VA’s process for deciding veterans’ eligibility for disability compensation begins when a veteran submits a claim to VA. The claim is reviewed at one of VBA’s 56 regional offices where staff members assist the veteran by gathering any additional evidence, such as military and medical records, needed to evaluate the claim. Based on this evidence, and the results of any necessary medical examinations, VBA decides whether the veteran is entitled to compensation and, if so, how much. VBA assigns a rating of 0 to 100 percent disability in increments of 10 percentage points depending on the severity of the disability. This rating percentage then determines the monthly payment amount the veteran will receive. According to VA data, in many cases (74 percent), the veteran submitting a claim either is already a beneficiary but is seeking increased compensation, or the veteran was denied benefits previously and is claiming them again. In fiscal year 2015, VBA decided 1.4 million compensation claims and had an inventory of 363,000 claims at the end of the fiscal year. As previously noted, in fiscal year 2015, VA paid about $63.7 billion in disability compensation to about 4.1 million veterans. A veteran dissatisfied with VBA’s initial claim decision can generally appeal within one year from the date of VBA’s notification letter to the veteran. According to the Board, veterans appeal most often because they believe VBA: (1) incorrectly denied them compensation for service- connected disabilities, or (2) under-rated their service-connected disabilities. An appeal begins with the veteran filing a Notice of Disagreement (NOD). VBA then re-examines the case and generally issues a Statement of the Case (SOC) that represents its decision. A veteran who is or remains dissatisfied with VBA’s decision can file an appeal with the Board. In filing that appeal, the veteran could indicate whether they would like a Board hearing. VBA prepares the claim file for Board review and certifies it as ready for review. If the veteran requests a hearing so they can present new evidence or arguments, the Board will generally hold a hearing either by video conference or at a local VBA regional office. The Board reports to the Office of the Secretary of Veterans Affairs, and is independent of VBA. The Board’s members, also known as Veterans Law Judges (VLJ), decide appeals and are supported by attorneys and administrative staff. After the appeal is docketed at the Board, a VLJ or panel of VLJs reviews the evidence and either (1) grants the claimed benefit, (2) denies the benefit, or (3) returns (remands) the claim to VBA for additional work on one or more issues pertinent to the claim and a new decision. According to VA, the Board remands an appeal to VBA in cases where consideration of new evidence, clarification of evidence, correction of procedural defect, or any other action it deems is essential to achieve a proper decision. If the veteran is unsatisfied with the Board’s final decision, the veteran can continue an appeal beyond VA to federal court. Such an appeal begins with the U.S. Court of Appeals for Veterans Claims, then may go to the U.S. Court of Appeals for the Federal Circuit, and finally to the U.S. Supreme Court. See figure 1 for a representation of the appeals process for VA disability compensation benefit decisions. According to VA officials, the number of appeals filed has increased steadily as has the length of time needed for the agency to make a final decision. At the end of fiscal year 2015, according to VA data, VA had over 427,000 pending appeals, approximately 81,000 of which were at the Board. While the percentage of pending appeals awaiting decisions from the Board was less than a quarter of all pending appeals, the fiscal year 2015 inventory was almost double the 41,000 pending at the end of fiscal year 2011. About 20 percent of this growth occurred from fiscal year 2014 through 2015. According to Board data, timeliness has worsened since fiscal year 2011 as well. From fiscal years 2011 through 2015, the average amount of time needed for the Board to make a final decision once the appeal is docketed increased from 240 to 270 days. In addition, the proportion of cases taking the longest to resolve (from when the Board receives the certified appeal to them making a final decision)—over 600 days— increased from 10 percent in fiscal year 2011 to 14 percent in fiscal year 2015 (see fig. 2). Given that the median time for the Board to decide an appeal was 145 days in fiscal year 2015 (compared to an average of 270 days), these data suggest that a relatively small number of appeals is driving up the Board’s reported average processing times. To illustrate, VA officials noted one case where a veteran appealed 27 times over the course of 25 years before the original appeal was concluded. VA has identified three broad approaches for addressing factors that it identified as having contributed to increased appeal inventories and reduced timeliness of appeals decisions, and has already taken action on all three fronts. Citing