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United States Government Accountability Office: 
GAO: 

Report to Congressional Requesters: 

September 2011: 

Veterans Disability Benefits: 

Clearer Information for Veterans and Additional Performance Measures 
Could Improve Appeal Process: 

GAO-11-812: 

GAO Highlights: 

Highlights of GAO-11-812, a report to congressional requesters. 

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. Ninety-three 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. 

View [hyperlink, http://www.gao.gov/products/GAO-11-812]. For more 
information, contact Daniel Bertoni at (202) 512-7215 or 
bertonid@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

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

The DRO Review More Often Results in Additional Benefits, but Does Not 
Reduce Appeals Going to the Board: 

VA Faces Challenges in Defining Role of and Training for DROs: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: VA Appeal Process Request Letter Template: 

Appendix III: Comments from the Department of Veterans Affairs: 

Appendix IV: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Clear Federal Communication Criteria for VA Letter Analysis: 

Table 2: Percentages of Appeals Using DRO and Traditional Reviews and 
Related Odds and Odds Ratios (Unadjusted and Adjusted), by 
Representation Status and Other Factors: 

Table 3: Percentages of Appeals Granted Full or Partial Awards and No 
Awards and Related Odds, and Odds Ratios (Unadjusted and Adjusted), by 
Type of Review and Other Factors: 

Table 4: Implementation of Structured Phone Interviews with Veterans: 

Figures: 

Figure 1: VA Disability Claim Appeal Process: 

Figure 2: Number of DRO Reviews and Traditional Reviews, Fiscal Years 
2003-2010: 

Figure 3: Percentage of Regional Office Managers Who Said Veterans Can 
Make Informed Decision Using VA Letter Alone: 

Figure 4: Excerpt from VA Appeal Process Request Letter Template and 
Examples of Clear Communication Analysis: 

Figure 5: Percentage of Appeals Receiving Full or Partial Grants of 
Benefits after Regional Office Review of the Notice of Disagreement, 
Fiscal Years 2003-2010: 

Figure 6: Average Days for Regional Office to Issue Decision on Notice 
of Disagreement, Fiscals Years 2003-2009: 

Figure 7: Percentage of Appeals Resolved at Regional Office Level, 
Fiscal Years 2003-2008: 

Figure 8: Regional Office Appeal Outcomes, Fiscal Years 2003-2008: 

Figure 9: Percentage of Regional Office Managers Rating Specific 
Activities as Very or Moderately Effective in Resolving Appeals: 

Figure 10: Regional Office Managers' Estimates of Proportion of DROs' 
Time Spent on Specific Tasks: 

Figure 11: Percentage of Regional Managers Who Said Training on 
Certain Topics Would Greatly or Moderately Enhance New DROs' 
Performance: 

Figure 12: Regional Offices Selected for Site Visits: 

Abbreviations: 

Board: Board of Veterans Appeals: 

DRO: Decision Review Officer: 

RVSR: Rating Veterans Service Representative: 

VA: Department of Veterans Affairs: 

VACOLS: Veterans Appeals Control and Locator System: 

VBA: Veterans Benefits Administration: 

VSO: veteran service organization: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

September 29, 2011: 

The Honorable Patty Murray: 
Chairman: 
The Honorable Richard Burr: 
Ranking Member: 
The Honorable Daniel Akaka Member: 
Committee on Veterans' Affairs: 
United States Senate: 

The Department of Veterans Affairs (VA) paid more than an estimated 
$36 billion in disability compensation in fiscal year 2010 to over 
three million veterans who incurred new or aggravated existing 
disabilities during their military service. Veterans apply for 
disability compensation benefits through one of VA's 57 regional 
offices. Those who disagree with VA's initial decision on their claim 
may appeal to the regional office that made the decision. If still 
dissatisfied with the regional office's decision on their appeal, they 
can continue their appeal to the Board of Veterans Appeals (Board) in 
Washington, D.C.[Footnote 1] In fiscal year 2010, VA received more 
than 140,000 appeals--a 45 percent increase over fiscal year 2007--and 
the Board has struggled with an increasing backlog of cases.[Footnote 
2] On average, veterans wait 8 months after filing an appeal to 
receive a decision from the regional office, and those who continue to 
the Board wait over two more years for a decision. 

In an effort to resolve more appeals at the regional level, thus 
shortening total wait times for veterans, and improve the quality of 
appeals which go on to the Board, in 2001, VA established the Decision 
Review Officer (DRO) review--an alternative review process at the 
regional level. Prior to that time, regional offices reviewed initial 
claim decisions and generally could only overturn them when they 
received new evidence; otherwise appeals had to go to the Board for 
consideration of a grant of additional benefits. Under the alternative 
process, DROs (who are senior staff) have the authority to overturn an 
initial disability claim decision without any new evidence based only 
on difference of opinion. However, veterans still have the option of 
choosing traditional review, which is VA's term for the process that 
existed prior to 2001. As of July 2010, there were over 400 DROs 
nationwide. At your request, this report examines aspects of the DRO 
program. We evaluated (1) the extent to which veterans choose a DRO 
review as opposed to a traditional review, (2) outcomes for veterans 
who choose a DRO review, and (3) challenges VA faces in managing DROs. 

To address these items, we reviewed relevant federal laws, VA 
regulations, policy manuals, and regional office materials, as well as 
previous VA studies, GAO reports, and other documents relevant to DROs 
and the appeal process. We analyzed appeals management data from the 
Veterans Appeals Control and Locator System (VACOLS), an electronic 
Board database, for fiscal years 2003 through 2010. Although the DRO 
process was established in 2001, VACOLS began tracking DRO involvement 
in appeals in fiscal year 2003. VA extracted the VACOLS data for us on 
April 7, 2011. We assessed the data and determined they were reliable 
for the purposes of this study. We administered an online survey to 
all 57 regional office managers, and conducted phone interviews with a 
randomly selected but nongeneralizeable sample of 40 veterans who had 
recently appealed their disability claim decision through either a DRO 
or a traditional review.[Footnote 3] We conducted site visits to four 
of VA's regional offices--Atlanta, Georgia; Providence, Rhode Island; 
Waco, Texas; and Salt Lake City, Utah--and interviewed VA staff and 
veterans service organizations (VSO) representatives who assist 
veterans with their claims and appeals.[Footnote 4] We selected 
offices based on several factors, including geographic location, 
number of staff, timeliness of appeal processing for appeals in which 
DRO was selected, and participation in a pilot study of new criteria 
for assessing DRO performance. 

We conducted this performance audit from July 2010 through September 
2011 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. Appendix I 
contains a more detailed description of our scope and methodology. 

Background: 

Disability Claims Process: 

To apply for disability compensation, a veteran submits a claim to 
VA's Veterans Benefits Administration (VBA).[Footnote 5] A Veterans 
Service Representative at one of VA's regional offices reviews the 
claim and assists the veteran in gathering required evidence, 
including military service records and medical treatment records from 
VA facilities and private providers. A Veteran Service 
Representative's responsibilities may include establishing claims 
files, generating notification letters to veterans, assisting veterans 
in obtaining the evidence needed to support their claims, and 
assisting in processing appeals of claim decisions. A Rating Veterans 
Service Representative (RVSR) then evaluates the evidence and, if the 
RVSR finds the veteran to be eligible, determines the percentage 
rating for purposes of compensation. Disability compensation varies 
with the degree of disability and the number of a veteran's 
dependents, and is paid monthly. Monthly base benefits in 2011 for an 
individual range from $123 for 10 percent disability to $2,673 for 100 
percent disability. A veteran may cite multiple medical issues in a 
claim, for example, post-traumatic stress disorder, knee impairment, 
and hearing loss. The RVSR may grant all, some, or none of the issues 
in a claim. The veteran can obtain help by submitting a claim and 
navigating the process with a VSO representative, private attorney, or 
agent accredited by VA to assist veterans.[Footnote 6] In fiscal year 
2010, VA received over one million disability compensation claims, a 
46 percent increase from fiscal year 2007. 

Appeal Process: 

Regional office review of notice of disagreement (initial appeal 
stage). If a veteran disagrees with the regional office's initial 
decision on a claim, he or she appeals by submitting a written notice 
of disagreement to the regional office.[Footnote 7] (See figure 1 for 
a flowchart of appeals process at the VA.) A veteran may choose a 
traditional review or a DRO review by responding to an appeal process 
request letter sent by VA.[Footnote 8] VA sends this letter to a 
veteran after receiving his or her notice of disagreement; the letter 
informs the veteran of the DRO review and traditional review options, 
requests the veteran choose one, and states how to obtain 
representation if the veteran does not already have it. If the veteran 
chooses the traditional review, the reviewer, who may be a RVSR or 
DRO, examines the claim file and any new evidence that the veteran 
submits and may hold a formal, transcribed hearing with the veteran. 
The reviewer may overturn the original decision based only on (1) new 
evidence or (2) a clear and unmistakable error made in the original 
decision. However, if a veteran chooses the DRO review, a DRO conducts 
a de novo review of the claim, meaning a new and complete review 
without deference to the original decision, and can revise that 
decision without new evidence or a clear and unmistakable error--in 
other words, based on a difference of opinion.[Footnote 9] In addition 
to formal hearings, DROs may hold informal conferences with the 
veteran or the veteran's representative to discuss an appeal, 
including why benefits already awarded are appropriate. Ultimately, in 
either process, the reviewer may: (1) award a full grant, in which all 
claimed benefits are awarded at the maximum level; (2) award a partial 
grant, in which some benefits are granted but not necessarily at the 
maximum level or for all claimed medical issues; or (3) confirm the 
original decision on the claim, in which no further benefits are 
granted on any issues.[Footnote 10] If a full grant is awarded, the 
appeal ends. Otherwise, the regional office issues a written 
explanation to the veteran in a statement of the case. 

Regional office preparation of appeal for the Board. Regardless of 
whether a DRO or a traditional review is chosen, if a veteran 
disagrees with the regional office's appeal decision, he or she may 
file what VA calls a substantive appeal to the Board, which is 
processed initially by the regional office.[Footnote 11] The 
substantive appeal is a document that the veteran completes to explain 
the issues being appealed and why the veteran believes the VA decided 
his or her case incorrectly. After receiving this document and 
reviewing any additional supporting evidence provided by the veteran, 
the regional office may award additional benefits. A veteran may 
submit new evidence multiple times and each submission requires the 
regional office to re-evaluate the claim. When the regional office 
determines no further work is necessary, it certifies the appeal as 
complete and transfers it to the Board. 

Board review of appeal. When the Board receives the file, it may grant 
or deny the claim. If the Board finds it cannot make a decision until 
the regional office does additional work (e.g., requesting a more 
recent medical exam) it sends, or remands, the case back to the 
regional office or to the VBA Appeals Management Center in Washington, 
D.C., which develops evidence and adjudicates the claim. A veteran 
dissatisfied with the Board's decision can appeal, in succession, to 
the U.S. Court of Appeals for Veterans Claims, to the Court of Appeals 
for the Federal Circuit, and finally to the Supreme Court of the 
United States.[Footnote 12] 

Figure 1: VA Disability Claim Appeal Process: 

[Refer to PDF for image: illustration] 

Veteran chooses either a traditional review or a DRO review at 
regional office: 

Traditional review: 
RVSR or DRO affirms original decision or grants additional benefits if 
error or new evidence. 

DRO review: 
DRO conducts a completely new (de novo) review and can decide based on 
difference of opinion in addition to error or new evidence. 

Full grant? 

Yes: 
Appeal closed. 

No: 
Veteran receives a summary of the appeal decision (statement of the 
case); 
Veteran withdraws appeal or fails to respond: Appeal closed. 
or: 
Veteran files appeal to Board. 

Regional office prepares appeal for Board: 
* If new evidence, reviews and may make new decision; 
* If no new evidence, sends appeal to Board; 
Veteran receives full grant or withdraws appeal: Appeal closed. 
or: 
Board review of appeal: 
Board remands appeal or grants or denies claim. 

Source: GAO analysis of VBA process. 

[End of figure] 

Evolution of the DRO Position and Review Process: 

VA created the DRO position and implemented the DRO review process 
nationally in 2001 after a 1997-1998 pilot in 12 regional offices. In 
the pilot, DROs were responsible for performing reviews of all appeals 
and had the ability to make a new decision based solely on a 
difference of opinion with the original decision. VA promulgated final 
regulations when it implemented DRO review nationwide in 2001, which 
made the process optional and required the veteran to expressly choose 
it.[Footnote 13] Later in 2001, VA headquarters issued guidance to the 
regional offices expanding the responsibilities of DROs to include 
mentoring and training other disability claims staff and working with 
regional office managers to identify error trends and training needs. 

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.[Footnote 14] 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.[Footnote 
15] The percentage of appeals in which a DRO review was chosen 
increased each year, from 54 percent of all appeals in fiscal year 
2003 to 65 percent in fiscal year 2010 (see figure 2). However, there 
was significant variation across VA's regional offices. For example, 
during the 8-year time period, the regional office in Columbia, South 
Carolina, had the lowest percentage of DRO reviews chosen--32 percent-
-and San Diego, California, the highest--87 percent. More than half of 
the regional offices had the DRO review chosen in at least 50 percent 
of all appeals filed. 

Figure 2: Number of DRO Reviews and Traditional Reviews, Fiscal Years 
2003-2010: 

[Refer to PDF for image: stacked vertical bar graph] 

Fiscal year: 2003; 
DRO reviews: 59,206; 
Traditional reviews: 50,614. 

Fiscal year: 2004; 
DRO reviews: 56,042; 
Traditional reviews: 45,704. 

Fiscal year: 2005; 
DRO reviews: 59,501; 
Traditional reviews: 40,478. 

Fiscal year: 2006; 
DRO reviews: 57,423; 
Traditional reviews: 38,368. 

Fiscal year: 2007; 
DRO reviews: 60,989; 
Traditional reviews: 36,831. 

Fiscal year: 2008; 
DRO reviews: 69,443; 
Traditional reviews: 39,627. 

Fiscal year: 2009; 
DRO reviews: 81,353; 
Traditional reviews: 43,422. 

Fiscal year: 2010; 
DRO reviews: 90,482; 
Traditional reviews: 49,244. 

Fiscal year: 2010; 
DRO reviews: 90,482; 
Traditional reviews: 49,244. 

Source: GAO analysis of Board data. 

[End of figure] 

Our review suggests a key factor in the choice of a DRO review is 
whether a veteran has assistance from a third party, such as a VSO 
representative or a private attorney.[Footnote 16] Sixty-three percent 
of all appeals filed by veterans with representation chose a DRO 
review compared to 44 percent of those filed by veterans without 
representation across all regional offices. Controlling for selected 
factors that may affect the choice of a DRO review, veterans with 
representation are still more likely to choose a DRO review for their 
appeals.[Footnote 17] Additionally, we found that representation may 
also be one of the factors that contribute to the variation in the 
percentage of veterans choosing a DRO review across regional offices. 
As the percentage of appeals with representation increased, the 
percentage of DRO reviews also increased across regional offices. 
However, representation alone does not fully explain the variation in 
DRO reviews chosen across regional offices. Other factors that we did 
not analyze, such as demographic factors, may contribute to the 
variation across regional offices. 

Representatives may recommend one appeal option over another to their 
veterans. Of the 40 veterans we interviewed, 22 told us that 
representatives from a VSO or state or county agency helped them 
decide between the DRO and the traditional review, and 17 of the 22 
said that the assistance they received was very or somewhat helpful in 
deciding between the appeal options.[Footnote 18] Most VSO 
representatives we interviewed said they usually recommend a DRO 
review because they believe it is faster or because a DRO may be more 
likely to grant the claim. Some also said they recommend a DRO review 
over a traditional review because a DRO will thoroughly review all the 
evidence and a veteran has the opportunity to make his or her case to 
the regional office. VSO representatives at one regional office we 
visited said that they recommend a DRO review if they believe, based 
on experience, that the DRO likely to be assigned the case is more 
open to working with them. However, some VSO representatives also said 
that they recommend a traditional review under certain circumstances. 
For example, if an appeal has ambiguous evidence, they may recommend a 
traditional review because it may result in an appeal going to the 
Board faster and because they believe the Board has more flexibility 
than a DRO to grant benefits in such cases. Also, VSO representatives 
at one site visit told us they generally recommend a traditional 
review because in their view a DRO review takes too much time. 

Of all appeals filed since fiscal year 2003, 53 percent included the 
fact that they chose the DRO review option on the notice of 
disagreement. According to VSO representatives we interviewed, because 
veterans' representatives have power of attorney, they can choose an 
appeal option at the same time they file an appeal for a veteran 
rather than waiting for the veteran to receive VA's appeal process 
request letter. A DRO review may be chosen on the same day an appeal 
is filed in order to save time because the regional office does not 
have to send the appeal process request letter and wait for the 
veteran's response before beginning its review.[Footnote 19] 

Veterans filing 13 percent of appeals chose an appeal option without 
assistance from a representative, and these veterans may not fully 
understand their options as described in the VA appeal process request 
letter, some VA officials and VSO representatives told us. The VBA 
manual provides a template of the letter for the regional offices, 
which prepare and mail it to a veteran after receiving the notice of 
disagreement.[Footnote 20] VA headquarters officials told us that 
while regional offices have flexibility to add information to the 
template letter, they cannot exclude any information, and headquarters 
prefers that the regional offices use the template letter. (For VA's 
template letter, see appendix II.) Some VA officials and VSO 
representatives said veterans may not be able to make an informed 
decision based on the letter alone. Specifically, 29 of 55 regional 
office managers we surveyed (53 percent) answered that they believed 
no or only some veterans could make an informed decision using only 
the VA letter. The other regional office managers we surveyed (47 
percent) said that all or most veterans could make an informed 
decision using only the VA letter (see figure 3). Of the DROs we spoke 
with, 10 of 17 said that in their view, no or only some veterans could 
make informed decisions based on the letter alone, and most VSO 
representatives at the regional offices we visited said that few or no 
veterans could do so[Footnote 21]. Representatives from one VSO told 
us veterans may phone after receiving the letter because they do not 
understand its description of appeal options. Some managers in our 
survey and VA staff we interviewed suggested changes to the template, 
for example, shortening its length, using simpler language and less 
jargon, using graphics or tables to aid understanding, explaining the 
benefits of representation, and advising veterans they can request 
informal or formal hearings if they choose a DRO review. They also 
said the letter could better explain differences between DRO and 
traditional reviews, particularly in the treatment of evidence and the 
authority given a DRO to render a new decision without additional 
evidence. 

