GAO-23-106097, VA DISABILITY BENEFITS: Actions Needed to ...

July 2023

United States Government Accountability Office

Report to Congressional Committees

VA DISABILITY BENEFITS

Actions Needed to Further Examine Racial and Ethnic Disparities in Compensation

GAO-23-106097

Highlights of GAO-23-106097, a report to congressional committees

July 2023

VA DISABILITY BENEFITS

Actions Needed to Further Examine Racial and Ethnic Disparities in Compensation

Why GAO Did This Study

Veterans from historically disadvantaged racial and ethnic groups comprised almost 24 percent of the total veteran population in 2017, according to a VA report. By 2045, this group of veterans will make up over 36 percent of all living veterans, according to VA projections.

Public Law 117-66 includes a provision for GAO to assess whether there are racial and ethnic disparities with respect to disability compensation, among other areas. This report examines the extent to which (1) VA has taken steps to collect and assess data about the racial and ethnic composition of veterans who may apply for disability compensation; and (2) racial and ethnic disparities exist in the provision of compensation, and what factors could contribute to disparate outcomes.

GAO reviewed relevant federal laws, regulations, and VA policies; analyzed VA's claims data by race, ethnicity, and sex from fiscal year 2010 through 2020 (the most recent full year of data available); and interviewed VA officials and representatives from a VA advisory group and selected veterans service organizations.

What GAO Recommends

GAO is making three recommendations to VA, including that it develop a plan to address limitations with its race and ethnicity data, and to conduct a comprehensive assessment of disability compensation to identify the root causes that could contribute to racial and ethnic disparities. VA agreed with the recommendations.

What GAO Found

The Department of Veterans Affairs (VA) has taken steps to improve how it collects race and ethnicity data to understand the experiences of veterans who may apply for disability compensation through the Veterans Benefits Administration (VBA). For example, VA created a working group that specifically focused on improving demographic data collection. VA's collection efforts could enhance the data available to VBA to assess racial and ethnic disparities in disability compensation. However, VA has not developed a documented plan for how it will improve the availability of data for certain racial and ethnic groups who may not be accessing VA services and benefits. Without a plan to identify and document concrete actions, VA will not have the data it needs to ensure veterans are treated equitably. GAO's analysis of fiscal year 2010 through 2020 compared initial claims approval rates for all racial and ethnic groups to Non-Hispanic White (White) veterans-- the largest group with decisions. GAO found that Non-Hispanic Black or African American (Black) veterans had the lowest approval rate among all groups (see figure). Similarly, GAO's analysis of selected medical conditions most frequently decided by VA found that differences in approval rates were particularly prominent between Black male and White male veterans, with Black male veterans' rates being 3 to 22 percentage points lower. These differences were prevalent for nine of the 10 conditions GAO analyzed such as tinnitus and posttraumatic stress disorder. VBA has conducted studies on racial and ethnic disparities in disability compensation for some conditions and found disparities. However, it has not comprehensively studied the root causes of the disparities it has found or potential disparities in the provisions of compensation more broadly. As a result, VA lacks the information it needs to ensure equitable decisions.

VA Disability Compensation Approval Rates for Initial Claims, by Race and Ethnicity (Fiscal Years 2010?2020)

Note: GAO grouped individuals of Hispanic ethnicity under that designation regardless of race.

View GAO-23-106097. For more information, contact Elizabeth H. Curda at (202) 512-7215 or curdae@.

United States Government Accountability Office

Contents

Letter

Appendix I Appendix II Appendix III Appendix IV Tables

1

Background

5

VA Has Taken Steps to Improve Its Collection of Race and

Ethnicity Data, but Has Not Documented Its Plans to Address

Limitations

10

VA Approved Initial Disability Claims at Lower Rates for Black

than White Veterans, but Has Not Comprehensively Studied

Racial and Ethnic Disparities

14

Conclusions

31

Recommendations for Executive Action

31

Agency Comments and Our Evaluation

32

Objectives, Scope, and Methodology

34

Analysis of Department of Veterans Affairs' Data on Disability Claims,

Fully Developed Claims, and Disability Ratings

45

Comments from the Department of Veterans Affairs

159

GAO Contact and Staff Acknowledgments

163

Table 1: VA Disability Compensation Approval Rates for Veterans

with Initial Claims and Additional Claims, by Race and

Ethnicity, Fiscal Years 2010?2020

19

Table 2: VA Disability Compensation Approval Rates for Fully

Developed Claims Program and Standard Claims Process

by Race and Ethnicity, Fiscal Years 2015?2020

21

Table 3: VA Disability Compensation Approval Rates for White

and Black Male Veterans for Selected Medical Conditions,

Fiscal Years 2010?2020

23

Table 4: Most Common Conditions Decided by VA from Veterans'

