Breadcrumb

Review of VBA’s Process for System Overrides

Report Information

Issue Date
Report Number
25-00630-89
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Report Topic
Claims and Medical Exams
Major Management Challenges
Benefits for Veterans
Recommendations
5
Questioned Costs
$67,155
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

The VA Office of Inspector General (OIG) sought to assess whether Veterans Benefits Administration (VBA) claims processors were appropriately overriding warnings and calculator results within the Veterans Benefits Management System for Rating (VBMS R). The review focused on overrides processed between April 1 and September 30, 2024, and evaluated compliance with applicable laws, policies, and procedures.

The OIG found that while many overrides were properly executed, an estimated 9,900 were not warranted or lacked valid justification. These unwarranted override decisions occurred (1) because VBA did not conduct regular quality reviews that would provide feedback to processors, (2) because of the absence of clear guidance on what constitutes a valid override justification, and (3) because of limited functionality in two VBMS R oversight tools. These deficiencies hindered VBA’s ability to perform efficient oversight and could lead to quality reviewers examining cases that did not actually involve an override.

Actions by VBA claims processors caused about $67,200 in improper disability benefits payments and unnecessary exam costs, with the potential to affect future disability benefits payments or result in unnecessary exam costs. The OIG briefed VBA on the review’s progress in March 2025, and VBA agreed with the sample review results. In December 2025, the OIG officially briefed VBA on the findings. Although VBA has since taken steps to enhance aspects of its override process by releasing a new reporting dashboard in February 2026, the OIG has not reviewed or tested it.

To address the issues the OIG identified and strengthen the VBMS-R override process, the OIG made five recommendations focused on improving guidance, oversight, and system functionality. VBA agreed to implement all five recommendations.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Develop and communicate guidance that explains what detail should be included in a valid justification for every Veterans Benefits Management System for Rating override.

No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Develop and implement a plan to reestablish an overrides quality review process that provides individualized feedback for claims processors.

No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Develop and implement a plan to monitor the effectiveness of override reviews and continue to address areas and trends that are found to need improvement.

No. 4
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Identify the business need for the override review tab and, if there is one, develop and implement requirements for updating and using it.

No. 5
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)

Develop and implement a plan that addresses the limitations of the aggregate dashboard.

Total Monetary Impact of All Recommendations
Open: $ 67,155.00
Closed: $ 0.00