The Compensation Service Could Better Use Special-Focused Reviews to Improve Claims Processing

Report Information

Issue Date
Report Number
21-01361-192
VISN
State
District
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Recommendations
6
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
Given the importance of accurately and consistently deciding veterans’ claims for disability benefits, the Veterans Benefits Administration (VBA) includes in its quality assurance efforts special-focused reviews that target specific topic areas, such as military sexual trauma. The Office of Inspector General (OIG) reviewed VBA’s design and implementation of its special-focused review process, including applying Government Accountability Office (GAO) standards. The OIG team assessed 10 special-focused reviews completed from January 2019 through April 2021 and identified weaknesses in all five of GAO’s internal control components. The OIG also found the VBA Compensation Service’s standard operating procedure related to these special-focused reviews does not provide sufficient guidance to fully support disability claims-processing improvement. For example, the procedure does not specify that final reports flowing from special-focused reviews must discuss the causes for errors. Without this “root cause” information, leaders are not well-positioned to reduce the risk of continued errors or deficiencies. The OIG made six recommendations to the under secretary for benefits, who submitted responsive corrective action plans to all. VBA agreed to recommendations to update the special-focused review standard operating procedure to require an analysis of why errors occurred, to establish controls for ensuring reports communicate both benefit entitlement and procedural errors, and to convey information on all errors identified at both the national and regional office levels. The OIG also recommended VBA measure the effectiveness of actions taken in response to each special focused review and determine whether a follow-up review is needed. Finally, VBA was called on to reassess special-focused review errors marked as “corrected” to determine whether sufficient actions were taken and assess whether an enhancement to the Quality Management System could help prevent claims processors from closing errors without correction and ensure corrective actions are taken on all errors.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Update the special-focused review standard operating procedure to require analysis of why errors occurred.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Establish controls to ensure special-focused review reports communicate both benefit entitlement and procedural errors.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Establish controls to ensure special-focused review reports communicate all errors identified at both the national and regional office levels.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Implement a process to measure the effectiveness of actions taken in response to each special-focused review and determine whether a follow-up review is needed.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Reassess special-focused review errors marked as “corrected” to determine whether corrective actions were taken.
No. 6
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Assess whether an enhancement to the Quality Management System could mitigate the risk of claims processors closing special-focused review errors without correction and develop a process to ensure corrective actions are taken on all errors.