Findings
In March and April 2005, we surveyed RVSRs and DROs to obtain their input on issues that affect the rating of disability compensation claims. The survey had 38 questions about the backgrounds and training of the RVSRs and DROs, claims development, application of the rating schedule, production standards, and staffing. We also offered respondents the opportunity to provide comments on these or other issues. We received responses from 1,349 (67.7 percent) of the 1,992 potential respondents.
Demographics of Respondents. Survey respondents reported working an average of 6
years as RVSRs or DROs and an average of 14 years as VBA employees. The average age of the respondents is 47. Forty-five percent are veterans, and 59.2 percent of the veterans have service-connected disabilities.
Training. RVSRs and DROs expressed generally positive opinions of the quality of their
training, but their responses indicate training has not received high priority.
• Fifty-seven percent evaluated the overall quality of training as good or very good; 16
percent evaluated it as poor or very poor.
• Forty-five percent reported that in the last 12 months they had received 10 hours or
less of formal classroom instruction on rating policies and procedures. An additional 24.1 percent reported that they had received 11–20 hours of formal classroom instruction in the last 12 months.
• When asked how often their offices provide formal classroom instruction on rating
policies and procedures, 18.0 percent replied once a week, 45.6 percent said once a month, and 36.4 percent said once a quarter or less often.
Claims Development. RVSRs and DROs expressed dissatisfaction with the adequacy of
claims development. Forty-one percent of respondents estimated that 30 percent or more of the claims sent to the rating teams in the past 12 months as ready to rate were not actually ready. An additional 45.0 percent of respondents estimated that 10–29 percent of the claims were not ready.
Respondents believe that some claims are rated without all the needed information. Twenty percent estimated that, of the claims that were not ready to rate, more than 10 percent were actually rated without all the needed information. An additional 19.3 percent of respondents estimated that 5–10 percent of the claims that were not ready were actually rated without all the needed information.
Survey responses indicate that the quality of C&P medical exams performed by VA examiners and contract examiners is comparable. Forty-eight percent evaluated the quality of exams by VA examiners as good or very good; 18.5 percent evaluated them as poor or very poor. Forty-nine percent evaluated the quality of exams by contract examiners as good or very good; 16.3 percent evaluated them as poor or very poor.
Respondents believe that more C&P exams should be returned to the examiners as insufficient for rating purposes. Responses to two survey questions showed a significant disparity between estimates of the percentage of C&P exams that should have been returned and the percentage that were actually returned.
• Thirty-two percent of respondents estimated that 20 percent or more of exams should
have been returned as insufficient. An additional 14.7 percent estimated that 11–19 percent of exams should have been returned as insufficient.
• Only 6.5 percent of respondents estimated that 20 percent or more of C&P exams
were returned to the examiners as insufficient. An additional 8.5 percent estimated that 11–19 percent of exams were returned.
Application of Rating Schedule. Questions pertaining to the rating schedule resulted in
mixed responses. Respondents indicated that they generally do not have difficulty using the schedule to assign diagnostic codes and degrees of disability, but that they could often support two or more different ratings for the same medical condition.
• Fifty-two percent of respondents stated it is generally easy or very easy to translate
complete medical evidence to a diagnostic code with degrees of disability; 16.5 percent stated it is generally difficult or very difficult.
• In response to another question, 52.4 percent of respondents replied it is somewhat
likely or very likely that two or more different ratings for the same medical condition could be supported; 25.0 percent replied it is somewhat unlikely or very unlikely. When questioned about the ease of rating disabilities in each body system, RVSRs and DROs indicated that they have the least difficulty rating claims involving cardiovascular, respiratory, auditory, and eye conditions. They consider claims involving neurological and convulsive disorders, dental and oral conditions, and mental disorders the most difficult to rate. Survey responses indicated it is most likely that two or more different ratings could be supported for claims involving musculoskeletal conditions, mental disorders, and neurological and convulsive disorders. It is least likely that two or more different ratings could be supported for claims involving auditory and eye conditions, dental and oral conditions, and respiratory disorders.
Most respondents stated that when rating a claim they assume the veteran is applying for the highest possible rating and apply a broad and liberal interpretation of the rating schedule.
• Eighty-one percent strongly agreed or agreed somewhat with the statement that when
rating a claim they start with the assumption that the veteran is applying for the highest possible rating for the claimed disability. Only 5.2 percent disagreed somewhat or strongly disagreed with that statement.
• Eighty percent strongly agreed or agreed somewhat with the statement that when
rating a claim they apply a broad and liberal interpretation of the rating schedule. Only 7.3 percent disagreed somewhat or strongly disagreed with that statement.
RVSRs and DROs believe their objectives are different from those of their managers. We asked them to rank the importance of 16 potential objectives. Their responses indicated that when rating claims their most important objectives are complying with applicable criteria, granting the highest ratings allowed, and ensuring they have sufficient information before making decisions. We also asked them to rank the importance to their managers of 15 comparable objectives. Their responses indicated that they believe the most important objectives for their managers are maximizing the number of ratings done each day, reducing the backlog of pending work, and improving the timeliness of ratings.
