We evaluated the Roanoke VARO to see how well it accomplishes its mission. We found the VARO staff did not accurately process 17 (28 percent) of 60 disability claims we reviewed. We sampled claims we considered at higher risk of processing errors, thus these results do not represent the overall accuracy of disability claims processing at this VARO. Specific to the claims we reviewed, 14 of 30 temporary 100 percent disability evaluations were inaccurate. Generally, these errors occurred because VARO staff did not schedule medical reexaminations, enter suspense diaries in the electronic record to ensure reminders to schedule the reexaminations, or take actions to reduce benefits as appropriate. Additionally, management did not provide effective oversight of second signature reviews and therefore incorrectly processed 3 of 30 traumatic brain injury claims. VARO managers ensured Systematic Analyses of Operations were complete and timely. However, staff did not always address Gulf War veterans’ entitlement to mental health treatment. Further, staff did not provide adequate outreach to homeless veterans in the VARO’s area of jurisdiction. We recommended the VARO Director should implement a plan to ensure staff schedule medical reexaminations, enter suspense diaries in the electronic record, and follow up to reduce temporary 100 percent disability evaluations as appropriate. The Director should ensure staff review the accuracy of 709 temporary evaluations we provided at the end of this inspection. Further, management should implement a plan to ensure effective second signature reviews of traumatic brain injury claims and ensure staff provide outreach to homeless veterans within the VARO’s area of jurisdiction. The VARO Director concurred with our recommendations.