New York VA Audit Shows 30% Veterans’ Claims Improperly Evaluated

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New York VA Audit

Benjamin KrauseNew York, NYA New York VA audit revealed the New York VA Regional Office failed to properly evaluate 30 percent of disability claims in the sample. Half of those claims improperly evaluated had the potential or did affect the veteran’s benefit.

The sample indicated VA made improper payments valued at $195,331 to 16 veterans of the 90 disability compensation cases evaluated. Like most things VA OIG does, they mainly quantified the amount of payments VA paid out that were paid under improper criteria. VA OIG did not clearly aggregate the value of the payments not paid due to VA foibles. This is yet another example of VA incompetency and exemplifies how the agency erratically applies criteria created both out of central office and under local standards.

How is it that a federal agency is allowed to create and maintain local standards? This misguided flexibility is part of the problem VA faces due to an overall inability to create guidelines across the nation’s VA facilities. As they say, “When you have been to one VA, you have been to one VA.” These local standards are part of what led to the VA wait list scandal and disability compensation irregularities across the country.

Here is the OIG summary:

We evaluated the New York VA Regional Office (VARO) to see how well it accomplishes its mission. We found the VARO staff did not accurately process 27 (30 percent) of 90 disability claims reviewed. We sampled claims we considered at higher risk of processing errors, thus these results do not represent the overall accuracy of disability claims processing at this VARO. Specifically, 13 of 30 temporary 100 percent disability evaluations we reviewed were inaccurate, generally because VARO staff delayed ordering medical reexaminations on average for 9 months after receiving reminder notifications. VARO staff incorrectly processed 8 of 30 traumatic brain injury (TBI) claims. Most of the errors occurred because staff misinterpreted VBA policy for rating a TBI with a coexisting mental condition. Staff also incorrectly processed 6 of 30 claims related to special monthly compensation (SMC) and ancillary benefits. Generally, these errors occurred because VARO staff did not follow VBA policy to forward these complex claims to a specialized team for evaluation. VARO managers ensured Systematic Analyses of Operations were complete and timely. However, staff inaccurately processed and delayed completion of 14 of 30 rating reduction claims we reviewed because management did not prioritize this work. We recommended the VARO Director develop and implement a plan to ensure timely and appropriate action on reminder notifications for medical reexaminations and on the 320 temporary 100 percent disability evaluations remaining from our inspection universe. We also recommended the VARO Director develop and implement a plan to ensure accurate second signature reviews of TBI claims, routing of higher level SMC claims to a specialized team for processing as required, and prioritization of benefits reduction actions in order to minimize improper payments to veterans. The VARO Director concurred with all recommendations.

[Download the full New York Regional Office VA OIG report]

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Voc Rehab Survival GuideBenjamin Krause is an award winning investigative reporter, Veterans Benefits Law attorney, and disabled veteran of the US Air Force, where he served in its Special Operations Command. He attended Northwestern University and  the University of Minnesota Law School using VA Vocational Rehabilitation.

While in law school, Benjamin won his decade-long fight for full disability benefits and now helps others do the same with this website and his guide, the Voc Rehab Survival Guide for Veterans. Since its first publication in 2011, the guide has helped the veteran community receive millions in untapped benefits through the VA Chapter 31 Vocational Rehabilitation & Employment program. 

Connect with Benjamin on  Google+,  Twitter,  Facebook and LinkedIn.

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13 Comments

  1. I have been in constant conflict with my regional office and my compensation payments reflect this. Non payment, late payment, and miscalculations. Once the health care system at va has been completely evaluated, the regional offices should be thoroughly evaluated for the improper culture that is clearly mistake prone, and abusive in nature.

    • Carl, this likely means that bonuses are paid to VA workers who make these “mistakes”. Have you noticed how when the VA makes a mistake it is almost always in favor of them and not the veteran? What I love is, when they finally admit they were wrong, they just do it again. My congressman is working on an investigation into the Benefits Division of the VA now that the Health Care fiasco has been exposed. He (Doug LaMalfa) has actually been working on it for some time. You can find him on video, speaking to the House of Representatives, using visual aids like giant blow up photos of thousands of claims piled up on a table that have not been touched or worked on for several years. You can bet that other Congressman are doing the same type of investigation. Have you called yours and asked him/her to do the same? If you are in California, don’t bother with your Senator because it will be either Boxer or Fienstein and they could care less about vets. They are queens on their thrones after sitting their on their butts for decades getting re-elected because people just blindly re-elect them.