Production Standards. Each VARO establishes production standards for its RVSRs and
DROs, and those standards must equal or exceed national standards established by VBA.
For journeyman RVSRs, the production standards range from 3 to 5 weighted8 cases per
day for those working in the VAROs and from 3 to 7 weighted cases per day for those working at home. DROs have production standards ranging from 3 to 4 weighted cases per day.
Survey responses showed that RVSRs and DROs are concerned about their production standards, and many respondents indicated that the need to meet production standards adversely affects the quality of their work.
• Forty-seven percent said it is generally difficult or very difficult to meet their daily
production standards; 22.5 percent said it is generally easy or very easy.
• Forty-nine percent strongly disagreed or disagreed somewhat with the statement that
they have no difficulty meeting their production standards without sacrificing quality; 30.5 percent strongly agreed or agreed somewhat with that statement.
• Fifty-seven percent strongly agreed or agreed somewhat with the statement that they
have difficulty meeting their production standards if they make sure they have
8 Cases are assigned different weights based on the type of claim and the number of claimed disabilities or issues rated.
sufficient evidence for rating each case and thoroughly review the evidence; 24.1 percent strongly disagreed or disagreed somewhat with that statement.
Staffing. Most RVSRs and DROs do not believe VAROs have sufficient rating staff.
Sixty-five percent indicated that the rating activities in their offices have somewhat smaller or much smaller staffs than needed to provide timely and high quality service. Thirty-one percent indicated that the rating activities have about the right number of staff, and 4 percent indicated that the rating activities have somewhat larger or much larger staffs than needed.
Respondent Comments. At the end of the survey, we invited respondents to provide
comments, and 593 provided additional input on a wide range of issues. Twenty-one respondents provided comments that were entirely positive, 424 identified problems or suggested improvements, and 148 provided statements with no apparent positive or negative connotations. The most frequently discussed issue, mentioned by 193 respondents, was management’s perceived emphasis on production at the expense of quality. The second most frequently discussed issue, mentioned by 44 respondents, was the need for more and better training. Other issues mentioned by multiple respondents included managers’ reluctance to return insufficient C&P exams, inadequacy of claims development, inconsistency of the production standards at different VAROs, inconsistent handling of PTSD claims, and the need to update the rating schedule. A selection of comments is provided below:
“Although management wants to meet quality goals, they are much more concerned with quantity. An RVSR is much more likely to be disciplined for failure to meet production standards than for failing to meet quality standards.”
“I have been encouraged to grant the highest benefit allowed by law since the date I began working for the VA. Management in our office stresses the importance of giving the veteran the highest benefit to which he or she is entitled by law. However, there is a lot of pressure to make your production standard. In fact, your performance standard centers around production and a lot of awards are based on it. Those who don't produce could miss out on individual bonuses, etc.”
“I believe our office should participate more in the broadcasts, many times they are taped and we are told we can see them at a later date, but never do. I beli[e]ve there should be more centralized training for RVSRs and DROs in order to provide more consistent ratings. I have worked brokered cases from several stations and have seen great differences in the way benefits are granted. One example is the grant of PTSD. Some offices grant service connection using only the Vietnam Service Medal as a stressor. This is not correct. Another observation is that there is never
any recognition or awards for quality work, awards only go to those who produce the most ratings. Management has indicated on several occasions that quality is as important as quantity, but this is not supported when it comes to handing out awards.”
“I find that there are too many changes in how cases are expected to be rated without enough training and instruction….”
“Exams often lack basic information needed for rating a disability, and generally speaking, we do not send back VA exams as insufficient.”
“The Rating Schedule allows for too much subjectivity in rating many conditions. For example when rating a digestive condition we rate on pronounced, severe, moderate or mild symptoms however we have no specific definition on what is considered pronounced, severe, moderate or mild.”
“Our local management does not make any requirements to rate cases that are not ready, or to inaccurately rate cases. Cases are rated based on the evidence of record….”
“If consistency nationwide is the goal, then the current rating schedule and other regulations are inadequate. Generally, there is too much room for subjective interpretation of evidence as applied to rating schedule criteria, even if the medical evidence is 'complete' (which it often is not; the generally poor or inconsistent quality of VA examinations plays a role in this issue, as well). That is why there is even a question of whether or not an individual or a station encourages a 'liberal' or a 'narrow' interpretation. Purely, or at least more, objective criteria for all body systems and diagnostic codes might help.”
“For the past 10 years no examination has been allowed to be returned as inadequate because the regional office concocted a deal with the hospital to cook the books on examination quality….Rating specialists and DRO's have been pressured to make rating decisions unwarranted by the evidence to make 'problem cases' go away….”
“The real truth will show that we are doing a fair job with each case we handle. Each veteran counts and the disabilities are rated as they should be, fairly.”
