To measure overall claims processing timeliness, VBA uses two  measures: (1) the number of days the average pending claim has been  awaiting a decision (Average Days Pending) and (2) the average number  of days that VBA took to complete a claim where a decision has been  reached (Average Days to Complete). A number of factors have contributed to the substantial increase in claims  received. One factor was the commencement in October 2010 of VBA’s  adjudication of 260,000 previously denied and new claims when a  presumptive service connection was established for three additional  Agent Orange-related diseases.and assigned experienced claims staff to process and track them. While federal law requires veterans to use an application form prescribed  by VA when submitting a claim for original disability compensation  benefits, VBA central office officials said they accept reopened claims or  claims requesting an increase in disability compensation benefits in any  format, which can contribute to lengthy processing times. Gathering Records from Federal Agencies and Others Can Take Months

According to VBA officials, delays in obtaining military service and  medical treatment records, particularly for National Guard and Reserve  members, is a significant factor lengthening the evidence gathering  phase. VBA Is Taking Steps to Improve Claims and Appeals Processing, but Future Impact Is Uncertain

VBA is currently taking steps to improve the timeliness of claims and  appeals processing. Although VBA is monitoring these  efforts, the planning documents provided to us lack key aspects of sound  planning, such as performance measures for each effort. In  exchange for expedited processing, veterans participating in the FDC  program send VBA any relevant private medical evidence with the claim  and certify that they have no additional evidence to provide. Efforts to Redesign Key Aspects of the Process Are Under Way without a Comprehensive Plan

In March 2012, VBA implemented a nationwide initiative that requires  staff to use the Simplified Notification Letter (SNL), a process to  communicate ratings decisions to veterans.the goal of the SNL is to reduce the time it takes claims staff to provide  veterans with claims decisions that are more consistent and easier to  understand. According to claims staff at each of the regional offices we   According to VBA officials,  visited, SNL has decreased the time it takes to rate claims, but claims  staff in three regional offices told us it created additional steps in  preparing the decision letter sent to the veteran, adding time to the  processing awards phase. For this initiative, VBA created  specialized teams that process claims based on their complexity. In 2010, VBA began to develop the Veterans Benefits Management  System (VBMS), a paperless claims processing system that is intended to  help streamline the claims process and reduce processing times. According to VBA officials, the Claims  Organizational Model and VBMS will work together to reduce processing  times and help VA process veterans’ claims within 125 days by 2015. Although VBMS began its pilot in 2010, VBA has not yet reported on how  VBMS has affected processing times. Conclusions

VA provides a critical benefit to veterans who have incurred disabilities as  a result of their military service. For years, VA’s disability claims and  appeals processes have received considerable attention as VA has  struggled to process disability compensation claims in a timely fashion. And that number is  projected to continue to increase as 1 million servicemembers become  veterans over the next 5 years due to the drawdown of troops from a  decade of conflict in Afghanistan and Iraq. Moreover, the evidence  gathering phase in fiscal year 2011, which took over 5 months (157 days)  on average, continues to worsen in 2012, partly due to difficulties in  obtaining records for National Guard and Reserve and SSA medical  records, according to VBA officials. Develop improvements for partnering with Social Security  Administration officials to reduce the time it takes to gather medical  records. Ensure the development of a robust backlog reduction plan for VBA’s  initiatives that, among other best practice elements, identifies  implementation risks and strategies to address them and performance  goals that incorporate the impact of individual initiatives on processing  timeliness. In its comments, VA stated it generally agreed  with our conclusions and concurred with our recommendations, and  summarized efforts that are planned or underway to address the  recommendations. GAO staff who made key contributions to this  report are listed in appendix V.

