FOCUS: VA Required Thousands of ‘Unwarranted Reexaminations’ for Vets Receiving Disability Benefits

Veterans shouldn’t have to jump through unnecessary hoops to get the benefits they deserve.

But the Department of Veterans Affairs is doing that to thousands of disabled veterans and wasting millions of dollars in the process.

A report by VA’s Office of Inspector General says employees required veterans to undergo unwarranted medical reexaminations to continue getting benefits in over one-third of the cases studied.

“While reexaminations are important in the appropriate situation to ensure taxpayer dollars are appropriately spent, unwarranted reexaminations cause undue hardship for veterans,” the report said. “They also generate excessive work, resulting in significant costs and the diversion of VA personnel from veteran care and services.”

Based on its study, the inspector general estimated that employees sought unwarranted reexaminations in 19,800 cases out of 53,500, during the March-August 2017 review period. That’s 37 percent and means undue hardship for lots of people.

“VA’s goal is to ensure all Veterans receive the benefits to which they are entitled under the law,” Curt Cashour, VA’s press secretary, said by email. “While we apologize for any inconvenience to the affected Veterans, these exams were meant to ensure VA was meeting that goal.”

In addition to the inconvenience, the cost is no small matter, either.

During the six-month review period, the Veterans Benefits Administration, a component of the department, spent $10.1 million on unwarranted reexaminations. “The review team estimated that VBA would waste $100.6 million on unwarranted reexaminations over the next five years,” the report says, “unless it ensures that employees only request reexaminations when necessary.”

Reexaminations are not necessary when veterans qualify for exclusions, including having a permanent disability or a disability that has not substantially improved over five years. “VBA policy requires employees to exercise prudent judgment in determining the need for reexaminations by requesting them only when necessary, and making every effort to limit those requests,” according to the inspector general.

Clearly, prudent judgement was often lacking.

In addition to the hassle and the uncertainty for vets, reexaminations mean staffers are pulled from providing needed services.

“Unwarranted reexaminations also created unnecessary work for VA employees,” the report said, “which reduced VBA’s capacity to process benefits claims and the Veterans Health Administration’s (VHA’s) capacity to provide healthcare services.”

This is a management problem.

“As long as VA continues to emphasize productivity work measurements over quality, the agency will continue to waste taxpayer dollars on unnecessary claim development,” said Jamie Rudert, an associate general counsel of the Paralyzed Veterans of America. “Unwarranted medical reexaminations are a clear example of a VBA employee getting work credit for a wrong result and this translates to other areas of VBA decision making.”

Almost all of this could have been avoided if VA employees properly reviewed claims folders before seeking reexaminations. But of the 19,800 cases, the inspector general said 15,500, or 78 percent, lacked an appropriate pre-exam review, indicating “management routinely bypassed this internal control.”

Managers sent work to lower-level employees “who lacked the training and experience necessary to make accurate determinations about whether a reexamination was warranted.” Veterans service representatives were tasked with making reexamination decisions, but 14 of the 24 staffers interviewed by the inspector general’s office said “they were unfamiliar with the criteria for determining whether a reexamination was necessary.”

VA’s response included in the report took issue with the OIG’s wording of various points, but VBA agreed in whole or in principle with the inspector general’s four recommendations.

Sometimes a simple mistake in coding results in a costly and time-consuming error.

One case study in the report told of a veteran with a back problem and right leg nerve issues. An employee “incorrectly coded the veteran’s claim for reexamination 18 months in the future for both conditions. Because of this error, a service representative requested a reexamination in March 2017 without a pre-exam review.”

The inspector general found that reexamination was not necessary for a variety of reasons, including “the veteran’s back and nerve conditions did not show substantial improvement over five years. . .the veteran’s disabilities were permanent and not likely to improve. . .the veteran’s claim file contained updated medical evidence sufficient to continue both disability evaluations without additional examinations.”

Nonetheless, the veteran was required to have reexaminations for both conditions, costing VA $889.50. In the end, “the veteran’s overall benefits did not change,” the report said, “which reinforced the needlessness of the reexaminations.”

Sen. Jon Tester of Montana, the top Democrat on the Senate Veterans’ Affairs Committee, said the unwarranted reexaminations mean ” VA needs to get it right the first time. Veterans shouldn’t be forced to come in for evaluations if they wouldn’t substantially affect the outcome of a rating decision. Reevaluations are important if a veteran’s condition changes over time, but they shouldn’t be frivolous. The VA must root out and fix this blatant example of waste at the expense of veterans and taxpayers.”

Sen. Johnny Isakson, R-Ga., the committee chairman, declined to comment.