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VA Claims: Disabled Veterans Community|Hadit.com

VA DISABILITY EXAMS: Improved Performance Analysis and Training Oversight Needed for Contracted Exams

What GAO Found

The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency’s quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors’ quality scores fell well below VBA’s target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information. GAO-19-13: Published: Oct 12, 2018. Publicly Released: Nov 8, 2018

VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA’s quality and timeliness information limit VBA’s ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.

A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.

Why GAO Did This Study

In 2016, VBA awarded 12 contracts to five private firms for up to $6.8 billion lasting up to 5 years to conduct veterans’ disability medical exams. Both VBA contracted medical examiners and medical providers from the Veterans Health Administration perform these exams, with a growing number of exams being completed by contractors. Starting in 2017, VBA contracted examiners conducted about half of all exams. GAO was asked to review the performance and oversight of VBA’s disability medical exam contractors.
This report examines (1) what is known about the quality and timeliness of VBA contracted exams; (2) the extent to which VBA monitors contractors’ performance; and (3) how VBA ensures that its contractors provide qualified and well-trained examiners. GAO analyzed the most recent reliable data available on the quality and timeliness of exams (January 2017 to February 2018), reviewed VBA and selected contract documents and relevant federal laws and regulations, and interviewed agency officials, exam contractors, an audit firm that checks examiners’ licenses, and selected veterans service organizations.

What GAO Recommends

GAO recommends VBA (1) develop a plan for using its new data system to monitor contractors’ quality and timeliness performance, (2) analyze overall program performance, (3) verify that contracted examiners complete required training, and (4) collect information to assess the effectiveness of that training. The Department of Veterans Affairs agreed with GAO’s recommendations.
View Report (PDF)
https://www.gao.gov/assets/700/694986.pdf

Unwarranted Medical Reexaminations for Disability Benefits VA OIG 17-04966-201

Why the OIG Did This Review

The OIG conducted this review to determine whether Veterans Benefits Administration (VBA) employees required disabled veterans to submit to unwarranted medical reexaminations.1
VBA employees have authority to request reexaminations for veterans “whenever VA determines there is a need to verify either the continued existence or the current severity of a disability,” and when there is no exclusion from reexamination.2 While reexaminations are important in the appropriate situation to ensure taxpayer dollars are appropriately spent, unwarranted reexaminations cause undue hardship for veterans. They also generate excessive work, resulting in significant costs and the diversion of VA personnel from veteran care and services.

What the Review Found

VBA employees did not consistently follow policy to request reexaminations only when necessary.3 The OIG team reviewed a statistical sample of 300 cases with reexaminations from March through August 2017 (review period) and found that employees requested unwarranted medical reexaminations in 111 cases. Based on this sample, the review team estimated that employees requested unwarranted reexaminations in 19,800 of the 53,500 cases during the review period (37 percent). VBA employees requested reexaminations for veterans whose cases qualified for exclusion from reexamination for one or more of the following reasons:

  • Over 55 years old at the time of the examination, and not otherwise warranted by unusual circumstances or regulation
  • Permanent disability and not likely to improve
  • Disability without substantial improvement over five years
  • Claims folders contained updated medical evidence sufficient to continue the current disability evaluation without additional examination
  • Overall combined evaluation of multiple disabilities would not change irrespective of the outcome of reexamining the particular condition
  • Disability evaluation of 10 percent or less
  • Disability evaluation at the minimum level for the condition4

The review team estimated that during the six-month review period, VBA spent $10.1 million on unwarranted reexaminations—$5.3 million involving Veterans Health Administration clinicians and $4.8 million involving VBA contractors.5 The review team estimated that VBA would waste $100.6 million on unwarranted reexaminations over the next five years unless it ensures that employees only request reexaminations when necessary.
In assessing the unnecessary burdens for veterans, the review team estimated that VBA required 19,800 veterans to report for unwarranted medical reexaminations during the review period. Reinforcing the needlessness of the reexaminations, approximately14,200 veterans experienced no change to their disability evaluations because of their reexamination. The review team estimated that the reexaminations resulted in proposed benefit reductions for about 3,700 veterans.6 At the conclusion of the review period, these proposed reductions remained subject to a final decision and an appeal process; therefore, the OIG did not make a determination on whether the reductions were justified.7 Unwarranted reexaminations also created unnecessary work for Veterans Affairs employees, which reduced VBA’s capacity to process benefits claims and the Veterans Health Administration’s (VHA’s) capacity to provide healthcare services.

