VA DISABILITY EXAMS: Improved Performance Analysis and Training Oversight Needed for Contracted Exams

What GAO Found

The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency’s quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors’ quality scores fell well below VBA’s target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information. GAO-19-13: Published: Oct 12, 2018. Publicly Released: Nov 8, 2018

VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA’s quality and timeliness information limit VBA’s ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.

A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.

Why GAO Did This Study

In 2016, VBA awarded 12 contracts to five private firms for up to $6.8 billion lasting up to 5 years to conduct veterans’ disability medical exams. Both VBA contracted medical examiners and medical providers from the Veterans Health Administration perform these exams, with a growing number of exams being completed by contractors. Starting in 2017, VBA contracted examiners conducted about half of all exams. GAO was asked to review the performance and oversight of VBA’s disability medical exam contractors.
This report examines (1) what is known about the quality and timeliness of VBA contracted exams; (2) the extent to which VBA monitors contractors’ performance; and (3) how VBA ensures that its contractors provide qualified and well-trained examiners. GAO analyzed the most recent reliable data available on the quality and timeliness of exams (January 2017 to February 2018), reviewed VBA and selected contract documents and relevant federal laws and regulations, and interviewed agency officials, exam contractors, an audit firm that checks examiners’ licenses, and selected veterans service organizations.

What GAO Recommends

GAO recommends VBA (1) develop a plan for using its new data system to monitor contractors’ quality and timeliness performance, (2) analyze overall program performance, (3) verify that contracted examiners complete required training, and (4) collect information to assess the effectiveness of that training. The Department of Veterans Affairs agreed with GAO’s recommendations.
View Report (PDF)


Veterans Suicide – An American Legion White Paper

Suicide prevention is a top priority of The American Legion.
Deeply concerned about the number of military veterans who take their own lives at rates higher than that of the general population, the nation’s largest organization of wartime veterans established a Suicide Prevention Program under the supervision of its TBI/PTSD standing committee, which reports to the national Veterans Affairs & Rehabilitation Commission.
The TBI/PTSD Committee reviews methods, programs and strategies that can be used to treat traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD). In order to reduce veteran suicide, this committee seeks to influence legislation and operational policies that can improve treatment and reduce suicide among veterans, regardless of their service eras.
This white paper report examines recent trends in veteran suicide and their potential causes and recommends steps to address this public health crisis.

Since 2001, the U.S. military has been actively engaged in combat operations on multiple continents in the Global War on Terror.More than 3 million Americans have served in Iraq or Afghanistan through the first 17 years of the war. Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) have become known as the “signature wounds” of the war, and in recent years, countless studies, articles and reports have documented an inordinately high suicide rate among those who have come home from the war, those of previous war eras and among active-duty personnel.

The American Legion is deeply concerned by the high suicide rate among service- members and veterans, which has increased substantially since 2001.1 The suicide rate among 18-24-year-old male Iraq and Afghanistan veterans is particularly troubling, having risen nearly fivefold to an all-time high of 124 per 100,000, 10 times the national average. A spike has also occurred in the suicide rate of 18-29-year-old female veterans, doubling from 5.7 per 100,000 to 11 per 100,000.2 These increases are startling when compared to rates of other demographics of veterans, whose suicide rates have stayed constant during the same time period.

Read the full report below:
[pdf-embedder url=”” title=”American Legion White Paper on Veteran Suicide by Jared Keller”]

What does ‘privatization’ of Veterans Affairs really mean?

Giving veterans choices about their care is something we can all get behind. Dismantling VA in lieu of private care will hurt todays veterans and tomorrows veterans.
Lots of veterans have good solid reasons for hating the VA for medical care, and there are tons more that love their care.
For years they have talked about the great debt we are owed and the state of the art care we receive. It’s time for them to pay that debt and provide us the care they say we deserve.
Farming us out to private care may not be the best thing for veterans in the long term, though short term it may seem like a great solution.

“Our view is that Congress and the administration must fix what is wrong with the VA health care system — improve hiring authorities, expand and fix its aging infrastructure, improve access, customer service — and not just simply turn to the private sector when VA facilities are having problems,” said Carlos Fuentes, director of the National Legislative Service at Veterans of Foreign Wars.

“Community care is part of the solution, but not the only answer.”

21st Anniversary Veteran to Veteran Podcast Veteran to Veteran 21st Anniversary. Tbird, founder of will be the guest and talk about the history of and will take calls from veterans.

