Inspection of the VA Regional Office Winston-Salem, North CarolinaIn December 2016, we evaluated the Winston-Salem VA Regional Office (VARO) to see how well staff processed disability claims, proposed rating reductions, claim information, and special controlled correspondence. Veterans Service Center (VSC) staff did not consistently process one of the two types of disability claims reviewed. Staff inaccurately processed seven of the 60 disability claims we reviewed. Five errors affected benefits payments resulting in 139 improper monthly payments of approximately $86,400 to 5 veterans. The remaining errors had the potential to affect benefits payments. We reviewed 30 of 3,222 veterans’ traumatic brain injury (TBI) claims; all 30 were accurately processed. Staff did not consistently process entitlement to special monthly compensation (SMC) and ancillary benefits claims correctly. We reviewed 30 of 146 SMC claims processed and found 7 claims contained errors—an increase from our 2015 inspection, when 5 of 30 were inaccurate. The errors occurred because staff were inexperienced in processing higher-level SMC and ancillary benefits claims and because of an ineffective secondary review process. Staff processed rating reductions accurately but needed to prioritize this workload. We reviewed 30 of 1,180 rating reduction cases and found staff delayed processing 10. As of November 1, 2016, the delays resulted in an average of five months of improper payments. Delays occurred because management prioritized other workloads. The 10 cases with delays resulted in 45 improper payments of approximately $19,900. Staff needed to improve the accuracy and completeness of information entered into the electronic system at the time of claims establishment. We reviewed 30 of the 4,060 newly established claims and found claims assistants entered inaccurate and/or incomplete information in the electronic system for 24 of the claims due to incomplete training and an inconsistent quality review process. Staff needed to improve the processing of special controlled correspondence. We reviewed 30 of the 1,784 special controlled correspondences and found staff incorrectly processed 14. The errors occurred because of a lack of training and inadequate oversight. We recommended the VARO Director implement a plan to monitor the effectiveness of SMC training, ensure secondary reviewers accurately evaluate higher-level SMC and ancillary benefits claims, ensure staff receive all mandatory training on establishing claims, and ensure consistency in quality reviews. The Director should implement a plan to ensure staff receive training and comply with policy when processing special controlled correspondence. We recommended the North Atlantic District Director ensure the timely processing of the rating reduction workload. The Directors concurred with our recommendations and their planned actions are responsive.
Veterans Affairs Office of Inspector General (OIG)
No comments:
Post a Comment