Warren Calls Out Ineffectiveness of VA’s Privatized Disability Rating Exams, Pushes for Review of Private Contractors’ Service Quality

April 24, 2024

Warren Calls Out Ineffectiveness of VA's Privatized Disability Rating Exams, Pushes for Review of Private Contractors' Service Quality

Veterans Face Delays and Denials of Benefits due to Private Contractors Inadequate Exams

"[M]y office has heard numerous 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. These veterans would have been spared such hardship if the contracted exam was conducted correctly the first time. "

Text of Letter (PDF)

Washington, D.C. - Senator Elizabeth Warren (D-Mass.) wrote to the Department of Veterans Affairs (VA) calling out the failures of contracted veterans' compensation and pension (C&P) examinations, following disturbing reports of inadequate and unprofessional treatment of Massachusetts veterans at facilities in the state.

Senator Warren asked the VA a series of detailed questions about the VA's use of private contractors, asking for "a review …of the waiting times for C&P exams, the quality of service that veterans receive during these exams, and the Department of Veterans Affairs' oversight of C&P vendors."

C&P examinations help determine if a veteran has a service-connected disability, so the VA can assign a disability rating and get them the benefits they are owed. For decades, disability claims, including C&P exams were conducted almost exclusively by VA physicians. But by 2017, in an effort to provide some relief to a strained VA system, all regional offices were allowed to assign C&P exams to outside contractors. Over time, the VA shifted its disability exams casework almost completely to contractors.

Today, almost 90% of all disability exams are performed by VA contractors. The increased reliance on contracted C&P exams did help address the backlog, increasing the number of completed Examination Scheduling Requests (ESR) by 69% between 2016 and 2022. However, several veterans recently submitted complaints and concerns to Senator Warren's office about the quality of the contracted exams conducted in Massachusetts and across the country.

For example, veterans reported that contractor examiners failed to review service treatment records prior to their appointment, and shredded medical questionnaires instead of adding them to medical files as evidence because they could not be added due to VA rules. Veterans also shared that they were directed to meet contractors for exams outside of medical facilities, including co-working offices, broom closets, and hotel rooms.

At the same time, veterans report having to wait 30-45 days or longer for their examinations to be complete, compared to about 10 days for exams conducted by VA doctors at VA Boston, and that these exams may require the veteran to travel to multiple locations on different days to complete the exam. Constituents have also shared numerous heart-breaking reports describing the financial hardship, emotional pain, and stress that they endured when they experienced a denial or a slow-moving appeal in cases where their exam was inadequate.

These problems are not new. In 2019, a VA Office of Inspector General (OIG) report identified several challenges faced by VA staff in overseeing the C&P program, including limitations with the electronic management systems, a lack of reliable data, inadequate staffing, and inability to validate the completion of contractors' requirements. While the Veterans Benefits Administration (VBA) addressed most of the OIG recommendations, they failed to address the quality of contract C&P examiners. The IG also found numerous issues with VA contracts that limited the agency's ability to hold contractors accountable for problems. Furthermore, as recently as February 2024, the VA OIG found that VA officials did not follow requirements to ensure contractor employees were properly vetted, which may increase risks to health, safety, and well-being of veterans and VA employees.

In November 2020, Senator Warren joined ten other senators in warning that the privatization of disability examinations would have long-term negative impacts on services and benefits to veterans, especially when the VA had no established process to evaluate the quality of contractor exams.

Senator Warren is pushing for answers from the VA about the eligibility requirements, license verification, training and resources, and assessment methods for C&P exam contractors by May 14, 2024.

Senator Warren is a longtime leader in fighting for the health and well-being of military veterans:

• In April 2024, Senator Warren introduced the Blast Overpressure Safety Act, to mitigate the risks of blast overpressure and traumatic brain injury for service members by regularizing neurocognitive tests, requiring blast overpressure exposure and TBI logs, improving transparency in weapons safety in the acquisition process, enhancing the Warfighter Brain Health Initiative, supporting service member treatment, and improving the data on subconcussive and concussive injuries to better track this issue.

• In February 2024, Senator Warren led a hearing on the impacts of blast overpressure on American service members and the need for DoD to better protect service members from blast overpressure.

• In January 2024, Senators Warren, Ernst, and Tillis sent a letter to Secretary of Defense Lloyd Austin, asking him to provide updates on steps the DoD is taking to better understand and address the effects of blast exposure on service member mental and physical health during training and operations.

• In November 2020, Senator Warren joined ten colleagues in expressing grave concerns over the Department of Veterans Affairs' (VA) decision to increase the privatization of Compensation and Pension (C&P) exams, negatively impacting services and benefits provided to disabled veterans.

• On October 2, 2020, she joined Senator Tester in calling on the VA to step up its monitoring and support of these long-term care facilities, to better protect the health and lives of veterans-especially during the COVID-19 pandemic.

• On June 26, 2020, Senator Warren led a letter with Senator Markey and Representative Ayanna Pressley (D-Mass.) to Governor Charlie Baker requesting an independent investigation into the COVID-19 outbreak at Chelsea Soldiers' Home (CSH).

• On June 24, 2020, Senator Warren released a statement on the completion of the independent investigation in the COVID-19 outbreak at the Holyoke Soldiers' Home.

• On May 5, 2020, Senators Warren, Tester, Markey, and Casey also requested the Government Accountability Office (GAO) review oversight by the VA of quality of care at State Veterans Homes. On May 14, the GAO agreed to conduct this investigation.

• On April 3, 2020, she led a letter with other members of the MA Congressional delegation to the VA New England Healthcare System seeking additional VA resources to help State Veterans Homes (SVHs) stop the spread of COVID-19 and prevent similar outbreaks at VA-operated long-term care facilities across the Commonwealth.

• In January 2020, Senator Warren sent a letter to DoD and the Treasury Department requesting information about the collection of military hospital debt from low-income, civilian patients.

• In May 2019, Senators Warren and Ernst introduced the Blast Pressure Exposure Study Improvement Act, which would require more frequent progress reports from DoD regarding the longitudinal study and added two feasibility assessments to the study.

• Senator Warren introduced an amendment in the Fiscal Year 2018 National Defense Authorization Act (Sec. 734) that required DoD to establish a longitudinal medical study examining the effects of blast pressure exposure.

• In May 2018, Senators Warren and Ernst introduced the Blast Exposure and Brain Injury Prevention Act to improve research on TBIs, speed up the development of therapies to treat TBI, and strengthen DoD's capacity to track and prevent blast pressure exposure.

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