Sen. Elizabeth Warren (D-MA)
WASHINGTON, DC — Veterans are reporting disability exam experiences with third-party contractors that are “inadequate and unprofessional,” and it has a leading Democratic senator asking what the VA plans to do about it.
In a letter to VA Secretary Denis McDonough, Sen. Elizabeth Warren (D-MA) related complaints from constituents that included everything from contracted examiners failing to review service records prior to appointments to shredding medical questionnaires instead of adding them as evidence to medical files. Contractors have held disability exams–known as a compensation and pension (C&P) exam–outside of medical facilities and doctors’ offices, including in co-working offices, hotel rooms and broom closets, Warren wrote.
Warren said she’s also received reports of third-party contractors taking up to 45 days to complete an exam, compared to 10 days at a VA facility, and that exams can require veterans to travel to multiple locations over multiple days.
“My office has heard heart-breaking reports from veterans who described the financial hardship and emotional pain and stress that they endured when they experienced a denial or a slow-moving appeal in cases where their exam was inadequate,” Warren told McDonough. “These veterans would have been spared such hardship if the contracted exam was conducted correctly the first time.”
These stories of frustration and poor treatment by third-party examiners is not new. As early as 2017, watchdog agencies were telling VA that examiners were falling short of quality goals. Reports from the Government Accountability Office (GAO) and the VA Office of the Inspector General (OIG) found that contractors had difficulties processing complex claims, leading to disability ratings mistakes that later needed to be corrected.
They also found that VA was unable to hold examiners accountable due to inadequacies in the contract language. Many of the incentives and disincentives in the examiners’ contracts are based on timeliness of exams, which inspectors found VA unable to accurately gauge.
A 2021 OIG investigation also found that 65,000 veterans had been required to drive over the maximum allowed distance for their disability exam—something VA had been unaware of until the investigation.
Despite these reports, the role of contracted disability examiners has grown steadily since their use was first approved in 1996. The goal of that expansion has been to free up VA providers to treat patients, get through the backlog of exam requests quicker, and get veterans their benefits sooner. As of 2023, contractors were responsible for 85% of disability exams.
Warren has pressed VA on this issue before. In 2020, she and 10 other senators raised concerns about VA’s decision to “expand privatization of C&P exams within VA, eliminating the associated VA personnel conducting these exams and leaving the examination of veterans’ disability exams in the hands of private contractors at a potentially enormous cost to American taxpayers.” They also noted that VA “had no clinical quality measurement for the evaluation of contractor exams.”
In her recent letter, Warren said, “Despite these warnings, problems do not appear to have been prevented or resolved by VA.”
Attached to her letter, she included a list of questions for VA leaders about examiner eligibility requirements, license validation, examiner training, quality assessment, as well as whether veterans are aware they have the right to request their exam be conducted by VA personnel in a VA facility.
Asked at a press conference about the issue, McDonough declined to comment on any of those specific questions until he had officially responded to Warren.
“This is an issue that we’ve been focused on. About quality [of exams],” he said. “We are tracking quality very closely, and we’re going to make sure that we hold contractors accountable to their commitments on quality. I can say that last year we did have, I think, 15% more completed C&P exams than we’ve ever had. That’s positive—but only positive if it’s also correlated with high quality.”