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VA Claims: Disabled Veterans Community|Hadit.com

VA DISABILITY EXAMS: Improved Performance Analysis and Training Oversight Needed for Contracted Exams

What GAO Found

The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency’s quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors’ quality scores fell well below VBA’s target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information. GAO-19-13: Published: Oct 12, 2018. Publicly Released: Nov 8, 2018

VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA’s quality and timeliness information limit VBA’s ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.

A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.

Why GAO Did This Study

In 2016, VBA awarded 12 contracts to five private firms for up to $6.8 billion lasting up to 5 years to conduct veterans’ disability medical exams. Both VBA contracted medical examiners and medical providers from the Veterans Health Administration perform these exams, with a growing number of exams being completed by contractors. Starting in 2017, VBA contracted examiners conducted about half of all exams. GAO was asked to review the performance and oversight of VBA’s disability medical exam contractors.
This report examines (1) what is known about the quality and timeliness of VBA contracted exams; (2) the extent to which VBA monitors contractors’ performance; and (3) how VBA ensures that its contractors provide qualified and well-trained examiners. GAO analyzed the most recent reliable data available on the quality and timeliness of exams (January 2017 to February 2018), reviewed VBA and selected contract documents and relevant federal laws and regulations, and interviewed agency officials, exam contractors, an audit firm that checks examiners’ licenses, and selected veterans service organizations.

What GAO Recommends

GAO recommends VBA (1) develop a plan for using its new data system to monitor contractors’ quality and timeliness performance, (2) analyze overall program performance, (3) verify that contracted examiners complete required training, and (4) collect information to assess the effectiveness of that training. The Department of Veterans Affairs agreed with GAO’s recommendations.
View Report (PDF)
https://www.gao.gov/assets/700/694986.pdf

Understanding Decisions from RAMP

Background

Guest Post from Hill & Ponton


RAMP (Rapid Appeals Modernization Program) is the VA’s pilot program for the new appeals system created by the VA Appeals Improvement and Modernization Act of 2017. RAMP is an optional program, available to veterans with claims that are currently on appeal. If a veteran does not want to opt into the RAMP program, they do not have to submit anything to the VA; their appeals will continue to be processed in the current appeals system now referred to as the Legacy Appeals System.

Information on RAMP Rating Decisions

Now that the RAMP program has been in effect for several months, veterans who opted in are receiving rating decisions. It is important to understand the information included in these decisions, and also what your options are if you are not happy with the decision.
The appearance of rating decisions hasn’t changed much with the RAMP program. However, the information that must be included in the rating decision has changed slightly. RAMP rating decisions must list all favorable findings that the VA identified when reviewing the case, including listing what evidence was considered as favorable. The VA must also identify the evidencethey considered to be unfavorable. In the narrative part of the rating decision, the VA must explain how the favorable and unfavorable evidence was weighed in coming to their ultimate finding. In addition to listing the evidence, the VA also has to include a list of all regulations and laws that were applied in making their decision.

Forms Included in RAMP Rating Decisions

In addition to the explanation and the list of evidence and regulations,  RAMP decisions will have two forms attached. These two forms are the RAMP Review Rights form and the RAMP Selection form.
The RAMP Review Rights form gives information about how to appeal the decision. The different ways to appeal a decision from RAMP are based on the different lanes that make up the RAMP program.  The appeal options include:

  • Supplemental Claim: If you are unhappy with the rating decision and would like to submit new evidence, this is the appeal option to select. Once the new evidence (must be new and relevant) is submitted, a different rater will review the case.
  • Higher Level Review: This appeal option can only be selected if the decision being appealed was issued out of the supplemental claim lane,  and you do not have any additional evidence to submit. (Note: if opting into RAMP, the only requirement is that no additional evidence can be submitted.) A higher-level VA employee will review the decision that is being appealed based on the evidence of record.
  • Board of Veterans’ Appeals (BVA): If you are unhappy with the rating decision and want to take your appeal straight to the BVA, use this appeal option (Note: the BVA will not begin deciding RAMP appeals until October 2018). If you choose to appeal to the Board of Veterans’ Appeals, you will have to select one of three options. These options are:
  • Direct Docket: Select this if you have no additional evidence to submit, and you do not want a hearing. The BVA will issue their decision based on the evidence of record.
  • Evidence Only Docket: Select this if you would like to submit additional evidence, but do not want a hearing. After submitting your appeal, you will have 90 days to submit additional evidence.
  • Hearing Docket: Select this if you would like to have a hearing with a Veterans Law Judge. You will also be able to submit additional evidence up to 90 days after submitting your appeal.

The second form that will be attached to a RAMP rating decision is the RAMP Selection form. After deciding which appeal option is best for you, fill out the RAMP Selection form. This form requires you to specify which issues you are appealing, and which appeal option you are choosing.

VA’s Rapid Appeals Modernization Program (RAMP)

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What is RAMP?

