we designated VA’s disability 

program, along with other federal disability programs, as high-risk.1

 In 

part, we designated VA’s program as high-risk because of concerns about 

consistency of decision-making. Despite VA’s efforts to provide training 

and enhance communication to improve the consistency of decisions, we 

found indications of inconsistency such as the wide variation among states 

in the average compensation payment per veteran. 

You asked us to update our 2002 report in which we found that the Board 

needed to improve its quality review program.2 Specifically, the Board 

needed to revise its sampling methods, the way it weighted quality review 

results in its calculation of accuracy rates, and the types of errors reported 

in the accuracy rates. In that report, we also found that VA needed to take 

action to assure consistency of decision-making within VA as a whole. 

Today I would like to highlight the steps the Board has taken since our 

2002 report and discuss VA’s recent efforts to address inconsistent 

decision-making. To update our 2002 report, we interviewed officials of 

and/or obtained pertinent documentation from the Board and the Veterans 

Benefits Administration (VBA), which oversees the operations of VA’s 57 

regional offices. We obtained comments from Board officials on the 

updated information contained in this testimony regarding the Board's 

quality assurance system, and they agreed with this information. We did 

our work in accordance with generally accepted government auditing 

standards in April 2005. 

In summary, we found that the Board has taken action to strengthen its 

system for reviewing the quality of its own decisions, but VA still lacks a 

systematic method for ensuring the consistency of decision-making within 

VA as a whole. With respect to the Board, it has taken steps to improve the 

sampling and accuracy rate calculation methods of its quality review 

system and also to assure that serious errors are not obscured by mixing 

 1

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

2

GAO, Veterans’ Benefits: Quality Assurance for Disability Claims and Appeals 

Processing Can Be Further Improved, GAO-02-806 (Washington, D.C.: Aug. 16, 2002). 
Page 2 GAO-05-655T 

them with less significant deficiencies. Regarding consistency, VA still 

lacks a plan for an ongoing, systematic assessment of decision-making 

consistency at all levels of adjudication within VA. As we concluded in 

2002, such an assessment is needed to provide a foundation for 

determining acceptable levels of decision-making variation and to reduce 

variations found to be unacceptable. Although VA has much left to do 

regarding consistency of decision-making, it has begun efforts to 

understand the reasons behind one indication of inconsistency: the wide 

variations from state to state in the average compensation payment per 

veteran. These efforts include studies being done by VA’s Office of 

Inspector General and VBA. 

VA’s disability compensation program pays monthly cash benefits to 

eligible veterans who have service-connected disabilities resulting from 

injuries or diseases incurred or aggravated while on active military duty. 

The benefit amount is based on the veteran’s degree of disability, 

regardless of employment status or level of earnings. 

A veteran starts the claims process by submitting a disability 

compensation claim to one of the 57 regional offices administered by VBA 

(see fig. 1). In the average disability compensation claim, the veteran 

claims about five disabilities. For each claimed disability, the regional 

office adjudicator must develop evidence and determine whether each 

disability is connected to the veteran’s military service.3

 The adjudicator 

then applies the medical criteria in VA’s Rating Schedule to evaluate the 

degree of disability caused by each service-connected disability, and then 

the adjudicator determines the veteran’s overall degree of serviceconnected disability. 

If a veteran disagrees with the adjudicator’s decision on any of the claimed 

disabilities, the veteran may file a Notice of Disagreement. If the regional 

office is unable to resolve the disagreement to the veteran’s satisfaction, 

 3

The Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, (2000) requires VBA to 

assist claimants who have filed a complete claim for benefits. Specifically, VBA must: 

(1) notify claimants of the information necessary to complete the application; (2) indicate 

what information not previously provided is needed to prove the claim and distinguish 

between the portion of the information for which the claimant will be responsible and the 

portion for which VA will be responsible; (3) make reasonable efforts to assist claimants in 

obtaining evidence to substantiate claimant’ eligibility for benefits, including relevant 

records; and (4) inform claimants when relevant records are unable to be obtained. 

Background: The 

Disability Claims and 

Appeals Process 
Page 3 GAO-05-655T 

the veteran may appeal to the Board.4 A veteran can dispute a decision not 

only if the regional office denies benefits by deciding that an impairment 

claimed by the veteran is not service-connected. Even for a claimed 

impairment found to be service-connected, the veteran may dispute the 

severity rating that the regional office assigns to the impairment and ask 

for an increase in the rating. 

