Veterans' Benefits:

Improved Operational Controls and Management Data Would Enhance VBA's Disability Reevaluation Process

GAO-08-75: Published: Dec 6, 2007. Publicly Released: Dec 21, 2007.

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To help ensure that veterans are properly compensated for disabilities, VA is required to perform disability reevaluations for specific disabilities. VA also performs reevaluations whenever it determines there is a need to verify either the continued existence or current severity of veterans' disabilities. VBA completed about 17,700 reevaluations in fiscal year 2005. GAO was asked to review the Veterans Benefits Administration's (VBA) disability reevaluation program. This report assesses (1) the operational controls VA uses to ensure the effectiveness of the disability reevaluation process and (2) the management information VA collects and uses to manage the disability reevaluation process. To conduct this study, GAO analyzed VBA data, reviewed federal regulations and VBA procedures, conducted site visits, and interviewed VBA officials.

VBA's operational controls do not adequately ensure that staff schedule or conduct disability reevaluations as necessary; however, VBA is planning to improve some of the controls. VBA claims processing software does not automatically establish or prompt regional office staff to schedule a time - known as a diary date - to determine whether a disability reevaluation should proceed. Consequently, some cases that require a reevaluation may never receive it. After the diary date matures, staff perform a preliminary review of a veteran's claim file to determine if a more comprehensive reevaluation should be conducted. If staff determine during this review that a reevaluation is no longer needed, the reevaluation is cancelled. However, cancellations are not tracked or subject to quality assurance reviews to ensure adherence to program policies and procedures. VBA plans on improving some of its control mechanisms through its new claims management system, the Veterans Service Network (VETSNET), including developing the ability to track cancellations. However, VBA has no plans to include a prompt for scheduling reevaluation diary dates in VETSNET. VBA cannot effectively manage the disability reevaluation process because some of the data it collects are inconsistent and it does not systematically collect and analyze key management data. While VBA collects data on the amount of time regional offices take to conduct disability reevaluations, these data are not consistentbecause regional offices use different starting points for measuring timeliness. Also, VBA does not know the types of disabilities being reevaluated, the length of time before reevaluations are conducted, or the results of the reevaluations. As a result, VBA cannot ensure that it is effectively and appropriately using its resources.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In November 2007, VBA provided instructions to its regional offices to use the date the VA Form 21-2507a, Request for Physical Examination, is generated as the date of claim for reexaminations.

    Recommendation: The Secretary of the Department of Veterans Affairs should direct the Under Secretary for Benefits, in order to enhance VBA's disability reevaluation process, to clarify its guidance so that all regional offices consistently use the date they are notified of a matured diary date as the starting point for measuring timeliness.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA conducted two special reviews of canceled reevaluations in August 2008 and July 2009 based on our recommendation. Based on the results of these reviews--few mistakes found-- VBA determined that further QA reviews of canceled reevaluations were not necessary. VA has increased the number of rating related cases it samples for STAR quality reviews and as a result the number of completed disability reevaluations included in its STAR reviews has increased. VA reports that the number of completed reevaluations reviewed for quality assurance purposes increased by 87% from 485 in fiscal year 2007 to 905 in fiscal year 2009.

    Recommendation: The Secretary of the Department of Veterans Affairs should direct the Under Secretary for Benefits, in order to enhance VBA's disability reevaluation process, to include cancelled reevaluations in its quality assurance reviews and should evaluate the feasibility of periodically sampling a larger number of completed disability reevaluations for quality assurance review.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VBA reported that they have completed and submitted the Veterans Service Network (VETSNET) programming requirements specifying that when certain diagnostic codes are at issue the user receives a message that a future reevaluation is needed. The user will be presented with a yes or no selection. This allows for needed flexibility as determined by the facts of the claim, yet provides a mechanism to ensure that the proper controls can be applied. Standard VETSNET audit tables give VBA the flexibility to review the controls being applied.

    Recommendation: The Secretary of the Department of Veterans Affairs should direct the Under Secretary for Benefits, in order to enhance VBA's disability reevaluation process, to modify its electronic claims processing system to ensure that a diary date is automatically generated by the system for all disabilities where a reevaluation is required by VA's Schedule for Rating Disabilities.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: VBA reported that they had completed the Rating Board Automation 2000 (RBA2000) programming specifying that a user is presented with a forced entry to denote whether a future examination is required for service connected disabilities.

    Recommendation: The Secretary of the Department of Veterans Affairs should direct the Under Secretary for Benefits, in order to enhance VBA's disability reevaluation process, to modify its electronic claims processing system so that a rating decision cannot be completed without staff completing the diary date field.

    Agency Affected: Department of Veterans Affairs

  5. Status: Closed - Implemented

    Comments: VBA completed a review and analysis of all routine future reexamination disability claims completed in fiscal year 2007 and concluded that the selection and timing of disability reevaluations was correct 94 percent of the time. However, 6 percent of routine future exams scheduled and conducted appeared to be for diagnostic codes at a percentage where a reevaluation was not necessary. VBA plans to provide refresher training on when a reevaluation should be completed.

    Recommendation: The Secretary of the Department of Veterans Affairs should direct the Under Secretary for Benefits, in order to enhance VBA's disability reevaluation process, to develop a plan to collect and analyze data on the results of disability reevaluations. To the extent necessary, this information could be used to refine guidance on the selection and timing of future disability reevaluations.

    Agency Affected: Department of Veterans Affairs

 

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