Figure 3: Percentage of Regional Office Managers Who Said Veterans Can 
Make Informed Decision Using VA Letter Alone: 

[Refer to PDF for image: pie-chart] 

All or most veterans: 47%; 
Some veterans: 38%; 
Few or none of the veterans: 15%. 

Source: GAO survey of managers in 57 VA regional offices. 

[End of figure] 

Our analysis of the template in the VBA manual, based on criteria 
established for federal government communication with the public, 
found the letter did not clearly explain appeal options and the appeal 
process.[Footnote 22] Although we found the letter met several 
criteria for clear communication by federal agencies and programs, 
such as simple structure, concise headings, and avoidance of complex 
language overall, we found it did not meet some other criteria, 
including: 

* defining terms that could be unfamiliar to the veteran, such as 
"decision review officer," "de novo reviews," "clear and unmistakable 
error," and "substantive appeal"; 

* highlighting key deadlines for responding by including them at the 
beginning of the letter, so the veteran is clear that VA needs a 
response within 60 days; and: 

* using tables or graphics to explain appeal options and enhance 
recipient's understanding (see figure 4). 

Figure 4: Excerpt from VA Appeal Process Request Letter Template and 
Examples of Clear Communication Analysis: 

[Refer to PDF for image: illustration] 

Department of Veterans Affairs: 
Regional Office: 

We received your written notice of disagreement with the Department of 
Veterans Affairs (VA) decision of [date]. This letter describes what 
happens next. 

Will VA try to resolve my disagreement?[A] 

This local VA office will try to resolve your disagreement through the 
Post-Decision Review Process. As part of this process, you must decide 
how you would like us to handle your appeal. You may choose to have a 
Decision Review Officer (DRO)[B] assigned to your case or to follow 
the traditional appeal process. 

How does the Decision Review Officer Process work? 

New decision: The DRO will then make a new decision. The DRO has the 
authority to grant benefits based on clear and unmistakable error, de 
novo review,[C] or the receipt of new and material evidence. You will 
be notified of the decision and your appeal rights. If you are not 
satisfied with the DRO's decision, you may then appeal, using the
traditional appeal process. 

How does the Traditional Appeal Process work? 

Statement of the Case: If we cannot grant your appeal based on the 
review and an examination of any additional evidence, we will then 
prepare a Statement of the Case (SOC) and send you a copy. The SOC 
will include a summary of the evidence, a citation to pertinent laws, 
a discussion of how those laws affect the decision, and a summary of
the reasons for the decision. If you still do not agree with that 
decision and wish to continue your appeal, you need to submit a 
substantive appeal[D] that your case can be sent to the Board of 
Veterans’ Appeals.[E] Instructions on how to file a substantive appeal 
will be provided in our letter notifying you of the decision. 

How do I select the Decision Review Officer process or traditional 
appeal process? 

You must notify us within 60 days from the date of this letter whether 
you want to have your case reviewed by the Decision Review Officer 
process or by the traditional appeal process. If we do not hear from 
you within 60 days, your case will be reviewed under the traditional 
appeal process.[F] 

We hope we will be able to resolve your disagreement to your 
satisfaction. If you have questions about the information in this 
letter please call us at 1-800-827-1000. 

Source: GAO. 

[A] This letter helps the reader by using concise headings to organize 
information. 

[B] The letter does not define the “Decision Review Officer” (DRO). 
For example, the reader does not know that the DRO is a senior expert on
disability claims or that a DRO is not involved in the original claim. 

[C] The term “clear and unmistakable error” does not make it clear 
that the DRO could grant the claim because the initial rater made an 
error on the original claim. 

The letter does not define a “de novo review.” For example, the reader 
does not know that a de novo review is a completely new review of the 
claim and that the DRO can make a new decision without additional 
evidence. 

[D] The letter does not define “substantive appeal.” 

[E] Letter does not explain the role of the Board of Veterans’ Appeals 
or who serves on the Board. 

[F] One purpose of this letter is to explain that the veteran must 
choose a DRO review within 60 days to receive one. Because the 
deadline for choosing an appeal option is near the bottom of the 
letter, a veteran who skims the letter may not recognize the urgency 
of responding to the VA with a choice. 

[End of figure] 

One of the regional offices we visited made changes to the template 
that address some of these issues, for example, including instructions 
on how to request a hearing and italicizing important information, 
such as the 60-day deadline for a veteran to respond with an appeal 
choice. 

Of the 40 veterans we interviewed, 14 remembered receiving and were 
able to describe the appeal process request letter, and 9 of those 
told us that the letter explained the appeal options only somewhat 
clearly or not at all clearly. Five said it explained the options very 
clearly.[Footnote 23] Some of the veterans we spoke with offered 
suggestions on how VA could improve the letter, for example, by 
providing a point of contact for veterans with questions, explaining 
when they might next hear from VA about their appeal, and more 
thoroughly describing the two appeal options. VA headquarters 
officials said VBA management and attorneys reviewed the letter 
template but they did not test it with focus groups of veterans 
because VBA does not have contracts to conduct focus groups. According 
to federal guidelines for clear communication with the public, testing 
documents should be an integral part of an agency's plain-language 
planning and writing process. 

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. 
[Footnote 24] From fiscal years 2003 through 2010 at least some 
additional benefits were awarded at the regional level in 32 percent 
of DRO reviews compared to 23 percent of traditional regional office 
reviews, according to our analysis of Board data (see figure 5). 
[Footnote 25] We found that having a DRO review was associated with a 
greater chance of being awarded some additional benefits even after 
controlling for some other factors that may affect appeal outcomes, 
such as whether a veteran had a representative or the regional office 
in which the appeal was filed.[Footnote 26] Veterans awarded 
additional benefits at this appeal stage receive these benefits 
immediately even if they continue their appeals, according to a VA 
official. 

Figure 5: Percentage of Appeals Receiving Full or Partial Grants of 
Benefits after Regional Office Review of the Notice of Disagreement, 
Fiscal Years 2003-2010: 

[Refer to PDF for image: vertical bar graph] 

Fiscal year: 2003; 
Traditional review: 24%; 
DRO review: 35%. 

Fiscal year: 2004; 
Traditional review: 21%; 
DRO review: 33%. 

Fiscal year: 2005; 
Traditional review: 23%; 
DRO review: 30%. 

Fiscal year: 2006; 
Traditional review: 24%; 
DRO review: 31%. 

Fiscal year: 2007; 
Traditional review: 24%; 
DRO review: 31%. 

Fiscal year: 2008; 
Traditional review: 22%; 
DRO review: 31%. 

Fiscal year: 2009; 
Traditional review: 22%; 
DRO review: 31%. 

Fiscal year: 2010; 
Traditional review: 22%; 
DRO review: 30%. 

Source: GAO analysis of Board data. 

[End of figure] 

DRO reviews took about a month longer than traditional reviews to 
complete, or 266 days compared to 235 days, on average, for the time 
period from fiscal years 2003 through 2009 (see figure 6).[Footnote 
27] It is possible DRO reviews take longer because they involve a more 
thorough examination of the evidence. For example, one DRO we spoke 
with said such reviews take longer because they require a completely 
fresh look at all evidence in the original claim. Regardless of 
whether veterans choose a DRO or a traditional review, their waiting 
time for a decision on the notice of disagreement is considerably less 
than if they continue their appeal to the Board. For appeals filed 
from fiscal years 2003 through 2007, the time from filing of the 
notice of disagreement to Board decision was more than 1,000 days on 
average.[Footnote 28] 

Figure 6: Average Days for Regional Office to Issue Decision on Notice 
of Disagreement, Fiscals Years 2003-2009: 

[Refer to PDF for image: vertical bar graph] 

Fiscal year: 2003; 
Traditional review: 212; 
DRO review: 237. 

Fiscal year: 2004; 
Traditional review: 215; 
DRO review: 255. 

Fiscal year: 2005; 
Traditional review: 230; 
DRO review: 247. 

Fiscal year: 2006; 
Traditional review: 252; 
DRO review: 262. 

Fiscal year: 2007; 
Traditional review: 265; 
DRO review: 279. 

Fiscal year: 2008; 
Traditional review: 264; 
DRO review: 302. 

Fiscal year: 2009; 
Traditional review: 222; 
DRO review: 273. 

Source: GAO analysis of Board data. 

Note: We analyzed data for fiscal years 2003 through 2009 because 
about 90 percent or more of appeals filed in these years had received 
a decision at the initial stage. 

[End of figure] 

Appeal Resolution Rate Is Similar for DRO and Traditional Reviews, 
Leading to Minimal Change in the Number of Appeals to the Board: 

Although veterans choosing a DRO review were more likely to gain some 
additional benefits at the regional office level, in comparison to a 
traditional review, DRO review does not appear to reduce the number of 
appeals continuing to the Board--which was an important goal for VA in 
introducing this appeal option. The resolution rate at the regional 
office level for appeals in which a DRO review was selected has been 
about the same as the rate for traditional reviews. Of the 593,526 
appeals of disability claim decisions receiving either DRO or 
traditional reviews from fiscal years 2003 through 2008 that had a 
final regional office outcome, 72 percent ended at the regional office 
level. The remainder continued to the Board[Footnote 29]. For appeals 
in which a DRO review was selected, 71 percent ended at the regional 
office level compared to 73 percent of appeals in which a traditional 
review was chosen.[Footnote 30 The resolution rate for DRO and 
traditional reviews was roughly the same in each year during this 6- 
year period (see figure 7). Resolution rates varied across VA's 
regional offices. For both DRO and traditional reviews, resolution 
rates ranged from less than 50 percent to more than 80 percent in 
individual offices, with the majority having rates of more than 70 
percent for both types of reviews. VA officials offered several 
possible explanations for the variation across offices, for example, 
the extent to which VSO representatives are proactive in submitting 
necessary evidence. 

Figure 7: Percentage of Appeals Resolved at Regional Office Level, 
Fiscal Years 2003-2008: 

[Refer to PDF for image: vertical bar graph] 

Fiscal year: 2003; 
Traditional review: 73%; 
DRO review: 71%. 

Fiscal year: 2004; 
Traditional review: 67%; 
DRO review: 71%. 

Fiscal year: 2005; 
Traditional review: 73%; 
DRO review: 70%. 

Fiscal year: 2006; 
Traditional review: 74%; 
DRO review: 70%. 

Fiscal year: 2007; 
Traditional review: 75%; 
DRO review: 71%. 

Fiscal year: 2008; 
Traditional review: 77%; 
DRO review: 75%. 

Source: GAO analysis of Board data. 

Note: We analyzed data for fiscal years 2003 through 2008 because 
about 90 percent or more of appeals filed in these years had been 
resolved at the regional level or certified to the Board. 

[End of figure] 

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. Although a slightly higher percentage of 
DRO reviews resulted in full grants of benefits for veterans, veterans 
choosing DRO review were less likely than those choosing traditional 
review to end their appeals when not granted full 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 figure 8)[Footnote 
31]. On this front, traditional reviews were somewhat more likely than 
DRO reviews to be resolved through veterans' failure to respond--41 
percent versus 36 percent, respectively. 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. Most decisions to grant full benefits 
were made at the initial appeal stage, while some were made during the 
stage in which the regional office prepares the appeal for the Board. 
The remaining appeal resolutions were due to veterans or their 
representatives withdrawing their appeals by contacting VA or to the 
death of the veteran. 

Figure 8: Regional Office Appeal Outcomes, Fiscal Years 2003-2008: 

[Refer to PDF for image: vertical bar graph] 

Regional office outcome: Traditional review; 
Failure to respond: 41%; 
Full grant: 17%; 
Withdrawal: 12%; 
Death of veteran: 3%; 
Continued to Board: 27%. 

Regional office outcome: DRO review; 
Failure to respond: 36%; 
Full grant: 21%; 
Withdrawal: 12%; 
Death of veteran: 2%; 
Continued to Board: 29%. 

Source: GAO analysis of Board data. 

Note: We analyzed data for fiscal years 2003 through 2008 because 
about 90 percent or more of appeals filed in these years had been 
resolved at the regional level or certified to the Board. 

[End of figure] 

While we found no difference in how veterans responded to a partial 
grant of benefits based on their choice of appeal option, we found 
that veterans who chose a traditional review appeared to respond 
differently than those who chose a DRO review when no additional 
benefits were granted at the initial appeal stage. Board data for 
fiscal years 2003 through 2008 show that when no additional benefits 
were granted (i.e., the original decision was upheld), appeals in 
which a traditional review was chosen were somewhat more likely than 
those in which a DRO review was chosen to end at the regional office 
level--57 percent versus 51 percent, respectively. By contrast, in 
cases that resulted in the award of partial benefits, there was no 
difference based on which appeal option had been chosen--75 percent of 
both traditional appeals and DRO appeals were ended at the regional 
level.[Footnote 32] Representation may be a factor in why veterans 
selecting a traditional review are more likely to end their appeals 
after receiving no additional benefits from the regional office. 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. 
As noted previously, veterans without representation are more likely 
to choose a traditional review. 

VA regional office staff told us that certain aspects of the DRO 
review can be effective in resolving appeals before they continue to 
the Board. Managers we surveyed rated DROs' authority to make a 
completely new (de novo) decision on a claim and to hold informal 
conferences with veterans and representatives as the most effective 
tools for resolving appeals (see figure 9). Of the 17 DROs we 
interviewed, 15 rated their authority to make a completely new 
decision as very or moderately effective in resolving appeals, 10 
rated informal conferences as very or moderately effective, and 7 
rated formal hearings as very or moderately effective. Many DROs in 
our site visits told us their authority to make a completely new 
decision on a claim allows them to reverse original decisions without 
submission of additional evidence by the veteran. DROs also said 
informal conferences may help resolve appeals because they enable DROs 
to obtain information from a veteran's representative or explain to a 
representative and veteran why no additional benefits can be granted. 

Figure 9: Percentage of Regional Office Managers Rating Specific 
Activities as Very or Moderately Effective in Resolving Appeals: 

[Refer to PDF for image: vertical bar graph] 

Specific task: De Novo Review; 
Very or moderately effective: 82%. 

Specific task: Informal conference; 
Very or moderately effective: 65%. 

Specific task: Directed development[A]; 
Very or moderately effective: 55%. 

Specific task: Formal hearing; 
Very or moderately effective: 49%. 

Specific task: Traditional review; 
Very or moderately effective: 38%. 

Source: GAO survey of managers in 57 VA regional offices. 

[A] Directed development involves a DRO directing another staff member 
to collect additional evidence such as medical or personnel records. 

[End of figure] 

While many regional staff believe DRO reviews have a greater potential 
to resolve appeals, we found that the appeal resolution rate for DRO 
and traditional reviews are quite similar, perhaps in part because 
VA's criteria for assessing and rewarding individual DROs' performance 
do not always encourage them to use their unique authorities to 
resolve appeals. VA currently assesses the performance of individual 
DROs using four criteria: quality of work, productivity, customer 
service, and timeliness. The existing criteria do not specifically 
encourage appeal resolution at the regional level, according to 60 
percent of surveyed managers and 10 of the 17 DROs we interviewed. For 
example, managers in one office we visited said the current criteria 
encourage DROs to complete tasks that help them meet their 
productivity requirement but may not necessarily lead to appeal 
resolution. 

The department is currently revising its criteria for assessing DRO 
performance based on a 90-day pilot program in eight regional offices 
conducted in fiscal year 2010, and it expects to implement new 
criteria nationwide in fiscal year 2012. According to VA officials, 
the revisions are intended in part to focus DROs' attention more on 
resolving appeals at the earliest possible stage of the process. VA 
officials told us the new criteria under development will better 
encourage appeal resolution by restructuring the way work credits-- 
needed to meet the productivity requirement--are awarded to DROs. For 
example, under the existing criteria, work credits are awarded for 
holding informal conferences, but under the new criteria additional 
credits would be awarded when the conference results in resolving the 
appeal.[Footnote 33] In addition, VA officials said the new criteria 
aim to promote appeal resolution by more explicitly promoting regular 
communication with veterans' representatives. They said that even 
though such communication can help resolve appeals by helping 
representatives understand, for example, why further benefits cannot 
be granted in a particular case, DROs have become less focused on 
communication over the years due to production pressures. 

