May 27 2014
Jillian Kay Melchior
Though staffers at the Veterans Affairs Regional Office in Albuquerque were supposed to schedule a follow-up medical examination for one disabled veteran receiving temporary benefits, they failed to do so — for ten years and three months.
Failure to properly schedule medical examinations at Veterans Affairs offices has caused some disabled veterans to receive less than the benefits they were entitled to. This mistake has also resulted in overpayments that cost taxpayers significantly.
The shortcoming, which has persisted despite numerous warnings from the VA’s Office of Inspector General, is just the latest instance of incompetence within the agency, albeit one the public has not yet adequately examined. “There’s cases of underpayment, and there’s cases of overpayment, and you see that all the time,” says Zachary Hearn, deputy director for claims at the American Legion.
When a veteran is deemed to have a temporary disability, VA staff are supposed to use an electronic “suspense diary” to promptly arrange a follow-up medical examination. These appointments not only document a veteran’s health problems but can also help establish a connection between an incident in the military service and a veteran’s condition, a critical part of the adjudication for a permanent-disability award, Hearn says.
National Review Online examined reports from the VA’s inspector general, going back to 2010, revealing that in many of the VA offices mired in scandal, veterans’ medical examinations were either scheduled late or never scheduled at all. “When these delays in the scheduling occur, it can take months if not years to have a veteran’s claim properly adjudicated, especially if it goes through the appellate process,” Hearn says. “That doctor’s examination is critical.”
In Cheyenne, St. Louis, and Atlanta, inspectors found instances where veterans had been underpaid by thousands of dollars. The statistics in the inspector general’s reports were not comprehensive because, in many instances, the lack of medical examinations meant no evidence existed to determine whether the VA had handled veterans’ benefits correctly. The reports noted dozens of additional cases where veterans’ benefits could potentially be affected.
Meanwhile, largely because a follow-up medical examination was never conducted, veterans who were no longer completely disabled continued to improperly receive at least $1.97 million in benefits in seven states alone — Arizona, Georgia, Missouri, New Jersey, New Mexico, South Carolina, and Wyoming. The VA is permitted to try to recoup that money from the overpaid veterans.
In 2010, inspectors investigated the Cheyenne Veterans Service Center and found that 18 percent of the 65 disability claims reviewed were inaccurately processed. In one instance, the VA had paid $160,758 over a period of nearly eight years, basing its decision in large part “on a veteran’s claimed service in Vietnam.” But “evidence in the claims folder did not indicate the veteran served in Vietnam.”
When the VA inspectors returned to Cheyenne in February 2013, problems appeared to have grown worse: Nineteen of the 24 temporary-disability evaluations reviewed were processed incorrectly, and “staff incorrectly reinstated” service for the beneficiary flagged earlier, “even though evidence continued to show that the veteran had not served in the Republic of Vietnam.”
Meanwhile, because Cheyenne Veteran Service Center “staff did not schedule a follow-up medical examination after receiving a system-generated reminder notification,” the VA had failed to pay nearly $2,000 to a different disabled veteran.
A 2012 inspection of the VA’s Phoenix Regional Office reported that “management of [temporary-full-disability] evaluations had excessive processing errors. . . . Only 13 percent of the claims [examined] were done right.” There, the VA had overpaid veterans by more than $192,000, and the report noted that most of the errors “resulted from the staff not establishing suspense diaries.”
The federal government has long been aware of these scheduling problems and of their costs to both veterans and taxpayers. An audit published in 2011 warned that disability examinations weren’t being properly scheduled, warning that if the Veterans Benefit Administration “does not take timely corrective action, they will overpay veterans a projected $1.1 billion over the next 5 years.”
— Jillian Kay Melchior is a Thomas L. Rhodes Fellow for the Franklin Center for Government and Public Integrity. She is also a senior fellow at the Independent Women’s Forum.