Improving Outcomes for Disabled Veterans: Oversight of VA’s Medical Disability Examination Office

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                         IMPROVING OUTCOMES FOR5                  DISABLED VETERANS: OVERSIGHT OF VA'S6                 MEDICAL DISABILITY EXAMINATION OFFICE78=======================================================================910                                HEARING1112                               before the1314                       SUBCOMMITTEE ON DISABILITY15                    ASSISTANCE AND MEMORIAL AFFAIRS1617                                 of the1819                     COMMITTEE ON VETERANS' AFFAIRS2021                     U.S. HOUSE OF REPRESENTATIVES2223                    ONE HUNDRED NINETEENTH CONGRESS2425                             FIRST SESSION26                               __________2728                      THURSDAY, NOVEMBER 20, 202529                               __________3031                           Serial No. 119-3532                               __________3334       Printed for the use of the Committee on Veterans' Affairs3536               [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]3738                    Available via http://govinfo.gov3940                                ------4142                  U.S. GOVERNMENT PUBLISHING OFFICE434462-605                    WASHINGTON : 20264546                     COMMITTEE ON VETERANS' AFFAIRS4748                     MIKE BOST, Illinois, Chairman4950AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking51  American Samoa, Vice-Chairwoman      Member52JACK BERGMAN, Michigan               JULIA BROWNLEY, California53NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire54MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,55GREGORY F. MURPHY, North Carolina      Florida56DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky57MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois58JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois59KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York60JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon61ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey62KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota63  Mariana Islands64TOM BARRETT, Michigan6566                       Jon Clark, Staff Director67                  Matt Reel, Democratic Staff Director6869       SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS7071                    MORGAN LUTTRELL, Texas, Chairman7273AUMUA AMATA COLEMAN RADEWAGEN,       MORGAN MCGARVEY, Kentucky, Ranking74  American Samoa                       Member75JACK BERGMAN, Michigan               CHRIS PAPPAS, New Hampshire76NANCY MACE, South Carolina           MAXINE DEXTER, Oregon77KEITH SELF, Texas                    KELLY MORRISON, Minnesota7879Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public80hearing records of the Committee on Veterans' Affairs are also81published in electronic form. The printed hearing record remains the82official version. Because electronic submissions are used to prepare83both printed and electronic versions of the hearing record, the process84of converting between various electronic formats may introduce85unintentional errors or omissions. Such occurrences are inherent in the86current publication process and should diminish as the process is87further refined.8889                         C  O  N  T  E  N  T  S9091                               ----------9293                      THURSDAY, NOVEMBER 20, 20259495                                                                   Page9697                           OPENING STATEMENTS9899The Honorable Morgan Luttrell, Chairman..........................     1100The Honorable Morgan McGarvey, Ranking Member....................     3101102                               WITNESSES103104                                Panel I105106Ms. Elizabeth Curda, Director, Education, Workforce, and Income107  Security, U.S. Government Accountability Office................     4108109Ms. Mary Glenn, Deputy Executive Director, Medical Disability110  Examination Office, Veterans Benefits Administration, U.S.111  Department of Veterans Affairs.................................     6112113        Accompanied by:114115    Ms. Tara Flores, Director, Acquisition Service, Strategic116        Acquisition Center, Office of Acquisition, Logistics and117        Construction, U.S. Department of Veterans Affairs118119                                APPENDIX120121                    Prepared Statements Of Witnesses122123Ms. Elizabeth Curda Prepared Statement...........................    27124Ms. Mary Glenn Prepared Statement................................    38125126                       Statements For The Record127128Veterans of Foreign Wars of the United States Prepared Statement.    41129Paralyzed Veterans of America Prepared Statement.................    44130National Organization of Veterans' Advocates, Inc. Prepared131  Statement......................................................    