Review of Alleged Mismanagement of Informal Claims Processing at VA Regional Office Oakland, California

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02/17/2015 07:00 PM EST

On July 10, 2014, the Office of Inspector General (OIG) received a request for assistance from the Under Secretary for Benefits to review allegations that the VA Regional Office (VARO) in Oakland, CA, had not processed nearly 14,000 informal requests. The allegation indicated some claims dated back to the mid 1990s. The same allegation was forwarded to us by Representative Doug LaMalfa, who also requested an OIG review. In addition, another complainant alleged that “informal claims” were being improperly stored. We immediately initiated an unannounced, onsite review at VARO Oakland and its Sacramento satellite office. We substantiated the allegations that VARO staff had not processed informal claims. We confirmed that staff had not properly controlled these claims documents, which were accidently found in a filing cabinet, during a construction project. We did not identify any current storage or control issues during our site visit. VARO management advised that a team assisting the Oakland Veterans Service Center (VCS) had located approximately 14,000 informal claims, some of which dated back to the mid-1990s. VA considers an informal claim as any type of communication or action, indicating the intent to apply for one or more benefits, in accordance with existing laws. Management stated it counted the documents and actually identified 13,184 informal claims. Of these 13,184 informal claims, 2,155 required review or action by VARO staff. VARO management told us they had created a “special project team” to process the 2,155 informal claims and thought the task had been completed. However, in April through May 2014, VARO staff again “discovered” additional claims, some of which the VARO’s “special project team” had annotated as reviewed. After two months, VARO management created a tracking spreadsheet to determine which claims needed to be processed. VARO management determined staff (assigned to the special project team) had not processed 537 informal claims. At the time of our onsite review, we could not confirm the existence of the 13,184 informal claims, or which of them were the 2,155 claims needing review or action. We could not confirm the existence of a VARO special project team, their names, or their qualifications. None of the work, claimed to have been accomplished by the VARO staff or management, could be confirmed – much less the accuracy of that work – due to poor record keeping practices. We reviewed 34 of these newly “discovered” claims and found 7 (21 percent) remained unprocessed. While no claims in our sample dated back to the mid-1990s, some were as old as July 2002. We also found VARO staff had repeatedly reviewed these seven informal claims from December 2012 through June 2014 for various reasons, but took additional action on them, as required. VARO staff did not maintain adequate records or provide proper supervision to ensure informal claims received timely processing. As a result, veterans did not receive consideration for benefits to which they may have been entitled. During our inspection, no current issues related to the lack of control and improper storage of informal claims documents came to our attention. We recommended the VARO Director complete and certify the review of the 537 informal claims, take appropriate action, and provide documentation to certify these actions are complete. Also, the Director should better enforce compliance with existing VBA and VARO policies pertaining to the processing of informal claims.