Veterans' Disability Benefits: Preliminary Findings on Claims Processing Trends and Improvement Efforts
Published: 2009-07-29T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Senate Veterans' Affairs Committee asked GAO to present its preliminary findings on the Department of Veterans Affairs' (VA) disability claims process. This statement discusses (1) the trends in VA compensation claims and appeals, and (2) the steps VA is taking to improve disability claims processing. This testimony is based on ongoing work. GAO's findings are based largely on VA performance data and information obtained from VA documents and through interviews with VA officials. This testimony is also based on past GAO work on this subject, updated as appropriate to reflect VA's current workload and initiatives.
section_title: What GAO Found
paragraphs: Over the past several years, VA disability claims workloads at both the initial and appellate levels have improved in some areas and worsened in others. For example, the number of disability claims VA completes annually at the initial level increased about 60 percent--from about 458,000 in fiscal year 1999 to about 729,000 in fiscal year 2008. However, during this same period, the number of claims pending at year-end increased 65 percent to about 343,000. Several factors affect these and other disability claims workloads, including increases in disability claims received, growing complexity of claims, court decisions and changes in regulation. Disability claims workloads at the appellate level have also improved in some areas and worsened in others. For example, over the past several years, the number of appeals resolved increased 22 percent, from more than 72,000 cases in fiscal year 2003 to almost 88,000 cases in fiscal year 2008. However, it took on average 96 days longer in fiscal year 2008 to resolve appeals than in fiscal year 2003. One factor that affects workloads at the appellate level is the submission of new evidence or claims that must be evaluated. VA has taken several steps to improve claims processing, but the effect of some of these actions is not yet known. For example, VA increased claims processing staff about 58 percent from fiscal years 2005 to 2009, which has helped to increase the total number of decisions VA issues annually. However, VA expects individual staff productivity to decline in the short-term in part because of the challenge of training and integrating new staff. In addition, VA has established 15 resource centers to which it redistributes claims and appeals for processing from backlogged regional offices. Although VA has not collected data to evaluate the effect of its workload redistribution efforts, these efforts may ultimately increase the timeliness and consistency of VA's decisions. VA is also implementing a pilot with the Department of Defense (DOD) to perform joint disability evaluations that has the potential to streamline the disability process for prospective veterans. Finally, VA has begun other initiatives, which we are in the process of reviewing, such as targeting certain claims for fast-track processing and leveraging technology.

section_title: Letter
paragraphs: I am pleased to have the opportunity to comment on the Department of  Veterans Affairs’ (VA) disability compensation claims process. In fiscal  year 2008, VA paid $30.7 billion in benefits to nearly 3 million veterans  through its disability compensation program. For years, the claims process  has been the subject of concern and attention by VA, Congress, and  veterans service organizations, due in large part to long waits for decisions  and large numbers of claims pending a decision. Further, we and VA’s  Inspector General have identified concerns about the consistency of  decisions across regional offices.
You asked us to discuss preliminary findings of our ongoing work for this  Committee examining VA’s disability compensation claims process.  Specifically, my statement today addresses (1) trends in VA compensation  claims and appeals workloads and (2) steps VA is taking to improve its  claims processing. To identify trends in VA’s disability claims and appeals  workloads, we analyzed compensation claims processing data from VA’s  Veterans Benefits Administration (VBA) and Board of Veterans’ Appeals  (Board). To identify steps VA is taking to improve its claims process, we  reviewed VA’s budget submissions, strategic plans, and other documents  such as external studies and VA’s Office of Inspector General reports;  interviewed VA officials and veterans service organization representatives;  and examined ongoing initiatives or those that VA completed within the  last 3 fiscal years. In addition, we visited four VBA regional offices and the  Board to learn more about these initiatives. In selecting the regional  offices—Chicago, Illinois; Seattle, Washington; Togus, Maine; and  Winston-Salem, North Carolina—we considered regional offices that  would provide: (1) insights about ongoing initiatives such as pilots; (2) a  mix of offices located in different geographic settings (e.g., urban and  rural); and (3) a mix of offices that are above and below VBA’s averages  for select case-processing measures. Our work, which began in November  2008, is being conducted in accordance with generally accepted  government auditing standards. Given testimony timelines we have not yet  completed our assessment of the reliability of VA data. We plan to issue a  final report at a later date.