48132133                         IMPROVING OUTCOMES FOR134                  DISABLED VETERANS: OVERSIGHT OF VA'S135                 MEDICAL DISABILITY EXAMINATION OFFICE136137                              ----------138139                      THURSDAY, NOVEMBER 20, 2025140141   Subcommittee on Disability Assistance &142                          Memorial Affairs,143                    Committee on Veterans' Affairs,144                             U.S. House of Representatives,145                                                    Washington, DC.146    The subcommittee met, pursuant to notice, at 12 p.m., in147room 360, Cannon House Office Building, Hon. Morgan Luttrell148(chairman of the subcommittee) presiding.149    Present: Representatives Luttrell, Bergman, Self, McGarvey,150Pappas, Dexter, and Morrison.151152         OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN153154    Mr. Luttrell. The subcommittee will come to order. The155chair may declare a recess at any time. Once again, good156morning to everyone.157    This morning, the subcommittee is conducting oversight on158one of the Veterans Benefits Administration's (VBA) most159critical offices, supporting and overseeing the disability160claims process, the Medical Disability Examination Office, or161the MDEO. This is the office responsible for managing162contractors who conduct medical disability exams for veterans163nationwide.164    Those exams form the foundation of the medical evidence165used by VBA to evaluate a veteran's claims for disability166compensation. If an exam is wrong, incomplete, or inaccurate,167or delayed, the veteran, obviously, may not receive the168benefits they have earned for their service.169    That is what we are going to focus on today. Accuracy,170accountability, and a positive outcome for our brothers and171sisters.172    When a veteran files a claim for disability compensation,173Veterans Affairs is responsible for helping the veteran prove174their eligibility for benefits. For years, U.S. Department of175Veterans Affairs (VA) has relied heavily on its own clinicians176at VA medical centers to perform these exams. As demand has177increased, VA turned to vendors to help handle the workload to178ensure quicker process rates and shorter wait times.179    Today, more than 90 percent, 90 percent, of all exams are180done outside the VA through contractors. Sourced out of four181major contractors, four major contractors, these multi-year182contracts cover more than 9 million exams and a multi-year183budget ceiling of 13 billion dollars. A contracted medical184examiner uses a disability benefits questionnaire, or DBQ, to185document the veteran's symptoms and medical findings. MDEO, the186VA office responsible for exam oversight, ensures DBQs meet187quality standards, that vendors are held--and that vendors are188held accountable, and that the taxpayer's investment is189delivering for our veterans.190    According to a recent report from the government of--not191affairs--accountability, the Government Accountability Office192(GAO), that might not have happened over the past couple years.193The Accountability Office found that MDEO wrongly awarded194millions of dollars in financial incentives in 2024 to vendors195who did not meet performance standards. Production, customer196satisfaction, exam quality, timeliness in scheduling, and197timeliness and completion as well. When vendors meet or exceed198these metrics, they can earn a bonus or face financial199penalties if they fall short.200    The Accountability Office found that MDEO used a manual201process to calculate these incentives, which had no202standardized checks or formal written procedure to verify the203accuracy of payments. Apparently, MDEO miscalculated204performance scores and overpaid vendors again by millions of205dollars. The office charged with maintaining quality assurance206and disability claims for veterans did not--did not207consistently apply the standards that are necessary.208    The Accountability Office recommended MDEO develop written209procedures and automated verification tools. MDEO says they210have started doing that, which is obviously a great step211forward. The Accountability Office also found that MDEO has212fallen short in meetings--in meeting its own schedule for213special focus reviews, known as SFRs.214    These reviews are supposed to happen every 2 years for215complex claims such as traumatic brain injury (TBI), military216sexual trauma, and Gulf War illness. These are the cases most217prone to error, where exam quality can make or break veteran's218claims. Two are overdue and the third one, a start date, has219not been provided, from what I understand.220    Let me be perfectly clear, if there is one area where you221cannot cut corners, it is in the cases revolving around post-222traumatic stress, post-traumatic stress disorder, and traumatic223brain injury. Without these reviews, MDEO has no way to know if224its previous corrective actions are working or if the exam225quality is improving. Without understanding if exam quality is226improving, it also means MDEO cannot update examiner training227or identify and correct DBQ errors. The same errors keep228happening, leaving some veterans with delays or incorrect229decisions. This is a systematic failure.230    The Accountability Office also identified new areas for231improvement, suggesting that MDEO gather more feedback from the232field. Contracted examiners told the Accountability Office they233often have no direct line of communication with the VA.234Instead, they are told to send the feedback through their235vendors. This sounds harmless, but make no mistake, it is not.236    One examiner told the Accountability Office that different237vendors have conflicting instructions on how to fill out the238DBQ. Therefore, depending on which contractor a veteran is239scheduled with, their exam