VBA piloted the DRC program in May 2017 and implemented it nationally by September 2017. VBA anticipated completing 25 percent of its disability compensation claims workload through the DRC program once it was implemented nationwide. However, from May 2017 through September 2018, VBA had only completed 1,803 claims. Since participation fell far short of VBA’s expectations, the Office of Inspector General (OIG) focused this review on the planning and implementation of the DRC program.
What the Review Found The OIG addressed two separate issues in this report. First, the OIG determined that VBA did not effectively plan the DRC program. VBA did not fully consider historical data from a similar program as a benchmark when defining program goals. Further, VBA did not obtain broad acceptance from key stakeholders, nor did it ensure information technology (IT) system functionality was in place to allow easier VSO access and to provide a self-service option for veterans. Second, VBA contravened the plain language of federal statutes and regulations by obligating and expending funds for contract medical examinations before an application for disability compensation benefits was submitted by the veteran…
Conclusion The OIG found evidence that VBA completed contract medical examinations for veterans who were not entitled to such examinations under the plain language of relevant federal laws and regulations. The existence of a claim is a prerequisite for an entitlement to a medical examination,38 and a veteran participating in the DRC program does not submit a claim for benefits until after his or her contract examination is completed.39 Under the applicable appropriations statutes, appropriated funds may be used only to provide medical examinations to which an individual is entitled under the law.40 Thus, any obligation or expenditure of funds for an examination to which an individual is not entitled would be an apparent violation of the Antideficiency Act. Here, VBA obligated approximately $9.6 million for a contract to assist it in determining whether medical examinations were necessary and expended about $972,000 in contract medical examination costs for examinations to which individuals were not entitled under the law…
Read the full 46-page report here.
Source: Decision Ready Claims Program Hindered by Ineffective Planning – May 21, 2019. VA OIG.
