VA Benefits: Other Programs May Provide Lessons for Improving Individual Unemployability Assessments
Published: 2005-10-27T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Department of Veterans Affairs (VA) provides disability compensation to veterans disabled by injuries or diseases that were incurred or aggravated while on active military duty. Under Individual Unemployability (IU) benefit regulations, a veteran can receive increased compensation at the total disability compensation rate if VA determines that the veteran is unemployable because of service-connected disabilities. GAO has reported that numerous technological and medical advances, combined with changes in society and the nature of work, have increased the potential for people with disabilities to work. Yet VA has seen substantial growth of IU benefit awards to veterans over the last five years. In 2001 GAO reported that a growing number of private insurance companies in the United States have focused their programs on developing and implementing strategies to enable people with disabilities to return to work. Our testimony will describe how U.S. private insurers facilitate return to work in three key areas: (1) the eligibility assessment process, (2) work incentives, and (3) staffing practices. It will also compare these practices with those of VA's IU eligibility assessment process.
section_title: What GAO Found
paragraphs: The disability programs of the three private insurers we reported on in 2001 included three common return-to-work practices in their disability assessment process. Incorporate return-to-work considerations from the beginning of the assessment process: Private insurers integrated return-to-work considerations early and throughout the eligibility assessment process. Their assessment process both evaluated a person's potential to work and assisted those with work potential to return to the labor force. Provide incentives for claimants and employers to encourage and facilitate return to work: These incentives included requirements for obtaining appropriate medical treatment and participating in a return-to-work program, if such a program would benefit the individual. In addition, they provided financial incentives to employers to encourage them to provide work opportunities for claimants. Strive to use appropriate staff to achieve accurate disability decisions and successful return-to-work outcomes: Private insurers have access to staff with a wide range of expertise not only in making eligibility decisions, but also in providing return-to-work assistance. The three private disability insurers told us that they selected the appropriate type and intensity of staff resources to assess and return individuals with work capacity to employment cost-effectively. In comparison, VA's Individual Unemployability decision-making practices lag behind those used in the private sector. As we have reported in the past, a key weakness in VA's decision-making process is that the agency has not routinely included a vocational specialist in the evaluation to fully evaluate the applicant's ability to work. Preliminary findings from our ongoing work indicate that VA still does not have procedures in place to fully assess veterans' work potential. In addition, the IU decision-making process lacks sufficient incentives to encourage return to work. In considering whether to grant IU benefits, VA does not have procedures to include vocational specialists from its Vocational Rehabilitation and Education (VR&E) services to help evaluate a veteran's work potential. By not using these specialists, VA also misses an opportunity to have the specialist develop a return-to-work plan, in collaboration with the veteran, and identify and provide needed accommodations or services for those who can work. Instead, VA's IU assessment is focused on the veterans' inabilities and providing cash benefits to those labeled as "unemployable," rather than providing opportunities to help them return to work. Incorporating return-to-work practices could help VA modernize its disability program to enable veterans to realize their full productive potential without jeopardizing the availability of benefits for people who cannot work.

section_title: Letter
paragraphs: Thank you for inviting me to testify on how the Department of Veterans  Affairs (VA) Individual Unemployability (IU) disability assessment  practices compare with those used by private sector insurers in helping  people with severe disabilities realize their full potential to work. It is  especially fitting, with the continuing deployment of our military forces to  armed conflict, that we reaffirm our commitment to those who serve our  nation in its times of need. Therefore, ensuring the most effective and  efficient management of benefits and services to those who incur  disabilities because of military service is of paramount importance. At the  same time, many people with disabilities have indicated that they want to  work and be independent and would do so if they receive the supports  they need. Fortunately, numerous technological and medical advances,  combined with changes in society and the nature of work, have increased  the potential for people with disabilities to work. Nevertheless, VA has  seen substantial growth of unemployability benefit awards to veterans  with service-connected disabilities. From fiscal years 1999 to 2004, the  number of veterans receiving unemployability benefits has more than  doubled, from 95,000 to 197,000.
