Many errors in VA mental health claims

Post date: May 24, 2011 1:50:45 PM

By Rick Maze - Staff writer Posted : Monday May 23, 2011 16:30:07 EDT

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.