Inspection of the
 

VA Regional Office
 

Buffalo, New York
 

OFFICE OF AUDITS AND EVALUATIONS

August 25, 2011 

11-00523-258 
ACRONYMS AND ABBREVIATIONS
 

C&C Confirmed and Continued 

NOD Notice of Disagreement 

OIG Office of Inspector General 

PTSD Post-Traumatic Stress Disorder 

RVSR Rating Veterans Service Representative 

SAO Systematic Analysis of Operations 

STAR Systematic Technical Accuracy Review 

TBI Traumatic Brain Injury 

VACOLS Veterans Appeals Control and Locator System 

VARO Veterans Affairs Regional Office 

VBA Veterans Benefits Administration 

VSC Veterans Service Center 

To Report Suspected Wrongdoing in VA Programs and Operations:
 

Telephone: 1-800-488-8244
 

E-Mail: vaoighotline@va.gov
 

(Hotline Information: http://www.va.gov/oig/contacts/hotline.asp)
 
Report Highlights: Inspection of the VA 

Regional Office, Buffalo, New York 

Why We Did This Review 

The Veterans Benefits Administration has a 

nationwide network of 57 VA Regional 

Offices (VAROs) that process disability 

claims and provide a range of services to 

veterans. We conducted this inspection to 

evaluate how well the Buffalo VARO 

accomplishes this mission. 

What We Found 

Buffalo VARO staff correctly established 

dates of claim in the electronic record. 

VARO performance was generally effective 

in processing post-traumatic stress disorder 

claims and correcting errors identified by the 

Veterans Benefits Administration’s 

Systematic Technical Accuracy Review 

program staff. 

The VARO lacked accuracy in processing 

some disability claims. Inaccuracies in 

processing temporary 100 percent disability 

evaluations resulted when staff did not 

schedule future medical reexaminations as 

required. Staff incorrectly interpreted policy 

and used insufficient medical examinations 

to process traumatic brain injury claims. 

Errors in herbicide exposure-related 

disability claims were due to inadequate 

training and oversight. Overall, VARO staff 

did not correctly process 32 (32 percent) of 

the 101 disability claims reviewed. 

VARO management did not ensure staff 

completed Systematic Analyses of 

Operations, properly processed mail, and 

immediately completed final competency 

determinations. Although the VARO did 

not meet the 7-day standard in recording 

Notices of Disagreement, it exceeded the 

national average for appeals processing 

timeliness. 

What We Recommended 

We recommended the VARO Director 

follow policy on timely processing 

temporary disability reevaluations, and 

implement a plan to review adequacy of 

training on processing herbicide exposurerelated claims. Management needs to 

provide refresher training and ensure staff 

return inadequate medical examination 

reports to hospitals for correction to support 

proper processing of traumatic brain injury 

claims. Additionally, management needs to 

ensure oversight and control of mail 

handling, as well as completion 

Systematic Analyses of Operations. 

of 

Agency Comments 

The VARO Director concurred with our 

recommendations. Management’s planned 

actions are responsive and we will follow up 

as required on all actions. 

BELINDA J. FINN
 

Assistant inspector General
 

for Audits and Evaluations
 

i 
TABLE OF CONTENTS
 

Introduction......................................................................................................................................1
 

Results and Recommendations ........................................................................................................2
 

1. Disability Claims Processing ..................................................................................................2
 

2. Data Integrity ..........................................................................................................................8
 

3. Management Controls .............................................................................................................9
 

4. Workload Management.........................................................................................................10
 

5. Eligibility Determinations.....................................................................................................12
 

Appendix A VARO Profile and Scope of Inspection ............................................................14 

Appendix B VARO Director’s Comments............................................................................16 

Appendix C Inspection Summary..........................................................................................20 

Appendix D OIG Contact and Staff Acknowledgments........................................................21 

Appendix E Report Distribution ...........................................................................................22 

ii 
Inspection of the VA Regional Office, Buffalo, New York 

Objective
 

Scope of
 

Inspection
 

INTRODUCTION 

The Benefits Inspection Program is part of the Office of Inspector General’s 

(OIG) efforts to ensure our Nation’s veterans receive timely and accurate 

benefits and services. The Benefits Inspection Division contributes to 

improved management of benefits processing activities and veterans’ 

services by conducting onsite inspections at VA Regional Offices (VAROs). 

These independent inspections provide recurring oversight focused on 

disability compensation claims processing and performance of Veterans 

Service Center (VSC) operations. The objectives of the inspections are to: 

	 Evaluate how well VAROs are accomplishing their mission of providing 

veterans with access to high quality benefits and services. 

	 Determine if management controls ensure compliance with VA 

regulations and policies; assist management in achieving program goals; 

and minimize the risk of fraud, waste, and other abuses. 

	 Identify and report systemic trends in VARO operations. 

In addition to this standard coverage, inspections may examine issues or 

allegations referred by VA employees, members of Congress, or other 

stakeholders. 

In May 2011, the OIG conducted an inspection of the Buffalo VARO. The 

inspection focused on 5 protocol areas examining 10 operational activities. 

The five protocol areas were disability claims processing, data integrity, 

management controls, workload management, and eligibility determinations. 

We reviewed 71 (14 percent) of 518 disability claims related to 

post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and 

herbicide exposure that the VARO completed from January 2011 through 

March 2011. In addition, we reviewed 30 (13 percent) of 228 rating 

decisions where VARO staff granted temporary 100 percent disability 

evaluations for at least 18 months, generally the longest period a temporary 

100 percent disability evaluation may be assigned under VA policy without 

review. 

Appendix A provides details on the VARO and the scope of the inspection. 

Appendix B provides the VARO Director’s comments on a draft of this 

report. Appendix C provides criteria we used to evaluate each operational 

activity and a summary of our inspection results. 