To help people with disabilities achieve their full potential, the disability  programs financed by social insurance systems in other countries focus on  returning beneficiaries with disabilities to work. Also, in recent years, a  growing number of private insurance companies in the United States have  been focusing on developing and implementing strategies to enable people  with disabilities to return to work. Today I would like to discuss how   U.S. private sector disability programs facilitate return to work in three  key areas: (1) the eligibility assessment process, (2) work incentives, and   (3) staffing practices. I will describe these three elements for U.S. private  sector disability insurers and compare these practices with those of VA’s  IU eligibility assessment process.
My testimony is based primarily upon our prior work, including our   2001 report assessing the disability practices of selected private insurance  companies and other countries. This work involved in-depth interviews  and document review for three private sector disability insurers:  UNUMProvident, Hartford Life, and CIGNA. In addition, we used our   1987 review of Individual Unemployability benefits as well as preliminary  observations from our ongoing review of these benefits.
In summary, the disability systems of the private insurers we reviewed  integrated return-to-work considerations early after disability onset and  throughout the eligibility assessment process. This involved both  determining—as well as enhancing—the ability of each claimant to return  to work. For example, private insurers used vocational specialists to help  ensure they fully assess the work capacity of claimants, identify needed  accommodations, and develop individualized plans to help those who can  return to work. In addition, these insurers provided incentives for  claimants to take part in vocational rehabilitation programs and to obtain  appropriate medical treatment. They also provided incentives for  employers to provide work opportunities for claimants. Managers of these  other programs also explained to us that they have developed  techniques—such as separating (or triaging) claims—to use staff with the  appropriate expertise to provide return-to-work assistance to claimants in  a cost-effective manner.
VA’s individual unemployability decision-making practices lag behind  those used in the private sector. As we have reported in the past, a key  weakness in VA’s decision-making process is that the agency did not  routinely include a vocational specialist in the evaluation to fully evaluate  an applicant’s ability to work. Preliminary findings from our ongoing work  indicate that VA still does not have procedures in place to fully assess  veterans’ work potential. In addition, the IU decision-making process lacks  sufficient incentives to encourage return to work. In considering whether  to grant IU benefits, VA does not have procedures to include vocational  specialists from its Vocational Rehabilitation and Education (VR&E)  services to help evaluate a veteran’s work potential. By not using these  specialists, VA also misses an opportunity to have the specialist develop a  return-to-work plan, in collaboration with the veteran, and identify and  provide needed accommodations or services for those who can work.  Instead, VA's IU assessment is focused on the veterans’ inabilities and  providing cash benefits to those labeled as “unemployable,” rather than  providing opportunities to help them return to work. Incorporating return- to-work practices could help VA modernize its disability program to  enable veterans to realize their full productive potential without  jeopardizing the availability of benefits for people who cannot work.
subsections: section_title: Background
paragraphs: VA pays basic compensation benefits to veterans incurring disabilities  from injuries or diseases that were incurred or aggravated while on active  military duty. VA rates the severity of all service-connected disabilities by  using its Schedule for Rating Disabilities. The schedule lists types of  disabilities and assigns each disability a percentage rating, which is  intended to represent an average earning impairment the veteran would  experience in civilian occupations because of the disability. All veterans  awarded service-connected disabilities are assigned single or combined   (in case of multiple disabilities) ratings ranging from 0 to 100 percent, in  increments of 10 percent, based on the rating schedule; such a rating is  known as a schedular rating. Diseases and injuries incurred or aggravated  while on active duty are called service-connected disabilities.
subsections: section_title: VA’s Individual Unemployability Benefits
paragraphs: Disability compensation can be increased if VA determines that the  veteran is unemployable (not able to engage in substantially gainful  employment) because of the service-connected disability. Under VA’s  unemployability regulations, the agency can assign a total disability rating  of 100 percent to veterans who cannot perform substantial gainful  employment because of service-connected disabilities, even though their  schedular rating is less than 100 percent. To qualify for unemployability  benefits, a veteran must have a single service-connected disability of   60 percent or more or multiple disabilities with a combined rating of   70 percent or more, with at least one of the disabilities rated 40 percent or  more. VA can waive the minimum ratings requirement and grant  unemployability benefits to a veteran with a lower rating; this is known as  an extra-schedular rating.
