VA Disability Benefits: Additional Planning Would Enhance Efforts to Improve the Timeliness of Appeals Decisions
Highlights
What GAO Found
The Department of Veterans Affairs' (VA) is taking steps to improve the timeliness of its benefit compensation appeals process, in which veterans who are dissatisfied with claims decisions by the Veterans Benefits Administration (VBA) can appeal first to VBA, and then to the Board of Veterans' Appeals (the Board). VA has taken actions related to increasing staff, reforming the process, and updating information technology (IT), which are consistent with relevant sound planning practices. However, gaps in planning exist, thereby reducing the agency's ability to ensure that these actions will improve the timeliness of disability appeals decisions.
Increase staff: VA determined that staff resources have not sufficiently kept pace with increased pending appeals, and concluded that additional staff are needed, particularly at the Board, to improve timeliness and reduce its appeals inventory. The Board received approval to hire more staff in fiscal year 2017, and expects to need an additional hiring surge beginning in fiscal year 2018. As of October 2016, officials estimated that if the agency does not take any action, such as increasing staff in 2018, veterans may have to wait an average of 8.5 years by fiscal year 2026 to have their appeals resolved.
Consistent with sound workforce planning practices, VA modeled different options for increasing staff levels to support its conclusion that staff increases in conjunction with process change would reduce the appeals inventory sooner. However, contrary to sound practices, VA often used fixed estimates for key variables in its models—such as staff productivity—rather than a range of estimates (sensitivity analysis) to understand the effect variation in these key variables could have on staffing needs. Also, VA's written workforce plans—which cover recruiting, hiring and training—did not include detailed steps, time frames, and mitigation strategies consistent with sound workforce planning practices. For example, while VA has established a center for excellence in hiring to focus on recruitment and hiring the agency has not finalized training or telework plans or otherwise mitigated space constraints that it encountered for hiring staff in fiscal year 2017. Without a timely, detailed workforce plan, VA risks delays in hiring and preparing staff to help manage workloads as soon as possible.
Reform process: VA determined that new evidence—which a veteran can submit at any point during his or her appeal—inefficiently causes an additional round of reviews, and thus delays appeals decisions, and in response it proposed legislation (not enacted) to streamline the process. Consistent with sound practices for process redesign, VA worked with veterans service organizations (VSO) and other key stakeholders in developing the proposal, and continued to update VSOs about the development of its implementation plans.
VA's proposed reform is promising, but there are several gaps in its implementation plans. In particular, VA plans to fully implement appeals process reform at the Board as well as at VBA regional offices across the country while it concurrently manages the existing appeals inventory, a hiring surge, and planned system changes discussed below. However, VA's plans run counter to sound redesign practices that suggest pilot testing the process changes in a more limited fashion before full implementation, in order to manage risks and help ensure successful implementation of significant institutional change. VA officials told GAO that pilot testing—which would require legislation to implement—will prolong a process that is fundamentally broken and delay urgently needed repairs. However, without pilot testing VA may experience challenges and setbacks on a broader scale, which could undermine planned efficiencies and other intended outcomes. In addition, VA has not sufficiently identified how it will monitor progress, evaluate efficiency and effectiveness, identify trouble spots, and otherwise know whether implementation of its proposed process change is on track and meeting expectations. The absence of a robust monitoring plan with success criteria is inconsistent with sound planning practices for redesign and places the agency at risk of not being able to quickly identify and address setbacks. In addition, the timeliness measures that VA currently plans to report to Congress and the public lack transparency because they focus on individual parts of the agency and pieces of the new process rather than overall appeals resolution time from the veterans' perspective. Without a strategy for assessing the proposed new process that includes comprehensive measures, VA, the public, and Congress cannot know the extent to which the proposed process represents an improvement over the old process.
Update technology: VA determined that the computer system supporting its appeals process is outdated, prone to failures, and does not adequately support electronic claims processing. VA proposed a new IT system to reduce delays in appeals to the Board, and better integrate data from other systems. Consistent with sound practices, VA clearly laid out the scope and purpose of IT upgrades, and identified risks and strategies to mitigate them. However, the agency's plan lacks details for how and when its new system will be implemented, as suggested by sound planning practices for implementing new technology. Without a detailed schedule, VA risks not having new systems aligned with potential changes in the appeals process when they are implemented.
Why GAO Did This Study
VA compensates veterans for disabling conditions incurred in or aggravated by military service. Veterans can appeal VBA's decisions on their compensation claims, first to VBA and then to the Board, a separate agency within VA. In fiscal year 2015, more than 427,000 appeals were pending and veterans waited over 3 years on average for decisions. Of this total, about 81,000 were pending at the Board and the average cumulative time veterans waited for a decision by the Board in 2015 was almost 5 years.
