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VETERANS AFFAIRS UPDATE

VA Plans to Contract Out All Compensation

and Pension Medical Exams

Thomas V. Holohan M.D., FACP
There have clearly been problems with the VA (DVA) There are a number of similar VA OIG findings that
Compensation and Pension (C&P) program. However, have determined that the problems inherent in the C&P
there is little evidence that the difficulties have been process are not often caused by errors, inadequacies, or
a result of the C&P medical history review or physical carelessness on the part of the VHA examiners, although
examinations, which have usually been completed by such instances may be found. [e.g., VA OIG Report
Veterans Health Administration (VHA) staff. However, 17-04966-201 July 17, 2018 Unwarranted Medical
several very recent reviews by both the VA Office of Reexaminations]. Since the major source of error seems
the Inspector General (VA OIG) and the Government not to derive from the VHA examiners, it raises the ques-
Accountability Office (GAO) have identified inefficient tion as to why the substitution of contracted civilian
or ineffective processes and procedures on the part of the examiners for experienced VHA staff would be expected
Veterans Benefits Administration (VBA) that have com- to improve the process or outcomes. This is particularly
promised the process. curious given that few contractors would have any experi-

Since the major source of error seems not to derive from the

VHA examiners, it raises the question as to why the substitution

of contracted civilian examiners for experienced VHA staff

would be expected to improve the process or outcomes.

The OIG found that between 11/01/2018 and 04/30/2019 ence in evaluating veteran claims of SC, which often differ
“VBA decision-makers” incorrectly evaluated 12% of vet- substantially from disability claims under entities such as
erans with service-connected (SC) heart disease. Major Workers Compensation or Social Security.
causes were identified as due to imprecision in the “system
generated” forms of the Disability Benefits Questionnaire Indeed, the VA OIG has recently identified significant
(DBQ) and the lack of VBA personnel requests for problems with the management and oversight of the con-
clarification of examiners’ responses. [VA OIG Report tracted disability examination program. In a 2019 report
19-08095-198 August 5, 2020] the IG found that from 11/01/2017 through 04/2018
VBA requested more than 1.3 million C&P examinations
The OIG also reported that despite the fact that spine from contractors and that subsequently the number of
conditions account for two of the VA’s top ten SC dis- canceled examinations increased by 74%. The IG con-
abilities, VBA incorrectly processed more than half of the cluded that oversight of the contracted process was inad-
claims decided in the first half of 2018. [VA OIG report equate. [VA OIG Report 18-04266-115 June 10, 2019]
18-05663-189 Sept. 5, 2019] The IG identified the cause
as VBA’s “inadequate process” for ensuring accurate and The Government Accountability Office (GAO) has also
complete evaluation, due to a lack of specified objective identified serious problems with the contracted C&P
criteria for spine-related conditions. examination process. They noted that the VBA has

14 The Mariner • 2020 WINTER Edition • Volume 63 • Issue 3