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Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans (2019)

Chapter: Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims

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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans’ Disability Claims

TABLE N-1 Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans’ Disability Claims

Title (Year) Purpose of Report Findings Recommendations
Opportunities Exist to Better Ensure Successful Appeals Reform (2018) The Veterans Appeals Improvement and Modernization Act of 2017 makes changes to the VA’s current (legacy) appeals process, giving veterans new options to have their claims further reviewed by VBA or appeal directly to the board. The act requires the VA to submit to Congress and GAO a plan for implementing a new appeals process, and includes a provision for GAO to assess the VA’s plan. This testimony focuses on the extent to which the VA’s plan (1) addresses the required elements in the act and (2) reflects sound planning practices identified in prior GAO work. The VA’s plan for implementing a new disability appeals process while attending to appeals in the current process addresses most, but not all, elements required by the Veterans Appeals Improvement and Modernization Act of 2017. The VA’s appeals plan addresses 17 of 22 required elements, partially addresses 4, and does not address 1. For example, not addressed is the required element to include the resources needed by the Veterans Benefits Administration (VBA) and the Board of Veterans’ Appeals to implement the new appeals process and address legacy appeals under the current process. The VA’s appeals plan reflects certain sound planning practices, but it could benefit from including important details in several key planning areas: performance measurement, project management, and risk assessment. GAO recommends that the VA:
  • Fully address all legally required elements in its appeals plan
  • Articulate how it will monitor and assess the new appeals process as compared to the legacy process
  • Augment its master schedule for implementation
  • More fully address risk
(See Some Progress, But Further Steps Needed to Improve Appeals Reform Planning for the VA’s Progress)
Some Progress, But Further Steps In March 2018, GAO found that the VA could help ensure successful Since the March 2018 report, the VA has updated its plan and taken some steps to address aspects of
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
Needed to Improve Appeals Reform Planning (2018) implementation of appeals reform by addressing gaps in planning and made four recommendations, with which the VA agreed (See Opportunities Exist to Better Ensure Successful Appeals Reform). This testimony focuses on the steps the VA has taken to address GAO’s recommendations and what aspects remain unaddressed. these recommndations, but further steps are needed:
  • Address all legally required elements. GAO reported that the VA’s plan did not address one and only partially addressed four of 22 elements required by the Veterans Appeals Improvement and Modernization Act of 2017, and it recommended that the VA fully address them all. In a May 2018 update to its plan, the VA took steps to address the five elements, such as developing productivity projections and a model to forecast resource needs for processing appeals. These steps address one element related to projecting productivity and partially address the four remaining elements.
  • Articulate performance measurement. GAO also recommended that the VA clearly articulate how it will monitor and assess the new appeals process relative to the legacy process. This recommendation includes specifying timeliness goals for five new appeals options to be made available to veterans as well as additional goals or measures of performance, such as accuracy in processing appeals. The VA’s updated plan states that the agency will develop goals and measures for all appeals options after fully implementing appeals reform. Contrary to sound planning practices, it does not articulate these performance goals and measures now, which would provide a vision for what successful implementation would look like. Lacking this vision, the VA does not have an “end state” to guide its implementation and help establish accountability.
  • Augment project plan. GAO recommended that the VA augment its master schedule for
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
  • implementing appeals reform to include all key activities and reflect other sound practices for guiding implementation and establishing accountability. Although the VA’s May 2018 updated master schedule added activities, it omitted a pilot test of the new Board of Veterans’ Appeals options. More generally, the plan does not reflect interdependencies among activities. Until all key activities are accounted for and the master schedule reflects sound practices, the VA cannot provide reasonable assurance that it has the essential information needed to manage its appeals reform implementation.