Why This Occurred

Prior to requesting that a veteran appear for a medical reexamination, VBA policy requires a Rating Veterans Service Representative (RVSR) to review the veteran’s claims folder and determine whether the reexamination is needed (pre-exam review).8 The pre-exam review serves as an internal control to prevent unwarranted reexaminations. The review team estimated, however, that 15,500 of 19,800 unwarranted reexaminations (78 percent) lacked a pre-exam review by an RVSR, indicating that VBA management routinely bypassed this internal control. Instead, VA Regional Office (VARO) managers routed these cases directly to a Veterans Service Representative (VSR) for scheduling the reexamination.
VARO managers explained that routing cases directly to VSRs was consistent with guidance from the Executive in Charge for VBA. The guidance recommends that tasks not directly related to making a disability rating decision should not be assigned to an RVSR. The Executive in Charge confirmed that the VARO managers’ interpretation was consistent with his expectations. He explained to the review team that RVSR capacity is limited, and therefore an RVSR should not spend time on activities that do not directly relate to making rating determinations. Reinforcing the Executive in Charge’s mandate, VBA redesigned its employee performance standards in 2017. This revision resulted in RVSRs earning work credit for rating decisions but not for other transactions, such as canceling an unwarranted reexamination.
Bypassing the pre-exam review caused unwarranted reexaminations. VARO managers routed the work to VSRs who lacked the training and experience necessary to make accurate determinations about whether a reexamination was warranted. Determining whether a reexamination is necessary is an RVSR responsibility; however, VSRs were tasked with making this determination. VBA employees and managers stated that determining the necessity of a reexamination requires specialized knowledge, including the ability to review medical evidence. Similarly, 14 of the 24 VSRs interviewed told the review team that they were unfamiliar with the criteria for determining whether a reexamination was necessary.
VBA also did not invest in developing alternative internal controls to compensate for the lack of a pre-exam review. VBA could add features to the Veterans Benefits Management System (VBMS) to prevent the scheduling of reexaminations in cases that meet the exemption criteria, such as information system automation. VBA has not implemented these features in VBMS due to reported competing technology priorities and a lack of funding. In September 2017, VBA took initial steps and implemented a technology strategy designed to reduce unnecessary work by identifying and canceling work items for veterans age 55 or older that would have resulted in unwarranted reexaminations. This effort resulted in the one-time elimination of approximately 45,000 reexaminations. VBA plans to implement additional one-time cancellations in the future, and VBMS automation is scheduled for FY 2019 or later.
Finally, VBA’s quality assurance processes did not measure whether VBA employees requested reexaminations only when necessary, nor did these processes evaluate whether an RVSR conducted a pre-exam review as required by VBA policy.

What the OIG Recommended

The OIG made four recommendations to the Under Secretary for Benefits:

  • Establish internal controls sufficient to ensure that a reexamination is necessary prior to employees ordering it, and modify VBA procedures as appropriate to reflect these improved business processes.
  • Take steps to prioritize the design and implementation of system automation reasonably designed to minimize unwarranted reexaminations.
  • Enhance VBA’s quality assurance reviews to evaluate whether employees correctly requested reexaminations and to categorize unwarranted reexaminations as errors.
  • Conduct a special focused quality improvement review of cases with unwarranted reexaminations to understand and redress the causes of any avoidable errors.

