Review of Healthcare Services and Benefits for Resident U.S. Virgin Islands Veterans

The VA Office of Inspector General (OIG) conducted this review to evaluate Congressional concerns that veterans residing in the U.S. Virgin Islands (USVI) receive disparate healthcare services and benefits in comparison to veterans residing in Puerto Rico. We substantiated the allegation USVI veterans could face language barriers and problems communicating with non-direct patient care staff while at the VAMC in San Juan. However, we did not find language barriers negatively impacted patient care. We also found English language proficiency was not consistently documented in SF 52 Request for Personnel Action forms. We partially substantiated the allegation USVI veterans do not have access to the same level of Veterans Health Administration (VHA) services as the veterans in Puerto Rico because VHA does not provide inpatient care, 24-hour emergency care, or outpatient specialty care in the USVI. Because the Veterans Affairs Caribbean Healthcare System (VACHS) allows USVI Community-Based Outpatient Clinic (CBOC) providers liberal use of fee basis care, access to care for USVI veterans is not limited or less than that of the veterans in Puerto Rico. In addition, we confirmed that patient satisfaction was not measured at the local level for the USVI CBOCs as required. We could not confirm or refute the allegation veterans must generally wait 3 months for a medical appointment. Appointments for new patients exceeded the VHA goal of less than 30 days from the desired date of the appointment at the St. Thomas CBOC. However, established patients were generally seen within 30 days of the desired appointment date, and patients were consistently seen promptly by fee basis providers and within 30 days at the San Juan VAMC. We could not substantiate the allegation of disparate treatment of benefits claims filed by veterans residing in the USVI. No evidence suggested that VBA processed benefits claims differently based on a veteran’s residency. Further, the San Juan VARO processed benefit applications for USVI veterans on average 4 days sooner than benefit applications submitted by veterans residing in Puerto Rico. We could not substantiate allegations that VHA applied travel reimbursements unequally for claims submitted by veterans residing in the USVI compared to claims submitted by veterans residing in Puerto Rico. We recommend that the Veterans Integrated Service Network 8 Director require the VA Caribbean Healthcare System Director ensure English language proficiency is documented in SF 52 forms for physicians, nurses, and residents, as required. We also recommended the Director ensure that primary care appointments at the USVI CBOCs be available within the timeframes prescribed by VHA policy. We recommended the Director determine the feasibility of sending medical examiners to the USVI to perform Compensation and Pension examinations that do not require medical specialists or non-portable specialized medical equipment. Finally, we recommended the Director allow veterans residing in the USVI to submit mileage reimbursement claims retroactively for eligible visits completed between January 9, 2009, and September 30, 2010; and that he ensures the San Juan VAMC develops appropriate oversight mechanisms to review and monitor mileage reimbursement claims for the VA Caribbean Healthcare System. The VISN and System Directors agreed with the findings and recommendation contained in the draft report and provided responsive implementation plans to address our recommendations. We will monitor progress and follow up on implementation until all proposed actions are completed. The Acting Under Secretary for Benefits stated that VBA appreciated the opportunity to review the draft report but offered no comments.