On July 17, 2018, the VA Office of Inspector General (OIG) released a report entitled “Unwarranted Medical Reexaminations for Disability Benefits,” that found that VA conducts thousands of unnecessary medical exams for disabled veterans, and is on track to spend more than $100 million over the next five years on these unwarranted reexaminations if nothing changes.
Why Was the Report Issued?
VA OIG’s report reviewed the Veterans Benefits Administration’s (VBA) practices for conducting medical reexaminations for veterans with service-connected disabilities. When veterans are granted a disability rating for a service-connected condition, VA will reevaluate that disability in the future to determine if the veteran’s condition has worsened, improved, or remains unchanged. The purpose of these reexaminations is to determine if VA needs to adjust a veteran’s disability rating, and thus his or her compensation payments. Based on the findings of these examinations, VA can reduce a veteran’s rating if it finds that the condition has improved, increase the disability rating if the veteran’s condition has worsened, or leave the rating unchanged if neither a reduction nor increase is warranted. These reexaminations are only supposed to occur if a veteran’s condition is NOT deemed to be permanent, or the veteran meets other criteria (see “What OIG Found”).
VA OIG conducted the review of VBA’s practices for reexamining veterans’ disabilities to ensure that VBA employees were not ordering unnecessary exams, which can waste VBA money and time, and potentially pose hardships to the veteran.
What Does It Mean for a Condition to Be “Permanent”?
If a service-connected condition is “permanent,” it means that VA has determined, based on medical evidence, that the veteran’s service-connected condition is unlikely to improve in the course of the veteran’s life, and it will not reevaluate the veteran’s condition in the future. If a service-connected condition is not considered to be permanent, VA can schedule the veteran for a future examination to reassess the severity of the condition, and possibly assign a new rating if warranted. A major concern for veterans whose conditions are not determined to be permanent is that VA will propose to reduce their disability rating based on the findings of a reexamination.
What VA OIG Found
In the report, VA OIG found that VBA employees did not “consistently follow policy to request reexaminations only when necessary,” and that VBA was submitting disabled veterans to unwarranted reexaminations for their disabilities. VA OIG looked at a sample of 300 cases with reexaminations throughout a 6 month period (March 2017 to August 2017), and found that VBA employees “requested unwarranted medical reexaminations in 111 cases,” approximately a third of the cases OIG selected for sampling.
OIG states that VBA employees requested reexaminations for veterans who were supposed to be excluded from reexamination for reasons such as:
- They were over 55 years old at the time of the exam and the exam was “not otherwise warranted by unusual circumstances or regulation”
- The veteran had a permanent disability that was not likely to improve
- The veteran had a disability that did not show substantial improvement over 5 years
- The veteran’s claims file contained medical evidence that was sufficient for VA to continue the veteran’s current disability rating without conducting an examination
- The veteran’s “overall combined evaluation of multiple disabilities would not change irrespective of the outcome of reexamining the particular condition”
- The veteran had a disability evaluated at 10% disabling or less
- The veteran’s disability evaluation was at the minimum level for the condition
Often veterans who fell into several of these categories were scheduled for reexamination of their service-connected disabilities.
How Much Money does VBA Spend on reexaminations?
VA covers the costs of these reexaminations, and the OIG’s report found that during the 6 month period under review, “VBA spent $10.1 million on unwarranted examinations – $5.3 million involving Veterans Health Administration (VHA) clinicians and $4.8 million involving VBA contractors.” Based on their review, OIG estimates that VBA is on track to spend $100.6 million on unwarranted reexaminations over the course of the next 5 years.
Why Is This Important?
VA Employees Failed to Follow Internal Procedure
Before a veteran is scheduled for a reexamination, a Rating Veterans Service Representative (RVSR) reviews the veteran’s file to see if a reexamination is warranted. In some cases, there is enough evidence in the veteran’s file that their disability rating should be continued, or that the veteran’s disability is permanent in nature, and would not need a reexamination. The review by a RSVR is intended to prevent unwarranted examinations. However, OIG found that 78% of unwarranted examinations did not have a pre-exam review by a RVSR. This finding shows that VA employees were not abiding by their internal policies and procedures; instead, they skipped the review stage and directly routed the cases to a Veterans Service Representative (VSR) to be sent for reexamination. VSRs are not trained and do not have the specialized knowledge to determine if a veteran needs a reexamination, and by skipping the review stage and referring cases directly to the VSR, VBA ended up requesting numerous unwarranted reexaminations.
The OIG report states that “a lack of pre-exam reviews, lack of system automation, and inadequate quality assurance reviews […] contributed to VBA employees requesting unwarranted reexaminations,” and cost VBA millions of dollars.
OIG mentions in its report that by conducting unnecessary examinations, VA created needless work for employees, stretching the capacity of a workforce that is already burdened. The additional workload also diverted VBA resources and capacity away from processing benefits claims, and VHA “capacity to provide healthcare services.”
Submitting Veterans to Unnecessary Examinations
By failing to properly assess if reexaminations were warranted, OIG estimates that “VBA requested 19,800 veterans to report for unwarranted reexaminations during the review period.” VA OIG also found that approximately 14,200 of the 19,800 veteran did not have their disability evaluation changed following the reexaminations, and 3,700 veterans received VA proposals to reduce their disability benefits, even though they were not supposed to be reexamined in the first place.
Submitting veterans to these unnecessary examinations results in a burden for the veteran, financially and timewise. Veterans must travel to the facility to be reexamined, and those who received proposals to reduce their disability rating are then subject to the long appeal process to fight the reduction if they choose to do so.
What Does OIG Recommend?
OIG offers several recommendations to VBA in an effort to curtail the scheduling of unwarranted reexaminations:
- That the Under Secretary for Benefits set up internal controls that would ensure that a reexamination is appropriate before the VBA employee orders the exam, and modify “VBA procedures as appropriate to reflect these improved business processes.”
- The Under Secretary should prioritize the “design and implementation of system automation” to “minimize unwarranted reexaminations.”
- The Under Secretary should strengthen quality assurance reviews in order to evaluate if employees are correctly requesting reexaminations “and categorize unwarranted reexaminations as errors.”
- The Under Secretary should conduct “a special focused quality improvement review of cases with unwarranted reexaminations […] to understand and redress the causes of any avoidable errors.”
If a veteran believes that they were scheduled or are being scheduled for an unnecessary reexamination, they should contact their representative.