might be completely different, even240though it is for the same condition.241    That kind of disconnect undermines the trust in the system.242MDEO is the office for--MDEO is the office responsible for243ensuring exam consistency. To their credit, MDEO says they are244developing a direct feedback line so examiners can raise issues245directly to the office.246    A pattern of manual errors, misreviews, and broken247communications are being fixed. This issue points out a broader248issue with MDEO. Of course, there is always more to do. We need249a proactive, not a reactive VA.250    With that, I will yield to the Ranking Member.251252      OPENING STATEMENT OF MORGAN MCGARVEY, RANKING MEMBER253254    Mr. McGarvey. Thank you, Mr. Chairman, and thank you all255for being here today.256    We often say, and I think it is true, there is no wrong257door into the VA. Whenever, wherever, and however a veteran258comes into the VA, they are all welcome there. We know that259their health and financial well-being will be better for it.260However, it is also true that for most veterans, the entry261point into the VA benefits is the compensation and pension262system. Applying for disability benefits and then receiving a263disability rating and the VA healthcare that follows, that is264the most common door that veterans walk through to get into the265VA. The key to that doorway for most veterans is the266compensation and pension exam, or the C&P exam, which documents267their medical conditions and provides the basis for a claims268decision. Ensuring that this exam process operates in a way269that best serves the veteran is crucial.270    To me, that means that the exam can be scheduled quickly271and happens close to home, is conducted by a competent,272qualified medical professional, and is completed thoroughly and273accurately. It is extremely important for VA, and specifically274the Medical Disability Exam Office, or MDEO, to ensure all that275happens correctly. Unfortunately, in too many instances, it276seems that our current system of contract exams fails a lot of277veterans, and MDEO fails to oversee it properly.278    You can just come to my office and take some of the calls279or go on social media and just look through and be flooded with280stories of veterans having exams scheduled without their281knowledge or in locations that are hugely inconvenient for the282veteran and the family to get to. We hear tons of stories about283veterans being sent to an exam that has nothing to do with284their condition, or veterans sent to doctors who do not have285the specialty training needed for their injury or illness, or a286less than 10-minute mental health exam, or orthopedic exams287conducted via telehealth. The stories are endless.288    VA is supposed to be monitoring the conduct of these289examiners and holding contract vendors accountable.290Unfortunately, it does not seem as though this is happening as291thoroughly as it should. In fact, MDEO seems to think that292everything is running smoothly with these vendors. That293assessment just does not match up with what we are seeing out294here in the real world.295    A recent Government Accountability Office report noted that296$2.3 million in incentive pay was incorrectly given to297contracted examiners. I do not know about you, but I find that298alarming, especially as only a half million in penalties were299imposed on contracted examiners who did not meet quality300standards. To me, that seems low based on what we hear from our301constituents.302    Today, I hope that you all can help us square that circle,303because I look forward to hearing about the progress that the304MDEO has made after the significant backlog experienced during305the 2020 pandemic. I look forward to an honest discussion about306where MDEO is falling short and not living up to its mission to307serve veterans. That is what we do here. Our mission is to308serve veterans. On this committee, we come together to honor309that promise we made to take care of the men and women who put310on a uniform for us.311    We want to continue to see a pattern--as we continue to see312a pattern of challenges with oversight, quality, and assurance,313and adequate control over these contract exams, we want to get314to the bottom of it. Since about 90 percent of disability exams315are done outside the VA by for-profit third-party contracted316examiners, it is really about time we get a better handle on317this program and put stronger rules and quality checks in318place. A program this large and this hard to oversee is open to319abuse or even just mistakes that ended up costing our veterans320time and our taxpayers' money. As we continue to work on behalf321of veterans, we must hold VA and those in contracts to conduct322exams to a high standard.323    That is the work we embark on today. I really appreciate324you all being here and look forward to hearing your remarks.325    Mr. Chair, I yield back to you.326    Mr. Luttrell. Thank you, Mr. McGarvey.327    I will introduce the witnesses.328    From the Government Accountability Office, we welcome Ms.329Elizabeth Curda, Director of Education, Workforce, and Income330Security. Good morning.331    Our lead witness from VA is Ms. Mary Glenn, Deputy Director332of the Medical Disability Examination Office at the Veterans333Benefits Administration. Good morning.334    She is joined by Ms. Tara Flores, Director of Acquisitions335Service at the Strategic Acquisition