Management Comments

The Under Secretary for Benefits concurred with three of the four recommendations, and concurred in principle with the fourth recommendation. The Under Secretary for Benefits provided acceptable action plans for all four recommendations. The OIG will monitor VBA’s progress and follow up on implementation of the recommendations until all proposed actions are completed.
The Under Secretary for Benefits also provided technical comments related to this report. The OIG considered those comments and made clarifications where applicable.

1 VBA also refers to medical reexaminations as routine future examinations.

2 38 CFR §3.327, Reexaminations.

3 The relevant policy is found in M21-1 Adjudication Procedures Manual, Part III, Subpart iv, Chapter 3, Section B, Topic 2, Determining the Need for Review Examinations.

4 VBA relies on these objective criteria to identify disabilities that are unlikely to improve and therefore do not merit the expense and burden of reexamination.

5 The review team estimated the cost of unwarranted reexaminations using the results of the team’s statistical sample claims review. See Appendix C for more information on the statistical sampling methodology and results.

6 The review team did not project cost savings based on the 3,700 veterans with proposed reductions because the reductions were only proposals—not final reductions. When VBA makes a final decision, the proposed reduction amount may be changed, or there may be no reduction at all.

7 The review team estimated the number of veterans who had proposed benefits reductions using the results of the team’s statistical sample. Some reexaminations resulted in increases to veterans’ benefits, but the small sample size prevented the review team from making a statistical projection to estimate the value of all increases during the review period.

8 M21-1 Adjudication Procedures Manual, Part III, Subpart iv, Chapter 3, Section C, Topic 2, Control of Future Examinations. For this report, the OIG defines the required RVSR review prior to a reexamination request as the Pre-exam Review.

unwarranted-medical-reexaminations-for-disability-benefits-VAOIG-17-04966-201

VA DISABILITY BENEFITS: Opportunities Exist to Better Ensure Successful Appeals Reform GAO-18-349T: Published: Jan 30, 2018

What GAO Found

The Department of Veterans Affairs’ (VA) plan for implementing a new disability appeals process while attending to appeals in the current process addresses most, but not all, elements required by the Veterans Appeals Improvement and Modernization Act of 2017 (Act). VA’s appeals plan addresses 17 of 22 required elements, partially addresses 4, and does not address 1. For example, not addressed is the required element to include the resources needed by the Veterans Benefits Administration (VBA) and the Board of Veterans’ Appeals (Board) to implement the new appeals process and address legacy appeals under the current process. VA needs this information to certify, as specified under the Act, that it has sufficient resources to implement appeals reform and make timely appeals decisions under the new and legacy processes.
VA’s appeals plan reflects certain sound planning practices, but it could benefit from including important details in several key planning areas:
Performance measurement: VA’s plan reflects steps taken to track performance, but could articulate a more complete and balanced set of goals and measures for monitoring and assessing performance on a range of dimensions of success. Specifically, the plan reports that VA is developing a process to track timeliness of the new and legacy processes. However, contrary to sound planning practices, the plan does not include timeliness goals for all five appeals options available to veterans, does not include goals or measures for additional aspects of performance (such as accuracy or cost), and does not explain how VA will monitor or assess the new process compared to the legacy process. Unless VA clearly articulates a complete and balanced set of goals and measures, it could inadvertently incentivize staff to focus on certain aspects of appeals performance over others or fail to improve overall service to veterans.
Project management: VA’s plan includes a master schedule for implementing the new appeals plan; however, this schedule falls short of sound practices because it does not include key planned activities—such as its pilot test of two of the five appeals options. In addition, the schedule does not reflect other sound practices for guiding implementation and establishing accountability—such as articulating interim goals and needed resources for, and interdependencies among, activities. Unless VA augments its master schedule to include all key activities and reflect sound practices, VA may be unable to provide reasonable assurance that it has the essential program management information needed for this complex and important effort.
Risk assessment: VA has taken steps to assess and mitigate some risks related to appeals reform by, for example, pilot testing two of the five appeals options through its Rapid Appeals Modernization Program (RAMP). However, as designed, RAMP does not include key features of a well-developed and documented pilot test. For example, VA has not articulated how it will assess RAMP before proceeding with full implementation. In addition, RAMP is not pilot testing three options and, as a result, VA will not have data on the extent to which veterans will appeal directly to the Board when given the option. Unless VA identifies and mitigates key risks associated with implementing a new process, VA is taking a chance that untested aspects will not perform as desired.

