Two days ago, VA OIG released its inspection results for the Nashville, Tennessee, VA Regional Office. The results were less than stellar.
VA has changed how it reports the numbers of errors. They used to tell readers the total percentage of claims that were processed wrong, and then a break down.
Now, the VA OIG just gives you a break down of the numbers. I would like to see more reporting on how many veterans were adversely impacted by poor claims adjudications.
Nashville RO Report Highlights
What really jumped out at me was the high number of Traumatic Brain Injury claims that were processed incorrectly – 34% were done wrong.
I was also surprised at the number of temporary 100% disability claims that were processed incorrectly – 47 percent of the claims evaluated for this were done wrong.
Here is the full report (click on the hyperlinked title) followed by the highlights directly from the VA OIG. Read the full report too, to see if VA is accurately summarizing the inspection. Sometimes they flub the numbers.
Why We Did This Review
The Veterans Benefits Administration
(VBA) has 56 VA Regional Offices
(VAROs) and 1 Veterans Service Center
nationwide that process disability claims and
provide a range of services to veterans. We
evaluated the Nashville VARO to see how
well it accomplishes this mission.
What We Found
Overall, VARO staff did not accurately
process 24 (41 percent) of 59 disability
claims we reviewed. We sampled claims for
certain types of medical disabilities that we
considered to be at higher risk of processing
errors. Thus, these results do not represent
the overall accuracy of disability claims
processing at this VARO. Where claims
processing lacks compliance with VBA
procedures, VBA risks paying inaccurate and
unnecessary financial benefits.
Specifically, 47 percent of the 30 temporary
100 percent disability evaluations we
reviewed were inaccurate. Generally, these
errors occurred because VARO staff did not
schedule medical reexaminations or take
actions to reduce benefits as appropriate.
Further, staff incorrectly processed
34 percent of 29 traumatic brain injury
claims. Most errors occurred when peers
rather than Quality Review Team staff
conducted second-level reviews of TBI
Management generally ensured Systematic
Analyses of Operations were complete and
timely. However, staff did not always
properly address Gulf War veterans’
entitlement to mental health care. Staff also
did not provide outreach to homeless
veterans in their entire area of jurisdiction
or consistently identify their claims.
What We Recommend
The VARO Director should develop and
implement a plan to ensure suspense diaries
are entered in the electronic record, staff
follow up to reduce benefits when
appropriate, and qualified staff conduct
secondary traumatic brain injury claim
reviews. Management should provide
homeless outreach in its entire area of
jurisdiction and accurately track all claims
received from homeless veterans.
The VARO Director concurred with our
recommendations. Management’s planned
actions are responsive and we will follow
up as required.