VBA Has Improved Its Measurement of Claims-Processing Accuracy

The new STAR system represents an important step forward by VBA in measuring the accuracy of compensation and pension claims processing and in providing data to identify error-prone cases and correct the causes of errors, including those that result in reversals and remands by the Board of Veterans’ Appeals. Compared with the previous accuracy measurement system that VBA had been using since 1992, the STAR system is a step forward because it focuses more on RO decisions that are likely to contain claims-processing errors, uses a stricter method for computing accuracy rates, provides more data on the performance of additional organizational levels within VBA, collects more data on errors, and stores the results of more accuracy reviews in a centralized database for further review and analysis. These data on deficiencies in evidence are entered in the STAR database. VBA Can Further Address Vulnerabilities in the Integrity of Performance Data

To ensure integrity in the operation of government programs, standards for internal controls call for separation of key duties, and standards for performance audits call for those who review and evaluate a program’s performance to be organizationally independent of the program’s managers. VBA Faces Challenges in Meeting Its Goal for Improving Claims-Processing Accuracy

VBA has set a goal of achieving a claims-processing accuracy rate of 93 percent by fiscal year 2004. Beyond any improvements that VBA might make in the STAR system, VBA acknowledges that there are challenges it must address successfully in order to meet its goal for improving accuracy. Such training is important not only for current employees but also for the many new employees whom VBA will have to hire to replace retiring employees. Whether these training efforts will enable VBA to meet its accuracy goal cannot yet be determined. To further strengthen VBA’s ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under the Results Act, and keep the Congress informed about VBA’s progress in addressing challenges that must be met in order to improve accuracy, we recommend that the Secretary of the Department of Veterans Affairs direct the Under Secretary for Benefits to take the following actions. The intent was for STAR to collect additional data that would help VA better identify (1) specific types of medical conditions that RO adjudicators have difficulty evaluating correctly and (2) specific types of inadequacies in medical evidence that are most prevalent in incorrect decisions.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) regional offices' (RO) accuracy in processing disability claims, focusing on: (1) the extent of improvements made by the Systematic Technical Accuracy Review (STAR) system in measuring claims-processing accuracy; (2) additional efforts needed to strengthen the system; and (3) challenges the Veterans Benefits Administration (VBA) faces in meeting goals for improving claims-processing accuracy.

What GAO Found

GAO noted that: (1) the new STAR system represents an important step forward by VBA in measuring the accuracy of compensation and pension claims processing; (2) compared with the previous system, STAR focuses more on RO decisions that are likely to contain processing errors, uses a stricter method for computing accuracy rates, provides more data on the performance of organizational levels within VBA, collects more data on processing errors, and stores more accuracy review results in a centralized database; (3) even so, VBA can further strengthen STAR's ability to identify error-prone cases and claims-processing weaknesses so that it can take corrective actions; (4) VBA needs to better pinpoint error-prone cases and weaknesses in the development of evidence by collecting more specific data on the types of medical characteristics and deficiencies in medical evidence that are most prevalent in incorrect decisions; (5) VBA can also better address vulnerabilities in the integrity of accuracy data; (6) STAR reviewers in ROs do not have sufficient separation of duties or adequate independence to meet government standards for internal controls or program performance audits; (7) these shortcomings raise concern about the integrity of STAR accuracy data, which are a key factor in the performance measurement system designed by VBA to meet the requirements of the Government Performance and Results Act (GPRA) of 1993; (8) while such system improvements are necessary, they alone are not sufficient for VBA to meet its goal for improving accuracy; (9) using the STAR pilot test's 64-percent accuracy rate as a baseline, VBA's goal is to achieve a 93-percent accuracy rate by fiscal year 2004; (10) VBA faces management challenges that it must address successfully in order to meet its accuracy improvement goal; (11) to do this, VBA recognizes that: (a) its newly implemented performance measurement system must hold program managers accountable for performance; and (b) the training program under development must effectively train the current RO workforce as well as the many new employees who will have to be hired in the coming decade to replace those who retire; and (12) it is too early to determine whether VBA's efforts to meet these challenges will be successful.