WASHINGTON — Has the VA improved its process of dealing with military sexual trauma, or are errors resulting in veterans being denied the care they need?
That was the question addressed in a recent legislative hearing.
Three years ago, a scathing VA Inspector General report revealed that the department’s claims processors were mishandling claims related to military sexual trauma (MST). When IG investigators conducted a follow-up investigation—the results of which were released in August—they discovered that not only has VA failed to address the first report’s recommendations, but the numbers have actually gotten worse.
In November, officials from the VBA and Inspector General’s Office testified before the House VA Committee. The IG documented VBA’s decade-long problems with handling MST-related claims, as well as a lack of support for VA’s MST coordinators, who are charged with helping veterans with MST navigate the system and get the care they need.
VA officials argued that the past few years represent a success for the department, which is processing more MST claims than ever. Additionally, they argued that the errors documented in the IG report represent harmless clerical errors and would not necessarily impact the decision on whether to award a veteran benefits.
The August 2018 report found that 49% of denied MST-related claims were improperly processed and that processors had failed to complete all of the necessary steps to obtain and review evidence before rendering their decision. The report noted that these premature denials could have led to veterans not receiving benefits they were owed. And, because veterans suffering from MST frequently have stories of not being believed by commanders and of retaliation when they decide to come forward about their experience, being denied by VA could easily be retraumatizing.
The report made six recommendations directed at reviewing the previous two years of denied claims and to help VBA better process claims in the future. At the time, VBA officials agreed with the recommendations and said that they would adopt them.
The follow-up investigation found that, during the last three years, VBA failed to address the recommendations and consequently the percentage of improperly processed MST claims rose to 52%.
One of the recommendations in the 2018 report was that MST-related claims should only be handled by a specialized group of claims processors trained to handle MST claims. As of Nov. 27, 2018, this recommendation became an official VBA requirement.
OIG investigators found that about 80% of the MST claims denied from Oct. 1 to Dec. 31, 2019, were reviewed by VBA employees who were not part of this specialized group, however.
Five MST Reports
The VA OIG has released five MST-related oversight reports since 2010, both on the benefits and healthcare side, each identifying deficiencies and recommending corrective action. Testifying before the committee, VA Inspector General Michael Missal said that two major themes run through these reports: ignoring procedure and failure to govern.
“Benefit claims processors often ignored the procedures VA set up for quality assurance. Proper processing is critical, as it drives accuracy,” Missal said. “[Also], failures in governance have resulted in VA not fully implementing recommendations and healthcare program support that would improve outcomes for veterans seeking care and benefits for MST.”
Asked if he could grade VBA on their handling of MST-related claims, Missal deferred, saying that, because the OIG only looked at denied claims, they couldn’t grade VA’s efforts overall.
“But whatever grade, it wouldn’t be a great grade,” he added. “Because we found so many issues. What was particularly disturbing is we had a 2018 audit in which we identified a variety of processing issues, detailed them for VBA in the report, put together recommendations that we believed were going to address them. And then when we were in the process of assessing their response to the recommendations, we had concerns they weren’t doing them correctly and that’s what caused us to do the second audit.”
VBA officials asked legislators to look at different numbers. According to VBA, in FY2018 the grant rate for MST-related claims was 57% compared to 74% in FY2021. Officials credited this increase to some of the very recommendations made by the OIG’s office, including improvements in training, procedural guidance and operational processes.
As for the still-high percentage of improperly processed denied claims, Beth Murphy, VBA’s executive director for compensation service, said many of these are innocuous clerical errors that would have no impact on the accuracy of a denied claim.
“If a claims processor neglects to upload a checklist into the veteran’s file, that’s considered a procedural error,” Murphy explained. “It doesn’t mean the claim was done incorrectly or there was a wrong outcome. But I agree there is room for areas to improve in execution and tighten things up.”
However, VA’s difficulties in handling veterans suffering from MST does not stop at the claims process. Concerned about how these veterans were faring once they entered the VA system, the committee asked Missal and his office to look at VA’s MST coordinator program.
MST coordinators are responsible for providing outreach and support for veterans who experienced MST and to assist VA staff with those veterans.
“The OIG found that MST coordinators had a sincere commitment to the role, were thoughtful about the challenges and were enthusiastic about serving in the position,” Missal explained. “However, they often lacked the support and resources they need to be successful.”
The role of MST coordinator is assigned on top of an employee’s other duties and is considered one-fifth of a full-time employee, or an eight-hour a week commitment. Many of the MST coordinators that investigators interviewed reported that this was not enough time to fill all the responsibilities of the role.
“Someone with MST will likely need a number of services from VHA,” Missal said. “The coordinator really is orchestrating the care that someone who has MST is going to get, and if they don’t have enough time it’s a problem.”
In June 2020, VHA issued an operational memo, which essentially told hospital administrators to make sure that MST coordinators have enough time in their schedule to complete their duties.
“Two months later, that’s when we heard many of them [saying] we still don’t have enough time, despite this operational memo,” Missal declared.
The question for VA now is whether eight hours a week is enough time to designate to that role. According to Missal, VA can’t answer that question, because it varies from hospital to hospital and the specific MST needs at each.
Some committee members are seeking to improve VA’s MST claims process through legislation. In November, Reps. Mike Bost (R-IL) and Troy Nehls (R-Texas) introduced H.R. 6064, which would require VA to partner with the National Academies to complete a comprehensive review of the MST disability exam process.
“The National Academies will determine whether VA’s diagnostic criteria meet the national standard; whether examiners have the appropriate credentials and training; and [make sure that] disability exams account for conditions that have both physical and psychological cause,” Nehls explained at the hearing. “The bill would also require VA to report on any actions it plans to take to improve the MST exam process following the National Academies study.”