VA Should Ensure Veterans’ Records in the New Electronic Health System Are Reviewed before Deciding Benefits Claims

Veterans Benefits Administration (VBA) staff need access to the full range of Veterans Health Administration (VHA) records for proper benefits claims processing. In October 2020, VBA officials emailed a memo instructing processors to search for, identify, and “flash” claims (affix electronic tags) from veterans with records in VA’s new electronic health system for proper routing to a select group of staff with access to those records. The Office of Inspector General (OIG) assessed whether claims processors followed VBA guidance for identifying and routing claims from veterans with records in the new electronic health system. The OIG found 21,057 rating decisions were completed for veterans with records in the new system from August 1, 2021, through July 31, 2022. Of those, 5,605 claims (27 percent) were either missing a flash or the flash was added after staff decided the claim. The review team found, however, from a judgmental sample of 30 decisions that the missing flashes did not ultimately affect veterans’ benefits in those instances. Still, VBA leaders must ensure all benefits claims from veterans with records in the new electronic health system are checked before they are decided by VBA personnel with access. Staff must satisfy their duty to assist veterans in obtaining all evidence, including relevant VA medical records, before deciding a claim. If not completed, veterans may not receive the benefits to which they are entitled. Therefore, the OIG concluded VBA should strengthen its oversight to confirm a flash is applied to all claims from veterans with records in the new system. VBA concurred with the OIG’s two recommendations to conduct refresher training and update written guidance to improve VBA staff’s handling of claims involving records in the new electronic health system and strengthen oversight by clarifying staff accountability for failure to consider all evidence.