Exam Verification Agent
Description
The process for a Veteran Service Representative (VSR) to determine if an exam is warranted for a claim for increase (claims with end product [EP] 020) for a given contention requires that the VSR expend considerable effort and time to review extensive documentation within a Veteran or Claimant's eFolder. VSR needs review this documentation to identify whether sufficient evidence already exists for the claim to proceed to a rating or if an exam should be ordered to be able to rate the claim. The AI will reduce the time needed to review the evidence by providing a list of related evidence to the contention and a recommendation on whether an exam is needed.
Detailed example
The product will provide VSRs with: - An agentic AI tool that identifies whether an exam is required for each contention for which there is a Claim for Increase - A summary of evidence identified within the file and links to the documents identified within the Veteran’s file.
AI / analytics pattern
Agentic AI: AI systems that perform tasks or make decisions autonomously with minimal human intervention.
Automation level / stage
a) Pre-deployment – The use case is in a development or acquisition status.
Expected benefit
The Exam Verification Agent system will reduce the time needed to develop a claim, increasing efficiency in benefits processing. It transforms the complex and time-intensive process of determining medical exam necessity for disability claims for increase by deploying multiple specialized AI agents. The agents autonomously evaluate claim evidence and provide a recommendation and a summary of the reasoning for the recommendation to the user.
Controls / human review
ATO: Not reported; PIA: Not published