The VA Office of Inspector General (OIG) conducted this review to determine whether Veterans Benefits Administration (VBA) staff properly created deferrals for disability compensation claims in its web based electronic program and if they resolved these deferrals in a timely manner.
What the Review Found
VBA staff generally resolved VBMS deferrals issued from February through April 2018 within the required five business days. However, rating veterans service representatives (RVSRs) did not always properly create deferrals, as the OIG team determined some deferrals were unwarranted, did not have the most appropriate reason selected in VBMS, or were incomplete. The OIG team estimated that within the three-month review period, 23,200 unwarranted deferrals occurred when the deferral, or part of the deferral, was not necessary. Unwarranted deferrals could result in needless examination costs, delayed processing, unnecessary rework, and improper guidance to claims processors. For example, if a deferral erroneously directed a claims processor to request a medical examination to support a veteran’s disability claim, the time and cost associated with the examination would be unnecessary and the claim would be delayed. During the review period, an estimated 7,000 unwarranted deferrals resulted in avoidable medical examinations. The unwarranted deferrals in the sample resulted in delays in processing veterans’ claims by an average of 43 days. Based on rates at the time of the review, the OIG team estimated that VBA could spend at least $8.8 million on unnecessary medical examinations over the next five years if corrective actions are not taken…
What the OIG Recommended
The OIG recommended the Under Secretary for Benefits conduct the following actions:
- Implement plans to enhance quality assurance by conducting periodic national oversight of deferrals and ensuring local oversight specifically addresses all aspects of the accuracy of deferrals created in VBMS.
- Establish internal controls documenting when RVSRs are informed of their mitigated deferrals and corrective action is taken.
- Update guidance to clarify why certain reason selections should be made for deferrals, provide training on this guidance, and monitor the effectiveness of the training.
- Establish plans to modify VBMS to allow sufficient space for inputting deferral instructions and require claims processors to input references when creating deferrals… Read the full 36-page report here.
Source: Deferrals in the Veterans Benefits Management System – May 15, 2019. Oversight.gov.
