This is the accessible text file for GAO report number GAO-05-655T 
entitled 'VA Disability Benefits: Board of Veterans' Appeals Has Made 
Improvements in Quality Assurance, but Challenges Remain for VA in 
Assuring Consistency' which was released on May 5, 2005.

This text file was formatted by the U.S. Government Accountability 
Office (GAO) to be accessible to users with visual impairments, as part 
of a longer term project to improve GAO products' accessibility. Every 
attempt has been made to maintain the structural and data integrity of 
the original printed product. Accessibility features, such as text 
descriptions of tables, consecutively numbered footnotes placed at the 
end of the file, and the text of agency comment letters, are provided 
but may not exactly duplicate the presentation or format of the printed 
version. The portable document format (PDF) file is an exact electronic 
replica of the printed version. We welcome your feedback. Please E-mail 
your comments regarding the contents or accessibility features of this 
document to Webmaster@gao.gov.

This is a work of the U.S. government and is not subject to copyright 
protection in the United States. It may be reproduced and distributed 
in its entirety without further permission from GAO. Because this work 
may contain copyrighted images or other material, permission from the 
copyright holder may be necessary if you wish to reproduce this 
material separately.

Testimony Before the Subcommittee on Disability Assistance and Memorial 
Affairs, Committee on Veterans' Affairs, House of Representatives:

United States Government Accountability Office:

GAO:

For Release on Delivery Expected at 10:30 a.m. EDT:

Thursday, May 5, 2005:

VA Disability Benefits:

Board of Veterans' Appeals Has Made Improvements in Quality Assurance, 
but Challenges Remain for VA in Assuring Consistency:

Statement of Cynthia A. Bascetta, Director, Education, Workforce and 
Income Security:

GAO-05-655T:

GAO Highlights:

Highlights of GAO-05-655T, a testimony before the Subcommittee on 
Disability Assistance and Memorial Affairs, House Committee on 
Veterans' Affairs:

Why GAO Did This Study:

The House Subcommittee on Disability Assistance and Memorial Affairs 
asked GAO to update a 2002 study to determine what VA has done to 
(1) correct reported weaknesses in methods used by the Board to select 
decisions for quality review and calculate the accuracy rates reported 
by the Board and (2) address the potential for inconsistency in 
decision-making at all levels of adjudication in VA, including VA’s 57 
regional offices and the Board. GAO said in 2002 that VA had not 
studied consistency even though adjudicator judgment is inherently 
required in the decision-making process, and state-to-state variations 
in the average disability compensation payment per veteran raised 
questions about consistency. In January 2003, in part because of 
concerns about consistency, GAO designated VA’s disability program as 
high-risk.

What GAO Found:

The Department of Veterans Affairs (VA) has taken steps to respond to 
GAO’s 2002 recommendations to correct weaknesses in the methods for 
selecting decisions by the Board of Veterans’ Appeals (Board) for 
quality review and calculating the accuracy rates reported by the 
Board. Specifically, the Board now ensures that decisions made near the 
end of the fiscal year are included in the quality review sample, and 
the Board now excludes from its accuracy rate calculations any errors 
that do not have the potential for resulting in a reversal by or remand 
from the court. GAO found that the Board had not yet revised its 
formula for calculating accuracy rates in order to properly weight the 
quality review results for original Board decisions versus the results 
for Board decisions on cases remanded by the court. However, GAO 
believes correcting this calculation method will not materially affect 
the Board’s reported accuracy rates.

VA still lacks a systematic method for ensuring the consistency of 
decision-making within VA as a whole, but has begun efforts to 
understand why average compensation payments per veteran vary widely 
from state to state. These efforts include studies underway by VA’s 
Office of Inspector General and the Veterans Benefits Administration, 
which oversees the operations of VA’s regional offices. Some variation 
is expected since adjudicators often must use judgment in making 
disability decisions, but VA faces the challenge of determining whether 
the extent of variation is confined within a range that knowledgeable 
professionals could agree is reasonable.