Why GAO Did This Study

VA’s disability compensation program pays cash benefits to veterans with disabilities connected to their military service. In recent years, the number of appeals of VA’s benefit decisions has been rising. For decisions made on appeal in fiscal year 2017, veterans waited an average of 3 years for resolution by either VBA or the Board, and 7 years for resolution by the Board. The Veterans Appeals Improvement and Modernization Act of 2017 makes changes to VA’s current (legacy) appeals process, giving veterans new options to have their claims further reviewed by VBA or appeal directly to the Board. The Act requires VA to submit to Congress and GAO a plan for implementing a new appeals process, and includes a provision for GAO to assess VA’s plan.
This testimony focuses on the extent to which VA’s plan: (1) addresses the required elements in the Act, and (2) reflects sound planning practices identified in prior GAO work. GAO’s work entailed reviewing and assessing VA’s appeals plan and related documents against sound planning practices, and soliciting VA’s views on GAO’s assessments.

What GAO Recommends

In its forthcoming report, GAO is considering recommending that VA: fully address all legally required elements in its appeals plan, articulate how it will monitor and assess the new appeals process as compared to the legacy process, augment its master schedule for implementation, and more fully address risk.

Full Report

Accessible Version

VA Burial Benefits: Service-Connected or Non-Service Connected – There’s a Benefit for You

VA Burial Benefits: Service-Connected or Non-Service Connected – There’s a Benefit for You

How to Apply for a Veterans Burial Allowance

Source: VA.gov

Find out how to get Veterans burial allowances to help cover burial, funeral, and transportation costs.

Can I get allowances to help pay for a Veteran’s burial and funeral costs?

You may be able to get burial allowances if you’re paying for the burial and funeral costs, and if any of the below relationships or professional roles describes your connection to the Veteran.

One of these must describe your relationship or role. You’re:

  • The Veteran’s surviving spouse (Note: we recognize same-sex marriages), or
  • A surviving child of the Veteran, or
  • A parent of the Veteran, or
  • The executor or administrator of the Veteran’s estate (someone who officially represents the Veteran)

To get this benefit, the Veteran must NOT have received a dishonorable discharge, and one of the below circumstances must be true.

One of these must be true of the Veteran. They:

  • Died as a result of a service-connected disability (a disability related to service), or
  • Had been getting a VA pension or compensation when they died, or
  • Had chosen to get military retired pay instead of compensation, or
  • Died while getting VA care, either at a VA facility or at a facility contracted by VA, or
  • Died while traveling to approved VA care, or
  • Died with a reopened claim for VA compensation or a pension that would have qualified them to get benefits, or
  • Died on or after October 9, 1996, while a patient at a VA-approved state nursing home

Note: Veterans Affairs will also provide an allowance for the cost of transporting a Veteran’s remains for burial in a national cemetery.

When do I need to file a claim?

You must file a claim for a non-service-connected burial allowance within 2 years after the Veteran’s burial or cremation. If a Veteran’s discharge was changed after death from dishonorable to another status, you must file for an allowance claim within 2 years after the discharge update.

There’s no time limit to file for a service-connected burial, plot, or interment allowance.

What kind of benefits can I get?

  • An allowance for burial and funeral costs
  • An allowance for the plot or interment
  • An allowance for transporting the Veteran’s remains for burial in a national cemetery

What documents and information do I need to apply?