Center within the Office336of Acquisitions, Logistics, and Construction. Did you write337that? That is impressive. Thank you for being here today.338    I ask that the witnesses please stand and raise your right339hand.340    [Witnesses sworn.]341    Mr. Luttrell. Thank you. Let the record reflect that the342witnesses have answered in the affirmative. You may be seated.343Thank you.344    Ms. Curda, you are now recognized for 5 minutes to deliver345your opening statement on behalf of the Government346Accountability Office.347348                  STATEMENT OF ELIZABETH CURDA349350    Ms. Curda. Good morning. Chairman Luttrell, Ranking Member351McGarvey, and members of the subcommittee, I am pleased to352discuss GAO's work on VBA's oversight of the quality of353contracted disability examinations.354    When veterans file claims for disability benefits, VBA355claims processors may request medical exams for veterans before356making decisions on their claims. These exams help determine357whether disability benefits are warranted, and if so----358    Mr. Luttrell. Ms. Curda, I apologize. Is your microphone359on?360    Ms. Curda. Can you hear me better now?361    Mr. Luttrell. There you go. Thank you. I apologize. Can you362kind of lean into it?363    Ms. Curda. Yes. Do you want me to start again?364    Mr. Luttrell. Nope.365    Ms. Curda. Okay.366    Mr. Luttrell. I could vaguely hear you. You are good to go.367Thank you.368    Ms. Curda. The responsibility for performing these exams369has largely shifted from VA medical centers to contractors who370provide the medical professionals called examiners. In 2024,371they performed 93 percent of the exams at a cost of over $5372billion. Robust oversight of contractors is important for373ensuring quality exams because errors can result in incorrect374decisions, costly rework, and delays for the veteran.375    To oversee contracted exam performance, in 2016, VBA376established the Medical Disability Exam Office.377    My testimony today discusses first, VBA's processes for378overseeing exam quality and second, GAO's five recommendations379for improving these processes.380    Since 2016, VBA has refined its processes for overseeing381contracted exams and implemented numerous GAO and VA Inspector382General (IG) recommendations along the way. VBA oversees exam383quality using a variety of techniques that fall into three384categories.385    Prevention. These techniques aim to prevent errors or low-386quality work from occurring during exams. These include things387like training and guidance. Second, detection. These techniques388aim to identify exam errors that do occur. These are things389like using checklists to review completed exam paperwork for390errors. Third, correction. These techniques respond to exam391errors. Things like contractor quality action plans, and392imposing financial incentives for performance.393    While VBA has put in place these oversight processes, our394recent work has identified opportunities to strengthen them.395Specifically, in our 2024 and 2025 reports, we found first,396breakdowns and procedures for tackling the most frequent or397complex problems with contracted exams. Second, incorrect398financial incentive payments to contractors. Third, a gap in399obtaining firsthand perspectives from examiners, a key400stakeholder group.401    To address these issues, GAO made five recommendations. The402VA agreed or agreed in principle with each recommendation and403has described plans to address them. As of today, VA has made404some progress, but none of the five have been fully405implemented. VA needs to fully address these recommendations to406improve exam quality. Let us look at each of these407recommendations now.408    Two of our five recommendations focus on VBA's efforts to409correct the most frequent exam errors and address the most410complex problems, such as claims dealing with military sexual411trauma and traumatic brain injury. For example, we found VBA's412oversight of contractors planned corrective actions lacked413procedures to follow up to determine whether they were414implemented and effective. Effectively addressing root causes415is critical for correcting the identified problems and416preventing future reoccurrences, all while fostering a culture417of a continuous improvement.418    Two other recommendations deal with VBA's efforts to hold419contractors accountable by assigning financial incentives to420contractors based on their performance, which includes exam421quality. We found that VBA did not have written procedures for422checking the accuracy of its calculations for these incentives,423resulting in some mistakes. For instance, VBA overpaid almost424$2.3 million in financial incentives in the first quarter of425Fiscal Year 2024.426    Our fifth recommendation focuses on collecting and427addressing feedback directly from examiners who perform these428exams and who provide a key perspective on exam quality issues.429We found that VBA did not collect feedback directly from430examiners. Five of the six examiners we randomly selected and431interviewed said that they would like the opportunity to432provide feedback directly to VBA. All six said unaddressed433concerns about quality made it harder to provide quality high434quality exams.435    In summary, fully implementing our five recommendations436would help VBA improve exam quality, particularly by437identifying and correcting the most frequent errors and438tackling the most