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limited information on whether contractors conducting gammopathy of uncertain significance (MGUS), and the
such examinations meet the agency’s quality and time- appropriate confirmatory laboratory tests were not ordered
liness standards, that VBA itself reported that the “vast at the time of the examination. In other cases, non-physi-
majority” of contractors’ quality scores fell below VBA’s cians reported on veterans with blood disorders where it
target, and that they did not possess accurate informa- was clear that the examiners could not distinguish between
tion regarding contractors’ timeliness. GAO concluded the several types of leukemias or differentiate leukemia
that VBA did not have the ability to effectively oversee from similar disorders (a diagnosis of importance since
contractors. Moreover, VBA did not verify if contractors SC designation due to environmental, physical, chem-
have completed training in C&P examinations (which has ical or radiologic exposure differs by disease). In another
been required for all VHA staff performing such exams) case a contracted DBQ completed by a non-physician
even though in 2016 VBA awarded 12 contracts in 2016 included a neurologic examination report contradictory to
for up to $6.8 billion, lasting up to 5 years. [GAO Report an examination two weeks prior and entered in the elec-
GAO-19-13, Nov 8, 2018] tronic health record by a VHA neurologist. One contract
physician reported a mitral valve murmur that was present
Subsequently GAO found that VBA had not resolved 25% of the time, a clearly ridiculous statement. One veter-
issues regarding inadequate oversight of the quality and an’s DBQ’s prepared by two private physicians included a
timeliness of contracted C&P examinations. GAO rec- paragraph describing a history of signs and symptoms that
ommended that VBA develop the capability to assess con- were identical, word for word, with a letter submitted by
tractor timeliness, monitor time spent correcting exams, the veteran to VBA several months prior to the date of the
verify proper invoicing, and develop a system to verify DBQ’s preparation.
that all contracted examiners have completed the required
training. [GAO Report GAO-19-715T, Sept. 19,2019] Considering that:
n there is a lack of evidence that VHA staff examiners
In this author’s experience performing fee-basis C&P are a significant source of problems for the disability
examinations between 2008 and 2020, it became clear in evaluation process;
the process of reviewing the complete medical records of n there is evidence the contracted examiner procedures
veteran claimants that a proportion of prior contracted are inadequately monitored for examiner training,
Disability Benefit Questionnaires (DBQ) contained seri- timeliness and quality;
ous errors, but given the HIPPA laws protecting personal n the contractors more often utilize non-physician
medical information, these observations must fall under the examiners than does VHA;
category of anecdotes. These included, but were not limited n veteran disability claims may differ substantially
to: incomplete review of the entirety of the military and from those in the civilian sector such as Workers
post-discharge medical record; inadequate understanding Compensation or Social Security;
of the disease process for which the veteran had claimed n civilian contractors are less familiar than VHA staff
SC; superficial description of the physical examination; and with disorders that are rare in non-veteran popula-
lack of clarity as to how the medical history and physical tions (such as cold injuries, barotrauma, projectile
findings led to the final diagnoses and observed disability. wounds, exposure to toxins, radiation sources, and
Some contract examiners’ reports did not comport with the chemical weapons, uncommon infections (e.g.
information in the electronic medical records indicating Acinetobacter as seen in Iraq) and parasites, blast
that a full review of all military and post-discharge med- injury, traumatic brain injury, et al).;
ical records (a time-consuming task) had not been done.
In some instances, the contract examiners were non-phy- It is unclear why the “solution” of fully contracted C&P
sicians (nurses, nurse practitioners, or physician assistants) exams should be considered a prudent, beneficial, or
asked to evaluate complex disorders with which they were appropriate initiative. It will eliminate those examiners
unfamiliar. To give but a few examples, a nurse practitioner who have not been identified as a source of problems and
completed a report on a patient claiming multiple myeloma, will do nothing to change the flaws identified by the OIG
but the DBQ did not cite the correct diagnostic criteria, and the GAO.
did not distinguish between myeloma and monoclonal continued on page 16

The Naval Enlisted Reserve Association 15