DBQ news from VA OIG

[Berta]

12:00 PM EDT
"The VA Office of Inspector General (OIG) reviewed whether the Veterans Benefits Administration (VBA) complied with legal requirements to reinstate disability benefits questionnaire forms from non-VA medical providers. The forms are used to submit medical information needed for processing veterans’ disability claims. The OIG also examined whether VBA claims processors followed VA procedures for using the published questionnaires.

Previous OIG reports found significant internal control problems with publicly available questionnaires. In February 2020, the OIG issued a report responsive to allegations that some veterans’ benefits claims using publicly available questionnaires were potentially fraudulent. The report noted that while VBA had taken some steps to mitigate this risk, there were further internal control and procedural deficiencies.

This report finds that VBA complied with the requirements of the law by reinstating 69 questionnaires on its public-facing website. However, disability benefits questionnaires that were incomplete, inaccurate, or of questionable authenticity from non-VA medical providers were not always processed correctly when determining benefits entitlement—causing underpayments of about $13,900 and overpayments of $74,800 over the nine months studied.

Improper processing occurred because VBA lacked sufficient controls to ensure disability benefits questionnaires from non-VA medical providers were properly relied on when determining entitlement to benefits.

VBA concurred with the OIG’s five recommendations, including that VBA correct all identified processing errors and report back the results. Additionally, the VBA’s adjudication procedures manual should be revised and updated to clarify and communicate steps claims processors must take to verify all certification elements on the publicly available questionnaires; clarify the intent of guidance involving authenticity, face value, and validation of the questionnaires; and define valid rationale to ensure medical opinions are well supported. Finally, the OIG recommended VBA ensures claims processors understand the need to document the evaluation of evidence when using publicly available benefits questionnaires."

 

Source VA OIG email 03/09/2022 

[Buck52]

I put this up too ms Berta  but I deleted it cause it came from my email   so good thing you posted it. 

Thanks

Edited March 10, 2022 by Buck52

[Berta]

I get stuff many time a week in email from the VA , from the VA OIG, VA Central, and also VA OGC re: a personal  matter I have with them Buck, 

I wish I had time to post here all the VA email that is geared to be shared with all veterans-

I get dozens of emails every day-regarding vet issues and only have time to triage them.

You can post anything VA sends you that is of importance to veterans.

But like you, I do not post the actual email with my email address- I ust post a copy of the VA Logo and the source, from the email.

 

 

 

Edited March 10, 2022 by Berta

[Vync]

20 hours ago, Berta said:

Improper processing occurred because VBA lacked sufficient controls to ensure disability benefits questionnaires from non-VA medical providers were properly relied on when determining entitlement to benefits.

VBA concurred with the OIG’s five recommendations, including that VBA correct all identified processing errors and report back the results. Additionally, the VBA’s adjudication procedures manual should be revised and updated to clarify and communicate steps claims processors must take to verify all certification elements on the publicly available questionnaires; clarify the intent of guidance involving authenticity, face value, and validation of the questionnaires; and define valid rationale to ensure medical opinions are well supported. Finally, the OIG recommended VBA ensures claims processors understand the need to document the evaluation of evidence when using publicly available benefits questionnaires."

Hmm... So the OIG said "define valid rationale to ensure medical opinions are well supported". I just checked a couple of DBQs over at https://www.benefits.va.gov/compensation/dbq_publicdbqs.asp and there are still no fields or boxes available which direct non-VA docs to opine. Instead there is a "remarks" section at the very end before they sign off. However, internally the VA has a completely separate medical opinion form where trained VA C&P examiners can indicate SC or not, not/less than/as likely as not/more than/is logic, and also explain their opinion/rationale. Perhaps if the VA would make that form public too, or append it's contents to the end of each public DBQ, then non-VA docs would better understand what they need to document.

It's also a bit odd that they refer to these as "public". They should be the exact same forms used internally by the VA.

 

[Berta]

DBQs, are ,in my opinion, the worse thing a Good IMO/IME doctor can fill out.

I imagine the VA ignores them when they do not reognize the doctor's name ( one more reason the "list" that has been removed, by Tbird in  the S--t list Thread is so important.)

Since we are ususally paying real money for an IMO/IME it should follow the criteria here at hadit-

These DBQs are geared to C & P doctors who usually never take the time to really assess our medical files or C files.Or our SMRs.

 

A non VA IMO/IMEdoctor-

(there are 44 very good ones on the list from the VA, removed by Tbird (but still available if you are interested in finding it-)

with give you a 'through and conscientous review' of all of your claimed issues, more detailed then any 20minute C & P exam.

38 CFR 4.6 requires the VA to do that as well- if not it can set up a CUE.As I explained here in another post this AM, and also 'ad finitum'---here ----for YEARS.

 

 

 

 

 

Edited March 10, 2022 by Berta
added more.

[Vync]

The OIG mentions "verify all certification elements". That leads me to believe that if the doc who fills out the DBQ misses even one box, the VARO will consider it an inadequate exam. 

The last C&P I had was in late 2019. I asked the LHI NP if they had thoroughly reviewed my records. She said she "searched" it using their tools in the system. That's fine and dandy if during scanning the optical character recognition (OCR) algorithm managed to accurately translate the typed/printed/handwritten characters in each document. Essentially, it's a very lazy and  error-prone approach.

[Buck52]

I tell veterans all the time to get an IMO/IME perfer a specialist in what your claiming.  IFthey need it  and take copy of the VA guidlines on how the IMO/IME is conducted  kinda like a C&P .

They also can make copies of this new DBQ and ask the Dr to adress it    but be sure he uses the VA Crateria  and reads up on your medical records that proceeds what your claiming.  coipes copies copies   give the Dr  so he can have it in is records....its a good Idea if you ask the Dr to keep his record  in case the VA CALLS.  I think they do anyway.

I had a specailst years ago 2002 give me an exam   for a private  IMO.IME/  I took him my records and he read up on them  for what it was I was claiming the VA had written in their reporst on a botch  VA C&P Exam  from a VA Dr that said a bunch of lies. anyway  I had a DRO Hearing at my Respected Reginol Office  AND A VA Rating Specialist was present at my Hearing   after the hearing was over this rating specialist (Rater) called this Dr 'S office   and ask if he went by the VA Criteria      they went pulled my records from the copies I give them   and  Bingo THAT WAS ALL THE RATING SPECIALIST NEEDED.

When you call these Dr's OFFICE and ask if they see Veterans that need a IMO IME:   ASK AT THIS TIME IF THE DR IS VETERAN FRIENDLY?

   THAT WILL SAVE YOU A WHOLE LOT OF TIME , JUST  BE HONEST WITH THEM TELL THEM WHAT YOU NEED  IF THERE VETERAN FRIENDLY  YOU SHOULD HAVE NO PROBLEM.