Initial Disability Compensation Claims, Fiscal Years 2010?

2020

40

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GAO-23-106097 VA Disability Benefits

Table 5: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation Claims by Race, Ethnicity, and

Sex, Fiscal Years 2010?2020

46

Table 6: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation Claims Each Fiscal Year (FY) by

Race, Ethnicity, and Sex, Fiscal Years 2010?2020

48

Table 7: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation Claims with Fewer Than Eight

Conditions by Race, Ethnicity, and Sex, Fiscal Years

2010?2020

53

Table 8: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation Claims with Eight or More

Conditions by Race, Ethnicity, and Sex, Fiscal Years

2010?2020

55

Table 9: VA Approval and Denial Rates Combining Veterans with

Initial and Additional Disability Compensation Claims by

Race, Ethnicity, and Sex, Fiscal Years 2010?2020

57

Table 10: Proportions of Veterans Who Received VA Disability

Compensation Combined Ratings for Initial Claims by

Race, Ethnicity, and Sex, Fiscal Years 2010?2020

59

Table 11: Proportions of Veterans Who Received VA Disability

Compensation Combined Ratings for Initial Claims with

Fewer Than Eight Conditions by Race, Ethnicity, and Sex,

Fiscal Years 2010?2020

61

Table 12: Proportions of Veterans Who Received VA Disability

Compensation Combined Ratings for Initial Claims with

Eight or More Conditions by Race, Ethnicity, and Sex,

Fiscal Years 2010?2020

63

Table 13: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Tinnitus by Race, Ethnicity, and Sex, Fiscal Years

2010?2020

65

Table 14: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Hearing Loss by Race, Ethnicity, and Sex, Fiscal

Years 2010?2020

67

Table 15: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Limitation of Flexion of the Knee by Race, Ethnicity,

and Sex, Fiscal Years 2010?2020

69

Table 16: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

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GAO-23-106097 VA Disability Benefits

for Lumbosacral or Cervical Strain by Race, Ethnicity, and

Sex, Fiscal Years 2010?2020

71

Table 17: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Limited Motion of the Ankle by Race, Ethnicity, and

Sex, Fiscal Years 2010?2020

73

Table 18: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Limitation of Motion of the Arm by Race, Ethnicity, and

Sex, Fiscal Years 2010?2020

75

Table 19: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Paralysis of the Sciatic Nerve by Race, Ethnicity, and

Sex, Fiscal Years 2010?2020

77

Table 20: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Migraine by Race, Ethnicity, and Sex, Fiscal Years

2010?2020

79

Table 21: Proportions of Veterans with Initial Claims Who

Received VA Disability Compensation Individual Ratings

for Posttraumatic Stress Disorder by Race, Ethnicity, and

Sex, Fiscal Years 2010?2020

81

Table 22: VA Approval and Denial Rates for Veterans' Fully

Developed Claims by Race, Ethnicity, and Sex, Fiscal

Years 2015?2020

83

Table 23: VA Approval and Denial Rates for Veterans' Fully

Developed Claims with Fewer Than Eight Conditions by

Race, Ethnicity, and Sex, Fiscal Years 2015?2020

85

Table 24: VA Approval and Denial Rates for Veterans' Fully

Developed Claims with Eight or More Conditions by Race,

Ethnicity, and Sex, Fiscal Years 2015?2020

87

Table 25: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Tinnitus by Race, Ethnicity,

and Sex, Fiscal Years 2010?2020

89

Table 26: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Tinnitus Each Fiscal Year

(FY) by Race, Ethnicity, and Sex, Fiscal Years 2010?2020 91

Table 27: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Hearing Loss by Race,

Ethnicity, and Sex, Fiscal Years 2010?2020

96

Table 28: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Hearing Loss Each Fiscal

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GAO-23-106097 VA Disability Benefits

Year (FY) by Race, Ethnicity, and Sex, Fiscal Years

2010?2020

98

Table 29: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Limitation of Flexion of the

Knee by Race, Ethnicity, and Sex, Fiscal Years 2010?