VA Faces Challenges in Defining Role of and Training for DROs: 

Lack of Performance Measures for Appeal Resolution Hinders VA's 
Ability to Assess Use of DROs: 

Since the DRO pilot program in 1997-1998, VA has expanded DRO duties 
to include tasks not related to appeals. According to the estimates of 
regional office managers who responded to our survey, DROs overall 
tend to spend the majority of their time on appeal-related tasks, but 
also spend a significant amount of time on training other staff and 
performing quality reviews (see figure10). Time spent on different 
tasks varies across regional offices. For example, the proportion of 
time spent on conducting de novo reviews of appeals--that is, a 
completely new evaluation of a claim without deference to the original 
decision--ranged from 3 to 70 percent in individual offices, and on 
formal training ranged from 0 to 40 percent. The four offices we 
visited typically assigned individual DROs to specific 
responsibilities, such as reviewing appeals, training other staff, and 
conducting quality reviews of other staff's work, rather than having 
each DRO perform the full range of tasks. Managers in one office said 
specialization is helpful because it permits DROs to focus on training 
without the distraction of appeals work. Regional office managers may 
also assign DROs to different duties at different times to meet 
changing office needs. For example, one office we visited had recently 
assigned more DROs to training and quality review to address problems 
with its RVSRs' performance, and managers said preliminary results 
showed an improvement in RVSR quality scores after this reallocation 
of DRO resources. 

Figure 10: Regional Office Managers' Estimates of Proportion of DROs' 
Time Spent on Specific Tasks: 

[Refer to PDF for image: horizontal bar graph] 

Task: De novo review; 
Time Spent on task: 30%. 

Task: Quality review and informal training; 
Time Spent on task: 15%. 

Task: Traditional review; 
Time Spent on task: 39%. 

Task: Formal training duties; 
Time Spent on task: 38%. 

Task: Directed development; 
Time Spent on task: 37%. 

Task: Formal hearings; 
Time Spent on task: 37%. 

Task: Certifying appeals; 
Time Spent on task: 37%. 

Task: Informal conferences; 
Time Spent on task: 36%. 

Task: Initial claims; 
Time Spent on task: 35%. 

Task: Remands; 
Time Spent on task: 35%. 

Task: Other; 
Time Spent on task: 38%. 

Source: GAO survey of managers in 57 VA regional offices. 

Note: We asked regional office managers to estimate the proportion of 
time that DROs in their office spend on specific tasks. Percentages 
here reflect the average responses from regional offices about each 
specific task, but not the percentage of time that all DROs nationally 
spend on each task, because different regional offices have different 
numbers of DROs. 

[End of figure] 

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. In 2006, an 
internal VA study group that assessed the impact of the DRO review 
process recommended that VA limit the scope of DRO duties to reviewing 
appeals and have them perform de novo reviews of all appeals--not just 
those in which a DRO review was selected. Their report found that 
there was a sufficient number of DROs to perform de novo reviews of 
all appeals if DROs' duties were limited to appeals-related tasks. 
Officials told us that VA management decided not to implement these 
recommendations because of concerns that there was an insufficient 
number of DROs to review all appeals and a belief that other tasks are 
also important DRO functions. There was also a mix of opinions on this 
topic among regional office managers we surveyed and interviewed. 
Almost two-thirds of those surveyed stated that eliminating the DRO 
review election process and having DROs perform only de novo reviews 
of all appeals would somewhat or greatly improve their effectiveness. 
On the other hand, managers said it could be difficult to have their 
DROs spend more time on such reviews. About 60 percent of surveyed 
managers said they would prefer to allocate more DRO time to 
performing de novo reviews, but some respondents noted that they 
cannot allocate DROs' time optimally because of staff and resource 
limitations and the need to assign DROs to other duties. 

While VA has expanded the role of the DROs so they are contributing to 
other VA goals beyond appeal resolution, the department has not 
developed performance measures to assess whether DROs are successful 
in meeting their original purpose of reducing the number of appeals to 
the Board. The measures that VA uses to assess national and regional 
office performance in processing appeals do not include the proportion 
of appeals resolved at regional offices. Existing VA measures for 
national and regional office appeals performance involve the number of 
appeals awaiting a decision, number of days appeals have been pending 
a decision, and percentage of appeals that are remanded from the 
Board. We have previously noted that agencies should develop 
performance measures that are linked to agency goals.[Footnote 34] 
Linking performance measures to broader agency goals at each operating 
level reinforces the importance of these goals and may help managers 
identify areas where problems exist and corrective action is required. 

VA already collects some data related to appeal resolution, but some 
VA officials question the value of a performance measure related to 
appeal resolution. The department tracks data on the number of appeals 
resolved at different stages of the appeal process--for example, 
through the veteran's failure to respond to the statement of the case 
or after the veteran's submission of a substantive appeal to the Board-
-nationally and by regional office. It makes these data available to 
regional offices. About half the regional office managers surveyed 
said an appeal resolution goal at the regional office level would 
somewhat or greatly enhance DROs' effectiveness. However, VA officials 
told us they have not established a performance measure for appeal 
resolution because this outcome is not entirely under the control of 
the DRO, as a veteran has a right to continue his or her appeal to the 
Board. Some VA managers and staff in the offices we visited also 
expressed a concern that such a goal could have a negative impact. For 
example, it could push DROs to grant benefits that are not completely 
justified or to pressure veterans to withdraw their appeals. While we 
understand this potential concern, we note that VA has quality review 
procedures in place to ensure the quality and accuracy of DRO 
decisions. Specifically, VA reviews on average five cases per month 
that each DRO has worked on. VA assesses each case against several 
criteria, including whether all claimed issues were addressed, whether 
all applicable evidence was discussed, and whether all issues were 
correctly granted or denied. Some regional office managers agreed that 
setting an appeal resolution goal would not encourage DROs to grant 
unjustified benefits, because, for example, existing quality review 
procedures would prevent this from happening. 

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. The training available to DROs 
from VA headquarters is the same training offered to RVSRs (staff who 
evaluate initial claims). VA requires its claims processing staff, 
including DROs, to take 85 hours of training annually. Headquarters 
and regional office officials told us DROs typically take the same 
courses as RVSRs. As part of its training for claims processors, VA 
has three courses for all regional office staff who process appeals: 
an orientation to the appeals team, a course on the appeal process, 
and a course on how to use the Board's appeals tracking system. VA 
headquarters officials told us they have not developed training 
specifically for new DROs because they should already be technical 
experts in evaluating claims when promoted. However, they acknowledged 
that the department has not completed an analysis of DRO tasks 
specifically to determine the training needs of this position. 
According to generally accepted criteria, a key step in developing 
successful training in the federal government is for an agency to 
understand the skills that its workforce needs to achieve agency 
goals. Furthermore, these criteria stress the need for agencies to 
incorporate continuous, life-long learning into their training--even 
experienced staff may still need additional training in certain areas. 
[Footnote 35] 

A number of managers and DROs in the regional offices we visited said 
the skills DROs learn before promotion may not be sufficient to 
perform their new tasks. Several managers told us new DROs, based on 
their prior experience, are indeed technical experts in evaluating 
claims; however, managers and DROs said new DROs may lack experience 
with certain responsibilities, such as holding formal hearings and 
informal conferences, training other staff, processing appeals, and 
balancing multiple priorities. Regional managers at three of the four 
offices we visited said the appeals courses offered by VA are not 
sufficient to teach new DROs how to perform their duties; a manager in 
one office said these courses provide a general overview and are not 
primarily used to train them. DROs in the four offices we visited 
learn their duties primarily on the job and by observing more 
experienced colleagues, according to managers. However, some offices 
have developed more formal training for DROs. Forty percent of 
surveyed regional managers said their office has developed specific 
training that address such topics as the appeals process, conducting 
formal hearings and informal conferences, reviewing other staff's 
work, and policy and regulatory changes. 

Despite regional office efforts to provide targeted training, our 
survey of regional managers found that 93 percent believe a nationally 
standardized training program for newly promoted DROs would improve 
their effectiveness, and 16 of the 17 DROs we interviewed also said a 
national training program would be helpful. Managers in two regional 
offices we visited said a training program developed by VA's central 
office would ensure consistency in how DROs are trained across the 
nation. Managers responding to our survey indicated that tailored 
training on a number of topics would enhance the ability of new DROs 
to perform their job duties (see figure 11). 

Figure 11: Percentage of Regional Managers Who Said Training on 
Certain Topics Would Greatly or Moderately Enhance New DROs' 
Performance: 

[Refer to PDF for image: vertical bar graph] 

Training area: Training other staff; 
Greatly or Moderately Enhance New DROs' Performance: 75%. 

Training area: Policy and legal changes; 
Greatly or Moderately Enhance New DROs' Performance: 69%. 

Training area: Mentoring; 
Greatly or Moderately Enhance New DROs' Performance: 64%. 

Training area: Workload management; 
Greatly or Moderately Enhance New DROs' Performance: 64%. 

Training area: Informal conferences; 
Greatly or Moderately Enhance New DROs' Performance: 62%. 

Training area: Quality review; 
Greatly or Moderately Enhance New DROs' Performance: 62%. 

Training area: Appeals process; 
Greatly or Moderately Enhance New DROs' Performance: 60%. 

Training area: Formal hearings; 
Greatly or Moderately Enhance New DROs' Performance: 60%. 

Source: GAO survey of managers in 57 VA regional offices. 

[End of figure] 

A formal, centrally designed training program--especially for new 
DROs--has been proposed within VA. Under this proposal, according to 
one VA official involved with the management of the DROs nationally, 
new DROs would receive instruction in areas such as training other 
staff and communicating with veterans and their representatives. The 
training might be administered in a central location for new DROs from 
multiple regional offices, or developed centrally and then 
administered by regional offices. However, VA does not yet have formal 
plans to move ahead with the development of such a program, according 
to VA officials. 

Conclusions: 

Review of veterans' appeals by VA's DROs has had some positive impacts 
for veterans, and it is possible that more veterans would choose a DRO 
review if they fully understood the distinction between the DRO and 
traditional reviews. Because VA's outreach letter lacks information 
and clarity that veterans need to make an informed choice between the 
options, some--in particular, those without a representative--may not 
be taking advantage of the DRO review process. 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. 
Indeed, while VA is taking steps to place a greater focus on appeal 
resolution in the criteria it uses to assess the performance of 
individual DROs, it has yet to establish any national or regional 
office performance measures related to resolving appeals at the 
regional level. Certainly, VA must balance competing demands on DROs, 
senior claims processors in its regional offices, to both resolve 
appeals and train and supervise less experienced staff, but without a 
more strategic approach--which includes goals and measures for 
resolution of appeals--VA does not know it is fully leveraging DRO 
reviews and, ultimately, their effectiveness for the veterans VA 
serves. Regardless of the proper balance between their different 
responsibilities, DROs may not be contributing as much as they could 
be, either to the goal of appeal resolution or to the goal of 
developing newer claims processing staff, because they do not always 
receive training specific to their duties. 

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. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to VA for review and comment. In 
its written comments (see appendix III), VA concurred fully with two 
of our recommendations and partially with our recommendation regarding 
an appeal resolution performance measure. The department concurred 
with our recommendation to revise its sample appeal election letter. 
It reported that it has formed a workgroup to assess and recommend 
changes to the appeal election process, potentially including changes 
to the letter. VA also concurred with our recommendation to assess the 
knowledge and skills that DROs need and if necessary develop a 
training curriculum for them. VA said it plans to develop additional 
training based on the results of skills certification tests 
administered to DROs and on a job task analysis conducted to aid the 
design of these certification tests. 

VA partially concurred with our recommendation to establish national 
and regional performance measures related to the resolution of appeals 
at the regional office level. The department noted that--as explained 
previously in our report--it is revising the criteria used to assess 
the performance of individual DROs to place greater emphasis on 
resolving appeals at the earliest stage possible, for example through 
communication with veterans and their representatives. 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. We acknowledge that DROs impact VA operations beyond 
appeals. Yet VA's own documents--including its 2006 review of the DRO 
program--state that the department's primary goal in establishing the 
DRO review process was to increase the percentage of appeals resolved 
before continuing to the Board, and the changes VA is now making to 
its criteria for measuring individual DRO performance indicate that 
appeal resolution remains a major goal. We are not recommending that 
an appeal resolution performance measure replace existing VA 
performance measures related to appeals or to other VA processes on 
which DROs could have an impact. Our recommendation is that VA add 
such a measure to gauge whether the program is meeting its specific 
intended goal and help the department assess whether further 
adjustments are needed. We also acknowledge that it is not possible to 
prevent all appeals from continuing to the Board; such an objective 
may not even be desirable. However, based on its changes to the 
criteria for individual DRO performance, VA clearly believes that 
changes in incentives can encourage behaviors that are likely to 
resolve more appeals early on. Finally, as VA also noted in its 
comments, individual DROs must meet rigorous accuracy standards in 
their appeals work, which should mitigate against the granting of 
unjustified benefits. However, if VA does not believe that its 
existing quality control measures are sufficient to guard against the 
granting of unjustified benefits, we would encourage the department to 
consider what additional quality control measures it could implement 
to ensure that the addition of a new performance measure would not 
have the unintended consequence of increasing the award of unjustified 
benefits. 

As agreed with your offices, unless you publicly announce the contents 
of this report earlier, we plan no further distribution until one day 
from the report date. At that time, we will send copies of this report 
to the relevant congressional committees, the Secretary of Veterans 
Affairs, and other interested parties. This report is also available 
at no charge on GAO's website at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions regarding this report, please 
contact me at (202) 512-7215 or bertonid@gao.gov. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. Staff members who made key 
contributions to this report are listed in appendix IV. 

Signed by: 

Daniel Bertoni: 
Director, Education, Workforce, and Income Security issues: 

[End of section] 

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. To answer these objectives, we reviewed relevant laws and 
regulations, and VA documents including procedural manuals, internal 
studies, and the sample appeal election letter that VA headquarters 
provides for its regional offices. We interviewed cognizant officials 
from the Veterans Benefits Administration (VBA) and the Board of 
Veterans' Appeals (Board). 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. We obtained and analyzed administrative data from the Board 
on outcomes and processing times for appeals of disability 
compensation claims. Finally, to learn about veterans' perspectives on 
the DRO review election process we conducted phone interviews with a 
small sample of veterans who had appealed their disability 
compensation claims. 

We conducted this review from July 2010 to September 2011 in 
accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Analysis of VA Appeal Process Request Letter: 

We analyzed the VBA's appeal process request letter as a factor that 
may affect veterans' decisions about the appeal options. For our 
analysis we used the sample letter in the VBA manual since VBA central 
office officials said that regional offices use the sample as a 
template for the letters they mail to veterans.[Footnote 36] We 
selected 16 criteria for clear federal communication using information 
from the Plain Language Guidelines,[Footnote 37] a previous GAO report 
on VBA letter clarity,[Footnote 38] and the VBA manual (see table 1). 
We reviewed the letter and came to a consensus about which criteria 
were met and which were not met. 

Table 1: Clear Federal Communication Criteria for VA Letter Analysis: 

Clear federal communication criteria: The letter includes statements 
of deadlines; 
Criteria descriptions: The letter should include a statement of the 
deadline for responding to the letter; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter includes contact 
information; 
Criteria descriptions: Contact information includes a phone number for 
the veteran to call or an address that the veteran could write to; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter states the purpose; 
Criteria descriptions: As part of the critical structure, letters 
should identify the purpose; 
Did the letter meet the criterion? No. 

Clear federal communication criteria: Most important information is at 
the beginning, such as the purpose; 
Criteria descriptions: Most important information should be stated at 
the beginning, and background information (when necessary) should be 
included toward the end. The document's purpose and its bottom line 
are stated at the beginning. Unnecessary content is eliminated; 
Did the letter meet the criterion? No. 

Clear federal communication criteria: The letter is in a logical 
sequence; 
Criteria descriptions: Similar ideas are grouped and are not 
contradictory, steps are presented chronologically, and general 
information is presented earlier than specific information; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter addresses one person 
rather than a group (for example, "you" or "a veteran" instead of 
"veterans"); 
Criteria descriptions: Singular nouns and verbs prevent confusion 
about whether a statement or requirement applies to individual users 
or to groups; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter's structure is simple; 
there are not more than five levels of headings; 
Criteria descriptions: Crafting documents with four, five, or even 
more levels of headings makes it difficult for the audience to keep 
track of where they are in the structure of the document; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter uses concise headings 
to organize information; 
Criteria descriptions: Headings should not be so long that they 
overwhelm the material in the section itself. Headings with one-word 
answers should be avoided; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The headings highlight short 
sections of information; 
Criteria descriptions: Short sections break up material so it appears 
easier to comprehend; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter does not use jargon; 
Criteria descriptions: Jargon refers to terms that are unfamiliar to 
and undefined for the average layperson, including unexplained 
acronyms and highly technical medical or legalistic terminology; 
Did the letter meet the criterion? No. 

Clear federal communication criteria: The letter does not use 
convoluted language; 
Criteria descriptions: Convoluted language refers to situations where 
the sentence structure or syntax is overly complex; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter appropriately uses 
examples, lists, tables, or illustrations to clarify complex concepts; 
Criteria descriptions: Examples help to clarify complex concepts and 
can substitute for long explanations. The more complex the concept, 
the more using examples should be considered. Vertical lists highlight 
a series of requirements or other information in a visually clear way. 
Vertical lists help the user focus on important material but not to 
over-emphasize trivial matters. Tables can make complex material 
easier to understand and help the audience see relationships that are 
often times hidden in dense text; 
Did the letter meet the criterion? No. 

Clear federal communication criteria: The letter uses bold and italics 
to make important concepts stand out; 
Criteria descriptions: Using emphasis, such as bold and italics, is 
effective at drawing readers' attention to a short, particularly 
important section, sentence, phrase, or word; 
Did the letter meet the criterion? No. 