This report examines VA's approaches to address challenges it identified as contributing to lengthy appeals processing times, and the extent to which those approaches are consistent with sound planning practices.
GAO focused mainly on the Board, which experienced an increase in workload of about 20 percent from fiscal year 2014 to 2015. GAO reviewed VA's proposed plans and actions and compared them to sound practices relevant to workforce planning and implementing process redesign and new information technology identified in federal guidance, such as internal control standards, and prior GAO work. GAO also analyzed VA's data for fiscal years 2011-2015 (the most recent available) on appeals decision timeliness and workloads; reviewed relevant federal laws, regulations, and planning documents; and interviewed VA officials and veterans service organizations.
Recommendations
GAO is making five recommendations to VA and one matter for congressional consideration. VA should: apply sensitivity analyses when projecting staff needs, develop a more timely and detailed workforce plan, develop a robust plan for monitoring process reform, develop a strategy for assessing process reform, and create a schedule for IT improvements that takes into account plans for potential process reform. VA concurred in principle with the five recommendations, but believes it has met the intent of those recommendations and does not need to take additional action. GAO disagrees and—while recognizing VA's ongoing efforts—believes further action is needed on all five recommendations to improve VA's ability to successfully implement reforms, as discussed in the report.
VA disagreed with an additional draft recommendation that it incorporate pilot testing of its proposed appeals process into implementation plans and pursue necessary legislative authority. VA cited its perspective that the appeals process is broken and that piloting a new process would result in further delays to veterans appealing their disability decisions. GAO maintains that the benefits of pilot testing—which provides an opportunity to resolve implementation challenges and make refinements to the process on a smaller scale—outweigh the potentially negative consequences of delaying full implementation. Therefore, GAO removed the recommendation and added a matter for congressional consideration stating that Congress should consider requiring that appeals process reform be subject to a pilot test.
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| To improve VA's ability to successfully implement appeals process reform, Congress should consider requiring that reforms of the VA disability appeals process be subject to a pilot test. To aid in the development of such a pilot test, Congress could require the Secretary of Veterans Affairs to propose options that would allow the agency the flexibility to test and refine the new process in a cost-effective and efficient manner, while ensuring pre-established interim goals and success criteria are being met prior to full implementation. | In August 2017, Congress enacted the Veteran Appeals Improvement and Modernization Act (P.L. 115-55). This legislation grants the Secretary of Veterans Affairs the ability to carry out such programs as the Secretary considers appropriate to test any assumptions relied upon in developing the comprehensive plan required by section 3(a) of the Act and to test the feasibility and advisability of any facet of the new appeals system. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to ensure development of a timely, detailed workforce plan for recruiting, hiring and training new hires. In particular, this plan should: (1) include detailed steps and timetables for updating training curriculum (such as preparing decisions in a virtual environment) and ensuring office space (such as telework guidance); and (2) incorporate risk mitigation strategies that consider how the timing of recruitment and training dovetails with uncertain time frames for implementing a new appeals process. |
Since our March 2017 report, Congress passed the Veterans Appeals Improvement and Modernization Act of 2017, which required VA to produce a comprehensive plan for managing appeals under the legacy and new processes and that the plan address, among other things, hiring, training, office space needs and related risks. Consistent with the Act and our recommendation, VA took steps to recruit, hire, train, and manage office space for additional FTEs to address appeals workloads (part 1 of this recommendation) and to clarify risk mitigation strategies for calibrating its workforce dedicated to appeals (part 2). Specifically, VA substantially addressed both parts of this recommendation by: (1) meeting VBA and Board hiring goals, (2) developing a schedule for training new staff, (3) refining training by incorporating lessons learned from pilot testing of the new options, (4) identifying additional office space for new VBA and Board staff, (5) developing a telework plan that indicated how the Board would adjudicate cases and provide ongoing training in a virtual environment, (4) modeling projected workloads, and (6) testing appeals reform at VBA and collecting empirical data at the Board to help to identify risks and mitigation strategies that informed implementation of appeals reform in February 2019.
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| Department of Veterans Affairs | To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a schedule for IT updates that explicitly addresses when and how any process reform will be integrated into new systems and when Caseflow will be ready to support a potential streamlined appeals process at its onset. |
VA concurred and has taken several actions to significantly address this recommendation. Since 2018, VA has deployed a new Caseflow information technology (IT) system to support the new appeals process and, in February 2019, it implemented appeals reform. In May 2021, a VA IT team assessing Caseflow identified a number of shortfalls and made recommendations to address them, which VA officials told us have led the agency to pursue a more refined approach to Caseflow planning. In December 2021, the agency provided us with detailed plans that reflect an Agile project management method for developing, implementing, and integrating functionality envisioned under Caseflow. An Agile method includes rolling-wave planning in which near-term work is planned in detail and all future work is identified at a high level. It also includes processes for ensuring that the software meets stakeholder needs. VA also a longer-term plan for managing the development and deployment of Caseflow features and detailed plans showing prioritized lists of tasks, as well as releases of software during a series of two-week increments. These actions should help ensure that Caseflow addresses the agency's needs when processing appeals. While we consider this recommendation to be implemented, because Caseflow development is ongoing, we will continue to track VA's progress in deploying Caseflow through our ongoing monitoring of this high-risk area.
