VA Disability Benefits: Improved Planning Practices Would Better Ensure Successful Appeals Reform

GAO-18-352 Published: Mar 22, 2018. Publicly Released: Mar 22, 2018.
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Highlights

What GAO Found

The Department of Veterans Affairs' (VA) plan for implementing a new disability appeals process while attending to appeals in the current process addresses most, but not all, elements required by the Veterans Appeals Improvement and Modernization Act of 2017 (Act). VA's appeals plan addresses 17 of 22 required elements, partially addresses 4, and does not address 1. For example, not addressed is the required element to include the resources needed by the Veterans Benefits Administration (VBA) and the Board of Veterans' Appeals (Board) to implement the new appeals process and address legacy appeals under the current process. VA needs this information to certify, as specified under the Act, that it has sufficient resources to implement appeals reform and make timely appeals decisions under the new and legacy processes.

VA's appeals plan reflects certain sound planning practices, but it could benefit from including important details in several key planning areas:

Performance measurement: VA's plan reflects steps taken to track performance, but could articulate a more complete and balanced set of goals and measures for monitoring and assessing performance on a range of dimensions of success. Specifically, the plan reports that VA is developing a process to track timeliness of the new and legacy processes. However, contrary to sound planning practices, the plan does not include timeliness goals for all five appeals options available to veterans, does not include goals or measures for additional aspects of performance (such as accuracy or cost), and does not explain how VA will monitor or assess the new process compared to the legacy process. Unless VA clearly articulates a complete and balanced set of goals and measures, it could inadvertently incentivize staff to focus on certain aspects of appeals performance over others or fail to improve overall service to veterans.

Project management: VA's plan includes a master schedule for implementing the new appeals plan. However, this schedule falls short of other sound practices for guiding implementation and establishing accountability, such as articulating interim goals and needed resources for, and interdependencies among, activities. Unless VA augments its master schedule to include all key activities and reflect sound practices, VA may be unable to provide reasonable assurance that it has the essential program management information needed for this complex and important effort.

Risk assessment: VA has taken steps to assess and mitigate some risks related to appeals reform by, for example, pilot testing two of the five appeals options through its Rapid Appeals Modernization Program (RAMP). However, as designed, RAMP does not include key features of a well-developed and documented pilot test. For example, VA has not articulated how it will assess RAMP before proceeding with full implementation. In addition, RAMP is not pilot testing three options and, as a result, VA will not have data on the extent to which veterans will appeal directly to the Board when given the option. Unless VA identifies and mitigates key risks associated with implementing a new process, VA is taking a chance that untested aspects will not perform as desired.

Why GAO Did This Study

VA's disability compensation program pays cash benefits to veterans with disabilities connected to their military service. In recent years, the number of appeals of VA's benefit decisions has been rising. For decisions made on appeal in fiscal year 2017, veterans waited an average of 3 years for resolution by either VBA or the Board, and 7 years for resolution by the Board. The Veterans Appeals Improvement and Modernization Act of 2017 makes changes to VA's current (legacy) appeals process, giving veterans new options to have their claims further reviewed by VBA or appeal directly to the Board. The Act requires VA to submit to Congress and GAO a plan for implementing a new appeals process, and includes a provision for GAO to assess VA's plan.

This report examines the extent to which VA's plan (1) addresses the required elements in the Act, and (2) reflects sound planning practices identified in prior GAO work. GAO reviewed and assessed VA's appeals plan and related documents against sound planning practices, and solicited VA's views on its assessments.