Appendix I: Objectives, Scope, and Methodology

This report examines the (1) factors that contribute to lengthy processing  times for disability claims and appeals at the Department of Veterans  Affairs (VA) and (2) status of the Veteran Benefits Administration’s (VBA)  recent efforts to improve disability claims and appeals processing  timeliness. To examine factors that contribute to lengthy processing times for  disability claims and appeals, we reviewed past GAO and VA Office of  Inspector General (OIG) reports and other relevant studies on VA’s  claims and appeals processing, such as the Veterans’ Disability Benefits  Commission’s 2007 report, Honoring the Call to Duty: Veterans’ Disability  Benefits in the 21st Century. Below is a list of  15 improvement efforts we identified as having a stated purpose of  improving timeliness of claims or appeals processing, based on a review  of VA documents and interviews with VBA officials.
Why GAO Did This Study

For years, VA has struggled with an increasing workload of disability compensation claims. The average time to complete a claim was 188 days in fiscal year 2011, and VA expects an increase in claims received as 1 million servicemembers leave military service over the next 5 years. As GAO and other organizations have previously reported, VA has faced challenges in reducing the time it takes to decide veterans’ claims. GAO was asked to review these issues. Specifically, this report examines (1) the factors that contribute to lengthy processing times for disability claims and appeals, and (2) the status of VBA’s recent efforts to improve disability claims and appeals processing timeliness. To do this, GAO analyzed VBA performance data and program documents, reviewed relevant studies and evaluations, met with staff from five VA regional offices, and interviewed VBA officials and Veterans Service Organizations.

What GAO Found

A number of factors—both external and internal to the Veterans Benefits Administration (VBA)—have contributed to the increase in processing timeframes and subsequent growth in the backlog of veterans’ disability compensation claims. As the population of new veterans has swelled in recent years, the annual number of claims received by VBA has gone up. Compared to the past, these claims have a higher number of disabling conditions, and some of these conditions, such as traumatic brain injuries, make their assessment complex. Moreover, due to new regulations that have established eligibility for benefits for new diseases associated with Agent Orange exposure, VBA adjudicated 260,000 previously denied and new claims. Beyond these external factors, issues with the design and implementation of the compensation program have contributed to timeliness challenges. For example, the law requires the Department of Veterans Affairs (VA) to assist veterans in obtaining records that support their claim. However, VBA officials said that lengthy timeframes in obtaining military records—particularly for members of the National Guard and Reserve—and Social Security Administration (SSA) medical records impact VA’s duty to assist, possibly delaying a decision on a veteran’s disability claim. As a result, the evidence gathering phase of the claims process took an average of 157 days in 2011. Further, VBA’s paper-based claims processing system involves multiple hand-offs, which can lead to misplaced and lost documents and can cause unnecessary time delays. Concerning timeliness of appeals, VBA regional offices have shifted resources away from appeals and toward claims in recent years, which has led to lengthy appeals timeframes.
VBA is currently taking steps to improve the timeliness of claims and appeals processing; however, prospects for improvement remain uncertain because timely processing remains a daunting challenge. VBA is using contractors to handle some aspects of the claims process, and is also shifting some workload between regional offices. Also, VBA is modifying and streamlining certain claims and appeals processing procedures for veterans who opt to participate in these initiatives in exchange for an expedited decision. For example, veterans receive expedited processing when they submit a claim that is certified as having all required evidence. Not many veterans have elected this option, but VA is making adjustments to increase its attractiveness. In addition, VBA is trying to decrease the amount of time it takes to gather medical evidence. For example, VBA recently encouraged medical providers to use a standardized form when responding to VBA’s request for information. However, results of this initiative have been mixed. VBA is also taking steps to streamline the claims process, including implementing initiatives to create (1) standardized language for decision letters sent to veterans, (2) specialized teams that process claims based on level of complexity, and (3) a paperless claims system. According to VBA officials, these efforts will help VA process veterans’ claims within 125 days by 2015. However, the extent to which VA is positioned to meet this ambitious goal remains uncertain. Specifically, VBA’s backlog reduction plan—its key planning document—does not articulate performance measures for each initiative, including their intended impact on the claims backlog. Furthermore, VA has not yet reported on how these efforts have affected processing times, a condition which raises concern given the mixed results that have emerged to date.

What GAO Recommends

GAO recommends that VBA (1) partner with military officials to reduce timeframes to gather records from National Guard and Reserve sources, (2) partner with SSA to reduce timeframes to gather SSA medical records, and (3) ensure the development of a robust plan for its initiatives that identifies performance goals that include the impact of individual initiatives on processing timeliness. In response to a draft of this report, VA officials generally agreed with GAO’s conclusions and concurred with the recommendations, and summarized efforts that are planned or underway to address the recommendations.