VA Disability Benefits: Compensation Program Could Be Strengthened by Consistently Following Leading Reform Practices
Fast Facts
The Veterans Benefits Administration provided more than $112 billion in disability benefits to about 5.6 million veterans and their families in FY 2021. The agency has faced longstanding challenges managing claims workloads and has been on our High Risk List since 2003.
We found the agency implemented 23 reforms from FYs 2017 through 2020. Our closer look at 5 of them found the agency didn't always follow leading practices for effective reforms, such as establishing goals and implementation plans. In addition, the agency does not have a method for tracking and prioritizing its efforts.
Our 8 recommendations address these and other issues.
Highlights
What GAO Found
GAO identified 23 reforms the Veterans Benefits Administration (VBA) implemented that were aimed at improving its disability compensation program and were underway from fiscal years 2017 through 2020.
GAO's review of five of these reforms found that VBA did not consistently follow relevant leading practices for effective reforms that GAO has identified in prior work, such as establishing outcome-oriented goals and implementation plans, involving key stakeholders, and using data and evidence to justify the reform.
Extent to Which Five Randomly Selected VBA Efforts to Reform the Disability Compensation Program Followed Relevant Leading Reform Practices
|
Reform practices: |
Duty to assist initiative |
Eliminate 48-hour VSO review period |
Develop Exam Management System |
Initial claims predictive models |
Specialized military sexual trauma teams |
|
Establishing goals and outcomes |
● |
◐ |
◐ |
● |
◐ |
|
Involving key stakeholders and employees |
● |
◐ |
◐ |
● |
◐ |
|
Using data and evidence |
● |
◐ |
● |
● |
● |
|
Addressing high risk and longstanding challenges |
● |
N/A |
● |
● |
○ |
|
Leadership focus and attention |
● |
● |
● |
● |
◐ |
|
Managing and monitoring |
● |
◐ |
◐ |
● |
◐ |
|
Employee performance management |
● |
N/A |
● |
N/A |
◐ |
Legend: ● Generally followed ◐ Partially followed ○ Not followed N/A = Does not apply
VSO = Veterans Service Organization
Source: GAO analysis of Veterans Benefit Administration (VBA) documentation and interviews. | GAO-22-104488
GAO found that VBA has managed its reforms on a project-by-project basis. VBA officials told GAO they do not manage reforms as a whole because they addressed diverse issues that have arisen over time. As a result, VBA had not compiled or tracked reforms or had a method to prioritize or oversee these efforts. Moving forward, as VBA continues to plan and implement reforms, designating a centralized leadership team may help VBA to track, prioritize, and oversee ongoing and new reforms aimed at improving the disability compensation program. Also, VBA could be better positioned to effectively implement such reforms by developing a policy that comprehensively describes leading practices that its managers should follow when undertaking these efforts.
Why GAO Did This Study
In fiscal year 2021, VBA provided over $112 billion in disability compensation to approximately 5.6 million veterans and their families. Over the past decade, VBA has taken steps aimed at improving its disability compensation program. GAO's prior work has shown that effective agency reforms depend on following leading practices, such as establishing outcome-oriented goals. GAO was asked to review VBA's implementation of reforms to improve its disability compensation program.
This report identifies reforms VBA has undertaken, examines the extent to which five selected VBA reforms followed leading reform practices, and reviews how VBA has managed the overall set of reforms.
GAO reviewed relevant documents, interviewed VA officials, and randomly selected five reforms based on criteria such as the number of VA offices involved and milestones completed. GAO compared the agency's efforts to relevant leading practices for effective agency reforms and managing portfolios of projects, and federal standards for internal control.
Recommendations
GAO is making eight recommendations, including that VBA take additional actions to fully follow leading practices where needed for the selected reforms; designate a centralized leadership team to oversee VBA's many reforms; and develop a policy describing the leading practices that VA officials should follow when undertaking reforms. VA generally concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Under Secretary for Benefits should develop and use performance measures to assess the Exam Management System's effect on claims processing time. These measures should align with best practices in Agile development. (Recommendation 1) |
VA agreed in principle with this recommendation. As of June 2022, VA is using performance measures, such as numbers of exams completed and timeliness measures to assess the performance of the exam management system. These timeliness measures are one of several inputs that affect the overall timeliness of claims processing. Officials explained that ongoing updates to improve the performance of the system are using an Agile framework. Within this framework, VA releases updated software in 2-week increments and program increment cycles that are in 3-month increments. According to Agile best practices, these increments should prioritize the work that provides the most value to the agency and meaningful metrics for assessing the value delivered. These metrics should also align with organization-wide goals and objectives. As we noted in our report, VA established a clear and specific outcome-oriented goal for EMS: to facilitate timely exams to veterans and move toward automating claims processing. Although the agency provided us with historical information in February 2023, which documented how the exam management system improved exam timeliness relative to the years before the system was developed, it has not provided us with the current performance measures for the system. Without performance measures, these achievements lack context for understanding progress toward established expectations for improving timeliness. Therefore, we continue to believe that developing and using performance measures to assess the effect of EMS on claims processing is warranted. With performance measures in place for the system, VA would be able to use this performance data to determine the impact of the investment in this system on claims processing. We will consider closing this recommendation when VA provides us with documentation connecting its ongoing development work with the performance standards for timeliness.
