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VA OIG Found VA Over Paid Thousands of Veterans for Inadequately Making Them Permanent and Total

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VA OIG Found VA Over Paid Thousands of Veterans for Inadequately Making Them Permanent and Total

Permanent and Total decisions state the evidence must allow VA to be “reasonably certain” that a total disability is likely to continue throughout a life.
Veterans Benefits Administration Inadequately Supported Permanent and Total Disability Decisions

 

The Veterans Benefits Administration Inadequately Supported Permanent and Total Disability Decisions

 
 
 
09/10/2020 10:00 AM EDT
 
 
 
The Veterans Benefits Administration (VBA) manages the VA’s disability compensation program, which pays benefits based on a veteran’s degree of disability, ranging from 0 to 100 percent. When veterans are found 100 percent disabled or unemployable due to service-connected disabilities, VBA must also consider whether veterans qualify for permanent and total (P and T) disability status.
 
 

The VA Office of Inspector General (OIG) examined whether VBA staff cited adequate medical evidence demonstrating that veterans met statutory requirements for P and T status. The review team found that 61 percent of the decisions sampled did not cite adequate medical evidence, and about 15,100 veterans received  P and T status without this evidence. As a result, VA may have improperly paid an estimated $38 million in additional benefits for P and T veterans for dental care, as well as education benefits and healthcare coverage for dependents between October 1, 2017, and December 31, 2019.

 
 
 
The OIG further estimated that VA may improperly pay more than $84 million over the next five years for these benefits. The review team determined that VA’s adjudication procedures manual is inconsistent with the statute on P and T status. The statute requires decision-makers to be “reasonably certain” that a total disability is likely to continue throughout a veteran’s lifetime, while the manual allows them to establish P and T status without using this standard.
 
 
 
In addition, decision-makers did not always explain the reasons why they established P and T status in the rating decisions as required. The OIG recommended that VBA ensure the adjudication procedures manual is reviewed and updated for consistency with statute; revise procedures to ensure staff supports P and T status decisions by citing evidence; and revise the title and language used in the decisions to more clearly explain the establishment of P and T status. The OIG also recommended VBA provide staff with appropriate training on the updated procedures.

 

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