The VA Office of Inspector General (OIG) conducted this review to determine whether Veterans Benefits Administration (VBA) decision makers accurately completed disability evaluations for veterans’ service-connected heart disease. The OIG estimated VBA decision makers incorrectly evaluated about 12 percent of claims for heart disease between November 1, 2018, and April 30, 2019. Of those, about 870 resulted in improper payments totaling at least $5.6 million. VBA decision makers inappropriately evaluated heart disease using information from disability benefits questionnaires filled out either by VA or contracted medical providers. Decision makers also made other inaccurate decisions on claims. The OIG determined that the disability benefits questionnaire format contributed to the inappropriate evaluations of veterans’ heart conditions. The system-generated instructions for the questionnaire prompted unclear medical statements. VBA decision makers did not consistently ask for the clarification they needed to make accurate disability determinations. The OIG made three recommendations for improving the handling of disability benefits questionnaires for heart diseases to ensure they are properly filled out with unambiguous and consistent information. The OIG made no recommendation on the inaccurate claims decisions because the review team did not identify a common trend or pattern for these errors.
Wednesday, August 5, 2020
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
Component, if applicable:
Veterans Benefits Administration
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