Steps in the Veterans Disability Claims and Appeals Process: 

[See PDF for image]

[End of figure]

What GAO Recommends:

This testimony updates actions VA has taken to implement 
recommendations from the GAO’s 2002 report, in which GAO recommended 
that VA take steps to (1) correct the weaknesses in the Board’s 
sampling and accuracy rate calculation methods and (2) establish a 
system for assessing the consistency of decision-making at all levels 
of adjudication in VA, including VA’s regional offices and the Board.

www.gao.gov/cgi-bin/getrpt?GAO-05-655T.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Cynthia A. Bascetta at 
(202) 512-7101.

[End of section]

Mr. Chairman and Members of the Subcommittee:

Thank you for inviting me to discuss our work related to the efforts of 
the Department of Veterans Affairs (VA) to assure the quality and 
consistency of disability decisions. Assuring the quality and 
consistency of VA's disability decisions is vital for assuring program 
integrity and equitable decisions. As you know, in January 2003, we 
designated VA's disability program, along with other federal disability 
programs, as high-risk.[Footnote 1] In part, we designated VA's program 
as high-risk because of concerns about consistency of decision-making. 
Despite VA's efforts to provide training and enhance communication to 
improve the consistency of decisions, we found indications of 
inconsistency such as the wide variation among states in the average 
compensation payment per veteran.

You asked us to update our 2002 report in which we found that the Board 
needed to improve its quality review program.[Footnote 2] Specifically, 
the Board needed to revise its sampling methods, the way it weighted 
quality review results in its calculation of accuracy rates, and the 
types of errors reported in the accuracy rates. In that report, we also 
found that VA needed to take action to assure consistency of decision-
making within VA as a whole. Today I would like to highlight the steps 
the Board has taken since our 2002 report and discuss VA's recent 
efforts to address inconsistent decision-making. To update our 2002 
report, we interviewed officials of and/or obtained pertinent 
documentation from the Board and the Veterans Benefits Administration 
(VBA), which oversees the operations of VA's 57 regional offices. We 
obtained comments from Board officials on the updated information 
contained in this testimony regarding the Board's quality assurance 
system, and they agreed with this information. We did our work in 
accordance with generally accepted government auditing standards in 
April 2005.

In summary, we found that the Board has taken action to strengthen its 
system for reviewing the quality of its own decisions, but VA still 
lacks a systematic method for ensuring the consistency of decision-
making within VA as a whole. With respect to the Board, it has taken 
steps to improve the sampling and accuracy rate calculation methods of 
its quality review system and also to assure that serious errors are 
not obscured by mixing them with less significant deficiencies. 
Regarding consistency, VA still lacks a plan for an ongoing, systematic 
assessment of decision-making consistency at all levels of adjudication 
within VA. As we concluded in 2002, such an assessment is needed to 
provide a foundation for determining acceptable levels of decision-
making variation and to reduce variations found to be unacceptable. 
Although VA has much left to do regarding consistency of decision-
making, it has begun efforts to understand the reasons behind one 
indication of inconsistency: the wide variations from state to state in 
the average compensation payment per veteran. These efforts include 
studies being done by VA's Office of Inspector General and VBA.

Background: The Disability Claims and Appeals Process:

VA's disability compensation program pays monthly cash benefits to 
eligible veterans who have service-connected disabilities resulting 
from injuries or diseases incurred or aggravated while on active 
military duty. The benefit amount is based on the veteran's degree of 
disability, regardless of employment status or level of earnings.

A veteran starts the claims process by submitting a disability 
compensation claim to one of the 57 regional offices administered by 
VBA (see fig. 1). In the average disability compensation claim, the 
veteran claims about five disabilities. For each claimed disability, 
the regional office adjudicator must develop evidence and determine 
whether each disability is connected to the veteran's military 
service.[Footnote 3] The adjudicator then applies the medical criteria 
in VA's Rating Schedule to evaluate the degree of disability caused by 
each service-connected disability, and then the adjudicator determines 
the veteran's overall degree of service-connected disability.