VA Office of Inspector General 1 
Inspection of the VA Regional Office, Buffalo, New York 

RESULTS AND RECOMMENDATIONS 

1. Disability Claims Processing 

The OIG inspection team focused on disability claims processing related to 

temporary 100 percent disability evaluations, PTSD, TBI, and herbicide 

exposure. We evaluated claims processing accuracy and its impact on 

veterans’ benefits. 

Finding 1	 Disability Claims Processing Accuracy Could Be 

Improved 

The Buffalo VARO lacked accuracy in disability claims processing. VARO 

staff incorrectly processed 32 (32 percent) of the total 101 disability claims 

we reviewed. VARO management agreed with our findings and initiated 

action to correct the inaccuracies identified. 

The following table reflects the errors affecting, and those with the potential 

to affect, veterans’ benefits processed at the Buffalo VARO. 

Table Disability Claims Processing Results 

Type Reviewed 

Claims Incorrectly Processed 

Total Affecting 

Veterans’ 

Benefits 

Potential To 

Affect Veterans’ 

Benefits 

Temporary 

100 Percent Disability 

Evaluations 

30 17 4 13 

Post-Traumatic Stress 

Disorder Claims 30 1 1 0 

Traumatic Brain 

Injury Claims 11 8 0 8 

Herbicide 

Exposure-Related 

Disabilities Claims 

30 6 1 5 

Total 101 32 6 26 

Temporary 

100 Percent 

Disability 

Evaluations 

Source: VA OIG 

VARO staff incorrectly processed 17 (57 percent) of 30 temporary 

100 percent disability evaluations we reviewed. Veterans Benefits 

Administration (VBA) policy requires a temporary 100 percent disability 

evaluation for a service-connected disability following surgery or when 

specific treatment is needed. At the end of a mandated period of 

VA Office of Inspector General 2 
Inspection of the VA Regional Office, Buffalo, New York 

convalescence or treatment, VARO staff must request a follow-up medical 

examination to help determine whether to continue the veteran’s 100 percent 

disability evaluation. 

For temporary 100 percent disability evaluations, including confirmed and 

continued (C&C) evaluations where rating decisions do not change veterans’ 

payment amounts, VSC staff must input suspense diaries in VBA’s 

electronic system. A suspense diary is a processing command that 

establishes a date when VSC staff must schedule a reexamination. As a 

suspense diary matures, the electronic system generates a reminder 

notification alerting VSC staff to schedule the reexamination. 

Available medical evidence showed that 4 of the 17 processing inaccuracies 

affected veterans’ benefits—2 involved overpayments totaling $124,552 and 

2 involved underpayments totaling $45,356. Details on the most significant 

overpayment and underpayment follow. 

	 A Rating Veterans Service Representative (RVSR) did not include in a 

rating decision a future date to reevaluate a veteran’s service-connected 

prostate cancer. VA medical treatment records supported no more than a 

0 percent evaluation entitling the veteran to health care for the condition 

but not monetary compensation. As a result, VA overpaid the veteran 

$104,772 over a period of 3 years and 8 months. 

	 An RVSR correctly granted a 100 percent disability evaluation for a 

veteran’s prostate cancer. Six months following completion of treatment, 

the RVSR reduced the evaluation to 20 percent disabling on the same 

rating decision document although no medical evidence existed to 

support the change. The RVSR also assigned an incorrect effective date 

of November 1, 2005 for the 20 percent reduction. However, a VA 

medical examination in January 2006 supported a 60 percent disability 

evaluation, effective February 1, 2006. In a subsequent disability 

decision on this same condition, an RVSR correctly increased the 

evaluation to 100 percent disabling based on private treatment records 

showing residual prostate cancer, but again assigned an incorrect 

effective date. Medical evidence showed entitlement should have been 

granted one month earlier. As a result of these multiple inaccuracies, VA 

underpaid the veteran $40,946 over a period of 4 years and 3 months. 

The remaining 13 inaccuracies had the potential to affect veterans’ benefits. 

Following are descriptions of these inaccuracies. 

	 In nine cases, VSC staff did not schedule follow-up medical 

reexaminations needed to determine whether the temporary 100 percent 

evaluations should continue. An average of 4 years and 8 months 

elapsed from the time staff should have scheduled the medical 

VA Office of Inspector General 3 
Inspection of the VA Regional Office, Buffalo, New York 

reexaminations until the date of our inspection—the date staff ultimately 

ordered the reexaminations to obtain the necessary medical evidence. 

The delays ranged from 5 months to 9 years and 9 months. 

	 In three cases, RVSRs incorrectly requested future reexaminations for 

veterans diagnosed with incurable Chronic Lymphocytic Leukemia. In 

making these decisions, the RVSRs also did not consider entitlement to 

additional benefits for Dependents’ Educational Assistance as required 

by VBA policy. 

	 In one case, an RVSR proposed reducing a veteran’s 100 percent 

disability evaluation. VARO staff received the veteran’s request for a 

personal hearing on May 27, 2010; however, VSC staff had not taken 

action on this request at the time of our inspection in May 2011. Until 

VSC staff conduct the requested hearing, neither VARO staff nor we can 

ascertain the current level of the veteran’s disability. 

Six of the 17 errors resulted from staff not establishing suspense diaries 

when they processed rating decisions requiring temporary 100 percent 

disability reexaminations. Five of these errors involved C&C rating 

decisions. In November 2009, VBA provided guidance reminding VAROs 

about the need to add suspense diaries in the electronic record for C&C 

rating decisions. However, VARO management had no oversight procedure 

in place for C&C rating decisions to ensure VSRs established suspense 

diaries as reminders of the need for reexaminations. 

In response to a recommendation in our report, Audit of 100 Percent 

Disability Evaluations (Report No. 09-03359-71, January 24, 2011), the 

Acting Under Secretary for Benefits agreed to review all temporary 

100 percent disability evaluations and ensure each evaluation had a future 

exam date entered in the electronic record. Therefore, we made no 

additional recommendations for improvement in this area. To assist in 

implementing the agreed upon review, we provided the VARO with 

198 claims remaining from our universe of 228 temporary 100 percent 

disability evaluations. 

