VBA Did Not Ensure Complex Appeals Were Decided by Appropriate Staff

The Veterans Benefits Administration (VBA) provides compensation benefits to veterans for disabilities incurred or aggravated during active military service. Veterans can appeal VBA decisions. Decision review operations centers (DROCs) are responsible for appeals processing. DROC staff must be designated and trained to decide complex appeals. The VA Office of Inspector General (OIG) conducted this review to assess the merits of a March 2022 hotline allegation that a DROC was not designating or training appropriate staff to decide complex appeals. After reviewing three distinct samples of complex appeals completed by DROC staff from October 1, 2021, through February 28, 2022, the OIG substantiated some staff from each of the three DROCs did not meet all requirements. An estimated 1,200 complex appeals were decided by staff who were undesignated, had not completed all mandatory training, or made decisions that did not receive required second reviews. The OIG found that VBA’s Office of Administrative Review (OAR) did not monitor completed appeals to ensure they were decided by staff who met all requirements. Managers with OAR noted they did not monitor appeals this way because, prior to the OIG’s findings, they were unaware complex appeals were being decided by staff who had not met requirements. Further, VBA’s work routing system has to be manually updated to match staff designations for complex appeals. The OIG estimated 400 complex appeals were assigned by the work routing system to undesignated staff. The OIG made four recommendations to the acting under secretary for benefits, including ensuring that complex appeals decisions were completed by designated staff; ensuring DROCs communicate who meets all requirements to issue complex appeals decisions; providing guidance for maintaining routing rules and establishing a procedure to ensure correct DROC workload designations; and monitoring the effectiveness of modified procedures for informal conferences at the St. Petersburg DROC.