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    Subject Term: "Disability compensation"

    5 publications with a total of 15 open recommendations including 2 priority recommendations
    Director: Melissa Emrey-Arras
    Phone: (617) 788-0534

    3 open recommendations
    Recommendation: To help ensure VHA medical examiners are prepared to conduct the Gulf War general medical exam, the Secretary of Veterans Affairs should direct the Under Secretary for Health to require medical examiners to complete training, such as the 90-minute Gulf War Illness web-based course, before conducting these exams.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed this recommendation and stated it has plans to address it. Specifically, VA said it plans to make its 90-minute web-based training course mandatory for its medical examiners who conduct Gulf War Illness exams.
    Recommendation: To provide more complete information to veterans whose Gulf War Illness claims are denied, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to update guidance to require that decision letters indicate whether Gulf War Illness medical issues were evaluated under both a presumptive and direct service connection method.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed this recommendation and stated it has plans in place to address it. Specifically, VA noted it would improve how it communicates decisions to veterans and is in the process of updating its guidance to the regional offices to clarify the language required for its Gulf War Illness decision letters.
    Recommendation: To increase the likelihood of making progress toward developing a single case definition of Gulf War Illness, the Secretary of Veterans Affairs should direct the Under Secretary for Health to prepare and document a plan to develop a single case definition of Gulf War Illness. 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 research to help VA achieve this goal.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed this recommendation and stated it has plans to address it. Specifically, VA noted it would convene a group of subject matter experts to work on a plan - as described in our report - to establish a single case definition of Gulf War Illness.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to ensure development of a timely, detailed workforce plan for recruiting, hiring and training new hires. In particular, this plan should: (1) include detailed steps and timetables for updating training curriculum (such as preparing decisions in a virtual environment) and ensuring office space (such as telework guidance); and (2) incorporate risk mitigation strategies that consider how the timing of recruitment and training dovetails with uncertain time frames for implementing a new appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA took additional steps to recruit, hire, manage space and train additional FTEs to address appeals workloads. However, detailed workforce plans would help ensure timely hiring and proper supports and training. We will close this recommendation when VA provides documentation of its actions and related guidance in several areas: agency telework plan; case adjudication in an virtual environment; status of hiring for FY17; hiring goals for FY18; space management plan indicating how FY17 and FY18 hiring will be accommodated; and plans for ongoing training for remote teleworkers.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a schedule for IT updates that explicitly addresses when and how any process reform will be integrated into new systems and when Caseflow will be ready to support a potential streamlined appeals process at its onset.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation. In July 2017, VA reported its latest actions to address this recommendation, including documentation of the 6-month road map. However, we continue to believe that while the agile process can help mitigate risks and avoid cost overruns and delays, VA should define schedules beyond 6 months. Such planning allows VA to take additional steps to consider the scope of potential changes required by a new appeals process and have a broad plan in place to ensure that all aspects of the new process are adequately supported by Caseflow.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to conduct additional sensitivity analyses based on the assumptions used in projection models to more accurately estimate future appeals inventories and timeliness. In doing so, consider running additional analyses on how these factors, in conjunction with one another, may affect the timeliness and cost of deciding pending appeals.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation, noting that it plans to refine the model on a regular basis. However, we continue to believe that additional analyses of potential hiring options and of the compounded effect of assumptions that VA identified is consistent with sound practices and will help the agency anticipate and plan for different contingencies. In addition, as VA goes forward with appeals process reform and begins to collect real-time data, these data could improve modeling accuracy and serve as a valuable management tool. VA also noted plans to analyze, update and refine the model. We will consider closing this recommendation when VA completes these efforts and provides documentation of plans for modeling inventories and resource needs.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a more robust plan for closely monitoring implementation of process reform that includes metrics and interim goals to help track progress, evaluate efficiency and effectiveness, and identify trouble spots.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA agreed in principle with this recommendation. However, to fully implement it, VA needs to develop a monitoring plan with metrics and interim goals for implementing appeal process reform. Although VA agreed that developing such a plan is valuable for monitoring the implementation of process reform, VA also stated that it considered this recommendation complete and noted that preparing such a detailed plan depends on appeals reform legislation being enacted. While we recognize that VA cannot assume to know the exact provisions that may be included in future enacted legislation, we consider having a more robust monitoring plan - for example, that includes metrics and interim goals to help track implementation progress, evaluate efficiency and effectiveness of the reformed process, and identify trouble spots - to be essential to the successful implementation of a new appeals process.
    Recommendation: To better understand whether appeals process reform, in conjunction with other efforts, has improved timeliness, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate to develop a strategy for assessing process reform--relative to the current process--that ensures transparency in reporting to Congress and the public on the extent to which VA is improving veterans' experiences with its disability appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation and reported on its plans to measure veteran wait times as well as use customer satisfaction surveys to measure the success of the new appeals process. However, while we agree that metrics based on the different options could be valuable for VA, the Congress, and the public, we disagree that VA's focus on measuring timeliness by option is in the best interest of the veteran. Because veterans may pursue more than one option under VBA, the Board or both, we believe that VA's approach does not take into account the veteran's perspective of how long it took for them to receive a final appeal decision. Metrics from the veterans' overall perspective would complement, not replace, metrics for VBA, the Board, and each option. The absence of such metrics raises questions as to how the agency will ensure appropriate resources are devoted to managing appeals under the new versus old process, or intended results are achieved as the new process is implemented. Further, while the legislation requires VA to report a number of metrics, the agency still needs to implement the legislation. We will consider closing this recommendation when VA develops a plan for collecting metrics consistent with this recommendation.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To help improve the quality of VBA's disability compensation claim decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to 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.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, VA reported that VBA has submitted business requirements to add new functionality in VA's electronic claims processing system, the Veterans Benefit Management System (VBMS), that will allow the agency to identify deficiencies during the claims process. If an error is detected, the claim will be paused to allow an in-process review (IPR), conducted by quality review teams, to occur. These new business requirements are under review for inclusion in a future release of VBMS. VBA expects to deploy the new VBMS functionality to pause the claims process by July 2017. In addition, the agency has secured funding and is in the process of developing a new quality assurance database that will capture data from all types of quality reviews at various stages of the claims process, to include local regional office individual quality reviews, IPRs, national STAR and consistency studies. VBA stated that this new database will support increased data analysis capabilities and allow VBA to evaluate the effectiveness of quality assurance activities through improved and vigorous error trend analysis. VBA anticipates deploying the new quality assurance database by July 2017. We will close this recommendation when VA provides documentation of the systems change that allows the process to be paused.
    Recommendation: To help improve the quality of VBA's disability compensation claim decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to take additional steps to evaluate the effectiveness of quality assurance activities to identify opportunities to improve or better target these activities.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, VA reported that VBA is in the process of developing a new quality assurance database that will capture data from all types of quality reviews at various stages of the claims process, to include local regional office individual quality reviews in-process reviews, national STAR reviews and consistency studies. VBA stated that this new database will support increased data analysis capabilities and allow VBA to evaluate the effectiveness of quality assurance activities through improved and vigorous error trend analysis. VBA anticipates deploying the new quality assurance database by July 2017. To help close this recommendation, the agency will need to explain how this new approach will be used to evaluate the effectiveness of quality assurance activities and thus improve their rigor.
    Director: J. Christopher Mihm
    Phone: (202) 512-6806

