Accuracy of Claims Decisions Involving Conditions of the Spine

Spinal conditions account for two of VA’s top 10 service-connected disabilities, totaling some 1.5 million cases as of September 30, 2018. The VA Office of Inspector General (OIG) conducted this review after determining disability claims related to conditions of the spine have a higher risk of processing errors, which can result in veterans not receiving the proper benefits. The OIG estimated the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018, accounting for at least $5.9 million in either over- or underpayments. Processing errors included improper evaluations, missed secondary conditions, and evaluations based on inadequate exams. The OIG found these incorrectly decided claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. VBA’s primary means of evaluating disability contains minimal guidance and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability. During the review, VBA acknowledged issues the OIG identified were problematic and that it has taken steps to update some of its tools and guidance. VBA has also initiated mandatory training to help employees who approve and review claims better understand medical opinions. The OIG recommended the under secretary for benefits instruct VBA to update its disability rating process to establish objective criteria for spine-related conditions and improve VBA’s internal controls to help ensure the accuracy and consistency of claims decisions for conditions of the spine.