Report Summary

Title: Greater Consistency Study Participation and Use of Results Could Improve Claims Processing Nationwide
Report Number: 19-07062-255 Download
Report
Issue Date: 9/29/2020
City/State:
VA Office: Veterans Benefits Administration (VBA)
Report Author: Office of Audits and Evaluations
Report Type: Review
Release Type: Unrestricted
Summary:

Making accurate and consistent decisions on disability compensation claims is vital to ensuring eligible veterans receive their benefits. The Veterans Benefits Administration (VBA) uses the Quality Review and Consistency Program (consistency study program) to ensure accurate and timely claims processing. The VA Office of Inspector General (OIG) examined whether VBA managed the consistency study program to improve uniformity in processing disability benefits claims. This review is one in a series of five reports regarding VBA’s quality assurance program.

The consistency study program identifies error trends in quality reviews to develop consistency studies for claims processors. The program completed 60 consistency studies from October 1, 2015, through April 30, 2019, and conducted required training. However, the OIG found VBA missed opportunities to drive nationwide uniformity in claims processing. For example, the Compensation Service could have shared more accessible information with regional offices on their claims processors’ knowledge and performance.

VBA’s Office of Field Operations (OFO) also did not ensure all claims processors participated in required studies, nor did staff follow up on study results to ensure improvements were made. The office was reported to have prioritized productivity over accuracy.

The OIG concluded OFO should require regional office managers to take corrective action on consistency study results to improve accuracy and staff performance. Overall, VBA lacked strong processes for sharing and monitoring study results and could capitalize on information it already collects to help close knowledge gaps and improve the consistency of claims decisions.

Recommendations include that the Compensation Service ensure detailed consistency study reports go to OFO and all regional office managers. OFO should also develop a process to monitor regional offices to increase employee participation in consistency studies and require regional managers to review study results to address performance issues.