    4 open recommendations
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Secretary of Agriculture should direct the Under Secretary for Natural Resources and Environment, to improve Forest Service's customer service standards and feedback review, to: (1) ensure standards include performance targets or goals, (2) ensure standards include performance measures, (3) ensure standards are easily publicly available, (4) develop a feedback mechanism to collect comments agency-wide, which should include guidance or criteria to elevate customer feedback from local and regional offices to identify the need for and to make service improvements.

    Agency: Department of Agriculture
    Status: Open

    Comments: In August 2017, Forest Service provided an update for completing the tasks necessary to respond to our recommendations. In accordance with our recommendations, for each of its customer service standards, the Forest Service has developed goals, targets and measures and we consider this part of the recommendation closed. Forest Service stated the remaining part of the recommendation will be implemented by December 2018. Specifically, the Forest Service stated by December 2018 it will begin to make standards easily publicly available on its public-facing websites. The Forest Service provided the criteria for elevating customer comments and by December 2018 stated it will begin to deploy and collect feedback forms. We will close this recommendation as implemented when standards are publicly available and customer feedback forms are deployed.
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Secretary of Education should direct Federal Student Aid's Chief Operating Officer, to improve Federal Student Aid's customer service standards and feedback review, to: (1) ensure standards are easily publicly available, (2) develop a feedback mechanism that includes guidance or criteria for service providers to elevate customer feedback to identify the need for and to make service improvements.

