Errors Found in Processing of PTSD and TBI Claims

Post date: May 24, 2011 1:27:44 PM

On May 24, 2011, in In the News, by VetLawyers

According to a recent Military Times article, 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.

A review of 16,000 PTSD claims files processed between April 2009 and July 2010 revealed that 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. For TBI, investigators looked at 4,100 claims completed from April 2009 through July 2010 and found 800 were processed incorrectly. 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. The errors were found to be largely the result of lack of sufficient experience and training. 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.

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