VA Policy for Administering Traumatic Brain Injury Examinations

The VA Office of Inspector General (OIG) conducted this review at the request of the Subcommittee on Disability Assistance and Memorial Affairs, House Committee on Veterans’ Affairs. The Subcommittee asked the OIG to respond to questions related to the qualifications of the individuals who perform initial traumatic brain injury (TBI) medical examinations, equitable relief offered to those who had an initial TBI medical examination conducted by someone other than a designated specialist, and contract provisions between VA and vendors that provide initial TBI medical examinations. In 2008, VA revised the criteria used to evaluate TBI. However, VA failed to implement procedures then to ensure veterans received adequate initial TBI medical examinations. Subsequent Veterans Benefits Administration (VBA) and Veterans Health Administration (VHA) policies regarding initial TBI medical examinations were not consistent. Between September 2007 and July 2015, VBA updated its policy relating to TBI medical examinations five times while VHA changed its policies four times. In July 2016, VBA sent letters to more than 24,000 veterans informing them of the opportunity to undergo a new TBI medical examination and TBI disability determination. However, TBI medical examination worksheets changed over the years and they did not always differentiate between initial and review TBI medical examinations or did not state examiner credentials. Therefore, VBA and VHA could not identify all initial TBI medical examinations completed between 2007 and 2015. The OIG recommended that VBA coordinate with VHA to determine whether any veterans who had received initial TBI medical examinations by an individual other than one of the four designated specialists were excluded from equitable relief. The OIG also recommended that VBA confirm whether there are other veterans entitled to consideration for equitable relief by the VA Secretary.