    Agency: Department of Education
    Status: Open

    Comments: We emailed Department of Education in June 2017 for an update on the status of this recommendation. Once a response is received we will update this recommendation.
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Commissioner of U.S. Customs and Border Protection should, to improve CBP's customer service standards: (1) ensure standards include performance targets or goals, (2) ensure standards include performance measures.

    Agency: Department of Homeland Security: United States Customs and Border Protection
    Status: Open

    Comments: In January 2017, CBP sent an email stating that the agency has done all it can to fully implement the recommendation at this time. Because CBP does not have performance goals or targets for customer service standards this recommendation remains open. In April 2016, CBP provided us with customer service survey questions they use to collect data. Based on our review of that information, we were unable to confirm CBP had established performance targets and goals for the data being collected. As we stated in the report, performance goals should be in a quantifiable and measurable form to define the level of performance to be achieved for program activities each year. Although CBP is collecting new customer service data based on survey responses, without predetermined performance targets that align with a customer service standard it is not clear what or if internal targets or customer needs are being met. In June 2017, we emailed CBP for an update on the status of this recommendation. Once a response is received we will update this recommendation.
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Secretary of the Interior should direct the Assistant Secretary of Fish, Wildlife and Parks, to improve the National Park Service's customer service standards and feedback review, to: (1) ensure standards include performance targets or goals, (2) ensure standards include performance measures, (3) ensure standards are easily publicly available, (4) develop a feedback mechanism that includes guidance or criteria to review and elevate customer feedback from local and regional offices to identify the need for and to make service improvements.

    Agency: Department of the Interior
    Status: Open

    Comments: According to NPS officials, NPS plans on defining a strategy that describes the intended customer experience for highest customer interactions such as Volunteer in Parks program and Teacher engagement program. NPS will align the strategy with overall organizational strategy, share the strategy with all employees (e.g., documentation, training), and update strategy plans to include performance targets and goals for customer service. NPS also plans on soliciting feedback from customers about their experiences with the VIP and Teacher Outreach Programs, collecting unsolicited feedback from customers about their experiences with the organization (e.g., by mining calls, emails, or social media posts), and gathering input from employees about their experiences with customers and their role in delivering the customer experience. NPS plans to share customer experience metrics and models with all employees (e.g., distribute reports and dashboards, conduct training sessions), publish customer service standards on website so that customers know what to expect, and publish customer service data to ensure actual service levels are transparent. Finally NPS plans on piloting the "Federal Feedback" Button and evaluate for expanded use in fiscal year 2018. In June 2017, we emailed NPS for an update on this recommendation. Once a response is received we will update this recommendation.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    1 open recommendations
    including 1 priority recommendation
    Recommendation: The Secretary of Veterans Affairs should take steps to better understand both the difficulties faced by readjusting veterans and the characteristics of those who may be more likely to face such difficulties, and use the results to determine how best to enhance its benefits and services to these veterans.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA has begun taking steps to better understand the difficulties faced by readjusting veterans but has not yet completed them. Since November 2014, VA reported that it has been working with DOD to develop the joint process for conducting Care Coordination Process Reviews (formerly known as Qualitative Case Reviews), which will focus on reviewing care coordination processes and effectiveness. VA's Interagency Care Coordination Committee (IC3) Policy and Oversight Work Group is revising the policies and procedures for these reviews and has begun a national roll out of the Lead Coordinator initiative, which, according to VA, will improve the level of complex care coordination within and between DOD and VA. After completing a tabletop exercise of case review presentations on October 3, 2016, VA identified areas which needed fine tuning, so it developed open forums for lead coordinators to discuss process and resources. In an effort to enhance its briefings under the Transition Assistance Program, now known as the Transition Goals, Plans, Success program, VA used participant satisfaction data and is developing a long-term survey instrument that will assist VA in identifying and tracking recommended process improvements. In January 2015, VA produced a report on veteran economic competitiveness that recommended that VA develop targeted strategies for vulnerable populations, such as veterans who separate from the military without a GED or high school diploma and veterans who are separating after their rehabilitation. The report also recommended that VA continue to research the educational and economic status of veterans and coordinate with other federal agencies to identify and address gaps in current programs and policies that may result in barriers to economic success among vulnerable segments of the veteran population. GAO will consider this recommendation closed when VA has completed the joint Care Coordination Process Reviews, developed the long-term survey instrument for the Transition Goals, Plans, and Success program, and used the results from these reviews and survey to determine how best to enhance its benefits and services to veterans.