If a veteran disagrees with the adjudicator's decision on any of the 
claimed disabilities, the veteran may file a Notice of Disagreement. If 
the regional office is unable to resolve the disagreement to the 
veteran's satisfaction, the veteran may appeal to the Board.[Footnote 
4] A veteran can dispute a decision not only if the regional office 
denies benefits by deciding that an impairment claimed by the veteran 
is not service-connected. Even for a claimed impairment found to be 
service-connected, the veteran may dispute the severity rating that the 
regional office assigns to the impairment and ask for an increase in 
the rating.

During fiscal years 2003 and 2004, respectively, the regional offices 
made about 715, 000 and 598,500 decisions involving disability 
compensation claims. According to VBA, during fiscal years 2003 and 
2004, respectively, veterans submitted Notices of Disagreement in about 
13.4 and 14.5 percent of all decisions involving disability ratings, 
and of the veterans who filed Notices of Disagreement, about 34.9 and 
44.4 percent went on to submit appeals to the Board. Assisted by 240 
staff attorneys, the Board's 52 veterans law judges decide veterans' 
appeals on behalf of the Secretary. The Board has full de novo review 
authority and gives no deference to the regional office decision being 
appealed. The Board makes its decisions based on only the law, VA's 
regulations, precedent decisions of the courts, and precedent opinions 
of VA's General Counsel. During the appeals process, the veteran or the 
veteran's representative may submit new evidence to the Board and 
request a hearing.

Figure 1: Steps in the Disability Claims and Appeals Process:

[See PDF for image]

[End of figure]

In fiscal year 2004, for all VA programs, the Board decided about 
38,400 appeals, of which about 94 percent (35,900) were appeals of 
disability compensation cases that contained an average of 2.2 
contested issues per case. In any given case, the Board might grant the 
requested benefits for one issue but deny benefits for another. In some 
instances, the Board may find that a case is not ready for a final 
decision and return (or remand) the case to VBA for rework, such as 
obtaining additional evidence and reconsidering the veteran's claim. If 
VBA still does not grant the requested benefits after obtaining the 
additional evidence, it returns the case to the Board for a final 
decision. Of the appeals involving compensation cases decided during 
fiscal year 2004, the Board reported that it granted requested benefits 
for at least one issue in about 18 percent of the cases, denied all 
requested benefits in about 23 percent of the cases, and remanded about 
58 percent of the cases to VBA for rework.[Footnote 5]

Effective February 22, 2002, VA issued a new regulation to streamline 
and expedite the appeals process. Previously, the Board had remanded 
all decisions needing rework directly to VBA's regional offices. The 
new regulation, however, allowed the Board to obtain evidence, clarify 
evidence, cure a procedural defect, or perform almost any other action 
essential for a proper appellate decision without having to remand the 
appeal to the regional office. It also allowed the Board to consider 
additional evidence without having to refer the evidence to the 
regional office for initial consideration and without having to obtain 
the appellant's waiver. According to the Board, this change in the 
process reduced the time required to provide a final decision to the 
veteran on an appeal, allowed regional offices to use more resources 
for processing initial claims rather than remands, and virtually 
eliminated multiple remands on the same case to the regional offices. 
However, in May 2003, the U.S. Court of Appeals for the Federal Circuit 
held that the Board could not, except in certain statutorily authorized 
exceptions, decide appeals in cases in which the Board had developed 
evidence.[Footnote 6] As a result, VA established a centralized Appeals 
Management Center within VBA in Washington, D.C., to take over evidence 
development and adjudication work on remands.

If the Board denies requested benefits or grants less than the maximum 
benefit available under the law, veterans may appeal to the U. S. Court 
of Appeals for Veterans Claims, an independent federal court. Unlike 
the Board, the court may not receive new evidence. It considers only 
the Board's decision; briefs submitted by the veteran and VA; oral 
arguments, if any; and the case record that VA considered and that the 
Board had available. In cases decided on merit (cases not dismissed on 
procedural grounds), the court may (1) reverse the Board's decision 
(grant contested benefits), (2) affirm the Board's decision (deny 
contested benefits) or (3) remand the case back to the Board for 
rework. Of the 3,489 cases decided on merit during fiscal years 2003-
2004, the court reversed or remanded in part or in whole about 88 
percent of the cases. Under certain circumstances, a veteran who 
disagrees with a decision of the court may appeal to the U.S. Court of 
Appeals for the Federal Circuit and then to the Supreme Court of the 
United States.

