Veterans' Disability Benefits: Timely Processing Remains a Daunting Challenge
Published: 2012-12-21T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: For years, VA has struggled with an increasing workload of disability compensation claims. The average time to complete a claim was 188 days in fiscal year 2011, and VA expects an increase in claims received as 1 million servicemembers leave military service over the next 5 years. As GAO and other organizations have previously reported, VA has faced challenges in reducing the time it takes to decide veterans’ claims. GAO was asked to review these issues. Specifically, this report examines (1) the factors that contribute to lengthy processing times for disability claims and appeals, and (2) the status of VBA’s recent efforts to improve disability claims and appeals processing timeliness. To do this, GAO analyzed VBA performance data and program documents, reviewed relevant studies and evaluations, met with staff from five VA regional offices, and interviewed VBA officials and Veterans Service Organizations.
section_title: What GAO Found
paragraphs: A number of factors—both external and internal to the Veterans Benefits Administration (VBA)—have contributed to the increase in processing timeframes and subsequent growth in the backlog of veterans’ disability compensation claims. As the population of new veterans has swelled in recent years, the annual number of claims received by VBA has gone up. Compared to the past, these claims have a higher number of disabling conditions, and some of these conditions, such as traumatic brain injuries, make their assessment complex. Moreover, due to new regulations that have established eligibility for benefits for new diseases associated with Agent Orange exposure, VBA adjudicated 260,000 previously denied and new claims. Beyond these external factors, issues with the design and implementation of the compensation program have contributed to timeliness challenges. For example, the law requires the Department of Veterans Affairs (VA) to assist veterans in obtaining records that support their claim. However, VBA officials said that lengthy timeframes in obtaining military records—particularly for members of the National Guard and Reserve—and Social Security Administration (SSA) medical records impact VA’s duty to assist, possibly delaying a decision on a veteran’s disability claim. As a result, the evidence gathering phase of the claims process took an average of 157 days in 2011. Further, VBA’s paper-based claims processing system involves multiple hand-offs, which can lead to misplaced and lost documents and can cause unnecessary time delays. Concerning timeliness of appeals, VBA regional offices have shifted resources away from appeals and toward claims in recent years, which has led to lengthy appeals timeframes.
VBA is currently taking steps to improve the timeliness of claims and appeals processing; however, prospects for improvement remain uncertain because timely processing remains a daunting challenge. VBA is using contractors to handle some aspects of the claims process, and is also shifting some workload between regional offices. Also, VBA is modifying and streamlining certain claims and appeals processing procedures for veterans who opt to participate in these initiatives in exchange for an expedited decision. For example, veterans receive expedited processing when they submit a claim that is certified as having all required evidence. Not many veterans have elected this option, but VA is making adjustments to increase its attractiveness. In addition, VBA is trying to decrease the amount of time it takes to gather medical evidence. For example, VBA recently encouraged medical providers to use a standardized form when responding to VBA’s request for information. However, results of this initiative have been mixed. VBA is also taking steps to streamline the claims process, including implementing initiatives to create (1) standardized language for decision letters sent to veterans, (2) specialized teams that process claims based on level of complexity, and (3) a paperless claims system. According to VBA officials, these efforts will help VA process veterans’ claims within 125 days by 2015. However, the extent to which VA is positioned to meet this ambitious goal remains uncertain. Specifically, VBA’s backlog reduction plan—its key planning document—does not articulate performance measures for each initiative, including their intended impact on the claims backlog. Furthermore, VA has not yet reported on how these efforts have affected processing times, a condition which raises concern given the mixed results that have emerged to date.
section_title: What GAO Recommends
paragraphs: GAO recommends that VBA (1) partner with military officials to reduce timeframes to gather records from National Guard and Reserve sources, (2) partner with SSA to reduce timeframes to gather SSA medical records, and (3) ensure the development of a robust plan for its initiatives that identifies performance goals that include the impact of individual initiatives on processing timeliness. In response to a draft of this report, VA officials generally agreed with GAO’s conclusions and concurred with the recommendations, and summarized efforts that are planned or underway to address the recommendations.

section_title: Letter
paragraphs: The Department of Veterans Affairs (VA) disability compensation program  provides monetary support to veterans with disabling conditions that were  incurred or aggravated during military service. In fiscal year 2011, the  program provided $39.4 billion in benefits to 3.35 million veterans. For  years, the disability compensation claims process has been the subject of  concern and attention by VA, Congress, and Veterans Service  Organizations (VSO), due in large part to long waits for decisions and the  large number of claims pending a decision. Moreover, VA’s backlog of  claims—defined as claims awaiting a decision for over 125 days—has  more than tripled since September 2009. Against this backdrop, 1 million  servicemembers are expected to become veterans in the next 5 years  according to VA officials, with a significant number expected to apply for  disability benefits. As we and other organizations have reported over the  last decade, VA has faced challenges in reducing the time it takes to  decide veterans’ claims. For example, the average length of time to  complete a claim has increased from 161 days in 2009 to 260 days in  2012. Moreover, in August 2012, 568,043 claims—approximately two-  In addition,  thirds of all compensation rating claims—were backlogged.timeliness of appeals processing at VA regional offices has also slowed  by 56 percent over the last several years. The Veterans Benefits  Administration (VBA) has a number of ongoing initiatives in place to help  meet its stated timeliness goals. In this context, we were asked to  examine issues VA regional offices face in processing disability claims  and appeals in a timely fashion. Specifically, we addressed the following  questions:  1.  What factors contribute to lengthy processing times for disability  claims and appeals?  2.  What is the status of VBA’s recent efforts to improve disability  claims and appeals processing timeliness?
To address our objectives, we collected and analyzed information through  multiple methods. We reviewed relevant federal laws and regulations,  court decisions, VBA policy manuals and documents, and training  materials. We also reviewed past GAO and VA Office of Inspector  General (OIG) reports, VBA studies and evaluations, and other  documents relevant to claims and appeals processing at VBA regional  offices. We collected data on claims and appeals processing workload  and timeliness from VBA’s internal dashboard. To assess the reliability of  the data, we conducted interviews with VBA officials in charge of  maintaining VBA’s internal dashboard about their quality control  procedures and practices used to extract timeliness and workload data  from underlying data sources. We relied on past GAO data reliability  assessments of the underlying data sources where enterprise-wide data  on workload and timeliness of claims and appeals processing is stored  and extracted into the internal dashboard tool. In addition, we collected  data on claims processing resources from VBA’s Personnel and  Accounting Integrated Database. To assess the reliability of these data,  we interviewed officials in VBA’s Office of Human Resources about  practices to record personnel actions, quality control procedures  conducted within the Office of Human Resources to ensure the quality of  the data, as well as potential limitations to the data. We reviewed the data  and found it to be sufficiently reliable for the purpose of analyzing  timeliness, workload, and resources assigned to claims processing. We  interviewed VBA central office officials, including officials in VBA’s  Implementation Center (which was established as a project management  office to manage improvement initiatives), and VSO representatives who  assist veterans with their claims and appeals. We also met with staff from  five VA regional offices—Atlanta, Georgia; Houston, Texas; Los Angeles,  California; New York, New York; and Philadelphia, Pennsylvania. We  selected offices based on size of metropolitan area, claims workload, and  timeliness of claims and appeals processing. For each location, we  interviewed regional office management and staff, analyzed workload  management documents, and reviewed written notifications sent to  veterans (see fig. 1). For additional information on our scope and  methodology, see appendix I.
