Veterans' Benefits Claims:

Further Improvements Needed in Claims-Processing Accuracy

HEHS-99-35: Published: Mar 1, 1999. Publicly Released: Mar 8, 1999.

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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) regional offices' (RO) accuracy in processing disability claims, focusing on: (1) the extent of improvements made by the Systematic Technical Accuracy Review (STAR) system in measuring claims-processing accuracy; (2) additional efforts needed to strengthen the system; and (3) challenges the Veterans Benefits Administration (VBA) faces in meeting goals for improving claims-processing accuracy.

GAO noted that: (1) the new STAR system represents an important step forward by VBA in measuring the accuracy of compensation and pension claims processing; (2) compared with the previous system, STAR focuses more on RO decisions that are likely to contain processing errors, uses a stricter method for computing accuracy rates, provides more data on the performance of organizational levels within VBA, collects more data on processing errors, and stores more accuracy review results in a centralized database; (3) even so, VBA can further strengthen STAR's ability to identify error-prone cases and claims-processing weaknesses so that it can take corrective actions; (4) VBA needs to better pinpoint error-prone cases and weaknesses in the development of evidence by collecting more specific data on the types of medical characteristics and deficiencies in medical evidence that are most prevalent in incorrect decisions; (5) VBA can also better address vulnerabilities in the integrity of accuracy data; (6) STAR reviewers in ROs do not have sufficient separation of duties or adequate independence to meet government standards for internal controls or program performance audits; (7) these shortcomings raise concern about the integrity of STAR accuracy data, which are a key factor in the performance measurement system designed by VBA to meet the requirements of the Government Performance and Results Act (GPRA) of 1993; (8) while such system improvements are necessary, they alone are not sufficient for VBA to meet its goal for improving accuracy; (9) using the STAR pilot test's 64-percent accuracy rate as a baseline, VBA's goal is to achieve a 93-percent accuracy rate by fiscal year 2004; (10) VBA faces management challenges that it must address successfully in order to meet its accuracy improvement goal; (11) to do this, VBA recognizes that: (a) its newly implemented performance measurement system must hold program managers accountable for performance; and (b) the training program under development must effectively train the current RO workforce as well as the many new employees who will have to be hired in the coming decade to replace those who retire; and (12) it is too early to determine whether VBA's efforts to meet these challenges will be successful.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To further strengthen VBA's ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under GPRA, and keep Congress informed about VBA's progress in addressing challenges that must be met in order to improve accuracy, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to revise STAR to, for RO disability decisions found to be in error, collect more detailed medical characteristics data, such as the human body systems, the specific impairments, and the specific deficiencies in medical evidence involved in these disability claims, so that VA can identify and focus corrective actions on specific problems that RO adjudicators have in correctly evaluating certain types of medical conditions or in correctly determining whether medical evidence is adequate to make a decision.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Not Implemented

    Comments: In September 2000, VBA stated that the "earliest VBA foresees developing the data elements and possibly incorporating this data into STAR would be Fiscal Year 2002." However, as of September 2002, VBA has no plans to develop the recommended data elements and does not foresee developing them in the future. VBA does not believe such data would enhance its QA efforts to a degree that would justify the cost of developing the data elements and making the required modifications to its computerized data collection system.

    Recommendation: To further strengthen VBA's ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under GPRA, and keep Congress informed about VBA's progress in addressing challenges that must be met in order to improve accuracy, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to implement a claims-processing accuracy review function that meets the government's internal control standard on separation of duties and the program performance audit standard on organizational independence.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: In October 2001, VBA implemented a modification to its claims processing quality assurance program (STAR) that brings it into compliance with the standards on segregation of duties and organizational independence. All STAR reviews are now conducted by staff in the Compensation and Pension Service, who themselves do not process claims and do not report to managers responsible for claims processing. Staff in VBA's regional offices are no longer responsible for conducting the STAR reviews that determine regional office accuracy rates. As a result, the STAR system complies with the requirements of the Veterans Millenium Health Care and Benefits Act of 1999, as well as with the recommendation. All FY 2002 accuracy rates for regional offices are based on reviews conducted by the VBA's STAR unit in the C&P Service.

    Recommendation: To further strengthen VBA's ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under GPRA, and keep Congress informed about VBA's progress in addressing challenges that must be met in order to improve accuracy, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to inform Congress on VBA's progress in the annual GPRA reports by: (1) establishing stricter employee accountability for the achievement of performance goals; and (2) developing more effective training for claims adjudicators.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: In June 1999, VBA stated that it concurs with this recommendation and would include in future GPRA reports the status of implementing the Balanced Scorecard, including its effectiveness in establishing accountability at all organizational levels. In January 2000, the VA annual GPRA report described VBA's continued development of: (1) a standardized, computer-assisted training program; (2) a performance assessment of each employee through a sampling of work products at the individual employee level; and (3) a certification of skills requirement that will be imposed prior to employees becoming eligible for promotion.

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