Clear federal communication criteria: The letter uses minimal cross- 
references (for example, referring to regulations, manual citations, 
etc.); 
Criteria descriptions: Numerous cross-references can confuse users and 
make them less attentive to the message; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: Document design does not appear 
cluttered or dense; 
Criteria descriptions: There should be no lists within lists and the 
text should not be fully justified so that documents do not appear 
cluttered or dense. Also, the document should have five or six 
sections on each printed page (about two on each typewritten page); 
use lists and tables often, but not overuse them and not have lists 
within lists; 
and use ragged margins where possible, rather than fully justifying 
text; 
Did the letter meet the criterion? Yes. 

Clear federal communication criteria: The letter clearly explains the 
actions that the claimant can take; 
Criteria descriptions: The communication should clearly state: the 
actions the claimant can take, including procedures and time limits; 
how the claimant can contact VBA for more information; 
and, any responsibilities that the claimant might have; 
Did the letter meet the criterion? No. 

Source: GAO analysis. 

[End of table] 

Site Visits to VA Regional Offices: 

We conducted site visits to 4 of VA's 57 regional offices: Atlanta, 
Georgia; Providence, Rhode Island; Salt Lake City, Utah; and Waco, 
Texas. We conducted these visits to learn about regional office 
practices in utilizing DROs and regional staff's opinions on such 
topics as how veterans choose between appeal options, factors 
affecting DRO review outcomes, and challenges facing VA in utilizing 
DROs. In each regional office, we interviewed regional office 
managers, at least one appeals coach, multiple DROs, and local VSO 
staff. In total, we interviewed 17 DROs across the 4 offices, with 
varying levels of experience in their position. In some offices we 
also interviewed the regional office training coordinator. We 
judgmentally selected these offices to achieve variation in several 
factors, including geographic location, number of staff, timeliness of 
appeal processing for appeals in which DRO was selected, and 
participation in a pilot study of revised criteria for assessing DRO 
performance (see figure 12). What we report about these sites may not 
necessarily be representative of other VA regional offices. 

Figure 12: Regional Offices Selected for Site Visits: 

[Refer to PDF for image: illustrated U.S. map] 

Eastern area: 
Location: Providence, Rhode Island; 
Number of staff (rank): 60 (47th); 
Processing time for DRO reviews: 224 days (25th)
Performance criteria pilot site: Yes. 

Southern area: 
Location: Atlanta, Georgia; 
Number of staff (rank): 303 (6rd); 
Processing time for DRO reviews: 475 days (54th); 
Performance criteria pilot site: No. 

Central area: 
Location: Waco, Texas; 
Number of staff (rank): 460 (2nd); 
Processing time for DRO reviews: 160 days (11th); 
Performance criteria pilot site: No. 

Western area: 
Location: Salt Lake City, Utah; 
Number of staff (rank): 171 (21st); 
Processing time for DRO reviews: 158 days (10th); 
Performance criteria pilot site: Yes. 

Sources: VA; Map Resources (map). 

Note: Number of staff represents claims processing staff as of July 
31, 2010. Processing time for DRO reviews represents the average 
number of days from the veteran's election of DRO review to the 
regional office's issuance of a statement of the case, from January 1, 
2007 through August 15, 2010. 

[End of figure] 

Analysis of Administrative Data from the Board: 

To analyze data on VA's appellate workload, including the number of 
appeals in which DRO and traditional reviews were selected, the 
outcomes for DRO and traditional reviews, and the processing times for 
DRO and traditional reviews, we obtained record-level appeals data 
extracted on April 7, 2011, from the Veterans Appeals Control and 
Locator System (VACOLS). We limited our analysis to appeals of 
disability compensation claims. We also limited our analysis to 
original appeals, as opposed to, for example, appeals that had been 
remanded by the Board. Using the record-level data, we generated 
nationwide annual data on appeals filed from fiscal years 2003 through 
2010. The data for each fiscal year includes all notices of 
disagreement filed with the VA during that fiscal year. We looked at 
data back to fiscal year 2003, even though the DRO review process was 
established in 2001, because the VACOLS data element that identifies 
appeals in which DRO review was selected was only added to VACOLS at 
the end of 2002. For some analyses, we excluded data for appeals filed 
in recent fiscal years because a high proportion of these appeals were 
still pending some action by the regional office. To assess the 
reliability of the record-level appeals data, we (1) reviewed 
documentation on VACOLS including the data dictionary, (2) interviewed 
Board officials about VACOLS and any data reliability issues, and (3) 
performed electronic testing. We found the data to be sufficiently 
reliable for our reporting objectives. 

Statistical Analysis of Factors Affecting Choice of DRO Review: 

To investigate the relationship between DRO review selection and 
representation, using VACOLS data, we first examined descriptive 
statistics at the regional office level. We found substantial 
variation in rates of DRO election, as well as rates of representation 
among veterans filing appeals, across regional offices. Using linear 
multiple regression analysis, we estimated that at the regional office 
level, a one percentage point increase in the proportion of veterans 
with representation was associated with approximately half a 
percentage point increase in the rate of DRO election across regional 
offices, after controlling for fiscal year.[Footnote 39] However, 
variation in representation levels across regional offices did not 
fully explain variation in DRO election across offices. 

Our next analysis focused on appeals level data. Descriptive data show 
that, prior to controlling for other factors, veterans with 
representation were more likely to choose a DRO review than those 
without representation. Specifically, table 2 shows that approximately 
63 percent of those veterans with representation requested a DRO 
reviews, compared to approximately 44 percent of veterans with no 
representation. 

An alternative way to examine the likelihood of DRO election among 
veterans with and without representation is the odds of requesting a 
DRO review. Prior to controlling for other factors, the odds that a 
veteran with no representation requesting a DRO review is defined as 
the proportion of veterans requesting a DRO review divided by the 
proportion requesting a traditional review, or 0.79 (44.1/55.9). In 
comparison, among veterans with representation, the odds of requesting 
a DRO review were 1.72 (63.3/36.7). To compare the relative proportion 
of veterans with and without representation that requested a DRO 
review, we can construct an odds ratio that compares the odds of DRO 
selection to the reference group of veterans without representation, 
which is 2.18 (1.72/0.79). In other words, prior to controlling for 
other factors, the unadjusted odds that a veteran with representation 
requesting a DRO review were 2.18 times that of the odds that a 
veteran without representation requesting such review. 

Although unadjusted odds provide useful summary information, they do 
not account for multiple other factors that could also affect a 
veteran's choice of review. Logistic regression analysis can be used 
to estimate the odds ratio comparing the likelihood of DRO selection 
among veterans with and without representation, after also controlling 
for other factors that could potentially influence the choice of 
review type. We estimated a logistic regression model of DRO selection 
controlling for other factors including the fiscal year of the appeal, 
the regional office of the appeal, whether the veteran filing the 
appeal had representation, how many distinct medical issues were 
associated with each appeal, and what type of body systems were 
included in the issues under appeal. We were not able to control for 
certain other factors, such as the timing of DRO election, because we 
lacked comparative data for traditional reviews. There may be 
systematic differences between veterans who decide not to appeal a 
ruling and those who appeal a ruling and thus chose between DRO and 
traditional reviews. Additionally, we lacked information to control 
for certain factors such as a veteran's branch of service or 
demographic characteristics.[Footnote 40] 

After controlling for fiscal year, regional office, number of issues 
in each appeal, and body systems related to the issues under appeal, 
we found that appeals filed by veterans with representation were 
substantially more likely than those filed by veterans without 
representation to elect the DRO review process. Per the last column of 
table 2, we can see that, after controlling for other factors, the 
odds that an appeal filed by a veteran with representation underwent a 
DRO review were approximately two times higher than the odds that an 
appeal filed by a veteran without representation underwent a DRO 
review. This result was statistically significant at the p<0.05 level. 

Other factors were also significantly associated with a veteran's 
choice of review. Table 2 shows that even after controlling for 
representation, appeals filed at different regional offices varied 
substantially in the odds that they underwent a DRO review.[Footnote 
41] After controlling for other factors, the odds that an appeal 
elected a DRO review were approximately four times higher in San 
Diego, California, than the odds at Albuquerque, New Mexico, and the 
odds that an appeal filed at Columbia, South Carolina, elected DRO 
were approximately 75 percent lower than those filed in Albuquerque. 
Additionally, compared to appeals with only one issue, veterans filing 
appeals with multiple issues had higher odds of electing a DRO review 
after controlling for other factors. After controlling for other 
factors, the odds that an appeal elected a DRO review increased 
significantly over time. For example, the odds that an appeal filed in 
fiscal year 2010 underwent a DRO review were about 63 percent higher 
than the odds for an appeal filed in fiscal year 2003. For the most 
part, appeals that included issues related to some body systems had 
odds of DRO review similar to appeals that did not mention those 
systems, although the difference was statistically significant for 
several issues. 

As noted previously, we could not control for the full range of 
variables that could conceivably affect a veteran's choice of review 
type, including the timing of DRO election, a veteran's branch of 
service or demographic information, or what factors affected whether a 
veteran decided to appeal rather than accept an initial ruling. To the 
extent that these appeal-specific factors are correlated with both the 
choice of a DRO review rather than traditional review and other 
variables in our model, our model estimates may be biased. We tested 
several alternative specifications of the model, such as reclassifying 
those whose representation status was unknown to either having or not 
representation, and found that the direction and magnitude of our 
results were similar across models. We further confirmed that the 
model estimates were not sensitive to the inclusion or exclusion of 
body system or of the variable measuring the number of issues in an 
appeal. Overall, while we are confident that our models of the type of 
review provides some explanatory power and are robust to alternative 
specifications, they are limited in their ability to substantially 
explain individual veterans' decisions to choose a DRO review rather 
than a traditional review.[Footnote 42] 

Table 2: Percentages of Appeals Using DRO and Traditional Reviews and 
Related Odds and Odds Ratios (Unadjusted and Adjusted), by 
Representation Status and Other Factors: 

Representation status: 

No representation; 
Appeals with a DRO review: 44.1%; 
Appeals with a traditional review: 55.9%; 
Odds of DRO selection: 0.79; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

Had representation; 
Appeals with a DRO review: 63.3%; 
Appeals with a traditional review: 36.7%; 
Odds of DRO selection: 1.72; 
Unadjusted odds ratio prior to controlling for other factors: 2.19[A]; 
Adjusted odds ratio controlling for other factors: 2.01[A]. 

Representation status unknown; 
Appeals with a DRO review: 45.4%; 
Appeals with a traditional review: 54.6%; 
Odds of DRO selection: 0.83; 
Unadjusted odds ratio prior to controlling for other factors: 1.06[A]; 
Adjusted odds ratio controlling for other factors: 0.93[A]. 

Fiscal year: 

2003; 
Appeals with a DRO review: 53.9%; 
Appeals with a traditional review: 46.1%; 
Odds of DRO selection: 1.17; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

2004; 
Appeals with a DRO review: 55.1%; 
Appeals with a traditional review: 44.9%; 
Odds of DRO selection: 1.23; 
Unadjusted odds ratio prior to controlling for other factors: 1.05[A]; 
Adjusted odds ratio controlling for other factors: 1.03[A]. 

2005; 
Appeals with a DRO review: 59.5%; 
Appeals with a traditional review: 40.5%; 
Odds of DRO selection: 1.47; 
Unadjusted odds ratio prior to controlling for other factors: 1.26[A]; 
Adjusted odds ratio controlling for other factors: 1.26[A]. 

2006; 
Appeals with a DRO review: 59.9%; 
Appeals with a traditional review: 40.1%; 
Odds of DRO selection: 1.50; 
Unadjusted odds ratio prior to controlling for other factors: 1.28[A]; 
Adjusted odds ratio controlling for other factors: 1.26[A]. 

2007; 
Appeals with a DRO review: 62.3%; 
Appeals with a traditional review: 37.7%; 
Odds of DRO selection: 1.66; 
Unadjusted odds ratio prior to controlling for other factors: 1.42[A]; 
Adjusted odds ratio controlling for other factors: 1.38[A]. 

2008; 
Appeals with a DRO review: 63.7%; 
Appeals with a traditional review: 36.3%; 
Odds of DRO selection: 1.75; 
Unadjusted odds ratio prior to controlling for other factors: 1.50[A]; 
Adjusted odds ratio controlling for other factors: 1.47[A]. 

2009; 
Appeals with a DRO review: 65.2%; 
Appeals with a traditional review: 34.8%; 
Odds of DRO selection: 1.87; 
Unadjusted odds ratio prior to controlling for other factors: 1.60[A]; 
Adjusted odds ratio controlling for other factors: 1.60[A]. 

2010; 
Appeals with a DRO review: 64.8%; 
Appeals with a traditional review: 35.2%; 
Odds of DRO selection: 1.84; 
Unadjusted odds ratio prior to controlling for other factors: 1.57[A]; 
Adjusted odds ratio controlling for other factors: 1.63[A]. 

Number of issues in appeal: 

Appeals with 1 issue; 
Appeals with a DRO review: 59.2%; 
Appeals with a traditional review: 40.8%; 
Odds of DRO selection: 1.45; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

Appeals with between 2 and 4 issues; 
Appeals with a DRO review: 62.7%; 
Appeals with a traditional review: 37.3%; 
Odds of DRO selection: 1.68; 
Unadjusted odds ratio prior to controlling for other factors: 1.16[A]; 
Adjusted odds ratio controlling for other factors: 1.17[A]. 

Appeals with between 5 and 8 issues; 
Appeals with a DRO review: 62.4%; 
Appeals with a traditional review: 37.6%; 
Odds of DRO selection: 1.66; 
Unadjusted odds ratio prior to controlling for other factors: 1.15[A]; 
Adjusted odds ratio controlling for other factors: 1.22[A]. 

Appeals with between 9 and 16 issues; 
Appeals with a DRO review: 62.8%; 
Appeals with a traditional review: 37.2%; 
Odds of DRO selection: 1.69; 
Unadjusted odds ratio prior to controlling for other factors: 1.17[A]; 
Adjusted odds ratio controlling for other factors: 1.32[A]. 

Appeals with 17 or more issues; 
Appeals with a DRO review: 60.0%; 
Appeals with a traditional review: 40.0%; 
Odds of DRO selection: 1.50; 
Unadjusted odds ratio prior to controlling for other factors: 1.03; 
Adjusted odds ratio controlling for other factors: 1.28[A]. 

Regional office: 

Albuquerque, NM; 
Appeals with a DRO review: 61.8%; 
Appeals with a traditional review: 38.2%; 
Odds of DRO selection: 1.62; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

Anchorage, AK; 
Appeals with a DRO review: 62.3%; 
Appeals with a traditional review: 37.7%; 
Odds of DRO selection: 1.65; 
Unadjusted odds ratio prior to controlling for other factors: 1.02; 
Adjusted odds ratio controlling for other factors: 1.05. 

Atlanta, GA; 
Appeals with a DRO review: 72.6%; 
Appeals with a traditional review: 27.4%; 
Odds of DRO selection: 2.65; 
Unadjusted odds ratio prior to controlling for other factors: 1.63[A]; 
Adjusted odds ratio controlling for other factors: 1.62[A]. 

Baltimore, MD; 
Appeals with a DRO review: 41.4%; 
Appeals with a traditional review: 58.6%; 
Odds of DRO selection: 0.71; 
Unadjusted odds ratio prior to controlling for other factors: 0.44[A]; 
Adjusted odds ratio controlling for other factors: 0.46[A]. 

Boise, ID; 
Appeals with a DRO review: 61.9%; 
Appeals with a traditional review: 38.1%; 
Odds of DRO selection: 1.62; 
Unadjusted odds ratio prior to controlling for other factors: 1.00; 
Adjusted odds ratio controlling for other factors: 0.94. 

Boston, MA; 
Appeals with a DRO review: 46.6%; 
Appeals with a traditional review: 53.4%; 
Odds of DRO selection: 0.87; 
Unadjusted odds ratio prior to controlling for other factors: 0.54[A]; 
Adjusted odds ratio controlling for other factors: 0.50[A]. 

Buffalo, NY; 
Appeals with a DRO review: 62.4%; 
Appeals with a traditional review: 37.6%; 
Odds of DRO selection: 1.66; 
Unadjusted odds ratio prior to controlling for other factors: 1.03; 
Adjusted odds ratio controlling for other factors: 0.99. 

Cheyenne, WY; 
Appeals with a DRO review: 73.1%; 
Appeals with a traditional review: 26.9%; 
Odds of DRO selection: 2.71; 
Unadjusted odds ratio prior to controlling for other factors: 1.67[A]; 
Adjusted odds ratio controlling for other factors: 1.67[A]. 

Chicago, IL; 
Appeals with a DRO review: 62.2%; 
Appeals with a traditional review: 37.8%; 
Odds of DRO selection: 1.64; 
Unadjusted odds ratio prior to controlling for other factors: 1.01; 
Adjusted odds ratio controlling for other factors: 0.98. 

Cleveland, OH; 
Appeals with a DRO review: 69.5%; 
Appeals with a traditional review: 30.5%; 
Odds of DRO selection: 2.28; 
Unadjusted odds ratio prior to controlling for other factors: 1.41[A]; 
Adjusted odds ratio controlling for other factors: 1.38[A]. 

Columbia, SC; 
Appeals with a DRO review: 31.5%; 
Appeals with a traditional review: 68.5%; 
Odds of DRO selection: 0.46; 
Unadjusted odds ratio prior to controlling for other factors: 0.28[A]; 
Adjusted odds ratio controlling for other factors: 0.26[A]. 