We conducted this performance audit from March 2012 through  December 2012 in accordance with generally accepted government  auditing standards. Those standards require that we plan and perform the  audit to obtain sufficient, appropriate evidence to provide a reasonable  basis for our findings and conclusions based on our audit objectives. We  believe that the evidence obtained provides a reasonable basis for our  findings and conclusions based on our audit objectives.
subsections: section_title: Background
subsections: section_title: Disability Claims Process
paragraphs: VA pays monthly disability compensation to veterans with service- connected disabilities (i.e., injuries or diseases incurred or aggravated  while on active military duty) according to the severity of the disability.  VA also pays additional compensation for certain dependent spouses,  children, and parents of veterans. VA’s disability compensation claims  process starts when a veteran submits a claim to VBA (see fig. 2). A  claim folder is created at 1 of VA’s 57 regional offices, and a Veterans  Service Representative (VSR) then reviews the claim and helps the  veteran gather the relevant evidence needed to evaluate the claim. Such  evidence includes the veteran’s military service records, medical  examinations, and treatment records from Veterans Health Administration  (VHA) medical facilities and private medical service providers. Also, if  necessary to provide support to substantiate the claim, VA will provide a  medical examination for the veteran. Once VBA has gathered the  supporting evidence, a Rating Veterans Service Representative  (RVSR)—who typically has more experience at VBA than a VSR— evaluates the claim and determines whether the veteran is eligible for  benefits. If so, the RVSR assigns a percentage rating. Later, the veteran  can reopen a claim to request an increase in disability compensation from  VA if, for example, a service-connected disability has worsened or a new  disability arises.
If the veteran disagrees with VA’s decision regarding a claim, he or she  can submit a written Notice of Disagreement to the regional office  handling the claim. In response to such a notice, VBA reviews the case  and provides the veteran with a written explanation of the decision if VBA  does not grant all appealed issues. Appendix II contains more  information regarding VBA’s notifications to veterans throughout the  disability compensation claims and appeals processes. If additional  evidence is provided, VBA reviews the case again and if this new  evidence does not result in a grant of all appealed issues, VBA produces  another written explanation of the decision. If the veteran further  disagrees with the decision, he or she may appeal to the Board of  Veterans’ Appeals (the Board). Before transferring the appeal to the  Board, VBA reviews the case again and then certifies that the appeal is  ready for review by the Board. After the appeal has been certified, the  Board conducts a hearing if the veteran requests one, then grants  benefits, denies the appeal, or returns the case to VBA to obtain  additional evidence necessary to decide the claim. If the veteran is  dissatisfied with the Board’s decision, he or she may appeal, in  succession, to the U.S. Court of Appeals for Veterans Claims, to the  Court of Appeals for the Federal Circuit, and finally to the Supreme Court  of the United States.
section_title: VA’s Duty to Assist Requirements
paragraphs: Congress clarified VA’s duties with regard to assisting in the development  of claims in the Veterans Claims Assistance Act of 2000 (VCAA). VCAA  eliminated the requirement that a veteran submit a “well-grounded” claim  before VA could assist in developing the claim and instead obligated the  agency to assist a claimant in obtaining evidence that is necessary to  establish eligibility for the benefit being sought. Specifically, VA must: (1)  notify claimants of the information necessary to complete the  application; (2) indicate what information not previously provided is  needed to substantiate the claim; (3) make reasonable efforts to assist  claimants in obtaining evidence to substantiate claimants’ eligibility for  benefits, including relevant records; and (4) notify claimants when VA is  unable to obtain relevant records. According to VA regulations, VA  efforts to obtain federal records should continue until the records are  obtained or until VA has deemed it reasonably certain that such records  do not exist or that further efforts to obtain those records would be futile.
section_title: Timeliness of Claims and Appeals Processing
paragraphs: Timeliness of VA compensation rating claims and appeals processing has  worsened in recent years. As a key indicator of VBA’s performance in  claims and appeals processing, timeliness is measured in various ways.  To measure overall claims processing timeliness, VBA uses two  measures: (1) the number of days the average pending claim has been  awaiting a decision (Average Days Pending) and (2) the average number  of days that VBA took to complete a claim where a decision has been  reached (Average Days to Complete). Both measures of claims  processing timeliness have worsened substantially over the last several  years (see fig.3).
VBA also collects data on the timeliness of the different phases of the  claims process, which is used to identify trends and bottlenecks  throughout the process. In fiscal year 2011, each phase took longer on  average than its stated agency timeliness target (see fig. 4). The  evidence gathering phase is the most time-intensive phase, taking over 5  months (157 days) on average in fiscal year 2011 and continuing to grow  throughout fiscal year 2012.
The timeliness of appeals processing at VA regional offices has worsened  as well. The average timeframes in VBA’s response to Notices of  Disagreement and the certification of appeals to the Board have  increased since fiscal year 2009 (see fig. 5).
section_title: Rising Workloads, along with Program Rules and Inefficient Processes, Contribute to Lengthy Processing Time Frames
subsections: section_title: Rise in Claims Submitted Is Outpacing Claims Production
paragraphs: In recent years, VA’s claims processing production has not kept pace with  the increase in incoming claims. In fiscal year 2011, VA completed over 1  million compensation rating claims, a 6 percent increase from 2009.  However, the number of VA compensation rating claims received has  grown 29 percent—from 1,013,712 in fiscal year 2009 to 1,311,091 in  fiscal year 2011 (see fig. 6). As a result, the number of backlogged  claims—defined as those claims awaiting a decision for more than 125  days—has increased substantially since 2009. As of August 2012, VA  had 856,092 pending compensation rating claims, of which 568,043 (66  percent) were considered backlogged.
Similar to claims processing, VA regional office appeals processing has  not kept pace with incoming appeals received. The number of Notices of  Disagreement—the first step in the appeals process when the veteran  provides a written communication to VBA that he or she wants to contest  the claims decision—received by VBA fluctuated over the last 4 years, yet  those awaiting a decision grew 76 percent over that time period (see fig.  7). Moreover, the number of Statements of the Case—an explanation of  VBA’s decision on the appellant’s case—that were mailed by VBA  decreased 24 percent over the last 4 years—from 100,291 in 2009 to  76,685 in 2012. In addition, the time it took to mail a Statement of the  Case increased 57 percent over that time period—from 293 days to 460  days on average.
