Unwarranted Medical Reexaminations for Disability Benefits

The VA Office of Inspector General (OIG) reviewed reexamination requests by the Veterans Benefits Administration (VBA) and estimated that, from March through August 2017, VBA spent $10.1 million on unwarranted reexaminations. The OIG estimated that VBA would waste an additional $100.6 million over the next five years unless it ensures that VBA employees only request reexaminations when necessary. According to VBA policy, employees can request reexaminations for veterans when there is a need to verify the continued existence or current severity of a disability, and when there is no exclusion from reexamination. However, before requesting a medical reexamination, VBA policy requires a Rating Veterans Service Representative to review the veteran’s claims folder and determine whether the reexamination is needed. This pre-exam review serves as an internal control to prevent unwarranted reexaminations. The OIG estimated that 15,500 of 19,800 unwarranted reexaminations (78 percent) lacked a pre-exam review, indicating that VBA management routinely bypassed this internal control. Instead, VA Regional Office managers routed these cases directly to a Veterans Service Representative for scheduling the reexamination. Bypassing the pre-exam review caused the unwarranted reexaminations. About 14,200 veterans saw no change to their disability evaluations as a result of these reexaminations. The OIG estimated that the reexaminations resulted in proposed benefit reductions for about 3,700 veterans. Unwarranted reexaminations also created unnecessary work for VA employees by reducing VBA’s capacity to process benefits claims and the Veterans Health Administration’s capacity to provide healthcare services. The OIG made four recommendations including establishing internal controls to ensure that a reexamination is necessary, prioritizing the design and implementation of system automation to minimize unwarranted reexaminations, enhancing VBA’s quality assurance reviews of requested reexaminations, and conducting a focused quality improvement review of cases with unwarranted reexaminations to understand and redress the causes of avoidable errors.