Review of Assignment of Noncompensable Musculoskeletal Joint Disabilities

Report Information

Issue Date
Report Number
25-02645-131
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Report Topic
Claims and Medical Exams
Major Management Challenges
Benefits for Veterans
Recommendations
4
Questioned Costs
$44,979,787
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

The VA Office of Inspector General (OIG) conducted this review to determine whether VBA claims processors correctly assigned noncompensable evaluations for service-connected musculoskeletal joint disabilities—the most common service-connected disabilities among veterans. When service connection is warranted, a claims processor evaluates the veteran’s claim and assigns a disability percentage. If the evaluation determines a disability is compensable, it may result in monthly payments to the veteran. If there is no evidence of limited or painful range of motion, a noncompensable evaluation is assigned, and the veteran does not receive payment for that disability.

The OIG found that claims processors incorrectly evaluated noncompensable joint disabilities based on painful motion about 50 percent of the time from April 1, 2024, through March 31, 2025. Furthermore, the OIG team confirmed that as of November 2025, VBA continued to experience similar errors for noncompensable joint disabilities. These errors resulted in an estimated monetary impact of at least $45 million in underpayments to veterans. That said, VBA reported in March 2026 that all errors identified by the OIG had been corrected as of February 2026.

The errors occurred because many claims processors misunderstood how to properly apply key regulatory provisions governing painful motion under 38 C.F.R. § 4.59. Staff reported confusion about how to weigh subjective reports of pain versus objective medical findings and how to determine when pain alone warrants a compensable rating. Regulations were inconsistently interpreted not only among claims processors in regional offices but also among staff from several offices in VBA’s Compensation Service. The OIG also found that unclear terminology in VBA’s procedures and rating tools contributed to the problem.

The OIG issued four recommendations to the under secretary for benefits aimed at clarifying regulatory guidance and ensuring consistent application of compensable evaluations for joint disabilities.

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)

Consult with the VA Office of General Counsel to establish a clear and consistent interpretation of 38 C.F.R. § 4.59, to include clarification of whether pain alone without painful motion is sufficient to warrant a compensable evaluation.

No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Based on the clarified interpretation of 38 C.F.R. § 4.59, consider revising the Adjudication Procedures Manual to improve consistency of terms, and notify claims processors of the revision.

No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Assess whether guidance is clear to claims processors regarding the requirement to review all evidence, including both objective and subjective evidence, as well as the proper weight that should be given to each piece of evidence.

No. 4
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Determine what actions are necessary to the evaluation builder tool to mitigate confusion and ensure decision consistency for all musculoskeletal joint conditions.

Total Monetary Impact of All Recommendations
Open: $ 44,979,787.00
Closed: $ 0.00