March 13, 2009 – VBA understated the claim decision error rate by about 10 percent and they did not fully implement the review plans designed to ensure that claims for similar conditions received the same evaluations and benefits.
However, they did not fully implement the review plans designed to ensure that compensation claims for similar conditions received the same evaluations and benefits.
VBA officials planned to conduct 22 reviews in FY 2008 consisting of 20 grant/denial rate and 2 evaluation reviews.
Report Summary
Audit of Veterans Benefits Administration Compensation Rating Accuracy and Consistency Reviews
Report Number 08-02073-96, 3/12/2009
The Office of Inspector General (OIG) conducted an audit to evaluate selected aspects of the Veterans Benefits Administration’s (VBA) quality assurance program.
The objectives for this audit were to determine whether: (1) the Systematic Technical Accuracy Review (STAR) process effectively identified and reported errors in compensation rating decisions and (2) VBA’s rating consistency reviews ensured that rating claims for similar conditions received the same evaluations and benefits, regardless of which VA regional office’s staff completed the rating decision.
VBA’s STAR process did not effectively identify and report errors in compensation claim rating decisions.
VBA identified a national compensation claim rating accuracy of 87 percent for the 12-month period ending February 2008.
However, they only initiated two grant/denial rate reviews and they were not completed until December 2008.
Although data security and integrity issues impacted STAR management’s ability to complete the planned reviews, VBA officials could have mitigated these problems by increasing efforts to correct data security issues and by assigning a sufficient number of staff to conduct the consistency reviews.
The Under Secretary for Benefits agreed with our findings and recommendations and made acceptable plans to implement appropriate actions.
We projected that VBA officials understated the error rate by about 10 percent, which equates to approximately 88,000 additional claims where veterans’ monthly benefits may be incorrect.
In total, we projected about 77 percent (approximately 679,000) of the almost 882,000 claims completed were accurate for the 12-month period ending February 2008.
VBA officials developed an adequate rating consistency review plan and implemented metrics to monitor rating consistency.
