We evaluated the New York VA Regional Office (VARO) to see how well it accomplishes its mission. We found the VARO staff did not accurately process 27 (30 percent) of 90 disability claims 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. Specifically, 13 of 30 temporary 100 percent disability evaluations we reviewed were inaccurate, generally because VARO staff delayed ordering medical reexaminations on average for 9 months after receiving reminder notifications. VARO staff incorrectly processed 8 of 30 traumatic brain injury (TBI) claims. Most of the errors occurred because staff misinterpreted VBA policy for rating a TBI with a coexisting mental condition. Staff also incorrectly processed 6 of 30 claims related to special monthly compensation (SMC) and ancillary benefits. Generally, these errors occurred because VARO staff did not follow VBA policy to forward these complex claims to a specialized team for evaluation. VARO managers ensured Systematic Analyses of Operations were complete and timely. However, staff inaccurately processed and delayed completion of 14 of 30 rating reduction claims we reviewed because management did not prioritize this work. We recommended the VARO Director develop and implement a plan to ensure timely and appropriate action on reminder notifications for medical reexaminations and on the 320 temporary 100 percent disability evaluations remaining from our inspection universe. We also recommended the VARO Director develop and implement a plan to ensure accurate second signature reviews of TBI claims, routing of higher level SMC claims to a specialized team for processing as required, and prioritization of benefits reduction actions in order to minimize improper payments to veterans. The VARO Director concurred with all recommendations.