Denver, CO; 
Appeals with a DRO review: 79.1%; 
Appeals with a traditional review: 20.9%; 
Odds of DRO selection: 3.79; 
Unadjusted odds ratio prior to controlling for other factors: 2.34[A]; 
Adjusted odds ratio controlling for other factors: 2.21[A]. 

Des Moines, IA; 
Appeals with a DRO review: 73.8%; 
Appeals with a traditional review: 26.2%; 
Odds of DRO selection: 2.82; 
Unadjusted odds ratio prior to controlling for other factors: 1.74[A]; 
Adjusted odds ratio controlling for other factors: 1.62[A]. 

Detroit, MI; 
Appeals with a DRO review: 72.7%; 
Appeals with a traditional review: 27.3%; 
Odds of DRO selection: 2.66; 
Unadjusted odds ratio prior to controlling for other factors: 1.64[A]; 
Adjusted odds ratio controlling for other factors: 1.54[A]. 

Fargo, ND; 
Appeals with a DRO review: 65.8%; 
Appeals with a traditional review: 34.2%; 
Odds of DRO selection: 1.93; 
Unadjusted odds ratio prior to controlling for other factors: 1.19[A]; 
Adjusted odds ratio controlling for other factors: 1.17[A]. 

Ft. Harrison, MT; 
Appeals with a DRO review: 60.9%; 
Appeals with a traditional review: 39.1%; 
Odds of DRO selection: 1.56; 
Unadjusted odds ratio prior to controlling for other factors: 0.96; 
Adjusted odds ratio controlling for other factors: 0.94. 

Hartford, CT; 
Appeals with a DRO review: 46.5%; 
Appeals with a traditional review: 53.5%; 
Odds of DRO selection: 0.87; 
Unadjusted odds ratio prior to controlling for other factors: 0.54[A]; 
Adjusted odds ratio controlling for other factors: 0.50[A]. 

Honolulu, HI; 
Appeals with a DRO review: 61.2%; 
Appeals with a traditional review: 38.8%; 
Odds of DRO selection: 1.58; 
Unadjusted odds ratio prior to controlling for other factors: 0.97; 
Adjusted odds ratio controlling for other factors: 1.04. 

Houston, TX; 
Appeals with a DRO review: 64.1%; 
Appeals with a traditional review: 35.9%; 
Odds of DRO selection: 1.78; 
Unadjusted odds ratio prior to controlling for other factors: 1.10[A]; 
Adjusted odds ratio controlling for other factors: 1.05. 

Huntington, WV; 
Appeals with a DRO review: 51.1%; 
Appeals with a traditional review: 48.9%; 
Odds of DRO selection: 1.05; 
Unadjusted odds ratio prior to controlling for other factors: 0.65[A]; 
Adjusted odds ratio controlling for other factors: 0.59[A]. 

Indianapolis, IN; 
Appeals with a DRO review: 55.2%; 
Appeals with a traditional review: 44.8%; 
Odds of DRO selection: 1.23; 
Unadjusted odds ratio prior to controlling for other factors: 0.76[A]; 
Adjusted odds ratio controlling for other factors: 0.75[A]. 

Jackson, MS; 
Appeals with a DRO review: 48.3%; 
Appeals with a traditional review: 51.7%; 
Odds of DRO selection: 0.93; 
Unadjusted odds ratio prior to controlling for other factors: 0.58[A]; 
Adjusted odds ratio controlling for other factors: 0.60[A]. 

Lincoln, NE; 
Appeals with a DRO review: 79.3%; 
Appeals with a traditional review: 20.7%; 
Odds of DRO selection: 3.84; 
Unadjusted odds ratio prior to controlling for other factors: 2.37[A]; 
Adjusted odds ratio controlling for other factors: 2.20[A]. 

Little Rock, AR; 
Appeals with a DRO review: 73.8%; 
Appeals with a traditional review: 26.2%; 
Odds of DRO selection: 2.82; 
Unadjusted odds ratio prior to controlling for other factors: 1.74[A]; 
Adjusted odds ratio controlling for other factors: 1.73[A]. 

Los Angeles, CA; 
Appeals with a DRO review: 44.9%; 
Appeals with a traditional review: 55.1%; 
Odds of DRO selection: 0.82; 
Unadjusted odds ratio prior to controlling for other factors: 0.50[A]; 
Adjusted odds ratio controlling for other factors: 0.49[A]. 

Louisville, KY; 
Appeals with a DRO review: 55.9%; 
Appeals with a traditional review: 44.1%; 
Odds of DRO selection: 1.27; 
Unadjusted odds ratio prior to controlling for other factors: 0.78[A]; 
Adjusted odds ratio controlling for other factors: 0.74[A]. 

Manchester, NH; 
Appeals with a DRO review: 65.8%; 
Appeals with a traditional review: 34.2%; 
Odds of DRO selection: 1.93; 
Unadjusted odds ratio prior to controlling for other factors: 1.19[A]; 
Adjusted odds ratio controlling for other factors: 1.14[A]. 

Manila, PI; 
Appeals with a DRO review: 41.4%; 
Appeals with a traditional review: 58.6%; 
Odds of DRO selection: 0.71; 
Unadjusted odds ratio prior to controlling for other factors: 0.44[A]; 
Adjusted odds ratio controlling for other factors: 0.70[A]. 

Milwaukee, WI; 
Appeals with a DRO review: 65.2%; 
Appeals with a traditional review: 34.8%; 
Odds of DRO selection: 1.87; 
Unadjusted odds ratio prior to controlling for other factors: 1.16[A]; 
Adjusted odds ratio controlling for other factors: 1.10[A]. 

Montgomery, AL; 
Appeals with a DRO review: 58.0%; 
Appeals with a traditional review: 42.0%; 
Odds of DRO selection: 1.38; 
Unadjusted odds ratio prior to controlling for other factors: 0.85[A]; 
Adjusted odds ratio controlling for other factors: 0.80[A]. 

Muskogee, OK; 
Appeals with a DRO review: 70.9%; 
Appeals with a traditional review: 29.1%; 
Odds of DRO selection: 2.43; 
Unadjusted odds ratio prior to controlling for other factors: 1.50[A]; 
Adjusted odds ratio controlling for other factors: 1.46[A]. 

Nashville, TN; 
Appeals with a DRO review: 52.8%; 
Appeals with a traditional review: 47.2%; 
Odds of DRO selection: 1.12; 
Unadjusted odds ratio prior to controlling for other factors: 0.69[A]; 
Adjusted odds ratio controlling for other factors: 0.63[A]. 

New Orleans, LA; 
Appeals with a DRO review: 41.6%; 
Appeals with a traditional review: 58.4%; 
Odds of DRO selection: 0.71; 
Unadjusted odds ratio prior to controlling for other factors: 0.44[A]; 
Adjusted odds ratio controlling for other factors: 0.42[A]. 

New York, NY; 
Appeals with a DRO review: 71.2%; 
Appeals with a traditional review: 28.8%; 
Odds of DRO selection: 2.47; 
Unadjusted odds ratio prior to controlling for other factors: 1.53[A]; 
Adjusted odds ratio controlling for other factors: 1.47[A]. 

Newark, NJ; 
Appeals with a DRO review: 67.2%; 
Appeals with a traditional review: 32.8%; 
Odds of DRO selection: 2.05; 
Unadjusted odds ratio prior to controlling for other factors: 1.27[A]; 
Adjusted odds ratio controlling for other factors: 1.21[A]. 

Oakland, CA; 
Appeals with a DRO review: 71.8%; 
Appeals with a traditional review: 28.2%; 
Odds of DRO selection: 2.55; 
Unadjusted odds ratio prior to controlling for other factors: 1.57[A]; 
Adjusted odds ratio controlling for other factors: 1.56[A]. 

Philadelphia, PA; 
Appeals with a DRO review: 50.4%; 
Appeals with a traditional review: 49.6%; 
Odds of DRO selection: 1.02; 
Unadjusted odds ratio prior to controlling for other factors: 0.63[A]; 
Adjusted odds ratio controlling for other factors: 0.64[A]. 

Phoenix, AZ; 
Appeals with a DRO review: 54.7%; 
Appeals with a traditional review: 45.3%; 
Odds of DRO selection: 1.21; 
Unadjusted odds ratio prior to controlling for other factors: 0.74[A]; 
Adjusted odds ratio controlling for other factors: 0.74[A]. 

Pittsburgh, PA; 
Appeals with a DRO review: 68.8%; 
Appeals with a traditional review: 31.2%; 
Odds of DRO selection: 2.20; 
Unadjusted odds ratio prior to controlling for other factors: 1.36[A]; 
Adjusted odds ratio controlling for other factors: 1.33[A]. 

Portland, OR; 
Appeals with a DRO review: 71.6%; 
Appeals with a traditional review: 28.4%; 
Odds of DRO selection: 2.53; 
Unadjusted odds ratio prior to controlling for other factors: 1.56[A]; 
Adjusted odds ratio controlling for other factors: 1.47[A]. 

Providence, RI; 
Appeals with a DRO review: 33.9%; 
Appeals with a traditional review: 66.1%; 
Odds of DRO selection: 0.51; 
Unadjusted odds ratio prior to controlling for other factors: 0.32[A]; 
Adjusted odds ratio controlling for other factors: 0.29[A]. 

Reno, NV; 
Appeals with a DRO review: 64.0%; 
Appeals with a traditional review: 36.0%; 
Odds of DRO selection: 1.78; 
Unadjusted odds ratio prior to controlling for other factors: 1.10[A]; 
Adjusted odds ratio controlling for other factors: 1.10[A]. 

Roanoke, VA; 
Appeals with a DRO review: 53.0%; 
Appeals with a traditional review: 47.0%; 
Odds of DRO selection: 1.13; 
Unadjusted odds ratio prior to controlling for other factors: 0.69[A]; 
Adjusted odds ratio controlling for other factors: 0.67[A]. 

Salt Lake City, UT; 
Appeals with a DRO review: 53.4%; 
Appeals with a traditional review: 46.6%; 
Odds of DRO selection: 1.15; 
Unadjusted odds ratio prior to controlling for other factors: 0.71[A]; 
Adjusted odds ratio controlling for other factors: 0.61[A]. 

San Diego, CA; 
Appeals with a DRO review: 87.2%; 
Appeals with a traditional review: 12.8%; 
Odds of DRO selection: 6.79; 
Unadjusted odds ratio prior to controlling for other factors: 4.19[A]; 
Adjusted odds ratio controlling for other factors: 4.18[A]. 

San Juan, PR; 
Appeals with a DRO review: 48.2%; 
Appeals with a traditional review: 51.8%; 
Odds of DRO selection: 0.93; 
Unadjusted odds ratio prior to controlling for other factors: 0.57[A]; 
Adjusted odds ratio controlling for other factors: 0.63[A]. 

Seattle, WA; 
Appeals with a DRO review: 67.9%; 
Appeals with a traditional review: 32.1%; 
Odds of DRO selection: 2.11; 
Unadjusted odds ratio prior to controlling for other factors: 1.30[A]; 
Adjusted odds ratio controlling for other factors: 1.27[A]. 

Sioux Falls, SD; 
Appeals with a DRO review: 60.4%%; 
Appeals with a traditional review: 39.6%%; 
Odds of DRO selection: 1.53; 
Unadjusted odds ratio prior to controlling for other factors: 0.94; 
Adjusted odds ratio controlling for other factors: 0.90[A]. 

St. Louis, MO; 
Appeals with a DRO review: 59.3%; 
Appeals with a traditional review: 40.7%; 
Odds of DRO selection: 1.46; 
Unadjusted odds ratio prior to controlling for other factors: 0.90[A]; 
Adjusted odds ratio controlling for other factors: 0.84[A]. 

St. Paul, MN; 
Appeals with a DRO review: 69.2%; 
Appeals with a traditional review: 30.8%; 
Odds of DRO selection: 2.25; 
Unadjusted odds ratio prior to controlling for other factors: 1.39[A]; 
Adjusted odds ratio controlling for other factors: 1.30[A]. 

St. Petersburg, FL; 
Appeals with a DRO review: 66.0%; 
Appeals with a traditional review: 34.0%; 
Odds of DRO selection: 1.94; 
Unadjusted odds ratio prior to controlling for other factors: 1.20[A]; 
Adjusted odds ratio controlling for other factors: 1.12[A]. 

Togus, ME; 
Appeals with a DRO review: 71.5%; 
Appeals with a traditional review: 28.5%; 
Odds of DRO selection: 2.51; 
Unadjusted odds ratio prior to controlling for other factors: 1.55[A]; 
Adjusted odds ratio controlling for other factors: 1.51[A]. 

Waco, TX; 
Appeals with a DRO review: 64.8%; 
Appeals with a traditional review: 35.2%; 
Odds of DRO selection: 1.84; 
Unadjusted odds ratio prior to controlling for other factors: 1.14[A]; 
Adjusted odds ratio controlling for other factors: 1.06[A]. 

Washington, D.C.; 
Appeals with a DRO review: 33.9%; 
Appeals with a traditional review: 66.1%; 
Odds of DRO selection: 0.51; 
Unadjusted odds ratio prior to controlling for other factors: 0.32[A]; 
Adjusted odds ratio controlling for other factors: 0.40[A]. 

White River Junction, VT; 
Appeals with a DRO review: 62.2%; 
Appeals with a traditional review: 37.8%; 
Odds of DRO selection: 1.65; 
Unadjusted odds ratio prior to controlling for other factors: 1.02; 
Adjusted odds ratio controlling for other factors: 1.00. 

Wichita, KS; 
Appeals with a DRO review: 58.3%; 
Appeals with a traditional review: 41.7%; 
Odds of DRO selection: 1.40; 
Unadjusted odds ratio prior to controlling for other factors: 0.86[A]; 
Adjusted odds ratio controlling for other factors: 0.80[A]. 

Wilmington, DE; 
Appeals with a DRO review: 56.1%; 
Appeals with a traditional review: 43.9%; 
Odds of DRO selection: 1.28; 
Unadjusted odds ratio prior to controlling for other factors: 0.79[A]; 
Adjusted odds ratio controlling for other factors: 0.83[A]. 

Winston-Salem, NC; 
Appeals with a DRO review: 45.6%; 
Appeals with a traditional review: 54.4%; 
Odds of DRO selection: 0.84; 
Unadjusted odds ratio prior to controlling for other factors: 0.52[A]; 
Adjusted odds ratio controlling for other factors: 0.50[A]. 

Source: GAO analysis of VACOLS data. 

Note: Odds ratios are odds in comparison to the reference category 
indicated for each variable. In addition to the control variables 
presented in the table, logistic regression models also included 
control variables for different body systems included as issues in 
each appeal. Depending on the system, the adjusted odds ratio for 
different systems ranged between 0.90 and 1.07 when compared to 
appeals that did not indicate that specific body system as one of the 
issues in the appeal. 

[A] A statistical significance at the p<0.05 level. 

[End of table] 

Statistical Analysis of Factors Affecting Grant Awards: 

We used appeals level VACOLS data to examine whether DRO reviews were 
more or less likely to have a full or partial award granted than 
traditional reviews. Table 3 shows the likelihood of grant awards by 
review type (DRO or traditional). Although 22.7 percent of appeals 
that underwent a traditional review received a full or partial award, 
31.5 percent of appeals that underwent a DRO review received a full or 
partial award. Comparing the odds of a full or partial award for cases 
that underwent different review processes, the unadjusted odds ratio 
comparing the odds of an award for a DRO review to those of a 
traditional review is 1.56. In other words, prior to controlling for 
other factors that could affect the odds of an award, the odds that a 
DRO-reviewed appeal received an award were 56 percent higher than 
those for a traditional-reviewed appeal. 

We used logistic regression analysis to assess if DRO reviews still 
had higher odds of receiving a full or partial grant, even after 
controlling for selected factors that could affect the likelihood of 
an award grant. We controlled for fiscal year; regional office; number 
of issues in each appeal, and body systems related to the issues under 
appeal; and veterans' representation status. After controlling for 
these factors, we found that DRO-reviewed appeals still were 
significantly more likely than traditional reviews to receive an 
award. Specifically, table 3 shows that the odds that an appeal that 
underwent a DRO review received a full or partial award were still 
approximately 60 percent higher than an appeal that went underwent a 
traditional review after controlling for other factors (odds ratio 
1.58). Besides a veteran's choice of appeal option, some other 
variables were also correlated with higher odds of a receiving an 
award. For example, appeals filed in certain regional offices were 
significantly more likely to receive grants than appeals in other 
offices. 

We also found that, after controlling for review type and other 
factors, the odds that an appeal filed by a veteran with 
representation won a full or partial award were quite similar to that 
of an appeal filed by a veteran without representation (odds ratio 
1.03, or approximately 3 percent higher odds). Furthermore, compared 
to appeals with only one issue, veterans filing appeals with multiple 
issues had notably lower odds of receiving a full or partial award 
after controlling for other factors (between approximately 25 and 50 
percent lower than the odds of appeals with one issue). 