Staff at VA’s regional offices make virtually all eligibility decisions for  disability compensation benefits, including IU benefits. The 57 VA regional  offices use nonmedical rating specialists to evaluate veterans’ eligibility  for these benefits. Upon receipt of an application for compensation  benefits, the rating specialist would typically refer the veteran to a VA  medical center or clinic for an exam. Based on the medical examination  and other information available to the rater, the rater must first determine  which of the veteran’s conditions are or are not service-connected. For  service-connected conditions, the rater compares the diagnosis with the  rating schedule to assign a disability rating.
Along with medical records, raters may also obtain other records to  evaluate an IU claim. VA may require veterans to furnish an employment  history for the 5-year period preceding the date on which the veteran  claims to have become too disabled to work and for the entire time after  that date. VA guidance also requires that raters request basic employment  information from each employer during the 12-month period prior to the  date the veteran last worked. In addition, if the veteran has received  services from VA’s VR&E program or Social Security disability benefits,  the rater may also request and review related information from these  organizations.
Once VA grants unemployability benefits, a veteran may continue to  receive the benefits while working if VA determines that the work is only  marginal employment rather than substantially gainful employment.  Marginal employment exists when a veteran’s annual earned income does  not exceed the annual poverty threshold for one person as determined by  the U.S. Census Bureau—$ 9,827 for 2004. Furthermore, if veterans are  unable to maintain employment for 12 continuous months due to their  service-connected disabilities they may retain their IU benefits, regardless  of the amount earned.
section_title: Modernizing Federal Disability Programs
paragraphs: After more than a decade of research, GAO has determined that federal  disability programs were in urgent need of attention and transformation  and placed modernizing federal disability programs on its high-risk list in  January 2003. Specifically, our research showed that the disability  programs administered by VA and the Social Security Administration  (SSA) lagged behind the scientific advances and economic and social  changes that have redefined the relationship between impairments and  work. For example, advances in medicine and technology have reduced  the severity of some medical conditions and have allowed individuals to  live with greater independence and function in work settings. Moreover,  the nature of work has changed in recent decades as the national economy  has moved away from manufacturing-based jobs to service- and  knowledge-based employment. Yet VA’s and SSA’s disability programs  remain mired in concepts from the past—particularly the concept that  impairment equates to an inability to work—and as such, we found that  these programs are poorly positioned to provide meaningful and timely  support for Americans with disabilities.
In contrast, we found that a growing number of U.S. private insurance  companies had modernized their programs to enable people with  disabilities to return to work. In general, private insurer disability plans  can provide short- or long-term disability insurance coverage, or both, to  replace income lost by employees because of injuries and illnesses.  Employers may choose to sponsor private disability insurance plans for  employees either by self-insuring or by purchasing a plan through a private  disability insurer. The three private disability insurers we reviewed  recognized the potential for reducing disability costs through an increased  focus on returning people with disabilities to productive activity. To  accomplish this comprehensive shift in orientation, these insurers have  begun developing and implementing strategies for helping people with  disabilities return to work as soon as possible, when appropriate.
section_title: Private Insurers Incorporate Return- to-Work Considerations from the Beginning of the Assessment Process
paragraphs: The three private insurers we studied incorporate return-to-work  considerations early in the assessment process to assist claimants in their  recovery and in returning to work as soon as possible. With the initial  reporting of a disability claim, these insurers immediately set up the  expectation that claimants with the potential to do so will return to work.  Identifying and providing services intended to enhance the claimants’  capacity to work are central to their process of deciding eligibility for  benefits. Further, the insurers continue to periodically monitor work  potential and provide return-to-work assistance to claimants as needed  throughout the duration of the claim. Their ongoing assessment process is  closely linked to a definition of disability that shifts over time from less to  more restrictive—that is, from an inability to perform one’s own  occupation to an inability to perform any occupation.
