Rating Schedule Updates for Hip and Knee Replacement Benefits Were Not Consistently Applied

The Veterans Benefits Administration (VBA) uses the VA Schedule for Rating Disabilities (rating schedule) to determine monthly compensation to eligible veterans for service connected disabilities based on documented medical severity. In 2021, VA updated the rating schedule for the musculoskeletal body system. The VA Office of Inspector General (OIG) reviewed the effectiveness of VBA’s implementation of the changes to the rating schedule specifically for hip and knee replacements or resurfacing.

The OIG estimated that in approximately 33 percent of reviewed claims, VBA rating specialists did not assign the correct number of months when granting periods of convalescence. Ratings specialists lack effective tools to determine convalescence benefits and help calculate the proper period. The specialists rely on manually entered dates, increasing the risk of error. Approximately 18 percent of claims did not accurately consider veterans’ additional entitlement to special monthly compensation, and an estimated 38 percent resulted in improper payments of about $3.3 million dollars in total benefits overpayments and underpayments. Further, VBA did not sufficiently monitor claims decision accuracy following the rating schedule update. The OIG team also determined that although VBA provided training on the rating schedule update, nearly 75 percent of staff did not achieve a passing score of 80 percent and required retraining.

The under secretary for benefits concurred with the OIG’s four recommendations: (1) review hip and knee replacements and resurfacing claims completed from February 7, 2021, through August 31, 2022, to ensure benefits to veterans were correct; (2) implement a plan to assist rating specialists in determining accurate benefits; (3) develop procedures to monitor claims and ensure processing is compliant with rating schedule revisions; and (4) supplement training on rating schedule updates to improve comprehension on applying changes.