RAMP allows Veterans to seek faster resolution of their disagreement with VA’s decision on a disability compensation claim. Opting into RAMP means you can remove your appeal from the old, limited appeals process and enter the new, more efficient review process. In RAMP, you can choose between two new ways to have your disagreement reviewed: as a supplemental claim or via a higher-level review. VA will then provide you with a decision on your disagreement in an average of 125 days.
[/one-half-first][one-half]More on RAMP
Veterans Appeals Improvement and Modernization Act

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VA Appeals Modernization

RAMP is part of VA’s larger Appeals Modernization Program. On August 23, 2017, the President signed the Veterans Appeals Improvement and Modernization Act of 2017 (Appeals Modernization Act) into law, creating a new process that allows VA to improve the delivery of benefits and services to Veterans and their families.The Appeals Modernization Act establishes a new review process for VA claims that is timely, transparent and fair. Although the new Appeals Modernization Act process does not go into effect until February 2019, VA is giving eligible Veterans the opportunity to participate in two of the new review lanes early through RAMP.

Opting into RAMP

Now, any Veteran with an eligible disability compensation appeal may choose to opt into RAMP. To find out if your disability compensation appeal is in an eligible stage you can go to www.vets.gov and use the Appeals Status Tool. There are three ways you can opt into RAMP:

 Are you eligible for RAMP?

 Veterans who have a disability compensation appeal pending in one of the following legacy appeal stages are able to opt into RAMP:

  •  Notice of Disagreement (NOD) 
  •  Form 9, Appeal to Board of Veterans’ Appeals
  • Certified to the Board (sent to the Board but not yet formally placed on its docket)
  • Remand from the Board to VBA

What If You Disagree with a RAMP Decision?

If you disagree with a decision you received from RAMP, you can choose to have your claim reviewed again either as a higher-level review or as a supplemental claim. Choosing one review option initially does not prevent you from choosing another review option after you’ve received an initial decision in RAMP. For example, if you initially choose the Higher-Level Review Lane and disagree with VA’s decision from that review, you can then choose the Supplemental Claim Lane to add new and relevant evidence to support your claim.Alternatively, you may choose to file an NOD directly to the Board.


More on RAMP
Veterans Appeals Improvement and Modernization Act

 

VA: Actions Needed to Address Employee Misconduct Process and Ensure Accountability

Employee misconduct at VA’s medical facilities can have serious consequences for veterans. We looked at how VA deals with employee misconduct and found several opportunities for improvement. For example:

VA doesn’t always maintain required files and documents for adjudication, suggesting that employees may not have received due process.

VA officials found guilty of misconduct sometimes received a lesser punishment than recommended or no punishment.

Whistleblowers were 10 times more likely than their peers to receive disciplinary action within a year of reporting misconduct.

 Why GAO Did This Study

VA provides services and benefits to veterans through hospitals and other facilities nationwide. Misconduct by VA employees can have serious consequences for some veterans, including poor quality of care. GAO was asked to review employee misconduct across VA. This report reviews the extent to which VA (1) collects reliable information associated with employee misconduct and disciplinary actions, (2) adheres to documentation-retention procedures when adjudicating cases of employee misconduct, (3) ensures allegations of misconduct involving senior officials are reviewed according to VA investigative standards and these officials are held accountable, and (4) has procedures to investigate whistle-blower allegations of misconduct; and the extent to which (5) data and whistle-blower testimony indicate whether retaliation for disclosing misconduct occurs at VA.
GAO analyzed 12 information systems across VA to assess the reliability of misconduct data, examined a stratified random sample of 544 misconduct cases from 2009 through 2015, analyzed data and reviewed cases pertaining to senior officials involved in misconduct, reviewed procedures pertaining to whistle-blower investigations, and examined a nongeneralizable sample of whistle-blower disclosures from 2010 to 2014.

What GAO Found

The Department of Veterans Affairs (VA) collects data related to employee misconduct and disciplinary actions, but fragmentation and data-reliability issues impede department-wide analysis of those data. VA maintains six information systems that include partial data related to employee misconduct. For example, VA’s Personnel and Accounting Integrated Data system collects information on disciplinary actions that affect employee leave and pay, but the system does not collect information on other types of disciplinary actions. The system also does not collect information such as the offense or date of occurrence. GAO also identified six other information systems that various VA administrations and program offices use to collect specific information regarding their respective employees’ misconduct and disciplinary actions. GAO’s analysis of all 12 information systems found data-reliability issues—such as missing data, lack of identifiers, and lack of standardization among fields. Without collecting reliable misconduct and disciplinary action data on all cases department-wide, VA’s reporting and decision making on misconduct are impaired.
VA inconsistently adhered to its guidance for documentation retention when adjudicating misconduct allegations, based on GAO’s review of a generalizable sample of 544 out of 23,622 misconduct case files associated with employee disciplinary actions affecting employee pay. GAO estimates that VA would not be able to account for approximately 1,800 case files. Further, GAO estimates that approximately 3,600 of the files did not contain required documentation that employees were adequately informed of their rights during adjudication procedures—such as their entitlement to be represented by an attorney. The absence of files and associated documentation suggests that individuals may not have always received fair and reasonable due process as allegations of misconduct were adjudicated. Nevertheless, VA’s Office of Human Resource Management does not regularly assess the extent to which files and documentation are retained consistently with applicable requirements.
VA did not consistently ensure that allegations of misconduct involving senior officials were reviewed according to investigative standards and these officials were held accountable. For example, based on a review of 23 cases of alleged misconduct by senior officials that the VA Office of Inspector General (OIG) referred to VA facility and program offices for additional investigation, GAO found VA frequently did not include sufficient documentation for its findings, or provide a timely response to the OIG. In addition, VA was unable to produce anydocumentation used to close 2 cases. Further, OIG policy does not require the OIG to verify the completeness of investigations, which would help ensure that facility and program offices had met the requirements for investigating allegations of misconduct. Regarding senior officials, VA did not always take necessary measures to ensure they were held accountable for substantiated misconduct. As the figure below shows, GAO found that the disciplinary action proposed was not taken for 5 of 17 senior officials with substantiated misconduct.
Action Proposed in Department of Veterans Affairs (VA) Office of Accountability Review’s Legacy Referral Tracking List Compared with Final Action Taken

