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)

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5 VA Health Care Myths – Opinion – WaPo



Read the highlights below and then check out the full article
Mr Longman writes an interesting opinion piece laying out what he describes as the 5 Myths about VA Healthcare. Whether you agree with him or not he provides enough information to back his myths – worth a read.

  1. The claims process is slow because of VA bureaucrats.

    • “… it is ultimately Congress that makes it so difficult for many veterans to get VA care. Because of laws that strictly limit eligibility, veterans must show that they are either poor or suffer from some specific degree of disabilityrelated to their military service to qualify for many health-care services as well as pension benefits. The requirement to litigate different health conditions — such as, say, whether a veteran’s hearing loss is a result of artillery fire or exposure to rock-and-roll — is the ultimate reason the VA claims process is prolonged and often humiliating to vets …”
  2. Wait times to see a doctor at VA are an exceptional problem.

    • “…  The key question that often goes unanswered is: compared with what? A 2015 study by the Rand Corp. concluded that, in general, “wait times at the VA for new patient primary and specialty care are shorter than wait times reported in focused studies of the private sector …”
  3. VA delivers mediocre care or worse.

    • “…  Commission on Care , found the quality of VA’s behavioral health programs “largely unrivalled.” In many areas, VA offers specialized polytrauma and rehabilitative care for veterans that cannot be obtained at any price elsewhere. Part of the reason you hear so many negative stories about VA health care is that it receives far more scrutiny than the rest of the health-care system, including from two standing committees in Congress, an inspector general, veterans service organizations and a highly engaged press …”
  4. VA should offer patients maximum choice in doctors.

    • “… Sending veterans to other providers could also threaten the viability of VA hospitals and clinics, many of which already face rapid shrinking in their patient populations, owing to the passing of the World War II generation. If VA hospitals wind up closing, that would leave veterans with less, not more, choice in doctors …”
  5. Allowing veterans to see private doctors means ‘privatizing’ VA.

    • “… not all calls for VA to make better use of private providers amount to “privatization,” as some liberals and public employee unions claim. VA has a long history of partnering with private medical schools and purchasing care in the community. Especially in rural areas, VA often lacks the facilities and personnel to offer vets timely, convenient, high-quality care. In such circumstances, joining with local private providers to create integrated networks of care makes both clinical and fiscal sense …”

Read the full article on the Washington Post
Phillip Longman served on the Commission on Care, established by Congress to study the future of VA, and is the author of a book on VA, “Best Care Anywhere.” He is policy director at the Open Markets Institute and a senior editor at the Washington Monthly.
Related

Commission on Care Final Report

New GI Bill Would Make College Education a Lifetime Benefit

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A proposal to enhance the GI Bill would make the education benefit a lifetime possibility for new recruits.

Read the full article at: www.military.com

Thanks to the Harry W. Colmery Veterans Educational Assistance Act of 2017, education as a lifetime benefit for the new generation of veterans may become a reality.
Education as a lifetime benefit would be a huge benefit pre and post 9/11 veterans would remain at whatever entitlement they currently have. The post 9/11 GI Bill has a use it or loose term of 15 years which remains in effect for those veterans. Let’s watch this one and see how far it gets.

Highlights:

Section 107. Restoration of Entitlement to Post-9/11 Educational Assistance for Veterans Affected by Closures of Educational Institution.

This section would restore entitlement to individuals when their school closes in the middle of a semester. This section would also authorize additional living stipend payments to be paid to students whose school closes in the middle of the semester for no more than 4 months, or the length of the semester, where they were attending training.

Section 114. Department of Veterans Affairs High Technology Pilot Program.

This section would authorize VA to conduct a 5-year pilot program that would provide veterans the opportunity to enroll in high technology courses (coding boot camp, IT certifications etc.). VA would enter into contracts with these schools or programs and would provide tuition and fees payments on a sliding scale that incentivizes the schools to graduate the student and ensure they find a job in their field of study. The section would also authorize a living stipend payment equal to the Post-9/11 rate to students while they are using the benefit.

Section 202. Duration of Educational Assistance under Survivors’ and Dependent’ Educational Assistance Program.

