The Veterans Benefits Administration (VBA) gives money every month to veterans who have disabilities caused by diseases or injuries they got while serving in the military. If veterans disagree with a decision made by the VBA about their claim, they can appeal it.
There are special centers called Decision Review Operations Centers (DROCs) that handle these appeals, especially the complicated ones related to conditions like ALS, MST, and TBI.
There are staff called raters who are supposed to handle these complex appeals, and they have to meet certain requirements, like completing mandatory training and undergoing reviews.
But in March 2022, someone complained anonymously to the VA Office of Inspector General (OIG) that one of the DROCs was not assigning the right staff to work on complex appeals, and that the staff hadn’t received enough training.
Previous reports by the OIG have found that when raters are not trained properly or assigned correctly, they can make mistakes in processing complex appeals and paying out money incorrectly.
For example, during this review, the OIG found three mistakes made by raters who didn’t meet the requirements, which resulted in a veteran being paid $12,900 less for an evaluation related to ALS.
As a result, the OIG did this review to check if the complaint was true. It’s important to make sure that raters meet the requirements and get proper training when making decisions about complex appeals, because mistakes can lead to improper payments.
Veterans should be aware of these challenges in the appeals process and make sure that their claims are handled by qualified and trained personnel.
What did the Review Find?
An investigation by the Office of Inspector General (OIG) found that some employees at the Department of Veterans Affairs (VA) who were responsible for making decisions on complex appeals did not meet the requirements.
The OIG estimated that 93% of the complex appeals (1,200 out of 1,300) were decided by employees who did not meet the necessary requirements.
These requirements include being designated in the VA’s Workforce Improvement Team (WIT) to handle complex appeals, completing mandatory training, and receiving required second signature reviews.
The OIG found that the VA’s Office of Accountability Review (OAR) did not properly monitor completed appeals to ensure that they were being decided by employees who met the requirements.
OAR conducted site visits to check if the designated percentage of employees at the Decision Review Operations Centers (DROCs) were trained for complex appeals, but did not verify if the employees who issued decisions actually met the necessary requirements.
Some DROC managers and supervisors assumed that DROCs were meeting the requirements and could decide any type of appeal.
Also, the VA’s work routing system, which assigns appeals to employees, was not always updated to match WIT designations, which resulted in complex appeals being assigned to employees who were not designated to handle them.
The St. Petersburg DROC tried a web-based program that assigned appeals involving informal conferences to employees, including complex appeals, without verifying if they met the requirements.
The OIG investigation brought this issue to light, and updated procedures were provided by OAR to ensure that cases are routed to appropriate employees.
The OIG also found that the adjudication procedures manual did not require DROCs to keep records of employees who met the accuracy standards for providing single-signature decisions on TBI appeals, which resulted in a lack of documentation on this issue. The manual was updated after these findings.
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What the OIG Found and Recommended for Veterans’ Appeals
When the Office of the Inspector General (OIG) checked how the Department of Veterans Affairs (VA) handles complex appeals, they found some issues and made suggestions for improvement.
The OIG gave four main recommendations to the VA:
- Make sure that only DROC employees who meet all the necessary requirements handle decisions for complex appeals.
- Clearly tell managers and staff which employees are qualified to make decisions on complex appeals.
- Give guidance to DROC supervisors on how to maintain the rules for assigning work.
- Check regularly that the workload at DROCs matches the requirements.
The senior advisor for policy, who was in charge of benefits, agreed with the OIG’s findings and recommendations.
The VA has already taken some actions in response to the recommendations, and the OIG will make sure they follow through with all the planned actions before closing the recommendations.
The OIG also got some comments from the VA about previous reports and the accuracy of decisions.
The OIG clarified that their review was not about checking the accuracy of decisions, but they did find three cases where wrong decisions affected veterans’ benefits.
The VA fixed these cases after the OIG told them about it.
Overall, the OIG’s recommendations are meant to improve how the VA handles complex appeals, so that veterans get accurate and timely decisions on their appeals.
If you were filing an appeal and believe it may have been mishandled, please contact us at Hill and Ponton.
We’re here to help you with the appeals process and fight to get the benefits you deserve.
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