Veterans' Disability Benefits: Timely Processing Remains a Daunting Challenge

GAO-13-89 Published: Dec 21, 2012. Publicly Released: Jan 18, 2013.
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What GAO Found

A number of factors—both external and internal to the Veterans Benefits Administration (VBA)—have contributed to the increase in processing timeframes and subsequent growth in the backlog of veterans’ disability compensation claims. As the population of new veterans has swelled in recent years, the annual number of claims received by VBA has gone up. Compared to the past, these claims have a higher number of disabling conditions, and some of these conditions, such as traumatic brain injuries, make their assessment complex. Moreover, due to new regulations that have established eligibility for benefits for new diseases associated with Agent Orange exposure, VBA adjudicated 260,000 previously denied and new claims. Beyond these external factors, issues with the design and implementation of the compensation program have contributed to timeliness challenges. For example, the law requires the Department of Veterans Affairs (VA) to assist veterans in obtaining records that support their claim. However, VBA officials said that lengthy timeframes in obtaining military records—particularly for members of the National Guard and Reserve—and Social Security Administration (SSA) medical records impact VA’s duty to assist, possibly delaying a decision on a veteran’s disability claim. As a result, the evidence gathering phase of the claims process took an average of 157 days in 2011. Further, VBA’s paper-based claims processing system involves multiple hand-offs, which can lead to misplaced and lost documents and can cause unnecessary time delays. Concerning timeliness of appeals, VBA regional offices have shifted resources away from appeals and toward claims in recent years, which has led to lengthy appeals timeframes.

VBA is currently taking steps to improve the timeliness of claims and appeals processing; however, prospects for improvement remain uncertain because timely processing remains a daunting challenge. VBA is using contractors to handle some aspects of the claims process, and is also shifting some workload between regional offices. Also, VBA is modifying and streamlining certain claims and appeals processing procedures for veterans who opt to participate in these initiatives in exchange for an expedited decision. For example, veterans receive expedited processing when they submit a claim that is certified as having all required evidence. Not many veterans have elected this option, but VA is making adjustments to increase its attractiveness. In addition, VBA is trying to decrease the amount of time it takes to gather medical evidence. For example, VBA recently encouraged medical providers to use a standardized form when responding to VBA’s request for information. However, results of this initiative have been mixed. VBA is also taking steps to streamline the claims process, including implementing initiatives to create (1) standardized language for decision letters sent to veterans, (2) specialized teams that process claims based on level of complexity, and (3) a paperless claims system. According to VBA officials, these efforts will help VA process veterans’ claims within 125 days by 2015. However, the extent to which VA is positioned to meet this ambitious goal remains uncertain. Specifically, VBA’s backlog reduction plan—its key planning document—does not articulate performance measures for each initiative, including their intended impact on the claims backlog. Furthermore, VA has not yet reported on how these efforts have affected processing times, a condition which raises concern given the mixed results that have emerged to date.

Why GAO Did This Study

For years, VA has struggled with an increasing workload of disability compensation claims. The average time to complete a claim was 188 days in fiscal year 2011, and VA expects an increase in claims received as 1 million servicemembers leave military service over the next 5 years. As GAO and other organizations have previously reported, VA has faced challenges in reducing the time it takes to decide veterans’ claims. GAO was asked to review these issues. Specifically, this report examines (1) the factors that contribute to lengthy processing times for disability claims and appeals, and (2) the status of VBA’s recent efforts to improve disability claims and appeals processing timeliness. To do this, GAO analyzed VBA performance data and program documents, reviewed relevant studies and evaluations, met with staff from five VA regional offices, and interviewed VBA officials and Veterans Service Organizations.

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GAO recommends that VBA (1) partner with military officials to reduce timeframes to gather records from National Guard and Reserve sources, (2) partner with SSA to reduce timeframes to gather SSA medical records, and (3) ensure the development of a robust plan for its initiatives that identifies performance goals that include the impact of individual initiatives on processing timeliness. In response to a draft of this report, VA officials generally agreed with GAO’s conclusions and concurred with the recommendations, and summarized efforts that are planned or underway to address the recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Veterans Benefits Administration to develop improvements for partnering with relevant federal and state military officials to reduce the time it takes to gather military service records from National Guard and Reserve sources.
Closed – Implemented
VA has made significant progress in coordinating with the Department of Defense to improve the process for gathering military service records for National Guard and Reserve sources. The joint Veterans Benefits Administration and Department of Defense (DoD) Disability Claims Reduction Task Force met in 2013 to evaluate the process to request records, among other issues, with the aim of improving the timeliness of record exchanges between the two agencies. As a result of the recommendations of the task force, the Veterans Benefits Administration (VBA) initiated a pilot program in January 2014 to centralize National Guard and Reserve records requests at the VA Records Management Center VA Liaison Office. In December 2014, VA received approval for additional resources to support national deployment of a promising pilot program, and in February 2015 reported that it was working on a timeline to hire, train, and staff the national deployment. VBA completed the pilot program for centralizing requests for records for Reserve and National Guard members in March 2015. VA reported that VBA delivered training to its 56 regional offices and deployed the process for requesting records for Reserve and National Guard members nationally. They also transitioned to using the VBA application, Personnel Records Information Exchange System (PIES) to improve and streamline the processing of these requests. VA stated that they hired and continued to train staff to support this process. In July 2016, VA reported continued progress in integrating with DoD's Electronic Case File Transfer system to process Integrated Disability Evaluation System claims electronically. The first phase, which allowed transfer of case files, was completed in December 2013. In December 2016, VA reported it had completed phases 2 and 3, which involved developing certain business requirements. VA also reported these business requirements are dependent upon the completion of two additional phases (related to file transfer/communication with DoD). Once these are completed, VA will better position itself to improve the processing time for disability cases involving National Guard and Reserve service records.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Veterans Benefits Administration to develop improvements for partnering with Social Security Administration officials to reduce the time it takes to gather medical records.
Closed – Implemented
In September 2013, 300 VBA employees across all VA regional offices and the Appeals Management Center were trained on the new SSA Government to Government Services Online (GSO) system, which provides direct electronic access to SSA medical records. By the end of FY 2014, all VBA employees with a need to request SSA records will do so electronically by using the GSO system.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Veterans Benefits Administration to ensure the development of a robust backlog reduction plan for VBA's initiatives that, among other best practice elements, identifies implementation risks and strategies to address them and performance goals that incorporate the impact of individual initiatives on processing timeliness.
Closed – Implemented
In January 2013, the Department of Veterans' Affairs (VA) published the Strategic Plan to Eliminate the Compensation Claims Backlog, which identifies implementation risks as well as tracks overall performance based on a number of metrics, including processing timeliness. Although some initiatives lack individual performance goals and metrics, such as the Disability Benefits Questionnaire (DBQ) initiative, we believe VA has addressed the overall intent of the recommendation by providing metrics for all the major initiatives mentioned in the Plan. That stated, as VA moves forward, the agency may find opportunities to ensure the DBQ and other initiatives are working as intended.

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