The Board Has Taken Steps to Improve Its Quality Assurance Program:

The Board of Veterans' Appeals has taken action to strengthen its 
internal system for reviewing the quality of its own decisions. 
Specifically, the Board has taken steps to improve its quality review 
system's sampling methodology and to avoid obscuring serious errors by 
mixing them with less significant deficiencies. We found, however, that 
the Board still needs to revise its formula for calculating accuracy 
rates in order to avoid potentially misleading accuracy rates.

During our 2002 evaluation, we reviewed the Board's methods for 
selecting random samples of Board decisions and calculating accuracy 
rates for its decisions. We found that the number of decisions reviewed 
was sufficient to meet the Board's goal for statistical precision in 
estimating its accuracy rate.[Footnote 7] However, we pointed out some 
Board practices that might result in misleading accuracy rates. These 
practices included not ensuring that decisions made near the end of the 
fiscal year were sampled and not properly weighting quality review 
results in the formula used to calculate accuracy rates. At the time of 
our 2002 report, the Board had agreed in principle to correct these 
practices.

We found in our most recent work that the Board took corrective action 
in fiscal year 2002 to assure that decisions made near the end of the 
fiscal year were sampled. The quality review program now selects every 
20th original decision made by the Board's veterans law judges and 
every 10th decision they make on cases remanded by the court to the 
Board for rework. However, we found that the Board had not revised its 
formula for calculating accuracy rates in order to properly weight the 
quality review results for original decisions versus the results for 
decisions on remanded cases. We determined that, even if this 
methodological error had been corrected earlier, the accuracy rate 
reported by the Board for fiscal year 2004 (93 percent) would not have 
been materially different. However, to avoid the potential for 
reporting a misleading accuracy rate in the future, corrective action 
needs to be taken, and the Board agreed to correct this issue in the 
very near future.

In our 2002 evaluation, we also found that the Board included 
nonsubstantive deficiencies (errors that would not be expected to 
result in either a remand by the court or a reversal by the court) in 
calculating its reported accuracy rates. We concluded that the reported 
accuracy rates understated the level of accuracy that would result if 
the Board, like VBA, counted only substantive deficiencies in the 
accuracy rate calculation.[Footnote 8] VBA had ceased counting 
nonsubstantive deficiencies in its error rate after the VA Claims 
Processing Task Force said in 2001 that mixing serious errors with less 
significant deficiencies could obscure what is of real concern. 
Similarly, we recommended that the Board's accuracy rates take into 
account only those deficiencies that would be expected to result in a 
reversal or a remand by the court. In fiscal year 2002, the Board 
implemented our recommendation.

Also, during the course of our 2002 evaluation of the quality review 
program, we brought to the Board's attention the governmental internal 
control standard calling for separation of key duties and the 
governmental performance audit standard calling for organizational 
independence for agency employees who review and evaluate program 
performance. These issues arose because certain veterans law judges who 
were directly involved in deciding veterans' appeals were also involved 
in reviewing the accuracy of such decisions. The Board took corrective 
actions during our review in May 2002 to resolve these issues so all 
quality reviews from which accuracy rates are determined are done by 
persons not directly involved in deciding veterans' appeals.

In 2002, we also found that the Board collected and analyzed issue-
specific data on the reasons that the Court remanded decisions to the 
Board in order to provide feedback and training to the Board's veterans 
law judges; however, the Board did not collect issue-specific data on 
the errors that its own quality reviewers found in decisions of the 
Board's veterans law judges. We recommended that the Board revise its 
quality review program to begin collecting such issue-specific error 
data in order to identify training that could help improve decision 
quality. In April 2005, the Board said it did not implement this 
recommendation because it believes the benefits would be too limited to 
justify the substantial reprogramming of the data system that would be 
required to collect issue-specific data. The Board also pointed out 
that the issue-specific data captured for court remands have not proved 
to be as useful as it had expected in identifying ways to provide 
training that could reduce court remands.

