May 21, 2011 • Ben Krause

VA health care workers and benefits processors are receiving new training in how to handle disability evaluations for veterans claiming traumatic brain injuries after an internal investigation found a high percentage of errors on those types of claims.

A May 18 report by the VA Inspector General says a spot review of disability claims found an 8 percent error rate in claims related to post-traumatic stress disorder and a 19 percent error rate in claims related to traumatic brain injury.

Half of the PTSD claims and slightly more than half of the TBI claims affected benefits, according to the report.

Overall, the IG found a 23 percent error rate in the cases it reviewed, stemming mainly from the fact that 82 percent of claims involved temporary 100 percent disability ratings for veterans who needed surgery or a specific treatment for their service-connected disability. The majority of these errors were technical and did not affect benefits, the report said.

For PTSD-related claims, a review of 16,000 files processed between April 2009 and July 2010 found that the VA employees processing claims lacked enough experience and training to be accurate.

The single biggest mistake was failing to verify a specific event or events in service that resulted in the stress, something that became easier in July 2010 when VA rules were amended so a veteran’s statement by itself is considered sufficient evidence. However, one-quarter of the errors resulted from assigning incorrect effective dates to claims, and about 20 percent of the errors involved incorrect mental health evaluations.

VA officials said they believe the problems with PTSD cases are resolved but will continue to monitor accuracy.

For TBI, investigators looked at 4,100 claims completed from April 2009 through July 2010 and found 800 were processed incorrectly. Like the problems with PTSD claims, the chief problem was inexperience and undertrained staff, the report said.

Eighty-four percent of the errors were the result of problems with medical examinations being either inadequate or incorrect in identifying the symptoms of TBI and whether there were residual disabilities that coexisted with other mental conditions.

In response to the report, VA benefits and health care officials said they are working to ensure that compensation and pension examiners are trained in the proper procedures and will require regional offices that process benefits to provide a second reviewer for many TBI-related claims. A rater will be allowed to work without a reviewer only if they have achieved a 90 percent accuracy rate on 10 consecutive TBI cases, VA officials said in their formal response to the report.

Training for medical personal in proper exam procedures should be completed by June 30, but the new process for second reviews of TBI cases will not take effect until Sept. 30.

St. Louis, MO (KSDK) - Some veterans in the St. Louis region are still having surgery and dental procedures canceled or postponed two months after the all clear was given at the St. Louis VA Medical Center.

Officials suspended all procedures on February 2, 2011 after an employee found a surgical tray pitted with corrosion. Multiple investigations took place and more than 200 surgeries scheduled at the facility were instead performed at other St. Louis hospitals at tax payer's expense.

The center reopened March 10, more than a month after closure. VA experts, along with private vendors and independent consultants, examined the sterilization processing department and determined it was safe to start surgeries again.  But veterans are still having surgeries and dental procedures postponed.

The hold up, according to VA officials, has to do with the decision to replace or restore 63,000 dental and surgical instruments.

"We have a patient safety culture here. We wanted to make sure when the instruments come out that we felt comfortable using them on patients," said Dr. Michael Crittenden, Chief of Surgery.

He explained the enormity and complexity of the restoration process takes time.  But veterans tell the I-Team, all of that time is taking a toll on services they've earned.

The surgery center is operating only at 70 percent while the dental clinic hasn't done any restorative work like fillings or crowns in four months. Routine dental cleanings are taking place at 60 percent of what it was prior to the February closure.

One patient, who feared speaking on camera, said she had three appointments canceled since February and worries about losing some of her teeth.

"It just makes my blood boil that any veteran would be put in that situation but also, these are lingering problems from what has happened months and months and months ago," said Congressman Russ Carnahan, who spearheaded a campaign for investigations and congressional hearings. 

National Dental Labs contacted by the I-Team, say restoring dental instruments should take three days.  So why after eight weeks are surgeries and dental procedures still being canceled?

Aesculap, a German company, is restoring the VA's instruments at its Hazelwood facility.  A company vice president told the I-Team, "We have been working with St. Louis VA since mid-February...we don't control what we receive and when...but it's typically a three day turn around."

VA officials insist it is not a procurement or bureaucratic red tape problem. Dr. Crittenden said turnaround is taking longer than three days but he is very pleased with the quality of work Aesculap has provided.

He said if a patient has a dental emergency, the VA will pay for an outside dentist. Dr. Crittenden said they've paid for outside services more than 100 times since the February closure.
Officials at the VA hope to be back to 100 percent capacity at both the surgical and dental centers sometime in the next two weeks.

The sterilization concern was the second in less than a year at the Cochran center. In 2010, faulty sterilization at the center's dental clinic raised concerns that 1,812 veterans were potentially exposed to hepatitis and HIV. Most of those veterans have been tested and no cases of HIV or hepatitis have been connected to the dental clinic.

A Congressional hearing titled "Sacred Obligation: Restoring Veteran Trust and Patient Safety," is now taking place in Washington, D.C.

December 23, 2010 - Vietnam Veterans suffering specific presumptive illnesses related to their Agent Orange exposure while in service began filing their disability claims approximately 6 weeks ago. In that time period, the Department of Veterans Affairs (VA) processed and resolved over 28,000 claims.

ST. PETERSBURG, Florida - From his one-room apartment,  Terry Richards does what he can to survive below the poverty level.

Richards, 62, is a Vietnam-era vet makes less than $12,000 a year in social security and pension benefits.  In years he spends a large portion of his income on medical expenses, he gets partial reimbursement.

"Every penny counts for me and others like me," Richards said of the 637,000 veterans and family members who rely on Veterans Benefits Administration (VBA) pensions.

See Also: Vets lose benefits as VA covers up mistake

But Richards recently discovered that the miles he claimed for trips to his doctor's appointments weren't reimbursed at the 41.5-cent rate Congress mandated in 2008.  Because the VA hadn't updated its expense report form in years, veterans were still instructed to only claim 28.5 cents per mile.

For Richards, it made the difference of $56 one year.  10 News found other veterans with larger discrepancies.

"$56 is a lot of money when you only make $985 a month," Richards said.

He started writing letters to the VBA and Congressman Bill Young, a long-time veterans advocate.  The VBA eventually sent him a check for the $56, but still didn't update the forms.

A spokesperson for the agency told 10 News that updating the form online was unnecessary, since the VBA automatically credits veterans the difference once they send in their annual reports with the wrong amount.

But they didn't in the cases 10 News studied.  They also weren't able to tell how many of the forms were turned in last year.

Congressman Young eventually penned a letter to the head of the agency, citing "the need to immediate update the VA's 'Medical Expense Report' form (VA Form 21-8416) to ensure that our nation's veterans are properly being reimbursed for their travel expenses."

READ: Rep. Bill Young's letter (PDF)

Young also urged an audit of reports filed to find out how many veterans may have been shortchanged since Congress changed the reimbursement rate in 2008.