Additionally, VARO staff did not follow VBA policy or the VSC workload 

management plan guidance on 810 work items. An 810 work item is a 

system-generated reminder notification to take future action on a claim. For 

work items related to temporary disability evaluations, VSC staff are 

responsible for reviewing the notifications and the corresponding claims files 

to determine the need to schedule medical reexaminations. We found 

75 pending work items for temporary 100 percent disability evaluations; the 

oldest had been pending since August 2010. The VSC’s workload 

management plan requires biweekly review of work items. Although VSC 

management was aware of the increased number of these work items, both 

VA Office of Inspector General 4 
Inspection of the VA Regional Office, Buffalo, New York 

PTSD Claims 

TBI Claims 

VSC management and staff stated they focused attention on other VSC 

priorities. As a result, VSC staff did not schedule medical reexaminations 

timely. 

VARO staff incorrectly processed 1 (3 percent) of 30 PTSD claims we 

reviewed. In this case, an RVSR improperly evaluated a veteran’s PTSD as 

10 percent disabling. The VA examination report provided medical evidence 

supporting a 30 percent evaluation. As a result, VA underpaid the veteran 

$759 over a period of 3 months. 

Because we did not consider the frequency of errors significant, we 

determined the VARO generally followed VBA policy related to PTSD 

claims processing. Therefore, we made no recommendations for 

improvement in this area. 

The Department of Defense and VBA commonly define a TBI as a 

traumatically induced structural injury or a physiological disruption of brain 

function caused by an external force. The major residual disabilities of TBI 

fall into three main categories—physical, cognitive, and behavioral. VBA 

policy requires staff to evaluate these residual disabilities. 

VARO staff incorrectly processed 8 (73 percent) of 11 TBI claims. All of 

these processing inaccuracies had the potential to affect veterans’ benefits. 

Following are summaries of these inaccuracies. 

	 In six cases, RVSRs and a Decision Review Officer prematurely 

evaluated residual TBI-related disabilities using inadequate medical 

examinations. According to VBA policy, when a medical examination 

does not address all required elements, VSC staff should return it to the 

clinic or healthcare facility as insufficient for rating purposes. Neither 

VARO staff nor we can ascertain all of the residual disabilities related to 

TBI without an adequate or complete medical examination. 

	 In two cases, RVSRs incorrectly continued 10 percent evaluations for 

TBI-related disabilities. The medical examiner attributed the symptoms 

to the veterans’ service-connected PTSD, not the TBI-related disabilities. 

Because of the veterans’ multiple service-connected disabilities, these 

errors did not affect the veterans’ monthly benefits but may affect future 

evaluations for additional benefits. 

Generally, errors associated with TBI claims processing occurred because 

VSC staff incorrectly interpreted VBA policy and used VA medical 

examinations that were inadequate for decision-making purposes. Interviews 

with staff revealed RVSRs and Decision Review Officers were using their 

own interpretations of medical examination results to decide TBI claims 

when medical professionals failed to provide opinions. VSC management 

VA Office of Inspector General 5 
Inspection of the VA Regional Office, Buffalo, New York 

Herbicide 

Exposure-Related 

Claims 

and training staff were not aware of issues regarding inadequate TBI 

examinations prior to our inspection. As a result, veterans did not always 

receive correct benefit payments. 

VARO staff incorrectly processed 6 (20 percent) of 30 herbicide 

exposure-related claims—1 of these claims processing inaccuracies affected 

a veteran’s benefits. In this case, an RVSR incorrectly established an 

effective date of July 16, 2009—the date VA received a claim for herbicide 

exposure-related conditions. However, the correct effective date should have 

been July 16, 2008. According to VA regulations, when a claimant submits 

a claim more than 1 year after a legislative change, VA may authorize 

benefits for a period of 1 year prior to the date of receipt of the claim, if the 

veteran is eligible. In this instance, eligibility existed to pay the veteran a 

year prior to submission of the claim because medical evidence showed a 

diagnosis at the time of the law change. As a result, VA underpaid the 

veteran $4,776 over a period of 1 year. 

The remaining five inaccuracies had the potential to affect veterans’ benefits. 

Following are summaries of these inaccuracies. 

	 In two cases, RVSRs failed to consider service connection for 

diabetes-related complications diagnosed in VA treatment and private 

medical records. The RVSRs should have requested compensation and 

pension medical examinations to rate these cases. Neither VARO staff 

nor we can ascertain all of the disabilities related to diabetes without a 

medical examination. 

	 An RVSR failed to increase a diabetes evaluation as required when 

medical evidence showed treatment with medication warranting a 

20 percent disability evaluation. This rating did not affect the veteran’s 

monthly benefits but may affect future evaluations for additional 

benefits. 

	 An RVSR prematurely evaluated diabetes complications using an 

inadequate medical examination. According to VBA policy, when a 

medical examination does not address all required elements, VSC staff 

should return it to the clinic or healthcare facility as insufficient for rating 

purposes. Neither VARO staff nor we can ascertain all of the disabilities 

related to diabetes without an adequate or complete medical examination. 

	 An RVSR correctly granted service connection for a veteran’s amputated 

right foot. However, in making this decision, the RVSR did not consider 

the veteran’s entitlement to an automobile allowance as required by VBA 

policy. 

Generally, errors in herbicide exposure-related claims processing resulted 

from inadequate quality assurance oversight. In May 2010, the VARO 

VA Office of Inspector General 6 
Inspection of the VA Regional Office, Buffalo, New York 

Recommendations 

Management 

Comments 

completed an internal Systematic Analyses of Operations (SAO) addressing 

station processing errors. Although the SAO identified a significant number 

of rating errors associated with diabetes-related complications, VSC 

management did not provide training until April 2011. VSC management 

and staff stated no mechanism was in place to evaluate the effectiveness of 

the training provided. Further, prior to our inspection, VSC quality 

assurance staff completed an additional level of review of one of the six 

inaccuracies without identifying any errors. Because of these deficiencies, 

veterans did not always receive correct benefits. 

