Federal Reports

While assessing an anonymous allegation of wrongdoing involving two fiduciaries, the VA Office of Inspector General (OIG) discovered inconsistencies in the disability benefits questionnaires the Veterans Benefits Administration (VBA) uses to elicit medical professionals’ assessments of veterans’ mental competency. VBA uses disability benefits questionnaires when inquiring about a veteran’s capability to manage their finances. Two of the four questionnaires included the regulatory definition of mental incompetency, but none of them posed the question for assessing mental competency in a way that matches the regulatory definition wording. Language discrepancies on the questionnaire can lead medical examiners to provide inconsistent competency decisions for veterans.According to 38 C.F.R. § 3.353(a), which VA promulgated, “A mentally incompetent person is one who because of injury or disease lacks the mental capacity to contract or to manage his or her own affairs, including disbursement of funds without limitation.” The regulation also states, “Unless the medical evidence is clear, convincing and leaves no doubt as to the person’s incompetency, the rating agency will make no determination of incompetency without a definite expression regarding the question by the responsible medical authorities.” When a disability medical examiner responds to the mental competency question, the response is used as evidence and can influence a rating veterans service representative’s decision regarding that veteran’s ability to manage their own affairs, including benefit payments. Consistency in the disability benefits questionnaires helps support appropriate and equitable outcomes.This memorandum is meant to convey the information necessary for VBA to determine if additional actions are warranted.

We found that the NPS was unable to effectively identify and manage its deferred maintenance due to inaccurate and unreliable data.

From 2020 to 2022, some schedulers at the VA medical center in Bay Pines, Florida, determined community care wait-time eligibility with a locally developed calculator that used an incorrect starting date and thus undercounted wait time by about 12 days, limiting veterans’ healthcare choices. The Orlando VA Medical Center discovered the inaccuracy after using this calculator in August 2022. The VA Office of Inspector General (OIG) conducted this review to determine the reasons behind the Bay Pines calculator’s inaccuracy and the facility’s inability to discover it, as well as the steps necessary to ensure all medical facilities correctly determine wait-time eligibility.Per the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, schedulers should use the file entry date—the date on which a veteran or care provider requests an appointment or consult—as the starting date to assess wait-time eligibility. Instead, in accordance with a previous law, the Bay Pines calculator used the patient indicated date, the date the provider and veteran agree is clinically indicated for care or the date the patient wants to be seen. Guidance for schedulers was also confusing, and oversight efforts were not designed to assess the accuracy of community care eligibility determinations.To address these issues, the OIG made four recommendations to the under secretary for health: ensure all scheduling guidance consistently references the dates that should be used to determine wait-time eligibility; provide ongoing oversight to ensure all facilities are using nationally approved tools to calculate wait-time eligibility; develop oversight processes to verify that schedulers are using the correct dates to calculate wait-time eligibility; and develop a mechanism to notify schedulers when it is appropriate to consider wait-time eligibility.