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Nonadherence to Requirements for Processing Gulf War Illness Claims Led to Premature Decisions

Report Information

Issue Date
Report Number
22-02194-152
VISN
1
State
District
Continental
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Recommendations
5
Questioned Costs
$25,000,000
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

A large population of veterans could be eligible for compensation for Gulf War illness, which refers to a group of unexplained or ill defined chronic symptoms found in veterans deployed to the Persian Gulf during Operations Desert Storm and Desert Shield. The VA Office of Inspector General (OIG) conducted this review to determine whether the Veterans Benefits Administration (VBA) processes disability claims related to this illness in accordance with applicable VA regulatory requirements. The OIG found that VBA’s Gulf War illness claims process did not ensure that all requirements were met before claims processors decided disability compensation claims. As a result, VBA prematurely decided an estimated 3,200 of the 13,800 Gulf War illness claims (23 percent) completed from October 1, 2021, through March 31, 2022, leading to at least $5.1 million in improper overpayments for those six months. Moreover, the team found that premature decisions are apt to continue due to shortcomings in exam requests and exam findings. About 5,500 of the 13,800 claims reviewed (40 percent) had medical examinations that did not contain the necessary information or related documentation. Among the shortcomings were that examination requests do not provide a full definition of some key terms. For example, while undiagnosed illnesses are defined, the instructions do not indicate what is needed to determine whether a veteran has a medically unexplained illness. Disability benefits questionnaires used for evaluating claims for Gulf War illnesses also do not ask specific questions that would show how a condition meets requirements to be an undiagnosed illness. The OIG made five recommendations to update instructions, definitions, and diagnostic criteria provided to examiners and clarify for claims processors that all regulatory requirements must be met to award benefits.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits update the instructions provided to examiners for completing Gulf War general medical examinations to add the definitional requirements for medically unexplained illness as outlined in 38 C.F.R.§ 3.317 and clarify the instructions and related procedures to reflect that an examiner’s determination that a disability pattern is an undiagnosed illness or a medically unexplained illness requires a written explanation.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)

The under secretary for benefits implement a plan to update the Gulf War general medical examination disability benefits questionnaire to add the definitional requirements for medically unexplained illness as outlined in 38 C.F.R.§ 3.317.

No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits implement a plan to incorporate into the Gulf War general medical disability benefits questionnaires the clinical requirements listed in 38 C.F.R.§ 3.317 for an undiagnosed illness and a medically unexplained illness.
No. 4
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits implement a plan to incorporate into the appropriate medical disability benefits questionnaires the diagnostic criteria for functional gastrointestinal disorders from 38 C.F.R.§ 3.317 and require examiners to provide an explanation of whether the disorder is functional or structural. This should include a requirement that any necessary testing has been completed before examiners diagnose specific functional gastrointestinal disorders.
No. 5
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits update VA’s Adjudication Procedures Manual to clearly state that all the requirements of 38 C.F.R.§ 3.317 must be met to award benefits. Clarify and reiterate instructions to claims processors that benefits should only be awarded after taking into consideration the overall evidence of record.
Total Monetary Impact of All Recommendations
Open: $ 25,600,000.00
Closed: $ 0.00