Inspection of VA Regional Office Wilmington, Delaware

In February 2017, we evaluated the Wilmington VA Regional Office (VARO) to see how well staff processed disability claims, proposed rating reductions, and input claims information in the electronic system of record. Wilmington Veterans Service Center (VSC) staff did not consistently process one of the two types of disability claims we reviewed. We reviewed all 16 veterans’ claims available involving entitlement to Special Monthly Compensation (SMC) and related ancillary benefits completed by VSC staff in calendar year 2016. We found VSC staff inaccurately processed eight claims. Of the eight claims with errors, three affected veterans’ benefits—resulting in improper payments totaling approximately $25,500. Generally, the errors occurred because second signature reviews were ineffective, and staff were unaware of policy involving eligibility for certain ancillary benefits. VSC staff generally processed rating reductions accurately but needed to complete this workload to ensure timely action. We reviewed all seven cases within scope and found VSC staff delayed or incorrectly processed four of the reductions. Delays occurred because the VSC managers prioritized other workloads higher in order to meet established performance goals related to processing disability claims. These delays and processing inaccuracies resulted in approximately $25,300 in overpayments. VSC staff needs to improve the accuracy of information input into the electronic systems at the time of claims establishment. We randomly sampled 30 of 196 newly established claims and found VSC staff did not correctly input information into the electronic system for 16 claims due to the lack of a quality review process for staff establishing claims. We recommended the VARO Director assess the effectiveness of secondary reviews associated with SMC claims, provide training for SMC, and monitor the effectiveness of this training. We also recommended the VARO Director implement a quality review process for claims establishment. The VARO Director concurred with our recommendations.