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The Veterans' Benefits Improvement Act of 2008 (P.L. 110– 389) mandated that GAO evaluate the Department of Veterans Affairs VA training for disability claims processors. This report answers the following two questions: (1) How appropriate is the training provided to experienced disability claims processors? (2) How adequate is the Veterans Benefits Administration's (VBA) monitoring and assessment of this training? To address these questions, GAO conducted a web–based survey of a nationally representative sample of claims processors, interviewed VBA headquarters and regional office officials, and reviewed VBA training material, relevant federal statutes, regulations, and court cases. [ABSTRACT FROM AUTHOR]

The article presents the evaluation report released by the U.S. Government Accountability Office (GAO) on the Veterans Benefits Administration's (VBA) disability reevaluation program in the U.S. It evaluates the operational controls that Veterans Affair (VA) uses to ensure the efficiency of the disability reevaluation process It also valuates the management information VA collects and uses to regulate the disability reappraisal process.

The Social Security Administration's (SSA) Disability Insurance and Supplemental Security Income programs provided around $128 billion to about 12.8 million persons with disabilities and their families in fiscal year 2005. Claimants who are denied benefits by SSA may appeal to federal courts. Through current initiatives, SSA is attempting to reduce the number of cases appealed to courts and remanded back to SSA for further review. In addition, there have been long-standing concerns about how SSA responds to court decisions that conflict with its policies. GAO was asked to examine: (1) trends over the past decade in the number of appeals reviewed by the courts and their decisions, (2) reasons for court remands and factors contributing to them, and (3) SSA's process for responding to court decisions that conflict with agency policy. GAO reviewed SSA data and documents on court decisions, remands and SSA's processes and interviewed agency officials and stakeholders on data trends, reasons for remands, and SSA processes. Between fiscal years 1995 and 2005, the number of disability appeals reviewed by the federal district courts increased, along with the proportion of decisions that were remanded. More disability claims were remanded than affirmed, reversed, or dismissed over the period, and the proportion of total decisions that were remands ranged from 36 percent to 62 percent, with an average of 50 percent. Remanded cases often require SSA to re-adjudicate the claim, with the result that--along with the passage of time and new medical evidence--the majority of remanded cases result in allowances. According to SSA officials and outside observers, a range of errors prompted by heavy workloads is responsible for court remands of SSA's disability determinations, but data that would confirm or clarify the issue are incomplete and not well-managed. SSA has only recently begun collecting data on remands, and we found these data to be incomplete. Additionally, this information is collected by two different offices that have created somewhat different categories for the data, making some of the information inconsistent and possibly redundant. Meanwhile, SSA has acknowledged the need to reduce remands and, in 2006 along with other initiatives, introduced new decision-writing templates to improve efficiency and reduce errors. SSA has a process in place for determining whether appellate court decisions conflict with the agency's interpretation of disability statutes or regulations and has taken steps in recent years to align its national policies with appellate court decisions. For example, officials and stakeholders attributed a downward trend in appellate court decisions that conflict with agency policy to significant policy changes instituted by SSA in the mid-1990s. In addition, for those cases where the agency acceded to conflicting appellate court decisions by issuing acquiescence rulings within the related circuits, we found that about... [ABSTRACT FROM AUTHOR]