staffing levels that have not kept pace with workloads, VA secured additional Board staff for fiscal year 2017, and analyzed options for another hiring surge in fiscal 2018. Concerned that its appeals process contributes to delays in appeals decisions—because new evidence may be submitted at any juncture and because VA may be continually required to develop or obtain additional evidence—VA developed a legislative proposal for streamlining its appeals process, including new appeals options designed to accelerate decision-making. Finally, VA has put forth plans to modernize its current, outdated, and inefficient computer system. VA has proposed increasing staff at the Board, as well as VBA, to manage its increasing inventory of appeals and to address related declines in the timeliness of appeals resolutions. VA officials stated that there is a direct and proportional correlation between the number of employees and the number of final appeals decisions, and that Board workloads especially have increased faster than the number of employees staffed to the Board. Specifically, officials have concluded that staff resources within the Board have not been sufficient to adjudicate the increasing number of appeals, ultimately lengthening appeals resolution times. According to VA, in fiscal year 2015 increases in staff (VLJs, attorneys, and support staff), as represented by full-time equivalents (FTEs), allowed the Board to make the highest number of decisions in nearly 30 years. However, despite Board staff increasing by 21 percent from fiscal years 2011 through 2015, officials said that this increase was not sufficient to address the growing inventory of pending appeals, which doubled during the same time period (see fig. 3). Although the increase in Board staff brought about a record number of appeals decisions in fiscal year 2015, according to VA data we reviewed, each appeal took an average of about 3 months (97 days) longer to reach a final decision than in fiscal year 2012. Similarly, in fiscal year 2015 one Board FTE produced an average of 86 appeals decisions, down from 91 completed per FTE in fiscal year 2011. Growing workloads and the increased complexity of cases, according to Board officials, have contributed to these longer appeal resolution times. More specifically, officials said that claims have become more complicated due to not only the number and complexity of injuries and illnesses, but also to advances in medicine that have improved survival rates from catastrophic injuries, experienced by today’s veterans. VA officials estimated that if the number of FTEs and number of appeals decided per FTE stays steady or decreases, appeals resolution times will continue to lengthen. Specifically, as of October 2016, VA projected that if nothing else changes, and if the number of FTEs hold steady at the fiscal year 2017 number (922 FTEs for the Board and 1,495 for VBA), the inventory of appeals could exceed 1 million in fiscal year 2026, which would mean that veterans would wait an average of 8.5 years for a final appeals decision. In light of this assessment, VA concluded that increasing the number of FTEs at the Board is a key step in mitigating the current and future pending inventory of appeals and ultimately improving appeals decision timeliness. In 2016, VA set a goal to decide the vast majority (90 percent) of appeals (including both those reviewed by VBA and the Board) within 1 year by 2021. As an initial step toward this goal, VA requested and received a funding amount that the agency asserted would allow it to fund an additional 242 FTEs for the Board in fiscal year 2017 (a 36 percent increase over the 680 FTEs funded in fiscal year 2016) for a total of 922 FTEs. VA also concluded, however, that this increase in staff will not be enough to reduce its appeals workload and decrease appeals processing time. Therefore, VA estimated the need for a subsequent hiring surge of up to 1,458 FTEs beginning in fiscal year 2018 to reduce the current pending appeals inventory. To understand the need for and implications of a future hiring surge, VA modeled different staffing scenarios. Initially, VA compared how increasing staff in combination with and without proposed changes to the appeals process would achieve inventory reductions, and at what cost. VA determined that by combining staff increases with a new process, it could clear pending appeals faster and at a lower cost than if it hired additional staff under the current process. In response to congressional inquiries, in September 2016 VA also modeled the cost and impact on appeals inventories of four surge options beginning in fiscal year 2018 (in addition to planned hiring in fiscal year 2017). VA estimated, for example, that projected pending appeals in fiscal year 2017 (535,726) would be cleared in 10 years under option 2, compared to a 60 percent reduction over the same time period if there were no hiring surge. See table 1 for a comparison of the four options. VA has proposed changes to its appeals process to address causes of delays in resolving appeals.