A number of factors have contributed to the substantial increase in claims  received. One factor was the commencement in October 2010 of VBA’s  adjudication of 260,000 previously denied and new claims when a  presumptive service connection was established for three additional  Agent Orange-related diseases.and assigned experienced claims staff to process and track them. VBA  officials said that 37 percent of its claims processing resources nationally  were devoted to adjudicating Agent Orange claims from October 2010 to  March 2012. VBA officials in one regional office we spoke to said that all  claims processing staff were assigned solely to developing and rating  Agent Orange claims for 4 months in 2011, and that no other new and  pending claims in the regional office’s inventory were processed during  that time. Also during this time period, special VBA teams—known as  brokering centers—which previously accepted claims and appeals from  regional offices experiencing processing delays, were devoted to  processing Agent Orange claims exclusively. According to VBA, other  factors that contributed to the growing number of claims include an  increase in the number of veterans from the military downsizing after 10  years of conflict in Iraq and Afghanistan, improved outreach activities and  transition services to servicemembers and veterans, and difficult financial  conditions for veterans during the economic downturn. In conjunction with  an increase in claims received, VBA officials said that claims today are  more complex than in the past. As we reported in 2010, VBA said it is  receiving more claims for complex disabilities related to combat and  deployments overseas, including those based on environmental and   VBA gave these claims a high priority  infectious disease risks and traumatic brain injuries. Claims with many  conditions can take longer to complete because each condition must be  evaluated separately and then combined into a single percentage rating.  According to VA, in 2011, the number of medical conditions claimed by  veterans who served in Iraq and Afghanistan averaged 8.5, an increase  from 3-4 conditions per claim for Vietnam veterans.
As we reported in 2010, VBA’s goal is for newly hired VSRs to be proficient within 18  months and new RVSRs to be proficient within 2 years. See GAO-10-213. However,  becoming proficient often takes longer—about 3 to 5 years for RVSRs. While VBA hired  additional temporary staff using American Recovery and Reinvestment Act of 2009 funds,  they were given limited training and less complex claims processing tasks. According to  VBA officials, in 2011, VA received authority to convert temporary employees into  permanent staff, which required additional training and mentoring. officials at one regional office said the number of claims processing staff  assigned to outreach activities has increased. Specifically, at the time of  our review, 37 out of 302 claims processing staff were conducting  outreach activities to servicemembers and veterans, such as giving  briefings and distributing materials at military bases about pre-discharge  and transition assistance programs.
According to VBA officials, a primary reason that appeals timeliness at VA  regional offices has worsened is a lack of staff focused on processing  these appeals. VBA officials at each of the five regional offices we met  with stated that over the last several years appeals staff have also had to  train and mentor new staff, conduct quality reviews, as well as develop  and rate disability claims to varying degrees. For example, at one regional  office, all staff on the appeals team focused exclusively on rating disability  claims for a 9-month period in 2010 instead of processing appeals.  Officials at another regional office stated that until 2012, their appeals  staff spent up to 2 weeks per month on non-appeals tasks. In addition, we  reported in 2011 that regional office managers estimated that Decision  Review Officers (DRO) spent on average 36 percent of their time on non- appeals processing tasks.office managers did not assign enough staff to process appeals, diverted  staff from processing appeals, and did not ensure that appeals staff acted   A 2012 VA OIG report noted that VA regional  on appeals promptly because, in part, they were assigned responsibilities  to process initial claims, which were given higher priority. The VA OIG  recommended that VBA identify staffing resources needed to meet their  appeals processing goals, conduct DRO reviews on all appeals, and  revise productivity standards and procedures to emphasize processing  appeals in a timely manner, such as implementing criteria requiring  appeals staff to initiate a review or develop for Notices of Disagreement  and certified appeals within 60 days of receipt. VBA agreed with the VA  OIG’s findings and is conducting a pilot to assess the feasibility of  addressing these recommendations.
section_title: Program Requirements Contribute to Long Processing Times
paragraphs: According to VA officials, federal laws and court decisions over the  past decade have expanded veterans’ entitlement to benefits but have  also added requirements that can negatively affect claims processing  times. For example, the VCAA requires VA to assist a veteran who files a  claim in obtaining evidence to substantiate the claim before making a  decision. This requirement includes helping veterans obtain all relevant  federal records and non-federal records. VA is required to continue  trying to obtain federal records, such as VA medical records, military  service records, and Social Security records, until they are either obtained  or the associated federal entity indicates the records do not exist. VA may  continue to process the claim and provide partial benefits to the veteran,  but the claim cannot be completed until all relevant federal evidence is  obtained.
While VA must consider all evidence submitted throughout the claims and  appeals processes, if a veteran submits additional evidence or adds a  condition to a claim late in the claims process it can require rework and  may subsequently delay a decision, according to VBA central office  officials. VBA officials at regional offices we spoke to said that submitting  additional evidence may add months to the claims process. New  evidence must first be reviewed to determine what additional action, if  any, is required. Next, another notification letter must be sent to the  veteran detailing the new evidence necessary to redevelop the claim and  additional steps VA will take in light of the new evidence. Then, VA may  have to obtain additional records or order another medical examination  before the claim can be rated and a decision can be made. Furthermore,  while VA may continue to process the claim and provide partial benefits to  the veteran, a claim is not considered “complete” until a decision is made  on all conditions submitted by the veteran. Moreover, a veteran has up to  1 year, from the notification of VA’s decision, to submit additional  evidence in support of the claim before the decision is considered final. In  addition, a veteran may submit additional evidence in support of their  appeal at any time during the process. If the veteran submits additional  evidence after VA completes a Statement of the Case, VA must review  the new evidence, reconsider the appeal, and provide another written  explanation of its decision—known as a Supplemental Statement of the  Case. Congress recently passed a law allowing VA to waive review of  additional evidence submitted after the veteran has filed a substantive  appeal and instead have the new evidence reviewed by the Board to  expedite VA’s process of certifying appeals to the Board.
While federal law requires veterans to use an application form prescribed  by VA when submitting a claim for original disability compensation  benefits, VBA central office officials said they accept reopened claims or  claims requesting an increase in disability compensation benefits in any  format, which can contribute to lengthy processing times. VBA will  accept an original disability claim informally if it is submitted in a non- standard format, but within 1 year the veteran must submit a VA Form 21- 526, Veteran’s Application for Compensation and/or Pension. VBA does  not track the number of claims submitted in non-standard formats;  however, officials at three regional offices we met with said they receive  claims submitted in various formats, including hand-written letters.  Officials at these three regional offices said that when such claims are  submitted, there is a risk that claims staff may not be able to identify all  the conditions the veteran would like to claim during initial development.  For example, officials at one regional office stated that if these conditions  are discovered later in the process, then VA must redevelop the claim— which could include sending another letter to the veteran, obtaining  additional records, and conducting another medical exam—before the  claim can be rated and a benefit amount determined and disbursed. VBA  officials said they expect the number of non-standard applications for  disability claims to decrease as more veterans file claims electronically  through the Veterans On Line Application (VONAPP), which is available  at VA’s eBenefits website.