complex issues. Ultimately, improving the439contracted exam process would support accurate decisions on440claims and help veterans receive benefits they are entitled to441without delays.442    This concludes my prepared statement, and I am happy to443address your questions.444445    [The Prepared Statement Of Elizabeth Curda Appears In The446Appendix]447448    Mr. Luttrell. The written statement of Ms. Curda will be449entered into the record.450    Ms. Glenn, you are now recognized for 5 minutes to deliver451your opening statement on behalf of the Department of Veterans452Affairs.453454                    STATEMENT OF MARY GLENN455456    Ms. Glenn. Thank you, sir. Good morning, Chairman Luttrell,457Ranking Member McGarvey, and distinguished members of the458subcommittee. Thank you for the opportunity to appear before459you today to discuss disability examinations administered by460the Department of Veterans Affairs. I am joined today by Tara461Flores, Director of Acquisition Service, Strategic Acquisition462Center.463    Over the last several years, VBA has made concerted efforts464to improve the contract exam experience for our veterans while465simultaneously improving output and accuracy. During this same466period, several landmark pieces of legislation, such as the The467Sergeant First Class Heath Robinson Honoring our Promise to468Address Comprehensive Toxics (PACT) Act, were signed into law.469These pieces of legislation led to unprecedented increases in470the number of exams requested for veterans. Due to the471unexpected increase in volume, VBA took actions to address472these challenges, such as adjusting projections and contractual473obligations. This included collaborating with the GAO, internal474partners, Congress, veteran organizations, and others to475identify problems and generate solutions.476    In Fiscal Year 2025, VBA completed over 3.3 million477examination scheduling requests. This resulted in over 4478million appointments and nearly 9 million disability benefits479questionnaires, or DBQs. During the fiscal year, the average480time to complete exams was 26.4 days, a marked improvement from481the 35.7 days in the prior fiscal year. Further, VBA's overall482veteran satisfaction score remained high among those who483completed the after visit survey. While we are proud of these484accomplishments, we recognize there is always room for485improvement. Therefore, VBA continues to enhance our internal486controls, grow our network of clinicians, and explore487opportunities to leverage new and existing technologies.488    Recently, Congress extended the license portability489provision of the Isakson Roe Act, which allows contract490examiners to provide services in any State or U.S. territory491without having to obtain multiple licenses. This flexibility492has allowed VBA to extend service to rural veterans, Native493American communities, and support claims clinics throughout the494country. We want to extend our sincere thanks to the committee495and Congress for passing this provision. This provision is496critical to the success of our ability to perform examinations497closer to where the veteran lives.498    VBA is most excited about the opportunity to modernize the499disability exam process by evaluating advanced tools and500technologies and reducing administrative burdens. A key area of501focus is to enhance our processes so that we can make more502decisions based on the information we already have. VA is503looking to leverage new technology to accomplish this. This504would enhance veterans' experience by reducing the potential505need to attend examinations.506    Another area of interest is to increase the use of private507provider DBQs that are completed by local examiners. This could508help reduce the need to travel to an examination, thereby509improving veteran experience. Collaboration across the entire510enterprise and with our stakeholders is essential to ensuring511an efficient veteran-focused service. While VBA continues to512innovate and improve veteran experience, we must also realize513that there are additional improvements to be made.514    We continue to partner with GAO to identify issues and515challenges and provide recommendations to improve our business516processes. In August 2025, GAO issued a report on improving the517quality of contract exams for veterans. I am pleased to report518that MDEO has recouped the overpayments mentioned in the519report, enhanced our methodology to prevent future errors, and520implemented all recommendations. As a result, we will be521requesting closure.522    Mr. Chairman and Ranking Member McGarvey, I want to express523my appreciation for your continued support of veterans, their524families, caregivers, and survivors. We remain dedicated to525continually improving medical disability examinations, and we526are grateful for the authority Congress has given us to obtain527contract examinations for veterans and transitioning service528members.529    This concludes my testimony. My colleagues and I are happy530to respond to any questions you or the subcommittee may have.531532    [The Prepared Statement Of Mary Glenn Appears In The533Appendix]534535    Mr. Luttrell. Thank you, Ms. Glenn. The written statement536will be entered into the hearing record.537    We will now move to questioning.538    Ms. Curda, MDEO failed to improperly implement quality539checks. As far as incentive pays, when was the first GAO report540asking VA to do that? What