1.	 We recommend the Buffalo VA Regional Office Director review all 

pending 810 work items related to temporary 100 percent disability 

evaluations to determine if medical reexaminations are required and take 

appropriate action. 

2.	 We recommend the Buffalo VA Regional Office Director implement 

oversight mechanisms to ensure staff follow Veterans Benefits 

Administration guidance and the local workload management plan for 

reviewing 810 work items. 

3.	 We recommend the Buffalo VA Regional Office Director develop and 

implement a plan to ensure Rating Veterans Service Representatives and 

Decisions Review Officers return inadequate medical examination 

reports to healthcare facilities to obtain the evidence needed to support 

traumatic brain injury claims rating decisions. 

4.	 We recommend the Buffalo VA Regional Office Director ensure Rating 

Veteran Service Representatives and Decision Review Officers receive 

refresher training on how to evaluate disabilities related to traumatic 

brain injuries. 

5.	 We recommend the Buffalo VA Regional Office Director develop and 

implement a plan to monitor the effectiveness and adequacy of training 

provided on proper processing of herbicide exposure-related claims. 

The VARO Director concurred with our recommendations. In response to 

recommendations 1 and 2, the Director stated VSC staff completed a review 

of all pending work items and established appropriate controls. To meet 

requirements of the workload management plan, a VSC staff member now 

provides supervisors with a list of pending 810 work items weekly for review 

and processing. In response to recommendation 3, VSC management 

provided training to VSC staff in June 2011 on inadequate medical 

examinations and during its monthly conference call with VA Medical 

Centers, VSC management emphasized medical examiners must comply 

with the TBI examination template. In response to recommendation 4, the 

Director stated, effective August 2011, all TBI ratings require a second 

VA Office of Inspector General 7 
Inspection of the VA Regional Office, Buffalo, New York 

OIG Response 

Dates of Claim 

Notices of 

Disagreement 

review by a Decision Review Officer. Additionally, VSC will provide 

refresher training on all aspects of TBI ratings before the end of 

September 2011. Further, in response to recommendation 5, the Director 

stated the VARO would review errors identified by national quality review 

for fiscal year 2010 and 2011 and structure training to address noted 

recurring inaccuracies. Additionally, VSC management will monitor all 

errors identified during local quality reviews and provided individual training 

as needed. 

Management’s actions are responsive to the recommendations. We will 

follow up as required on all actions. 

2. Data Integrity 

We analyzed claims folders to determine if the VARO was following VBA 

policy to establish correct dates of claim in the electronic record. In addition 

to establishing the timeframe for benefits entitlement, VBA generally uses a 

date of claim to indicate when a document arrives at a VA facility. VBA 

relies on accurate dates of claim to establish and track key performance 

measures, including the average days to complete a claim. 

VARO staff established correct dates of claim in the electronic record for all 

30 claims we reviewed. As a result, we determined the VARO was 

following VBA policy and we made no recommendations for improvement 

in this area. 

We analyzed claims folders to determine if the VARO was following VBA 

policy to timely record Notices of Disagreement (NODs) in the Veterans 

Appeals Control and Locator System (VACOLS). An NOD is a written 

communication from a claimant expressing dissatisfaction or disagreement 

with a benefits decision and a desire to contest the decision. An NOD is the 

first step in the appeals process. VACOLS is a computer application that 

allows VARO staff to control and track a veteran’s appeal and manage the 

pending appeals workload. VBA policy states staff must create a VACOLS 

record within 7 days of receiving an NOD. Accurate and timely recording of 

NODs is required to ensure appeals move through the appellate process 

expeditiously. 

VARO staff did not meet this standard for 4 (13 percent) of the 30 NODs we 

reviewed. Staff took an average of 20 days to record these four NODs in 

VACOLS. As of April 30, 2011, the VARO’s total NODs had been pending 

completion an average of 123 days, exceeding the national average of 

273 days by 150 days. Therefore, we made no recommendations for 

improvement in this area. 

VA Office of Inspector General 8 
Inspection of the VA Regional Office, Buffalo, New York 

Systematic 

Technical 

Accuracy 

Review 

Systematic 

Analysis of 

Operations 

Finding 2 

3. Management Controls 

We assessed management controls to determine whether VARO 

management adhered to VBA policy regarding correction of errors identified 

by VBA’s Systematic Technical Accuracy Review (STAR) staff. The STAR 

program is VBA’s multifaceted quality assurance program to ensure that 

veterans and other beneficiaries receive accurate and consistent 

compensation and pension benefits. VBA policy requires VAROs to take 

corrective action on errors identified by STAR. 

VARO staff did not correct 1 (5 percent) of 20 errors identified by VBA’s 

STAR program from October through December 2010. Because VARO 

management generally followed VBA policy regarding correction of STAR 

errors, we made no recommendations for improvement in this area. 

We assessed whether VARO management had adequate controls in place to 

ensure complete and timely submission of Systematic Analyses of 

Operations (SAOs). An SAO is a formal analysis of an organizational 

element or operational function. SAOs provide an organized means of 

reviewing VSC operations to identify existing or potential problems and 

propose corrective actions. VARO management must publish annual SAO 

schedules designating the staff required to complete the SAOs by specific 

dates. 

Oversight Needed To Ensure Complete SAOs 

Five (42 percent) of the VARO’s 12 SAOs were incomplete (missing 

required elements). The VSC Manager is responsible for completing the 

12 SAOs annually as part of ongoing analysis of VSC operations. VARO 

management did not provide adequate oversight to ensure VSC staff 

completed the SAOs in accordance with VBA policy. As a result, VARO 

management may not have adequately identified existing and potential 

problems for corrective actions to improve VSC operations. 

