VA Examinations Found to Be Inaccurate

Medical Exam
Shana DunnFounding partner and attorney, Shana Dunn, discusses the recent report by the VA Office of the Inspector General (VAOIG) that made evident the examiner's lack of accuracy, which put veterans at risk of inaccurate claims.

The VA Office of the Inspector General (VAOIG) has issued a report finding serious deficiencies in the examinations provided to veterans by the contracted exam providers LHI, QTC, and VES. This news will surprise no one who has participated in this exam process. This report, titled Contract Medical Exam Program Limitations Put Veterans at Risk for Inaccurate Claims Decisions, states that contract examiners have not met the required accuracy standards and that VA has not compelled them to improve their accuracy.

VA has spent nearly $6.8 billion dollars on contract exams since 2017. The contracts under which these companies are operating provide monetary disincentives for failing to meet quality requirements. VAOIG found that VA has not used these contractual tools to compel increased quality. VA responded that “[d]espite not meeting the [quality] requirement, vendors were providing the quality of service they were being paid for.” Further, VA asserted that VA claims processors had “become ‘very good at adapting to an imperfect product. Many veterans and veterans’ advocates would respectfully but vehemently disagree.

Low-quality VA examinations are a primary driver of denials of VA claims for service connection. VA is required to provide examinations and opinions to veterans once a certain, quite low, evidentiary burden has been met. When these contract examiners, as they often do, fail to review the evidence, or disregard a veteran’s competent lay testimony and provide a negative opinion, the veteran’s claim will almost certainly be denied. This is true even where veterans have provided high-quality medical opinions from non-VA doctors. Some veterans, discouraged at the result, likely give up on their claims. Many refile their claims and are subjected to the same flawed exam process again and again. The reliance on inaccurate examinations is costly to both the veteran and the government.

This report says nothing of the exam experience itself, which many veterans report to be extremely unprofessional. Exams are often conducted in non-medical settings, such as temporary office spaces. Most exams are completed by nurse practitioners or physician's assistants, even in complex cases. Veterans are often asked to drive for hours to attend an examination, even when the veteran resides in a major city. Scheduling is difficult, likely because the contract exam company wants to claim that exams are conducted within their timeliness guidelines. If a veteran is unable to report for an examination on the date offered, which is usually on very short notice, the contract exam company will often tell VA that the veteran refused the examination. This results in denials at worst, and in additional work for VA and the veteran.

Providing veterans with high-quality, thorough medical examinations and opinions, conducted by examiners who understand VA regulations (particularly as they relate to lay testimony) would immensely benefit both VA and veterans. VA wastes time and money redoing shoddy exams, and veterans are wrongly denied deserved benefits while they and their advocates must appeal and appeal to get a decent exam and opinion. Fixing this process should be a top priority for VA.

If you or a family member needs assistance appealing a VA claim, contact the legal experts at West & Dunn at 608-535-6420 or through our Contact Us page.

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