year?541    Ms. Curda. We developed that finding in a report that was542issued this year in September.543    Mr. Luttrell. This year?544    Ms. Curda. Yes.545    Mr. Luttrell. From what I understand, Ms. Glenn, you told546me that that is being taken care of, correct?547    Ms. Glenn. Yes, sir.548    Mr. Luttrell. How far along were we and how did we find549the--how did we find that discrepancy? That payment? I mean,550how did that show up? It went outbound. Who was looking at it551and found it?552    Ms. Glenn. Actually, it was brought to our attention by553GAO. Based on that, we went back and audited all of our554incentives and disincentives that were paid since we changed555the incentive and disincentive structure. The structure was556changed in a modification in September 2021. We went all the557way back to Fiscal Year 2022 and checked everything and found558no other discrepancies.559    Mr. Luttrell. Okay. Why did not the vendor say something?560    Ms. Glenn. We determine----561    Mr. Luttrell. Well, I mean, I got it. I probably would not562say anything either if you overpay me. $2 million. However----563    Ms. Glenn. Yes, we determine how much money the vendor will564get or not get. The vendor does not tell us how much money they565should get for incentives. We tell them we have a quarterly566report, performance report, with them every quarter. We provide567them with the information and the details of their performance.568At that point, we tell them how much they should get, either an569incentive or how----570    Mr. Luttrell. I asked you this question earlier.571    Ms. Glenn [continuing]. disincentives.572    Mr. Luttrell. How much should they have gotten?573    Ms. Glenn. It was that $2.3 million was over two different574contracts. It varied based on the contract. I can get you the575specifics after this.576    Mr. Luttrell. Okay, that has got to be interesting to see577how that happened. As far as course correcting this, my578question earlier was, is this one specific individual? Your579response was no.580    Ms. Glenn. Yes, sir.581    Mr. Luttrell. I want you to walk the committee through582that, please.583    Ms. Glenn. The invoices come in from the vendors. They are584immense. That is beside the point. They are reviewed by the585contracting officer representatives, who then pass it on to586their lead for approval. Once that approval is done, the587funding packages are--are sent forward through a portal, and588they go to the Office of Financial Management, who controls the589portal. They do not do a check on it. Then it goes straight to590the Treasury.591    Mr. Luttrell. The way I understand it, for our592conversation, is now there is a series of checks and balances,593internal----594    Ms. Glenn. Yes, sir.595    Mr. Luttrell [continuing]. internal to the VA.596    Ms. Glenn. Yes, sir. Previously, this was----597    Mr. Luttrell. That way, this problem does not happen again.598Now, my question is, two contracts for 2.3 million, plus or599minus, and incentive pay is--is for them to complete their job,600which we pay them to do anyway. Is that bonus included in the601initial contract? Or is that something that the VA say, hey,602this is a great idea. We are going to give you this to keep603going.604    Ms. Glenn. No, sir. The incentive and disincentive605structure is built into the contract. If that is what you are606asking me.607    Mr. Luttrell. It is, but you told--explain to me how that608works. You told me earlier, the VA creates that number that you609pay the specific corporation. If it was----610    Ms. Glenn. Yes, it is based on----611    Mr. Luttrell [continuing]. already in there----612    Ms. Glenn. It is based on their----613    Mr. Luttrell. Hold on for a second. If the number is inside614the contract, they would know how much they are supposed to615receive.616    Ms. Glenn. They----617    Mr. Luttrell. Correct?618    Ms. Glenn. The number in the contract is a percentage. A619percentage of their invoice. So,----620    Mr. Luttrell. Which is laid out in, I am assuming, phases.621They hit phase one and completed phase one, they would know the622percentage of the incentive pay that is coming their way?623    Ms. Glenn. Yes, sir.624    Mr. Luttrell. Okay, great. When they got $1.5 million more625than what that contract stated, you are telling me they did not626call you up and say, hey, you overpaid us $1.5 million?627    Ms. Glenn. No, sir, because there are changes to the628invoice quite frequently. Some of the charges that they put on629the invoice may be erroneous, and we make them go back and630either correct them or----631    Mr. Luttrell. Apparently, we missed that.632    Ms. Glenn. Well----633    Mr. Luttrell. If we paid them $2.3 million.634    Ms. Glenn. How did the vendor miss it?635    Mr. Luttrell. No, we did. I am sorry. The proverbial we.636The VA.637    Ms. Glenn. Oh, yes, sir. It was at that point in time, a638manual process being reviewed by, as I said, a couple of639people. We have changed that now. We have an automated process640that is put into place. We have a statement of operations that641everybody will follow. It is a written statement. We have642checks in place. We also have an audit contract now.643    Mr. Luttrell. Okay, Ms. Glenn, I will come back to that644question. Apologies. Ranking Member.645    Mr. McGarvey. [inaudible].646    Mr. Luttrell. Thank you. Continue.647    Ms. Glenn. We have an audit contract in place, and we are648working with