We tested a variety of alternative model specifications with different 
variables and populations. Given that a large portion of recent cases 
may not have been resolved as of the time our data were produced, we 
tested our model excluding the fiscal years 2009 and 2010 to avoid 
biasing our results towards those cases that could be quickly 
resolved. We confirmed that a DRO review still had higher odds of an 
award even after reclassifying the dependent variable into full grant 
versus partial or no grant. We further confirmed that the model 
estimates were not sensitive to the inclusion or exclusion of body 
system or recategorization of the variable measuring the number of 
issues in an appeal. We also tested a model with an interaction term 
between representation status and review type. These models confirmed 
that, compared to traditional cases with or without representation, 
appeals that went through DRO review were more likely to receive a 
full or partial grant. Overall, although our models provide some 
explanatory power and are robust to alternative specifications, we 
acknowledge that they are limited in their ability to substantially 
explain the outcome of the award process, especially in light of known 
omitted variables related to the specific case.[Footnote 43] 

Table 3: Percentages of Appeals Granted Full or Partial Awards and No 
Awards and Related Odds, and Odds Ratios (Unadjusted and Adjusted), by 
Type of Review and Other Factors: 

Type of review: 

Traditional review; 
Appeals granted full or partial award: 22.7%; 
Appeals granted no award: 77.3%; 
Odds of award granted: 0.29; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

DRO review; 
Appeals granted full or partial award: 31.5%; 
Appeals granted no award: 68.5%; 
Odds of award granted: 0.46; 
Unadjusted odds ratio prior to controlling for other factors: 1.56[A]; 
Adjusted odds ratio controlling for other factors: 1.58[A]. 

Representation status: 

No representation; 
Appeals granted full or partial award: 23.4%; 
Appeals granted no award: 76.6%; 
Odds of award granted: 0.31; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

Had representation; 
Appeals granted full or partial award: 28.1%; 
Appeals granted no award: 71.9%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 1.28[A]; 
Adjusted odds ratio controlling for other factors: 1.03[A]. 

Representation status unknown; 
Appeals granted full or partial award: 37.8%; 
Appeals granted no award: 62.%2; 
Odds of award granted: 0.61; 
Unadjusted odds ratio prior to controlling for other factors: 1.99[A]; 
Adjusted odds ratio controlling for other factors: 1.74[A]. 

Fiscal year: 

2003; 
Appeals granted full or partial award: 29.9%; 
Appeals granted no award: 70.1%; 
Odds of award granted: 0.43; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

2004; 
Appeals granted full or partial award: 27.8%; 
Appeals granted no award: 72.2%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 0.90[A]; 
Adjusted odds ratio controlling for other factors: 0.87[A]. 

2005; 
Appeals granted full or partial award: 26.8%; 
Appeals granted no award: 73.2%; 
Odds of award granted: 0.37; 
Unadjusted odds ratio prior to controlling for other factors: 0.86[A]; 
Adjusted odds ratio controlling for other factors: 0.82[A]. 

2006; 
Appeals granted full or partial award: 28.1%; 
Appeals granted no award: 71.9%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 0.92[A]; 
Adjusted odds ratio controlling for other factors: 0.88[A]. 

2007; 
Appeals granted full or partial award: 28.3%; 
Appeals granted no award: 71.7%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 0.92[A]; 
Adjusted odds ratio controlling for other factors: 0.86[A]. 

2008; 
Appeals granted full or partial award: 28.1%; 
Appeals granted no award: 71.9%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 0.92[A]; 
Adjusted odds ratio controlling for other factors: 0.85[A]. 

2009; 
Appeals granted full or partial award: 27.9%; 
Appeals granted no award: 72.1%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 0.91[A]; 
Adjusted odds ratio controlling for other factors: 0.83[A]. 

2010; 
Appeals granted full or partial award: 26.8%; 
Appeals granted no award: 73.2%; 
Odds of award granted: 0.37; 
Unadjusted odds ratio prior to controlling for other factors: 0.86[A]; 
Adjusted odds ratio controlling for other factors: 0.81[A]. 

Number of issues in appeal: 

Appeals with 1 issue; 
Appeals granted full or partial award: 29.6%; 
Appeals granted no award: 70.4%; 
Odds of award granted: 0.42; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

Appeals with between 2 and 4 issues; 
Appeals granted full or partial award: 26.0%; 
Appeals granted no award: 74.0%; 
Odds of award granted: 0.35; 
Unadjusted odds ratio prior to controlling for other factors: 0.83[A]; 
Adjusted odds ratio controlling for other factors: 0.75[A]. 

Appeals with between 5 and 8 issues; 
Appeals granted full or partial award: 27.0%; 
Appeals granted no award: 73.0%; 
Odds of award granted: 0.37; 
Unadjusted odds ratio prior to controlling for other factors: 0.88[A]; 
Adjusted odds ratio controlling for other factors: 0.67[A]. 

Appeals with between 9 and 16 issues; 
Appeals granted full or partial award: 27.7%; 
Appeals granted no award: 72.3%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 0.91[A]; 
Adjusted odds ratio controlling for other factors: 0.60[A]. 

Appeals with 17 or more issues; 
Appeals granted full or partial award: 25.5%; 
Appeals granted no award: 74.5%; 
Odds of award granted: 0.34; 
Unadjusted odds ratio prior to controlling for other factors: 0.81[A]; 
Adjusted odds ratio controlling for other factors: 0.48[A]. 

Regional office: 

Albuquerque, NM; 
Appeals granted full or partial award: 27.4%; 
Appeals granted no award: 72.6%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 
Reference; 
Adjusted odds ratio controlling for other factors: Reference. 

Anchorage, AK; 
Appeals granted full or partial award: 27.8%; 
Appeals granted no award: 72.2%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 1.02; 
Adjusted odds ratio controlling for other factors: 1.07. 

Atlanta, GA; 
Appeals granted full or partial award: 35.9%; 
Appeals granted no award: 64.1%; 
Odds of award granted: 0.56; 
Unadjusted odds ratio prior to controlling for other factors: 1.48[A]; 
Adjusted odds ratio controlling for other factors: 1.48[A]. 

Baltimore, MD; 
Appeals granted full or partial award: 34.2%; 
Appeals granted no award: 65.8%; 
Odds of award granted: 0.52; 
Unadjusted odds ratio prior to controlling for other factors: 1.37[A]; 
Adjusted odds ratio controlling for other factors: 1.59[A]. 

Boise, ID; 
Appeals granted full or partial award: 24.1%; 
Appeals granted no award: 75.9%; 
Odds of award granted: 0.32; 
Unadjusted odds ratio prior to controlling for other factors: 0.84[A]; 
Adjusted odds ratio controlling for other factors: 0.90[A]. 

Boston, MA; 
Appeals granted full or partial award: 27.5%; 
Appeals granted no award: 72.5%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 1.00; 
Adjusted odds ratio controlling for other factors: 1.10[A]. 

Buffalo, NY; 
Appeals granted full or partial award: 33.7%; 
Appeals granted no award: 66.3%; 
Odds of award granted: 0.51; 
Unadjusted odds ratio prior to controlling for other factors: 1.35[A]; 
Adjusted odds ratio controlling for other factors: 1.41[A]. 

Cheyenne, WY; 
Appeals granted full or partial award: 26.3%; 
Appeals granted no award: 73.7%; 
Odds of award granted: 0.36; 
Unadjusted odds ratio prior to controlling for other factors: 0.95; 
Adjusted odds ratio controlling for other factors: 0.94. 

Chicago, IL; 
Appeals granted full or partial award: 31.2%; 
Appeals granted no award: 68.8%; 
Odds of award granted: 0.45; 
Unadjusted odds ratio prior to controlling for other factors: 1.20[A]; 
Adjusted odds ratio controlling for other factors: 1.24[A]. 

Cleveland, OH; 
Appeals granted full or partial award: 21.0%; 
Appeals granted no award: 79.0%; 
Odds of award granted: 0.27; 
Unadjusted odds ratio prior to controlling for other factors: 0.70[A]; 
Adjusted odds ratio controlling for other factors: 0.70[A]. 

Columbia, SC; 
Appeals granted full or partial award: 27.4%; 
Appeals granted no award: 72.6%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 1.00; 
Adjusted odds ratio controlling for other factors: 1.22[A]. 

Denver, CO; 
Appeals granted full or partial award: 32.6%; 
Appeals granted no award: 67.4%; 
Odds of award granted: 0.48; 
Unadjusted odds ratio prior to controlling for other factors: 1.28[A]; 
Adjusted odds ratio controlling for other factors: 1.23[A]. 

Des Moines, IA; 
Appeals granted full or partial award: 37%; 
Appeals granted no award: 62.2%; 
Odds of award granted: 0.61; 
Unadjusted odds ratio prior to controlling for other factors: 1.61[A]; 
Adjusted odds ratio controlling for other factors: 1.63[A]. 

Detroit, MI; 
Appeals granted full or partial award: 32.3%; 
Appeals granted no award: 67.7%; 
Odds of award granted: 0.48; 
Unadjusted odds ratio prior to controlling for other factors: 1.27[A]; 
Adjusted odds ratio controlling for other factors: 1.27[A]. 

Fargo, ND; 
Appeals granted full or partial award: 25.6%; 
Appeals granted no award: 74.4%; 
Odds of award granted: 0.34; 
Unadjusted odds ratio prior to controlling for other factors: 0.91; 
Adjusted odds ratio controlling for other factors: 0.96. 

Ft. Harrison, MT; 
Appeals granted full or partial award: 31.5%; 
Appeals granted no award: 68.5;% 
Odds of award granted: 0.46; 
Unadjusted odds ratio prior to controlling for other factors: 1.22[A]; 
Adjusted odds ratio controlling for other factors: 1.26[A]. 

Hartford, CT; 
Appeals granted full or partial award: 21.5%; 
Appeals granted no award: 78.5%; 
Odds of award granted: 0.27; 
Unadjusted odds ratio prior to controlling for other factors: 0.73[A]; 
Adjusted odds ratio controlling for other factors: 0.81[A]. 

Honolulu, HI; 
Appeals granted full or partial award: 29.2%; 
Appeals granted no award: 70.8%; 
Odds of award granted: 0.41; 
Unadjusted odds ratio prior to controlling for other factors: 1.09[A]; 
Adjusted odds ratio controlling for other factors: 1.17[A]. 

Houston, TX; 
Appeals granted full or partial award: 30.0;% 
Appeals granted no award: 70.0%; 
Odds of award granted: 0.43; 
Unadjusted odds ratio prior to controlling for other factors: 1.14[A]; 
Adjusted odds ratio controlling for other factors: 1.19[A]. 

Huntington, WV; 
Appeals granted full or partial award: 30.0%; 
Appeals granted no award: 70.0%; 
Odds of award granted: 0.43; 
Unadjusted odds ratio prior to controlling for other factors: 1.14[A]; 
Adjusted odds ratio controlling for other factors: 1.24[A]. 

Indianapolis, IN; 
Appeals granted full or partial award: 25.0%; 
Appeals granted no award: 75.0%; 
Odds of award granted: 0.33; 
Unadjusted odds ratio prior to controlling for other factors: 0.88[A]; 
Adjusted odds ratio controlling for other factors: 0.94. 

Jackson, MS; 
Appeals granted full or partial award: 22.3%; 
Appeals granted no award: 77.7%; 
Odds of award granted: 0.29; 
Unadjusted odds ratio prior to controlling for other factors: 0.76[A]; 
Adjusted odds ratio controlling for other factors: 0.83[A]. 

Lincoln, NE; 
Appeals granted full or partial award: 29.0%; 
Appeals granted no award: 71.0%; 
Odds of award granted: 0.41; 
Unadjusted odds ratio prior to controlling for other factors: 1.08[A]; 
Adjusted odds ratio controlling for other factors: 1.09[A]. 

Little Rock, AR; 
Appeals granted full or partial award: 30.7%; 
Appeals granted no award: 69.3%; 
Odds of award granted: 0.44; 
Unadjusted odds ratio prior to controlling for other factors: 1.17[A]; 
Adjusted odds ratio controlling for other factors: 1.16[A]. 

Los Angeles, CA; 
Appeals granted full or partial award: 27.4%; 
Appeals granted no award: 72.6%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 1.00; 
Adjusted odds ratio controlling for other factors: 1.12[A]. 

Louisville, KY; 
Appeals granted full or partial award: 31.4%; 
Appeals granted no award: 68.6%; 
Odds of award granted: 0.46; 
Unadjusted odds ratio prior to controlling for other factors: 1.21[A]; 
Adjusted odds ratio controlling for other factors: 1.31[A]. 

Manchester, NH; 
Appeals granted full or partial award: 33.0%; 
Appeals granted no award: 67.0%; 
Odds of award granted: 0.49; 
Unadjusted odds ratio prior to controlling for other factors: 1.31[A]; 
Adjusted odds ratio controlling for other factors: 1.37[A]. 

Manila, PI; 
Appeals granted full or partial award: 7.7%; 
Appeals granted no award: 92.3%; 
Odds of award granted: 0.08; 
Unadjusted odds ratio prior to controlling for other factors: 0.22[A]; 
Adjusted odds ratio controlling for other factors: 0.23[A]. 

Milwaukee, WI; 
Appeals granted full or partial award: 34.9%; 
Appeals granted no award: 65.1%; 
Odds of award granted: 0.54; 
Unadjusted odds ratio prior to controlling for other factors: 1.42[A]; 
Adjusted odds ratio controlling for other factors: 1.44[A]. 

Montgomery, AL; 
Appeals granted full or partial award: 21.4%; 
Appeals granted no award: 78.6%; 
Odds of award granted: 0.27; 
Unadjusted odds ratio prior to controlling for other factors: 0.72[A]; 
Adjusted odds ratio controlling for other factors: 0.76[A]. 

Muskogee, OK; 
Appeals granted full or partial award: 27.9%; 
Appeals granted no award: 72.1%; 
Odds of award granted: 0.39; 
Unadjusted odds ratio prior to controlling for other factors: 1.02; 
Adjusted odds ratio controlling for other factors: 1.04. 

Nashville, TN; 
Appeals granted full or partial award: 20.6%; 
Appeals granted no award: 79.4%; 
Odds of award granted: 0.26; 
Unadjusted odds ratio prior to controlling for other factors: 0.69[A]; 
Adjusted odds ratio controlling for other factors: 0.76[A]. 

New Orleans, LA; 
Appeals granted full or partial award: 26.3%; 
Appeals granted no award: 73.7%; 
Odds of award granted: 0.36; 
Unadjusted odds ratio prior to controlling for other factors: 0.95; 
Adjusted odds ratio controlling for other factors: 1.08[A]. 

New York, NY; 
Appeals granted full or partial award: 35.7%; 
Appeals granted no award: 64.3%; 
Odds of award granted: 0.56; 
Unadjusted odds ratio prior to controlling for other factors: 1.47[A]; 
Adjusted odds ratio controlling for other factors: 1.45[A]. 

Newark, NJ; 
Appeals granted full or partial award: 32.2%; 
Appeals granted no award: 67.8%; 
Odds of award granted: 0.48; 
Unadjusted odds ratio prior to controlling for other factors: 1.26[A]; 
Adjusted odds ratio controlling for other factors: 1.27[A]. 

Oakland, CA; 
Appeals granted full or partial award: 34.1%; 
Appeals granted no award: 65.9%; 
Odds of award granted: 0.52; 
Unadjusted odds ratio prior to controlling for other factors: 1.37[A]; 
Adjusted odds ratio controlling for other factors: 1.32[A]. 

Philadelphia, PA; 
Appeals granted full or partial award: 22.6%; 
Appeals granted no award: 77.4%; 
Odds of award granted: 0.29; 
Unadjusted odds ratio prior to controlling for other factors: 0.78[A]; 
Adjusted odds ratio controlling for other factors: 0.84[A]. 

Phoenix, AZ; 
Appeals granted full or partial award: 26.8%; 
Appeals granted no award: 73.2%; 
Odds of award granted: 0.37; 
Unadjusted odds ratio prior to controlling for other factors: 0.97; 
Adjusted odds ratio controlling for other factors: 1.04. 

Pittsburgh, PA; 
Appeals granted full or partial award: 18.6%; 
Appeals granted no award: 81.4%; 
Odds of award granted: 0.23; 
Unadjusted odds ratio prior to controlling for other factors: 0.60[A]; 
Adjusted odds ratio controlling for other factors: 0.61[A]. 

Portland, OR; 
Appeals granted full or partial award: 33.5%; 
Appeals granted no award: 66.5%; 
Odds of award granted: 0.50; 
Unadjusted odds ratio prior to controlling for other factors: 1.34[A]; 
Adjusted odds ratio controlling for other factors: 1.32[A]. 

Providence, RI; 
Appeals granted full or partial award: 21.3%; 
Appeals granted no award: 78.7%; 
Odds of award granted: 0.27; 
Unadjusted odds ratio prior to controlling for other factors: 0.71[A]; 
Adjusted odds ratio controlling for other factors: 0.84[A]. 

Reno, NV; 
Appeals granted full or partial award: 28.6%; 
Appeals granted no award: 71.4%; 
Odds of award granted: 0.40; 
Unadjusted odds ratio prior to controlling for other factors: 1.06; 
Adjusted odds ratio controlling for other factors: 1.11[A]. 

Roanoke, VA; 
Appeals granted full or partial award: 27.5%; 
Appeals granted no award: 72.5%; 
Odds of award granted: 0.38; 
Unadjusted odds ratio prior to controlling for other factors: 1.01; 
Adjusted odds ratio controlling for other factors: 1.12[A]. 

Salt Lake City, UT; 
Appeals granted full or partial award: 40.6%; 
Appeals granted no award: 59.4%; 
Odds of award granted: 0.68; 
Unadjusted odds ratio prior to controlling for other factors: 1.81[A]; 
Adjusted odds ratio controlling for other factors: 2.08[A]. 

San Diego, CA; 
Appeals granted full or partial award: 41.2%; 
Appeals granted no award: 58.8%; 
Odds of award granted: 0.70; 
Unadjusted odds ratio prior to controlling for other factors: 1.86[A]; 
Adjusted odds ratio controlling for other factors: 1.79[A]. 