You may need a copy of:

  • The Veteran’s military discharge papers (DD214 or other separation documents)
  • The Veteran’s death certificate
  • Any documents you have for the cost of transporting the Veteran’s remains

How do I apply?

You can apply online right now. Apply for Burial Benefits

You can also apply:

By mail
Apply by mail using an Application for Burial Benefits (VA Form 21P-530). 
Download VA Form 21P-530.

Mail the application and other paperwork to your nearest VA regional benefit office. 
Find your nearest VA regional benefit office.

If you have questions, call 1-800-827-1000, Monday through Friday, 8:00 a.m. to 9:00 p.m. (ET). Our TTY number for people with hearing impairments is 711. Or call your VA regional benefit office.


Burial Allowance Amounts

What are the burial allowance amounts for a service-connected death?

StatusMaximum Burial Allowance
If the Veteran died on or after September 11, 2001$2,000
If the Veteran died before September 11, 2001$1,500
If the Veteran is buried in a VA national cemeteryWe may pay you back for some or all of the costs of moving the Veteran’s remains

What are the burial allowance amounts for a non-service-connected death?

StatusMaximum Burial Allowance
If the Veteran died on or after October 1, 2017We’ll pay a $300 burial allowance and $762 for a plot
If the Veteran died on or after October 1, 2016We’ll pay a $300 burial allowance and $749 for a plot
If the Veteran died on or after October 1, 2015We’ll pay a $300 burial allowance and $747 for a plot
If the Veteran died on or after October 1, 2014, but before October 1, 2015We’ll pay a $300 burial allowance and $745 for a plot
If the Veteran died on or after October 1, 2013, but before October 1, 2014We’ll pay a $300 burial allowance and $734 for a plot

What are the burial allowance amounts if the Veteran was hospitalized by VA at the time of their death?

StatusMaximum Burial Allowance
If the Veteran died on or after October 1, 2017We’ll pay a $762 burial allowance and $762 for a plot
If the Veteran died on or after October 1, 2016We’ll pay a $749 burial allowance and $749 for a plot
If the Veteran died on or after October 1, 2015We’ll pay a $747 burial allowance and $747 for a plot
If the Veteran died on or after October 1, 2014, but before October 1, 2015We’ll pay a $745 burial allowance and $745 for a plot
If the Veteran died on or after October 1, 2013, but before October 1, 2014We’ll pay a $734 burial allowance and $734 for a plot
  • We may also pay you back for some or all of the costs of moving the Veteran’s remains if they were hospitalized or in a VA-contracted nursing home at the time of death.
  • We may pay you back for some or all of the costs of moving the Veteran’s remains if they died while traveling to VA-authorized care.

Note: If a Veteran’s remains aren’t claimed, we’ll pay the person or organization responsible for the Veteran’s burial a $300 burial allowance. If the deceased qualifies, we may pay you back for the costs of moving the Veteran’s remains to a VA national cemetery.

Medallions for Veterans Buried in Private Cemeteries

Bronze Medallions

The Department of Veterans Affairs provides a medallion, by request, to be affixed to an existing, privately purchased headstone or marker to signify the deceased’s status as a Veteran.

This device is furnished in lieu of a traditional Government headstone or grave marker for those Veterans who served on or after Apr. 6, 1917 and whose grave in a private cemetery is marked with a privately purchased headstone or marker.

Why choose a medallion: Bronze medallions are durable and can be easily affixed to privately purchased headstones by anyone, avoiding headstone or marker setting fees. The medallion also offers a way to identify the grave as that of a Veteran when a cemetery only allows one headstone per grave, preventing the use of a standard VA marker as a footstone.

Bronze Medallion Sizes: The medallion is available in three sizes: Large(6-3/8”W x 4-3/4”H x 1/2”D), Medium (3-3/4”W x 2-7/8”H x 1/4″D) and Small (2”W x 1-1/2”H x 1/3”D). Each medallion is inscribed with the word “VETERAN” across the top and the branch of service at the bottom.

