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Veterans' Disability Benefits: VA Could Enhance Its Progress in Complying with Court Decision on Disability Criteria.

GAO-06-46 October 12, 2005

To properly decide veterans' disability claims, the regional offices of the Department of Veterans Affairs (VA) must obtain all medical evidence required by law and federal regulations. To do so, in fiscal year 2004, the regional offices asked VA's medical centers to examine about 500,000 claimants and provide examination reports containing the necessary medical information. Exams for joint and spine impairments are among the exams that regional offices most frequently request, and in 2002, VA found that 61 percent of the exam reports for such impairments did not provide sufficient information for regional offices to make decisions complying with disability criteria mandated by the U.S. Court of Appeals for Veterans Claims in DeLuca v. Brown, 8 Vet. App. 202 (1995). In DeLuca, the court held that when federal regulations define joint and spine impairment severity in terms of limits on range of motion, VA claims adjudicators must consider whether range of motion is further limited by factors such as pain and fatigue during "flare-ups" or following repetitive use of the impaired joint or spine. Whenever VA regional offices ask VA medical centers to conduct joint and spine disability exams, the medical centers should prepare exam reports containing the information mandated in DeLuca. Congress asked that we determine VA's progress since 2002 in ensuring that its medical centers consistently prepare joint and spine exam reports containing the information required by DeLuca.

In summary, since 2002, VA has made progress in ensuring that its medical centers' exam reports adequately address the DeLuca criteria, but more improvements are needed. As of May 2005, the percentage of joint and spine exam reports not meeting the DeLuca criteria had declined substantially from 61 percent to 22 percent. Much of this progress appears attributable to a performance measure for exam report quality that VHA established in fiscal year 2004. However, a 22 percent deficiency rate indicates that many joint and spine exam reports still did not comply with DeLuca, and moreover, the percentage of exam reports satisfying the DeLuca criteria varied widely--from a low of 57 percent to a high of 92 percent among VHA's 21 health care networks. Further, VA's Compensation and Pension Examination Project (CPEP) Office has found deficiencies in a substantial portion of the requests that VBA's regional offices send to VHA's medical centers, asking them to perform disability exams. For example, the CPEP Office found in early 2005 that nearly one-third of the regional office requests for spine exams contained errors such as not identifying the pertinent medical condition or not requesting the appropriate exam. However, VBA has not yet established a performance measure for the quality of the exam requests that regional offices submit to medical centers.
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Publication:General Accounting Office Reports & Testimony
Date:Jan 1, 2006
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