VA's data team to further refine our reports and649provide us with an additional check on the invoices.650    Mr. Luttrell. Okay. We just created this recently and we651have been doing this for a very long time?652    Ms. Glenn. Yes, sir. That has been something that we have653been trying to do.654    Mr. Luttrell. Okay. Thank you. Mr. McGarvey, sir, you are655recognized.656    Mr. McGarvey. Thank you, Mr. Chairman. Ms. Glenn, we will657just stick with you. How much money does MDEO pay contracted658medical examiners annually?659    Ms. Glenn. Sir, we do not pay the examiners. We pay the660vendors, and the examiners are subcontracted through the661vendors.662    Mr. McGarvey. How much do you pay the vendors?663    Ms. Glenn. It is dependent upon how many exams they664complete for us. It varies by region and by location. Rural665areas will not cost as much as New York City, for example. It666depends on the type of examination.667    Mr. McGarvey. What is the total?668    Ms. Glenn. The total for exams, let me get back to you on669that, sir.670    Mr. McGarvey. Okay. How many exams are they conducting per671year?672    Ms. Glenn. Last year, we did 3.3 million exams.673    Mr. McGarvey. 3.3 million exams. That is nationwide?674    Ms. Glenn. Yes, nationwide and internationally.675    Mr. McGarvey. Okay. You are telling me that there can be676different costs depending on where those services are. Fine. We677do want to know how much you are paying total, every year, in678this. Do you know roughly what the cost is per exam?679    Ms. Glenn. I do not, off the top of my head.680    Mr. McGarvey. Okay.681    Ms. Glenn. Let me take that back.682    Mr. McGarvey. Do you know what--do you know whether it683would be cheaper, or the same price, or more expensive if those684exams are done by Veterans Health Administration (VHA)685employees?686    Ms. Glenn. I do not have that information right now, sir. I687will say that every exam request that comes in hits against VHA688first, and it only comes to the contract if VHA does not have689the capacity to complete that examination close to the690veteran's home.691    Mr. McGarvey. Right. You will get us the information----692    Ms. Glenn. Yes, sir.693    Mr. McGarvey [continuing]. about the difference and how694much it costs? Okay, good. The program you are overseeing is695really large, and we are getting that by some of the answers696you do not have today. Do you have everything you need to697properly oversee this program at this point?698    Ms. Glenn. Yes, sir. I mean, there is a lot of improvements699that we want to make. As I pointed out in my opening statement,700there is a lot of technology that we want to check out and see701if it can help us improve our process. We thank you so much for702the license portability extension. That is a major thing for703us, and it really helps us be able to provide exams in rural704areas and across the country.705    Mr. McGarvey. I asked you if you have everything you need.706You said yes, and then you told me the things you want. I am707going to ask you again, do you have everything you need to708properly oversee this program?709    Ms. Glenn. There is always room for improvement, sir.710    Mr. McGarvey. Okay. Okay. Let us know what those are.711    Ms. Glenn. Okay.712    Mr. McGarvey. You know, we--we want to make sure that our713veterans are being taken care of and that taxpayer money is714being taken care of, and we can do both of those things at the715same time.716    I understand that MDEO lost a lot of staff at the beginning717of the year. Have you all replaced those employees?718    Ms. Glenn. We have enough staff right now to continue to do719our primary mission. We did lose some people. Some were720expected retirements. We--we are still keeping on and we721continue to be able to provide examinations for veterans and722keep track of those examinations.723    Mr. McGarvey. That was a government answer. You have lost724employees, you say--I get it. We are not--we want to take care725of our veterans. We want to give you the tools you need to take726care of our veterans. What happened? What do you need?727    Ms. Glenn. Again, I would say that we are going to be able728to do that. We are hopeful that a new organization chart will729be coming out shortly, and we will see what that looks like.730We--but we have enough people right now to continue our primary731mission.732    Mr. McGarvey. Okay. We will keep hitting on some of this733stuff. We want to get to the bottom of it, not just have the734government speak here in this committee.735    There are a lot of cuts because of Department of Government736Efficiency (DOGE) earlier this year, and there are a lot of737contracts that were cut. MDEO had several significant contracts738canceled, including one to conduct financial audits and invoice739validations, and one to collect data from veterans and their740experiences. Has the VA restored any of these contracts and or741otherwise replaced the capacity to do so?742    Ms. Glenn. Yes, sir. We were able to restore the financial743audit contract. It is now in place. We are working with the744Veterans Experience Office, and they have helped us develop a745new survey, which started going out to veterans the first week746in September.747    Mr. McGarvey. Okay. Ms. Curda, I am going to ask you a748question really quickly. I understand that you all were749tracking those cancellations as well in your August 2025 GAO-75025-107843 report. GAO