VSC staff stated they use the previous year’s SAO as a model, rather than 

following VBA’s policy to complete the current SAO. They also said they 

have not had any formal training on the requirements for SAOs. Similarly, 

VSC staff responsible for reviewing SAOs indicated they primarily check for 

completeness by comparing them to previous year’s SAOs and do not always 

refer to VBA policy. The VSC Manager accepted responsibility for the 

incomplete SAOs, stating she did not always have time to do a thorough 

review due to her multiple responsibilities and lack of assistance. An 

Assistant VSC Manager was recently hired; however, the position had been 

vacant for 15 months. 

VA Office of Inspector General 9 
Inspection of the VA Regional Office, Buffalo, New York 

Recommendation 

Management 

Comments 

OIG Response 

Mailroom 

Operations 

Triage Mail 

Processing 

Procedures 

One of the SAOs that VARO staff did not thoroughly complete involved 

quality of rating decisions. VARO Buffalo did not achieve VBA’s 

FY 2010 rating quality goal and at the time of our inspection its performance 

was below the FY 2011 goal. If VARO management had ensured proper 

completion of this required SAO, it might have identified deficiencies in 

rating decisions and developed a plan to improve rating quality. 

6.	 We recommend the Buffalo VA Regional Office Director develop and 

implement a plan for staff to address all required elements of Systematic 

Analyses of Operations. 

The VARO Director concurred with our recommendation. The Director 

stated VSC staff will receive training in September 2011 on the requirements 

of completing an SAO. Additionally, in an effort to improve quality, 

management will provide feedback to VSC staff who completed the SAO. 

Management’s actions are responsive to the recommendation. We will 

follow up as required on all actions. 

4. Workload Management 

We assessed controls over VARO mailroom operations to ensure staff timely 

and accurately processed incoming mail. VBA policy states staff will open, 

date-stamp, and route all mail to the appropriate locations within 4 to 6 hours 

of receipt at the VARO. The Buffalo VARO assigns responsibility for 

mailroom activities, including processing of incoming mail, to the Support 

Services Division. Mailroom staff were timely and accurate in processing, 

date-stamping, and delivering VSC mail to the Triage Team control point 

daily. As a result, we determined the mailroom staff were following VBA 

policy and made no recommendations for improvement in this area. 

We assessed the VSC’s Triage Team mail processing procedures to ensure 

staff reviewed, controlled, and processed all claims-related mail in 

accordance with VBA policy. VARO staff are required to use VBA’s 

tracking system, Control of Veterans Records System, to electronically track 

veterans’ claims folders and control search mail. VBA defines search mail 

as active claims-related mail waiting to be associated with veterans’ claims 

folders. Conversely, drop mail requires no processing action upon receipt. 

VBA policy allows the use of a storage area, known as the Military File, to 

hold mail temporarily when staff are unable to identify associated claims 

folders in the system. 

VA Office of Inspector General 10 
Inspection of the VA Regional Office, Buffalo, New York 

Finding 3
 

Recommendation 

Managements 

Comment 

OIG Response 

Oversight Needed to Ensure Proper Control and 

Processing of Triage Team Mail 

The Triage Team staff did not properly manage 12 (13 percent) of 90 pieces 

of mail we reviewed. Staff did not control search mail through COVERS for 

6 (20 percent) of 30 pieces of mail. At the time of our inspection, 

approximately 425 pieces of mail were on search awaiting association with 

the appropriate claims folders. The most significant delay occurred when the 

VARO received a new claim from a veteran on March 4, 2011, and placed it 

in the search mail holding area. By the time of our inspection in May 2011, 

the VARO had not initiated action on the claim. 

Further, the Triage Team staff did not always manage mail in the Military 

File according to VBA policy. Five (17 percent) of 30 items we reviewed 

were incorrectly stored in this cabinet. As an example, the VARO received a 

veteran’s request for documentation verifying his military service on 

December 16, 2010, and incorrectly placed it in the Military File cabinet. By 

the time of our inspection in May 2011, the VARO had not taken any action 

on this request. 

The above errors in search mail resulted from inadequate management 

oversight to ensure compliance with VSC’s Workload Management Plan. 

Although Triage Team staff completed weekly reviews of search mail and 

reported noncompliance issues to management, VSC management did not 

follow up to ensure station-wide compliance with Workload Management 

Plan search mail requirements. Further, errors related to the Military File 

occurred because staff did not thoroughly review documents prior to placing 

them in the Military File cabinet. Untimely association of mail with 

veterans’ claims folders can cause delays in processing benefits claims. As a 

result, beneficiaries may not receive accurate and timely benefits payments. 

7.	 We recommend the Buffalo VA Regional Office Director implement a 

plan for increased oversight to ensure Veterans Service Center staff 

process mail according to Veterans Benefits Administration policy and 

local guidance. 

The VARO Director concurred with our recommendation. The Director 

stated VSC staff drafted a standard operating procedure for search mail and 

updated its COVERS plan. Additionally, VSC staff will review all incoming 

military mail prior to placing it in the military file. VSC management will 

conduct a quarterly review of the military file. 

Management’s actions are responsive to the recommendation. We will 

follow up as required on all actions. 

VA Office of Inspector General 11 
Inspection of the VA Regional Office, Buffalo, New York 

Competency 

Determinations 

Finding 4 

5. Eligibility Determinations 

VA must consider beneficiary competency in every case involving a mental 

health condition that is totally disabling or when evidence raises questions as 

to a beneficiary’s mental capacity to manage his or her affairs. The 

Fiduciary Unit supports implementation of competency determinations by 

appointing a fiduciary, a third party who assists in managing funds for an 

incompetent beneficiary. We reviewed competency determinations made at 

the VARO to ensure staff completed them accurately and timely. Delays in 

making these determinations ultimately affect the Fiduciary Unit’s ability to 

appoint fiduciaries timely. 

VBA policy requires staff to obtain clear and convincing medical evidence 

that a beneficiary is capable of managing his or her affairs prior to making a 

final competency decision. The policy allows the beneficiary a 65-day due 

process period to submit evidence showing an ability to manage funds and 

other personal affairs. At the end of the due process period, VARO staff 

must take immediate action to determine if the beneficiary is competent. 

