Fast Facts

The Department of Veterans Affairs pays monthly compensation to veterans with disabling conditions caused or aggravated by their military service.

We found that more than half of the veterans receiving disability compensation used VA health care for their conditions. However, VA does not have a clear picture of whether these services improve veterans’ health. VA could also enhance its process for determining when to reevaluate possible changes in health conditions.

We made 5 recommendations, including that VA develop better research on health outcomes for veterans receiving disability pay and improve its reevaluation process.

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Military ID tags and US flag

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Highlights

What GAO Found

In fiscal year 2018, about 54 percent of veterans receiving Department of Veterans Affairs (VA) disability compensation had at least one VA outpatient visit to treat an injury or illness that VA deemed was incurred or aggravated during military service (i.e., a service-connected condition). However, the health outcomes of veterans with service-connected conditions, such as changes in the severity of symptoms or the incidence of mortality, are not well understood. Information about health outcomes is central to ensuring veterans' wellness and assessing improvement in their disability status. According to VA researchers GAO spoke with and academic studies GAO reviewed, various challenges have limited research on this population. For example, data reside in different VA systems and use different identifiers for medical conditions, hindering use of the data. While VA has begun to consider ways to analyze health outcomes, it has not yet established a plan for this effort, including the scope, specific activities, and timeframes for addressing the identified research challenges.

VA does not glean information from the results of reevaluations to help manage its disability compensation program. Disability reevaluations help VA gauge whether veterans' service-connected conditions have changed, and whether disability compensation should be modified to reflect those changes (see figure).

VA Disability Compensation Reevaluation Process

Fig High-5 v04_102893

However, VA does not fully use key management information, such as:

  • trends in how frequently certain conditions are reevaluated, including those required by VA regulations to be reevaluated; and
  • outcomes of reevaluation decisions for individual conditions (i.e., whether conditions worsened or improved).

Both trend and outcome information could help VA better target its resources toward reevaluating conditions more likely to change.

VA recently updated its procedures manual to specify which staff may determine whether a veteran's condition should be reevaluated, but has not clearly defined skill sets and training needed to consistently implement these procedures. Specifically, the updated procedures do not indicate the knowledge, skills, and abilities staff need to determine when to conduct reevaluations. Further, VA has not ensured that training aligns with these needed skillsets. Without improving procedures and training, VA is at risk of conducting unnecessary reevaluations and burdening veterans.

Why GAO Did This Study

VA receives billions of dollars per year to provide health care and disability compensation to promote the wellness of veterans with service-connected conditions. VA studies veterans' health through research and assesses changes in service-connected conditions through its reevaluation process.

GAO was asked to review VA's efforts to study and gauge the health outcomes of veterans with service-connected conditions. This report examines the extent to which (1) veterans used VA health care services to treat service-connected conditions, and what is known about their health outcomes; (2) VA uses information on reevaluations to help manage the program; and (3) VA's procedures position it to determine when to conduct a reevaluation.

GAO reviewed fiscal year 2018 VA health care data; selected studies; VA data on completed reevaluations from fiscal years 2013-2018; and relevant federal laws, regulations, and program guidance. GAO also interviewed staff at four VA regional offices (selected for variation in claims workload and location) and VA officials at the agency's central office.

