Unwarranted MedicalReexaminations forDisability Benefits

From the VA IG: Complete Post through this link…

Why the OIG Did This Review

The OIG conducted this review to determine whether Veterans Benefits Administration (VBA)
employees required disabled veterans to submit to unwarranted medical reexaminations.

VBA employees have authority to request reexaminations for veterans “whenever VA
determines there is a need to verify either the continued existence or the current severity of a
disability,” and when there is no exclusion from reexamination. While reexaminations are
important in the appropriate situation to ensure taxpayer dollars are appropriately spent,
unwarranted reexaminations cause undue hardship for veterans. They also generate excessive
work, resulting in significant costs and the diversion of VA personnel from veteran care and

What the Review Found

VBA employees did not consistently follow policy to request reexaminations only when
necessary. The OIG team reviewed a statistical sample of 300 cases with reexaminations from
March through August 2017 (review period) and found that employees requested unwarranted
medical reexaminations in 111 cases. Based on this sample, the review team estimated that
employees requested unwarranted reexaminations in 19,800 of the 53,500 cases during the
review period (37 percent).

VBA employees requested reexaminations for veterans whose cases qualified for exclusion from reexamination for one or more of the following reasons:
· Over 55 years old at the time of the examination, and not otherwise warranted by unusual
circumstances or regulation
· Permanent disability and not likely to improve
· Disability without substantial improvement over five years
· Claims folders contained updated medical evidence sufficient to continue the current
disability evaluation without additional examination
· Overall combined evaluation of multiple disabilities would not change irrespective of the
outcome of reexamining the particular condition.

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