The PACT Act significantly expanded veterans’ eligibility for disabilities that VA presumes are related to exposure to toxic substances. The VA Office of Inspector General (OIG) conducted this review to determine whether Veterans Benefits Administration (VBA) staff processed PACT Act claims for presumptive disabilities in accordance with applicable laws and procedures before denying them.
This report highlights that claims processors sometimes requested unwarranted examinations, which delayed claims processing and burdened veterans, or the processors did not return examinations for clarification when there was insufficient or conflicting information. Claims processors also sometimes requested medical opinions to determine service connection for disabilities the PACT Act presumed to be connected to service. These errors resulted in unnecessary payments for examinations and medical opinions, as well as underpayments to veterans. Additional errors had the potential to affect veterans’ benefits, such as when claims processors prematurely based decisions on inadequate or inconsistent examination results before denying veterans’ claims.
The OIG team also identified errors in claims processing that, while correctly denying service connection, resulted in an estimated $1.4 million in unnecessary costs for unwarranted examinations and medical opinions in the six-month review period. Underpayments were also identified totaling about $56,700 for two veterans’ claims during the same period who were improperly denied service connection. The team also found an estimated minimum of 870 potential errors that could affect veterans’ benefits. The OIG acknowledges that VBA has taken steps to address these kinds of errors for examinations, but that work is ongoing.
VBA concurred with the OIG’s two recommendations to update the claims processing manual to clarify when examinations and medical opinions are needed and to continue to develop tools to aid claims processors in determining when they are needed and to evaluate their effectiveness.