San Juan, PR; 
Appeals granted full or partial award: 13.3%; 
Appeals granted no award: 86.7%; 
Odds of award granted: 0.15; 
Unadjusted odds ratio prior to controlling for other factors: 0.41[A]; 
Adjusted odds ratio controlling for other factors: 0.43[A]. 

Seattle, WA; 
Appeals granted full or partial award: 30.7%; 
Appeals granted no award: 69.3%; 
Odds of award granted: 0.44; 
Unadjusted odds ratio prior to controlling for other factors: 1.18[A]; 
Adjusted odds ratio controlling for other factors: 1.17[A]. 

Sioux Falls, SD; 
Appeals granted full or partial award: 24.8%; 
Appeals granted no award: 75.2%; 
Odds of award granted: 0.33; 
Unadjusted odds ratio prior to controlling for other factors: 0.87[A]; 
Adjusted odds ratio controlling for other factors: 0.92. 

St. Louis, MO; 
Appeals granted full or partial award: 31.5%; 
Appeals granted no award: 68.5%; 
Odds of award granted: 0.46; 
Unadjusted odds ratio prior to controlling for other factors: 1.22[A]; 
Adjusted odds ratio controlling for other factors: 1.36[A]. 

St. Paul, MN; 
Appeals granted full or partial award: 37.3%; 
Appeals granted no award: 62.7%; 
Odds of award granted: 0.60; 
Unadjusted odds ratio prior to controlling for other factors: 1.58[A]; 
Adjusted odds ratio controlling for other factors: 1.65[A]. 

St. Petersburg, FL; 
Appeals granted full or partial award: 25.2%; 
Appeals granted no award: 74.8%; 
Odds of award granted: 0.34; 
Unadjusted odds ratio prior to controlling for other factors: 0.89[A]; 
Adjusted odds ratio controlling for other factors: 0.95. 

Togus, ME; 
Appeals granted full or partial award: 31.1%; 
Appeals granted no award: 68.9%; 
Odds of award granted: 0.45; 
Unadjusted odds ratio prior to controlling for other factors: 1.20[A]; 
Adjusted odds ratio controlling for other factors: 1.20[A]. 

Waco, TX; 
Appeals granted full or partial award: 19.1%; 
Appeals granted no award: 80.9%; 
Odds of award granted: 0.24; 
Unadjusted odds ratio prior to controlling for other factors: 0.63[A]; 
Adjusted odds ratio controlling for other factors: 0.67[A]. 

Washington, D.C.; 
Appeals granted full or partial award: 28.5%; 
Appeals granted no award: 71.5%; 
Odds of award granted: 0.40; 
Unadjusted odds ratio prior to controlling for other factors: 1.05; 
Adjusted odds ratio controlling for other factors: 1.11. 

White River Junction, VT; 
Appeals granted full or partial award: 40.2%; 
Appeals granted no award: 59.8%; 
Odds of award granted: 0.67; 
Unadjusted odds ratio prior to controlling for other factors: 1.78[A]; 
Adjusted odds ratio controlling for other factors: 1.87[A]. 

Wichita, KS; 
Appeals granted full or partial award: 24.6%; 
Appeals granted no award: 75.4%; 
Odds of award granted: 0.33; 
Unadjusted odds ratio prior to controlling for other factors: 0.86[A]; 
Adjusted odds ratio controlling for other factors: 0.94. 

Wilmington, DE; 
Appeals granted full or partial award: 33.6%; 
Appeals granted no award: 66.4%; 
Odds of award granted: 0.51; 
Unadjusted odds ratio prior to controlling for other factors: 1.34[A]; 
Adjusted odds ratio controlling for other factors: 1.40[A]. 

Winston-Salem, NC; 
Appeals granted full or partial award: 36.5%; 
Appeals granted no award: 63.5%; 
Odds of award granted: 0.57; 
Unadjusted odds ratio prior to controlling for other factors: 1.52[A]; 
Adjusted odds ratio controlling for other factors: 1.73[A]. 

Source: GAO analysis of VACOLS data. 

Note: Odds ratios are odds in comparison to the reference category 
indicated for each variable. In addition to the control variables 
presented in the table, logistic regression models also included 
control variables for different body systems included as issues in 
each appeal. Depending on the system, the adjusted odds ratio for 
different systems ranged between 0.77 and 1.54 when compared to 
appeals that did not indicate a specific body system as one of the 
issues in the appeal. 

[A] Indicates a statistical significance at the p<0.05 level. 

[End of table] 

Survey of Regional Office Managers: 

To obtain managerial views on the appeal process and use of DROs in 
VBA's 57 regional offices, and to understand variations among offices, 
we conducted a web-based survey of one regional office manager, or 
assistant manager if so designated by their director, at each office. 

Survey development. We developed survey questions with input from an 
official at VA's Office of Field Operations and GAO subject matter 
experts on survey design and performance management. To pretest the 
questionnaire, we conducted in-depth probing interviews and held 
debriefing sessions with four regional office managers by telephone. 
Pretest participants were selected to represent variety in regional 
office sizes and to include offices that participated in VBA's pilot 
program for new DRO performance measures. We conducted these pretests 
to determine if the questions were burdensome or difficult to 
understand and if they measured what we intended. On the basis of the 
feedback from the pretests and these other knowledgeable entities, we 
modified the questions as appropriate. 

Survey implementation. We obtained e-mail addresses of managers from 
VA's Office of Field Operations. This office sent a message to 
prospective respondents on December 20, 2010, encouraging 
participation in the upcoming survey. We then began the survey by e-
mailing passwords and links to the web-based questionnaire on January 
4, 2011. To obtain candid responses and a high response rate, we 
pledged not to link the responses presented in our report to 
individual survey participants, and we followed up with two e-mails to 
initial nonrespondents, the first on January 13, 2011, and the second 
on January 31, 2011. Additionally, we contacted those managers who had 
not responded to the survey e-mails by telephone from February 3 
through February 18, 2011. We also contacted some respondents by e-
mail to clarify unclear, inconsistent, or incomplete responses. We 
received usable responses from 56 of the 57 managers, for a 98 percent 
response rate, and ended the survey on February 22, 2011.[Footnote 44] 

Analysis of responses. We used computer programs verified to be 
written correctly by an independent GAO analyst to analyze the 
responses. We provided respondents with an opportunity to answer 
several open-ended questions. The responses to those questions were 
categorized and coded for content by a GAO analyst, while a second 
analyst verified that the first analyst had coded the responses 
appropriately. Some comments were coded into more than one category 
since some respondents commented on more than one topic. As a result, 
the number of coded items is not equal to the number of respondents 
who provided comments. 

Analysis of survey error. Because we identified and selected all 57 
regional offices for our survey, our data is not subject to errors due 
to selecting only a sample or failing to include a portion of the 
population in the sample. The practical difficulties of conducting any 
survey may introduce errors due to measurement, nonresponse, or data 
processing; however, steps taken during survey development, 
implementation, and analysis minimize the chance of such errors. 
Additionally, because of the high response rate, the risk of 
nonresponse error was further minimized, and because the sole 
nonresponding office was also one of the pretest sites, we were able 
to determine that the site's characteristics and pretest answers did 
not differ greatly from respondents' answers. Inclusion of what would 
likely have been their final answers, as determined by their pretest 
responses, would not materially affect overall results. As a result, 
we conclude that there is no material risk of nonresponse bias in our 
survey. 

Phone Interviews with Veterans: 

We conducted structured phone interviews with veterans to gather 
information on the factors that affect veterans' appeals decisions, 
such as the clarity of the VBA letter appeals process election letter, 
assistance from VSOs, and other specific reasons for choosing a DRO 
review or a traditional review. The team worked with a survey 
methodologist and communication expert in the development of a phone 
script and interview questions for the veterans, which were pretested 
with six veterans. The finalized phone script and questions included 
screening questions to determine if veterans understood the questions 
or recalled information accurately. 

To develop our sample, we obtained VACOLS data from the Board on 
veterans who had filed appeals of their disability compensation 
decisions between February 1, 2010 and July 31, 2010. The data 
provided by the Board included the date of the appeal; whether the 
veteran had selected a DRO or a traditional review; the date on which 
the DRO review was selected; the veteran's name; and, when available, 
the veteran's address and phone number. The file contained 77,542 
unique appeals, which corresponds to something less than 77,542 unique 
veterans, because one veteran may have filed multiple appeals. We 
removed from the list all veterans associated with a regional office 
that was a participant in VA's Expedited Claim Adjudication pilot 
project in 2008 since all veterans who took part in this pilot 
automatically received a DRO review, so our interview questions--which 
focus on how veterans made the decision to elect DRO review--would not 
have been relevant for them. Four regional offices were part of this 
pilot: Nashville, Tennessee; Seattle, Washington; Lincoln, Nebraska; 
and Philadelphia, Pennsylvania. The final file, without any veterans 
associated with the Expedited Claim Adjudication sites, contained 
71,891 appeals. We drew a random sample of 200 appeals from this final 
data file. The sample of appeals represented 200 unique veterans. The 
team used a random sample to protect against selection bias. 

Before conducting the interviews, we tried to obtain contact 
information for veterans with missing phone numbers or addresses, but 
were not able to identify contact information in all cases. When 
addresses were available, we sent notification letters to veterans 
before beginning the interviews. We conducted the interviews with 
veterans from December 2010 to April 2011. When contacting the 
veterans, the interviewer read the phone script and interview 
questions and documented the responses. In cases where a spouse or 
other family member stated that the veteran was not able to 
participate in the interview, we asked to speak with the person most 
knowledgeable of the appeal and conducted the interview with this 
person. We also spoke with surviving spouses or children who were 
appealing a disability claim of a deceased veteran. We successfully 
completed interviews with 40 veterans--28 of the veterans had chosen a 
DRO review of their appeal and 12 had chosen a traditional review. The 
results of our interviews cannot be generalized to the overall 
population of veterans who filed appeals between February 2010 and 
July 2010. (See table 4 for detailed information on the implementation 
of the phone interviews.) 

Table 4: Implementation of Structured Phone Interviews with Veterans: 

Number of veterans in the sample: 200. 

Number of veterans for whom phone numbers were obtained: 146. 

Number of veterans called[A]: 107. 

Number of veterans who participated in the interviews: 47. 

Number of valid interviews[B]: 40. 

Number of veterans who declined participation in the interview: 2. 

Source: GAO. 

[A] This total does not include 10 veterans who were called as part of 
the pretest process. Six of the 10 agreed to participate in pretests. 

[B] We have excluded seven interviews with veterans whom we determined 
did not understand the questions or were confused about the appeal to 
which we were referring. We did not use these seven interviews for our 
analysis. 

[End of table] 

[End of section] 

Appendix II: VA Appeal Process Request Letter Template: 

Appeal Process Request Letter: 

Department of Veterans Affairs: 
Regional Office: 
[date]
[appellant's name]
[appellant's address] In Reply Refer To: 

We received your written notice of disagreement with the Department of
Veterans Affairs (VA) decision of [date]. This letter describes what 
happens next. 

Will VA try to resolve my disagreement? 

This local VA office will try to resolve your disagreement through the 
Post-Decision Review Process. As part of this process, you must decide 
how you would like us to handle your appeal. You may choose to have a 
Decision Review Officer (DRO) assigned to your case or to follow the 
traditional appeal process. 

How does the Decision Review Officer Process work? 

Complete review: The DRO will review the materials in your VA claims 
folder, including evidence and arguments, and statements from your 
representative. This may lead the DRO to request additional evidence 
from you, your doctor or some other source. You may be asked to 
participate in an informal conference with DRO to discuss your case. 

New decision: The DRO will then make a new decision. The DRO has the 
authority to grant benefits based on clear and unmistakable error, de 
novo review, or the receipt of new and material evidence. You will be 
notified of the decision and your appeal rights. If you are not 
satisfied with the DRO's decision, you may then appeal, using the 
traditional appeal process. 

How does the Traditional Appeal Process work? 

Complete review: A VA staff member will check your file for 
completeness. Then a review will be made of your evidence and 
arguments, statements from your representative and any other 
information available in your claims folder. This may lead to a 
request for additional evidence from you, your doctor or other 
sources. You may be asked to clarify questions about your disagreement. 

Statement of the Case: If we cannot grant your appeal based on the 
review and an examination of any additional evidence, we will then 
prepare a Statement of the Case (SOC) and send you a copy. The SOC 
will include a summary of the evidence, a citation to pertinent laws, 
a discussion of how those laws affect the decision, and a summary of 
the reasons for the decision. If you still do not agree with that 
decision and wish to continue your appeal, you need to submit a 
substantive appeal so that your case can be sent to the Board of 
Veterans' Appeals. Instructions on how to file a substantive appeal 
will be provided in our letter notifying you of the decision. 

May I be represented? 

[Use this paragraph if appellant has a representative.]
You designated [name] from [organization] to represent you in 
presenting your claim to VA. The DRO will work with this 
representative while trying to resolve your disagreement. If you have 
not already done so, you should contact your representative directly 
to discuss your case. 

[Use this paragraph if appellant does not have a representative.]
If you do not have a representative, it is not too late to choose one. 
An accredited representative of a recognized service organization may 
represent you in your claim for VA benefits without charge. An 
accredited attorney or an accredited agent may also represent you 
before VA, and may charge you a fee for services performed after the 
filing of a notice of disagreement. In certain cases, VA will pay your 
accredited agent or attorney directly from your past due benefits. For 
more information on the accreditation process and fee agreements 
(including filing requirements), you and/or your representative should 
review 38 U.S.C. §5904 and 38 C.F.R. §14.636 and VA's website at 
[hyperlink, http://www.va.gov/ogc/accreditation.asp]. You can find the 
necessary power of attorney forms on this website, or if you ask us, 
we can send you the forms. You can also find the names of accredited 
attorneys, agents and service organization representatives on this 
website. 

How do I select the Decision Review Officer process or traditional 
appeal process? 

You must notify us within 60 days from the date of this letter whether 
you want to have your case reviewed by the Decision Review Officer 
process or by the traditional appeal process. If we do not hear from 
you within 60 days, your case will be reviewed under the traditional 
appeal process. 

We hope we will be able to resolve your disagreement to your 
satisfaction. If you have questions about the information in this 
letter please call us at 1-800-827-1000. 

Source: VA M21-1MR Manual. 

[End of section] 

Appendix III: Comments from the Department of Veterans Affairs: 

The Secretary of Veterans Affairs: 
Washington: 

September 9, 2011: 

Mr. Daniel Bertoni: 
Director: 
Education, Workforce and Income Security Issues: 
U.S. Government Accountability Office: 
441 G Street, NW: 
Washington, DC 20548: 

Dear Mr. Bertoni: 

The Department of Veterans Affairs (VA) has reviewed the Government
Accountability Office's (GAO) draft report, Veterans Disability 
Benefits: Clearer Information for Veterans and Additional Performance 
Measures Could Improve Appeals Process (GAO-11-812). The Department 
concurs with two recommendations and concurs in part with one 
recommendation. 

In this study, GAO concluded the Decision Review Officer (DRO) review 
process has not reduced the percentage of appeals continuing on to the 
Board of Veterans Appeals (BVA). In drawing this conclusion, GAO 
compared resolution rates between two courses of action an appeal can 
follow: the traditional appeal and the de novo review conducted by a 
DRO. 

GAO correlated the success of the DRO review process solely to 
resolution of appeals at the regional office level and, consequently, 
recommended that VA establish performance measures for appeals 
resolution rates. 

However, the success of the DRO program cannot be measured on the 
percent of appeals resolved through DRO review, although this could 
certainly be one beneficial outcome of the de novo review process. An 
appellant has a statutory right to proceed with an appeal to the 
Board, even after a DRO review results in further evidentiary 
development or even a partial grant of benefits. GAO asserts that the 
continuation of an appeal to the Board constitutes a failure of the 
DRO program, whereas, VA would regard the DRO review as a success 
because the DRO has ensured that VA has met its statutory duty to 
assist the appellant in obtaining all relevant records, although those 
efforts could not result in a complete grant of benefits. 

Moreover, as GAO itself noted, DRO duties include other functions such 
as training, mentoring, and performing quality reviews. We believe the 
success of the DRO program can be measured, as well, in terms of its 
effect on training and quality. 

The enclosure specifically addresses each of GAO's recommendations to 
the Department. VA appreciates the opportunity to comment on your 
draft report. 

Sincerely, 

Signed by: 

John R. Gingrich: 
Chief of Staff: 

Enclosure: 

[End of letter] 

Enclosure: 

Department of Veterans Affairs (VA) Comments to Government 
Accountability Office (GAO) Draft Report: Veterans Disability 
Benefits: Clearer Information for Veterans and Additional Performance 
Measures Could Improve Appeals Process (GA0-11-812): 

GAO recommendation: To clarify information for veterans and ensure the 
most effective use of DROs, the Secretary of Veterans Affairs should 
direct VBA to: 

Recommendation 1: 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. 

VA Response: Concur. Veterans Benefits Administration (VBA) has formed 
an Appeals Process Workgroup to analyze the current process and 
recommend changes to streamline it. Changes to the election letter are 
under consideration. 

Target Completion Date: March 31, 2012. 

Recommendation 2: Establish national and regional office performance 
measures related to appeals resolution at the regional level and 
ensure that existing quality review procedures are sufficient to 
prevent DROs from granting unjustified benefits. 

