Report Summary

Title: The Veterans Benefits Administration Inadequately Supported Permanent and Total Disability Decisions
Report Number: 19-00227-226 Download
Report
Issue Date: 9/10/2020
City/State:
VA Office: Veterans Benefits Administration (VBA)
Report Author: Office of Audits and Evaluations
Report Type: Review
Release Type: Unrestricted
Summary:

The Veterans Benefits Administration (VBA) manages VA’s disability compensation program, which pays benefits based on a veteran's degree of disability, ranging from 0 to 100 percent. When veterans are found 100 percent disabled or unemployable due to service-connected disabilities, VBA must also consider whether veterans qualify for permanent and total (P&T) disability status. The VA Office of Inspector General (OIG) examined whether VBA staff cited adequate medical evidence demonstrating that veterans met statutory requirements for P&T status.

The review team found that 61 percent of the decisions sampled did not cite adequate medical evidence, and about 15,100 veterans received P&T status without this evidence. As a result, VA may have improperly paid an estimated $38 million in additional benefits for P&T veterans for dental care, as well as education benefits and healthcare coverage for dependents between October 1, 2017, and December 31, 2019. The OIG further estimated that VA may improperly pay more than $84 million over the next five years for these benefits.

The review team determined that VA’s adjudication procedures manual is inconsistent with the statute on P&T status. The statute requires decision makers to be “reasonably certain” that a total disability is likely to continue throughout a veteran’s lifetime, while the manual allows them to establish P&T status without using this standard. In addition, decision makers did not always explain the reasons why they established P&T status in the rating decisions as required.

The OIG recommended that VBA ensure the adjudication procedures manual is reviewed and updated for consistency with statute; revise procedures to ensure staff support P&T status decisions by citing evidence; and revise the title and language used in the decisions to more clearly explain the establishment of P&T status. The OIG also recommended VBA provide staff with appropriate training on the updated procedures.