Veterans' Benefits:

Improvements Needed in Processing Disability Claims

HRD-89-24: Published: Jun 22, 1989. Publicly Released: Jul 25, 1989.

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In response to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) claims processing procedures for compensation and pension disability benefits, focusing on the extent to which the procedures violated veterans' due process rights or resulted in their unfair treatment.

GAO found that VA: (1) communicated its claims decisions primarily through written notices, which were often unclear and did not provide veterans with the necessary information to make knowledgeable appeals decisions; (2) had no evidence that it sent the notices; (3) did not inform many veterans that it closed their claims because they failed to provide requested information or did not appear for a medical examination; (4) did not properly determine veterans' benefits eligibility, obtained too much or too little evidence, or closed claims before allowing veterans sufficient time to provide requested evidence; (5) frequently did not send courtesy copies of development letters to veterans' representatives, which hindered their assistance; (6) took an average of 9 days to log compensation and pension claims, 2 days more than its goal; (7) attributed the unclear notices largely to its rigid automated notification system, which provided little flexibility to add explanatory information; and (8) suffered from such administrative control weaknesses as ineffective quality control over regional offices claims processing, an inaccurate and unorganized procedural manual, noncompliance with sampling requirements, and staff reductions.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA issued VBA Circular 21-90-1 to implement legislative requirements that notices include the reasons for the decision and a summary of the evidence considered.

    Recommendation: To better serve the veteran, the Secretary of Veterans Affairs should modify the Target system to provide greater flexibility in the preparation of decision notices, which should clearly state why a decision was made. At a minimum, notices should list the evidence considered and the basic rationale for decisions. Further, notices should be sent as VA regulations require.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: The index was published in September 1989. VA has published the six-part revised manual. The entire manual is on the Wang system which facilitates the revision and distribution process.

    Recommendation: To better serve the veteran, the Secretary of Veterans Affairs should improve the procedures manual by simplifying the structure, indexing subjects to make guidance more accessible, and ensuring that changes to the manual are printed and distributed promptly.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VA evaluation of employment data concluded that any change in the quality of claims processing can not be attributed to the level of supervision. To improve claims processing, VA established six regional adjudication advisory committees and installed an Automated Medical Information Exchange. All exam results from VA medical facilities are submitted to regional offices.

    Recommendation: To better serve the veteran, the Secretary of Veterans Affairs should evaluate as to whether the extent of supervision is sufficient to provide acceptable quality in claims processing.

    Agency Affected: Department of Veterans Affairs

 

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