The Ranking Democratic Member, House Committee on Veterans' Affairs, asked GAO to determine (1) whether VA's internal assessments indicate its regional offices are complying with the requirements of the Veterans Claims Assistance Act (VCAA) of 2000 for obtaining military service records for veterans' disability compensation claims and (2) whether VBA could improve its procedures for obtaining military service records for claims involving post-traumatic stress disorder (PTSD). The Department of Veterans Affairs' (VA) internal assessments indicate its regional offices generally comply with VCAA's requirements for obtaining military service records for veterans' compensation claims. For example, of the decisions made by regional offices on compensation claims during the first half of fiscal year 2006, Veterans Benefits Administration (VBA) quality reviewers found that less than 4 percent contained errors involving failure to obtain military service records. Similarly, of the appealed compensation cases decided by the Board of Veterans' Appeals during November 2004-January 2006, the board remanded less than 3 percent to VBA for rework due to deficiencies in obtaining military service records. However, VBA does not systematically evaluate the quality of research done on behalf of regional offices by a VBA unit at the National Personnel Records Center, where the service records of many veterans are stored. Regional offices rely on this unit to do thorough and reliable searches and analyses of records and provide accurate reports on the results. Without a systematic program for assessing the quality of this unit's work, VBA does not know the extent to which the information that this unit provides to regional offices is reliable and accurate. VBA potentially could improve its procedures and reduce the time required to process some veterans' claims for PTSD, which may result after a veteran participates in, or is exposed to, stressful events or experiences (stressors). Regional offices sometimes must turn to information contained in the military historical records of the Department of Defense (DOD) to verify the occurrence of claimed stressors. While regional offices are able to directly access and search an electronic library of such records for many Marine Corps veterans, they must rely on DOD's U.S. Army and Joint Services Records Research Center (JSRRC) to research such records for all other service branches. The JSRRC's response time to regional office requests approaches an average of 1 year. However, by building on work already done by several regional offices to establish and use an electronic library of DOD military historical records for the other service branches, VBA may be able to greatly reduce the time required to process many veterans' PTSD claims. [ABSTRACT FROM AUTHOR]

In March 2006, the Social Security Administration (SSA) published a rule that fundamentally alters the way claims for disability benefits are processed and considered. The rule establishes the Disability Service Improvement process (DSI)--intended to improve the accuracy, timeliness, consistency, and fairness of determinations. DSI's changes include an opportunity for an expedited decision during the initial determination process and the elimination of the Appeals Council, which had given claimants the right to appeal administrative law judge (ALJ) decisions before pursuing federal court review. DSI replaces the council with a Decision Review Board, which will selectively review ALJ decisions. However, dissatisfied claimants whose cases are not selected for board review must now appeal directly to the federal courts. Based on its ongoing work, GAO was asked to testify on (1) public and stakeholder concerns about the elimination of the Appeals Council and its replacement by the Decision Review Board and SSA's response to these concerns, as well as (2) the steps that SSA has taken to help facilitate a smooth implementation of the DSI process. Concerns regarding the replacement of the Appeals Council with the Decision Review Board--raised by the public and stakeholder groups, such as claimant representatives--generally fall into two areas: (1) potential for increasing the workload of the federal courts and (2) anticipated hardship for claimants in terms of the loss of an administrative appeal level and difficulties associated with pursuing their claim in federal court. SSA's response to concerns regarding the federal court workload is that all changes associated with the new DSI process--taken together--should reduce the need for appeal to the federal courts; at the same time, SSA plans to implement this final step gradually and with additional safeguards to minimize impact on the courts. In response to concerns about the loss of appeal rights, SSA contends that DSI introduces enhanced levels of federal review earlier in the process and that claimants should experience a decline in the amount of time it takes to receive a final agency decision. SSA has prepared in significant ways for the initial rollout of DSI in its Boston region, but the agency's timetable is ambitious and much work remains. The agency has moved forward in key areas that underpin the new system--human capital development, technical infrastructure, and quality assurance--taking actions consistent with past GAO recommendations for improving the disability determination process. For example, SSA has taken steps to ensure that key technical supports, particularly its electronic disability case processing system, are in place--even though it has allowed itself little time to address and resolve any glitches that may arise prior to implementation. SSA has also taken several steps to lay a foundation for quality assurance by centralizing its quality assurance reviews,... [ABSTRACT FROM AUTHOR]

The House Committee on Armed Services report that accompanies the National Defense Authorization Act of fiscal year 2006 directs GAO to review results of the military disability evaluation system. In response to this mandate, GAO determined: (1) how current DOD policies and guidance for disability determinations compare for the Army, Navy, and Air Force, and what policies are specific to reserve component members of the military; (2) what oversight and quality control mechanisms are in place at DOD and these three services of the military to ensure consistent and timely disability decisions for active and reserve component members; and (3) how disability decisions, ratings, and processing times compare for active and reserve component members of the Army, the largest branch of the service, and what factors might explain any differences. [ABSTRACT FROM AUTHOR]