In summary, over the past several fiscal years, VA disability compensation  claims workloads at both the initial and appellate levels have improved in  some areas and worsened in others. For example, at the initial level, the  number of claims VA completes annually increased about 60 percent from  fiscal year 1999 to fiscal year 2008. However, the number of claims  pending during this period increased by more than 65 percent to about  343,000, and the average time VA took to complete a claim increased about  9 days. A number of factors contribute to these results, including an  approximately 53 percent increase in VA’s claims workload, more complex  claims, and court decisions that have expanded benefit entitlement.  Workloads at the appellate level have also improved in some areas and  worsened in others. For example, for the past several fiscal years, the  number of appeals resolved increased 21 percent from more than 72,000 in  fiscal year 2003 to almost 88,000 in fiscal year 2008. On the other hand, it  took VA 96 days longer in fiscal 2008 to resolve appeals than it did in fiscal  year 2003. One factor that contributes to the challenge in further  improving workloads at the appellate level is the submission of new  evidence or claims that must be evaluated.
VA has taken several steps in an effort to improve claims processing, such  as increasing staffing, redistributing workloads, implementing a joint pilot  with the Department of Defense (DOD) to perform disability evaluations  and other initiatives, but the effect of some of these actions is not yet  known. For example, VA increased claims processing staff an estimated 58  percent from fiscal years 2005 to 2009, which has helped to increase the  total number of decision VA issues annually. However, VA expects  individual staff productivity to decline before it ultimately improves in part  because of the challenge of training and integrating new staff. In addition,  VA also established 15 resource centers to which it redistributes claims  and appeals workloads from backlogged regional offices. These centers  currently process thousands of cases annually. Such efforts may ultimately  increase the timeliness and consistency of VA’s decisions; however, VA  has not collected data to evaluate the effect of its workload redistribution  efforts. Another step VA has taken is partnering with DOD in piloting a  joint process for performing disability evaluations for servicemembers  who are going through the military’s disability evaluation system.  According to VA, preliminary pilot results suggest that the new process  expedites delivery of VA benefits to servicemembers upon discharge from  the military. This pilot represents a positive step toward streamlining the  disability process and expediting benefits for servicemembers upon  discharge from the military. However, we have noted that critical  implementation challenges will need to be addressed prior to worldwide  implementation. Moreover, given the relatively small number of cases in  the military’s disability evaluation system compared to the number of  claims processed under VA’s disability compensation program, the pilot  will have a limited impact on VA’s claims backlog. Finally, VA is taking  other steps that could improve the claims process, such as targeting other  claims for fast-track processing and leveraging technology.
subsections: section_title: Background
paragraphs: VA pays monthly disability compensation to veterans with service- connected disabilities (injuries or diseases incurred or aggravated while  on active military duty) according to the severity of the disability. VA also  pays additional compensation for some dependents––spouses, children,  and parents––of veterans. In fiscal year 2008, the disability compensation  program represented 78 percent, or $30.7 billion, of the cash benefits paid  through VBA’s Compensation and Pension Service. In addition, VA’s  pension program pays monthly benefits to wartime veterans who have low  incomes and are permanently and totally disabled for reasons that are not  service-connected.
VA’s disability compensation claims process starts when a veteran submits  a claim to one of VBA’s 57 regional offices. A service representative is then  responsible for assisting the veteran in obtaining the relevant evidence to  evaluate the claim. Such evidence includes veterans’ military service  records, medical examinations, and treatment records from VA medical  facilities and private medical service providers. Also, if necessary for  reaching a decision on a claim, the regional office arranges for the veteran  to receive a medical examination or opinion. Once a claim has all the  necessary evidence, a rating specialist evaluates the claim and determines  whether the claimant is eligible for benefits. If the veteran is eligible for  disability compensation, the rating specialist assigns a percentage rating.  Veterans with multiple disabilities receive a single composite rating. In  addition, veterans can reopen claims for additional benefits over time from  VA, for example, if a service-connected disability worsens or arises in the  future. If the veteran disagrees with the regional office’s decision, he or  she may begin the appeals process by submitting a written notice of  disagreement to the regional office. In response to such a notice, VBA  provides further written explanation of the decision, and if the veteran still  disagrees, the veteran may appeal to the Board. The Board, whose  members are attorneys experienced in veterans’ law and in reviewing  benefit claims, may grant or deny the appeal or return the case to VBA to  obtain additional evidence necessary to decide the veteran’s claim.
