In-House Compensation + Pension Exams

 

November 5, 2020

For years now, the Trump administration has been unprecedentedly opaque with Congressional leaders, Veterans Service Organizations (VSOs), and the public about massive outsourcing policies inside the Department of Veterans Affairs (VA).

 

This work took a radical turn in recent days when the administration quietly announced it would no longer perform in-house compensation and pension (C&P) exams, a critical service that directly influences whether veterans will be eligible for VA benefits. The VA must reverse course on this change immediately, as outsourcing these services to private sector examiners who have little understanding of veterans’ complex conditions will result in untold numbers of deserving veterans being denied assistance they deserve after the sacrifices they have made for our country.

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Let’s start with an overview of VA C&P exams, as this work takes place behind the curtains inside the rarely explored Veterans Benefits Administration (VBA). C&P exams are a critical part of the VA’s healthcare process for veterans. In most instances, a veteran must file and win a disability compensation benefit claim against VA before receiving free VA medical care. (There are, of course, some exceptions to this VA rule, including for veterans who deployed to a war zone.) 

VA’s existing claim process requires a veteran file several complex VA forms, submit detailed medical evidence, and then attend a lengthy C&P medical exam performed by a medical professional where VA seeks to determine first if a veteran’s medical condition exists and then the severity of the veteran’s condition. The C&P exam also generates a medical opinion stating if the condition is, or is not, related to a veteran’s military service.  That opinion is given to a non-medical VA claim processor to decide if the veteran will receive VA care and benefits.

For example, if a veteran files a disability benefit claim for a knee condition, then a VA C&P exam will determine if a veteran has a knee condition, and if the knee injury is related to an injury suffered by the veteran while in the military. If the condition is related to an event which occurred during service, such as a parachute jump, then VA will provide the veteran with free medical care and pay the veteran monthly compensation benefits based on the severity of the condition. However, if VA finds the veteran’s injury is related to an automobile collision after military service, then VA will deny the veteran’s claim, and the veteran will not receive free VA care or compensation for the knee condition.  In short, C&P exams are a critical component to protect veterans, the VA, and taxpayers.

VA’s obsolete and tissue-thin argument in favor of privatizing C&P focuses on improving speed and accuracy. In the past few years, VA has faced challenges in providing prompt and complete C&P exams, often due to a lack of funding and training.  In simple terms, there weren’t enough VA doctors to perform C&P exams fast enough, so VA sought help from doctors outside of VA.

In 2014, due to VA’s inability to meet sharply rising demand for both VA care and benefits, veterans waited months, or longer, for C&P exams at a VA hospital or clinic.  A VA delay in a C&P exam meant a veteran faced long waits in obtaining VA care or receiving benefits to pay the rent or feed a family. This prompted VA to deputize far too many C&P exams to the private sector to handle the surge. VA saw the situation as temporary and deliberately chose to outsource rather than hire more VA employees. Today, the situation has stabilized at VA, largely thanks to new hires, and timeliness has improved. However, VA still wants to avoid hiring government staff, preferring instead to pay private contractors. 

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As a result, the VA is today sinking billions of dollars into private sector exams, which, according to Stars & Stripes, now account for roughly 60 percent of such appointments. (The VA has not yet collected enough data to determine whether this massive expense is cost effective, though consistent evaluation errors force more tax dollars to be spent on repeat exams.) 

The decision to outsource is one that has been made absent the input of veterans, who have, for years, expressed concerns about the poor quality of such assessments. Many of their claims have been backed up by government watchdogs and independent studies that confirm civilian evaluators have little knowledge of the unique wounds of war – whether it’s PTSD, Gulf War Illness or military sexual assault. 

Take, for instance, the private company Veterans Evaluation Services (VES), which has been the subject of multiple unflattering reports. In 2015, the Tampa Bay Times reported that the company sent dozens of veterans to a Tampa doctor who was under federal investigation. The company has also been the target of many troubling allegations on the employer review website Glassdoor.  Employees have complained that the quantity of evaluations is prioritized over their quality. In previous reporting, Margaret Rajnic, a nurse who worked briefly for VES in early 2018, told VHPI fellow Jasper Craven that the organization is poorly run and that many of its reviewers had no familiarity with basic medical terms or procedures. Rajnic said she was fired after raising questions over the company’s business practices.

Other contractors have similarly poor track records. A 2018 report from the Government Accountability Office (GAO) found that VES and four other contractors routinely subjected veterans to long wait times and made significant errors in exam reports. The GAO also found that the VA is unable to oversee these private contractors.

Since VA’s most recent announcement, VHPI has obtained documents and connected with  veterans with bad C & P experiences in the private sector. In one case, a former Marine with hearing loss was sent to VetFed Resources after requesting an increase in his 10 percent disability rating. VetFed required he drive an incredibly far distance for an appointment (he doesn’t have a car) and then threatened to cut off his benefits altogether if he didn’t show up. (VetFed, like VES, has similarly amassed complaints that it improperly denies medical benefits to vets.) These issues are so endemic that an entire Washington law firm Bergmann & Moore today focuses on remedying poor benefit outcomes.

Congress should push aggressively to halt the VA’s actions using any and all levers and statutes it can muster to protect veterans, government workers, the integrity of the process, and billions of taxpayer dollars.

Specifically, lawmakers should demand that the VA’s changes go through legal channels that require federal comments from the public. Moreover, Congress must request information and communication surrounding this decision. Vital questions must be asked and answered, such as:  

  • Do the private sector C&P examiners have cultural competency, so they understand the vocabulary and terms used by former service members?

  • Do the for-profit examiners have adequate oversight by VA medical professionals and VA disability claim rating specialists?  Veterans have a right to know if the person examining them is properly qualified and trained to complete VA’s complex claim forms and provide adequate medical opinions about the relationship between a veteran’s medical condition and military service.

  • Has Congress and/or the GAO compared delay times, accuracy, thoroughness and cost for C&P exams performed by VA staff and non-VA staff?

  • Have VSOs and the veteran community reviewed and commented on VA’s sudden regulatory and process changes that took place only days before an election? 

  • What if a for-profit company goes out of business or suffers from a cyber-attack?  Who protects the privacy of our veterans? 

Finally, there is the issue of maintaining high ethical standards when hundreds of billions of dollars are on the table. This decision is rife with apparent conflicts of interest. For instance, many of C&P contractors today employ influential lobbyists like former HVAC Chairman Jeff Miller, who represents VES. Another major contractor, QTC Services, was long led by former VA Secretary Anthony Principi, now a lobbyist and Trump campaign surrogate. (VetFed, meanwhile counts among its lobbyists Joseph Lai, a former Trump advisor.) Lawmakers must request communications of these officials to understand whether this decision was motivated only by a private company’s bottom line.

Should lawmakers or the press wish to understand the true consequences of this decision, VHPI can provide access to veterans with stories about their experiences with outsourced care, including Essam Attia, who was funneled into a poorly cleaned and chaotically organized  medical clinic in New York City that tried to diagnose his PTSD by startling him during his exam, to Pam Campos, whose examiner had little cultural competency and thus gave her a dubious disability rating.

The bottom line is that when VA privatizes veteran benefits and care, veterans may be evaluated by unqualified examiners who seek to take advantage of veterans, the VA, and taxpayers.  Some of these private sector providers may not only be motivated by profit rather than service but actually engaged in criminal practices. Without a thorough review of VA outsourcing, VA’s claims may become the next “wild west” of failed government oversight.