Posttraumatic Stress Disorder Claims Processing Training and Guidance Need Improvement

In 2018, the VA Office of Inspector General (OIG) reported that nearly half of disability benefit claims that were denied service connection for posttraumatic stress disorder (PTSD) and were related to military sexual trauma were not processed properly. In contrast, this review focuses on PTSD claims that were unrelated to military sexual trauma. Most PTSD claims fall into this category. To decide that a veteran is eligible for disability benefits, claim processors for the Veterans Benefits Administration (VBA) must establish a connection between the disability and the veteran’s military service. The review team found that claims processors inaccurately processed about 18,300 of 118,000 PTSD claims completed in fiscal year 2019 (16 percent). Most errors occurred because claims processors did not verify or ask veterans to provide the disorder’s cause, known as an in-service stressor. In other cases, claims processors did not request a medical examination, medical opinion, or clarification of inconsistencies in the examination as required. Claims processors made these errors because they did not fully understand PTSD stressor types and the stressor verification process. VBA’s Compensation Service did not mandate any national training for claims processors on these subjects except during the first year in the position. In addition, VBA’s procedures manual was not effectively organized to allow staff to locate this information and lacked specific guidance for some aspects of PTSD claim processing. The OIG recommended that the under secretary for benefits determine the actions needed to ensure staff understand the requirements for gathering evidence and verifying stressor requirements for PTSD claims and, once the actions are implemented, monitor the results to ensure effectiveness. VBA should also assess whether its adjudication procedures manual needs to be reorganized and amended to help staff process PTSD claims accurately.