VA Faces Challenges in Measuring Consistency But Has Recently Initiated 
Studies:

Adjudicator judgment is an inherent factor in deciding disability 
claims, and it introduces the potential for variation in the process. 
Part of assessing inconsistency, as we recommended in 2002, would 
include determining acceptable levels of variation for specific types 
of disabilities. In late 2004, in response to adverse media reports, VA 
initiated its first study of consistency. Such studies are the first 
step in determining the degree of variation that occurs and what levels 
of variation are acceptable.

Adjudicator Judgment Results in Inherent Variation in Decision-making:

Adjudicators often must use judgment in making disability decisions. 
Judgment is particularly critical when the adjudicator must (1) assess 
the credibility of different sources of evidence; (2) evaluate how much 
weight to assign different sources of evidence; or (3) assess some 
disabilities, such as mental disorders, for which the disability 
standards are not entirely objective and require the use of 
professional judgment. In such cases, two adjudicators reviewing the 
same evidence might make differing judgments on the meaning of the 
evidence and reach different decisions, neither of which would 
necessarily be found in error by any of VA's quality reviewers.

For example, in an illustration provided by the Board, consider a 
disability claim that has two conflicting medical opinions, one 
provided by a medical specialist who reviewed the claim file but did 
not examine the veteran, and a second opinion provided by a medical 
generalist who reviewed the file and examined the veteran. One 
adjudicator could assign more weight to the specialist's opinion, while 
another could assign more weight to the opinion of the generalist who 
examined the veteran. Depending on which medical opinion is given more 
weight, one adjudicator could grant the claim and the other could deny 
it. Yet, a third adjudicator could apply VA's "benefit-of-the-doubt" 
rule and decide in favor of the veteran. Under this rule, if an 
adjudicator concludes that there is an approximate balance between the 
evidence for and the evidence against a veteran's claim, the 
adjudicator must decide in favor of the veteran.

In the design of their quality review systems, VBA and the Board 
acknowledge the fact that, in some cases, different adjudicators 
reviewing the same evidence can make differing, but reasonable, 
judgments on the meaning of the evidence. As a result, VBA and the 
Board instruct their quality reviewers that when they review a 
decision, they are not to record an error merely because they would 
have made a different decision than the one made by the adjudicator. 
VBA and the Board instruct their quality reviewers to not substitute 
their own judgment in place of the original adjudicator's judgment if 
the adjudicator's decision is adequately supported and reasonable.

Another example provided by the Board demonstrates how adjudicators 
must make judgments about the degree of severity of a disability. VA's 
disability criteria provide a formula for rating the severity of a 
veteran's occupational and social impairment due to a variety of mental 
disorders. This formula is a nonquantitative, behaviorally oriented 
framework for guiding adjudicators in choosing which of the degrees of 
severity shown in table 1 best describes the claimant's occupational 
and social impairment.

Table 1: VA's Medical Criteria for Evaluating the Degree of 
Occupational and Social Impairment Due to Mental Disorders:

Degree of occupational and social impairment as characterized in VA's 
medical criteria: Totally impaired; 
Disability rating (in percent): 100%.

Degree of occupational and social impairment as characterized in VA's 
medical criteria: Deficient in most areas such as work, school, family 
relations, judgment, thinking, or mood; 
Disability rating (in percent): 70%.

Degree of occupational and social impairment as characterized in VA's 
medical criteria: Reduced reliability and productivity; 
Disability rating (in percent): 50%.

Degree of occupational and social impairment as characterized in VA's 
medical criteria: Occasional decrease in work efficiency and 
intermittent periods of inability to perform occupational tasks; 
Disability rating (in percent): 30%.

