Fast Facts

In 2019, out of about 1 million disability claims the Veterans Benefits Administration processed, about 18,000 were for veterans living abroad. The VBA often uses medical exams to determine if disability benefits are warranted.

Claims from veterans living abroad increased 14% from FY2014 to FY2019. In this period, claims processing times improved.

Veterans' access to disability exams abroad also improved as VBA increased the number of countries using VBA-contracted medical examiners instead of embassy-referred examiners. However, travel costs and other factors sometimes hinder access to quality exams. We made 5 recommendations for improvements.

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Number of Disability Claims Processed for Veterans Living Abroad, FYs 2014-2019

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Highlights

What GAO Found

The number of disability claims for veterans living abroad—in foreign countries or U.S. territories—increased 14 percent from fiscal years 2014 to 2019. During this time period, claims processing time frames improved. In fiscal year 2019, the Veterans Benefits Administration (VBA) of the Department of Veterans Affairs (VA) approved comparable percentages of disability claims for veterans living abroad and domestically—63 percent and 64 percent respectively. However, for a subset of these claims—those where veterans likely received a disability medical exam scheduled by Department of State (State) embassy staff—approval rates were often lower.

Veterans' access to disability medical exams abroad improved as VBA has increasingly relied on contracted examiners, rather than embassy-referred examiners, to conduct these exams. According to VBA, this shift expanded the pool of trained examiners abroad and increased the frequency and depth of VBA's quality reviews for contract exams. These quality reviews help VBA and its contractor identify and address common errors, according to VBA and contractor officials. However, several factors continue to limit some veterans' ability to access quality disability medical exams (see figure).

Factors That Impair the Access of Veterans Living Abroad to Quality Disability Medical Exams

Factors That Impair the Access of Veterans Living Abroad to Quality Disability Medical Exams

Unknown quality of certain exams: A subset of veterans living abroad receive disability medical exams from an embassy-referred provider. VBA does not systematically assess the quality of these exams. Without doing so, VBA cannot determine if such exams affect the approval rates of veterans who receive them or contribute to longer processing times and are unable to make informed decisions about their use.

Travel reimbursement: Under current VA regulations, VA is not authorized to reimburse veterans for travel expenses for certain services incurred in foreign countries as it is for those incurred within the United States, including U.S. territories. Consequently, some veterans living in foreign countries may be unable to afford to travel to exams.

Examiner reimbursement: The Veterans Health Administration's (VHA) Foreign Medical Program reimburses examiners referred by embassy staff via paper checks in U.S. currency. These checks may be slow to arrive and not accepted by foreign banks, according to State and other officials and staff we interviewed. Such payment issues can deter examiners from being willing to conduct disability medical exams and thus limit veterans' access to these exams in foreign countries.

Why GAO Did This Study

Of the roughly 1 million disability claims VBA processed in fiscal year 2019, 18,287 were for veterans living abroad. Veterans living abroad are entitled to the same disability benefits as those living domestically, but GAO previously reported that veterans living abroad may not be able to access disability medical exams as readily as their domestic counterparts. VBA uses medical exam reports to help determine if a veteran should receive disability benefits. GAO was asked to review the disability claims and exam processes for veterans living abroad.

Among other things, this report examines disability claims trends for veterans living abroad and these veterans' ability to access quality disability medical exams. GAO analyzed VBA claims data for fiscal years 2014 to 2019; assessed data reliability; reviewed relevant federal laws, regulations, policies, and contract documents; and interviewed employees of VBA, State, and other stakeholders.

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Recommendations

GAO is making five recommendations, including that VBA assess the quality of embassy-referred exams, VBA and VHA assess whether to reimburse beneficiaries for travel to disability medical exams in foreign countries, and that VBA and VHA pay examiners located by embassy staff electronically. The Department of Veterans Affairs concurred with GAO's recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs 1. The Under Secretary for Benefits should work with State and SSA to identify and implement ways to help ensure that embassy staff and RFBOs are made aware of relevant changes in VA policy and standard operating procedures in a timely and consistent manner and can more readily identify available resources so they can efficiently help veterans living abroad with VA's disability claims process. (Recommendation 1)
Open
VA agreed with this recommendation and believes it has taken sufficient steps to implement it. Specifically, VA identified actions VBA has taken to provide relevant policy changes to the State, Bureau of Consular Affairs program staff who provide support to the embassies and SSA, and steps to help embassy staff readily identify available VBA resources. VA also reported that VBA recently communicated with points of contacts at State and SSA to ensure shared lines of communication remain open and work continues with these agencies to identify and implement improvements to the process as needed. While we applaud these efforts, we believe that VBA should take additional actions to meet the intent of our recommendation. Specifically, it will be important for VBA to demonstrate that it has taken steps to more systematically and consistently improve the flow of important policy change information to Regional Federal Benefits Officers and embassy-staff and increase embassy staff's awareness of available resources.
Department of Veterans Affairs 2. The Under Secretary for Benefits should identify and implement an interim strategy to consistently document the complete contact information for veterans living abroad within VBMS, while OIT and VBA continue to explore a long-term solution. (Recommendation 2)
Open
VA agreed with this recommendation and identified plans to address it. VBA will provide guidance on a uniform approach to record contact information that has been truncated within the Veterans Benefits Management System, which will help standardize the process until system updates can be made to the data fields. We will monitor the progress of these efforts and await documentation of their completion.
Department of Veterans Affairs 3. The Under Secretary for Benefits should systematically assess the quality of embassy-referred exams and use the results of this review to identify whether there are common problems related to the use of these exams, and, if necessary, take steps to address those problems, such as by developing tailored technical assistance for embassy-referred examiners. (Recommendation 3)
Open
VA agreed with this recommendation and identified plans to address it. VBA will initiate special tracking procedures for embassy-referred examinations, and will conduct an analysis of the tracked data to identify impact and quality of embassy-referred exams. We will monitor the progress of these efforts and await documentation of their completion.
Department of Veterans Affairs 4. The Under Secretary for Benefits and Under Secretary for Health—in concert with the General Counsel—should assess and decide whether to reimburse beneficiaries for travel to disability medical exams in foreign countries. (Recommendation 4)
Open
VA agreed with this recommendation and identified plans to address it. VBA, VHA, and VA's OGC will work together to assess whether to amend VA's regulation to allow reimbursement to beneficiaries for travel expenses related to disability examinations in foreign countries. We will monitor the progress of these efforts and await documentation of their completion.
Department of Veterans Affairs 5. The Under Secretary for Health, working with the Under Secretary of Benefits, should identify ways to reimburse examiners who conduct disability medical exams via direct deposit in the local currency, assess the cost-effectiveness of these options, and implement the method it selects. (Recommendation 5)
Open
VA agreed with this recommendation and identified plans to address it. VHA, VBA's Medical Disabilities Examination Program Office, and other relevant offices will work together to determine VA's approach for reimbursing foreign providers who perform disability examinations in response to embassy referrals in foreign countries. We will monitor the progress of these efforts and await documentation of their completion.

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