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Recommendations

GAO recommends that VA (1) fully address all legally required elements in its appeals plan, (2) articulate how it will monitor and assess the new appeals process as compared to the legacy process, (3) augment its master schedule for implementation, and (4) address risk more fully. VA agreed with GAO's recommendations and outlined its planned actions to address them.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should address all of the required elements in the Act in VA's appeals plan to Congress--including delineating resources required for all VBA and Board appeals options--using sensitivity analyses and RAMP results, where appropriate and needed. (Recommendation 1)
Closed - Not Implemented
VA took some steps to address the required elements but not enough to fully address it before implementing the Appeals Modernization Act in February 2019. VA's updated plan added information related to the five required elements. And for two of the elements - monitoring the processing of legacy appeals, and projecting staff productivity - it described using sensitivity models and other analyses to monitor and forecast future VBA and Board workloads, production, and staffing requirements. However, as of February 2019 when the agency implemented reform, the agency only partially addressed three elements: 1) monitoring progress toward implementation of the new process, 2) delineating total resources, and 3) identifying personnel requirements. Regarding element 1, VA set various goals or metrics for appeal options but did not establish well-defined, measurable criteria (such as for the testing of the new appeals processes) against which it could have assessed readiness for implementing appeals reform. For element 2, VA's plan projected the number of needed VBA and Board personnel and added FTE information for other offices that help implement the appeals process and used a model to monitor resource needs. As of February 2019, however, the plan did not delineate the total resources required by VBA and the Board, such as resources related to fully implementing information technology, training, and onboarding new Board staff in FY20 and beyond. Regarding element 3, VBA and the Board used modeling to project personnel needs and identified solutions to scale back resources when it is no longer processing legacy appeals. However, as of February 2019, the Board had not provided similar details about how it would address future personnel needs; and neither VBA nor the Board provide projected staffing levels when VA is no longer processing any legacy appeals. Overall, we continue to believe that VA was missing information required by the Act prior to implementing appeals reform.
Department of Veterans Affairs
Priority Rec.
This is a priority recommendation.
The Secretary of Veterans Affairs should clearly articulate in VA's appeals plan how VA will monitor and assess the new appeals process compared to the legacy process, including specifying a balanced set of goals and measures--such as timeliness goals for all VBA appeals options and Board dockets, and measures of accuracy, veteran satisfaction, and cost--and related baseline data. (Recommendation 2)
Open
VA concurred with this recommendation. As of February 2022, VBA and the Board of Veterans' Appeals (Board) have addressed some issues we had identified with how it monitored and assessed performance in deciding appeals. However, VA has yet to fully implement this recommendation. In its January 2022 action plan to address high-risk issues provided to GAO and a February 2022 progress report to Congress, VA has reported on a range of performance metrics for both new and legacy appeals, including average days pending and to complete appeals. VA also reported that it has deployed surveys to assess the veteran experience with both the new and legacy appeals processes. Moreover, in May 2021, VA established timeliness goals for all options (lanes) of the new appeals process. However, VA has not reported - and it is not clear the extent to which VA tracks - complete performance metrics for quality and veterans' satisfaction that can be used to monitor and assess the new appeals process. In addition, VA officials said they are taking steps to develop a methodology to compare the legacy and new appeals processes, but have not provided details about this effort. We will consider closing this recommendation when VA establishes (1) a balanced set of performance goals and measures for all new appeals options, including overall accuracy and veterans' satisfaction, as well as (2) a methodology for assessing how well the new process is performing relative to the legacy process.
Department of Veterans Affairs The Secretary of Veterans Affairs should augment the master schedule for VA's appeals plan to reflect all activities--such as modifications to information technology (IT) systems--as well as assigned responsibilities, interdependencies, start and end dates for key activities for each workgroup, and resources, to establish accountability and reduce overall risk of implementation failures. (Recommendation 3)
Closed - Implemented
VA concurred with this recommendation and has taken significant action to implement it. VA developed detailed plans about how it would implement sub-activities related to processing appeals and implementing Caseflow-an information technology system intended to help VA track and process appealed claims at the Board of Veterans' Appeals (Board). In particular, in December 2021, VA provided us with detailed plans that reflect an Agile project management method for developing, implementing, and integrating functionality envisioned under Caseflow. An Agile method includes rolling-wave planning in which near-term work is planned in detail and all future work is identified at a high level. It also includes processes for ensuring that the software meets stakeholder needs. VA has a longer-term plan for managing the development and deployment of Caseflow features and detailed plans showing prioritized lists of tasks, as well as releases of software during a series of two-week increments. VA's plans should help ensure the agency is well-positioned to implement changes required by the new appeals process. While we consider this recommendation to be implemented, because Caseflow development is ongoing, we will continue to track VA's progress in deploying Caseflow through our ongoing monitoring of this high-risk area.
Department of Veterans Affairs
Priority Rec.
This is a priority recommendation.
The Secretary of Veterans Affairs should ensure that the appeals plan more fully addresses risk associated with appeals reform--for example, by assessing risks against a balanced set of goals and measures, articulating success criteria and an assessment plan for RAMP, and testing or conducting sensitivity analyses of all appeals options--prior to fully implementing the new appeals process. (Recommendation 4)
Open
VA concurred with this recommendation. VA has implemented the Appeals Modernization Act (AMA) and, along with the Board of Veterans' Appeals (Board), has made strides to simultaneously manage two appeals processes. For example, VA is monitoring workloads, in part, through modeling, which enables it to better project resource needs for processing these workloads, as we have recommended. However, as of February 2022, VA has not fully developed mitigation strategies for certain workload risks, such as veterans choosing at much higher rates the Board's hearing option, which is the most resource intensive of the three AMA Board options. The lack of a risk mitigation strategy is significant because in January 2022, VA data show that this resource-intensive AMA hearing option accounted for nearly 55 percent of the AMA appeals inventory. This circumstance could mean veterans will have longer wait times and increasing backlogs under this hearing option. In addition, VA has yet to articulate other key goals and measures, such as the quality of AMA decisions or veteran's satisfaction, to create a balanced set of measures that would more fully inform VA's assessment of risk. These elements are largely missing from VA's January 2022 high-risk action plan provided to GAO and February 2022 progress report to Congress. VA's ability to effectively manage appeals lies, in part, in planning ahead and in proactively identifying and addressing risks that may impact the timeliness and quality of decisions and serving veterans. We will consider closing this recommendation when VA fully develops a mitigation strategy and plan for workload risks and comprehensively assesses risks against a balanced set of measurable goals.

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