Degree of occupational and social impairment as characterized in VA's 
medical criteria: Mild or transient symptoms that decrease work 
efficiency and ability to perform occupational tasks only during 
periods of significant stress, or symptoms can be controlled by 
continuous medication; 
Disability rating (in percent): 10%.

Degree of occupational and social impairment as characterized in VA's 
medical criteria: Not severe enough to interfere with occupational or 
social functioning or to require continuous medication; 
Disability rating (in percent): 0%.

Source: Board of Veterans' Appeals and VA's Schedule for Rating 
Disabilities.

[End of table]

Similarly, VA does not have objective criteria for rating the degree to 
which certain spinal impairments limit a claimant's motion. The 
adjudicator must assess the evidence and decide whether the limitation 
of motion is "slight, moderate, or severe." To assess the severity of 
incomplete paralysis, the adjudicator must decide whether the veteran's 
paralysis is "mild, moderate, or severe." The decision on which 
severity classification to assign to a claimant's condition could vary 
in the minds of different adjudicators, depending on how they weigh the 
evidence and how they interpret the meaning the of the different 
severity classifications.

Consequently, it would be unreasonable to expect that no decision-
making variations would occur. But it is reasonable to expect the 
extent of variation to be confined within a range that knowledgeable 
professionals could agree is reasonable, recognizing that disability 
criteria are more objective for some disabilities than for others. For 
example, if two adjudicators were to review the same claim file for a 
veteran who has suffered the anatomical loss of both hands, VA's 
disability criteria state unequivocally that the veteran is to be given 
a 100 percent disability rating. Therefore, no variation would be 
expected. However, if two adjudicators were to review the same claim 
file for a veteran with a mental disability, knowledgeable 
professionals might agree that it would not be out of the bounds of 
reasonableness if one adjudicator gave the claimant a 50 percent 
disability rating and the other adjudicator gave a 70 percent rating. 
However, knowledgeable professionals might also agree that it would be 
clearly outside the bounds of reasonableness if one adjudicator gave 
the claimant a 30 percent rating and the other, a 100 percent rating.

VA Began Studying Decision-making Consistency in December 2004:

Although the issue of decision-making consistency is not new, VA only 
recently began to study consistency issues. In a May 2000 
testimony[Footnote 9] before the House Subcommittee on Oversight and 
Investigations, Committee on Veterans' Affairs, we underscored the 
conclusion made by the National Academy of Public Administration in 
1997[Footnote 10] that VBA needed to study the consistency of decisions 
made by different regional offices, identify the degree of subjectivity 
expected for various medical issues, and then set consistency standards 
for those issues. In August 2002, we drew attention to the fact that 
there are wide disparities in state-to-state average compensation 
payments per disabled veteran, and we voiced the concern that such 
variation raises the question of whether similarly situated veterans 
who submit claims to different regional offices for similar conditions 
receive reasonably consistent decisions. In January 2003, we reported 
that concerns about consistency had contributed to GAO's designation of 
the VA disability program as high-risk in 2003. Again, in November 
2004, we highlighted the need for VA to develop plans for studying 
consistency issues.

Most recently, in December 2004, the media drew attention to the wide 
variations in the average disability compensation payment per veteran 
in the 50 states and published data showing that the average payments 
varied from a low of $6,710 in Ohio to a high of $10,851 in New Mexico. 
Reacting to these media reports, in December 2004, the Secretary 
instructed the Inspector General to determine why average payments per 
veteran vary widely from state to state. As of February 2005 the Office 
of Inspector General planned to use data obtained from VBA for all 
regional offices to identify factors that may explain variations among 
the regional offices.

In March 2005, VBA began a study of three disabilities believed to have 
potential for inconsistency: hearing loss, post-traumatic stress 
disorder, and knee conditions. VBA assigned 10 subject matter experts 
to review 1,750 regional office decisions and plans to complete its 
analysis of study data in mid-May 2005, develop a schedule for future 
studies of specific ratable conditions, and recommend a schedule for 
periodic follow-up studies of previously studied conditions.