2020

103

Table 30: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Limitation of Flexion of the

Knee Each Fiscal Year (FY) by Race, Ethnicity, and Sex,

Fiscal Years 2010?2020

105

Table 31: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Lumbosacral or Cervical

Strain by Race, Ethnicity, and Sex, Fiscal Years 2010?

2020

110

Table 32: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Lumbosacral or Cervical

Strain Each Fiscal Year (FY) by Race, Ethnicity, and Sex,

Fiscal Years 2010?2020

112

Table 33: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Limited Motion of the Ankle

by Race, Ethnicity, and Sex, Fiscal Years 2010?2020

117

Table 34: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Limited Motion of the Ankle

Each Fiscal Year (FY) by Race, Ethnicity, and Sex, Fiscal

Years 2010?2020

119

Table 35: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Limitation of Motion of the

Arm by Race, Ethnicity, and Sex, Fiscal Years 2010?2020 124

Table 36: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Limitation of Motion of the

Arm Each Fiscal Year (FY) by Race, Ethnicity, and Sex,

Fiscal Years 2010?2020

126

Table 37: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Scars General by Race,

Ethnicity, and Sex, Fiscal Years 2010?2020

131

Table 38: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Scars General Each Fiscal

Year (FY) by Race, Ethnicity, and Sex, Fiscal Years

2010?2020

133

Table 39: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Paralysis of Sciatic Nerve by

Race, Ethnicity, and Sex, Fiscal Years 2010?2020

138

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GAO-23-106097 VA Disability Benefits

Figures

Table 40: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Paralysis of Sciatic Nerve

Each Fiscal Year (FY) by Race, Ethnicity, and Sex, Fiscal

Years 2010?2020

140

Table 41: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Migraine by Race, Ethnicity,

and Sex, Fiscal Years 2010?2020

145

Table 42: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Migraine Each Fiscal Year

(FY) by Race, Ethnicity, and Sex, Fiscal Years 2010?2020 147

Table 43: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Posttraumatic Stress Disorder

by Race, Ethnicity, and Sex, Fiscal Years 2010?2020

152

Table 44: VA Approval and Denial Rates for Veterans' Initial

Disability Compensation for Posttraumatic Stress Disorder

Each Fiscal Year (FY) by Race, Ethnicity, and Sex, Fiscal

Years 2010?2020

154

Figure 1: Overview of VBA's Standard Claims Process and Fully

Developed Claims Program for Initial Claims

6

Figure 2: Selected VA Offices Involved in Disability Compensation

or Assessing Racial and Ethnic Disparities

8

Figure 3: Department of Veterans Affairs' Efforts to Improve Its

Collection of Racial and Ethnic Data

12

Figure 4: VA Disability Compensation Approval Rates for

Veterans' Initial Claims by Race and Ethnicity, Fiscal

Years 2010?2020

15

Figure 5: VA Disability Compensation Approval Rates for Initial

Claims for Black Veterans and White Veterans, Fiscal

Years 2010?2020

17

Figure 6: VA Disability Compensation Approval Rates for Tinnitus

Each Year, by Black and White Male Veterans, Fiscal

Years 2010?2020

24

Figure 7: Race, Ethnicity, Sex, and Age of Veterans with VA

Decisions on Initial Disability Claims, Fiscal Years 2010?

2020

37

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GAO-23-106097 VA Disability Benefits

Abbreviations

DOD I-DEA OMB USVETS VA VASRD VBA VHA VSO

Department of Defense Inclusion, Diversity, Equity, and Access Office of Management and Budget United States Veterans Eligibility Trends and Statistics U.S. Department of Veterans Affairs Veterans Affairs Schedule for Rating Disabilities Veterans Benefits Administration Veterans Health Administration veterans service organization

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GAO-23-106097 VA Disability Benefits

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