After a claim is received, the private insurers’ assessment process begins  with determining whether the claimant meets the initial definition of  disability. In general, for the three private sector insurers we studied,  claimants are considered disabled when, because of injury or sickness,  they are limited in performing the essential duties of their own occupation  and they earn less than 60 to 80 percent of their predisability earnings,  depending upon the particular insurer. As part of determining whether the  claimant meets this definition, the insurers compare the claimant’s  capabilities and limitations with the demands of his or her own occupation  and identify and pursue possible opportunities for accommodation— including alternative jobs or job modifications—that would allow a quick  and safe return to work. A claimant may receive benefits under this  definition of disability for up to 2 years.
As part of the process of assessing eligibility according to the “own  occupation” definition, insurers directly contact the claimant, the treating  physician, and the employer to collect medical and vocational information  and initiate return-to-work efforts, as needed. Insurers’ contacts with the  claimant’s treating physician are aimed at ensuring that the claimant has  an appropriate treatment plan focused, in many cases, on timely recovery  and return to work. Similarly, insurers use early contact with employers to  encourage them to provide workplace accommodations for claimants with  the capacity to work.
If the insurers find the claimant initially unable to return to his or her own  occupation, they provide cash benefits and continue to assess the claimant  to determine if he or she has any work potential. For those with work  potential, the insurers focus on return to work before the end of the 2-year  period, when, for all the private insurers we studied, the definition of  disability becomes more restrictive. After 2 years, the definition shifts  from an inability to perform one’s own occupation to an inability to  perform any occupation for which the claimant is qualified by education,  training, or experience. Claimants initially found eligible for benefits may  be found ineligible under the more restrictive definition.
The private insurers’ shift from a less to a more restrictive disability  definition after 2 years reflects the changing nature of disability and allows  a transitional period for insurers to provide financial and other assistance,  as needed, to help claimants with work potential return to the workforce.  During this 2-year period, the insurer attempts to determine the best  strategy for managing the claim. Such strategies can include, for example,  helping plan medical care or providing vocational services to help  claimants acquire new skills, adapt to assistive devices to increase  functioning, or find new positions. For those requiring vocational  intervention to return to work, the insurers develop an individualized  return-to-work plan, as needed. Basing the continuing receipt of benefits  upon a more restrictive definition after 2 years provides the insurer with  leverage to encourage the claimant to participate in a rehabilitation and  return-to-work program. Indeed, the insurers told us they find that  claimants tend to increase their efforts to return to work as they near the  end of the 2-year period.
If the insurer initially determines that the claimant has no work potential,  it regularly monitors the claimant’s condition for changes that could  increase the potential to work and reassesses after 2 years the claimant’s  eligibility under the more restrictive definition of disability. The insurer  continues to look for opportunities to assist claimants who qualify under  this definition of disability in returning to work. Such opportunities may  occur, for example, when changes in medical technology—such as new  treatments for cancer or AIDS—may enable claimants to work, or when  claimants are motivated to work.
The private insurers that we reviewed told us that throughout the duration  of the claim, they tailor the assessment of work potential and development  of a return-to-work plan to the specific situation of each individual  claimant. To do this, disability insurers use a wide variety of tools and  methods when needed. Some of these tools, as shown in tables   1 and 2, are used to help ensure that medical and vocational information is  complete and as objective as possible. For example, insurers consult  medical staff and other resources to evaluate whether the treating  physician’s diagnosis and the expected duration of the disability are in line  with the claimant’s reported symptoms and test results. Insurers may also  use an independent medical examination or a test of basic skills, interests,  and aptitudes to clarify the medical or vocational limitations and  capabilities of a claimant. In addition, insurers identify transferable skills  to compare the claimant’s capabilities and limitations with the demands of  the claimant’s own occupation. This method is also used to help identify  other suitable occupations and the specific skills needed for these new  occupations when the claimant’s limitations prevent him or her from  returning to a prior occupation. Included in these tools and methods are  services to help the claimant return to work, such as job placement, job  modification, and retraining.
section_title: Private Insurers Provide Incentives for Claimants and Employers to Encourage and Facilitate Return to Work
paragraphs: To facilitate return to work, the private insurers we studied employment  incentives both for claimants to participate in vocational activities and  receive appropriate medical treatment, and for employers to  accommodate claimants. The insurers require claimants who could benefit  from vocational rehabilitation to participate in an individualized return-to- work program. They also provide financial incentives to promote  claimants’ efforts to become rehabilitated and return to work. To better  ensure that medical needs are met, the insurers we studied require that  claimants receive appropriate medical treatment and assist them in  obtaining this treatment. In addition, they provide financial incentives to  employers to encourage them to provide work opportunities for claimants.
