Inspection of the VA Regional Office San Juan, Puerto Rico

In April 2017, we evaluated the San Juan VA Regional Office (VARO) to assess timeliness and accuracy of claims processing, rating reductions, systems compliance and specially controlled correspondence. We found VSC staff did not consistently process one of the two types of disability claims reviewed. We reviewed 30 veterans’ TBI claims and found all were accurately processed. OIG reviewed 23 SMC claims and found four claim inaccurately processed. The errors occurred because second signature reviews were ineffective. Overall, VSC staff accurately processed 49 of the 53 veterans’ disability cases. These cases included improper payments totaling approximately $4,900. VSC staff generally processed proposed rating reductions accurately but needed better oversight to ensure claims are completed at the expiration of the due process period. OIG reviewed all 16 benefits reduction cases and found processing delays in four cases resulting in overpayments of approximately $12,300. VSC staff entered inaccurate or incomplete claim and claimant information into the electronic systems in 19 of 30 claims reviewed. In general, these errors occurred because employees were inexperienced and lacked training related to the proper procedures for establishing claims while adhering to systems compliance requirements. VSC staff accurately, but slowly processed the single inquiry requiring special control received between December 1, 2016 and February 28, 2017. It took VSC staff 59 days to provide the final response. We also found staff did not input the correct received date for the inquiry we reviewed. We recommended the VARO Director develop and implement a plan to ensure secondary reviewers accurately evaluate higher-level SMC and ancillary benefits claims, implement a plan to ensure all claims processing staff receive additional training on claims establishment procedures, and monitor the effectiveness of that training. The VARO Director concurred with our recommendations. Management’s planned actions are responsive and we will follow up as required.