The VA’s new Medical Disability Examination Office (MDEO) provided an update last week to MOAA and other Veterans Service Organizations (VSOs) on the status of Compensation and Pension (C&P) medical exams, and asked the VSOs to use their platforms to spread the news.
All VA disability compensation and pension claims require a medical exam review on each submitted disability. This review is familiarly called a C&P exam. In most cases, the “exam” is more like an “interview,” the examiner asks the veteran questions from Disability Benefit Questionnaires (DBQs) about each claimed disability.
As you would expect, COVID-19 played havoc on the scheduling and execution of C&P exams. In March, after the pandemic took hold, the VA terminated the exams with no expectation of when they would resume.
In May, the Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA) announced the resumption of exams at 82 sites using Tele (virtual) C&P or ACE (Acceptable Clinical Evidence) competencies. During the two-plus month hiatus, the VA did not sit on their hands: VBA trained and exported VHA’s telehealth technology to contract examiners to be ready to conduct and complete virtual exams when it was deemed safe to resume.
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ACE, a new joint venture between VBA and VHA, was developed, piloted, and went on to reduce the national average time to complete a DBQ from 25 days down to just eight. It provides the VHA with the option to review a veteran’s existing medical records instead of performing an in-person or telehealth examination to complete a DBQ, expediting the rating process by eliminating the delay time to schedule and conduct an in-person or virtual exam.
When a claim is submitted, a VBA rating official will review the claimed disabilities and submit a request initiating VHA to schedule an exam for rating purposes. Under the new process, VHA can complete a DBQ without a medical exam if a veteran’s existing medical records contain sufficient evidence to complete a DBQ.
Contacting a Contractor
All contract medical exam vendor websites now contain portals providing veterans with real-time status of: appointments (planned, scheduled and completed); provider facility locations (address and contact information); travel reimbursement status (check number, payment amount, date paid, date check cashed); and answers to frequently asked questions (for example, how to cancel appointments, how to reschedule appointments, how to address billing questions, etc.). They can also be contacted via telephone:
- Logistics Health Inc. (LHI): 1-866-933-8387; logisticshealth.com
- QTC: 1-800-260-1515; https://www.qtcm.com
- Veterans Evaluation Services (VES): 1-877-637-8387; https://www.vesservices.com
So, where do we stand? At the time of the VA’s update, there were 340,754 pending C&P exams including 144,198 from pre-pandemic inventory. Contract vendors are operating at 120% of pre-pandemic capacity, averaging 34,700 DBQs per week. The VBA expects to complete 43% more exams in 2021 than 2020.
Of the pending exams, 57,000 are non-actionable: Either the veteran is unwilling to meet, even virtually, or communication cannot be established. Decisions on these claims will be held in abeyance until the veteran engages with the contract vendor or 60 days following the declared end of this national medical emergency.
As of March 27, there were 475,363 outstanding claims in the system, 205,773 pending more than 125 days (backlogged), the VA’s stated goal for claim completion. The current backlog is a far cry from the 611,000 backlogged claims in March 2013, but certainly a significant increase from the levels the VA had been able to maintain since late 2016. Over the last four-plus years, the average backlog fluctuated between 70,000 to 90,000 claims.
The MDEO provides oversight of the contract examination program, to include monitoring contractor production, timeliness, quality, and invoicing. It also will provide the list of veterans on the non-actionable list that are represented by a VSO to that organization. The VSO can access which vendor has been assigned the requisite exams and provide that information to the veteran.
C&P exams are being conducted in 37 foreign countries and U.S. territories. Four new countries were added in August 2020: Colombia, France, Ireland, and New Zealand. Tele and ACE are both authorized worldwide.
VA has a website related to its resumption of in-person C&P examinations, and other websites that have answers to commonly asked questions about the examination process. Visit the VA claim exam website for information ranging from what to expect at a VA examination, how to schedule an examination, and what happens after an examination. Information on VA’s Disability Compensation benefits can be found at this link.
The VA encourages all veterans to complete a customer service survey upon the completion of their C&P exams. Survey cards are included in appointment notification letters, and customer service surveys can also be completed at the C&P exam customer service survey website.