Are you a veteran or know someone who is? You might be interested in the shocking findings of a recent review by the Office of Inspector General (OIG) regarding the Veterans Benefits Administration (VBA).
The review found that VBA employees were requesting unnecessary medical reexaminations for disabled veterans, causing significant hardship for veterans and generating excessive work and high costs.
Why did the Office of Inspector General (OIG) conduct a review?
The Veterans Benefits Administration (VBA) has the power to request reexaminations for disabled veterans when necessary.
However, the Office of Inspector General (OIG) wanted to find out if VBA employees were making disabled veterans go through unnecessary medical reexaminations.
Reexaminations can be important to make sure that taxpayer dollars are used correctly, but sometimes they’re not needed and can be a problem for veterans.
They can cause hardship and create extra work and costs for the VA, which can take away from helping veterans.
What did the OIG find in their review?
The review found that VBA employees were requesting unnecessary medical reexaminations for disabled veterans, causing significant hardship for veterans and generating excessive work and high costs.
The OIG team reviewed a sample of 300 cases and found that 37% or 19,800 cases out of 53,500 during the review period had unwarranted reexaminations.
This resulted in VBA spending $10.1 million on unwarranted reexaminations during the review period alone.
These unnecessary reexaminations caused significant burdens for veterans, with an estimated 19,800 veterans required to report for unwarranted medical reexaminations during the review period.
The OIG team projected that VBA would waste $100.6 million on unwarranted reexaminations over the next five years unless it ensures that employees only request reexaminations when necessary.
Why did this occur?
VBA policy requires that before requesting a veteran to appear for a medical reexamination, a Rating Veterans Service Representative (RVSR) must review the veteran’s claims folder and decide whether a reexamination is necessary.
This pre-exam review is an internal control that is supposed to prevent unwarranted reexaminations. However, an OIG review found that 78% of unwarranted reexaminations lacked a pre-exam review, indicating that VBA management routinely bypassed this control.
Instead, cases were routed directly to a Veterans Service Representative (VSR) for scheduling the reexamination, even though VSRs lack the necessary knowledge and training to make accurate determinations.
VBA also did not invest in developing alternative internal controls to compensate for the lack of a pre-exam review.
This caused unnecessary reexaminations, which caused significant burdens for veterans and reduced VBA’s capacity to process benefits claims and provide healthcare services.
What did the OIG recommend as a result of their review?
The Office of Inspector General (OIG) provided four recommendations to the Under Secretary for Benefits. These recommendations are:
- Make sure that there are internal controls in place to ensure that a reexamination is necessary before an employee orders it. Additionally, modify the procedures of the Veterans Benefits Administration (VBA) as needed to reflect these improved processes.
- Prioritize designing and implementing a system automation that minimizes unnecessary reexaminations.
- Enhance the quality assurance reviews of the VBA to check if employees have correctly requested reexaminations and categorize unwarranted reexaminations as errors.
- Conduct a special quality improvement review of cases with unwarranted reexaminations to understand and correct any avoidable errors.
In conclusion, to help alleviate the burden on veterans and prevent the waste of funds, VBA employees must limit reexaminations to only when necessary.
The VBA can reduce unnecessary reexaminations by implementing better processes, such as internal controls and system automation. Improving quality assurance processes and conducting a special focused quality improvement review can also be beneficial.
By taking these steps, the VBA can ensure that reexaminations are requested only when truly needed, and veterans can receive the care and support they deserve.
Want to know more about the claims process or help with filing an appeal?
Hill & Ponton was founded in 1986 and has assisted veterans in their VA claims for the last two decades. Although the old law prevented us from being official representatives for the veterans before the VA, we would advise, pro bono, veterans seeking benefits.
In 2007, the law regarding attorney representation for veterans changed. We have been actively representing veterans before the VA ever since.
Our firm handles cases from Regional Offices around the nation through the appeals process to the Board of Veterans’ Appeals and then up to the Court of Appeals for Veterans Claims.
At Hill & Ponton, we are very proud of our firm and its accomplishments. We think our law firm provides our clients with the best representation possible for their disability claim.
If you are intending to appeal a denied claim, you can contact us for an evaluation and we can help you with this process.
However, if you are considering filing an initial claim, or even if you are interested in learning about the appeals process, we offer a free ebook to get you started on the right foot!
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