On September 10, 2018, the VA Office of Inspector General (OIG) released a report which found that VA officials understated the number of claims that have been awaiting decisions for over 125 days, resulting in VA inaccurately reporting the extent of the VA disability claim backlog.
Why Did the OIG Investigate and How?
The OIG looked at the pending disability claims backlog nationwide as it concerned disability claims over 125 days old that required rating decisions. The OIG was prompted to investigate when, in September 2015, the Chairman of the Committee on Veterans’ Affairs in the House of Representatives requested that the OIG review possible data manipulations at one of the VA Regional Offices (ROs). The OIG responded by conducting a nationwide review of ROs, and randomly selected the Regional Offices in Fargo, North Dakota; Fort Harrison, Montana; Louisville, Kentucky; Roanoke, Virginia; and Seattle, Washington for review.
Looking at End Product (EP) Completion
The OIG reviewed end products (EPs) that were completed during the first and second quarters of fiscal year (FY) 2016, and that were not considered part of VA’s claim backlog. They looked at EPs to determine if any of them were over 125 days old and required the issuance of a rating decision.
EPs are how VA establishes and distributes workloads, and each EP has a specific code that identifies the type of claim or the actions that are required. Specifically, the OIG focused on rating EPs, which are generally those that require a rating decision, and examples of claims with rating EPs include claims for service connection, increased ratings, VA pension, and dependency and indemnity compensation (DIC).
The OIG Finds VA Backlog Did Not Include All Claims
VA Limited Claims Included in Backlog
Upon their review, the OIG found that the VA claim backlog did not include all claims that were awaiting rating decisions for more than 125 days during the time period reviewed. Specifically, the OIG stated it “estimated VARO [RO] staff completed about 63,600 other EPs that required rating decisions that took over 125 days to complete but that VBA [Veterans Benefits Administration] did not count as part of the backlog.” According to the OIG, this means that VA only reported approximately 79% of all the claims that required rating decisions that took over 125 days, which comes out to an estimated 239,000 of 302,000 claims. Meaning, VA failed to report an estimated 63,000 claims in its backlog.
In 2010, VA established a Transformation Plan to attempt to eliminate the claims backlog by 2015. However, leaders at VA limited the types of claims included in the backlog to rating EPs, excluding those that were pending the issuance of a rating decision. The OIG was unable to determine why the backlog was limited to these claims.
VA Prioritized Rating EPs over Others
The OIG found that a part of the reason for the backlog is that in general, VA prioritizes working on rating EPs over other EPs, such as those for claims for dependency benefits. VA reported in May 2018 that their rating EPs were pending for about 90 days on average. However, the OIG found that other EP categories included cases that required the issuance of a rating decision, “and the category with the lowest average days pending was reported as being about 142 days.” Prioritizing rating EPs resulted “in significant delays in processing other EPs that were older and required rating decisions.”
Incorrect Processing of Claims after Examinations
The OIG also found that, specifically at the Montgomery RO, VA staff did not properly process several rating EPs as they related to medical examinations that were over a year old. The EPs were only put in the appropriate rating EP after the medical examination, and VA staff was then instructed to complete the EP that same day as the examination, especially if the claim was over two years old. This process prevented the claims from appearing in VA’s pending workload, and contributed to the misrepresentation of the claim backlog statistics.
Ineffective Oversight and Training of Claims Assistants
Lastly, the OIG found that “ineffective oversight and training due to lack of national performance and training plans for Claims Assistants resulted in inaccuracies that also affected the backlog.” Claims Assistants are VA employees who process mail, establish claims with the proper EPs, and update VA’s electronic systems. The OIG found that VA “did not perform consistent oversight of their productivity and quality,” which led to poor performance and errors which contributed to the incorrect reporting of VA’s backlog.
Erroneously changed or inaccurate EPs and dates of claims (DOCs) also contributed to the misrepresentation of the backlog. The OIG estimated that “staff erroneously changed a prior correct EP or DOC in approximately 1,300 cases,” in part stemming from the ineffective oversight of VA Claims Assistants.