Medical opinion requests are central and of the utmost importance to ensure Veterans get the disability compensation they are entitled to receive.
On September 7th, 2022 the Office of the Inspector General (OIG) released a report after conducting an audit for how well the VA Board of Appeals requests and obtains medical opinions for VA disability claims. Keep reading to learn more....
The results are appalling...but not surprising to us Veterans who struggle with the VA disability process.
The OIG found that 68% of the time the VA Board of Appeals failed to follow required procedures in Veterans claims.
Wait....What the (expletive)!
Yes, that is not a typo. 68% of the time they failed Veterans. So lets start with what are they supposed to do?
Per regulation:
"To request a medical opinion,
1. claims processors should identify relevant medical evidence for the examiner to review
2. write adequate medical opinion requests
3. request all warranted medical opinions
4. and only request medical opinions when necessary
The purpose of these procedures is to ensure that examiners can provide a medical opinion with sufficient rationale based on a review of the evidence."
The errors found by the OIG include:
1. Claims processors did not consistently identify relevant medical evidence for the examiner to review
38% of the time- no evidence was provided to the examiner
19% of the time- partial evidence was provided to the examiner
2. did not always use adequate language
18% of the time- the language was not adequate to communicate clearly what the requested opinion was for
3. did not regularly request all warranted medical opinions
12% of the time- medical opinion requests were not made and in those situations the medical opinion was critical to determine if a claim was valid
4. sometimes requested unnecessary medical opinions.
11% of the time- unnecessary medical opinion requests were made
These errors lead to inaccurate medical opinions/incorrect decisions (hence all of those strange denials we all received), unnecessary delays in Veterans claims, and wasteful spending.
The OIG identified areas of improvement including training, monitoring, and systems controls.
- It was identified that training did not cover how to request a medical opinion properly
- It was identified that the computer system allows processors to submit medical opinion requests without including medical evidence
- It was identified that there are areas of the monitoring system that can be improved to ensure there is proper oversight of the medical opinion process
The VA responded to this by:
enhance the electronic system with 3 updates
provide a minicourse update to processors to ensure proper training on requesting a medical opinion
adjustments to the checklist to ensure proper monitoring of the medical opinion process
At the end of the day efforts are being made to improve the systems and processes to do right by the Veteran population, but we are a long way away from where we should be in support of those who serve and protect us all. Private medical opinions and evidence are more important than ever. Don't give up.. Keep fighting for what you deserve.
P.S. here is the link to the full OIG report if you would like to read it in full chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.va.gov/oig/pubs/VAOIG-22-00404-207.pdf
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