In addition to receiving disability benefits from VA, veterans may receive  disability benefits from the Department of Defense (DOD). If the military  determines that a servicemember is unfit for duty because of conditions  incurred in the line of duty, the military assigns a combined percentage  rating for those unfit conditions using VA’s rating system as a guideline.  This one-time rating, along with years of service and other factors,  determines subsequent disability benefits from DOD. Unlike through VA,  veterans cannot reopen claims for additional benefits over time through  DOD’s disability determination process.
section_title: VA’s Disability Claims and Appeals Processing Has Improved in Some Areas and Worsened in Others
paragraphs: Over the past 10 fiscal years, the total number of compensation claims  decisions completed annually by VA and the average days compensation  claims were pending improved, while the total number of claims pending  at year end and the average days to complete a claim worsened. From  fiscal year 1999 to fiscal year 2008, VA increased the number of initial  compensation claims processed annually by nearly 60 percent from about  458,000 to about 729,000 (see fig. 1). Moreover, VA experienced  substantial year-to-year increases in the number of claims completed  between 2006 and 2008.
In fiscal year 2008, compensation claims were pending an average of 123  days compared to 152 days in fiscal year 1999 (see fig. 2). While slightly  higher than the average 115 days claims were pending in fiscal year 2003,  this represents a marked improvement over the average 188 days claims  were pending in fiscal year 2001. VA’s fiscal year 2009 average days  pending goal for rating-related actions is 116 days.
VA’s inventory of pending compensation claims has varied over time, but  on whole has increased significantly over the last decade. From the end of  fiscal year 1999 to the end of fiscal year 2008, pending claims increased by  more than 65 percent from about 207,000 to about 343,000 (see fig. 3).  During the same time period, the number of claims awaiting a decision  longer than 6 months increased by 20 percent from about 65,000 to about  78,000. However, more recent data show that pending claims declined  slightly from the end of fiscal year 2007 to 2008, and those pending more  than 6 months declined almost 20 percent.
The average time VA took to complete a claim has also varied over time,  although the agency experienced significant increases from fiscal years  2004 to 2007. In fact, the average number of days VA took to complete  claims increased from a low of 181 days in fiscal year 2004 to 200 days in  fiscal year 2007. However, recent data show that VA took on average 4  days less to complete a claim in fiscal year 2008 than in fiscal year 2007  (see fig. 4).
Several factors have contributed to the trends in VA’s disability workloads.  First, there has been a steady increase in the number of claims filed— including those filed by veterans of the Iraq and Afghanistan conflicts. The  number of compensation claims VA received annually increased about 53  percent, from about 468,000 in fiscal year 1999 to about 719,000 in fiscal  year 2008. In part, VA attributes increased claims receipts to its enhanced  outreach to veterans and servicemembers. VA reported that in fiscal year  2007, it provided benefits briefings to about 297,000 separating  servicemembers, up from about 210,000 in fiscal year 2003. Ongoing  hostilities also contribute to increased claims. For example, according to  VA, the claim rate of veterans from ongoing hostilities is 35 percent. In  addition, claims filed by veterans currently receiving compensation whose  conditions have worsened contribute to increased claims. VA anticipates  that the number of reopened claims will increase as current disability  benefit recipients—many of whom suffer from chronic progressive  disabilities such as diabetes, mental illness, and cardiovascular  disabilities—submit claims for increased benefits as they age and their  conditions worsen. In fiscal year 2008, VA received about 488,000  reopened claims for disability benefits, up 42 percent from about 345,000  in fiscal year 1999. Finally, according to VA officials, prior legislation and  VA regulations have also expanded benefit entitlement, adding to the  volume of claims received. In recent years, court decisions related to a  1991 law have created new presumptions of service-connected disabilities  for many Vietnam veterans and prisoners of war. In addition, VA  anticipates an increase in claims stemming from an October 2008  regulation change that affects how VA rates traumatic brain injuries (TBI).  According to a VA official, a letter was sent to approximately 32,000  veterans notifying them that their TBI rating could potentially increase  even if their symptoms had not changed.