A little history … Veteran to Veteran the website domain registered Jan 20, 1997.  The domain is registered and paid for thru Jan 21, 2023 at which time I plan to register it for another 15 years, Lord willing and the creek don’t rise.
I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton who told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with Veterans Affairs.
Well, bless his heart, he opened my medical file, read the first insert, looked me straight in the eye, and said, “You will be 50% for the rest of your life” and that he would file the claim for me. 50% was for surgery I had in the service. True to his word, he met with me and talked with me for a long time, filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. I didn’t even understand what PTSD was then.
By Feb 1991 I had moved to the San Francisco bay area and was staying at a friend’s apartment and pretty much was just a puddle. In desperation one night I called the suicide hotline. I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now I know what you are thinking, if I was 50% why didn’t I just go to the VA in the first place? Two reasons, 1st, this was Feb 1991 and the 50% didn’t come till May and secondly, even if it had come thru it is unlikely that I would have had the mental acuity at the time to put the two together.
I relay this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out-patient program, which I would soon be entering. Blah, blah, blah, after many miscommunications, and no call backs, I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for
Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday, waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn about the system.
While in the navy, I was a data analyst. I had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least, regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992, I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop where I earned a nickel per envelope I stuffed, throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at them. There was so much knowledge around me, it was
like the gold rush in those days. I could just sit on a bench where a veteran would sit down next to me, a little conversation later I had another nugget. I made copious notes. Phone numbers to call, ask for this guy or that guy, he’ll give you the straight scoop and they’d slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels as they gathered their nuts and I gathered mine 🙂
So I’m thinking I could put a little handbook together, print it out and hand it out at the VA. Or perhaps flyers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better. I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you, that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one 🙂 It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted. As it turned out,not so much. Lots of stuff, but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather.  I learned html and worked as a marketing systems analyst and worked on my claim. 1996/1997 a major ptsd cork blows and unemployment follows. Working my claim, working the website. January 20th, 1997 I register the domain name right after getting off the phone with the Veterans Affairs and saying, “I’ve had it with this”.  As fate would have it, the old DAV board went down just as mine opened up and folks start to wander in.
So has two main components, the website and the the discussion board with links, articles, research resources etc. that support it.  The website starts to grow, I can’t tell you how many times I had to switch servers for space and features.  Emotionally I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working hard on pulling myself back up. The website continued to do great during this time, I just stayed in the basement, bought new software, new books, and learned how to make things work and I continued to use this knowledge to make better.
My 100% finally came through from the Veterans Affairs.  I have a friend Patrick Heavy who is an advocate who helped me thru my SSDI claim. He was literally at my side through the entire process. For him I am grateful. My therapist and sister continued to try to get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by, my sister gets married and I move from the basement to the upstairs. There is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things and finding more information. 2003 I bought my own home with my VA loan. For years now I have just considered my purpose in life. And so goes the story of the conception and birth of At 21 years old, she is established and going strong, I couldn’t be more pleased or proud. Thank you to everyone who has supported her growth.

Top 10 VA Disability Claims Posts for 2017


VA Math, Confusing, Right? Calculate Your Final Rating Percentage!

Estimated reading time: 9 minutes We usually have a calculator on this page to add your disability percentages up. Ours broke, but we found this easy one

VA C&P Exam – Do’s and Don’ts – VA Compensation Pension Exam

The following is written from a VA C&P Examiners’ perspective relating to psychiatric exams. It is a good guideline for all exams but I only did psych exams. I’ve been examined by the VA for multiple problems and this is my format when I go to be examined.

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Can a 100 percent Disabled Veteran Work and Earn an Income?

You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons after being rated 100% disabled.

Common Claimed VA Service Connected Disabilities

Click on any disability to find discussions related to that disability. Learn something new. Common Disabilities claimed as service connected disability. These links will take you to relevant articles and posts on the subject.

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VA Disability Compensation Claims

Administrative practice and procedure Alcohol abuse Alcoholism Case law Claims Day care Dental health Department of Veterans Affairs Disability Disability benefits Drug abuse Government contracts Government procurement Grant programs-health Grant programs-veterans Health care Health facilities Health professions Health records Homeless IU Medical research Mental health programs Military Military personnel Nursing homes Posttraumatic stress disorder ptsd Reporting and recordkeeping requirements SAS sleep apnea TDIU Tinnitus Travel and transportation expenses Uncategorized Unemployability United States Department of Veterans Affairs va claims veteran Veterans veterans affairs Veterans Affairs disability Veterans benefits for post-traumatic stress disorder in the United States Veterans Health Administration Vietnam

Requesting A Copy of Your VA Claims Folder (C-File)

VA Claims Folders, the infamous C-File We can not stress enough how important it is to: View your VA Claims Folder at the Veterans Affairs regional office (find your Regional VA Office here) Call the VA at 1-800-827-1000 and request an appointment to view your C-File (VA Claims Folder).

