1 in 6 traumatic brain injury (TBI) claims incorrectly processed
On April 30, Boston’s VA Regional Office (VARO) came under public scrutiny when the Boston Herald reported that it incorrectly processed 1 in 6 TBI claims in 2015, despite a warning four years earlier. The Regional Office failed to fully implement previously recommended safeguards and quality control measures that could have prevented these inaccurate TBI evaluations.
The OIG Report
In 2015, the VA Office of Inspector General (OIG) published a report that found an “unacceptable” error rate in adjudicators’ assessments of traumatic brain injury claims. Inspectors found that 5 out of 30 TBI cases they reviewed had been incorrectly processed, leaving 1 in 6 veterans at risk of losing potentially thousands of dollars in VA benefits.
Traumatic brain injury is an increasingly common injury among veterans returning from Iraq and Afghanistan. Resulting from powerful IED blasts or other head trauma, TBI symptoms can be complex and often “invisible,” making them harder to diagnose. Symptoms include long-term health problems, including cognitive and behavioral deficits.
In May 2011, the Inspector General published an initial report that found that 11 of 30 TBI claims at the Boston VARO had been incorrectly processed – a 37 percent error rate. The report recommended TBI refresher trainings and a policy requiring a second signature from a Quality Review Specialist on each TBI case evaluation.
The problem in Boston
Although the Boston VARO did implement a second-signature policy, it was only partially enforced. The policy stated that individual adjudicators must get a second signature on his/her case evaluations until he/she demonstrates 90 percent accuracy in processing TBI claims.
According to the 2015 report, management at the Boston office failed to actually track the accuracy of individual adjudicators to ensure they met the 90 percent accuracy requirement. Managers could not even demonstrate that the staff conducting the second-signature reviews had attained the required 90 percent accuracy rate to do so. Two of the five cases with errors did not undergo a second-signature review at all.
Inspectors also faulted managers for not monitoring and identifying trends in the types of errors adjudicators were making. The report concludes that, had these previously recommended procedures been followed, the errors identified may have been prevented.
Processing of TBI claims Beyond Boston
The Boston VA Regional Office is, unfortunately, not unique in its handling of TBI claims. In 2016, then-Secretary of Veterans Affairs Bob McDonald had to issue special re-examinations for nearly 25,000 veterans whose traumatic brain injuries had been evaluated by unqualified medical examiners at VA medical centers across the country.