The Department of Veterans Affairs (VA) Veterans Benefits Administration (VBA) claims processors need better accuracy, according to the recent VA Office of Inspector General (OIG) Report (#23-01772-162).
The OIG Report covered the time period May 1, 2022, to April 30, 2023, and revealed that seventy-four (74%) percent of the granted Total Disability based Individual Unemployability (TDIU) contained at least one claims processing error.
During the same time period, the OIG reported that seventy-six (76%) percent of denied TDIU claims had at least one error.
The results of the granted and denied claims were at least $84.7 million in underpayments to disabled veterans and at least $9.8 million in overpayments to veterans during the 12-month OIG review period.
The VBA compensation program provides monthly payments to veterans for the effects of disabilities caused by diseases, events, or injuries incurred or aggravated during active military service
The VBA assigns each condition a rating from 0% percent to 100% percent to quantify the degree of the disability and how much it impairs the veteran’s health and ability to function. The VBA determines the amount of compensation based on the rating percentage.
When a disabled veteran is unable to secure and follow a substantially gainful occupation because of service-connected disabilities, the VA policy states that the veteran should be rated totally disabled—also referred to as total disability based on individual unemployability.
The VA Office of Inspector General (OIG) conducted this review to determine if claims processors were following policies and procedures and accurately deciding claims for individual unemployability.
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Individual unemployability claims are complex and require processors to have knowledge of regulations, policies, and procedures to correctly decide the claim and provide all required information in the rating decision.
The OIG Report indicated three (3) major categories of errors committed by the VBA claims processors. These categories were: Monetary Impact Errors; Potential Impact Errors; and Procedural Deficiencies.
Monetary Impact Errors occurred when the Rating Veterans Service Representatives (RVSRs) : (1) improperly grant or deny a claim, (2) improperly grant or deny a related benefit, or (3) assign an incorrect effective date.
Potential Impact Errors occurred when RVSRs commit a violation of regulations or other directives that could affect the veteran’s benefits but did not result in an improper payment.
Procedural Deficiencies occurred when a claims processor did not follow policies or procedures, but these errors do not directly affect the veteran’s benefits.
In the Monetary Impact Errors category, the OIG Report estimated that 5,452 of claims that granted individual unemployability entitlement (26 percent), and 2,174 of claims that denied these benefits (10 percent), had monetary impact errors.
Calculating the monetary impact for disabled veterans, the OIG estimated that veterans might have been short-changed by at least $84.7 million in underpayments.
The OIG made seven recommendations to the VA to help VBA improve the accuracy of individual unemployability claims decisions. These recommendations included updating guidance, enhancing information systems, improving training, and evaluating workload distribution.
The OIG placed emphasis on training the RVSRs. During the review period, VBA used two different training programs to increase claims processors’ knowledge of the individual unemployability claims process.
These were the Virtual and In-Person Progression (VIP) program, which is required for newly hired employees, and the Competency-Based Training System, which fully trained, experienced employees are required to complete annually.
The OIG Report discussed the significant flaws in each of the training programs, and the VBA’s Quality Assurance Office indicated it would take corrective action concerning the training programs.
My Opinion: The OIG Report is comprehensive and the OIG Team that prepared the report has found several significant areas of correction for the VBA staff to make in the future.
However, something is certainly lacking in the OIG Report. I am aware that of the three (3) areas cited for errors in the OIG report, two (2) categories (Potential Impact Errors and Procedural Errors) do not deal with monetary compensation due to disabled veterans.
The third category, Monetary Impact Errors, is troubling. According to the OIG Report, the OIG estimated that veterans MIGHT have been “short-changed” by at least $84.7 million in underpayments.
I have underscored the word “might” because the OIG Team does not have the authority to decide on TDUI claims. The OIG can assume that the VBA made an error, the VBA is the agency that can make that determination.
The OIG Report did not recommend that the VBA should go back and review the claims that the OIG Term cited, in which disabled veterans were “short-changed” of $84.7 million. The VBA did not state, at the conclusion of the Report, that they would pursue revisiting these claims.
Even if only twenty (20%) percent of these claims were valid and they were underpaid what they deserved; this would result in over $17.4 million that disabled veterans were “shot-changed.” Need I say more?
BioSketch: John Plahovinsak is a retired 32-year Army veteran, who served from 1967 to 1999. His last active-duty posting was as an Inspector General (IG) for a six (6) state area from 1996 to 1999. He can be contacted at: plahovinsak@msn.com.