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eBenefits Development Letter Sent

Development letters are sent in the early stages of your claim. It acknowledges your claim and asks for additional evidence if you have any. The VA is legally required to send this letter to you. The letter may ask for things that aren’t applicable to your case, like buddy statements, or it may ask for things you’ve already submitted, like medical records.

4 Things Veterans Should Know about VA Sleep Apnea Disability Claims

From Chris Attig Veterans Law Blog “I get asked more questions about how to file and win a Veterans Affairs sleep apnea disability claim than almost any other topic in all of VA Benefits Law.” [Reprinted here with permission from Veterans Law Blog] True story. And I’ve been getting asked these questions for years.

6 Reasons to Keep Pursuing VA Claims and Appeals – AFTER you reach 100%

Do not to pursue a rating % as your goal in your VA Claims and Appeals …. instead seek to service connect every disability that resulted from your military service.

10 Tips to Help You Keep the VA Compensation and Pension Exam (C&P exam) in Perspective

” I encouraged you to keep the VA compensation and pension exam in perspective. What is that Perspective? Honestly, it comes down to recognizing that the purpose of the C&P Exam is NOT to convince the doctor that your injury is service-connected, but to let him or her conduct their exam and draw their conclusion.

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VA Clears The Air On Doctors Talking To Veterans About Marijuana Use

Do you trust the VA to discuss medical marijuana? Many veterans don’t, VA docs can’t prescribe, they can, it says, discuss how it might interact with other medications or how it might effect pain management or PTSD symptoms.
VA providers are still NOT permitted to refer veterans to state-approved medical marijuana programs, since the drug is illegal under federal law, with no accepted medical use.
So do you trust VA?

AGAIN! Roanoke VA office cited for mishandling veterans’ claims

Sen. Kaine said, “These findings don’t enable veterans and Congress to have trust in VA’s performance. I will be asking the Veterans Affairs to provide confirmation that no veteran suffered any financial harm from these mistakes.”

I couldn’t agree more with Sen. Kane. I am finding it impossible to believe anything they cite as statistics, their track record on cooking the books is long and scandalous. It brought us the VA CHOICE program, which they cannot seem to manage.

Veterans Affairs Office of the Inspector General for the third time in seven years determined the Roanoke VA Regional Office mishandled veterans’ disability claims.
Auditors found the appeals staff closed case files by claiming veterans with multiple appeals withdrew some of their claims when they had not. Staff then merged all of a veteran’s claims into the oldest case file, which made it more difficult to process each issue, but boosted the Roanoke office’s clearance rate and placed appeals managers in line for bonuses. Read the Full Article

VA Asking Veterans to Return Benefit ‘Overpayments’

[no_toc]Keeping the bills paid, the kids feed and a thousand other things you have to worry about each month, the last thing you need is for your income to disappear and then be saddled by a huge debt. If VA overpaid you they have every right to inform you and work out a repayment plan, but they should not have the right to put a family in a desperate situation because of their errors.
In the story below Daniel faces a huge burden because the Veterans Affairs sent a letter informing him of the overpayment to an address he lived at 35 years ago, he never got that letter, but he did get the demand for repayment.

“The VA’s debt management center sent Daniel a letter in 2016 stating it paid him $18,000 more than what he was “entitled to receive.” “Once I retired, I still had children and a wife, and in 2006 they said you didn’t have them anymore, according to their records,” he said. The Veterans Affairs told Daniel he never updated nor returned a dependent verification form sent to him. “They said they sent it,” he said. “I never received it, never.” When Daniel called the Veterans Affairs to question the debt, he found out the Veterans Affairs sent the dependent verification form to an address he lived at 35 years ago.”
More on VA overpayments on our VA disability claims forums. 

Repayment Of Overpayment By Va Due To Va’s Mistake – Veterans … › … › Eligibility – Veterans Compensation Benefit Claims

Jul 31, 2014 – If the VA prevails in the reduction, it appears the error made by the VA has resulted in the overpayment of thousands of dollars to the veteran. No mention of fraud by the beneficiary in this case. QUESTION: In a situation where the VA determines it has overpaid disability compensation to a veteran as a result …

tdiu Overpayment Of $6k – Veterans Compensation Benefits Claims › … › Veterans Compensation Benefits Claims Research

Sep 21, 2007 – Terry Higgins said back on July 18, 2006. “Dear veterans & Friends. I had a VA overpayment of over thousand dollars. I went to the VBM and photo copy the letter with the regulatons that say if an overpayment occures by the VA and its not the vets fault. The VA eats it. I did not have to pay. Terry Higgins.”.

