VA OIG: Delays Occurred in Some Veterans’ Benefits Claims While Awaiting Decision

The National Work Queue (NWQ) division generally uses the NWQ tool and ranking rules to prioritize and distribute claims across VBA’s regional offices for processing. The OIG conducted this review after discovering some claims at the NWQ division had been awaiting decisions for one year or longer. The team identified 10,541 claims aged 365 days or older that, on August 1, 2022, were at the NWQ division awaiting decision and were not distributed to a regional office. Most of these claims had been at the NWQ division for at least six months, and over 99 percent required routing to specialized teams that process special mission herbicide-related claims. Office of Field Operations (OFO) leaders limited staffing for these teams to control quality for these complex claims and balance workloads, and they generally expected the delays. However, the OIG team reviewed VBA’s oldest pending claims and identified instances in which the NWQ division’s ranking rules unintentionally contributed to delays. Additionally, by comparing the ranking scores that the NWQ tool assigned with the NWQ division’s ranking rules, the OIG team found instances in which the NWQ tool incorrectly ranked some claims, which may have affected whether those claims were distributed to regional offices. Stronger monitoring could have allowed the NWQ division to identify these issues earlier and make adjustments to ensure claims were appropriately prioritized. The team also found that OFO’s FY 2022 internal controls assessment did not evaluate claims prioritization and distribution and did not mention the NWQ division or tool. To reduce delays in claims processing, the OIG recommended strengthening the NWQ division’s monitoring of claims awaiting decision to ensure its rules are operating as intended and ensuring OFO includes the NWQ division’s functioning in its annual internal controls assessment. The recommendations have been closed based on documentation provided.

See the report here.

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