  • Address risk fully. GAO recommended that the VA’s appeals plan more fully address risks in implementing a new process by, for example, testing all appeals options prior to full implementation. In its updated plan, the VA stated it will pilot all five new appeals options. By taking these steps, the VA should be better positioned to assess implementation risks. However, the updated plan does not have well-defined, measurable criteria for assessing lessons learned from these pilots and does not articulate how well these lessons translate to a broader context. Taking these steps would improve the VA’s ability to assess and mitigate risks as it implements its reforms.
Preparations for Transitioning to a New Electronic Health Record System Are Ongoing (2018) The VA relies on its health information system, the Veterans Health Information Systems and Technology Architecture (VistA), to provide health care services. However, the system is more than 30 years old, is costly to maintain, and does not support GAO’s preliminary results indicate that the VA is working to define VistA and identify system components to be replaced by the new system. However, according to VA officials, there is no single information source that fully defines the scope of VistA. This situation is partly due to differences in VistA at various facilities. In the absence of a complete definition of VistA, program In 2011, GAO reported on nine common factors critical to the success of major information technology (IT) acquisitions. Such factors include ensuring the active engagement of senior officials with stakeholders
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
interoperability with DoD and private health care providers. Since 2001, the VA has pursued multiple efforts to modernize the system. In June 2017, the VA announced plans to acquire the same system—the Cerner system—that DoD is implementing. GAO summarizes observations from its ongoing review of VistA. officials have taken a number of steps to define the system’s scope and to identify the components that the new system will replace. These steps have included conducting analyses, performing preliminary site (medical facility) assessments, and planning for a detailed assessment of each site where the new system will be deployed. and having qualified, experienced program staff. These critical success factors can serve as a model of best practices that the VA could apply to enhance the likelihood that the acquisition of a new electronic health record system will be successfully achieved.
Better Data and Evaluation Could Help Improve Physician Staffing, Recruitment, and Retention Strategies (2017) This report addresses (1) VHA data on how many mission-critical physicians provide care, (2) the extent to which VHA measures the workload and productivity of mission-critical physicians; and (3) what evaluations have been done on the effectiveness of VHA’s recruitment and retention strategies for all physicians. GAO identified the following issues:
  • Incomplete information on the number of physicians. VHA is unable to accurately count the total number of physicians who provide care in its VA medical centers (VAMCs). VHA has data on the number of mission-critical physicians it employs (more than 11,000) and on those physicians who serve on a fee-basis (about 2,800). However, VHA lacks data on the number of contract physicians and physician trainees. Five of the six VAMCs in GAO’s review used contract physicians or physician trainees to meet their staffing needs, but VHA has no information on the extent to which VAMCs nationwide use these arrangements.
  • Inconsistent productivity data. VHA measures productivity for some mission-critical physician occupations; however, mental health departments receive conflicting sets of productivity metrics from two VHA offices—the Office of Productivity, Efficiency, and Staffing and the Office of Mental Health Operations. VHA officials said that the two offices use differing data to serve different purposes and acknowledged that while information on how to interpret the two sets of productivity
GAO makes five recommendations, including that the VA develop a process to count all physicians, provide guidance on productivity measurement, and evaluate its physician recruitment and retention strategies. The VA concurred with four of the five recommendations, but not with the one to accurately count all physicians, stating that its workforce assessment tools are sufficient. However, GAO maintains that this is essential for effective workforce planning.
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
  • data is available, VAMC officials may find the data confusing.

  • Lack of a comprehensive evaluation of its recruitment and retention strategies. VHA has not evaluated the effectiveness of its physician recruitment and retention strategies.
Additional Planning Would Enhance Efforts to Improve the Timeliness of Appeals Decisions (2017) This report examines the VA’s approaches to address the challenges it identified as contributing to lengthy appeals processing times and the extent to which those approaches are consistent with sound planning practices. The VA has taken actions related to increasing staff, reforming the process, and updating IT, which are consistent with relevant sound planning practices. However, gaps in planning exist, thereby reducing the agency’s ability to ensure that these actions will improve the timeliness of disability appeals decisions.
  • Increase staff: The VA determined that staff resources have not sufficiently kept pace with increased pending appeals and concluded that additional staff are needed, particularly at the board, to improve timeliness and reduce its appeals inventory. The board received approval to hire more staff in fiscal year 2017, and it expects to need an additional hiring surge beginning in fiscal year 2018. As of October 2016, officials estimated that if the agency does not take any action, such as increasing staff in 2018, veterans may have to wait an average of 8.5 years by fiscal year 2026 to have their appeals resolved.
    Consistent with sound workforce planning practices, the VA modeled different options for increasing staff levels to support its conclusion that staff increases in conjunction with process change would reduce the appeals inventory sooner.
    However, contrary to sound practices, the VA often used fixed estimates for key variables in its models—such as staff productivity—rather than a range of estimates (sensitivity analysis) to
GAO made five recommendations to the VA:
  • Apply sensitivity analyses when projecting staff needs,
  • Develop a more timely and detailed workforce plan,
  • Develop a robust plan for monitoring process reform,
  • Develop a strategy for assessing process reform, and
  • Create a schedule for IT improvements that takes into account the plans for potential process reform.
The VA concurred in principle with the five recommendations, but it believes it has met the intent of those recommendations and does not need to take additional action. GAO disagrees and—while recognizing VA’s ongoing efforts—believes further
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
  • understand the effect that variation in these key variables could have on staffing needs.

