INSULT TO INJURIES
Boston VA bungles benefits for vets with brain trauma from IED-plagued battlefields
The Veterans Administration benefits office in Boston has bungled traumatic brain injury claims at an alarming rate, flunking inspections and cutting inaccurate disability checks — shortchanging some local war heroes out of thousands of dollars, a Herald review found.
A 2015 inspection of the Boston VA Regional Office, the most recent one conducted, found an “unacceptable” error rate in assessing the degree of disability in traumatic brain injury claims — one in six of the cases the VA inspector general reviewed that year — despite a warning four years earlier to add more oversight and safeguards.
Traumatic brain injury is a signature injury among vets returning from the IED-plagued battlefields of Iraq and Afghanistan. They often suffer complex, long-term health problems, including cognitive and behavioral deficits.
Anthony Hardie, director of the D.C. advocacy group Veterans for Common Sense, called the bungled benefits “an absolute travesty.” “Unfortunately, the veterans who are worst off — the veterans who are the most disabled, who have the most complex claims — they’re the ones that suffer the most when claims staff are not properly trained,” Hardie said. “They’re truly suffering and they’re dependent on VA to get it right quickly, accurately and compassionately.”
In 2011, the Boston VA Regional Office was found to have incorrectly processed 11 of 30 TBI claims randomly selected for review, or 37 percent. The rate had improved to 5 of 30 reviewed cases in 2015, but was still condemned by the VA’s inspector general.
“Despite refresher training and implementation of a second-level review for TBI claims, the current inspection still showed an unacceptable TBI claims processing error rate,” reads the 2015 inspection.
These errors led to mistaken calculations that were used to determine how much a veteran receives in monthly disability benefits
In one case, Boston staff evaluated a veteran’s TBI-related symptoms as only 70 percent disabling, when a review of exams showed they should have been deemed 100 percent disabling. The vet was underpaid by $31,797 over two years.
In another case, a vet was underpaid $6,400 over a year and a half because a VA benefits rep failed to grant additional benefits “based on evaluations of multiple, service related disabilities as required.”
The miscalculations cut both ways. One veteran was found to have been overpaid $17,000 in a year after a review showed insufficient evidence the vet actually had a TBI.
A broader VA assessment in 2012 also found the Boston VA “noncompliant” with requirements that patients be informed of positive TBI screening results and referred to comprehensive evaluations. In the 2011 inspection, an assistant manager for the Boston veterans service center admitted her staff “felt TBI claims were confusing and difficult.”
The VA Office of the Inspector General, in interviews with the Herald, blamed poor training and oversight for the benefits office’s repeated failures, and plans to conduct a new review next year.
The VA says the issues in Boston have been addressed through refresher training.
“We take seriously the OIG’s findings and recommendations and work diligently to implement any and all recommendations,”
“Generally, errors associated with TBI claims processing occurred because of a lack of training. ... As a result of this lack of training and experience, veterans did not always receive correct healthcare entitlements or benefits payments.” — VA Inspector General’s 2011 report on the Boston Regional VA
“Despite refresher training and implementation of a second-level review for TBI claims, the current inspection still showed an unacceptable TBI claims processing error rate” — VA Inspector General’s 2015 report on the Boston Regional VA
the Department of Veterans Affairs told the Herald in a statement. “The recommendations that OIG made have been fully addressed and corrective actions have been taken, sufficient to alleviate OIG’s concerns, and both reports are closed.”
The VA’s inspector general will conduct another inspection sometime in the next federal fiscal year, which runs from October through September 2018, spokesman Michael Nacincik said.
Veterans advocates say Boston’s issues are reflective of a wider problem the understaffed and backlogged VA has keeping up with the latest in TBI science and diagnostics.
The VA inspector general has found widespread TBI processing errors across the country, attributing it to staff “using inadequate medical examination reports to evaluate residual disabilities associated with traumatic brain injuries,” according to 2014 congressional testimony by assistant inspector general Linda Halliday.
Halliday cited “pressure to meet production requirements” — referring to processed claims — for the problem, and failure to distinguish between disabilities tied to a TBI and other issues.
Benjamin Krause, a Minnesota lawyer and TBI diagnosed veteran, said the VA has shown a tendency to assign the effects of TBIs to post-traumatic stress disorder, a less permanent condition.
“With TBI, you don’t improve,” Krause said. “With PTSD, the VA says you do.”
An investigation by Krause and a Minnesota television station last year found a host of instances where vets were screened for TBI by staffers who did not have the medical credentials the VA’s own guidelines require.
In response, the VA conducted a national review of TBI exams from 2007 to 2015, and offered to reprocess more than 24,000 vets who weren’t diagnosed by a required specialist.
“We let these veterans down,” Secretary of Veterans Affairs Robert McDonald acknowledged last year.