VA Needs a System for Routinely Monitoring Variations Inherent in Deciding Disability Claims

Because adjudicators often must use judgment when deciding disability  compensation claims, variations in decision making are an inherent  possibility. Without measuring the effect of judgment on  decisions, VA cannot provide reasonable assurance that consistency is  acceptable. An example involving mental disorders also demonstrates how  adjudicators sometimes must make judgments about the degree of severity  of a disability. Because of the inherent possibility that different adjudicators could make  differing decisions based on the same information pertaining to a specific  impairment, we recommended in November 2004 that the Secretary of  Veterans Affairs develop a plan containing a detailed description of how  VA would (1) use data from a newly implemented administrative  information system—known as Rating Board Automation 2000—to  identify indications of decision-making inconsistencies among the regional  offices for specific impairments and (2) conduct systematic studies of the  impairments for which the data reveal possible inconsistencies among  regional offices. Inconsistent Quality Of Disability Examination Reports Underscores Need to Monitor Consistency of Decisions

Because the existing medical records of disability claimants often do not  provide VBA regional offices with sufficient evidence to decide claims  properly, the regional offices often ask VHA medical centers to examine  the claimants and provide exam reports containing the medical  information needed to make a decision. To comply with the DeLuca decision’s requirements for joint and spine  disability exam reports, VHA instructs its medical center clinicians to  make not only an initial measurement of the range of motion in the  impaired joint or spine but also to measure range of motion after having  the claimant flex the impaired joint or spine several times. We reported earlier this month on the progress VA had made since 2002 in  ensuring that its medical centers consistently prepare joint and spine exam  reports containing the information required by DeLuca. We found that, as  of May 2005, the percentage of joint and spine exam reports not meeting  the DeLuca criteria had declined substantially from 61 percent to 22  percent. Moreover, in relation to the issue of consistency,  the percentage of exam reports satisfying the DeLuca criteria varied  widely across the 21 health care networks that manage VHA’s 157 medical  centers—from a low of 57 percent compliance to a high of 92 percent. Conclusions

As a national program, VA’s disability compensation program must ensure  that veterans receive fair and equitable decisions on their disability claims  no matter where they live across the nation. Given the inherent risk of  variation in disability decisions, it is incumbent on VA to ensure program  integrity by having a credible system for identifying indications of  inconsistency among its regional offices and then remedying any  inconsistencies found to be unreasonable.
Why GAO Did This Study

The House Subcommittee on Disability Assistance and Memorial Affairs asked GAO to discuss its work on the consistency of disability compensation claims decisions of the Department of Veterans Affairs (VA). GAO has reported wide state-to-state variations in average compensation payments per disabled veteran, raising questions about decisional consistency. In 2003, GAO designated VA's disability programs, along with other federal disability programs, as high risk, in part because of concerns about decisional consistency. Illustrating this issue, GAO reported that inadequate information from VA medical centers on joint and spine impairments contributed to inconsistent regional office disability decisions.

What GAO Found

GAO's November 2004 report explained that adjudicators in the Department of Veterans Affairs often must use judgment in making disability compensation claims decisions. As a result, it is crucial for VA to have a system for routinely identifying the effect of judgment on decisional variations among its 57 regional offices to determine if the variations are reasonable and, if not, how to correct them. In 2002, GAO reported that state-to-state variations of as much as 63 percent in average compensation payments per disabled veteran indicated potential inconsistency. The nature of the criteria that adjudicators must apply in evaluating the degree of impairment due to mental disorders provides an example of the extent of judgment required. GAO's October 2005 report on decisions for joint and spine disabilities showed one important way to improve consistency. Specifically, regional offices often rely on VA's 157 medical centers to examine claimants and provide medical information needed to decide the claims. However, VA has found inconsistency among its medical centers in the adequacy of their joint and spine disability exam reports that regional offices need to decide these claims. As of May 2005, the percentage of exam reports containing the required information varied across the medical centers from a low of 57 percent to a high of 92 percent. This could adversely affect the consistency of disability claims decisions involving joint and spine impairments. Although VA has made substantial progress, more remains to be done to improve the level of consistency in the disability exam reports.