This section would change the number of months of entitlement for individuals who become eligible for the Survivors’ and Dependents’ Educational Assistance Program from 45 months to 36 months. This would re-align this program with other GI Bill programs that provide 36 months of eligibility for educational assistance. This change would only apply to individuals that become entitled to this program on or after August 1, 2018.

Here’s the bill Harry W. Colmery Veterans Educational Assistance Act of 2017

Section By Section Of Gi Bill

Veterans Benefits by State

Alabama – Alaska – Arizona – Arkansas – California – Colorado – Connecticut – Delaware – Florida – Georgia – Hawaii –Idaho – Illinois – Indiana – Iowa – Kansas – Kentucky – Louisiana – Maine – Maryland – Massachusetts – Michigan – Minnesota – Mississippi – Missouri – Montana – Nebraska – Nevada – New Hampshire – New Jersey – New Mexico – New York – North Carolina – North Dakota – Ohio – Oklahoma – Oregon – Pennsylvania – Rhode Island – South Carolina – South Dakota – Tennessee – Texas – Utah – Vermont – Virginia – Washington – West Virginia – Wisconsin – Wyoming

https://www.dvnf.org/veterans-programs/veterans-benefits/veterans-benefits-by-state/

VA Disability Claims Forums

 Veterans Compensation Benefits Claims Research

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VA Disability Compensation Benefits Claims Research Forum

VA Disability Compensation benefits discussions. Post veterans compensation claims questions or answer for others. Read and research other veterans compensation claims experiences. Tip: Start a new topic with your question. Do not post your question in someone else’s post. We don’t want your question to get lost.

VA Disability Claims discussions post your Veterans Administration disability claims questions or answer for others. Read and research other veterans experiences.

How VA Identifies Claims

Original Claim

An original claim is the first claim you file for compensation from VA. This can be filed by a Servicemember, Veteran or survivors of deceased Veterans.

Reopened Claim

A reopened claim is a claim filed for a benefit that could not be granted and the decision has become final, meaning that it is over one year old and has not been appealed. VA cannot reopen these claims unless new and material evidence is received. New evidence is evidence that the VA has never before considered in connection with the specific benefit claimed. Material evidence is evidence that is relevant to and has a direct bearing on the issue at hand.

New Claim

A new claim is a claim for a benefit that may or may not have been filed before. Generally, the decision made on the claim is based entirely on new evidence. These may include claims for:

  • An increased disability evaluation
  • Special monthly compensation
  • Individual unemployability

A new claim differs from a reopened claim in that a decision on the claim is totally independent of any evidence submitted in connection with an earlier claim.

Secondary Claim

These are claims for disabilities that developed as a result of or were worsened by another service-connected condition. In other words, it is recognized that a service-connected disability may cause a second disability. This second disability may not otherwise be considered service-connected.

Win Your VA Disability Compensation Benefits Claim – Hadit.com For Veterans Who’ve Had it With The VA

no_toc]You finally decided to file a VA disability compensation claim, so now what do you do?

You Won Your VA Claim! Now, Calculate Your Retroactive Pay | hadit.com

VA claim disability rates listed below are for calculating your retroactive pay once you win your claim. For example, if you were awarded 50% from 1997 to the present you will be paid at the 50% rate for the corresponding years.

VA disability compensation (pay) offers a monthly tax-free payment to Veterans who got sick or injured while serving in the military and to Veterans whose service made an existing condition worse. You may qualify for VA disability benefits for physical conditions (like a chronic illness or injury) and mental health conditions (like PTSD) that developed before, during, or after service. Find out how to apply for and manage the Veteran’s disability benefits you’ve earned.
Source of Data: Veterans Affairs Compensation and Pension Benefits Website

VA Rating Calculator

You may wonder how the VA decides if I’m 70% or 30% well there are many reasons but let’s start with the basics and move on from there.

First, your disability is listed in the law 38CFR4 Schedule for Rating Disabilities this document is dry reading, read it anyway. It will list your disability/diagnosis and it will tell you what symptoms equal what percentage.

