VA worker errors when reviewing claims for full disability cost $100M, auditors say
Workers with the Department of Veterans Affairs made mistakes costing $100 million when reviewing veterans claims for full disability connected to injuries and illnesses from military service, a new report from the agency’s inspector general concluded.
About 75% of claims for a 100% disability rating that auditors reviewed between May 2022 and April 2023 were improperly processed, resulting in overpayments and underpayments, according to the July report.
“That’s way too high of a number and, frankly, unacceptable,” Rep. Morgan Luttrell, R-Texas, said last week at a hearing of the House Veterans’ Affairs Committee’s subpanel on disability assistance and memorial affairs.
The findings were the focus of a House hearing that looked at ways to improve education and training for processors to review and render decisions on disability claims.
The errors were the result of processors failing to follow VA policies and procedures for deciding compensation in complex claims for full disability, according to the findings.
“When claims processors have to redo their work, and when veterans and survivors have to appeal incorrect decisions on their claims, that adds months or years to how long veterans and survivors must wait to finally receive the benefits they are eligible for,” said Luttrell, the committee chairman and a Navy veteran.
Rep. Chris Pappas, D-N.H., said processors have larger workloads due to the volume of claims filed since passage of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, known as the PACT Act. Signed into law in 2022, the PACT Act provides disability compensation for veterans suffering illnesses linked to toxic exposure from burn pits, radiation and other hazardous materials during military duty.
“The VA has onboarded thousands of processors seemingly overnight in response to the PACT Act. Even the most robust system would be strained,” Pappas said. “Claims processors need the training and support from managers under increasing production quotas.”
Elizabeth Curda, director of education, workforce and income security issues at the Government Accountability Office, echoed those comments. She said the large volume of disability claims that veterans are filing can have an impact on the quality of the claim review.
Curda also said it is essential to have effective onboarding and training for new employees as well as ongoing education and development for the existing workforce.
The VA moved from on-the-job training for new processors to web-based and classroom education during the coronavirus pandemic. That practice continues.
As a result, new processors do not learn with the tools and technology that they will use as workers, said Linda Parker-Cooks, president of the American Federation of Government Employees Local 138, representing the Veterans Benefits Administration regional office in Detroit.
“They need to review claims in the system and gain hands-on experience with technology they will use every day,” she said.
Parker-Cooks said new employees are not adequately trained to analyze the evidence that veterans present when seeking 100% disability. Instead, they are presented with printed examples of outcomes.
Monthly compensation amounts from the VA are based on a veteran’s disability rating. A veteran with a rating of 100% is considered unemployable.
“When a veteran is unable to secure and follow a substantially gainful occupation because of service-connected disabilities, VA policy states that the veteran should be rated totally disabled — also referred to as total disability based on individual unemployability,” according to the inspector general report.
Auditors also found a large percentage of veterans were directed to undergo additional medical exams that were not needed to support their claims.
“Calling a veteran into an unnecessary exam is expensive, confusing to the veteran and delays the process. It’s a big issue. We have a lot of work to do,” said Ronald Burke, the VA deputy undersecretary for policy and oversight.
Luttrell said many veterans are giving up on pursuing disability claims because of incorrect decisions and the time it takes to appeal a decision. The appeals process can extend for months or years before a final decision is rendered.
Statistical samples of claims that were approved and denied for veterans seeking 100% disability were reviewed by auditors, according to the report.
Though auditors estimated processing mistakes cost $100 million, they said the value could be as high as $250 million. Most of the mistakes resulted in underpayment to veterans, according to the findings.
Burke said the agency is overhauling and modernizing training to improve the quality of decision making. He said the changes will include making class sizes smaller and giving new employees access to real cases in a more immersive learning environment.
“We’ve asked ourselves what can we do better? We are out in the field talking to claims processors. We’re listening to ideas and criticisms,” he said.