On August 21, 2018, the VA Office of Inspector General (OIG) released a report which found that VA wrongly denied thousands of veterans’ claims for post-traumatic stress disorder due to military sexual trauma (MST). The OIG looked at claims during a five-month period to see if VA was following its own rules regarding the processing of MST-related claims.
What Did the Report Find?
The OIG looked at 12,000 claims related to MST that were filed during fiscal year 2017, and found that VA had denied 5,500 of those claims. The OIG estimated that almost half of those denied claims were not properly processed by VA, specifically, that VA did not properly follow its policy on handling MST cases. These denials can result in undue stress on the claimant which can disrupt their treatment and discourage them from filing future claims.
In 2011, VA implemented rules for the processing and treatment of MST claims that instructed VA employees to liberally consider the veterans’ claims. These rules were implemented in part due to accepted knowledge that instances of sexual assault often go unreported in the military, making evidence difficult to find. Since there is often little evidence of MSTs, VA employees are supposed to look through the veteran’s records for signs that the MST occurred, called “markers.” Markers are indicators of the effects of the personal trauma of the MST on the veteran, and can include:
- Changes in performance, negative or positive
- Pregnancy tests, or testing for sexually transmitted diseases
- Substance abuse
- Requests for transfer
VA employees often ignored markers or other indicators, and denied claims without obtaining evidence or scheduling the veteran for a medical examination.
VA Not Requesting Examinations
Per VA’s policy regarding, even for MST-related claims with little supporting evidence, rating officers must request a VA medical examination in order to obtain a diagnosis and/or establish a link between the claimant’s post-traumatic stress disorder (PTSD) and their MST. However, the OIG found that in 28% of the claims that were denied, “evidence was sufficient to request a medical examination and opinion, but staff did not request one.” VA may only deny a MST claim without obtaining a medical examination if there is no evidence of the veteran’s stressor (the MST), behavioral markers, or evidence of symptoms of a veteran’s mental disorder.
VA Did Not Request Veteran’s Private Treatment Records
In 13% of those cases denied, VA did not gather relevant evidence for the veteran’s claim such as private treatment records. As part of the duty to assist, VA must help veterans in their claims for benefits by gathering evidence, particularly if the veteran indicates in his or her claim that certain records would help substantiate the claim. However, in some instances VA employees did not request relevant records that could have provided support for the veteran’s MST claim.
MST Coordinators Did Not Make Required Calls to Veterans
In 11% of cases, VA MST Coordinators did not make required telephone calls to the veterans, or VA raters did not “use required language in the letter sent to the veteran to determine whether the veteran reported the claimed traumatic event in service and to obtain a copy of the report.” When a veteran indicates that their claim is based on a sexual assault, a MST Coordinator is supposed to call the veteran and ask if they reported the sexual assault in service. If they are not able to reach the veteran by phone, a Veterans Service Representative (VSR) must send the veteran a letter requesting information about their sexual assault. In some cases, the MST Coordinator failed to attempt to contact the veteran, and the VSR did not send out the required letter. This left the veteran without the opportunity to provide information that might substantiate their claim.
VA Decided Veteran’s Claim was Contradictory
In 10% of denied claims, VA decided that the veteran’s claim was “based on contradictory or otherwise insufficient medical opinions.” In some cases where the veteran was given a compensation and pension examination in relation to their claim, and the VA examiner gave a favorable medical opinion, VA still denied the claim because the examiner used vague or contradictory language. The OIG report noted that “VBA [Veterans Benefits Administration] policy clearly states contradictory or otherwise insufficient medical opinions should be returned for clarification.” However, in these cases, VA instead denied the claims without requesting such clarification.
Why Did This Happen?
The OIG attributes the errors in processing MST claims to a few different factors including “lack of reviewer specialization, lack of an additional level of review, discontinued special focused reviews, and inadequate training.”
VA’s Lack of Reviewer Specialization
Prior to 2016, VA required specialized handling of MST claims. However, VA implemented a new system for processing claims in 2016 which resulted in MST claims being reviewed by raters who do not have specialized knowledge or experience in processing MST claims.
Lack of Additional Level of Review for MST Claims
Currently, VA requires an additional level of review for certain types of claims that are more complex, but MST claims are not given this additional level of review despite the sensitive and often complicated nature of the claims. The OIG states that “an additional level of review for MST-related claims would serve as an internal control to ensure VBA staff processes claims in accordance with applicable regulations.”
Discontinued VA Special Focused Reviews
Each VA Regional Office has a national Systematic Technical Accuracy Review (STAR) team for Compensation Service and the Quality Review Team (QRT) which is meant to conduct special, focused quality improvement reviews. However, the STAR team discontinued their reviews of MST claims in December of 2015 after they found that the error rate in MST cases declined. However, the OIG recommends that they reinstate the review in an effort to provide “targeted feedback and training” to those processing the claims.
VA Employees Not Adequately Trained
OIG found that VA’s MST training has not been updated since 2014, and that VA was currently “in ‘the process of transition’” for their MST training. The OIG reviewed the new training and “identified significant deficiencies, including flawed development procedures and misstated roles and responsibilities for the MST Coordinator.” The OIG recommends that VA make improvements to their training on processing MST claims.
The OIG requested that VA review the denied claims from 2017 and correct any mistakes they made. VA stated that the review would be complete by approximately September 2019.