During fiscal years 2003 and 2004, respectively, the regional offices made 

about 715, 000 and 598,500 decisions involving disability compensation 

claims. According to VBA, during fiscal years 2003 and 2004, respectively, 

veterans submitted Notices of Disagreement in about 13.4 and 14.5 percent 

of all decisions involving disability ratings, and of the veterans who filed 

Notices of Disagreement, about 34.9 and 44.4 percent went on to submit 

appeals to the Board. Assisted by 240 staff attorneys, the Board’s 52 

veterans law judges decide veterans’ appeals on behalf of the Secretary. 

The Board has full de novo review authority and gives no deference to the 

regional office decision being appealed. The Board makes its decisions 

based on only the law, VA’s regulations, precedent decisions of the courts, 

and precedent opinions of VA’s General Counsel. During the appeals 

process, the veteran or the veteran’s representative may submit new 

evidence to the Board and request a hearing. 

 4

In response to a Notice of Disagreement, the regional office provides a further written 

explanation of the decision, and if the veteran still disagrees, the veteran may appeal to the 

Board. Before appealing to the Board, a veteran may ask for a review by a regional office 

Decision Review Officer, who is authorized to grant the contested benefits based on the 

same case record that the regional office relied on to make the initial decision. 
Page 4 GAO-05-655T 

Figure 1: Steps in the Disability Claims and Appeals Process 

In fiscal year 2004, for all VA programs, the Board decided about 38,400 

appeals, of which about 94 percent (35,900) were appeals of disability 

compensation cases that contained an average of 2.2 contested issues per 
Page 5 GAO-05-655T 

case. In any given case, the Board might grant the requested benefits for 

one issue but deny benefits for another. In some instances, the Board may 

find that a case is not ready for a final decision and return (or remand) the 

case to VBA for rework, such as obtaining additional evidence and 

reconsidering the veteran’s claim. If VBA still does not grant the requested 

benefits after obtaining the additional evidence, it returns the case to the 

Board for a final decision. Of the appeals involving compensation cases 

decided during fiscal year 2004, the Board reported that it granted 

requested benefits for at least one issue in about 18 percent of the cases, 

denied all requested benefits in about 23 percent of the cases, and 

remanded about 58 percent of the cases to VBA for rework.5

Effective February 22, 2002, VA issued a new regulation to streamline and 

expedite the appeals process. Previously, the Board had remanded all 

decisions needing rework directly to VBA’s regional offices. The new 

regulation, however, allowed the Board to obtain evidence, clarify 

evidence, cure a procedural defect, or perform almost any other action 

essential for a proper appellate decision without having to remand the 

appeal to the regional office. It also allowed the Board to consider 

additional evidence without having to refer the evidence to the regional 

office for initial consideration and without having to obtain the appellant’s 

waiver. According to the Board, this change in the process reduced the 

time required to provide a final decision to the veteran on an appeal, 

allowed regional offices to use more resources for processing initial claims 

rather than remands, and virtually eliminated multiple remands on the 

same case to the regional offices. However, in May 2003, the U.S. Court of 

Appeals for the Federal Circuit held that the Board could not, except in 

certain statutorily authorized exceptions, decide appeals in cases in which 

 5

The statistics in the Board’s annual reports do not reflect all cases in which at least one 

issue is remanded or denied because the Board reports appeals outcomes on the basis of 

individual cases rather than individual issues within each case. To do this, the Board 

counts “case” dispositions using the following hierarchy: (1) allowed, (2) remanded, (3) 

dismissed, and (4) denied. Under this hierarchy, if any issue or part of the appeal is 

allowed, the entire case is counted as an allowance, regardless of whether any other issue 

in the case is remanded or denied. If no issue or part of the appeal is allowed, but part is 

remanded and part is denied, the case is counted as a remand. If no issue or part of the 

appeal is allowed or remanded, but part is dismissed and part is denied, the case is counted 

as a dismissal. A case is counted as denied only when all issues or parts of the appeal are 

denied. 
Page 6 GAO-05-655T 

the Board had developed evidence.6 As a result, VA established a 

centralized Appeals Management Center within VBA in Washington, D.C., 

to take over evidence development and adjudication work on remands. 

