Department of Veterans Affairs

Recommendations and Actions

DVA04: Streamline Benefits Claims Processing

Background

Congress created the U.S. Court of Veterans Appeals (COVA) in the Veteran's Judicial Review Act of 1988. The court consists of seven judges and is located in Washington, D.C. Its purpose is to provide veterans with an additional level of review beyond the Board of Veterans' Appeals, also located in Washington, D.C. Of the board's 67 members, 63 decide cases as members of 21 three-member panels.

The COVA began operations in late 1989 with a series of precedent- setting rulings. These decisions have significantly increased the quantity and complexity of the Department of Veterans Affairs' (VA's) workload. This is especially true at the Veterans Benefits Administration (VBA), which administers VA's nonmedical benefit and service programs.(1)

COVA decisions have mandated significant changes in VA's benefits claims adjudication process. The court's interpretation of VA's duty to assist claimants, for example, requires the department to expand assistance to claimants within a fairly legalistic framework. For example, VA cannot merely process the specific issue raised by a claimant, but must also ensure that all other issues of eligibility are identified on his or her behalf. It must obtain increased medical and legal documentation detailing the reasons and bases for its decisions. The department must also furnish information about its decision to the claimant and ensure that all documentation for appeals is forwarded to the board.(2)

Adjudication staffs in VBA's 58 regional offices render more than 3.3 million decisions appealable to the Board of Veterans' Appeals each year. Claimants receive notification that they can initiate an appeal by filing a notice of disagreement within one year. Approximately 70,000 (1.9 percent) of the claimants file these appeal notices annually. Of these, nearly 30 percent are resolved at the regional office level; the rest are forwarded to the board.

Historically, the board has overturned or remanded (i.e., sent back to regional offices for further development) less than 25 percent of the appeals received from the regions.(3) The board's current remand rate is about 50 percent. This increase is the result of a COVA mandate that cases processed under rules in effect before its creation must be reprocessed under its new rules.

The VA has rendered more than 11 million appealable decisions since the court's creation. Of the 142,088 rulings made by the Board of Veterans' Appeals in this period, approximately 6,300 have been appealed to the court. Of these, the court has reversed 79 decisions, remanded 1,350 for reprocessing, and dismissed 2,000. The remainder are still pending before the court.(4)

The court's decisions have affected many facets of the initial claims adjudication process, including the extensiveness of decisions and the complexity of notifications. VA claims examiners and rating specialists are forced to respond to frequent changes in processing guidelines, reprocess completed claims, and handle increased numbers of incoming claims.(5)

VA has analyzed its workload and found that it now takes regional office staff 25 to 40 percent longer to process a disability compensation rating decision or a detailed "Statement of the Case" for a veteran who appeals such a decision. The increased volume and detail required for evidence development and notifications to claimants adds another 10 to 15 percent to the documented total of completion times.(6)

Full-time equivalent employees (FTEs) and other resources have not increased commensurate with the workload. By the end of fiscal year 1992:

--- VA's adjudication staffs had dropped from the previous year's level of 4,203 to 4,122 people;

--- the total number of claims examiners decreased from 1,754 to 1,535; and

--- while cases increased in complexity, the number of senior adjudicators decreased from 439 to 414.(7)

The one increase occurred in the number of rating specialists, who went from 491 in 1991 to 596 in August 1993 (555 fully trained and 41 trainees). Since claims examiners and rating specialists must be quasi-legal and quasi-medical experts, over two years of training is required to attain full proficiency.

Workload problems will be further exacerbated by the anticipated downsizing of the military. While more than 800,000 new and reopened claims are filed annually, the number of original compensation claims--the most resource-intensive type--has risen from 102,000 in fiscal 1991 to a projected 160,000 for fiscal 1993, an increase of 54 percent. The current backlog of 557,000 cases is expected to approach 1 million by the end of fiscal 1994.(8)

VA has established prototype Case Manager/Self-Directed Work Teams in several regional offices to determine whether restructuring of regional office adjudication staffs can improve the timeliness and accuracy of decisions. Four such teams, consisting of 12 members each, have been established in the New York Regional Office.(9) Each team assumes responsibility for a claim from its inception through completion and notification of the claimant.(10) Teams are also accountable for examining, developing, and preparing cases for final adjudication. Team members advise veterans, their beneficiaries, and dependents of their rights and benefits from VA.

This initiative follows two years of extensive research by the New York Regional Office staff, aided by outside management consultants. Focus groups composed of veterans participated in the study. The department plans to reconvene the focus groups and to incorporate their assessments into measurements of performance. The effectiveness of the prototype teams will then be compared with that of other regional office staff using traditional claims processing methods.