Until recently, VBA did not have a clear, measurable definition of 

“immediate,” and this timeframe varied from office to office. In response to 

our summary report for FY 2010, Systemic Issues Reported During 

Inspections at VA Regional Offices (Report Number 11-00510-167, 

May 18, 2011), the Acting Under Secretary for Benefits defined “immediate” 

as 21 days following expiration of the due process period. 

Inadequate Controls Over Competency Determinations 

Using VBA’s newly defined interpretation of immediate, VARO staff 

unnecessarily delayed making final decisions in 9 (64 percent) of 

14 competency determinations completed from January through 

March 2011. The delays ranged from 1 to 111 days, with an average 

completion time of 36 days. Delays occurred because VARO staff 

responsible for overseeing and processing final competency determinations 

stated they were unaware of VBA’s policy requiring immediate action and 

therefore did not prioritize these cases. The risk of incompetent beneficiaries 

receiving benefits without fiduciaries assigned to manage those funds 

increases when staff do not complete competency determinations timely. 

The most significant case of placing funds at risk occurred when VARO staff 

unnecessarily delayed making a final incompetency decision for a veteran for 

approximately 4 months. During this period, the veteran received $10,692 in 

disability payments. While the veteran was entitled to these payments, 

fiduciary stewardship was not in place to ensure effective funds management 

and the welfare of the veteran. VBA plans to implement the new 21-day 

VA Office of Inspector General 12 
Inspection of the VA Regional Office, Buffalo, New York 

policy nationwide in June 2011. Therefore, we made no recommendation to 

the VARO Director regarding this issue. 

VA Office of Inspector General 13 
Inspection of the VA Regional Office, Buffalo, New York 

Appendix A 

Organization 

Resources 

Workload 

Scope 

VARO Profile and Scope of Inspection 

The Buffalo VARO is responsible for delivering nonmedical VA benefits 

and services to veterans and their families. The VARO fulfills these 

responsibilities by administering compensation and pension benefits, 

vocational rehabilitation and employment assistance, and outreach activities. 

As of March 2011, the Buffalo VARO had a staffing level of 

416.4 employees. Of these, the VSC had 109 employees assigned. 

As of April 2011, the VARO reported 6,168 pending compensation claims. 

The average time to complete claims was 196.3 days—21.3 days more than 

the national target of 175 days. As reported by STAR staff, the accuracy of 

compensation rating-related decisions was 86.9 percent, which was 

3.1 percent below the 90 percent VBA target. The accuracy of compensation 

authorization-related processing was 93.7 percent—2.3 percent below the 

96 percent VBA target. 

We reviewed selected management control, benefits claims processing, and 

administrative activities to evaluate compliance with VBA policies regarding 

benefits delivery and nonmedical services provided to veterans and other 

beneficiaries. We interviewed managers and employees and reviewed 

veterans’ claims folders. 

Our review included 71 (14 percent) of 518 claims related to PTSD, TBI, and 

herbicide exposure-related disabilities that the VARO completed from 

January 2011 through March 2011. For temporary 100 percent disability 

evaluations, we selected 30 (13 percent) of 228 existing claims from VBA’s 

Corporate Database. We provided VARO management with the 198 claims 

remaining from the universe of 228 for further review. These claims 

represented all instances in which VARO staff granted temporary 

100 percent disability determinations for at least 18 months. 

We reviewed the 12 mandatory SAOs completed in fiscal years 2010 and 

2011. Additionally, we reviewed 14 competency determinations completed 

by the Buffalo VARO during the 3-month period from January through 

March 2011. We reviewed 20 errors identified by VBA’s STAR program 

during October through December 2010. VBA measures the accuracy of 

compensation and pension claims processing through its STAR program. 

STAR’s measurements include a review of work associated with claims that 

require rating decisions. STAR staff review original claims, reopened 

claims, and claims for increased evaluation. Further, they review appellate 

issues that involve a myriad of veterans’ disability claims. 

Our process differs from STAR as we review specific types of disability 

claims related to PTSD, TBI, and herbicide exposure that require rating 

VA Office of Inspector General 14 
Inspection of the VA Regional Office, Buffalo, New York 

decisions. In addition, we review rating decisions and awards processing 

involving temporary 100 percent disability evaluations. 

For our review, we selected dates of claim, NODs, and Triage Team mail 

pending at the VARO during the time of our inspection. We completed our 

review in accordance with the Council of the Inspectors General on Integrity 

and Efficiency’s Quality Standards for Inspection and Evaluation. We 

planned and performed the review to obtain sufficient, appropriate evidence 

to provide a reasonable basis for our findings and conclusions based on our 

review objectives. We believe that the evidence obtained provides a 

reasonable basis for our findings and conclusions based on our review 

objectives. 

VA Office of Inspector General 15 
Inspection of the VA Regional Office, Buffalo, New York 

Appendix B VARO Director’s Comments 

DEPARTMENT OF VETERANS AFFAIRS Memorandum BUFFALO REGIONAL OFFICE 

To: Director, Benefits Inspection Division, San Diego 

From: Director, VA Regional Office Buffalo (307/00) 

Date: August 12, 2011 

Subj: Inspection of the VARO Buffalo, NY 

Attached are the Buffalo VARO’s comments on the OIG Draft Report: Inspection of 

VARO Buffalo. 

1. 

Questions may be referred to Ms. Donna Terrell, Director, at 716.857.3450, or Ms. 

Suzanne DeNeau, Veterans Service Manager, at 716.857.3030. 

2. 

(original signed by:) 

Donna Terrell 

Director 

Attachment 

VA Office of Inspector General 16 
Inspection of the VA Regional Office, Buffalo, New York 

Recommendation 1: We recommend the Buffalo VA Regional Office Director review all 

pending 810 work items related to temporary 100 percent disability evaluations to determine if 

medical reexaminations are required and take appropriate action. 