Another factor impacting VA’s claims workloads—particularly the average  time to complete a claim—is the complexity of claims received. VA notes  that it is receiving claims for more complex disabilities related to combat  and deployments overseas, including those based on environmental and  infectious disease risks and TBI. In addition, according to VA officials,  veterans cited more disabilities in their claims in recent years than in the  past, and these claims can take longer to complete because each disability  must be evaluated separately. The number of compensation claims VA  decided with 8 or more disabilities increased from 11 to 16 percent from  fiscal years 2006 to 2008. Further, a number of statutes and court  decisions related to VA’s disability claims process may have affected VA’s  ability to improve claims processing timeliness. For example, according to  VA officials, the Veterans Claims Assistance Act of 2000 added more steps  to the claims process, lengthening the time it takes to develop and decide a  claim.
Similarly, VA has experienced workload improvements and challenges in  the area of disability appeals. For example, over the past 6 fiscal years,  the number of appeals resolved increased about 22 percent from over  72,000 in fiscal year 2003 to almost 88,000 in fiscal year 2008 (see fig. 5).  Between fiscal years 2003 and 2008, VA also reduced the number of  pending appeals by 24 percent from about 126,000 to about 95,000 (see fig.  6).
However, the average time it took VA to process appeals of compensation  claims—from when a veteran files a notice of disagreement to when the  appeal is resolved—has trended upward from 543 days in fiscal year 2003  to 639 days—or approximately 21 months—in fiscal year 2008 (see fig. 7).  Several factors contribute to the time it takes VA to resolve appeals.  According to VA officials, each time appellants submit new evidence, VA  must review and summarize the case for the appellant again, adding to the  time it takes to resolve the appeal. Furthermore, appeals cannot be  forwarded to the Board for a decision until all of a veteran’s pending  claims are resolved, regardless of whether they relate to the appeal.  Therefore, cases that are pending resolution of other issues can forestall  final resolution for the appellant. Also, according to VA officials,  processing time is further lengthened when appeals are remanded back to  VBA by the Board for further work, such as correcting procedural errors  and obtaining additional evidence. According to VA, in fiscal year 2008,  about 18 percent of the Board’s decisions were remanded because of VBA  errors that were avoidable. Many other appeals are remanded because  requirements—such as the legal requirements discussed previously— change after the appeal is sent to the Board.
section_title: VA Continues to Take Steps to Improve Claims Processing
paragraphs: VA has taken several steps to improve claims processing, including  increasing claims processing staff, redistributing certain workloads,  implementing a joint pilot with DOD to perform disability evaluations, and  developing a number of other initiatives to expedite benefits to veterans.  VA expects these efforts to yield improvements, but their effects are not  yet known and we have identified challenges with some of these efforts.  For example, over the past 4 years, VA has hired a significant number of  disability claims staff, who are expected to improve the timeliness of  initial claims and appeals processing. From fiscal year 2005 to fiscal year  2009, VA expects VBA’s claims processing staff to increase by 58 percent  from about 7,550 to an estimated 11,948. During the same period, VA  expects the Board’s staff to increase by 20 percent, from 433 to an  estimated 519. In addition, VA plans to use funds from the American  Recovery and Reinvestment Act of 2009 (ARRA) to hire and train about  1,000 temporary employees and about 500 permanent employees, who will  replace staffing losses that VBA experiences through normal attrition. The  temporary employees will assist in developing disability claims and  perform other administrative tasks to free decision-makers to complete  more complex claims processing tasks.
We have reported that an infusion of a large number of staff has the  potential to improve VA’s capacity. However, quickly absorbing these staff  will likely pose human capital challenges for VA, such as how to train and  deploy them. The additional staff has helped VA process more claims and  appeals overall, but as VA has acknowledged, it has also reduced  individual staff productivity. For example, while VA has issued more  claims decisions annually since hiring the additional staff, the number of  rating-related claims processed per staff person declined from 101 in fiscal  year 2005 to 88 in fiscal year 2008. According to VA, this decline in  productivity is attributable primarily to new staff who have not yet  become fully proficient at processing claims and to the loss of experienced  staff due to retirements. VA expects its productivity to decline further  before it improves, in part because of the challenge of training and  integrating new staff. According to VA officials, it takes about 3 to 5 years  for newly hired rating specialists to become proficient given the  complexity of the job. Training new staff also reduces productivity in the  near-term because experienced staff must take time to train and mentor  them, and therefore may have less time to process their own claim  workloads. According to the VBA official in charge of training, VBA has  developed curricula that use practical application of key concepts to  accelerate the learning curve for new staff.
