The VA Office of Inspector General (OIG) reviewed whether the Veterans Benefits Administration (VBA) complied with legal requirements to reinstate disability benefits questionnaire forms from non-VA medical providers. The forms are used to submit medical information needed for processing veterans’ disability claims. The OIG also examined whether VBA claims processors followed VA procedures for using the published questionnaires.
Previous OIG reports found significant internal control problems with publicly available questionnaires. In February 2020, the OIG issued a report responsive to allegations that some veterans’ benefits claims using publicly available questionnaires were potentially fraudulent. The report noted that while VBA had taken some steps to mitigate this risk, there were further internal control and procedural deficiencies.
This report finds that VBA complied with the requirements of the law by reinstating 69 questionnaires on its public-facing website. However, disability benefits questionnaires that were incomplete, inaccurate, or of questionable authenticity from non-VA medical providers were not always processed correctly when determining benefits entitlement—causing underpayments of about $13,900 and overpayments of $74,800 over the nine months studied.
Improper processing occurred because VBA lacked sufficient controls to ensure disability benefits questionnaires from non-VA medical providers were properly relied on when determining entitlement to benefits.
VBA concurred with the OIG’s five recommendations, including that VBA correct all identified processing errors and report back the results. Additionally, the VBA’s adjudication procedures manual should be revised and updated to clarify and communicate steps claims processors must take to verify all certification elements on the publicly available questionnaires; clarify the intent of guidance involving authenticity, face value, and validation of the questionnaires; and define valid rationale to ensure medical opinions are well supported. Finally, the OIG recommended VBA ensures claims processors understand the need to document the evaluation of evidence when using publicly available benefits questionnaires.