In our 2002 report, we recommended that VA establish a system to 
regularly assess and measure the degree of consistency across all 
levels of VA adjudication, including regional offices and the Board, 
for specific medical conditions that require adjudicators to make 
difficult judgments. For example, we said VA could create hypothetical 
claims for certain medical conditions, distribute the claims to 
multiple adjudicators at each decision-making level, and analyze 
variations in outcomes. Such a system would identify variation in 
decision making and provide a basis to identify ways, if considered 
necessary, to reduce variation through training or clarifying and 
strengthening regulations, procedures, and policies.

Although VA agreed in principle with our recommendation and agreed that 
consistency is an important goal, it commented that it would promote 
consistency through training and communication. We support such efforts 
but still believe VA needs to directly evaluate and measure consistency 
across all levels of adjudication. Otherwise, VA cannot determine 
whether such training and other efforts are directed at the causes of 
inconsistency and whether such efforts actually improve consistency.

In our November 2004 report,[Footnote 11] we found that VBA's 
administrative data was insufficient to analyze inconsistency because 
we could not reliably use the data to identify decisions made after 
fiscal year 2000, identify the regional offices that made the original 
decisions, or determine service-connection denial rates for specific 
impairments. However, in October 2004, VBA completed its implementation 
of a new nationwide data system, known as Rating Board Automation (RBA) 
2000. VA said this new system could reliably collect the types of data 
needed to perform the analyses we sought to do. Therefore, we 
recommended that the Secretary of Veterans Affairs develop a plan, and 
include it in VA's annual performance plan, containing a detailed 
description of how VA intended to use data from the new RBA 2000 
information system. We recommended that VA conduct systematic studies 
of the impairments for which RBA 2000 data reveal indications of 
decision-making inconsistencies among regional offices. VA concurred 
with our recommendation. Because the new RBA 2000 data system had been 
recently implemented, we acknowledged that VA could not implement such 
a plan until it accumulated a sufficiently large body of data under the 
new system. In our judgment, at least one year of data would be needed 
to begin such a study.

While we believe the studies recently begun by the Office of Inspector 
General and VBA are positive steps forward in addressing consistency 
issues, the RBA 2000 data system, if found to be reliable, can provide 
VA with the data needed to proactively and systematically target 
specific impairments that have the widest variations in decision-making 
outcomes among the regional offices and focus VA's efforts to study 
reasons for variations on those impairments. Building in such 
analytical capability to augment its quality assurance program would 
help enhance program integrity and better assure that veterans' 
disability decisions are made fairly and equitably.

Mr. Chairman, this concludes my remarks. I would be happy to answer any 
questions you or the members of the subcommittee may have.

Contact and Acknowledgements:

For further information, please contact Cynthia A. Bascetta at (202) 
512-7101. Also contributing to this statement were Irene Chu, Ira 
Spears, Martin Scire, and Tovah Rom.

[End of section]

Related GAO Products:

Veterans Benefits: VA Needs Plan for Assessing Consistency of 
Decisions. GAO-05-99. Washington, D.C.: November 19, 2004.

High-Risk Series: An Update. GAO-03-119. Washington, D.C.: January 
2003. 

Veterans' Benefits: Quality Assurance for Disability Claims and Appeals 
Processing Can Be Further Improved. GAO-02-806. Washington, D.C.: 
August 16, 2002.

SSA and VA Disability Programs: Re-Examination of Disability Criteria 
Needed to Help Ensure Program Integrity. GAO-02-597. Washington, D.C.: 
August 9, 2002.

Veterans Benefits Administration: Problems and Challenges Facing 
Disability Claims Processing. GAO/T-HEHS/AIMD-00-146. Washington, D.C.: 
May 18, 2000.

FOOTNOTES

[1] GAO, High-Risk Series: An Update, GAO-03-119 (Washington, D.C.: 
January 2003).

[2] GAO, Veterans' Benefits: Quality Assurance for Disability Claims 
and Appeals Processing Can Be Further Improved, GAO-02-806 (Washington, 
D.C.: Aug. 16, 2002).

