The Department of Veterans Affairs plans to launch an automated fraud-detection tool to scan more than a million veterans disability benefits questionnaires for evidence of fabrication or other problems that could force a new medical exam and impact compensation. (Stars and Stripes)
WASHINGTON — The Department of Veterans Affairs plans to launch an automated fraud-detection tool to scan more than a million disability benefits questionnaires for evidence of fabrication or other problems that could force a new medical exam and impact compensation, according to a VA official.
James W. Smith, a deputy executive director at the Veterans Benefits Administration, told lawmakers that the tool will have the capability to quickly review submitted questionnaires — known as DBQs — that document medical evidence to determine a disability rating and monthly compensation.
The VA’s new automated tool is expected to launch in fiscal 2026 and is part of a larger push to fortify the benefits system against fraud and abuse, according to the VA.
But some veterans are raising questions about the effectiveness of an automated tool for uncovering fraud.
“There will be some fraud found, but a lot of DBQs [will be] questioned that may not be fraud,” predicted Jason Cameron, a Marine Corps veteran and retired benefits service officer.
The plan is to use the tool to re-analyze DBQs dating to 2010 and flag claims with potential problems.
DBQs are downloadable forms available on the VA website that private medical providers fill out to describe the severity of a service-connected condition.
The questionnaires often are a standard part of a claims submission for benefits.
“We have determined that there are telltale signs that a DBQ could potentially be fraudulent,” Smith said in the final minutes of a House VA subcommittee hearing last month. “The tool will be [able] to quickly identify potential problem cases. The VA is being proactive in this space.”
Suspect DBQs could include high-volume submissions from so-called fraud mills that use similar boilerplate language on multiple questionnaires for different individuals.
When a DBQ is flagged, the VA most likely will order a new compensation and pension exam, Smith said.
The exams are a standard medical evaluation for determining a disability rating for a service-connected medical condition.
But the VA’s disclosure of its plans for the fraud-detection tool is prompting discussions, warnings — and alarm — from veterans and their advocates on social media.
“Yes, the VA is talking about fraud. Yes, DBQs are being looked at harder,” said David Pineda, a disabled Army veteran and former federal air marshal. (David Pineda)
“Let’s talk about this new panic wave going around the veteran community,” said David Pineda, a former federal air marshal and disabled Army veteran who hosts a podcast for veterans.
“Yes, the VA is talking about fraud. Yes, DBQs are being looked at harder,” Pineda said.
But he emphasized that the VA’s goal is not to investigate every claim but to detect medical evidence that may not be credible — regardless of how many years the veteran has been rated for a specific service-connected illness or injury.
Desert Storm Veterans, a Facebook group, posted a similar alert to members: “The VA is ramping up scrutiny on fraud. HONEST claims should be fine if backed by solid evidence. This could affect anyone using outside medical opinions,” the group told members.
The tool, for example, is being designed to flag DBQs that show signs of alteration, contain cut-and-paste verbiage or have incomplete information required in signature blocks.
The tool also will identify DBQs as suspect that list a doctor or other examiner with an address that is more than 100 miles from the veteran’s home.
“There will be some fraud found, but a lot of DBQs [will be] questioned that may not be fraud,” said Jason Cameron, a Marine Corps veteran, podcaster and retired VA benefits service officer. (Veterans InfoTap)
Cameron, who hosts the podcast “Info Tap,” said the onus will be on the veteran to explain the reason for using a private medical provider that requires a long-distance commute.
He is advising veterans worried about potential problems exposed in their DBQs to make an appointment with a VA doctor and provide an update on their medical condition, which then becomes part of their permanent health record.
“If a DBQ is flagged, they [the VA] will look at all of the evidence in the claim. If you have current office visits with the provider that correlate the severity on the DBQ, it will help you,” Cameron said.
The VA, at the same time, is opposing a bill that requires the VA to provide formal notification to a veteran when fraud is suspected and to stop the VA from changing a benefits decision without a court determination of fraud.
The FRAUD in VA Disability Exams Act would prevent the agency from reducing a benefit without a criminal conviction.
Pineda said he is concerned that the VA will alter disability ratings based “on suspicion alone,” without guardrails in place.
“The VA is basically saying convictions take too long. They admitted that they want the ability to adjust ratings faster than a federal criminal case can unfold,” said Pineda, who hosts a podcast called the Veterans Network Champions Club.
The bill would establish a process for auditing, identifying and reporting fraudulent DBQ activity and mandate reporting to the Office of Inspector General for a formal investigation.
Smith, of the Veterans Benefits Administration, said the VA is concerned the bill could conflict with its stepped-up efforts to root out potential cases of fraud in the benefits system.
“We recognize there are problem players out there,” Smith said. Claims processors also are trained to identify and report signs of fraud.
“The way [the bill] is written, it is a duplication of efforts that we have in place. It uses language that could potentially confuse veterans and requires [the VA] to notify veterans when DBQs are suspected. Just because there is a possibility of a fraudulent DBQ does not mean that it is,” Smith said.
