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Inspection of the VA Regional Office Seattle, Washington

Report Information

Issue Date
Report Number
16-04764-266
VISN
State
Washington
District
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Recommendations
10
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
In October 2016, we evaluated the Seattle VARO to determine how well VSC staff processed disability claims, how timely and accurately they processed proposed rating reductions, how accurately they entered claims-related information, and how well they responded to special controlled correspondence. VSC staff did not consistently process two types of disability claims. We reviewed 30 of 821 veterans’ TBI claims and found that RVSRs incorrectly processed three. We also reviewed 30 of 71 veterans’ SMC claims and found that RVSRs incorrectly processed four. RVSRs inaccurately processed seven of 60 veterans’ disability claims reviewed, resulting in 10 improper monthly payments to three veterans totaling approximately $23,900. Errors occurred due to TBI cases being assigned to RVSRs not on a specialized team responsible for working TBI cases. SMC errors were generally due to ineffective training, including training on effective dates to pay benefits. VSC staff generally processed proposed rating reductions accurately but they needed to prioritize workloads to ensure timely action. We reviewed 30 of 836 proposed rating reduction cases and found staff delayed or incorrectly processed 12. Delays were due to prioritization of other workloads and resulted in about $78,400 in overpayments. VSC staff needed to improve the accuracy of claims-related information input into the electronic systems at the time of claims establishment. We reviewed 30 of 2,027 established claims and found that Claims Assistants and VSRs did not correctly establish four because of ineffective training. The potential existed for claims to be misrouted and processing to be delayed. VSC staff needed to improve timeliness and accuracy in the processing of special controlled correspondences. We reviewed 30 of 381 special correspondences and found staff incorrectly processed 14 because of a lack of training and inadequate oversight. Thus, congressional staff were not timely made aware of the status of cases about which they had inquired, and VBA staff would not be able to review issues pertaining to timeliness and accuracy of such correspondence in the veterans’ electronic claims folders. We recommended the Director implement plans to provide refresher training for TBI, effective dates, special controlled correspondence, and establishing claims in the electronic record. We recommended the Director ensure TBI claims are assigned to qualified RVSRs and RVSRs follow VBA policies for processing TBI and SMC claims. We recommended the Director prioritize benefit reductions and provide oversight of special controlled correspondence. The Director concurred with our recommendations. Management’s planned actions are responsive.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to ensure traumatic brain injury claims are assigned to qualified Rating Veterans Service Representatives for processing.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to provide refresher training on traumatic brain injury and monitor the effectiveness of that training.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to ensure Rating Veterans Service Representatives follow second signature policy requirements for traumatic brain injury and special monthly compensation rating decisions.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director develop and implement a plan to provide refresher training to Rating Veterans Service Representatives regarding proper procedure for applying effective dates.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to ensure prioritization of proposed rating reduction cases for completion at the end of the due process time period.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to conduct comprehensive training for claims establishment staff that emphasizes the importance of ensuring all elements are considered when establishing claims, and assess the effectiveness of that training.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to ensure data input at the time of claims establishment are reviewed.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director monitor the effectiveness of the training regarding how to properly upload emails into electronic claims folders, and conduct refresher training as necessary.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a training plan to ensure all status updates on inquiries are made part of the electronic records, and monitor the effectiveness of that training.
No. 10
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
We recommended the Seattle VA Regional Office Director implement a plan to provide oversight and quality review of all types of special controlled correspondence.