Report Summary

To ensure veterans’ monthly compensation benefits are consistent with their levels of disability, the Veterans Benefits Administration (VBA) requires reexaminations for veterans when there is a need to verify the continued existence or the current severity of a disability. VBA’s policy is to request reexaminations only when mandated by law or if necessary before reducing an evaluation (i.e., reducing a veteran’s disability rating due to improvements in the disability). While required reexaminations are important to ensure taxpayer dollars are spent appropriately, unwarranted reexaminations are a waste of appropriated funds, could cause undue hardships for veterans, and reduce the efficiency and timeliness of claims processing. The OIG conducted this review to determine whether VBA staff correctly followed procedures when requesting medical reexaminations.

The OIG found VBA can reduce unwarranted reexaminations. When VBA staff complete rating decisions on veterans’ claims for benefits, they may enter approximate reexamination control dates in the electronic system. The review team estimated staff erroneously established reexamination controls in 66 percent of cases (3,149 of 4,754), including for veterans whose disabilities were permanent and not likely to improve. This occurred, in part, because VBA does not require staff to cite objective evidence for why reexaminations are needed.

Once the reexamination control date arrives, VBA’s policy is for a “locally designated claims processor with expertise in review examination ordering” to determine whether reexamination is still needed. However, VBA did not define or provide criteria for such a claims processor. Further, it did not establish training requirements or monitor completion of relevant training. The team estimated claims processors requested unwarranted reexaminations when controls matured in 44 percent of cases (9,733 of 22,534).

Until VBA strengthens its reexamination process, it lacks assurance that veterans are being required to attend reexaminations only when warranted. VBA concurred with the OIG’s three recommendations to update guidance, enhance information systems, and train employees.