Veterans' Disability Benefits: Better Measures Needed to Assess Regional Office Performance in Processing Claims

GAO-19-15 Published: Oct 03, 2018. Publicly Released: Oct 03, 2018.
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What GAO Found

In 2016, the Veterans Benefits Administration (VBA) centralized distribution of the disability compensation claims workload through the National Work Queue, which prioritizes and distributes claims to regional offices based on their capacity; however, there are gaps in VBA's guidance for processing claims with errors. Under the National Work Queue, multiple regional offices can work on a single claim instead of the claim remaining at one office for the duration of processing (see figure). GAO found gaps in guidance about whether a claims processor should fix an error made by another regional office, or return the claim to that office to be corrected. The former could result in missed opportunities to train staff who made the error, while the latter could result in processing delays.

VBA Disability Claims Workload Distribution Before and After the National Work Queue

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VBA primarily uses timeliness and accuracy measures to assess its regional offices' performance in processing disability compensation claims, but these measures do not adequately capture performance. The timeliness measure can be skewed because it is a snapshot of how long claims have been pending at an office on the last day of the month, and does not capture performance over a period of time. The accuracy measure is attributed to the office that finishes the claim, even though 88 percent of claims completed in fiscal year 2017 were processed at more than one office. VBA officials acknowledged that these measures are limited and said the agency is exploring alternatives, but VBA has no specific plan or time frame for determining and implementing new measures. Without measures to more accurately assess regional office performance, VBA may be limited in its ability to make efficient and effective decisions.

Veterans service organizations (VSO) and staff working for Members of Congress (congressional caseworkers) interviewed by GAO were generally satisfied with regional office communication regarding disability compensation claims. However, VBA's policy on whom VSOs should contact during different points in the process did not always align with what occurs at the offices we visited or with VSO needs. This could result in VSOs not receiving consistent and timely responses from VBA. Evaluating this policy could help VBA assist VSOs in better serving veterans. In addition, congressional caseworkers GAO interviewed identified ways that communication could be improved or that additional support could be provided, such as a list of contacts at all regional offices for claim inquiries. VBA officials GAO interviewed described an open-door policy through which they may receive feedback from caseworkers, but the agency does not formally solicit periodic feedback from them. Without such feedback, the agency may miss opportunities to identify and address caseworker communication needs that could help them better serve veterans.

Why GAO Did This Study

Each year, VBA processes more than 1 million disability compensation claims and provides about $65 billion in benefits to veterans. The Jeff Miller and Richard Blumenthal Veterans Health Care and Benefits Improvement Act of 2016 includes a provision for GAO to review VBA's regional offices to help VBA achieve more consistent performance in processing disability compensation claims.

This report examines (1) how VBA manages workload and performance for the disability compensation claims process, (2) how well VBA's timeliness and accuracy measures capture its regional offices' performance in processing these claims, and (3) how well selected regional offices communicate with VSOs and congressional caseworkers about these claims. GAO reviewed VBA policies and procedures; visited four regional offices selected to represent a range of performance scores and claims processing volume in fiscal year 2017; and interviewed VBA headquarters officials and management and staff from the selected regional offices. GAO also interviewed VSOs and congressional caseworkers—selected for House, Senate, and bipartisan representation—to learn more about their communication with VBA.

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GAO is making five recommendations to VBA to clarify guidance for correcting errors, develop and implement measures to better assess timeliness and accuracy at regional offices, and evaluate communication with VSOs and caseworkers. The Department of Veterans Affairs concurred with GAO's recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Veterans Benefits Administration The Under Secretary for Benefits should clarify how Veterans Service Representatives should handle claims when they identify an error, including when to defer a claim and when to correct the error on their own. (Recommendation 1)
Closed – Implemented
In September 2018, VBA provided guidance to staff to resolve errors from open to open deferrals on station regardless of the station that caused the error. Also, in January 2019, VBA provided a guide to staff explaining the deferral process, including the requirement to generally use the deferral process for all claims that require rework, and the reasons for deferring cases. This additional guidance should help to ensure that staff are more consistent in how they process claims with errors and make the process more efficient. As with other policy changes, moving forward, VA could also consider updating its policy manual.
Veterans Benefits Administration The Under Secretary for Benefits should develop and implement a new regional office performance measure that allows it to better assess each regional office's timeliness over a period of time. (Recommendation 2)
Closed – Implemented
VBA developed and added a new regional office performance measure for timeliness, called Time-to-Exit-Cycle (TEC), as a secondary metric in its regional office Director's Performance Plan. TEC accounts for the average time regional offices took to process claims throughout the previous month. Previously, VBA relied solely on its primary metric, Time-in-Queue (TIQ), which is based on a snapshot on the last day of each month of how long each claim in the office's queue has been waiting for action to be taken or completed. TEC provides VBA with a more complete picture of each regional office's timeliness over a period of time and serves as a check on TIQ. Combined, TEC and TIQ allows VBA to monitor regional offices' past performance and remaining workload simultaneously and helps to avoid any perverse incentives regarding the order in which claims are processed. According to VBA, TIQ remains the primary metric because it provides an incentive to process the oldest claims first; whereas, TEC could create an incentive to process the easiest claims first since it measures work that was completed and not the work that remains. We conducted additional analysis of VBA's TIQ and TEC data and determined that VBA's joint use of these data is reasonable for assessing VBA regional offices' timeliness.
Veterans Benefits Administration The Under Secretary for Benefits should develop and implement a new regional office performance measure that allows it to better measure the accuracy of each regional office's work. (Recommendation 3)
Open – Partially Addressed
VBA's FY22 regional office performance plan added a new secondary performance metric to help better measure accuracy, but it is not yet used as a primary performance metric to assess the accuracy of each regional office's work. In November 2022, VBA stated that it was still working toward establishing this secondary metric as a primary metric, with a target completion date of October 31, 2023. When VBA completes evaluation of this secondary metric and uses it as its primary performance metric for regional office accuracy, we will close this recommendation.
Veterans Benefits Administration The Under Secretary for Benefits should evaluate its policy for regional office communication with VSOs to ensure that it is clear, that it aligns with practice, and that it meets the communication needs of VSOs. (Recommendation 4)
Closed – Implemented
In December 2018, VBA conducted training with regional office employees responsible for stakeholder engagement, including explaining a new requirement to meet quarterly with local VSOs. VBA also incorporated this requirement in its guidance. In May 2019, VBA directed regional office leadership to discuss at their quarterly VSO meetings the role of Change Management Agents, who facilitate VBA changes and related communication at regional offices. VBA's instructions to RO leadership stated that VSOs should be advised to communicate with regional offices' Change Management Agents on claim-related matters throughout the claims process, including during the 48-hour review period that VSOs have to review disability ratings before they are finalized.
Veterans Benefits Administration The Under Secretary for Benefits should develop and implement a mechanism to obtain periodic feedback from congressional caseworkers on their communication with regional offices regarding claims and needed information or support. (Recommendation 5)
Closed – Implemented
The Veterans Benefits Administration facilitated training with regional office employees responsible for stakeholder engagement on December 21, 2018, which included outlining a requirement to meet quarterly with congressional caseworkers to, among other things, offer an opportunity for them to provide feedback and suggestions for improving communication, and incorporated this requirement into its guidance. As a result, VBA should be better positioned to understand the needs of congressional caseworkers moving forward.

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