Federal Reports

VA provides compensation to veterans for service-connected disabilities. Veterans file claims for this compensation, and in some cases, a disability compensation medical examination is needed for VA staff to decide these claims. Disability compensation examiners must complete training courses before conducting an examination, and the PACT Act resulted in additional training. The OIG conducted this review to determine whether VHA examiners and VBA contract examiners are complying with training requirements, including the recently added PACT Act training, before completing related medical examinations.

The team found that 29 of 100 VHA medical opinions reviewed were provided before PACT Act training was completed. From this number, the team estimated that in calendar year 2023, VHA disability compensation examiners provided about 8,600 nonpresumptive PACT Act medical opinions (29 percent) before completing the PACT Act Key Terms and Medical Opinions course. VHA was notified of the training in January 2023 and established August 1, 2023, as the deadline for completion, in part, to allow time for local union notifications and negotiations and for compensation examiners to complete the training. Most of the instances where opinions were provided before PACT Act training was completed occurred before August 1, 2023, which suggests the issue of VHA examiners providing opinions without necessary training was mostly resolved by the deadline.

The team also found that generally, compared to VHA examiners, more VBA contract examiners had completed PACT Act training before providing medical opinions. Nevertheless, in any instance where examiners provide opinions before taking necessary training, VA risks claims decisions leading to improper payments to veterans. Therefore, the OIG made one recommendation to the under secretary for benefits to ensure an independent assessment and medical opinion is provided for the cases identified by the OIG during this review. VBA concurred with the recommendation.

This management advisory memorandum outlines the OIG’s findings and observations about whether VA and Oracle Health followed electronic health record (EHR) interface testing procedures at the Captain James A. Lovell Federal Health Care Center, where VA had to synchronize its system rollout with the Department of Defense’s (DOD) system rollout before going live on March 9, 2024. The interfaces the OIG considered provided a connection between two devices, applications, or networks or a boundary across systems that communicate.
The OIG confirmed VA and Oracle Health conducted the correct tests and applicable retesting for the 24 interfaces reviewed. Although the correct tests were completed, the OIG team observed inadequate documentation. Sufficient documentation is needed to verify proper implementation, operation, and security requirements critical to future EHR deployments.
For example, the required repository for recording problems identified in testing did not show testing had been done before the healthcare center went live with the Financial Management System interface, which bridges the EHR system and VA’s payment and billing system. Testing was delayed by a cyberattack, and results were recorded in another system.
Further, some procedures did not clearly detail what to do when testing results and notations conflicted: The notation “no run” means no test steps were run, but it was used together with the notation “passed” for four of 24 interfaces. These four EHR interfaces exchange clinical health information involving imaging, patient movement, bed management, and surgical instruments.
Finally, the OIG confirmed a lack of functionality with two interfaces between VA and the DOD. For at least these two, documentation showed testers had not accounted for the joint nature of workflows at the Lovell facility.
This memorandum conveys information to VA so that VA can determine whether additional actions should be taken.

To accomplish our objective, we applied the agreed-upon procedures described in Attachment A to the payroll periods ended September 6, 2024, and March 7, 2025, coinciding with the Supplemental Semiannual Headcount Report for September 2024 and March 2025 and to the enrollment information submitted. We randomly selected another payroll period, ending February 7, 2025, for additional testing. We confirmed Retirement and Insurance Transfer System data by verifying payroll information to source documents. We randomly selected 45 employees and compared employee withholdings and employer contributions to documentation in the employees’ Official Personnel Files. For all employees, we independently calculated employee withholdings, Postal Service contributions, and enrollment information for health benefits, life insurance, and retirement. We compared the results to actual employee withholdings and Postal Service contributions submitted to the U.S. Office of Personnel Management to determine whether differences existed.