  • Reform process: The VA determined that new evidence—which a veteran can submit at any point during his or her appeal—inefficiently causes an additional round of reviews and thus delays appeals decisions, and in response it proposed legislation (not enacted) to streamline the process. Consistent with sound practices for process redesign, the VA worked with veterans service organizations (VSOs) and other key stakeholders in developing the proposal and continued to update VSOs about the development of its implementation plans.
action is needed on all five recommendations to improve VA’s ability to successfully implement reforms, as discussed in the report.
Improvements Needed for VA to Better Understand, Process, and Communicate Decisions on Claims (2017) Recently, questions have been raised about whether the VA is processing GWI (Gulf War illness) claims correctly. GAO was asked to review the VA’s handling of these claims. This report examines (1) recent trends in GWI disability claims, (2) challenges associated with accurately processing and clearly communicating decisions on GWI claims, and (3) how the VA uses GWI research to inform the disability compensation program. The VA’s ability to accurately process GWI claims is hampered by inadequate training, and its decision letters for denied claims do not communicate key information to veterans. The VA claims rating staff often rely on VA medical examiners to assess a veteran’s disability before a decision can be made on a claim. VA medical examiners told GAO that conducting Gulf War general medical exams is challenging because of the range of symptoms that could qualify as GWI. The VA has developed elective GWI training for its medical examiners, but only 10 percent of examiners had taken the training as of February 2017. Federal internal control standards call for adequate training for staff so they can correctly carry out an agency’s procedures. Medical examiners who do not take this GWI-specific training may not be able to provide the information that VA staff need to correctly decide whether to grant a veteran’s claim. Once a determination is made, VA regulations also require clear GAO recommends that VHA:
  • Require medical examiners to complete training, such as the 90-minute GWI web-based course, before conducting these exams.
  • Provide more complete information to veterans whose GWI claims are denied, and
  • Document a plan to develop a single case definition of GWI. This plan should include near- and long-term specific actions, such as analyzing and leveraging information in existing datasets and identifying any areas for future
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
explanations to veterans regarding claim decisions. GAO found that decision letters for GWI claims do not always include key information on why the claim was denied.

research to help the VA achieve this goal.

Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems (2017) The use of IT is crucial to helping the VA effectively serve the nation’s veterans, and each year the department spends over $4 billion on IT. However, over many years the VA has had difficulty managing its information systems. This statement summarizes results from key GAO reports related to increasing electronic health record interoperability between the VA and DoD; system challenges that have contributed to GAO’s designation of VA health care as a high-risk area; and the VA’s development of its system for processing disability benefits, data center consolidation, and legacy systems. GAO noted in July 2016 that the VA had moved forward with an effort to modernize its health information system, VistA, but that the department is uncertain of its long-term plan for addressing its electronic health record system needs beyond fiscal year 2018. Beyond modernizing VistA, GAO reported in August 2015 that the VA and DoD had not identified outcome-oriented goals and metrics to clearly define what they aim to achieve from their efforts to increase electronic health record interoperability (i.e., the electronic exchange and use of health records) between the two departments. Moreover, the VA has begun to modernize VistA separately from DoD’s planned acquisition of a commercially available electronic health record system, even though both departments have many health care business needs in common. GAO has made numerous recommendations to the VA to improve the modernization of its IT systems. For example, GAO has recommended that the VA develop goals and metrics for determining the extent to which its modernized electronic health record system is achieving interoperability with DoD’s; to address challenges associated with modernizing its scheduling system; to address shortcomings with VBMS planning and implementation; to take actions to improve progress in data center optimization; and to modernize or replace obsolete legacy IT systems.
Improvements Needed in Data and Monitoring of Clinical Productivity and Efficiency (2017) Beginning in fiscal year 2013, the VA began implementing clinical productivity metrics to measure physician providers’ time and effort to deliver various procedures in 32 clinical specialties. In addition, the VA developed 12 statistical models to measure clinical efficiency at the VA’s medical centers (VAMCs). Limitations with the VA’s metrics and models:
  • Productivity metrics are not complete because they do not account for all providers or clinical services. Due to systems limitations, the metrics do not capture all types of providers who deliver care at VAMCs, including contract physicians and advanced practice providers, such as nurse practitioners, serving as sole providers. The VA central office officials explained that the VA data
To improve the completeness of the VA’s productivity metrics, we recommended that the VA expand existing productivity metrics to track the productivity of all providers of care to veterans by, for example, including contract physicians who are
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
Under the models, the VA calculates each VAMC’s use and expenditures for different high-volume or high-expenditure components of health care delivery, such as emergency department and urgent care, and determines the extent to which use and expenditures differ from expected levels.
This testimony addresses (1) whether the VA’s clinical productivity metrics and efficiency models provide complete and accurate information on provider productivity and VAMC efficiency and (2) the VA’s efforts to monitor and improve clinical productivity and efficiency.
  • system limitations and other factors have made it difficult for the VA’s productivity metrics to capture the workload for all types of providers.

  • Productivity metrics may not accurately reflect the intensity of clinical workload. A 2016 VA audit shows that VA providers do not always accurately code the intensity of—that is, the amount of effort needed to perform—clinical procedures or services. As a result, the VA’s productivity metrics may not accurately reflect provider productivity, as differences between providers may represent coding inaccuracies rather than true productivity differences.
  • Productivity metrics may not accurately reflect providers’ clinical staffing levels. Officials at five of the six selected VAMCs we visited reported that providers do not always accurately record the amount of time they spend performing clinical duties, as distinct from other duties. The VA’s productivity metrics are calculated for providers’ clinical duties only.
  • Efficiency models may also be adversely affected by inaccurate workload and staffing data. To the extent that the intensity and amount of providers’ clinical workload are inaccurately recorded, some of the VA’s efficiency models examining VAMC use and expenditures may also be inaccurate.
not VA employees as well as advanced practice providers acting as sole providers. In addition, to improving the accuracy of the VA’s productivity metrics and efficiency models, we recommended that the VA help ensure the accuracy of underlying workload and staffing data by, for example, developing training for all providers on coding clinical procedures. The VA agreed in principle with our recommendations but did not provide information on how it plans to make improvements.
Ongoing Efforts Can Be Improved; Goals Are Needed to Promote Increased User Satisfaction (2016) This statement summarizes GAO’s September 2015 report (GAO-15-582) on (1) the VA’s progress toward completing the development and implementation of the VBMS and (2) the extent to which users report satisfaction with the system. As GAO reported in September 2015, VBA has made progress in developing and implementing the VBMS, with deployment of the initial version of the system to all of its regional offices as of June 2013. Since then, VBA has continued developing and implementing additional system functionality and enhancements that support the electronic processing of disability compensation claims. As a Three areas could benefit from increased management attention:
  • Cost estimating: The program office does not have a reliable estimate of the cost for completing the system. Without such an estimate,
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
result, 95 percent of records related to veterans’ disability claims are electronic and reside in the system. However, VBMS is not yet able to fully support disability and pension claims or appeals processing. While the Under Secretary for Benefits stated in March 2013 that the development of VBMS was expected to be completed in 2015, the implementation of functionality to fully support electronic claims processing has been delayed beyond 2015. In addition, VBA has not yet produced a plan that identifies when the system will be completed. Accordingly, holding the VA management accountable for meeting a time frame and for demonstrating progress will be difficult.
  • VA management and the department’s stakeholders have a limited view of the system’s future resource needs