The three private insurers we reviewed require claimants who could  benefit from vocational rehabilitation to participate in a customized  rehabilitation program or risk loss of benefits. As part of this program, a  return-to-work plan for each claimant can include, for example, adaptive  equipment, modifications to the work site, or other accommodations.  These private insurers mandate the participation of claimants whom they  believe could benefit from rehabilitation because they believe that  voluntary compliance has not encouraged sufficient claimant participation  in these plans.
The insurers told us that they encourage rehabilitation and return to work  by allowing claimants who work to supplement their disability benefit  payments with earned income. During the first 12 or 24 months of  receiving benefits, depending upon the particular insurer, claimants who  are able to work can do so to supplement their benefit payments and  thereby receive total income of up to 100 percent of predisability  earnings. After this period, if the claimant is still working, the insurers  decrease the benefit amount so that the total income a claimant is allowed  to retain is less than 100 percent of predisability income.
When a private insurer, however, determines that a claimant is able, but  unwilling, to work, the insurer may reduce or terminate the claimant’s  benefits. To encourage claimants to work to the extent they can, even if  only part-time, two of the insurers told us they may reduce a claimant’s  benefit by the amount the claimant would have earned if he or she had  worked to maximum capacity. The other insurer may reduce a claimant’s  monthly benefit by the amount that the claimant could have earned if he or  she had not refused a reasonable job offer—that is, a job that was  consistent with the claimant’s background, education, and training.  Claimants’ benefits may also be terminated if claimants refuse to accept a  reasonable accommodation that would enable them to work.
Since medical improvement or recovery can also enhance claimants’  ability to work, the private insurers we studied not only require, but also  help, claimants to obtain appropriate medical treatment. To maximize  medical improvement, these private insurers require that the claimant’s  physician be qualified to treat the particular impairment. Additionally, two  insurers require that treatment be provided in conformance with medical  standards for treatment type and frequency. Moreover, the insurers’  medical staff work with the treating physician as needed to ensure that the  claimant has an appropriate treatment plan. The insurers told us they may  also provide funding for those who cannot otherwise afford treatment.
The three private sector insurers we studied may also provide financial  incentives to employers to encourage them to provide work opportunities  for claimants. By offering lower insurance premiums to employers and  paying for accommodations, these private insurers encourage employers  to become partners in returning disabled workers to productive  employment. For example, to encourage employers to adopt a disability  policy with return-to-work incentives, the three insurers offer employers a  discounted insurance premium. If their disability caseload declines to the  level expected for those companies that assist claimants in returning to  work, the employers may continue to pay the discounted premium  amount. These insurers also fund accommodations, as needed, for  disabled workers at the employer’s work site.
section_title: Private Insurers Strive to Use Appropriate Staff to Achieve Accurate Disability Decisions and Successful Return-to- Work Outcomes
paragraphs: The private disability insurers we studied have developed techniques for  using the right staff to assess eligibility for benefits and return those who  can to work. Officials of the three private insurers told us that they have  access to individuals with a range of skills and expertise, including  medical experts and vocational rehabilitation experts. They also told us  that they apply this expertise as appropriate to cost effectively assess and  enhance claimants’ capacity to work.
The three private disability insurers that we studied have access to  multidisciplinary staff with a wide variety of skills and experience who can  assess claimants’ eligibility for benefits and provide needed return-to-work  services to enhance the work capacity of claimants with severe  impairments. The private insurers’ core staff generally includes claims  managers, medical experts, vocational rehabilitation experts, and team  supervisors. The insurers explained that they set hiring standards to  ensure that the multidisciplinary staff is highly qualified. Such  qualifications are particularly important because assessments of benefit  eligibility and work capacity can involve a significant amount of  professional judgment when, for example, a disability cannot be  objectively verified on the basis of medical tests or procedures or clinical  examinations alone. Table 3 describes the responsibilities of this core  staff of experts employed by private disability insurers, as well as its  general qualifications and training.
