Report Summary

Title: Accuracy of Claims Involving Service-Connected Amyotrophic Lateral Sclerosis
Report Number: 18-00031-05 Download
Report
Issue Date: 11/20/2018
City/State:
VA Office: Veterans Benefits Administration (VBA)
Report Author: Office of Audits and Evaluations
Report Type: Audit Report
Release Type: Unrestricted
Summary:

The VA Office of Inspector General (OIG) conducted this review to determine whether Veterans Benefits Administration (VBA) staff accurately decided veterans’ claims involving service-connected Amyotrophic Lateral Sclerosis (ALS), commonly referred to as Lou Gehrig’s disease. Initial OIG data testing for this review identified ALS cases as high-risk for improper payments.

The OIG found that VBA’s claims processing involving service-connected ALS needs improvement. About 45 percent of ALS claims completed from April through September 2017 had erroneous decisions. These errors resulted in estimated underpayments of about $750,000 and overpayments of about $649,000 to a total of 230 veterans. These errors were due to the complexity of these claims. ALS claims can involve a wide range of medical complications, evaluations, and special monthly compensation (SMC) levels, and most rating personnel do not decide ALS claims often enough to maintain proficiency.

Also, the OIG determined that VBA staff generally did not tell veterans about additional SMC benefits that may be available. VA is usually required to notify veterans of the conditions that must be met to grant a higher level of compensation. However, VBA’s Compensation Service staff stated they are not required to do so for SMC benefits.

Without information about SMC benefits, veterans with ALS may not know about benefits available to them, or they may not be sure they are receiving the correct SMC benefits. Also, they may not know when to file a claim for an increase in compensation.

The OIG recommended that VBA implement a plan to improve the decisions and additional reviews of claims involving service-connected ALS, and monitor ALS claims to ensure staff demonstrate proficiency. The OIG also recommended that VBA implement a plan to provide notice regarding additional SMC benefits that may be available to veterans with service-connected ALS.