VBA Could Improve the Accuracy and Completeness of Medical Opinion Requests for Veterans’ Disability Benefits Claims

For veterans seeking disability compensation benefits, the Veterans Benefits Administration (VBA) requires a disability exam to determine the severity of a disability or a medical opinion on whether a current condition can be connected to military service. VBA has committed an estimated total of $6.8 billion in contracts to complete disability examinations and medical opinions over a five-year period starting in 2016. Because medical opinion requests can be vital to ensuring veterans receive the benefits to which they are entitled, the VA Office of Inspector General (OIG) examined whether VBA staff correctly followed procedures when requesting medical opinions. The review team found that VBA can reduce inadequate medical opinions, incorrect or delayed claims decisions, and wasted resources by improving internal controls, personnel training, and monitoring of medical opinion requests. The team estimated that 27,900 of 41,100 requests (68 percent) did not follow required procedures during the review period (October 1, 2020–September 30, 2021). Claims processors did not consistently identify relevant medical evidence for the examiner’s review, did not always use clear and accurate language, did not regularly request all warranted medical opinions, and sometimes requested unnecessary medical opinions. These failings can lead to inaccurate medical opinions, incorrect decisions on veterans’ claims, delayed decisions for veterans, and inefficient use of resources (such as when the medical opinion requires rework). VBA concurred with OIG-identified deficiencies and recommendations to (1) implement electronic system enhancements to require claims processors to identify relevant evidence before a medical opinion request can be submitted, (2) enhance mandated training for all claims processors and demonstrate progress in achieving its intended impact, and (3) strengthen monitoring by refining quality review processes to help identify areas for improvement and show advancements in complying with required procedures.