  • System availability: Although VBA has improved its performance for ensuring the system is available to users, it has not established system response time goals.
  • System defects: While the program has actively managed system defects, a recent system release included unresolved defects that affected system performance and users’ experiences.
Ongoing Development and Implementation Can Be Improved; Goals Are Needed to Promote Increased User Satisfaction (2015) GAO (1) assessed the VA’s progress toward completing the development and implementation of VBMS and (2) determined to what extent users report satisfaction with the system. To do so, GAO reviewed relevant program documentation, administered a survey to a stratified random sample of about 3,500 users, and interviewed appropriate VA officials. VBA has made progress in developing and implementing the VBMS, with deployment of the system to all of its regional offices as of June 2013. While 95 percent of records related to veterans’ disability claims are electronic and reside in the system, additional capabilities have not yet been completed, such as automation of the steps associated with a veteran’s request for an increase in benefits. Furthermore, VBA has not yet developed and implemented pension processing capabilities in VBMS, nor has it articulated when the system will support appeals processing. See Ongoing Efforts Can Be Improved; Goals Are Needed to Promote Increased User Satisfaction (2016)
Improvements Could Further Enhance Quality This report evaluates (1) the extent to which VBA effectively measures and reports the accuracy of its disability compensation claim VBA’s dual approach for measuring accuracy is designed to provide additional information to better target quality improvement efforts, but its methods and practices lack rigor and transparency, thereby Leverage appropriate expertise to help VBA do each of the following:
  • Weight its accuracy
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
Assurance Efforts (2014) decisions and (2) whether VBA’s other quality assurance activities are coordinated and effective. GAO analyzed VBA claims and STAR accuracy data from fiscal year 2013 (the most recent fiscal year for which complete data are available); reviewed relevant federal laws, VBA guidance, and other documents relevant to quality assurance activities; and interviewed VBA staff from headquarters and four VBA regional offices (selected to achieve variety in geography, workload, and accuracy rates) as well as veteran service organization officials. undermining the usefulness and credibility of its measures. By not leveraging a statistician or otherwise following statistical practices in developing accuracy estimates, VBA is producing and relying on inaccurate estimates to make important internal management decisions. Similarly, by using a one-size sampling methodology, VBA is unnecessarily expending limited resources that could be used elsewhere. The systematic exclusion of redistributed claims and those moved between offices further calls into question the rigor of its accuracy estimates. Finally, VBA’s reporting of its two accuracy metrics lacks sufficient transparency to help members of Congress and other stakeholders fully understand the differences and limitations of each and thus may undermine their trust in VBA’s reported performance. VBA has enhanced and coordinated other aspects of its quality assurance framework, but shortcomings in implementation and evaluation detract from their overall effectiveness. For example, although VBA is disseminating the results of national STAR reviews and consistency studies and local quality review teams (QRTs) are using those results to focus related training or guidance to claims processing staff, until centralized guidance is consolidated and streamlined, staff lack ready access to information that will help them prevent errors. Moreover, absent adequate system capabilities to support local quality reviews, QRTs are unable to stop incorrect decisions from being finalized, and may not be aware of error trends that could be mitigated through training or other corrective action. Finally, although some of its quality assurance activities are
  • estimates to reflect the sample design for reviewed claims;

  • Determine and report the confidence intervals associated with its reported accuracy estimates; and
  • Re-examine its approach to calculating the regional office sample size for STAR. Take steps to ensure that redistributed claims and those moved between regional offices are not underrepresented in the STAR sample.
  • Increase transparency in explaining how the claim-based and issue-based accuracy rates are calculated as well as their key limitations when publicly reporting these metrics.
  • Review the multiple sources of policy guidance that VBA provides to determine ways to consolidate them.
  • Take steps to ensure that any future upgrades to local data systems allow QRTs to pause the claims process when errors are detected and enable QRTs to better track error trends.
  • Take additional steps to
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Title (Year) Purpose of Report Findings Recommendations
relatively new, VBA lacks specific plans to evaluate their effectiveness and may miss opportunities to further improve or target these activities to more error-prone areas. In general, unless VBA takes steps to improve the rigor of all its quality assurance methods and practices, VBA may find progress toward achieving its goal of 98 percent accuracy in fiscal year 2015 illusive—especially in the face of challenging workloads, limited resources, and expectations of timely claim decisions.

evaluate the effectiveness of quality assurance activities to identify opportunities to improve or better target these activities.