If the Board denies requested benefits or grants less than the maximum 

benefit available under the law, veterans may appeal to the U. S. Court of 

Appeals for Veterans Claims, an independent federal court. Unlike the 

Board, the court may not receive new evidence. It considers only the 

Board’s decision; briefs submitted by the veteran and VA; oral arguments, 

if any; and the case record that VA considered and that the Board had 

available. In cases decided on merit (cases not dismissed on procedural 

grounds), the court may (1) reverse the Board’s decision (grant contested 

benefits), (2) affirm the Board’s decision (deny contested benefits) or (3) 

remand the case back to the Board for rework. Of the 3,489 cases decided 

on merit during fiscal years 2003-2004, the court reversed or remanded in 

part or in whole about 88 percent of the cases. Under certain 

circumstances, a veteran who disagrees with a decision of the court may 

appeal to the U.S. Court of Appeals for the Federal Circuit and then to the 

Supreme Court of the United States. 

The Board of Veterans’ Appeals has taken action to strengthen its internal 

system for reviewing the quality of its own decisions. Specifically, the 

Board has taken steps to improve its quality review system’s sampling 

methodology and to avoid obscuring serious errors by mixing them with 

less significant deficiencies. We found, however, that the Board still needs 

to revise its formula for calculating accuracy rates in order to avoid 

potentially misleading accuracy rates. 

 6

In Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 

2003), the Court held that allowing the Board—which is VA’s “appellate tribunal” for 

deciding appeals of denials of veterans’ benefits claims—to consider additional evidence 

without having to remand the case to the agency of original jurisdiction (regional office) 

for initial consideration and without having to obtain the appellant’s waiver was contrary to 

the requirement of 38 U.S.C. § 7104(a) that “[a]ll questions in a matter which . . . is subject 

to decision by the Secretary shall be subject to one review on appeal to the Secretary.” 

Section 7104(b) does not permit the reconsideration of a claim disallowed by Board in the 

absence of new and material evidence as required by 38 U.S.C. 5108; however the 

regulation in question resulted in the veteran’s not being able to object effectively to any of 

the additional evidence obtained by the Board until after the Board had weighed the 

evidence and decided the appeal, therefore not permitting the veteran to explore effectively 

a basis for “one review on appeal to the Secretary” with respect to the additional evidence 

obtained by the Board. 

The Board Has Taken 

Steps to Improve Its 

Quality Assurance 

Program 
Page 7 GAO-05-655T 

During our 2002 evaluation, we reviewed the Board’s methods for 

selecting random samples of Board decisions and calculating accuracy 

rates for its decisions. We found that the number of decisions reviewed 

was sufficient to meet the Board’s goal for statistical precision in 

estimating its accuracy rate.7

 However, we pointed out some Board 

practices that might result in misleading accuracy rates. These practices 

included not ensuring that decisions made near the end of the fiscal year 

were sampled and not properly weighting quality review results in the 

formula used to calculate accuracy rates. At the time of our 2002 report, 

the Board had agreed in principle to correct these practices. 

We found in our most recent work that the Board took corrective action in 

fiscal year 2002 to assure that decisions made near the end of the fiscal 

year were sampled. The quality review program now selects every 20th 

original decision made by the Board’s veterans law judges and every 10th 

decision they make on cases remanded by the court to the Board for 

rework. However, we found that the Board had not revised its formula for 

calculating accuracy rates in order to properly weight the quality review 

results for original decisions versus the results for decisions on remanded 

cases. We determined that, even if this methodological error had been 

corrected earlier, the accuracy rate reported by the Board for fiscal year 

2004 (93 percent) would not have been materially different. However, to 

avoid the potential for reporting a misleading accuracy rate in the future, 

corrective action needs to be taken, and the Board agreed to correct this 

issue in the very near future. 

In our 2002 evaluation, we also found that the Board included 

nonsubstantive deficiencies (errors that would not be expected to result in 

either a remand by the court or a reversal by the court) in calculating its 

reported accuracy rates. We concluded that the reported accuracy rates 

understated the level of accuracy that would result if the Board, like VBA, 

counted only substantive deficiencies in the accuracy rate calculation.8

 7

The Board’s intention is that VA can have 95 percent confidence that the Board’s true 

accuracy rate is no more than 5 percentage points higher or lower than the estimated 

accuracy rate. 

8

At that time, the Board’s quality reviewers assessed decision accuracy on the basis of six 

areas: issues, evidence, laws and regulations, reasons and bases, due process, and format. 