VA Response: Concur in part. VBA is currently in the process of 
revising the Decision Officer Review (DRO) performance standard in an 
attempt to focus on resolving appeals at the earliest stage. This 
change will help to encourage interaction between the DRO, the 
appellant, and his or her representative in order to ensure that the 
parties have identified all relevant evidence and the DRO has clearly 
communicated the regulatory requirements underlying the decision made 
on appeal. 

In addition, the National DRO Performance Plan specifically addresses 
quality under element one, requiring that the DRO must consistently 
and conscientiously exercise sound, equitable judgment in applying 
stated policies to ensure accurate and timely decisions on 
compensation and pension benefit claims. The DRO must maintain a 90 
percent accuracy rate based on local review of an unbiased selection 
of an average of five cases per month, per employee. 

However, as indicated in the report, there are several key factors in 
the appellate process which are beyond the control of the DRO. 
Fundamentally, an appellant has the statutory right to continue an 
appeal to the Board of Veterans' Appeals (BVA) regardless of the 
decision rendered by a DRO. Shifting the focus to appeal resolution by 
establishing national and local performance measures based on appeals 
resolution rates may drive organizational performance toward granting 
appeals in cases where the evidence may not justify it. 

Recommendation 3: 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. 

VA Response: Concur. A job task analysis (JTA) was completed for the 
DROs in 2009 during the development of the DRO skills certification 
test. A JTA is required for the development of all skill certification 
tests to ensure that testing covers all aspects of the job. The DRO 
skills certification test was given for the first time in 2010 with 
the second test given in July 2011. The results of these tests along 
with the JTA will be used to continue to develop training for DROs. 

In addition, VBA recently signed a Memorandum of Understanding with 
BVA to develop joint appeals training that will improve consistency in 
the legal and procedural adjudicative process. Quality analysis 
results from Compensation Service and BVA will be incorporated into 
the training materials, which will promote uniformity and improved 
timeliness. A joint VBA/BVA workgroup is being formed to create and 
deliver training for Rating Veterans Service Representatives and DROs 
by the second quarter of FY 2012. 

Target Completion Date: March 31, 2012. 

[End of section] 

Appendix IV: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Daniel Bertoni, 202-512-7215 or bertonid@gao.gov: 

Staff Acknowledgments: 

In addition to the contact named above, Shelia Drake, Assistant 
Director; Lorin Obler; Susan Aschoff; Susan Baker; Jamie Berryhill; 
Jessica Botsford; Juliann Gorse; Mimi Nguyen; Anna Maria Ortiz; 
Patricia Owens; Carol Petersen; Carl Ramirez; and Walter Vance made 
key contributions to this report. 

[End of section] 

Related GAO Products: 

Military and Veterans Disability System: Worldwide Deployment of 
Integrated System Warrants Careful Monitoring. [hyperlink, 
http://www.gao.gov/products/GAO-11-633T]. Washington, D.C.: May 4, 
2011. 

High-Risk Series: An Update. [hyperlink, 
http://www.gao.gov/products/GAO-11-278]. Washington, D.C.: February 
16, 2011. 

Military and Veterans Disability System: Pilot Has Achieved Some 
Goals, but Further Planning and Monitoring Needed. [hyperlink, 
http://www.gao.gov/products/GAO-11-69]. Washington, D.C.: December 6, 
2010. 

Veterans' Disability Benefits: Expanded Oversight Would Improve 
Training for Experienced Claims Processors. [hyperlink, 
http://www.gao.gov/products/GAO-10-445]. Washington, D.C.: April 30, 
2010. 

Veterans' Disability Benefits: VA Has Improved Its Programs for 
Measuring Accuracy and Consistency but Challenges Remain. [hyperlink, 
http://www.gao.gov/products/GAO-10-530T]. Washington, D.C.: March 24, 
2010. 

Veterans' Disability Benefits: Further Evaluation of Ongoing 
Initiatives Could Help Identify Effective Approaches for Improving 
Claims Processing. [hyperlink, http://www.gao.gov/products/GAO-10-
213]. Washington, D.C.: January 29, 2010. 

Military Disability System: Increased Supports for Servicemembers and 
Better Pilot Planning Could Improve the Disability Evaluation Process. 
[hyperlink, http://www.gao.gov/products/GAO-08-1137]. Washington, 
D.C.: September 24, 2008. 

Veterans' Benefits: Increased Focus on Evaluation and Accountability 
Would Enhance Training and Performance Management for Claims 
Processors. [hyperlink, http://www.gao.gov/products/GAO-08-561]. 
Washington, D.C.: May 27, 2008. 

Veterans' Disability Benefits: VA Can Improve Its Procedures for 
Obtaining Military Service Records. [hyperlink, 
http://www.gao.gov/products/GAO-07-98]. Washington, D.C.: December 12, 
2006. 

Veterans' Benefits: Further Changes in VBA's Field Office Structure 
Could Help Improve Disability Claims Processing. [hyperlink, 
http://www.gao.gov/products/GAO-06-149]. Washington, D.C.: December 9, 
2005. 

Veterans' Disability Benefits: Claims Processing Challenges and 
Opportunities for Improvements. [hyperlink, 
http://www.gao.gov/products/GAO-06-283T]. Washington, D.C.: December 
7, 2005. 

Managing for Results: Enhancing Agency Use of Performance Information 
for Management Decision Making. [hyperlink, 
http://www.gao.gov/products/GAO-05-927]. Washington, D.C.: September 
9, 2005. 

VA Disability Benefits: Board of Veterans' Appeals Has Made 
Improvements in Quality Assurance, but Challenges Remain for VA in 
Assuring Consistency. [hyperlink, 
http://www.gao.gov/products/GAO-05-655T]. Washington, D.C.: May 5, 
2005. 

Veterans' Benefits: More Transparency Needed to Improve Oversight of 
VBA's Compensation and Pension Staffing Levels. [hyperlink, 
http://www.gao.gov/products/GAO-05-47]. Washington, D.C.: November 15, 
2004. 

Human Capital: A Guide for Assessing Strategic Training and 
Development Efforts in the Federal Government. [hyperlink, 
http://www.gao.gov/products/GAO-04-546G]. Washington, D.C.: March 2004. 

Veterans' Benefits: Improvements Needed in the Reporting and Use of 
Data on the Accuracy of Disability Claims Decisions. [hyperlink, 
http://www.gao.gov/products/GAO-03-1045]. Washington, D.C.: September 
30, 2003. 

Veterans Benefits Administration: Clarity of Letters to Claimants 
Needs to Be Improved. [hyperlink, 
http://www.gao.gov/products/GAO-02-395]. Washington, D.C.: April 23, 
2002. 

Human Capital: Practices That Empowered and Involved Employees. 
[hyperlink, http://www.gao.gov/products/GAO-01-1070]. Washington, 
D.C.: September 14, 2001. 

[End of section] 

Footnotes: 

[1] The Board consists of attorneys experienced in veterans' law, 
appointed by the Secretary of Veterans Affairs with the approval of 
the President, based on recommendations of the Chairman of the Board 
who is appointed by the President with the advice and consent of the 
U.S. Senate. 38 U.S.C. §§ 7101 and 7101A. Claims decisions can be made 
by an individual member of the Board or by a panel of not less than 
three members. 38 U.S.C. § 7102. 

[2] This figure includes appeals of disability, pension, and other 
benefits decisions. 

[3] We conducted the survey in January and February 2011, and received 
completed surveys from 56 of 57 regional offices, which makes the 
results generalizable. One of the 56 regional offices does not have 
any DROs and did not answer questions about DROs. 

[4] VSOs, such as Paralyzed Veterans of America and Disabled American 
Veterans, offer a wide range of assistance to veterans, including 
informing veterans about available benefits and assisting with the 
application and appeals processes. 

[5] VBA is the component of the VA responsible for administering 
programs that provide financial and other forms of assistance to 
veterans, including disability benefits. 

[6] 38 C.F.R. § 14.629(b). VSO representatives are not permitted to 
receive fees for helping veterans with claims or appeals, and 
accredited private attorneys and agents generally may only charge a 
fee after a decision has been issued on a claim and the veteran has 
initiated an appeal. 38 C.F.R. § 14.636(c). 

[7] 38 U.S.C. § 7105. 

[8] If the veteran does not choose an appeal option within 60 days, VA 
assigns the appeal to the traditional review process. 38 C.F.R. § 
3.2600(b). A veteran may also choose a DRO review or a traditional 
review when submitting his or her notice of disagreement. 

[9] 38 C.F.R. §3.2600. A DRO also may make a new decision based on new 
evidence or clear and unmistakable error. In addition, under the 
traditional review, the original decision may be overturned based on a 
difference of opinion with the original decision, but the Central 
Office must approve proposed revision. 38 C.F.R. §§ 3.105(b). 

[10] Benefits may also be reduced in certain situations. When benefits 
are reduced, the beneficiary is notified and given 60 days to present 
additional evidence to show that the benefit amount should not be 
reduced. If additional evidence is not received within that period, 
the benefit amount will be reduced in accordance with the requirements 
in VA's regulations. 38 C.F.R. § 3.105(e). 

[11] The veteran receives any benefits already granted while appealing. 

[12] 38 U.S.C. §§ 7252 and 7292. 

[13] 66 Fed. Reg. 21,871 (May 2, 2001). 

[14] When breaking out VACOLS data by fiscal year, we used the fiscal 
year in which appeals were filed. We examined data on individual 
appeals, although a single veteran may have filed multiple appeals. 

[15] Some veterans do not choose a traditional review for their appeal 
but default to it because they do not respond to the appeal process 
request letter within 60 days as required by regulation. Board data do 
not distinguish between a requested traditional review and a default 
traditional review. In this report, we include appeals that may 
default to a traditional when we refer to traditional review. 

[16] During the 8-year period, veterans filing 87 percent of appeals 
had such representation. Because VA does not record when veterans 
obtain representation, the Board data may reflect veterans who 
obtained representation after filing their appeals. 

[17] We used logistical analysis to assess the impact of several 
factors--including fiscal year, regional office, number of issues in 
an appeal, representation, and type of disabilities--on the choice of 
a DRO review. In addition to representation, we found that fiscal 
year, number of issues, and certain regional offices affected the 
choice of a DRO review. Those filing appeals in fiscal year 2010 were 
significantly more likely to choose a DRO review than those filing in 
fiscal year 2003. Veterans filing appeals with multiple issues were 
slightly more likely to choose a DRO review than those with one issue. 
There may be other factors affecting the choice of a DRO review that 
we did not analyze. For example, we did not control for other factors 
that might have had an influence on a veteran's decision to choose the 
DRO process, such as a veteran's branch of service or demographic 
information. For more information, see appendix I. 

[18] We used a random sample of veterans for the interviews to avoid 
selection bias; however, interviews with the veterans are 
nongeneralizable. We do not generalize to the population due to our 
sample size and lack of information concerning the characteristics and 
experiences of those who chose to and chose not to participate in our 
phone interviews. We interviewed veterans who had filed notices of 
disagreement between February 1, 2010 and July 31, 2010. For more 
information on our methodology, see appendix I. 

[19] The veteran has 60 days after VA mails the appeal process letter 
to choose a DRO review. If the veteran does not choose a DRO review 
within 60 days, VA proceeds with the traditional review. 38 C.F.R. § 
3.2600(b). 

[20] M21-1MR Manual. 

[21] We interviewed 17 DROs at the 4 regional offices we visited. We 
asked regional office managers to identify DROs for interviews with a 
mix of specializations, such as appeals, training, and quality reviews. 

[22] We assessed the VA's template for the appeal process request 
letter in the VBA manual, using criteria from Plain Language 
Guidelines, one of our previous reports [GAO, Veterans Benefits 
Administration: Clarity of Letters to Claimants Needs to Be Improved, 
[hyperlink, http://www.gao.gov/products/GAO-02-395] (Washington, D.C.: 
April 2002)], and guidance in the VBA manual. The Plain Language 
Action and Information Network, a community of federal employees, 
developed the Plain Language Guidelines to provide advice for federal 
agencies on clear communication. The Plain Language Writing Act of 
2010 (Pub. L. No. 111-274, 124 Stat, 2861) requires that, by October 
13, 2011, each federal agency write in a "clear, concise, well-
organized" manner when drafting documents covered under the law, which 
include documents describing benefits or necessary to obtain a 
government benefit. The Office of Management and Budget's final 
guidance on implementation of the act (OMB M-11-15, Apr. 13, 2011) 
states that agencies should follow the Federal Plain Language Writing 
Guidelines when drafting covered documents. For information on our 
methodology, see appendix I. 

[23] Of the 40 veterans we interviewed, 17 had chosen a DRO review 
when they filed their appeals and therefore did not receive the letter. 

[24] DROs have the authority to conduct a completely new (de novo) 
review and make a new decision based on difference of opinion only 
during this initial appeal stage, in appeals in which a DRO review was 
selected. However, some appeals in which a DRO review was not selected 
may actually have received a completely new review by a DRO, and our 
data do not allow us to identify these cases. About one-third of 
regional office managers we surveyed said DROs in their offices, when 
processing appeals in which a DRO review was not selected, may make a 
new decision based purely on difference of opinion. 

[25] We calculated the percentage of full or partial grants among all 
decisions made by regional offices on notices of disagreement filed in 
a given fiscal year. Among DRO reviews, 15 percent received full 
grants and 16 percent received partial grants; among traditional 
reviews, 12 percent received full grants and 11 percent received 
partial grants. In some other analyses, we excluded recent fiscal 
years because a high proportion of appeals filed in these years was 
still pending action by the regional office. 

[26] We used logistic regression to estimate the impact of certain 
factors on regional office decisions on notices of disagreement: DRO 
review versus traditional review, representation of veteran, fiscal 
year in which appeal was filed, regional office in which appeal was 
filed, number of issues under appeal, and types of disabilities 
claimed. There may be other factors affecting regional office 
decisions that we did not consider or were not able to control for. 
For more information see appendix I. 

[27] This processing time covers the period from the regional office's 
receipt of a notice of disagreement to the office's issuance of either 
a decision to grant full benefits or a statement of the case 
explaining how to submit a substantive appeal. We analyzed data only 
through fiscal year 2009 because a substantial proportion of appeals 
filed in fiscal year 2010 did not yet have a decision at the initial 
appeal stage as of the date our data were extracted. 

[28] This average processing time includes only appeals with an 
outcome at the Board level. The percentage of appeals filed in 2007 
with Board outcomes as of the date our data were extracted from VACOLS 
was smaller than the percentage of appeals filed in prior years, but 
the percentage of 2007 appeals with Board outcomes was similar for 
both DRO and traditional review appeals. 

[29] We included in our analysis all appeals which were resolved at 
the regional level for any reason or certified to the Board. We did 
not include appeals still pending a decision at the regional office 
level at the time our data were extracted. We analyzed data only 
through fiscal year 2008 because a substantial proportion of appeals 
filed in fiscal years 2009 and 2010 were still pending. 

[30] From fiscal years 2003 through 2008, 348,674 appeals in which a 
DRO review was selected and 244,852 appeals in which a traditional 
review was selected had either been resolved at the regional level or 
transferred to the Board and are included in this analysis. 

[31] The percentages presented in this paragraph are based on all 
appeals with a final outcome at the regional office level. 

[32] The percentage that opted not to continue their appeals to the 
Board includes those who failed to respond to the statement of the 
case and those who withdrew their appeals. 

[33] To meet their productivity requirement, DROs must earn a certain 
number of credits per day. They may earn credits for activities such 
as holding an informal conference, conducting a formal hearing, and 
preparing a decision. 

[34] GAO, Managing for Results: Enhancing Agency Use of Performance 
Information for Management Decision Making, [hyperlink, 
http://www.gao.gov/products/GAO-05-927] (Washington, D.C.: Sept. 9, 
2005). 

[35] See GAO, Human Capital: A Guide for Assessing Strategic Training 
and Development Efforts in the Federal Government, [hyperlink, 
http://www.gao.gov/products/GAO-04-546G] (Washington, D.C.: March 
2004). 

[36] M21-1MR, Part I, Chapter 5-B-16. 

[37] The Plain Writing Act of 2010 (P.L. 111-274) requires the use of 
plain writing in federal agency documents. The Office of Management 
and Budget issued final guidance for the Plain Writing Act on April 
13, 2011, stating that agencies should follow the Plain Language 
Guidelines when drafting documents for the public. 

[38] GAO, Veterans Benefits Administration: Clarity of Letters to 
Claimants Needs to Be Improved, [hyperlink, 
http://www.gao.gov/products/GAO-02-395] (Washington, D.C.: April 2002). 

[39] This estimate was statistically significant at the p<0.01 level. 

[40] To the extent omitted factors and factors correlated with the 
initial decision to appeal are also correlated with the selection of 
review type, the estimates from our models may be subject to some bias. 

[41] We examined the distribution of DRO election rates across offices 
to select a reference office to use in calculations of odds ratios, 
and selected Albuquerque because its mean rate of DRO election across 
all years fell at approximately the midpoint of all regional offices. 
To compare odds to a regional office other than Albuquerque, one can 
divide the odds ratios from table 1 that are associated with the 
offices of interest to create an odds ratio that will compare the odds 
of DRO election for the city in the numerator to the city in the 
denominator. 

[42] The model presented in table 2 was able to correctly predict the 
outcome of 66.1 percent of appeals. 

[43] The model presented in table 3 correctly predicted 62.5 percent 
of cases. 

[44] One of the offices that responded to our survey had no DROs. This 
office does not process disability compensation claims or appeals. 
Therefore we analyzed survey responses for 55 regional offices. 

[End of section] 

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