Action Proposed in Department of Veterans Affairs (VA) Office of Accountability Review’s Legacy Referral Tracking List Compared with Final Action Taken


*Adverse action.
As a result of June 2017 legislation, a new office within VA—the Office of Accountability and Whistleblower Protection—will be responsible for receiving and investigating allegations of misconduct involving senior officials.
VA has procedures for investigating whistle-blower complaints, but the procedures allow the program office or facility where a whistle-blower has reported misconduct to conduct the investigation. According to the OIG, it has the option of investigating allegations of misconduct, or exercising a “right of first refusal” whereby it refers allegations of misconduct to the VA facility or program office where the allegation originated. VA does not have oversight measures to ensure that all referred allegations of misconduct are investigated by an entity outside the control of the facility or program office involved in the misconduct, to ensure independence. As a result, GAO found instances where managers investigated themselves for misconduct, presenting a conflict of interest.Data and whistle-blower testimony indicate that retaliation may have occurred at VA. As the table below shows, individuals who filed a disclosure of misconduct with the Office of Special Counsel (OSC) received disciplinary action at a much higher rate than the peer average for the rest of VA in fiscal years 2010–2014.
Data and whistle-blower testimony indicate that retaliation may have occurred at VA. As the table below shows, individuals who filed a disclosure of misconduct with the Office of Special Counsel (OSC) received disciplinary action at a much higher rate than the peer average for the rest of VA in fiscal years 2010–2014.

Comparison of Adverse Disciplinary Action Taken for Nonanonymous Department of Veterans Affairs (VA) Employees Who Reported Wrongdoing and Those Who Did Not, 2010–2014
Employee category Percentage for whom adverse actions were taken
Prior to disclosure Year of disclosure Year after disclosure
Individuals who filed a disclosure 2 10 8
Rest of VA 1 1 1

Additionally, GAO’s interviews with six VA whistle-blowers who claim to have been retaliated against provided anecdotal evidence that retaliation may be occurring. These whistle-blowers alleged that managers in their chain of command took several untraceable actions to retaliate against the whistle- blowers, such as being denied access to computer equipment necessary to complete assignments.

What GAO Recommends

GAO makes numerous recommendations to Veterans Affairs to help enhance its ability to address misconduct issues.
GAO recommends, among other things, that the Secretary of Veterans Affairs

  • develop and implement guidance to collect complete and reliable misconduct and disciplinary-action data department-wide; such guidance should include direction and procedures on addressing blank fields, lack of personnel identifiers, and standardization among fields;
  • direct applicable facility and program offices to adhere to VA’s policies regarding misconduct adjudication documentation;
  • direct the Office of Human Resource Management to routinely assess the extent to which misconduct-related files and documents are retained consistently with applicable requirements;
  • direct the Office of Accountability and Whistleblower Protection (OAWP) to review responses submitted by facility or program offices to ensure evidence produced in senior-official case referrals demonstrates that the required elements have been addressed;
  • direct OAWP to issue written guidance on how OAWP will verify whether appropriate disciplinary action has been implemented; and
  • develop procedures to ensure (1) whistle-blower investigations are reviewed by an official independent of and at least one level above the individual involved in the allegation, and (2) VA employees who report wrongdoing are treated fairly and protected against retaliation.

GAO also recommends, among other things, that the VA OIG

  •  revise its policy and require verification of evidence produced in senior-official case referrals.

VA concurred with nine recommendations and partially concurred with five. In response, GAO modified three of the recommendations. The VA OIG concurred with one recommendation and partially concurred with the other. GAO continues to believe that both are warranted. GAO modified three of the recommendations. The VA OIG concurred with one recommendation and partially concurred with the other. GAO continues to believe that both are warranted.
https://www.gao.gov/products/GAO-18-137

Employee misconduct at VA’s medical facilities can have serious consequences for veterans. We looked at how VA deals with employee misconduct and found several opportunities for improvement. For example:VA doesn’t always maintain required files and documents for adjudication, suggesting that employees may not have received due process.VA officials found guilty of misconduct sometimes received a lesser punishment than recommended or no punishment.Whistleblowers were 10 times more likely than their peers to receive disciplinary action within a year of reporting misconduct.