[3] The Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 
(2000) requires VBA to assist claimants who have filed a complete claim 
for benefits. Specifically, VBA must: (1) notify claimants of the 
information necessary to complete the application; (2) indicate what 
information not previously provided is needed to prove the claim and 
distinguish between the portion of the information for which the 
claimant will be responsible and the portion for which VA will be 
responsible; (3) make reasonable efforts to assist claimants in 
obtaining evidence to substantiate claimant' eligibility for benefits, 
including relevant records; and (4) inform claimants when relevant 
records are unable to be obtained.

[4] In response to a Notice of Disagreement, the regional office 
provides a further written explanation of the decision, and if the 
veteran still disagrees, the veteran may appeal to the Board. Before 
appealing to the Board, a veteran may ask for a review by a regional 
office Decision Review Officer, who is authorized to grant the 
contested benefits based on the same case record that the regional 
office relied on to make the initial decision.

[5] The statistics in the Board's annual reports do not reflect all 
cases in which at least one issue is remanded or denied because the 
Board reports appeals outcomes on the basis of individual cases rather 
than individual issues within each case. To do this, the Board counts 
"case" dispositions using the following hierarchy: (1) allowed, (2) 
remanded, (3) dismissed, and (4) denied. Under this hierarchy, if any 
issue or part of the appeal is allowed, the entire case is counted as 
an allowance, regardless of whether any other issue in the case is 
remanded or denied. If no issue or part of the appeal is allowed, but 
part is remanded and part is denied, the case is counted as a remand. 
If no issue or part of the appeal is allowed or remanded, but part is 
dismissed and part is denied, the case is counted as a dismissal. A 
case is counted as denied only when all issues or parts of the appeal 
are denied.

[6] In Disabled American Veterans v. Secretary of Veterans Affairs, 327 
F.3d 1339 (Fed. Cir. 2003), the Court held that allowing the Board--
which is VA's "appellate tribunal" for deciding appeals of denials of 
veterans' benefits claims--to consider additional evidence without 
having to remand the case to the agency of original jurisdiction 
(regional office) for initial consideration and without having to 
obtain the appellant's waiver was contrary to the requirement of 38 
U.S.C. § 7104(a) that "[a]ll questions in a matter which . . . is 
subject to decision by the Secretary shall be subject to one review on 
appeal to the Secretary." Section 7104(b) does not permit the 
reconsideration of a claim disallowed by Board in the absence of new 
and material evidence as required by 38 U.S.C. 5108; however the 
regulation in question resulted in the veteran's not being able to 
object effectively to any of the additional evidence obtained by the 
Board until after the Board had weighed the evidence and decided the 
appeal, therefore not permitting the veteran to explore effectively a 
basis for "one review on appeal to the Secretary" with respect to the 
additional evidence obtained by the Board.

[7] The Board's intention is that VA can have 95 percent confidence 
that the Board's true accuracy rate is no more than 5 percentage points 
higher or lower than the estimated accuracy rate.

[8] At that time, the Board's quality reviewers assessed decision 
accuracy on the basis of six areas: issues, evidence, laws and 
regulations, reasons and bases, due process, and format. One error (or 
deficiency) in any area meant that a decision failed the quality test. 
However, according to the Board, all six areas included certain 
deficiencies that are not substantive. According to the Board, most 
deficiencies in the "format" category were not substantive, such as 
errors in grammar, spelling, or decision structure.

[9] GAO, Veterans Benefits Administration: Problems and Challenges 
Facing Disability Claims Processing, GAO/T-HEHS/AIMD-00-146 
(Washington, D.C.: May 18, 2000).

[10] National Academy of Public Administration, Management of 
Compensation and Pension Benefits Claim Processes for Veterans, 
(Washington, D.C.: August 1997).

[11] GAO, Veterans Benefits: VA Needs Plan for Assessing Consistency of 
Decisions, GAO-05-99 (Washington, D.C.: Nov. 19, 2004).