Advocates for patients with inflammatory bowel disease (IBD) believe that the Social Security Administration's (SSA) process for determining eligibility for Disability Insurance (DI) may treat some claimants unfairly. As a result, claimants with IBD believe they are likely to be denied benefits at the initial decision and reconsideration levels, making it necessary for them to appeal to SSA's hearings level to have their claims allowed. This congressionally mandated study focuses on (1) how SSA evaluates claims involving IBD to establish disability under Title II of the Social Security Act and (2) what unique challenges claimants with IBD encounter when applying for DI benefits, and what actions, if any, SSA has taken to address these challenges. SSA evaluates DI claims involving IBD just as it does all claims, using a five-step sequential evaluation process to determine whether: (1) the individual is working and earning an amount exceeding established thresholds, (2) the impairment or combination of impairments significantly limits a person's physical or mental ability to perform basic work activities, (3) the individual's impairment meets or equals a pre-established list of the medical criteria for impairments considered severe enough to prevent an individual from earning wages above the established threshold, (4) the claimant can return to previous work based on what the individual can still do in a work setting despite physical or mental limitations, or his or her "residual functional capacity," and (5) the claimant can do any work in the economy. As claims move through the five-step process, their assessment requires additional evidence and increasingly complex judgments on the part of adjudicators. For example, at step three, claimants with IBD who are diagnosed with Crohn's disease would meet the medical criteria if their weight fell below the minimum on SSA's weight table. In contrast, to determine the residual functional capacity of claimants with IBD at steps four and five, SSA adjudicators must assess claimants' mental and physical capacity and make judgments regarding allegations of pain and fatigue. Adjudicators at the initial, reconsideration, and hearings levels use the same five-step process, although differences exist between the levels that may affect decisions. For example, claimants may be represented by an attorney or nonattorney at the hearings level. While claimants with IBD are somewhat less likely to be allowed DI benefits than claimants with other impairments, their experiences applying for disability benefits are not unique, and SSA has efforts under way that may address some claimant concerns. When we analyzed DI decisions in 2003 by decision-making levels, we found that claimants with IBD, like many others, experienced lower allowance rates at the initial and reconsideration levels compared to the hearings level, although the difference between the levels was more pronounced for claimants with IBD. Lower allowance rates at the initial levels and higher allowance rates at the hearings level may reflect challenges that claimants with IBD share with many other claimants in applying for disability benefits. For example, both claimants with IBD and other claimants are unlikely to be allowed at step five of the process at the initial levels but not at the hearings level. SSA is pursuing efforts that may address some claimant concerns. For example, the agency is currently updating the medical criteria used for many impairments, including IBD, and is proposing changes to its decision-making process that may improve consistency between decision-making levels. SSA is also trying to improve claimants' understanding of the disability claims evaluation process, but lacks assurance that the majority of claimants who file in person or over the phone understand and provide information critical to SSA's assessment of their claims as part of steps four and five of the process. [ABSTRACT FROM AUTHOR]

Provides an overview of claims processing in the disability compensation program through which the U.S. Department of Veterans Affairs provides cash benefits to veterans, their dependents, and survivors. Payment of the monthly benefits based on degree of disability to veterans who have service-connected disabilities; Administration of the program by the Veterans Benefits Administration; Concerns about backlogs of claims, long waits for disability decisions, and the poor quality of the decisions.

This testimony discusses long-standing management problems plaguing Department of Veterans Affairs (VA) programs that provide financial and other benefits to veterans, their dependents, and survivors. These programs include disability compensation benefits, disability pension benefits, education assistance, life insurance, housing loan guaranty, and vocational rehabilitation and counseling services. Concerns have been raised about the programs' outmoded processes, long waits for disability decisions, and the quality of decisions all of which affect the quality of service provided to veterans and the effective use of taxpayer dollars. This testimony discusses (1) recent progress by the Veterans Benefits Administration, which runs the benefits programs; (2) areas in which progress is lacking; and (3) changes in program design that could hold potential for greater gains. [ABSTRACT FROM AUTHOR]