Inspection of the VA Regional Office, Detroit, Michigan
In April 2017, we evaluated the VARO in Detroit, Michigan, to determine how well VSC staff processed disability claims, processed proposed rating reductions, entered claims-related information, and responded to special controlled correspondence. Staff improved the accuracy of processing TBI claims but inaccurately processed a significant number of claims for special monthly compensation. We reviewed 30 of 679 veterans’ TBI claims and found RVSRs accurately processed 28 cases. RVSRs did not always process entitlement to SMC and ancillary benefits consistently with VBA policy. We reviewed 30 of 52 SMC claims and found RVSRs inaccurately processed five cases due to ineffective second-signature reviews for higher-level SMC cases completed by VSC managers. Four errors resulted in 43 improper monthly payments totaling approximately $32,800. We sampled claims we considered at increased risk of processing errors, thus these results do not represent the overall accuracy of disability claims processing at this VARO. Staff generally processed proposed rating reductions accurately but needed better oversight to ensure timely actions. We reviewed 30 of 268 benefits reduction cases and found that RVSRs and VSRs delayed or inaccurately processed eight cases. Delays occurred because management prioritized other workload higher to meet established performance goals related to processing disability claims. These delays and processing inaccuracies resulted in 66 improper monthly payments to eight veterans, totaling approximately $48,000. Staff needed to improve the accuracy of data input into the electronic systems at the time of claims establishment. We reviewed 30 of 1,982 newly established claims and found Claims Assistants did not correctly input claim information in 20 cases due to inexperience and ineffective quality reviews. These inaccuracies may result in misrouted claims and delays in claims processing. Staff generally processed special controlled correspondence timely. We reviewed 30 of 173 special correspondences and found staff and management did not accurately control 21 inquiries due to insufficient oversight to ensure inquiries were properly established with the correct dates of claim. We recommended the VARO Director implement a plan to ensure the accuracy of reviews of higher-level SMC cases; implement a plan to ensure Claims Assistants receive comprehensive training on claims establishment; and improve the quality review process for claims establishment. The Director should ensure staff use the correct dates of claim for EP 500s to improve the management of special controlled correspondence. The Director concurred with our recommendations. Management’s planned actions are responsive. We will follow up as required on the remaining recommendations.
Veterans Affairs Office of Inspector General (OIG)
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