Four VA reviews flagged one reviewer's pace; none recommended a fix

The Veterans Benefits Administration paid over $152.5 billion in disability compensation to almost six million veterans in fiscal year 2024.▸ Two safeguards are supposed to catch errors before that money moves: a senior reviewer who authorizes each rating decision as the last check before payment, and a national override process for the moments when a computer system's warnings don't match the facts of a veteran's claim. Two VA Office of Inspector General reviews tested both safeguards. One found a single reviewer authorizing decisions 19 times faster than the national rate for three straight years while four internal assessments noticed and did nothing. The other found more than a third of a specific override type, sampled nationwide, wasn't properly justified -- tracing back to an oversight procedure VBA discontinued in 2019.

In VBA regional offices, a disability claim moves through several steps before a veteran sees a payment.▸ A veterans service representative (VSR) gathers evidence and drafts a rating decision; the claim then moves to a senior VSR, whose job is to review the decision and the underlying file for accuracy before authorizing the award and releasing it to the claimant. VBA considers the senior VSR the last line of defense⧉ against errors reaching a veteran's benefits.

A hotline complaint in July 2024⧉ alleged that a senior VSR at the Philadelphia VA Regional Office was "blindly" approving hundreds of rating decisions a day.▸ OIG's review substantiated it: from at least FY2022 through FY2024, the employee authorized about 85,300 claims -- 19 times the national average for the position -- spending an average of 4.7 minutes reviewing each one, against a 21-minute national average. That volume mattered to management: the same employee contributed more than 35 percent each year toward the Philadelphia office's claims-completion goal, a metric built into regional executive directors' own performance standards.

VBA's own district directors raised the alarm more than once.▸ In October 2023, the Southeast District director told the other three district directors that authorizing 25 claims an hour was "unrealistic unless you go by the old motto 'Y and fly' … this means the person don't review and just authorizes the award. Definitely a red flag." The Northeast District director separately told the Philadelphia executive director it was "not physically possible to do that many authorizations and perform the real functions of the job" -- who defended the employee as an assigned "quick hit" authorizer. The Philadelphia office capped the employee at eight to 10 authorizations an hour starting around October 2023, without requiring document review within that limit.

In August 2024, VBA's own Office of Field Operations found the reviewer was a national outlier authorizing a decision every one to three minutes -- and made no recommendations.▸ In November 2024, a VBA integrated project team concluded the workflow "pose[s] potential risk to the Agency" -- and made no recommendations either. Through it all, the employee met the individual quality metric, because VBA's quality reviews checked less than 1 percent of the employee's work.

OIG tested the work directly.▸ Of about 15,600 rating decisions the Philadelphia senior VSR authorized between January and June 2024, OIG sampled 32 and found 27 had at least one error -- projecting to an estimated 13,200 decisions, about 84 percent, with at least one error VBA-wide for that employee. The errors OIG could quantify resulted in at least an estimated $2.2 million in improper payments during that six-month window alone. OIG made two recommendations to the under secretary for benefits -- reviewing and correcting the identified errors, and evaluating whether authorization-rate outliers need new controls -- and VA's acting principal deputy under secretary concurred with both.

A second, separate OIG review⧉ examined a different safeguard nationwide: the override function in VBA's rating system, which lets a claims processor bypass a system warning or calculator result when it doesn't match the actual evidence.▸ From a national sample, OIG estimated 50,800 such overrides occurred between April and September 2024, of which 26,600 involved reexaminations or claims rated under overlapping diagnostic codes ("pyramiding") -- the two override types the review scrutinized most closely. An estimated 9,900 of those, 37 percent, were not properly warranted or justified; in about 5,200 of those cases, the underlying decision to override was itself wrong.

Twelve of the 96 unwarranted overrides OIG sampled in detail caused about $67,200 in avoidable costs -- $60,800 in improper disability payments and $6,300 in unnecessary medical exams.▸ In one example, a claims processor overrode a reexamination warning and kept a veteran at a 100 percent disability rating instead of the 10 percent regulation required, an overpayment of about $16,000 plus a $490 unnecessary exam.

The review traced the gap to oversight that used to exist.▸ Override reviews were an assigned duty of VBA's quality teams starting in January 2018 -- but in February 2019, VBA's Compensation Service removed the override-review procedures from its own manual, after finding the process for sorting override data inefficient and concluding overrides were "mostly correct." No standard method or requirement for reviewing overrides has existed nationwide since. Of four regional offices OIG visited, three had overrides pending review in VBMS-R's tracking tool dating back to 2017 and the fourth to 2018; one station alone reported more than 15,000 pending reviews. OIG made five recommendations, and in April 2026 VA's principal deputy under secretary for benefits concurred with all of them, including a decision to "sunset" the current override-tracking dashboard for a replacement.