One error (or deficiency) in any area meant that a decision failed the quality test. However, 

according to the Board, all six areas included certain deficiencies that are not substantive. 

According to the Board, most deficiencies in the “format” category were not substantive, 

such as errors in grammar, spelling, or decision structure. 
Page 8 GAO-05-655T 

VBA had ceased counting nonsubstantive deficiencies in its error rate after 

the VA Claims Processing Task Force said in 2001 that mixing serious 

errors with less significant deficiencies could obscure what is of real 

concern. Similarly, we recommended that the Board’s accuracy rates take 

into account only those deficiencies that would be expected to result in a 

reversal or a remand by the court. In fiscal year 2002, the Board 

implemented our recommendation. 

Also, during the course of our 2002 evaluation of the quality review 

program, we brought to the Board’s attention the governmental internal 

control standard calling for separation of key duties and the governmental 

performance audit standard calling for organizational independence for 

agency employees who review and evaluate program performance. These 

issues arose because certain veterans law judges who were directly 

involved in deciding veterans’ appeals were also involved in reviewing the 

accuracy of such decisions. The Board took corrective actions during our 

review in May 2002 to resolve these issues so all quality reviews from 

which accuracy rates are determined are done by persons not directly 

involved in deciding veterans’ appeals. 

In 2002, we also found that the Board collected and analyzed issue-specific 

data on the reasons that the Court remanded decisions to the Board in 

order to provide feedback and training to the Board’s veterans law judges; 

however, the Board did not collect issue-specific data on the errors that its 

own quality reviewers found in decisions of the Board’s veterans law 

judges. We recommended that the Board revise its quality review program 

to begin collecting such issue-specific error data in order to identify 

training that could help improve decision quality. In April 2005, the Board 

said it did not implement this recommendation because it believes the 

benefits would be too limited to justify the substantial reprogramming of 

the data system that would be required to collect issue-specific data. The 

Board also pointed out that the issue-specific data captured for court 

remands have not proved to be as useful as it had expected in identifying 

ways to provide training that could reduce court remands. 
Page 9 GAO-05-655T 

Adjudicator judgment is an inherent factor in deciding disability claims, 

and it introduces the potential for variation in the process. Part of 

assessing inconsistency, as we recommended in 2002, would include 

determining acceptable levels of variation for specific types of disabilities. 

In late 2004, in response to adverse media reports, VA initiated its first 

study of consistency. Such studies are the first step in determining the 

degree of variation that occurs and what levels of variation are acceptable. 

Adjudicators often must use judgment in making disability decisions. 

Judgment is particularly critical when the adjudicator must (1) assess the 

credibility of different sources of evidence; (2) evaluate how much weight 

to assign different sources of evidence; or (3) assess some disabilities, 

such as mental disorders, for which the disability standards are not 

entirely objective and require the use of professional judgment. In such 

cases, two adjudicators reviewing the same evidence might make differing 

judgments on the meaning of the evidence and reach different decisions, 

neither of which would necessarily be found in error by any of VA’s quality 

reviewers. 

For example, in an illustration provided by the Board, consider a disability 

claim that has two conflicting medical opinions, one provided by a medical 

specialist who reviewed the claim file but did not examine the veteran, and 

a second opinion provided by a medical generalist who reviewed the file 

and examined the veteran. One adjudicator could assign more weight to 

the specialist’s opinion, while another could assign more weight to the 

opinion of the generalist who examined the veteran. Depending on which 

medical opinion is given more weight, one adjudicator could grant the 

claim and the other could deny it. Yet, a third adjudicator could apply VA’s 

“benefit-of-the-doubt” rule and decide in favor of the veteran. Under this 

rule, if an adjudicator concludes that there is an approximate balance 

between the evidence for and the evidence against a veteran’s claim, the 

adjudicator must decide in favor of the veteran. 

In the design of their quality review systems, VBA and the Board 

acknowledge the fact that, in some cases, different adjudicators reviewing 

the same evidence can make differing, but reasonable, judgments on the 

meaning of the evidence. As a result, VBA and the Board instruct their 

quality reviewers that when they review a decision, they are not to record 

an error merely because they would have made a different decision than 

the one made by the adjudicator. VBA and the Board instruct their quality 

reviewers to not substitute their own judgment in place of the original 

VA Faces Challenges 

in Measuring 

Consistency But Has 

Recently Initiated 

Studies 

Adjudicator Judgment 

Results in Inherent 

Variation in Decisionmaking 
Page 10 GAO-05-655T 

adjudicator’s judgment if the adjudicator’s decision is adequately 

supported and reasonable. 