Similar to processing for reopened claims, VA’s procedures allowing  veterans to submit appeals in any format can negatively affect appeals  processing times, according to VBA officials. For example, a veteran’s  intention to appeal a prior decision may be overlooked initially by staff  because there is no standard appeals submission form and a veteran’s  statement to appeal a prior decision may be included along with other  written correspondence for other purposes, such as submitting a new  claim, according to VBA officials. When appeals are overlooked and later  found, it can delay recording Notices of Disagreement in appeals data  systems and result in longer processing times, according to VBA officials.
section_title: Gathering Records from Federal Agencies and Others Can Take Months
paragraphs: According to VBA officials, delays in obtaining military service and  medical treatment records, particularly for National Guard and Reserve  members, is a significant factor lengthening the evidence gathering  phase. According to VBA officials, 43 percent of Global War on Terror  veterans are National Guard and Reserve members. According to a VA  official, Department of Defense (DOD) Instruction 6040.45 requires  military staff to respond to VA requests for National Guard and Reserve  records in support of VA disability compensation claims. However, VBA  area directors and officials at all five regional offices we met with  acknowledged that delays in obtaining these records are a system-wide  challenge. Military records of National Guard or Reserve members can  often be difficult to obtain, in particular, because these servicemembers  typically have multiple, non-consecutive deployments with different units  and their records may not always be held with their reserve units and may  exist in multiple places. Moreover, according to VBA officials, National  Guard and Reserve members may be treated by private providers  between tours of active duty and VA may have to contact multiple military  personnel and private medical providers to obtain all relevant records,  potentially causing delays in the evidence gathering process.
Difficulties in obtaining timely and complete medical information,  especially from private medical providers, can also contribute to a lengthy  evidence gathering phase. For example, officials at one regional office  said the process may be delayed if veterans are slow to return their  consent forms that allow VA to pursue private medical records. Also,  according to VBA officials, private medical providers may not respond to  VA records requests in a timely fashion. In addition, officials at one  regional office we met with mentioned that time frames can also be  affected if veterans fail to show up for scheduled examinations. Officials  at two regional offices we met with said that even when medical records  are obtained, medical exams and opinions may include erroneous  information or be missing necessary evidence, which then requires VA  officials to follow-up with medical providers to clarify information. In some  cases, another examination must be ordered before a decision can be  made on the claim, which can add months to the process. VBA area  directors acknowledged that obtaining complete and sufficient medical  information is a system-wide challenge.
Difficulties obtaining Social Security Administration (SSA) medical  records, as one specific example, can also lengthen the evidence  gathering phase. Currently, an interagency agreement exists that  establishes the terms and conditions under which SSA discloses  information to VA for use in determining eligibility for disability benefits,  according to VBA officials. Although VBA regional office staff have direct  access to SSA benefits payment histories, they do not have direct access  to medical records held by SSA. If a veteran submits a disability claim  and reports receiving SSA disability benefits, VA is required to help the  veteran obtain relevant federal records, including certain SSA medical  records, to process the claim. VBA’s policy manual instructs claims staff  to fax a request for medical information to SSA and if no reply is received,  to wait 60 working days before sending a follow-up fax request. If a  response to the follow-up request is not received after 30 days, the  manual instructs claims staff to send an email request to an SSA liaison.  VBA officials at four of the five regional offices we reviewed told us that  when following this protocol, they have had difficulty obtaining SSA  medical records in a timely fashion. Moreover, they reported having no  contact information for SSA, beyond the fax number, to help process their  requests. In complying with VA’s duty to assist requirement, VBA staff  told us they continue trying to retrieve SSA records by sending follow-up  fax requests until they receive the records or receive a response that the  records do not exist. VBA area directors said some regional offices have  established relationships with local SSA offices and have better results,  but obtaining necessary SSA information has been an ongoing issue  nationally. For example, officials at one regional office said a response  from SSA regarding a medical records request can sometimes take more  than a year to receive.
section_title: Some Work Processes Are Inefficient
paragraphs: VBA’s work processes, stemming mainly from its reliance on a paper- based claims system, can lead to misplaced or lost documents, which can  contribute to lengthy processing times. VBA officials at three of the five  regional offices we met with mentioned that errors and delays in handling,  reviewing, and routing incoming mail to the correct claim folder can delay  the processing of a claim or cause rework. For example, VBA officials at  one regional office said that a claim may be stalled in the evidence  gathering phase if a piece of mail that contains outstanding evidence is  misplaced or lost. In addition, claims staff may rate a claim without  knowledge of the additional evidence submitted and then, once the mail is  routed to the claim folder, have to rerate the claim in light of the new  evidence received. Furthermore, VBA officials at one regional office we  met with said that processing can also be delayed if mail staff are slow to  record new claims or appeals into IT systems. As of August 2012, VBA  took 43 days on average to record Notices of Disagreement in the  appeals system—36 days longer than VBA’s national target. In May 2011,  the VA OIG reported that VA regional office mailroom operations needed  strengthening to ensure that staff process mail in an accurate and timely  manner. Specifically, the VA OIG found that staff did not always record  incoming mail into IT systems within 7 days of receipt and that they did  not properly process and route mail to existing claims folders in a timely  fashion in 10 of the 16 VA regional offices they reviewed. VBA area  directors said that mail processing timeliness varies by regional office and  that the more efficient offices in general do a better job of associating mail  with the correct claims folder. In addition, VBA area directors said that  standardizing the mail handling and sorting process in an integrated mail  processing center—a component of the Claims Organizational Model  implemented in 18 regional offices in fiscal year 2012—is intended to  improve mail processing by involving more senior staff in the process.  VBA officials also said that moving claims folders among regional offices  and medical providers contributes to lengthy processing times. According  to a 2011 VA OIG report, processing delays occurred following medical  examinations because staff could not match claims-related mail with the  appropriate claim folders until the folders were returned from the VA  Medical Center. In addition, processing halts while a claim folder is sent  to another regional office or brokering center.
Lastly, according to VBA officials, the lack of an integrated IT system that  provides all necessary information and functionality to track and process  claims and appeals can decrease the productivity of claims processing  staff. For example, according to staff at one VA regional office we spoke  with, currently, they must use different systems to track claims folders,  order medical exams, record claim processing actions taken by VBA staff  and evidence received on a claim, rate claims, process awards, and  record the status of appeals to the Board. The lack of an integrated  system requires staff to enter claim information multiple times, search  through multiple systems for claim information, and maintain processing  notes on the status of the claim or appeal in multiple systems. For  example, officials at two regional offices we met with said RVSRs must  enter information into the Rating Board Automation system that was  already entered in the Modern Award Processing-Development (Map-D)  system. In addition, appeals staff must maintain claim processing notes  and information on the status of appeals in two different systems—one  maintained by the Board (Veterans Appeals Control and Locator System)  and one maintained by VBA (MAP-D). According to regional office staff,  the redundant data entry takes extra time that could have been spent  working on other cases. Moreover, staff at one regional office said they  did not always keep their claim processing notes up-to-date in both  systems.
section_title: VBA Is Taking Steps to Improve Claims and Appeals Processing, but Future Impact Is Uncertain
paragraphs: VBA is currently taking steps to improve the timeliness of claims and  appeals processing. Based on a review of VA documents and interviews  with VBA officials, we identified 15 efforts with a stated goal of improving  claims and appeals timeliness. We selected 9 for further review— primarily based on interviews with VBA officials and a review of recent VA  testimonies. VBA’s improvement efforts include using existing VBA staff  and contractors to manage workload, modifying and streamlining  procedures, improving records acquisition, and redesigning the claims  and appeals processes (see fig. 8). Although VBA is monitoring these  efforts, the planning documents provided to us lack key aspects of sound  planning, such as performance measures for each effort.