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| Department of Veterans Affairs | To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to conduct additional sensitivity analyses based on the assumptions used in projection models to more accurately estimate future appeals inventories and timeliness. In doing so, consider running additional analyses on how these factors, in conjunction with one another, may affect the timeliness and cost of deciding pending appeals. |
As of May 2018, VA developed a new forecast model that allows it to change assumptions related to key variables-both individually and in conjunction with one another. Variables include rates that veterans with pending appeals opt out of the legacy process into the new one, refile rates (in cases where veteran agrees with appeal decision under new system), Board remand rates under new and legacy process, annual number of VBA claim decisions and claim disagreement rates (appeals), productivity under new and legacy processes, percent of appeals under various options in the new process, and staff assigned to work in various VBA review options and Board appeal dockets. Among other things, VA anticipates that this model will allow the agency to project potential budget needs and staffing requirements and more accurately predict resolution of legacy appeals given certain assumptions. Further, VA anticipates using the model to determine an efficient distribution of resources, and quickly react to changes in its pending legacy and new appeals processes, as well as changes in claimant behavior and other trends. While VA's actions taken to date address this recommendation, we will continue monitoring VA's application of this forecast model to inform decision making related to implementing appeals reform, pursuant to recommendation 4 in GAO-18-352.
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| Department of Veterans Affairs | To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a more robust plan for closely monitoring implementation of process reform that includes metrics and interim goals to help track progress, evaluate efficiency and effectiveness, and identify trouble spots. |
VA agreed in principle with this recommendation. Since our report, Congress passed the Veterans Appeals Improvement and Modernization Act of 2017, which required VA to produce a comprehensive appeals plan for, among other things, monitoring implementation of the new appeals system consistent with our 2017 recommendation. As of February 2019 (full implementation), VA substantially completed and reported various actions for monitoring implementation of appeals reform. At the broadest level, VA produced a comprehensive plan for implementing appeals reform (Nov. 2017) and subsequently issued four updates to the plan (Feb., May, Aug., and Nov. 2018) prior to implementation. As of November 2018, VA's plans have reflected a range of efforts consistent with this recommendation, including: (1) continuous updates to its Integrated Master Schedule, which outlined steps and timetables for implementing appeals reform as envisioned by the Appeals Modernization Act; (2) continuous identification of risks and updates to risk mitigation strategies associated with implementing appeals reform; (3) designation of project management leads who met regularly to coordinate all activities; (4) testing of appeals reform at VBA and the Board to collect empirical data on its effectiveness; (5) Board efforts to work with a change management expert and VBA's development of a change management plan; and (6) development of surveys of veterans who have active appeals to assess their experience with the legacy and eventually the new appeals process. While the Board had not addressed all aspects of the recommendation and VA efforts could have been improved upon further, we believe VA's actions significantly address this recommendation. Moving forward, we will continue to track whether VBA and the Board is adequately positioned to monitor and identify trouble spots in its implemented appeals process under recommendations 2 and 4 in GAO-18-352.
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| Department of Veterans Affairs | To better understand whether appeals process reform, in conjunction with other efforts, has improved timeliness, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate to develop a strategy for assessing process reform--relative to the current process--that ensures transparency in reporting to Congress and the public on the extent to which VA is improving veterans' experiences with its disability appeals process. |
VA concurred in principle with this recommendation and has taken action to implement it. Moreover, since our report was issued, Congress passed the Veterans Appeals Improvement and Modernization Act of 2017, which required VA to produce a comprehensive appeals plan that required VA, among other things, to periodically publish a range of metrics, including timeliness, related to the processing of appeals under the new and legacy system. As of 2019, VA implemented appeals reform and took steps to address this recommendation. For instance, VA established timeliness goals for all new appeals options. In addition, as of April 2024, VBA and the Board compared the two processes across various aspects of performance using qualitative and quantitative methods. For example, the Board compared remand rates, decision timeliness, and veteran satisfaction under the legacy and new appeals processes. VA communicated these analyses through various vehicles, such as periodic progress reports on appeals reform, its Web site, and annual reports. (This recommendation is related to recommendation #2 in GAO-18-352.)
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