Actions Needed to Address Hurdles Facing Program Modernization (2012) Concerns exist that the VA’s rating schedule—the criteria used to assign degree of work disability—is not consistent with changes in medicine and the labor market. GAO examined (1) the VA’s progress in revising its rating schedule with updated medical and economic information and (2) the opportunities and challenges of various policy approaches proposed by commissions and others for updating the VA’s disability benefits structure. The VA initiated a comprehensive effort in 2009 to revise its disability rating schedule with both updated medical and earnings information, but it faces hurdles with several key aspects. The current revision effort takes a more comprehensive and empirical approach than the VA’s past efforts. The VA has hired full-time staff to revise the rating schedule’s medical information and plans to conduct studies to evaluate veterans’ average loss of earnings in today’s economy. As part of this effort, the VA is considering modifying the rating schedule—currently based largely on the degree of medical severity—to include a veteran’s ability to function in the workplace. Moving in this direction is more consistent with how experts conceive of disability. Conduct focused studies on various approaches to modernize disability benefits and, if necessary, propose relevant legislation. GAO is also making several recommendations to improve the VA’s capacity to revise the rating schedule now and in the future. These include completing plans for conducting earnings loss studies and developing a written strategy for implementing revisions to the rating schedule.
VA Needs Plan for Assessing Consistency of Decisions (2004) Key questions: (1) Since the issuance of GAO’s 2002 report, what actions has the VA taken to assess the consistency of regional office decisions on disability compensation claims? (2) To what extent does the VA have program data that can be used to measure the Since the issuance of GAO’s 2002 report, the VA has not systematically assessed the consistency of regional office decisions on specific impairments. Existing compensation program data have limitations that preclude identifying indications of decision-making inconsistency among regional offices. However, the VA is implementing a new data collection system that may afford an Develop a plan, and include it in the VA’s annual performance plan, that details how the VA will: (1) use data collected through RBA 2000 to identify indications of possible inconsistencies among regional offices in the
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Title (Year) Purpose of Report Findings Recommendations
consistency of decision making among regional offices? opportunity to identify indications of inconsistency in the future. award and denial of benefits for specific impairments and (2) conduct systematic studies of consistency for specific impairments for which RBA 2000 data reveal indications of inconsistencies among decisions made by the regional offices.
Problems and Challenges Facing Disability Claims Processing (2000) Focus on four key areas related to compensation claims processing: (1) longstanding performance problems, (2) claims-processing complexities, (3) challenges to improving performance, and (4) VBA’s initiatives to improve performance. VBA’s problems with large backlogs and long waits for decisions have not yet improved, despite years of studying these problems. VBA’s new quality measurement system shows that nearly one-third of decisions are incorrect or have technical or procedural errors. Many performance problems stem from the process’s complexity, which is growing as the number of service-connected disabilities per veteran increases and judicial review requires more procedures and documentation. Although VBA has initiated a number of efforts to streamline its claims-processing performance, it is unclear how much improvement will be gained. VBA may need to collect and analyze additional case-specific data to better understand its claims-processing problems and better target its corrective actions. Furthermore, because some issues affecting VBA’s performance are a function of program design, more fundamental changes may have to be made.
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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Page 197
Suggested Citation:"Appendix N: Summary Table of U.S. Government Accountability Office Reports Relevant to Adjudication of Veterans' Disability Claims." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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The Veterans Benefits Administration (VBA) provides disability compensation to veterans with a service-connected injury, and to receive disability compensation from the Department of Veterans Affairs (VA), a veteran must submit a claim or have a claim submitted on his or her behalf. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans reviews the process by which the VA assesses impairments resulting from traumatic brain injury for purposes of awarding disability compensation. This report also provides recommendations for legislative or administrative action for improving the adjudication of veterans’ claims seeking entitlement to compensation for all impairments arising from a traumatic brain injury.

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