VBA has several ongoing efforts to leverage internal and external  resources to help manage its workload (see fig. 8). One ongoing effort  that began in 2001 is the use of brokering centers—which are 13 special  teams that process claims transferred from regional offices experiencing  a large backlog of claims. As we reported in 2010, these teams are  staffed separately from other regional office teams. According to VA  officials, brokering centers gather evidence for the claim, make a  decision, process awards payments, and work on appeals. Brokering  center teams processed nearly 171,000 claims in fiscal year 2009,  according to the VA OIG. VA central office officials told us that in fiscal  years 2010 and 2011, all brokering centers focused exclusively on the re- adjudication of Agent Orange claims. Through the first 11 months of fiscal  year 2012, brokering centers processed approximately 24,000 claims.  VBA officials at several regional offices told us that brokering, over the  past year, has helped to manage their overall claims workload.
VBA also began the Veterans Benefits Management Assistance Program  (VBMAP) in late fiscal year 2011 to obtain contractor support for evidence  gathering for approximately 279,000 disability claims. Under VBMAP,  regional offices send cases to a contractor to gather evidence. After  evidence has been gathered for an individual claim, the contractor sends  the file back to the originating regional office, which reviews the claim for  completeness and quality and then assigns a rating. Contractor staff are   As  required to complete their work within 135 days of receiving the file.of June 2012, VBA regional offices we spoke with were awaiting the first  batch of claims that were to be sent to the contractors, so it remains to be  seen if VBMAP reduces processing times. Contractors are required to  provide VBA with status reports that include several measures of  timeliness, including the time it took to receive medical evidence from  providers and the time it took to return a claim to VBA for rating.
subsections: section_title: VBA Is Changing Procedures and Modifying Requirements to Expedite Claims and Appeals Processing
paragraphs: With the intent of speeding up the claims and appeals processes, VBA  has several efforts that modify program requirements or relieve VA of  certain duties (see fig. 8). One effort is the Fully Developed Claims (FDC)  program, which began as a pilot in December 2008 and was implemented  nationwide in June 2010. The FDC program was implemented in  response to a congressional mandate that required VBA to conduct a pilot  program to expedite processing of fully developed claims in 90 days or  less. Normally, once a veteran submits a claim, VBA will review the  claim and then send the veteran a letter detailing additional evidence  required to support the claim. The FDC program eliminates this step and  saves time because the required notification is provided to the veteran  directly on the FDC form. The program also attempts to reduce the time  VBA would normally spend gathering evidence for the veteran. In  exchange for expedited processing, veterans participating in the FDC  program send VBA any relevant private medical evidence with the claim  and certify that they have no additional evidence to provide. While VBA  officials and VSOs expect the program to reduce processing delays for  veterans, claims submitted without the required evidence are considered  incomplete. Furthermore, claims submitted under the FDC program with  incomplete evidence sometimes lose their priority status and are  processed with VBA’s non-expedited workload, which can result in  additional processing time. According to VBA officials, in the first 2 years  of the program, VBA has processed 33,001 FDC claims, taking an  average of about 98 days to complete—8 days longer than the goal of 90  days for these claims. VBA officials attribute not meeting FDC processing  time goals to the increased workload resulting from processing Agent  Orange claims. As of July 2012, veteran participation in the FDC program  has been low—only 4 percent of all compensation rating claims submitted  in 2012. A VBA official told us that in response to VSO input, they have  made the FDC form easier to use. Moreover, the VBA official we spoke  with expects more FDC claims once veterans are able to electronically file  claims. While FDC claims are currently submitted by paper, the proposed  electronic system will guide veterans through the steps to gather the  necessary evidence in support of their claim and draw information needed  on the form from VBA electronic databases.
VBA also began the Appeals Design Pilot—implemented at a single  regional office—in spring 2012 to expedite appeals processing. The pilot  modifies several program procedures with the goal of decreasing appeals  processing times, according to management at the regional office  conducting the pilot. For example, veterans participating in the pilot do not  file appeals in non-traditional formats. Instead, they use a standardized  Notice of Disagreement form. The pilot also forgoes the election of a  traditional versus a DRO review of an appeal—providing DRO reviews for  all appeals from veterans participating in the pilot. This change  eliminates the need for VBA to wait up to 60 days for a veteran to make  an election on the type of regional office review in an appeal. In addition,  veterans submitting new evidence during the appeal can opt to have their  case expedited directly to the Board without having the regional office  review the additional evidence submitted. In addition to those mentioned  above, the Appeals Design Pilot also has several other elements. For  example, expedited processing is provided to appeals that are filed with  only one or two disabling conditions. Under the pilot, some VSOs are also  waiving the right to a local review of the appeal, but preserving the current  practice of permitting VSOs to review the appeal once it goes before the   From March through June 2012, 2,300 veterans participated in  Board.the pilot. According to VBA, pilot changes have, based on early results,  significantly improved processing times.
section_title: Efforts to Improve Records Acquisition Have Produced Mixed Results
paragraphs: VBA has established efforts to standardize and expedite the process for  acquiring medical records of veterans (see fig. 8). According to a VBA  official, in September 2010, in seven regional offices, VBA began the  Vendors for Private Medical Records initiative, which uses a contractor to  obtain veterans’ medical records from private physicians. According to VBA, as of July 2012, the contactor had obtained 39,662 treatment  records from private medical providers. VBA officials at one site told us  that the contractor is frequently able to communicate with doctors more  quickly because unlike claims staff who are tasked with multiple duties,  the contractor focuses solely on obtaining medical records.
VBA has another effort intended to reduce the amount of time spent  processing medical documentation. Specifically, physicians are asked to  complete Disability Benefits Questionnaires (DBQ), which are  standardized medical forms–downloaded from VA’s website—that are  designed to speed up the evidence gathering process by using check  boxes and standardized language that are intended to more accurately  capture information needed from providers. The DBQ forms have been  available since March 2012, and VBA claims staff at the sites we visited  reported mixed results. For instance, the forms have helped to  standardize the medical evidence gathering process, but regional office  claims staff in four of the regional offices we met with said that some DBQ  forms are quite lengthy, requiring them to scan through multiple pages to  find certain information, which can be time-consuming. Claims staff also  reported that some of the medical terminology used in the forms is not  current, which may make it difficult for providers to complete. VBA  officials said that improvements will be made to the forms when the  agency converts to a paperless claims system, which might make it  easier for claims staff to locate information contained in them. VBA has  begun to track through their performance reporting system the number of  DBQs completed and the completeness of those submitted by physicians,  but is not measuring the initiative’s impact on timeliness.
section_title: Efforts to Redesign Key Aspects of the Process Are Under Way without a Comprehensive Plan
paragraphs: In March 2012, VBA implemented a nationwide initiative that requires  staff to use the Simplified Notification Letter (SNL), a process to  communicate ratings decisions to veterans.the goal of the SNL is to reduce the time it takes claims staff to provide  veterans with claims decisions that are more consistent and easier to  understand. The SNL aims to reduce the time that VA staff spend  composing rating decisions for claims by providing staff with codes that  are associated with template language for rating decisions instead of the  previous practice of composing a free-form narrative for each claims  decision. According to claims staff at each of the regional offices we   According to VBA officials,  visited, SNL has decreased the time it takes to rate claims, but claims  staff in three regional offices told us it created additional steps in  preparing the decision letter sent to the veteran, adding time to the  processing awards phase. Claims staff we interviewed in one regional  office estimated that the time needed to authorize a claim had increased  from 3 minutes to 15 minutes. VBA officials said they have provided  additional guidance to staff experiencing challenges with the SNL. In spite  of these challenges, VBA reports an increase in production in two  regional offices that piloted the SNL initiative.