“The rules and regulations have changed so fast and ballooned in scope and complexity until I feel very strongly that: 1) no two RVSRs in our office would look at the same claim with the same evidence and come to
the same conclusion unless it was a very simple issue and 2) any reviewer could find something wrong with any rating that they picked up….One comment on the VA exam situation: some VA medical centers are very good and some are awful. We get everything we need from some and next to nothing from others. I have learned to live with what I have and rate accordingly….”
For a summary of responses to each question in the survey, see Appendix E.
Differences in Responses from States with Highest Compensation Payments and
States with Lowest Payments. We compared the responses of RVSRs and DROs from
the six states with the highest average compensation payments and the six states with the lowest average compensation payments to determine whether there were differences that might help explain the disparity in average payments to residents of those states. The comparison showed that the two groups have more similarities than differences. For example:
• The two groups of respondents are similar in length of experience, age, and
percentage with veteran status.
• They expressed similar levels of dissatisfaction with claims development and
indicated that more C&P exams should be returned to the examiners as insufficient for rating purposes.
• Similar percentages of respondents from both groups said that when rating a claim
they assume the veteran is applying for the highest possible rating and they apply a broad and liberal interpretation of the rating schedule.
• The two groups have similar objectives when rating disability claims.
• They share concerns about production standards and staffing.
The following paragraphs summarize differences between the responses of RVSRs and DROs from the states with the highest average compensation payments and the responses of those from states with the lowest average compensation payments.
Demographics of Respondents. Responses of RVSRs and DROs with veteran status
revealed differences in the percentages with service-connected disabilities and the periods of active duty. In states with the highest average payments, 75.4 percent of the RVSRs or DROs who are veterans have service-connected disabilities, while in states with the lowest payments this figure is 46.3 percent. In states with the highest average payments, RVSRs and DROs are more likely to have served on active duty during Peacetime or Gulf War than RVSRs and DROs in states with the lowest average payments, who are more likely to have served during the Vietnam Era.
Training. Survey responses indicated that training has received higher priority in the six states with the highest average compensation payments than in the six states with the lowest payments. The following graph compares estimates of the amount of formal classroom instruction on rating policies and procedures received by RVSRs and DROs in the past 12 months.
Figure 8. Hours of Formal Classroom Instruction
0 5 10 15 20 25 30 35 40 45 Percentage
States with highest average compensation payments States with lowest average compensation payments one –10 1–20 1–30 1–40 1–50 n50 N 1 1 2 3 4 ha t ore M Hours
Responses to other survey questions also indicated that training of RVSRs and DROs has received higher priority in states with the highest average compensation payments. For example, when asked how often their offices provide formal classroom instruction on rating policies and procedures, 35.1 percent of respondents from states with the highest payments said once a week, 41.7 percent said once a month, and 23.2 percent said once a quarter or less often. In contrast, only 15.4 percent of respondents from states with the lowest payments said their offices provide formal classroom instruction on rating policies and procedures once a week, 45.6 percent said once a month, and 39 percent said once a quarter or less often.
Claims Development. Respondents from states with the highest average compensation
payments have a more favorable opinion of C&P exams, whether performed by VA examiners or contract examiners, than respondents from states with the lowest average compensation payments.
• Fifty-two percent of respondents from states with the highest average compensation
good. Forty-two percent of respondents from states with the lowest payments evaluated the quality of exams performed by VA examiners as good or very good.
• Fifty-three percent of respondents from states with the highest average compensation
payments evaluated the quality of exams performed by contract examiners as good or very good. Thirty-seven percent of respondents from states with the lowest payments evaluated the quality of exams performed by contract examiners as good or very good.
Application of Rating Schedule. RVSRs and DROs from states with the highest
average compensation payments indicated they have less difficulty using the rating schedule to assign diagnostic codes and degrees of disability than RVSRs and DROs from states with the lowest payments, as shown in the following table:
Table 36. Ease of Translating Complete Medical Evidence to a Rating
States States Response
Six High Payment Six Low Payment
Very Easy 13.2 6.6
Generally Easy 43.7 41.4
Neither Easy Nor Difficult 31.8 35.4
Generally Difficult 10.6 15.5
Very Difficult 0.7 1.1
Impact of Recent Publicity. More than 90 percent of respondents from states with the
highest average compensation payments and from states with the lowest payments denied that their rating decisions have been affected by published comparisons of compensation payments to veterans in different states. However, respondents from states with the highest payments were less likely than respondents from states with the lowest payments to indicate that their rating decisions have been affected by published comparisons of compensation payments and less likely to indicate that managers have encouraged them to change their attitudes when rating disability claims. (It should be noted that for new claims in FY 2005, Illinois had moved to fifth place among the 50 states for average annual compensation payments.)
• Only 3.3 percent of respondents from states with the highest average compensation
payments and 9.4 percent of respondents from states with the lowest payments said their rating decisions in the last 2 to 3 months have been affected by published comparisons of compensation payments to veterans in different states.
• Fifteen percent of respondents from states with the highest average compensation
payments and 49 percent of respondents from states with the lowest payments said