Buffalo VSC Response: Concur 

The IG audit team identified 75 pending 810 work items for routine future examinations at the 

time of review. Following the IG audit, Buffalo Veterans Service Center (VSC) reviewed all 

pending 810 work items and identified additional cases requiring review for routine future 

examinations (total of 374 pending 810s). As of August 1, 2011, there are 43 pending 810 work 

items. The Triage Team properly ensured establishment of a 310 end product (EP) for all 

pending 810 work items for routine future examinations. These were handed out to the 

Pre-Determination Team VSRs per digit assignment. The complete list was reviewed an all 

appropriate action taken as of August 1, 2011. Currently, the Triage Team Coach runs the 

appropriate workload report each Monday to stay current with the 810 work items for routine 

future examinations. 

We request closure of this recommendation based on ongoing VSC actions taken to monitor 

progress in this area. 

Recommendation 2: We recommend the Buffalo VA Regional Office Director implement 

oversight mechanisms to ensure staff follow Veterans Benefits Administration guidance and the 

local workload management plan for reviewing 810 work items. 

Buffalo VSC Response: Concur 

Per the Buffalo VSC Workload Management Plan, the Senior Veterans Service Representative 

(VSR) runs the entire 810 work item list weekly. The list is divided by team, and is forwarded 

to each Coach’s area of responsibility. The Coaches are responsible for ensuring that their VSRs 

are completing their portion of the 810 work items by digit assignment. To increase emphasis 

on this portion of the VSC workload, each team’s total 810 work items will be discussed during 

the Veterans Service Center Monday Morning Workload Meeting and added to the weekly 

workload report. Additionally, the Senior VSR responsible for running the weekly report will 

identify and contact other regional offices when 810 work items appear on Buffalo’s workload. 

We request closure of this recommendation based on ongoing VSC actions taken to monitor 

progress in this area. 

Recommendation 3: We recommend the Buffalo VA Regional Office Director develop and 

implement a plan to ensure Rating Veterans Service Representatives and Decisions Review 

Officers return inadequate medical examination reports to healthcare facilities to obtain the 

evidence needed to support traumatic brain injury claims rating decisions. 

Buffalo VSC Response: Concur 

VA Office of Inspector General 17 
Inspection of the VA Regional Office, Buffalo, New York 

On June 2, 2011, the Quality/Training Decision Review Officers (DRO) and Rating Team Coach 

held a training session with all Rating VSRs and DROs to explain the inadequate TBI/Mental 

Disorder examination results the OIG had identified. In addition, during the monthly Medical 

Center/VSC joint conference call in June 2011, it was emphasized to all examination units that it 

is imperative for the TBI/Mental Disorder examiners to comply with the Note Section of the TBI 

examination template in order for the examinations to be considered sufficient for rating 

purposes. 

Additionally, a discussion was held with regard to manifestations of a comorbid mental or 

neurologic, or other physical disorder. Rating Veterans Service Representative (RVSRs) and 

DROs were informed that any case lacking the comorbidity statement must be returned to the 

VA examiner for clarification. 

The Buffalo RO also instituted the requirement that all TBI ratings require second signature 

review by one of the Quality/Training DROs. The specific procedures for this were conveyed 

and are outlined in the local TBI Second Signature SOP dated August 2, 2011. 

We request closure of this recommendation based on ongoing VSC actions taken to monitor 

progress in this area. 

Recommendation 4: We recommend the Buffalo VA Regional Office Director ensure Rating 

Veteran Service Representatives and Decision Review Officers receive refresher training on how 

to evaluate disabilities related to traumatic brain injuries. 

Buffalo VSC Response: Concur 

The Buffalo RO conducted refresher training on traumatic brain injury (TBI) with the Rating 

Activity on March 7 and March 9, 2011. Additionally, the VSC Exam Coordinator will continue 

to work closely with the VA Medical Centers to ensure TBI examinations are complete and 

sufficient for rating purposes. 

We also explained the requirement that all TBI ratings be second signed by the Quality DROs. 

The specific procedures for this were conveyed and are outlined in the August 2, 2011 TBI 

Second Signature Policy at the Buffalo Regional Office. Additional TBI training is scheduled 

prior to the end of fiscal year 2011 (FY2011) to ensure compliance with all directives. 

Recommendation 5: We recommend the Buffalo VA Regional Office Director develop and 

implement a plan to monitor the effectiveness and adequacy of training provided on proper 

processing of herbicide exposure-related claims. 

Buffalo VSC Response: Concur 

Training was completed in April 2011 to provide an overview of Agent Orange claims and 

associated presumptive conditions. This training was part of the nationally mandated training 

curriculum for FY2011. Additionally, medical information and rating guidelines associated with 

chronic complications and existing policy have been provided to RVSRs in order to achieve 

VA Office of Inspector General 18 
Inspection of the VA Regional Office, Buffalo, New York 

consistency in Rating Decisions pertaining to diabetic complications. Training specific to rating 

diabetes complications was completed in both February 2010 and April 2011, using the national 

training curriculum. 

With the recent addition of the three new presumptive conditions in August 2010, extensive 

training was completed during FY 2011 to include Nehmer and 38 CFR 3.114(a). Local and 

National quality reviews will be monitored to ensure compliance and understanding of these 

issues. 

For FY2012, the Buffalo RO will review trends of local errors called during national review, 

including missed diabetes complications from FY2010 and FY2011 and will structure training to 

address recurring errors. Additionally, the local errors will be monitored monthly and reviewed 

for commonality among RVSRs so that individual training can be completed if necessary. 

Recommendation 6: We recommend the Buffalo VA Regional Office Director develop and 

implement a plan for staff to address all required elements of Systematic Analyses of Operations. 

Buffalo VSC Response: Concur 

Training will be conducted in September 2011 on M21-4 Chapter 5 and the OIG’s SAO 

Notification of Errors. The training will utilize previous incomplete SAOs, as well as providing 

examples of proper SAOs. Additionally, all coaches and assistant coaches will be provided with 

electronic and hard copies of the updated M21-4 Chapter 5 as a guideline to assist with 

completion of their assigned SAO(s). Feedback, both positive and negative, for each SAO will 

be shared with each SAO preparer to improve overall quality and accuracy. 

