vaoFFICeoFInSpeCtorgeneraLInveStIgateSanonyMouStIp
Military & Veterans Affairs Committee Chairs : RobertBarton – RumbergerKirk & JanaeThomas – Quinteros , Prieto , WoodandBoyer , P . A .
oIgestimatesthat400 complexappealswere assignedtoraterswho werenotqualifiedtohandle thosetypesofclaims .
One year ago , in March 2022 , the Veterans ’ Administration Office of Inspector General ( OIG ) received an anonymous tip that a Decision Review Operations Center ( DROC ), the section of the Veterans Benefits Administration responsible for appeals processing , was improperly handling complex appeals .
Importantly , appeals of denials for veterans ’ benefits claims , such as amyotrophic lateral sclerosis ( ALS ), military sexual trauma ( MST ), and traumatic brain injury ( TBI ), are considered “ complex ” and should only be processed by decision review officers with specialized training . Additionally , decisions regarding claims for MST and TBI require the signature of two decision review officers . The OIG investigated the anonymous tip and released its findings on March 9 , 2023 .
The VA DROCs are located in Seattle , Washington ; St . Petersburg , Florida ; and Washington , D . C . These offices often transfer cases amongst themselves due to the Veterans ’ Benefits Administration ’ s national work queue , which redistributes appeals based on the workloads of the individual raters . Due to this redistribution , the OIG estimates that 400 complex appeals were assigned to raters who were not qualified to handle those types of claims .
In addition to reviewing the work routing system , the OIG review team looked at three samples of complex appeals , consisting of ALS , MST , and TBI decisions made between October 1 , 2021 , and February 28 , 2022 . The OIG estimated that 93 percent of those appeals were decided by DROC raters who were not designated to process them , not appropriately trained , or did not receive the required second signatures .
When OIG approached the DROCs about their findings , some managers and supervisors stated , “ they assumed [ decision review officers ] met requirements and could issue decisions on any type of appeal ” or that they “ did not know which raters were designated to issue decisions on complex appeals .” 1
VBA ’ s Office of Administrative Review ( OAR ), which is tasked with managing the DROCs , ensuring quality control , and implementing the appropriate training programs , was also contacted about OIG ’ s findings . OAR reported that it did conduct a site visit during the timeframe investigated but did not review completed appeals to
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