|
| Department of Veterans Affairs | The Under Secretary for Benefits should address the training, expertise, and testing tool deficiencies with the user-testing of the Exam Management System. (Recommendation 2) |
VA agreed with this recommendation. VA evaluated options for enhancing user testing of the Exam Management System and decided to hire contractors. As of April 2023, the agency hired contractors to perform independent testing of the System. Officials explained that additional testers could address previous inconsistencies in training, expertise, and tools available for testing.
|
| Department of Veterans Affairs | The Under Secretary for Benefits should develop a project road map that provides the strategic vision and goals and related time frames for completing the Exam Management System. This road map should align with best practices in Agile development to monitor the value of work completed and whether its meets stakeholder needs. (Recommendation 3) |
VA agreed with this recommendation. VA's Medical Disability Evaluation Office (MDEO) is using an Agile method, which includes rolling-wave planning in which near-term work is planned in detail and all future work is identified at a high level. VA has a roadmap that documents the MDEO's development priorities at a high level, including modernizing the exam management system. The roadmap also connects these efforts to specific benchmarks to help monitor progress toward achieving MDEO's strategic vision. Additionally, in keeping with Agile best practices, the roadmap states that MDEO will regularly review it to allow the office to plan enhancements iteratively and ensure the program meets mission needs. We encourage MDEO to continue its stated intention to review the roadmap at least annually to monitor the value of work completed and assess mission needs.
|
| Department of Veterans Affairs | The Under Secretary for Benefits should document clearly defined outcome-oriented goals and develop related levels of performance or targets to enable VBA to analyze and report on improvements to military sexual trauma disability claims processing. (Recommendation 4) |
VA agreed with this recommendation. As of February 2023, VA had established performance goals including both claims volume and processing quality for its newly established military sexual trauma (MST) disability claims processing operation center. In September 2023, VA developed a playbook for processing MST disability claims, which included a plan for regular quality monitoring. This plan includes monthly data reports, periodic spot checks, and a structure for reporting results to a biweekly management oversight meeting. As VA implements this plan, we encourage the agency to continue working with the Inspector General to ensure that the new operation center fully addresses deficiencies the inspector general had previously identified in MST claims processing.
|
| Department of Veterans Affairs | The Under Secretary for Benefits should develop a detailed plan for incorporating input from military sexual trauma disability claimants and VSO representatives into changes to the processing of those disability claims. (Recommendation 5) |
VA agreed with this recommendation. As of December 2023, VA had incorporated military sexual trauma (MST) disability claims processing into its plans for coordinating 13 MST related initiatives across the agency, which included incorporating input from veterans and their representatives. The plan also detailed specific timeframes and responsible offices for these activities. In particular, the agency outlined a schedule for quarterly updates with veteran service organizations on MST issues and an annual symposium that would also field input for continuous improvements.
|
| Department of Veterans Affairs | The Under Secretary for Benefits should update the implementation plan and timeline to identify deliverables, time frames, and interim milestones for consolidating military sexual trauma disability claims processing. (Recommendation 6) |
VA agreed with this recommendation. In September 2023, VA updated its plan for completing the consolidation of military sexual trauma (MST) disability claims into one MST operations center. Specifically, once the operations center reached its full staffing level, the agency would no longer use staff from other offices. As a result, the agency would maintain a consistent level of staffing for processing these claims. In October 2023, VA completed staffing its operations center and no longer relies on claims processing resources from other offices.
|
| Department of Veterans Affairs | The Under Secretary for Benefits should designate a centralized leadership team to oversee and prioritize VBA's ongoing and new reform efforts intended to improve the efficiency and effectiveness of the disability compensation program. (Recommendation 7) |
VA agreed in principle with this recommendation. As of September 2024, VBA officials reported taking steps to address it. Specifically, VBA leadership designated a team to develop an action plan and coordinate activities to develop a set of leading reform practices. VBA officials reported that they will pilot a framework for tracking adoption of these reform practices, among other efforts. They plan to finalize these efforts in the second quarter of fiscal year 2025. We are encouraged by VBA taking steps to help ensure its reform efforts are effectively planned, implemented, and assessed. We will consider closing this recommendation when VA demonstrates that it has developed and implemented a set of leading reform practices and is overseeing its managers use of them to plan and manage ongoing and future disability compensation program reforms.
|
| Department of Veterans Affairs |
Priority Rec.
The Under Secretary for Benefits should develop and implement a policy that comprehensively describes the leading practices for effective government reform that VBA officials should follow, as appropriate, when undertaking efforts to improve the efficiency and effectiveness of the disability compensation program. (Recommendation 8) |
VA agreed in principle with this recommendation. As of September 2024, VBA officials reported taking steps to address it. Specifically, VBA leadership designated a team to develop an action plan and coordinate activities to develop a set of leading reform practices. VBA officials reported that they will pilot a framework for tracking adoption of these reform practices, among other efforts. They plan to finalize these efforts in the second quarter of fiscal year 2025. We are encouraged by VBA initiating efforts to help ensure its reform efforts are effectively planned, implemented, and assessed. We will consider closing this recommendation when VA demonstrates that it has developed and implemented a set of leading reform practices, such as those described in our report, that managers should use to plan and manage ongoing and future disability compensation program reforms.
|