Another example provided by the Board demonstrates how adjudicators 

must make judgments about the degree of severity of a disability. VA’s 

disability criteria provide a formula for rating the severity of a veteran’s 

occupational and social impairment due to a variety of mental disorders. 

This formula is a nonquantitative, behaviorally oriented framework for 

guiding adjudicators in choosing which of the degrees of severity shown in 

table 1 best describes the claimant’s occupational and social impairment. 

Table 1: VA’s Medical Criteria for Evaluating the Degree of Occupational and Social 

Impairment Due to Mental Disorders 

Degree of occupational and social impairment as 

characterized in VA’s medical criteria 

Disability 

rating (in 

percent)

Totally impaired 100

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

thinking, or mood 70

Reduced reliability and productivity 50

Occasional decrease in work efficiency and intermittent periods of 

inability to perform occupational tasks 30

Mild or transient symptoms that decrease work efficiency and ability to 

perform occupational tasks only during periods of significant stress, or 

symptoms can be controlled by continuous medication 10

Not severe enough to interfere with occupational or social functioning or 

to require continuous medication 0

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

Similarly, VA does not have objective criteria for rating the degree to 

which certain spinal impairments limit a claimant’s motion. The 

adjudicator must assess the evidence and decide whether the limitation of 

motion is “slight, moderate, or severe.” To assess the severity of 

incomplete paralysis, the adjudicator must decide whether the veteran’s 

paralysis is “mild, moderate, or severe.” The decision on which severity 

classification to assign to a claimant’s condition could vary in the minds of 

different adjudicators, depending on how they weigh the evidence and 

how they interpret the meaning the of the different severity classifications. 

Consequently, it would be unreasonable to expect that no decision-making 

variations would occur. But it is reasonable to expect the extent of 

variation to be confined within a range that knowledgeable professionals 

could agree is reasonable, recognizing that disability criteria are more 
Page 11 GAO-05-655T 

objective for some disabilities than for others. For example, if two 

adjudicators were to review the same claim file for a veteran who has 

suffered the anatomical loss of both hands, VA’s disability criteria state 

unequivocally that the veteran is to be given a 100 percent disability rating. 

Therefore, no variation would be expected. However, if two adjudicators 

were to review the same claim file for a veteran with a mental disability, 

knowledgeable professionals might agree that it would not be out of the 

bounds of reasonableness if one adjudicator gave the claimant a 50 

percent disability rating and the other adjudicator gave a 70 percent rating. 

However, knowledgeable professionals might also agree that it would be 

clearly outside the bounds of reasonableness if one adjudicator gave the 

claimant a 30 percent rating and the other, a 100 percent rating. 

Although the issue of decision-making consistency is not new, VA only 

recently began to study consistency issues. In a May 2000 testimony9

before the House Subcommittee on Oversight and Investigations, 

Committee on Veterans’ Affairs, we underscored the conclusion made by 

the National Academy of Public Administration in 199710 that VBA needed 

to study the consistency of decisions made by different regional offices, 

identify the degree of subjectivity expected for various medical issues, and 

then set consistency standards for those issues. In August 2002, we drew 

attention to the fact that there are wide disparities in state-to-state average 

compensation payments per disabled veteran, and we voiced the concern 

that such variation raises the question of whether similarly situated 

veterans who submit claims to different regional offices for similar 

conditions receive reasonably consistent decisions. In January 2003, we 

reported that concerns about consistency had contributed to GAO’s 

designation of the VA disability program as high-risk in 2003. Again, in 

November 2004, we highlighted the need for VA to develop plans for 

studying consistency issues. 

Most recently, in December 2004, the media drew attention to the wide 

variations in the average disability compensation payment per veteran in 

the 50 states and published data showing that the average payments varied 

from a low of $6,710 in Ohio to a high of $10,851 in New Mexico. Reacting 

 9

GAO, Veterans Benefits Administration: Problems and Challenges Facing Disability 

Claims Processing, GAO/T-HEHS/AIMD-00-146 (Washington, D.C.: May 18, 2000). 