Medal of Honor Medallion Sizes: The Medal of Honor (MOH) Medallion comes in Medium and Large. Each medallion is inscribed with “MEDAL OF HONOR” at the top and the branch of service at the bottom.

To request a medallion, please use VA Form 40-1330M, Claim for Government Medallion for Placement in a Private Cemetery. When requesting the MOH Medallion, check “OTHER” in block 11 and specify MOH.

Once a claim for a medallion is received and approved, VA will mail the medallion along with a kit that will allow the family or the staff of a private cemetery to affix the device to a headstone, grave marker, mausoleum or columbarium niche cover.

Important: This benefit is only applicable if the grave is marked with a privately purchased headstone or marker. In these instances, eligible Veterans are entitled to either a traditional Government-furnished headstone or marker, or the new medallion, but not both.

For family members of eligible Veterans interested in submitting a claim for the medallion, instructions on how to apply for a medallion are available. Please use: 

“Forever GI Bill” Harry W. Colmery Educational Assistance Act of 2017


From Curtis L. Coy, Deputy Under Secretary for Economic Opportunity, Veterans Benefits Administration
Dear Fellow Veterans and Colleagues,
As you know, the recent passage of the Harry W. Colmery Educational Assistance Act of 2017, also known as the “Forever GI Bill,” enacts several changes to the GI Bill that will positively impact Veterans and their families. Some of the changes became effective the day the law was signed, some next fall, and some in the future. In the months to come, I’ll be updating you on how this new law impacts VA education benefits and what actions Veterans may need to take.
Here’s a breakdown of some of the legislation that immediately went into effect with the President’s signature, and what it means for you.

  • The 15-year time limitation for using Post-9/11 GI Bill – The 15-year limitation to use benefits is removed for Veterans who left active duty on or after January 1, 2013, children who became eligible for the Marine Gunnery Sergeant John David Fry Scholarship (Fry Scholarship) on or after January 1, 2013, and all Fry Scholarship eligible spouses. There is no action you need to take; if eligible, the limitation is simply removed for you.
  • Restoration of Benefits due to School Closure – We are now authorized to restore benefits and provide relief to Veterans affected by school closures or disapprovals. If you attended courses or programs discontinued from January 1, 2015 to August 16, 2017, and attended an accredited institution of higher learning, and did not transfer any credits to a comparable program, entitlement will not be charged for the entire period of your enrollment. The law also provides separate criteria for partial benefit restoration for school closures after January 1, 2015. To apply for restoration, we will develop a web page with instructions, information, and a form to complete and return. I will update you when this page is available, and we’ll post an announcement on our main GI Bill page and social media sites.
  • Independent study programs at career and technical education schools covered by GI Bill – This allows anyone eligible for GI Bill to use their benefits at an accredited independent study program at an area career and technical school, or a postsecondary vocational school providing postsecondary level education. A bit of background on this provision: before the passage of this law, most non-college degree programs weren’t approvable if any portion of it was online. This change allows those programs to be considered for approval even if some or all of the instruction is online/not in a classroom. There is no action for you to take here, as these programs will go through the normal course of approval by the appropriate State Approving Agency. Any new programs will be added to our GI Bill Comparison Tool.
  • Reservists who had eligibility under the Reserve Educational Assistance Program (REAP) and lost it due to sunset of the program will have that service credited toward the Post-9/11 GI Bill program – We are in the process of identifying the approximately 2,800 Reservists affected by this and will send them letters with instructions.

I will update you when the letters go out, and what to do if you did not receive a letter but feel you may be eligible for this restoration. We will also post more information on the GI Bill web and Facebook pages.
These changes will greatly benefit our nation’s Veterans by providing expanded access and opportunity to access education benefits. I will continue to update you as we work out the details of this legislation.
As always, thank you for your service.
Regards,
Curtis L. Coy, Deputy Under Secretary for Economic Opportunity, Veterans Benefits Administration, U.S. Department of Veterans Affairs, Washington, DC 20420

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