The three disability insurers we reviewed use various strategies for  organizing their staff to focus on return to work, with teams organized to  manage claims associated either with a specific impairment type or with a  specific employer (that is, the group disability insurance policyholder).  One insurer organizes its staff by the claimant’s impairment type—for  example, cardiac/respiratory, orthopedic, or general medical—to develop  in-depth staff expertise in the medical treatments and accommodations  targeted at overcoming the work limitations associated with a particular  impairment. The other two insurers organize their staff by the claimant’s  employer because they believe that this enables them to better assess a  claimant’s job-specific work limitations and pursue workplace  accommodations, including alternative job arrangements, to eliminate  these limitations. Regardless of the overall type of staff organization,  each of the three insurers facilitates the interaction of its core staff— claims managers, medical experts, and vocational rehabilitation experts— by pulling these experts together into small, multidisciplinary teams  responsible for managing claims. Additionally, one insurer engenders team  interaction by physically colocating core team members in a single  working area.
To provide a wide array of needed experts, the three disability insurers  expand their core staff through agreements or contracts with subsidiaries  or other companies. These experts—deployed both at the insurer’s work  site and in the field—provide specialized services to support the eligibility  assessment process and to help return claimants to work. For instance,  these insurers contract with medical experts beyond their core employee  staff—such as physicians, psychologists, psychiatrists, nurses, and  physical therapists—to help test and evaluate the claimant’s medical  condition and level of functioning. In addition, the insurers contract with  vocational rehabilitation counselors and service providers for various  vocational services, such as training, employment services, and vocational  testing.
The private insurers we examined told us that they strive to apply the  appropriate type and intensity of staff resources to cost-effectively return  to work claimants with work capacity. The insurers described various  techniques that they use to route claims to the appropriate claims  management staff, which include separating (or triaging) different types of  claims and directing them to staff with the appropriate expertise.  According to one insurer, the critical factor in increasing return-to-work  rates and, at the same time, reducing overall disability costs is proper  triaging of claims. In general, the private insurers separate claims by those  who are likely to return to work and those who are not expected to return  to work. The insurers told us that they assign the type and level of staff  necessary to manage claims of people who are likely to return to work on  the basis of the particular needs and complexity of the specific case (see  table 4).
As shown in table 4, claimants expected to need medical assistance, such  as those requiring more than a year for medical stabilization, are likely to  receive an intensive medical claims management strategy. A medical  strategy involves, for example, ensuring that the claimant receives  appropriate medical treatment. Claimants who need less than a year to  stabilize medically are managed much less intensively. For these claims, a  claims manager primarily monitors the claimant’s medical condition to  assess whether it is stable enough to begin vocational rehabilitation, if  appropriate. Alternatively, a claimant with a more stable, albeit serious,  medical condition who is expected to need vocational rehabilitation, job  accommodations, or both to return to work might warrant an intensive  vocational strategy. The private disability insurers generally apply their  most resource-intensive, and therefore most expensive, multidisciplinary  team approach to these claimants. Working closely with the employer and  the attending physician, the team actively pursues return-to-work  opportunities for claimants with work potential.