The Claims Organizational Model initiative is aimed at streamlining the  overall claims process (see fig. 8). For this initiative, VBA created  specialized teams that process claims based on their complexity.  Specifically, an “express team” processes claims with a limited number of  conditions or issues; a “special operations” team processes highly  complex claims, such as former prisoners of war or traumatic brain injury  cases; and a core team works all other claims. Each of these teams is  staffed with both development and ratings staff, which VBA believes will  lead to better coordination and knowledge-sharing. As of August 2012,  VBA had implemented the initiative at 18 regional offices. Under this  model, VBA also redesigned the procedures that mailrooms use to sort  and process incoming claims. According to VBA central office staff, these  changes entail incorporating more experienced claims staff to improve the  process of routing incoming mail to the appropriate team and claims  folder. This change aims to reduce the time it takes for claims-related mail  to be entered into the claims processing systems. VBA tracks the impact  of the claims process model using existing timeliness metrics and  regional office performance measures.
In 2010, VBA began to develop the Veterans Benefits Management  System (VBMS), a paperless claims processing system that is intended to  help streamline the claims process and reduce processing times.  According to VBA officials, VBMS is intended to convert existing paper- based claims folders into electronic claims folders that will allow VBA  employees electronic access to claims and evidence. Once completed,  VBMS will allow veterans, physicians, and other external parties to submit  claims and supporting evidence electronically. VBMS is currently being  piloted in four VA regional offices. Although the most recent VBMS  operating plan calls for national deployment of VBMS to start in 2012,  VBA officials told us that VBMS is not yet ready for national deployment,  citing delays in scanning claims folders into VBMS as well as other  software performance issues. According to VBA officials, the Claims  Organizational Model and VBMS will work together to reduce processing  times and help VA process veterans’ claims within 125 days by 2015.  Although VBMS began its pilot in 2010, VBA has not yet reported on how  VBMS has affected processing times.
These ongoing efforts should be driven by a robust, comprehensive plan;  however when we reviewed VBA’s backlog reduction plan, we found that  it fell short of established criteria for sound planning. Specifically, VBA  provided us with several documents, including a PowerPoint presentation  and a matrix that provided a high-level overview of over 40 initiatives, but  could not provide us with a robust plan that tied together the group of  initiatives, their inter-relationships, and subsequent impact on claims and  appeals processing times. Although there is no established set of  requirements for all plans, components of sound planning are important  because they define what organizations seek to accomplish, identify  specific activities to obtain desired results, and provide tools to help  ensure accountability and mitigate risks. Some of VBA’s planning  documents identify problems, summarize the overall purpose and goals of  the redesign effort, and include some general estimates of project  completion dates for some of the initiatives, as well as identify resources  for managing the overall implementation efforts. However, the planning  documents lack key elements of results-oriented planning. For example,  they do not identify implementation risks or strategies to address them. In  addition, the planning documents do not include performance goals,  measures to assess the effectiveness of each initiative, or their impact on  claims and appeals processing timeliness. VBA officials pointed out to us  the challenges in isolating the impact of any one initiative on processing  times. Nonetheless, sound practices require assessing the effectiveness  of each initiative.
section_title: Conclusions
paragraphs: VA provides a critical benefit to veterans who have incurred disabilities as  a result of their military service. For years, VA’s disability claims and  appeals processes have received considerable attention as VA has  struggled to process disability compensation claims in a timely fashion.  Despite this attention, VA continues to wrestle with several ongoing  challenges—some of which VA has little or no control over—that  contribute to lengthy processing timeframes. For instance, the number  and complexity of VA claims received has increased. And that number is  projected to continue to increase as 1 million servicemembers become  veterans over the next 5 years due to the drawdown of troops from a  decade of conflict in Afghanistan and Iraq. Moreover, the evidence  gathering phase in fiscal year 2011, which took over 5 months (157 days)  on average, continues to worsen in 2012, partly due to difficulties in  obtaining records for National Guard and Reserve and SSA medical  records, according to VBA officials. While recent process and technology  improvements hold some promise, without improved evidence gathering,  VBA may struggle to meet its goal of processing all compensation claims  within its 125 day goal by 2015. Although VBA is attempting to address  processing challenges through various improvement initiatives, without a  comprehensive plan to strategically manage resources and evaluate the  effectiveness of these efforts, the agency risks spending limited resources  on initiatives that may not speed up disability claims and appeals  processes. This may, in turn, result in forcing veterans to continue to wait  months and even years to receive compensation for injuries incurred  during their service to the country.
section_title: Recommendations for Executive Action
paragraphs: We recommend the Secretary of Veterans Affairs direct the Veterans  Benefits Administration to:  1.  Develop improvements for partnering with relevant federal and state  military officials to reduce the time it takes to gather military service  records from National Guard and Reserve sources.  2.  Develop improvements for partnering with Social Security  Administration officials to reduce the time it takes to gather medical  records.  3.  Ensure the development of a robust backlog reduction plan for VBA’s  initiatives that, among other best practice elements, identifies  implementation risks and strategies to address them and performance  goals that incorporate the impact of individual initiatives on processing  timeliness.
section_title: Agency Comments and Our Evaluation
paragraphs: VA provided us with comments on a draft of this report, which are  reprinted in appendix IV. In its comments, VA stated it generally agreed  with our conclusions and concurred with our recommendations, and  summarized efforts that are planned or underway to address the  recommendations. Specifically, VA agreed with our recommendation to  partner with relevant federal and state military officials to develop  improvements to reduce the time it takes to gather military service  records for National Guard and Reservists. VA stated it has recently  initiated several interagency efforts to improve receipt of military service  records. According to VA, on December 3, 2012, the joint VBA and DOD  Disability Claims Reduction Task Force met to begin to evaluate the  process to request records, among other issues, with the aim of  improving the timeliness of record exchanges between the two agencies.  In addition, VA stated that the joint VA-DOD Virtual Lifetime Electronic  Record initiative is focused on developing a complete electronic health  record for each servicemember that will be transmitted to VA upon the  service member’s military discharge, including National Guard and  Reservists. VA identified a targeted completion date of November 2013.   We believe these initiatives are heading in the right direction in order to  improve the timeliness of meeting VA requests for National Guard and  Reservists records.