Recommendation 7: We recommend the Buffalo VA Regional Office Director implement a plan 

for increased oversight to ensure Veterans Service Center staff process mail according to 

Veterans Benefits Administration policy and local guidance. 

Buffalo VSC Response: Concur 

A Search Mail SOP and an updated COVERS plan have been drafted and will be implemented 

within the Veteran Service Center, upon approval from the Veterans Service Center Manager. 

A Claims Assistant has been assigned to review all incoming military pending mail prior to the 

mail being filed into the military pending file. The file will be reviewed quarterly by the Triage 

Coach to ensure all documents in the file are appropriate. 

VA Office of Inspector General 19 
Inspection of the VA Regional Office, Buffalo, New York 

Appendix C Inspection Summary
 

Ten Operational 

Activities Inspected Criteria 

Reasonable 

Assurance of 

Compliance 

Yes No 

Claims Processing 

1. Temporary 

100 Percent 

Disability 

Evaluations 

Determine whether VARO staff properly reviewed temporary 100 percent 

disability evaluations. (38 CFR 3.103(b)) (38 CFR 3.105(e)) (38 CFR 3.327) 

(M21-1 MR, Part IV, Subpart ii, Chapter 2, Section J) (M21-1MR, Part III, 

Subpart iv, Chapter 3, Section C.17.e) 

X 

2. Post-Traumatic 

Stress Disorder 

Determine whether VARO staff properly processed claims for PTSD. 

(38 CFR 3.304(f)) X 

3. Traumatic Brain 

Injury 

Determine whether VARO staff properly processed claims for service 

connection for all residual disabilities related to in-service TBI. (FL 08-34 

and FL 08-36, Training Letter 09-01) 

X 

4. Herbicide 

Exposure-Related 

Disabilities 

Determine whether VARO staff properly processed claims for service 

connection for herbicide exposure-related disabilities. (38 CFR 3.309) 

(FL 02-33) (M21-1MR, Part IV, Subpart ii, Chapter 2, Section C.10) 

X 

Data Integrity 

5. Dates of Claim Determine whether VARO staff properly recorded the correct dates of 

claim in the electronic record. (M21-1MR, Part III, Subpart ii, Chapter 1, 

Section C) 

X 

6. Notices of 

Disagreement 

Determine whether VARO staff properly entered NODs into VACOLS. 

(M21-1MR, Part I, Chapter 5) X 

Management Controls 

7. Systematic 

Technical Accuracy 

Review 

Determine whether VARO staff properly corrected STAR errors in 

accordance with VBA policy. (M21-4, Chapter 3, Subchapter II, 3.03) X 

8. Systematic Analysis 

of Operations 

Determine whether VARO staff properly performed formal analyses of 

their operations through completion of SAOs. (M21-4, Chapter 5) X 

Workload Management 

9. Mail Handling 

Procedures 

Determine whether VARO staff properly followed VBA mail handling 

procedures. (M23-1) (M21-4, Chapter 4) (M21-1MR, Part III, Subpart ii, 

Chapters 1 and 4) 

X 

Eligibility Determinations 

10. Competency 

Determinations 

Determine whether VAROs properly assessed beneficiaries’ mental capacity 

to handle VA benefit payments. (M21-1MR, Part III, Subpart v, Chapter 9, 

Section A) (M21-1MR, Part III, Subpart v, Chapter 9, Section B) (FL 09-08) X 

Source: VA OIG 

CFR=Code of Federal Regulations, FL=Fast Letter, M=Manual, MR=Manual Re-write 

VA Office of Inspector General 20 
Inspection of the VA Regional Office, Buffalo, New York 

Appendix D OIG Contact and Staff Acknowledgments
 

OIG Contact	 For more information about this report, please 

contact the Office of Inspector General 

at (202) 461-4720. 

Acknowledgments	 Dawn Provost, Director 

Bridget Bertino 

Madeline Cantu 

Lee Giesbrecht 

Brian Jeanseau 

David Pina 

Dana Sullivan 

Brandi Traylor 

VA Office of Inspector General 21 
Inspection of the VA Regional Office, Buffalo, New York 

Appendix E Report Distribution 

VA Distribution 

Office of the Secretary 

Veterans Benefits Administration 

Assistant Secretaries 

Office of General Counsel 

Veterans Benefits Administration Eastern Area Director 

VA Regional Office Buffalo Director 

Non-VA Distribution 

House Committee on Veterans’ Affairs 

House Appropriations Subcommittee on Military Construction, Veterans 

Affairs, and Related Agencies 

House Committee on Oversight and Government Reform 

Senate Committee on Veterans’ Affairs 

Senate Appropriations Subcommittee on Military Construction, Veterans 

Affairs, and Related Agencies 

Senate Committee on Homeland Security and Governmental Affairs 

National Veterans Service Organizations 

Government Accountability Office 

Office of Management and Budget 

U.S. Senate: Kirsten Gillibrand, Charles Schumer 

U.S. House of Representatives: Gary Ackerman, Timothy Bishop, Ann 

Marie Buerkle, Yvette Clarke, Joseph Crowley, Eliot Engel, Christopher 

Gibson, Michael Grimm, Richard Hanna, Nan Hayworth, Brian Higgins, 

Maurice Hinchey, Kathleen Hochul, Steve Israel, Peter King, Nita Lowey, 

Carolyn Maloney, Carolyn McCarthy, Gregory Meeks, Jerrold Nadler, 

William Owens, Charles Rangel, Tom Reed, Jose Serrano, Louise McIntosh 

Slaughter, Paul Tonko, Edolphus Towns, Nydia Velazquez 

This report will be available in the near future on the OIG’s Web site at 

http://www.va.gov/oig/publications/reports-list.asp. This report will remain 

on the OIG Web site for at least 2 fiscal years. 

VA Office of Inspector General 22