  2. I have a question about the ratings system. if you are rated at 100%, you receive $2,858.24 (vet only). If you are 10% you receive $130.94 which is approximately 4.56% (vet only). Shouldn’t 10% of 100% be $285.82 (vet only)? I was thinking about this and it seems that it something is a percentage of a whole amount it should reflect that whole amount (20% should be 20% of the 100% ETC…). If anyone knows where to find how they figure this out could you please let me know. I think we should be paid the correct percentage of the whole amount not just a number they have come up with. I would like to know how this is done. Thanks

    • figure8fan, The percentage is taken from CFR 38 4.1 and it represents as far as practically can be determined the average impairment in earning capacity resulting from service connected injuries or diseases in comparison to civil employment. In other words, if you are 10% disabled that affects what the VA considers $130 per month more in income you could expect to earn in a civilian job if you did not have the disability. VA ratings are complicated because they represent partial disabilities. When a veteran becomes totally disabled they feel he could earn (as you point out) $2858. Is this fair? No, as some vets, like myself, earned well in excess of that amount before becoming totally disabled, while for others this becomes more money than they ever earned in their lives. I hope that helps

  3. This report is NOT unusual. If you dig into the stats (like I’ve done), you find that most of these offices do at least this poorly. I read somewhere (maybe on Ben’s website) that the most recent audit of the VA office in L.A. found an error rate of 50%.

    As Ben mentioned, these audits tend to focus on errors made in favor of the veterans.This is what, evidently, concerns the VA more than the vets they have screwed.

    I think a more germane statistic is one I read about the cases that are appealed. Of the cases that make it to the next level, something like 44% are sent back to the VA with instructions to correct an error and 27% are adjudicated in favor of the veteran. The main issue here is that it takes, on average, more than 3 years for the review board to rule on a case. If you do the math on this, that means that the appeals people find errors errors that have a negative impact on veterans in nearly 3/4 of the cases they rule on.

    When I go to the VARO here in SLC,, I see signs on every floor that read “125 days/98% accuracy — We can do it!” This is such a goddamn joke! According to the VA’s stats, this office has an accuracy rate of about 97%, but this is sheer fiction. The one number they can’t manipulate is the wait time on claims, and this is close to 300 days. They aren’t even, on average, getting the homeless vets’ claims adjudicated within 125 days.

    I was very encouraged to see that the nominee for VA head comes from a very successful career in the private sector. He’s a vet AND a former executive with P&G. If he has the power to clean up the VA cesspool, maybe he’ll get it done.

    My ideas? NOBODY working at the VARO gets a bonus unless (s)he meets these ridiculous goals the VA has set — then ignored. Maybe a good place to start is having the VA acknowledge that their employees are nowhere near their goals. Also, they need to bring in independent auditors to evaluate the true error rates. Lastly, they should start having to pay us interest on claims that have been pending for more than 12 months, and they should have to pay a penalty on claims that the appeals court rules have egregious errors.

    I know that this is unlikely. I’m sitting here — unemployable for more than a decade — while the Army pays a deserter $300K in backpay after promoting him twice when he was likely collaborating with the enemy. It’s madness. I’m angry and depressed that these people stole my youth and my health while holding a Rose Garden ceremony for a deserter at best — a traitor at worst.
    .

    • I agree with every word you say. I gave Bergdahl the benefit of the doubt at first, but now it is obvious he is a traitor. If he was a radical Chrisitian instead of a Muslim convert radical he would be in prison or left to be used as a cat toy by the Taliban tigers who trained him as one of their Manchurian Candidates.

  4. THE RATING “GAME” IS JUST THAT. BASED ON WHAT THE GOING “RATE” FOR YOUR IMPAIRMENT IS , OR WHAT THE VA/GOVT CAN GET AWAY WITH.
    THYEY CLAIM TO USE A “FORMULA, BUT I AM WITH YOU(figure8fan) SHOULD NOT THE NUMBERS BE PROPORTIONATE.

  5. I am doing some investigative research on the movement of CBW(defoliants). I can find where and how they were moved from RMA,TEAD,UMDA,PUDA to CON for oceanic shipment with USNS assigned to MSTS’s for DoD(only) Rainbow Agents and chemical weapons disbursement. I have also found the dates they reached OKC and on which ship. I have found out that the 315th and MAC(also under DoD guide lines)moved approx. 80% of supplies to Vietnam. Their main supply point for SEA was Okinawa,which they were conviently based out of,upon further research I find that due to the draft of a lot of MSTS cargo ships they were unable to off load and would get back logged trying to off load in Nam. Now fitting this puzzle together I find out that when MSTS ships were due repair and maintenance in SEA it was handled at Okinawa by the 2nd Logistical Command which the 267th and the 196th were all intermingled,(Cargo Handling Battallion 2 ?). I have explained this briefly so someone can see when I ask for some input to shorten my tracking I will and am very appreciative. What I am attempting to put together now is a paper trail of the names of the MSTS ships that may have ported at Okinawa from 1960 to 1969 for repairs so I can request deck logs thru the FOIA. I know the DoD is saying NO defoliants on Okinawa,however,that was their stance on Thailand until enough documents were uncovered,and as with any crime there will be some evidence that has failed to be turned up until someone diligently seeks it. This is only a brief insight into the time I have spent on this issue,I want the story to be complete when the media confronts the DoD and the VA. I am enough of a businessman to understand a COI and an ROI so if I’m sent an empty container to make repairs on it,when I return it,it’s going to be full of something(ammo,med supplies,clothing,and defoliants ?) Anyone wondering about the acronyms can research them and find they are legit. I’m not done,I have only scratched the surface of the lying SOB’s at the DoD and theVA now with all the media coverage we need to strike while the irons hot!!!!