VA agreed with our recommendation to work with SSA officials to develop  improvements to reduce the time it takes to gather SSA medical records.  VA stated that it is working with SSA to pilot a web-based tool to provide  VA staff a secure, direct communication with SSA staff and to automate  VA’s requests for SSA medical records. VA officials did not mention this  pilot during the course of our data collection and it was not included on  the agency’s list of efforts to improve claims and appeals processing  initiatives provided to us. VA identified a targeted completion date of  November 2013.
VA agreed with our recommendation to develop a robust backlog plan for  VBA’s initiatives that, among other elements, identifies implementation  risks and strategies as well as performance goals that incorporate the  impact of individual initiatives on processing timeliness. VA describes a  number of approaches it has taken to address our recommendation. Most  relevant are the Transformation Plan, which was provided to us during the  data collection phase and which we determined fell short of established  criteria for sound planning, and the Operating Plan, which was not  mentioned during the course of our data collection. According to VA, the  operating plan, currently under development, will focus on: (1) integration  of people, process, and technology initiatives, (2) identification of new  ways to improve efficiency and reengineer the claims process, (3) efforts  to automate the current paper-based claims process, and (4) the  measurement process. However, it is unclear at this time how the key  elements of the operating plan will better position VA to address our  recommendation. Moreover, without further information on how the  operating plan will focus on the measurement process, it is difficult for us  to determine at this time if VA will sufficiently address our  recommendation to include performance goals that incorporate  measuring the impact of individual initiatives to processing timeliness.
As agreed with your office, unless you publicly announce its contents  earlier, we plan no further distribution of this report until 28 days from its  issue date. At that time, we will send copies of this report to the  appropriate congressional committees, the Secretary of Veterans Affairs,  and other interested parties. In addition, the report will be made available  at no charge on GAO’s website at http://www.gao.gov.
If you or your staff have any questions about this report, please contact  me at (202) 512-7215 or bertonid@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff who made key contributions to this  report are listed in appendix V.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: This report examines the (1) factors that contribute to lengthy processing  times for disability claims and appeals at the Department of Veterans  Affairs (VA) and (2) status of the Veteran Benefits Administration’s (VBA)  recent efforts to improve disability claims and appeals processing  timeliness.
To examine factors that contribute to lengthy processing times for  disability claims and appeals, we reviewed past GAO and VA Office of  Inspector General (OIG) reports and other relevant studies on VA’s  claims and appeals processing, such as the Veterans’ Disability Benefits  Commission’s 2007 report, Honoring the Call to Duty: Veterans’ Disability  Benefits in the 21st Century. We reviewed congressional testimonies,  federal statutes, relevant court decisions, and policy manuals and  documents, including VA’s Web Automated Reference Manual System to  understand the program rules and procedures that govern the claims and  appeals processes. We also analyzed disability compensation and  pension rating claims processing data from VBA’s internal dashboard and  data on claims processing resources from VBA’s Personnel and  Accounting Integrated Database. Moreover, we interviewed VBA officials,  including VBA area directors, the Office of Field Operations,  Compensation Service, and the Office of Performance Analysis and  Integrity to gain a national perspective on factors affecting the timeliness  of claims and appeals processing. To identify factors within VA regional  offices that contribute to lengthy processing times, we conducted reviews  of five VA regional offices—Atlanta, Georgia; Houston, Texas; Los  Angeles, California; New York, New York; and Philadelphia,  Pennsylvania. These reviews consisted of interviewing regional office  management and claims processing staff and supervisors, reviewing  workload management and performance documents, and reviewing  written notifications sent to veterans. We did not conduct case file reviews  in these regional offices. We also spoke with representatives of Veterans  Service Organizations (VSO) in Los Angeles and in Washington, D.C. to  gather perspectives of veterans’ representatives on challenges in the  claims and appeals processes.
To examine the status of VBA’s recent efforts to improve disability claims  and appeals processing timeliness, we reviewed past GAO and VA OIG  reports and congressional testimonies. We conducted interviews with  officials from the VBA Implementation Center, Office of Strategic Planning  and Office of Field Operations. Also, during our review of five VA regional  offices, we interviewed claims and appeals processing staff about their  experiences with VBA’s initiatives. To identify which VBA efforts were  designed to improve timeliness, we reviewed documents providing an  overview of the efforts, which included documentation identifying the  purpose of each effort. We requested additional information for those  initiatives that VBA identified as having the purpose of reducing disability  claims and appeals processing times. Furthermore, we selected a sample  of nine of VBA’s efforts identified as having the purpose of reducing  disability claims and appeals processing times for further review primarily  based on interviews with VBA officials and a review of recent VA  testimonies. In addition, we spoke with representatives of national VSOs  to gather their perspectives on the impact on the veterans they represent  of recent and ongoing efforts. (For more information on VBA’s  improvement efforts, see appendix III).
subsections: section_title: Analysis of VBA Claims and Appeals Processing Timeliness and Resource Data
paragraphs: To assess VBA disability claims workload and processing timeliness, we  obtained monthly regional office and national data from VBA’s internal  dashboard, which aggregates key metrics used to assess performance  from a variety of data sources into one integrated tool. We limited our  analysis to timeliness and workload metrics used to measure the  performance of the disability compensation and pension rating claims and  appeals processing. We analyzed data from fiscal year 2009 through  August 2012. To verify the reliability of VBA’s internal dashboard, we  conducted interviews with officials from VBA’s Office of Performance  Analysis and Integrity about quality control procedures of VBA’s internal  dashboard and practices used to extract timeliness and workload data  from underlying data sources. We relied on past GAO data reliability  assessments on the Veterans Services Network (VETSNET) system and  accompanying VETSNET Operations Reports (VOR), and the Veterans  Appeals Control and Locator System (VACOLS), where enterprise-wide  workload and timeliness of claims and appeals processing data,  respectively, are stored and extracted into the internal dashboard tool.  We found the dashboard data to be reliable for reporting regional office  and national workload and timeliness trends.
To analyze VBA’s claims and appeals processing resources, we obtained  data from VA’s Personnel and Accounting Integrated Database and  accompanying ProClarity system. We limited our analysis to data on VBA  job titles that typically include claims or appeals processing  responsibilities—Veterans Service Representatives (VSR), Rating  Veterans Service Representatives (RVSR), and Decision Review Officers  (DRO)—from fiscal years 2009 through 2012. We reviewed data on full- time equivalents (FTE), number of employees, and personnel actions. To  assess the reliability of these data, we interviewed officials in VBA’s  Office of Human Resources about practices to record personnel actions,  quality control procedures conducted within the Office of Human  Resources to ensure the quality of the data, as well as potential  limitations to the data. We found the data provided to us by the Office of  Human Resources reliable for reporting on claims and appeals  processing resources.
section_title: Selection of VA Regional Offices for Review
paragraphs: We selected five VA regional offices for review to gather information on  the challenges these selected regional offices face in not only processing  disability claims and appeals in a timely fashion, but also in implementing  initiatives designed to address processing timeliness. Our five selected  sites, which account for 15 percent of all disability compensation and  pension rating claims, were Atlanta, Georgia; Houston, Texas; Los  Angeles, California; New York, New York; and Philadelphia,  Pennsylvania. We conducted site visits with the Los Angeles,  Philadelphia, and Atlanta regional offices and teleconferences with the  New York and Houston regional offices.