10National Academy of Public Administration, Management of Compensation and Pension 

Benefits Claim Processes for Veterans, (Washington, D.C.: August 1997). 

VA Began Studying 

Decision-making 

Consistency in December 

2004 
Page 12 GAO-05-655T 

to these media reports, in December 2004, the Secretary instructed the 

Inspector General to determine why average payments per veteran vary 

widely from state to state. As of February 2005 the Office of Inspector 

General planned to use data obtained from VBA for all regional offices to 

identify factors that may explain variations among the regional offices. 

In March 2005, VBA began a study of three disabilities believed to have 

potential for inconsistency: hearing loss, post-traumatic stress disorder, 

and knee conditions. VBA assigned 10 subject matter experts to review 

1,750 regional office decisions and plans to complete its analysis of study 

data in mid-May 2005, develop a schedule for future studies of specific 

ratable conditions, and recommend a schedule for periodic follow-up 

studies of previously studied conditions. 

In our 2002 report, we recommended that VA establish a system to 

regularly assess and measure the degree of consistency across all levels of 

VA adjudication, including regional offices and the Board, for specific 

medical conditions that require adjudicators to make difficult judgments. 

For example, we said VA could create hypothetical claims for certain 

medical conditions, distribute the claims to multiple adjudicators at each 

decision-making level, and analyze variations in outcomes. Such a system 

would identify variation in decision making and provide a basis to identify 

ways, if considered necessary, to reduce variation through training or 

clarifying and strengthening regulations, procedures, and policies. 

Although VA agreed in principle with our recommendation and agreed that 

consistency is an important goal, it commented that it would promote 

consistency through training and communication. We support such efforts 

but still believe VA needs to directly evaluate and measure consistency 

across all levels of adjudication. Otherwise, VA cannot determine whether 

such training and other efforts are directed at the causes of inconsistency 

and whether such efforts actually improve consistency. 

In our November 2004 report,11 we found that VBA’s administrative data 

was insufficient to analyze inconsistency because we could not reliably 

use the data to identify decisions made after fiscal year 2000, identify the 

regional offices that made the original decisions, or determine serviceconnection denial rates for specific impairments. However, in October 

 11GAO, Veterans Benefits: VA Needs Plan for Assessing Consistency of Decisions, 

GAO-05-99 (Washington, D.C.: Nov. 19, 2004). 
Page 13 GAO-05-655T 

2004, VBA completed its implementation of a new nationwide data system, 

known as Rating Board Automation (RBA) 2000. VA said this new system 

could reliably collect the types of data needed to perform the analyses we 

sought to do. Therefore, we recommended that the Secretary of Veterans 

Affairs develop a plan, and include it in VA’s annual performance plan, 

containing a detailed description of how VA intended to use data from the 

new RBA 2000 information system. We recommended that VA conduct 

systematic studies of the impairments for which RBA 2000 data reveal 

indications of decision-making inconsistencies among regional offices. VA 

concurred with our recommendation. Because the new RBA 2000 data 

system had been recently implemented, we acknowledged that VA could 

not implement such a plan until it accumulated a sufficiently large body of 

data under the new system. In our judgment, at least one year of data 

would be needed to begin such a study. 

While we believe the studies recently begun by the Office of Inspector 

General and VBA are positive steps forward in addressing consistency 

issues, the RBA 2000 data system, if found to be reliable, can provide VA 

with the data needed to proactively and systematically target specific 

impairments that have the widest variations in decision-making outcomes 

among the regional offices and focus VA’s efforts to study reasons for 

variations on those impairments. Building in such analytical capability to 

augment its quality assurance program would help enhance program 

integrity and better assure that veterans’ disability decisions are made 

fairly and equitably. 

Mr. Chairman, this concludes my remarks. I would be happy to answer any 

questions you or the members of the subcommittee may have. 

For further information, please contact Cynthia A. Bascetta at (202) 512-

7101. Also contributing to this statement were Irene Chu, Ira Spears, 

Martin Scire, and Tovah Rom. 

Contact and 

Acknowledgements 
Page 14 GAO-05-655T 

Veterans Benefits: VA Needs Plan for Assessing Consistency of 

Decisions. GAO-05-99. Washington, D.C.: November 19, 2004. 

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

2003. 

Veterans’ Benefits: Quality Assurance for Disability Claims and Appeals 

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