Finally, claimants who are likely not to return to work (or “stable and  mature” claims) are generally managed using a minimum level of  resources, with a single claims manager responsible for regularly  reviewing a claimant’s medical condition and level of functioning. The  managers of these claims carry much larger caseloads than managers of  claims that receive an intensive vocational strategy. For example, one  insurer’s average claims manager’s caseload for these stable and mature  claims is about 2,200 claims, compared with an average caseload of 80  claims in the same company for claims managed more actively.
section_title: VA’s Individual Unemployability Return-to-Work Efforts Lag behind Other Programs
paragraphs: Unlike disability compensation programs in the private sector, VA has not  drawn on vocational experts for IU assessments to examine the claimant’s  work potential and identify the services and accommodations needed to  help those who could work to realize their full potential. In our 1987  report, we found that VA had not routinely obtained all vocational  information needed to determine a veteran's ability to engage in  substantially gainful employment before it granted IU benefits. Without  understanding how key vocational factors, such as the veteran’s  education, training, earnings, and prior work history, affect the veteran’s  work capacity, VA cannot adequately assess the veteran’s ability to work.  To perform this analysis, VA officials told us that the agency has  vocational specialists who are specially trained to perform this difficult  analysis. Skilled vocational staff can determine veterans’ vocational  history, their ability to perform past or other work, and their need for  retraining. By not collecting sufficient information and including the  expertise of vocational specialists in the assessment, VA did not have an  adequate basis for awarding or denying a veteran's claim for  unemployability benefits.
Preliminary findings from our ongoing work indicate that VA still does not  have procedures in place to fully assess veterans’ work potential. In  addition, the IU decision-making process lacks sufficient incentives to  encourage return to work. In considering whether to grant IU benefits, VA  does not have procedures to include vocational specialists from its VR&E  services to help evaluate a veteran’s work potential. By not using these  specialists, VA also misses an opportunity to have the specialist develop a  return-to-work plan, in collaboration with the veteran, and identify and  provide needed accommodations or services for those who can work.  Instead, VA's IU assessment is focused on the veterans’ inabilities and  providing cash benefits to those labeled as “unemployable,” rather than  providing opportunities to help them return to work.
section_title: Concluding Observations
paragraphs: Return-to-work practices used in the U.S. private sector reflect the  understanding that people with disabilities can and do return to work. The  continuing deployment of our military forces to armed conflict has  focused national attention on ensuring that those who incur disabilities  while serving in the military are provided the services needed to help them  reach their full work potential. Approaches from the private sector  demonstrate the importance of using the appropriate medical and  vocational expertise to assess the claimant’s condition and provide  appropriate medical treatment, vocational services, and work incentives.  Applying these approaches to VA’s IU assessment process would raise a  number of important policy issues. For example, to what extent should the  VA require veterans seeking IU benefits to accept vocational assistance or  appropriate medical treatment? Such policy questions will be answered  through the national policymaking process involving the Congress, VA,  veterans’ organizations, and other key stakeholders. Nevertheless, we  believe that including vocational expertise in the IU decision-making  process could provide VA with a more adequate basis to make decisions  and thereby better ensure program integrity. Moreover, incorporating  return-to-work practices could help VA modernize its disability program to  enable veterans to realize their full productive potential without  jeopardizing the availability of benefits for people who cannot work.
Mr. Chairman, this concludes my prepared statement. I would be pleased  to respond to any questions you or members of the committee may have.
For future contacts regarding this testimony, please call Cynthia Bascetta  at (202) 512-7215. Carol Dawn Petersen, Julie DeVault, and   Joseph Natalicchio also made key contributions to this testimony.
section_title: Related GAO Products
paragraphs: 21st Century Challenges: Reexamining the Base of the Federal  Government, GAO-05-325SP (Washington, D.C.: February 2005).
High-Risk Series: An Update, GAO-05-207 (Washington, D.C.: January  2005).
High–Risk Series: An Update, GAO-03-119 (Washington, D.C.: January  2003).
SSA and VA Disability Programs: Re-Examination of Disability  Criteria Needed to Help Ensure Program Integrity, GAO-02-597  (Washington, D.C.: Aug. 9, 2002).
SSA Disability: Other Programs May Provide Lessons for Improving  Return-to-Work Efforts, GAO-01-153 (Washington, D.C.: Jan. 12, 2001).
SSA Disability: Return-to-Work Strategies May Improve Federal  Programs, GAO/HEHS-96-133 (Washington, D.C.: July 11, 1996).
Veterans’ Benefits: Improving the Integrity of VA’s Unemployability  Compensation Program, GAO/HRD-87-62 (Washington, D.C.: Sept. 21,  1987).
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