We selected regional offices for review based on the following criteria:
Geography: We selected at least one VA regional office in each of  VBA’s four areas. The New York and Philadelphia regional offices are  in the Eastern Area, Atlanta is in the Southern Area, Houston is in the  Central Area, and Los Angeles is in the Western Area.
Size of metropolitan area: We limited our selection process to  regional offices in the Top 15 Metropolitan Statistical Areas (MSA)  according to 2010 Census data, due to concerns about the ability of  these offices to recruit and retain staff and upper management.
Workload: We selected VA regional offices with medium or high  disability compensation and pension rating claims workloads. All  regional offices in the top 15 MSAs had more than 10,000 disability  compensation and pension rating claims pending. According to VBA’s  internal dashboard, the median regional office had 8,850 disability  compensation and pension rating claims pending as of April 2012.  The sites we selected had workloads ranging from 15,874 to 37,805  pending disability compensation and pension rating claims in April  2012.
Timeliness: To examine the timeliness of claims processing at VA  regional offices, we examined two metrics: the percentage of  backlogged disability compensation and pension rating claims— defined as claims pending over 125 days–and the average number of  days a disability compensation and pension rating claim was pending.  According to VBA’s internal dashboard, 65.6 percent of disability  compensation claims nationally were pending over 125 days in April  2012. For the regional offices we selected, the percent of backlogged  claims ranged from 61.6 percent to 79.9 percent. Claims were  pending an average 243.2 days nationally. For the regional offices we  selected, the average days pending ranged from 219.6 days to 325.3  days.
We conducted this performance audit from March 2012 through  December 2012 in accordance with generally accepted government  auditing standards. Those standards require that we plan and perform the  audit to obtain sufficient, appropriate evidence to provide a reasonable  basis for our findings and conclusions based on our audit objectives. We  believe that the evidence obtained provides a reasonable basis for our  findings and conclusions based on our audit objectives.
section_title: Appendix II: Veteran Notification during the Claims and Appeals Processes
paragraphs: After VBA receives a disability claim, it generally sends notifications to  veterans to either help gather evidence or to let them know that a  decision has been made (see fig. 9). Throughout the claims process, VBA  sends a standard form letter at the 60-, 120-, and 180-day marks, as  applicable, to inform the veteran that VBA has received the claim and that  the claim is still pending. During the initiating development phase, VBA  sends the Veteran Claims Assistance Act (VCAA) letter acknowledging  receipt of the claim, explaining the claims process, and outlining what  additional information is needed and what steps VBA will take to  substantiate the claim. Much of the notification to veterans occurs during  the evidence gathering phase. During this phase, VBA sends the veteran  a notification every time VBA makes an attempt to obtain additional  evidence or when attempts to obtain evidence have been unsuccessful.  Finally, at the end of the award processing phase, a decision letter is sent  to the veteran.
During the appeals process, VBA generally reaches out to veterans when  additional evidence or the veteran’s input is needed, or to announce and  explain a decision. The appeals process generally begins when a veteran  disagrees with VA’s decision on their disability claim, and files a Notice of  Disagreement (see fig. 10). If the veteran does not specify the type of  review in the Notice of Disagreement, VBA sends an election letter that  details the differences between a traditional and DRO review and asks  the veteran to choose a review process. Once a veteran indicates the  type of review desired, VBA sends a process letter that explains the  review process chosen and details the veteran’s rights throughout the  appeals process. Then, if additional evidence is needed to make a  decision, such as ordering another Veterans Health Administration (VHA)  examination, VBA sends notifications to the veteran throughout the  evidence gathering process, similar to the initial claims process. Once all  additional evidence is gathered, VBA will review the case. If VBA grants  the appeal in full, a decision letter is sent. If VBA denies the appeal or  does not grant the appeal in full, it sends a Statement of the Case (SOC)  explaining the decision. At this point, the veteran has the option to send in  additional evidence, which VBA must consider, and if this evidence does  not lead to a full grant, then VBA must send a Supplemental Statement of  the Case (SSOC) explaining their decision.
In addition to receiving written notifications during the claims and appeals  processes, veterans can proactively learn about the status of their claims  in several ways. For example, veterans can use eBenefits, a website that  VA and the Department of Defense launched in 2009 to help  servicemembers and veterans manage their benefits and personal  information. Veterans can also speak with staff in VA’s national call center  or can contact VA through VA’s web-based Inquiry Routing and  Information System (IRIS). Veterans can also visit a VA regional office to  speak with VA public contact staff.
section_title: Appendix III: Selected VBA Efforts to Improve Claims and Appeals Timeliness
paragraphs: According to VBA, there are currently over 40 ongoing improvement  efforts that are tracked by VBA’s Implementation Center. Below is a list of  15 improvement efforts we identified as having a stated purpose of  improving timeliness of claims or appeals processing, based on a review  of VA documents and interviews with VBA officials.
section_title: Appendix IV: Comments from the Department of Veterans Affairs
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Brett Fallavollita (Assistant  Director); Lucas Alvarez; Michelle Bracy; and Ryan Siegel made key  contributions to this report. In addition, key support was provided by  James Bennett, Robert Campbell, Susan Chin, James Rebbe, Almeta  Spencer, Kathleen van Gelder, and Walter Vance.
section_title: Related GAO Products
paragraphs: VA Disability Compensation: Actions Needed to Address Hurdles Facing  Program Modernization. GAO-12-846. Washington, D.C.: September 10,  2012.
VA Enhanced Monthly Benefits: Recipient Population Is Changing, and  Awareness Could Be Improved. GAO-12-153. Washington, D.C.:  December 14, 2011.
Veterans Disability Benefits: Clearer Information for Veterans and  Additional Performance Measures Could Improve Appeal Process.  GAO-11-812. Washington, D.C.: September 29, 2011.
Information Technology: Department of Veterans Affairs Faces Ongoing  Management Challenges. GAO-11-663T. Washington, D.C.: May 11,  2011.
GAO’s 2011 High-Risk Series: An Update. GAO-11-394T. Washington,  D.C.: February 17, 2011.
Veterans’ Disability Benefits: Expanded Oversight Would Improve  Training for Experienced Claims Processors. GAO-10-445. Washington,  D.C.: April 30, 2010.
Veterans’ Disability Benefits: Further Evaluation of Ongoing Initiatives  Could Help Identify Effective Approaches for Improving Claims  Processing. GAO-10-213. Washington, D.C.: January 29, 2010.
Social Security Disability: Additional Outreach and Collaboration on  Sharing Medical Records Would Improve Wounded Warriors’ Access to  Benefits. GAO-09-762. Washington, D.C.: September 16, 2009.
Veterans’ Benefits: Increased Focus on Evaluation and Accountability  Would Enhance Training and Performance Management for Claims  Processors. GAO-08-561. Washington, D.C.: May 27, 2008.
Veterans’ Disability Benefits: Claims Processing Challenges Persist, while  VA Continues to Take Steps to Address Them. GAO-08-473T.  Washington, D.C.: February, 14, 2008.