VA will soon submit a bill to Congress titled the "Veterans' Appeals Improvement Act of 1993." This measure will propose changes in procedures used by the Veterans' Appeals Board in adjudicating appeals after denials of veterans' benefits within VA. The bill would permit:

--- removal of the 67-member limit on the board's membership;

--- decisions on cases by individual members of the board;

--- reversals of member decisions by the board chair or vice-chair;

--- streamlined motion and decisionmaking procedures;

--- use of telecommunications technology in hearings;

--- employment of advisory medical opinions from the board's own staff physicians and physicians in VA and other federal departments and agencies; and

--- decisions by the board chair to order or not to order reconsideration of board decisions without judicial review.(11)

Legal authority for rulings by individual appeals board members would increase the number of decisions rendered. Decisions by the board fell from 45,308 in fiscal year 1991 to 33,483 in fiscal year 1992; the number is expected to drop to approximately 27,600 in fiscal year 1993. The response time for decisions rose from 139 days in fiscal year 1991 to 240 days in fiscal year 1992; the figure is expected to reach more than 440 days in fiscal year 1993.(12) The board estimates that the single step of allowing individual board members to issue and sign decisions would increase the number of decisions made from 29,185 to 36,550 in fiscal year 1994, an increase of 25.2 percent.(13)

VA's proposal would permit the chair or vice-chair of the appeals board to allow--i.e., reverse--an otherwise final decision by board members and rule in favor of a claimant. During 1989, the last full year this authority was in effect, allowances or reversals were granted in 65 cases. VA estimates that an additional 50 allowances per year over the next six years would result from restoration of this authority to the chair and vice-chair.(14)

The board chair would also be authorized to use modern telecommunications technology to allow a claimant at a remote location to fully participate in a hearing with a board panel sitting in Washington, D.C. This provision provides an alternative to sending board members to field facilities in cases where such travel would not be cost- or time-effective.

Actions

1. The Department of Veterans Affairs should assess the performance of the prototype Self-Directed Work Teams established in the VBA's New York Regional Office. It should closely monitor the progress of similar, ongoing reinvention initiatives in other VBA regional offices. Improved business practices identified through these initiatives should be implemented, where appropriate, throughout VBA's 58 regional offices.

2. The VA should ensure that staffing and other resources allocated to the adjudication process are commensurate with the quantity and complexity of the workload in each of VBA's regional offices.

3. The Veterans' Appeals Improvement Act of 1993 should be enacted into law.

Implications

Implementation of the first and second recommendations would result in improved service to veterans through enhanced quality and timeliness in the claims adjudication process. Members of regional office Self-Directed Work Teams would be responsible for completing each claim while maintaining personal contact with the claimant throughout the process. These responsibilities would encourage team members to relate each claim to the veteran or the veteran's family, rather than thinking of each claim as another file passing through the system.

Implementation of the third recommendation by enactment of the proposed "Veterans' Appeals Improvement Act" would enable the board to reverse decreasing productivity trends and increase response times of decisions. These changes would assist the board in complying with its statutory mandate to conduct hearings and dispose of appeals in a timely manner.

Fiscal Impact

There are no anticipated dollar savings from the first two recommendations. The underlying benefit of streamlining compensation and pension claims processing is to enable VA to meet its increased workload with current or decreased resources.

Enactment of the Veterans' Appeals Improvement Act of 1993 would result in estimated additional costs of approximately $300,000 a year, for a total of about $1.8 million over the six-year period from fiscal years 1994 through 1999.(15)

 Budget Authority (BA) and Outlays (Dollars in Millions) 
 ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
 Fiscal Year
             1994    1995    1996    1997    1998    1999    Total
             ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
 BA 	      0.3       0.3       0.3       0.3       0.3        0.3     1.8
 
 Outlays   0.3        0.3      0.3        0.3       0.3        0.3     1.8
 
 Change 
 in FTEs      0         0          0           0          0           0       0
 
 

Endnotes

1. U.S. Congress, House, Committee on Veterans Affairs, Subcommittee on Compensation, Pension and Insurance, testimony of R. J. Vogel, Deputy Undersecretary for Benefits, Department of Veterans Affairs, April 21, 1993.

2. U.S. Department of Veterans Affairs, Task Force on the Impact of the Judicial Review Act of 1988, Summary of Findings and Recommendations (Washington, D.C., May 15, 1992).

3. Ibid.

4. Interview with J. Gary Hickman, Director, Compensation and Pension Service, Veterans Benefits Administration (VBA).

5. Interview with Darryl W. Kehrer, Director, Benefits/Management Policy Service, Office of the Assistant Secretary for Policy and Planning, and member of the VA judicial review task force.

6. Interview with J. Gary Hickman.

7. Interview with Robert Haas, Compensation and Pension Service, VBA.

8. Interview with J. Gary Hickman.

9. VA has identified this initiative as a reinvention laboratory.

10. Interview with Joseph Thompson, Director, New York Regional Office, VBA, during an onsite review conducted by NPR on May 20, 1993.

11. Transmittal letter from the Secretary of Veterans Affairs to the Speaker of the U.S. House of Representatives accompanying draft bill titled "Veterans' Appeals Improvement Act of 1993." Other features of the proposed bill would revoke the chair's authority to designate temporary board members, remove the restrictions on the length of time acting members may serve, and statutorily recognize the position of deputy vice-chair.

12. Response time is the projected number of days it would take the board to decide all currently pending appeals based on the average number of decisions rendered per day over the preceding year.

13. Transmittal letter from the secretary to the Speaker of the House.

14. Ibid.

15. Transmittal letter from the secretary to the Speaker of the House.

Return To Report Index