ptsd Back Pay Confusion Possible Over Payment. – Veterans …

I just received my back pay for my disability claim, but I have not received my official decision letter yet. According to ebenefits I recieved 70% disability for my PTSD. The amount I received in back pay was much higher than 70% would have given me. It is the amount that 100% would have given me. I read that it might be …

Overpayment due to VA oversight and waiver – Veterans … › … › CUE Clear and Unmistakable Error

Nov 6, 2015 – Could I possibly get a waiver due to the VA not processing the request to remove my daughter and me advising them that I was being overpaid and them paying her for additional months of school despite her asking to not start her pay until August 2014? Does anyone have a sample hardship letter? Please …

Is There A Statue Of Limitations On Debt To Va? – Veterans … › … › Eligibility – Veterans Compensation Benefit Claims

Aug 2, 2011 – The VA is attesting that I was overpaid for my dependents because they never received notification of my divorce. At one time, I did have documentation of the package that I sent to the VA showing that my wife and I divorced, but I no longer have this. I had the postage receipt which of course, probably …

Suspected Overpay Or Pay Error – Veterans Compensation Benefits … › … › Veterans Compensation Benefits Claims Research

Sep 7, 2011 – MY question then is this: does ANYONE know how to contact the VA by telephone and either. question the provenance of an electronic deposit or alternatively report an overpayment so that. it can be returned to the proper authority/department? I very much appreciate your patience and indulgence with this …

Va Debt Collection – Veterans Compensation Benefits Claims › … › Veterans Compensation Benefits Claims Research

May 22, 2013 – The letter stated I recently received a letter explaining why (I never got any letter), and there has been a change in my benefits thus resulting in an overpayment. I called the VA Collection center to find out why. The have no record of a reason why, they just collect money, I called the 800-827-1000 number, …

Will The Va Notify Me If I Was Overpaid On My Pension? – Veterans … › Specialized Claims › VA Pensions

May 25, 2010 – I am concerned here though-as to why you fear an overpayment on your pension ? I see you get 10%-do you mean you get 10% VA compensation? Or do you mean you are 10% service connected but the pension is the greater amount so you receive the pension? Is it possible that the 10% is way too low?

ptsd Help Me Understand This Letter About … – Veterans…/53950-help-me-understand-this-letter-about-recoupm…

Nov 22, 2013 – That could impact on what I stated above,but in any event I interpret that statement in your letter as so similar to my case that I do believe VA must stop the recoupment and possibly award you retro due to overpayment of the recoupment, since they awarded SC at 100%. Hopefully others will chime in …

HR 4457 Veterans Empowerment Act – Not Empowering Despite the Name

Have you seen HR 4457 The Veterans Empowerment Act? Employing an old marketing trick giving a name that makes it sound like something you want. I want veterans to be empowered, so why wouldn’t I support a bill with empowerment right in the tittle? The bill is not about empowering veterans, but it is about dismantling the Veterans Affairs.

VFW says “H.R. 4457, the Veterans Empowerment Act, would dismantle the VA health care system, charge veterans for service-connected health care, and reduce VA to an insurance program for veterans. Congressman Lamborn and bill cosponsors”
Read the full bill here

In this bill, there are five tiers of Premium Support based on the disability rating of the veteran. Then there are six additional paragraphs that cover Additional Premium Support based on need or income. Instead of introducing something that is untested and that would, in effect, reduce the type and amount of care our veterans need, let’s fix our current system.

HR 4457 would remove a direct voice to the president from our veterans, eliminating the Department of Veterans Affairs, a federal cabinet agency, and replacing it with a corporation managed by 11 members.
This bill also calls for the termination of the Veterans Health Administration. Many of our veterans rely on this organization in order to maintain a standard quality of life. This bill would eliminate the basic services many of our veterans need.

Vietnam: The War That Keeps On Killing

Cholangiocarcinoma – a nasty little parasite from raw or undercooked fish showed up in at least 700 veterans over the past 15 years and a little less than half ever filed a claim for it. The VA rejected most of them in what was described as a haphazard way.
Veterans Affairs say they are studying it, but sadly if they were to make it presumptive by the time that happens, most of those veterans will be gone. The Vietnam veterans aren’t getting any younger and it looks like they continue to get the short end of the stick.
“A half a century after serving in Vietnam, hundreds of veterans have a new reason to believe they may be dying from a silent bullet — test results show some men may have been infected by a slow-killing parasite while fighting in the jungles of Southeast Asia.” Continue Reading at the Washington Post Veterans Affairs study shows parasite from Vietnam may be killing vets

Vietnam War Maps US Forces Vietnam Mid 1968 » VA Disability Claims Veteran to Veteran

Analysis | The Daily 202: McCain and Kerry outline lessons from Vietnam after watching new Ken Burns documentary