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Recommendations

GAO is making five recommendations, including that VA develop a plan to address challenges to studying health outcomes, use information on reevaluations to improve program management, and improve procedures and training for reevaluations. VA agreed with two recommendations and agreed in principle with the other three, but its proposed actions do not fully address GAO's concerns.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Office of Enterprise Integration develops a plan—including milestones and roles and responsibilities for OEI, VBA, and VHA—to address identified challenges that have hindered research on the health care outcomes for service-connected conditions of veterans receiving disability compensation. To align VA's efforts with the goals of its 2018-2024 Strategic Plan, VA's development of this plan should be completed and ready for implementation by June 1, 2020. (Recommendation 1)
Open
VA agreed with this recommendation. Since our report was issued, VA took steps to address the challenges hindering research on the health outcomes for this population; however, VA has yet to address the key issues with planning that we had identified. As of June 2021, VA officials reported that they established a Health Outcomes Work Group that has developed a plan to address the challenges hindering research on health care outcomes for service-connected conditions of veterans receiving disability compensation. According to VA officials, this plan contains a number of efforts led by various entities across the agency, such as initiating research related to this recommendation through VA's Learning Agenda; creating a crosswalk between the VHA diagnostic and VBA disability classification systems; and, establishing data use agreements. However, VA has not provided us with this plan and the summary provided to us does not include specific activities, such as the tasks associated with developing and implementing research plans, which agencies or data sets VA plans to include , or interim milestones that would help gauge progress toward accomplish these activities--elements of sound planning practices that are discussed in our report. VA's summary of its plan also does not describe the interrelationships among these various efforts and responsible entities or the process for reporting on progress in meeting the goals and milestones of these efforts to ensure accountability. We will consider closing this recommendation when VA provides a complete plan for developing, implementing, and integrating efforts to address these research efforts.
Department of Veterans Affairs The Under Secretary for Benefits should develop and implement a periodic analysis of program management data for trends in the individual service-connected conditions being reevaluated as well as data on the outcomes of reevaluations. (Recommendation 2)
Open
VA concurred with this recommendation. In June 2021, VA officials stated that they have developed an ad-hoc report to analyze historic trends in reevaluation of individual service-connected conditions. According to VA officials, they are reviewing the trend data to determine any further action, which may include development of a data dashboard to allow for periodic analysis of the data. VA expects to complete its review of the data and develop the data dashboard by September 30, 2021. We will consider closing this recommendation when VA continues to update its analysis using multiple data points to assess trends in reevaluations on a periodic basis.
Department of Veterans Affairs The Under Secretary for Benefits should implement the two recommendations in VBA's May 2018 consistency study to provide training on how to determine when a reevaluation is needed and review reevaluation decisions for accuracy at the lowest-scoring offices and take corrective action as needed. (Recommendation 3)
Open
VA concurred with this recommendation. VA has taken some action to address the accuracy of reevaluation decisions, but has yet to address key issues we had identified. Specifically, in April 2020, VA provided information from national accuracy reviews and individual claims processor quality reviews for these two offices. However, these reviews were not specifically designed to assess the quality of decisions on reevaluations, and as such, do not provide generalizable information on all reevaluations decided by these two offices. In June 2021, VA provided information from a special focused review of a sample of 50 claims with reevaluations from the five lowest-performing regional offices (based on national accuracy rates). VA reported that 14 of the 50 claims had benefit entitlement errors (defined as those having an impact or a potential impact on the outcome of a claim), for an accuracy rate of about 71 percent. VA stated that VBA is creating an action plan to address the identified deficiencies and plans to conduct further reviews of reevaluations handled by these offices by March 2022 to assess the results. We will consider closing this recommendation when VA's action are complete.
Department of Veterans Affairs The Under Secretary for Benefits should clarify guidance in its procedures manual regarding the knowledge, skills, and abilities needed to make decisions on whether to reevaluate veterans for changes in their service-connected conditions. (Recommendation 4)
Open
VA agreed with this recommendation in principle, acknowledging the importance of having appropriately skilled and trained employees to process reevaluations and other claims. VA stated that it believes the procedures outlined in its manual accurately describe the steps necessary for claims adjudicators to make the decision whether to reevaluate veterans for changes in their service-connected conditions. It further stated that regional office management ensures compliance with the procedures through the quality assurance program, and makes the decisions about which claims processors are best suited to perform the work. To address the recommendation, in February 2021, VA told us that VBA planned a targeted accuracy review of routine future examinations requested by non-raters. This accuracy review, conducted in October and November 2020, showed an 85 percent accuracy rate for non-raters. VA addressed the findings of this accuracy review by providing training for all claims processors in March and April 2021. Although VA's manual describes steps for conducting reevaluations and the agency has reviewed the accuracy of reevaluation decisions, these steps do not address our finding that VA has not provided guidance to regional offices on the types of knowledge, skills and abilities needed to decide whether a reevaluation is warranted. Without providing such guidance, VBA may be at risk of having unqualified staff continue to order unwarranted reevaluations. This risk, in turn, could result in wasted resources and an undue burden on veterans.
Department of Veterans Affairs The Under Secretary for Benefits should align training requirements with the knowledge, skills, and abilities needed for reviewing claims to decide whether to conduct a reevaluation. (Recommendation 5)
Closed - Implemented
VA agreed with this recommendation in principle. In February 2021, VA officials told us that VBA planned to conduct a targeted accuracy review of routine future examinations requested by claims processors and would review the results to determine if any additional training for claims processors was needed. This accuracy review, conducted in October and November 2020, showed an 85 percent accuracy rate for non-raters. Based on results of this accuracy review, VA officials told us that Compensation Service provided training to all claims processors in March and April to improve their knowledge and skill in processing reevaluations. Specifically, the training reviewed the errors identified in the targeted accuracy review and VA's policies for determining whether a reevaluation is needed. VA also identified scenarios when reevaluations were requested, but were not warranted to help guide claims processors' ability to make reevaluation decisions.

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