VA expects that the staff hired with ARRA funding will increase the  number of claims processed and reduce average processing times in 2010.  However, even though their responsibilities are expected to be limited to  less complex claims processing tasks, these additional staff could also  pose human capital challenges in the near-term while they are being  trained and integrated into the process.
In addition to increasing staffing, VA has also expanded its practice of  redistributing disability workloads, which is intended to improve the  timeliness and consistency of decisions. Since 2001, VA has created 15  resource centers that are staffed exclusively to process claims or appeals  from backlogged regional offices at distinct phases in the claims process.  The number and types of claims redistributed from backlogged offices are  determined on a monthly basis based on changing workloads. For  example, from 2001 to 2002, VA created nine resource centers to  exclusively rate claims from other offices. The number of claims  redistributed for rating has increased from about 88,000 in fiscal year 2006  to about 140,000 in fiscal year 2008. Claims initially had to meet specific  criteria to be eligible for redistribution, such as having seven or fewer  disabilities. However, VA relaxed these criteria in May 2008, which has  allowed more claims to be redistributed. In addition, since 2007, VA has  created four additional resource centers to exclusively develop claims for  rating, and in 2009 it created two more resource centers focusing  exclusively on reconsidering appealed claims before they are sent to the  Board. The claims development resource centers work on obtaining  information necessary for rating claims, while the appeals resource  centers work on reviewing appeals and providing written summaries of  cases for the veteran. According to VA officials, redistributing backlogged  claims to resource centers improves average processing times because VA  can better leverage its ever-changing capacity across its offices. Although  such efforts could improve the timeliness as well as the consistency of its  decisions, VA has not collected data to evaluate the effect of its workload  redistribution efforts.
VA has also expanded its efforts to assist servicemembers filing claims  prior to leaving military service and has consolidated the processing of  such claims at specific regional offices. For example, since 2006, disability  compensation claims filed by some servicemembers before they leave the  military and become veterans—known as Benefits Delivery at Discharge  (BDD) claims—are rated at two regional offices instead of at each of the  57 regional offices. In addition, in February 2008, we reported that VA  had increased the number of military locations where servicemembers  could file BDD claims. VA received about 32,000 BDD claims in fiscal year  2008. According to VA officials, the goal of BDD is to expedite delivery of  benefits to new veterans as soon as possible after leaving the military.  Consolidating certain tasks, such as rating BDD claims at a limited number  of regional offices, could improve consistency because of greater control  in communicating procedures and conducting training, but VA officials  said the agency lacks data to measure the impact of consolidating BDD  claims rating because VA did not consistently track BDD claims prior to  the consolidation. We have identified the need for VA to systematically  address concerns about the consistency of its decisions. VA’s Inspector  General has studied one indicator of possible inconsistency, which is a  wide variation in average payments per veteran from state to state. In May  2005, the Inspector General reported that variation in rating decisions was  more likely to occur for some disabilities like post-traumatic stress  disorder (PTSD) than for others, where much of the information needed to  make a determination is susceptible to interpretation and judgment. VA  took several steps to improve decision consistency, including conducting a  pilot project to monitor consistency of rating-related claims decisions,  reviewing the consistency of decisions on PTSD claims, and developing a  schedule for reviews of other disabilities. Given the increasing numbers of  veterans from the hostilities in Iraq and Afghanistan with PTSD claims, the  BDD program may offer opportunities to enhance consistency in rating  such impairments.
In addition to increasing staffing and redistributing and consolidating  certain workloads, VA is also implementing a joint pilot with DOD to  perform disability evaluations. Begun in November 2007, the pilot process  applies to servicemembers navigating the military’s disability evaluation  system, which determines whether servicemembers are fit for duty or  should be released from the military. In the pilot, VA completes disability  ratings for servicemembers found unfit for duty. Key features of the pilot  include a single physical examination conducted to VA standards,  disability ratings prepared by VA for use by both DOD and VA in  determining disability benefits, and additional outreach and case  management provided by VA staff at DOD pilot locations to explain VA  results and processes to servicemembers. The goals of the pilot are to  increase transparency and to reduce confusion about the disability  evaluations conducted, and if military separation or retirement is  necessary, to expedite VA disability compensation benefits upon  discharge. If deemed successful at pilot locations, DOD and VA intend to  implement the process worldwide.