  6. Figure8fan: The VA Schedule for comp is not true math as Dan Flynn pointed out. There is as you know, a huge discrepancy within the VA when it comes to C&P. Anyone that fell off the curb or a drug addict off the streets that barley made it out of basic or boot camp with no war time experience gets treated by this clinic in Martinez, California better than any war veteran. The team leader of the Concord, California a real coward and wannabe and probably through his connections is receiving comp that he never earned but as he did his job as a team leader lied, destroyed records and was awarded some plague for all the circle jerk’s he held with the same type of person he is. The replacement for him (because he retired) is just as bad if not worse. FTVA! I cannot believe that the VA people in charge say everything is great with the VA Medical when we all know what has been taking place in Washington D.C. and various hospitals that have been in the news these past week’s!

  7. I am a Veteran from Albany New York, my twenty two year old VA case has been in the above mentioned New York Regional Office since 1992. I have experienced the lost/destruction of my original claim file back in 1995. Since then I have experienced my request for a copy of claim file in 1994, which i received in 2010. I discovered a VA internal form signed & dated April 16, 2007 by an employee name Monica R. McLendon at the Appeals Management Center, which reads as: “Please provide treatment records from January 1993 to present. Please provide a negative response. questions should go to Monica.”

    On May 4, 2009 I received a letter dated May 2, 2008, saying the New York RO had received my appeal from the CAVA Court on June 10, 2008.

    On January 3, 2012 the BVA issued a Remand Order, remanding my appeal back to the New York RO, with instructions/directives to schedule Veteran for a cardiovascular disease examination with a cardiologist and also schedule Veteran for an examination for TDIU.

    On June 12, 2012 I reported to Albany Sam Stratton VA Medical Center for the scheduled compensation & pension examination. The examiner Dr. Daniel Tobin was a geriatrician specialist and not a cardiologist. During the examination my blood pressure was taken and found to be 260/191. I was not examined for TDIU.

    On June 18, 2012 I received the compensation & pension report, which was FRAUDULENT due to the fact Dr. Tobin said i did not have angina and I was not on heart medication.

    On August 25, 2012 my attorney submitted a letter informing the Joe Corretjer, Veterans Service Center Manager, the compensation & pension examination was FRAUDULENT due to the above mentioned reasons and it made no mention of my blood pressure being 260/191.

    As recently as of May 6, 2014 the BVA again remanded my appeal back to the New York RO, without response to my attorneys letter dated August 25, 2012 concerning FRAUD.

    It is completely evil how the President and Congress are allowing these criminal acts to be perpetrated against U.S. Veterans. We all must unite together because united we stand, divided we fall.

  8. I agree with all of the above. My claim says the VARO was negligent in my entire VA file but because they finally found in my favor it doesn’t matter that the 20 years of employment compensation lost, my family lost and all the wasted time going to the VA HCS appointments don’t matter. Let alone the pain and suffering from fucked up medical treatment and fraudulent record keeping isn’t taken into account. I hate these VA motherfuckers and now as I approach the last years of my life they want to flag or blacklist me for speaking out on my and fellow VETERANs behalf! I say bring it mf ‘ers!!!!

    • Oswaldo, I agree with you 100% my claim has taken so much of a toll on me that I have about a month to live. I wish it was more because I would be glad to go to Washington DC and testify to those POS what I have lost as a result of them taking so long (what are they going to do, kill me or take away my disability? That is already going to be done). And as for the rating being what you are to loose because of the amount of a person’s disability is pure BS. I can’t get a job because of the VA, my disability (VA service-connected) and their “slow to react” to my problem which has now put me in the spot I am in. I have to survive off of the $577 and change they send me. Try to do that. I am not eligible for unemployment, can’t get food stamps, and no one will hire me because of the VA’s screwed up ways which has made me a liability rather than as asset. I’ve tried to get a job that will make my condition worse just to pay the bills but no luck, I am becoming homeless as of next week because of the VA. I guess to put it basically the VA has killed me and they haven’t blinked an eye about it. They have not lost sleep every night about it, they don’t have over 16 ulcers (documented w/ pictures) from this (and my “we will fix it” is to increase my omeprazole to four pills a day and then they want to scope me in Aug). I will be dead by then so I guess they will be scoping a dead person. I really hope that the VA takes some very swift action on all of this stupidity so that my fellow vets will not have to go through what most of us have had to do. I hope and pray that my fellow vets will not have to loose what we have had to loose because of this broken down screwed up system. I can only hope. I also hope that heads roll from what is going on and I hope it is many. If someone has even the slightest involvement in what has been going on then they should be fired, no severance, no retirement w/ pay, nothing but maybe jail time if it is appropriate. Keep on them Oswaldo!!!

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