Veterans More Often Choose the DRO Review, but Some May Not Fully Understand Their Options

Since fiscal year 2003, when VA started tracking DRO involvement in  appeals, data show more veterans have chosen a DRO review than a  traditional review for appeals of decisions on their disability compensation  claims. From fiscal years 2003 through 2010, veterans chose a DRO  review in 534,439 appeals, or 61 percent of all appeals filed over this time  period, according to Board data. 2). Some VA officials and VSO representatives said veterans may not be  able to make an informed decision based on the letter alone. The DRO Review More Often Results in Additional Benefits, but Does Not Reduce Appeals Going to the Board

		DRO Reviews More Often Resulted in Additional Benefits than Traditional Reviews

Veterans who chose a DRO review were more likely than those who  chose a traditional review to get additional disability compensation  benefits after initial review of their notices of disagreement. The negligible difference between appeal resolution rates at the regional  office level for DRO and traditional reviews in part reflects veterans’  decisions on how to proceed if they do not receive a full grant of  requested benefits. Board data show that for appeals  filed from fiscal years 2003 through 2008 the most common reason for  resolution at the regional office level was a veteran’s failure to return a  form to continue the appeal (failure to respond) after receiving VA’s  explanation of its decision and of what steps to take to move the appeal  to the Board (see fig. The  second most common reason for appeal resolution at the regional level  was a full grant of benefits, which automatically ends the process. In  contrast to the first issue, DRO reviews were somewhat more likely than  traditional reviews to be resolved through a full grant of benefits—21  percent versus 17 percent, respectively. Fifty-nine  percent of appeals which received no additional benefits at the initial  appeal stage and in which the veteran had no representative were ended  by the veteran without going on to the Board, compared to 52 percent of  such appeals in which the veteran had a representative. Time spent on different tasks varies across  regional offices. Since the implementation of the DRO review process in 2001, there have  been differing opinions within VA about the proper balance between  processing appeals and performing other DRO tasks. About half the regional office managers surveyed said an appeal  resolution goal at the regional office level would somewhat or greatly  enhance DROs’ effectiveness. VA Provides No Nationwide Specialized Training for New DROs

VA has not developed a nationwide training curriculum for DROs to help  them learn the duties of the position. However, looking more  broadly, VA has not achieved its original goal for the DRO review process  of reducing the number of appeals continuing to the Board and thereby  shortening the time that veterans wait for appeal decisions. Recommendations for Executive Action

To clarify information for veterans and ensure the most effective use of  DROs, the Secretary of Veterans Affairs should direct the Veterans  Benefits Administration to take the following three actions:  revise the sample appeals election letter in its policy manual to define  unfamiliar terms and emphasize key deadlines, and test any revised  letter’s clarity with veterans before implementing it;   establish national and regional office performance measures related  to appeal resolution at the regional level and ensure that sufficient  quality review procedures are in place to prevent DROs from granting  unjustified benefits; and   assess the knowledge and skills that DROs need to perform their  varied responsibilities, determine if any gaps exist in the training  currently available, and, if necessary, develop a training curriculum or  program tailored to DROs. III), VA concurred fully with two of our  recommendations and partially with our recommendation regarding an  appeal resolution performance measure. However, it also stated that resolution of  appeals at the regional level should not be a performance measure used  to assess the impact of the DROs, for several reasons including (1) the  DROs also play an important role in training, mentoring, and quality  review, so an appeal resolution measure does not capture their full  impact; (2) each veteran has a right to continue an appeal to the Board if  dissatisfied with the regional office decision, and whether a veteran  continues is beyond a DRO’s control; and (3) establishing an appeal  resolution performance measure could encourage the granting of benefits  that are not justified. Appendix I: Objectives, Scope, and Methodology

We were asked to examine (1) the extent to which veterans choose a  Decision Review Officer (DRO) review as opposed to a traditional review,  (2) outcomes for veterans who choose a DRO review, and (3) challenges  the Department of Veterans Affairs (VA) faces in managing DROs. We interviewed managers, DROs, and veteran service  organization (VSO) staff in 4 regional offices, and we conducted a web- based survey of managers in all of VA’s 57 regional offices.
Why GAO Did This Study

The Department of Veterans Affairs (VA) has struggled to provide timely reviews for veterans who appeal decisions on their disability compensation claims. A veteran appeals to the VA regional office that made the initial decision, and if still dissatisfied, to the Board of Veterans Appeals (Board). An appeal to the Board adds more than 2 years, on average, to the wait for a decision on the appeal. To resolve more appeals at the regional level and avoid waits at the Board, VA, in 2001, established the Decision Review Officer (DRO) review as an alternative to the traditional regional office appeal review. A DRO is given authority to grant additional benefits after reviewing an appeal based on a difference of opinion with the original decision. In contrast, under the traditional review, new evidence is generally required for a grant of additional benefits. GAO examined (1) the extent to which veterans choose a DRO review, (2) outcomes for DRO reviews, and (3) VA's challenges in managing DROs. GAO analyzed Board data, surveyed managers in all 57 regional offices, visited 4 offices, and interviewed veterans.

What GAO Found

According to VA data, which has only tracked DRO involvement since 2003, veterans chose a DRO review in 61 percent (534,439) of all appeals filed from 2003 to 2010. Veterans who sought assistance with their appeal from a veteran service organization or other qualified representatives were more likely to choose a DRO review than those without a representative. Without assistance, veterans may not fully understand their two appeal options. GAO found that the letter VA uses to inform veterans of their options does not highlight key deadlines or differences between the two options. According to more than half of surveyed regional office managers, most veterans could not make an informed choice on the options based just on the letter. The DRO review process has helped some veterans get additional benefits at the regional office level, but has not reduced the percentage of appeals continuing on to the Board--the primary purpose of the program. In fiscal years 2003 through 2008, 21 percent of DRO reviews resulted in a full grant of benefits compared to 17 percent of traditional reviews. A full grant of benefits ends, or resolves, the appeal at the regional level. However, appeals may also be resolved at the regional level if veterans who do not receive full grants decide not to continue their appeal to the Board. VA gave DROs the flexibility to interact informally with veterans in part so they could explain when the benefits already granted are appropriate given the law. However, while DRO reviews led to the grant of full benefits at a higher rate, a higher percentage of veterans not granted benefits through traditional review voluntarily ended their appeals. As a result, in fiscal years 2003 through 2008 the overall percentage of appeals resolved at the regional level was about the same for DRO and traditional reviews--about 70 percent for both. VA faces challenges in how to most effectively use and train DROs. Since the DRO process and position were established, DRO duties have expanded beyond reviewing appeals to performing additional tasks such as quality review. However, VA officials have not reached consensus on how to balance DROs' time among different tasks. VA has no performance goal or measure for appeal resolution at the regional level that could help it determine whether it is achieving the most effective balance between different tasks. In addition, VA headquarters offers no nationwide, standardized training for new DROs, which according to managers and DROs would be beneficial, as they often lack experience with other tasks that DROs frequently perform such as conducting hearings. Ninetythree percent of surveyed regional managers said a nationally standardized training for new DROs would be beneficial.

What GAO Recommends

GAO recommends VA (1) revise its appeals election letter, (2) develop an appeal resolution goal at the regional level, and (3) develop a training curriculum on DRO duties. In its comments, VA concurred fully with GAO's first and third recommendations but only partially with the second. VA expressed concerns about an appeal resolution goal, including that it could encourage the unjustified granting of benefits. GAO feels that VA's quality control process minimizes this risk.