Implementing the pilot process worldwide may be challenging. VA and  DOD are using local agreements to establish the pilot process as it  expands to new locations. These agreements reflect local collaboration on  pilot implementation, notably to ensure that participants receive timely  examinations especially when there is no VA facility located nearby. While  local agreements may be an effective tool for implementing change  involving many parties, we found in our review of the BDD program that  their effectiveness may diminish over time due to changes in base  command, lack of communication between agencies, and resource  constraints. In addition, in September 2008, we reported that while DOD  and VA had established measures for the disability evaluation system  pilot’s performance and a mechanism for tracking performance, they had  not established criteria for determining whether the pilot was successful  and should be expanded on a large scale. For example, DOD and VA did  not establish how much improvement in timeliness or other indicators  would be needed before deciding that the pilot was successful. The  agencies plan to issue their final report to the Congress in August 2009;  however, it is unclear whether they will have identified criteria or  collected sufficient performance data on key indicators in order to move  forward with large-scale implementation.
If implemented widely, the pilot process could change the way many  veterans first receive disability benefits from VA. According to recent  testimony from a DOD official, preliminary pilot results suggest that the  new process expedites delivery of VA benefits to servicemembers  following discharge from the military. Moreover, implementing the pilot  process widely could reduce VA’s reported average processing times  because VA begins tracking the timeliness of these claims from the date a  servicemember is discharged. However, the number of claims affected by  widespread implementation of the pilot process would probably be small  compared to the total number of compensation claims processed by VA.  VA processes many compensation claims from veterans who are no longer  in the military. In fiscal year 2005, the military’s disability evaluation  system caseload was approximately 23,000 compared to the nearly 650,000  compensation claims received by VA that year.
VA has also begun other initiatives such as testing other ways to process  claims and leveraging technology. For example, in February 2009, VA  launched a pilot called Expedited Claims Adjudication in four regional  offices. This pilot, a joint effort between the VBA and the Board, is  intended to help accelerate the processing time of claims and appeals.  Claimants who opt into the pilot agree to respond to VA within timeframes  that are shorter than generally required. In return, the expectation is that  claimants will receive decisions from VA more quickly. Because this pilot  began only recently, little data are available about its effectiveness. In  addition, VA is leveraging technology to improve claims processing. For  example, in recent years, VA has upgraded its claims processing software  in phases. Such upgrades are intended to improve processing timeliness  and to improve data quality by minimizing the need for data entry. Further,  as of October 2008, claims processing staff review scanned versions of all  BDD claims. According to VA officials, this process is currently as efficient  as paper-based processing, but may eventually be more efficient and  enable further distribution of workloads as changing capacities and  demands require. VA is working to overcome technical challenges that  inhibit widespread implementation of paperless processing. We are in the  process of reviewing these initiatives as part of our ongoing study.
In conclusion, workload data indicate that VA has made progress in some  areas of its disability claims and appeals process, but it continues to  experience challenges in reducing the time it takes to process claims and  appeals and in reducing the number of claims awaiting decisions. VA has  taken a number of steps to improve its disability claims process, but  significant increases in claims workloads combined with multiple  conditions per claim continue to pose challenges to VA’s progress.  Productivity will be key to addressing the growing number of veterans  awaiting a decision on VA claims and appeals, underscoring the need to  address human capital challenges associated with training and integrating  VA’s new staff—a growing and significant portion of all its claims  processors—and the need to track and monitor performance data for  major initiatives in order to ensure that they are functioning as designed  and achieving optimal returns on investment.
Mr. Chairman, this concludes my prepared statement. I would be pleased  to answer any questions that you or other members of the committee may  have.
section_title: GAO Contact and Acknowledgments
paragraphs: For further information, please contact Daniel Bertoni at (202) 512-7215 or  bertonid@gao.gov. Also contributing to this statement were Shelia Drake,  Cynthia Grant, Joel Green, Lisa McMillen, Jessica Orr, Bryan Rogowski,  Christine San, and Walter Vance.
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