Now the compensation and pension exam doctor will examine you and make notes indicating your disability and your limitations then a VA rater will look at the doctor’s results, look at the evidence, look at your claim (contentions) and look at the law and then make a decision. So the moral of the story spending some time looking at the 38CFR4 Schedule for Rating Disabilities

While I’m here also check out the side effects of any medications you are on for your service-connected condition. Those can be claimed as secondary to your service-connected disability. You are your best advocate.

For Current VA Disability Compensation Rates Click Here

The research was unable to find rates for 1983 and 1999

Effective Date 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Effective Date2
5/1/74 $32 $59 $89 $122 $171 $211 $250 $289 $325 $584 5/1/74
8/1/75 $35 $65 $98 $134 $188 $236 $280 $324 $364 $665 8/1/75
10/1/76 $38 $70 $106 $145 $203 $255 $302 $350 $393 $707 10/1/76
10/1/77 $41 $75 $113 $155 $216 $272 $322 $373 $419 $754 10/1/77
10/1/78 $44 $80 $121 $166 $232 $292 $346 $400 $450 $809 10/1/78
10/1/79 $48 $88 $133 $182 $255 $321 $380 $440 $495 $889 10/1/79
10/1/80 $54 $99 $150 $206 $291 $367 $434 $503 $566 $1,016 10/1/80
10/1/81 $58 $107 $162 $232 $328 $413 $521 $604 $679 $1,130 10/1/81
10/1/82 $62 $114 $173 $249 $352 $443 $559 $648 $729 $1,213 10/1/82
                       
4/1/84 $64 $118 $179 $258 $364 $459 $579 $671 $755 $1,255 4/1/84
12/1/84 $66 $122 $185 $266 $376 $474 $598 $692 $779 $1,295 12/1/84
12/1/85 $68 $126 $191 $274 $388 $489 $617 $713 $803 $1,335 12/1/85
12/1/86 $69 $128 $194 $278 $394 $496 $626 $724 $815 $1,355 12/1/86
12/1/87 $71 $133 $202 $289 $410 $516 $652 $754 $849 $1,411 12/1/87
12/1/88 $73 $138 $210 $300 $426 $537 $678 $784 $883 $1,468 12/1/88
12/1/89 $76 $144 $220 $314 $446 $562 $710 $821 $925 $1,537 12/1/89
                       
1/1/91 $80 $151 $231 $330 $470 $592 $748 $865 $974 $1,620 1/1/91
12/1/91 $83 $157 $240 $342 $487 $614 $776 $897 $1,010 $1,680 12/1/91
12/1/92 $85 $162 $247 $352 $502 $632 $799 $924 $1,040 $1,730 12/1/92
12/1/93 $87 $166 $253 $361 $515 $648 $819 $948 $1,067 $1,774 12/1/93
12/1/94 $89 $170 $260 $371 $529 $666 $841 $974 $1,096 $1,823 12/1/94
12/1/95 $91 $174 $266 $380 $542 $683 $862 $999 $1,124 $1,870 12/1/95
12/1/96 $94 $179 $274 $391 $558 $703 $887 $1,028 $1,157 $1,924 12/1/96
12/1/97 $95 $182 $279 $399 $569 $717 $905 $1,049 $1,181 $1,964 12/1/97
12/1/98 $96 $184 $282 $404 $576 $726 $916 $1,062 $1,196 $1,989 12/1/98
12/1/99 $98 $188 $288 $413 $589 $743 $937 $1,087 $1,224 $2,036 12/1/99
12/1/00 $101 $194 $298 $427 $609 $769 $969 $1,125 $1,266 $2,107 12/1/00
12/1/01 $103 $199 $306 $439 $625 $790 $995 $1,155 $1,299 $2,163 12/1/01
12/2/02 $104 $201 $310 $445 $633 $801 $1,008 $1,171 $1,317 $2,193 12/1/02
12/1/03 $106 $205 $316 $454 $646 $817 $1,029 $1,195 $1,344 $2,239 12/1/03
12/1/04 $108 $210 $324 $466 $663 $839 $1,056 $1,227 $1,380 $2,299 12/1/04