said VA should do a better job making751sure its contractor incentive payments are calculated752correctly. Does that answer line up with what you all are753seeing? Do you feel that MDEO needs those services, whether754contracted or in-house, to do proper oversight? You have very755little time, and I apologize.756    Ms. Curda. Yes, I think those contracts are necessary. They757factor into the incentive payments, which consists of quality,758timeliness, and customer experience. If you are missing the759people who validate the timeliness measures, if you are missing760the customer experience measure, then you are--you are not761going to be able to calculate the performance incentive payment762and or they may be incorrect. I think they are important. Just763I want to point out that the Veteran Experience Survey was764recommended by the IG as to be done externally to the agency. I765do not know, I think, maybe now it is being done internally.766    Mr. McGarvey. Thank you. Mr. Chairman, I yield back.767    Mr. Luttrell. Thank you, Mr. McGarvey. General, you are768recognized for 5 minutes, sir.769    Mr. Bergman. Thank you, Mr. Chairman. Let me make a generic770statement here first. Bureaucracies, good bureaucracies, are771necessary and Okay. We need that. Stovepipes, not so much. What772I am hearing here is seems to be some really solid effort773within a bureaucracy to look at and manage stovepipes that774detract from the value of the outcome.775    In recent months, I have heard from veterans and Veterans776Service Organizations (VSO) in my district that critical777medical evidence meant to support a veteran's claim is not778consistently reaching compensation and pension examiners at the779VA. When a veteran's service representative flags certain files780for an examiner, I have heard that these files reach the781medical examiners enlarged, unorganized, dense, basically,782packets that show no level of help for that person who is going783to look at them next. When that evidence does not reach the784examiner or is not properly organized, exams are conducted785without key facts. I think we would all agree, DBQs could be786completed inaccurately, leading to a denial by the VBA.787Combined with GAO's findings on exam oversight gaps and delayed788quality reviews, it is clear that there is some systemic789breakdowns affecting those veterans' outcomes.790    I am trying to understand what causes the breakdown, you791know, as a, I guess, thinking as a pilot, we have to do things792in certain orders. Checklists, complete checklists, to ensure793that the flight is flown safely. Then after it is flown, we do794a maintenance log to make sure that that plane is ready for the795next crew.796    Along those lines, Ms. Curda, is VA's Medical Disability797Examination Office responsible for overseeing the DBQs?798    Ms. Curda. Yes, they are.799    Mr. Bergman. Okay. Based on your audit work at GAO, to what800extent might missing evidence contribute to DBQ errors,801inaccurate exams, or improper denials?802    Ms. Curda. Yes, it would contribute to those things if that803is occurring. Yes.804    Mr. Bergman. Okay. Ms. Glenn, when a compensation and805pension examiner is assigned a case, what information that may806be submitted by a veteran or VSO are they able to see?807    Ms. Glenn. Yes, sir. If it is in the veteran's claim808folder, everything is sent over to the examiner.809    Mr. Bergman. Okay. Then what quality controls are in place810to verify that required evidence appears in the exam packet811before the examiner conducts the evaluation? Have they got the812whole maintenance log on this veteran?813    Ms. Glenn. Yes, sir. It is done automatically. As soon as a814veteran is scheduled for an examination, it is an automatic815push to the vendor. The entire file goes over.816    Mr. Bergman. The push is automatic. How is the vendor's817evaluation of the data in front of verified that they had it818all?819    Ms. Glenn. To your point about marking things, the claims820processors review, also review the file, and they do tab821evidence that could be relevant. It is the examiner's job to822review the entire file. We do check and make sure that the823entire file goes over.824    Mr. Bergman. Is it a random check or 100 percent check?825    Ms. Glenn. I could not tell you that, sir. I will have to826get back to you.827    Mr. Bergman. Okay. Well, Ms. Glenn, will MDEO commit to828reviewing the process and form in which medical examiners829receive a veteran's supporting documents? It would be basically830standing there looking when that uniquely organized packet831shows up?832    Ms. Glenn. Yes, sir.833    Mr. Bergman. Okay. Well, again, I see my time is about to834run out. We know one thing for sure, veterans never quit. We835cannot quit on the veterans. We have to continue to refine the836oversight and the detail of that oversight in an ever-changing837world where we use the processes available to us now to be838better at what we do on the veterans' behalf, because they are839counting on us.840    With that, Mr. Chairman, I yield back.841    Mr. Luttrell. Thank you, General. Mr. Pappas, sir, you are842recognized for 5 minutes.843    Mr. Pappas. Thank you very much to the Chairman and Ranking844Member for holding this session.845    Ms. Glenn, if I can start with you. We heard from Ms. Curda846before about a recommendation around the non-collection of847feedback from examiners who want to offer it to make sure that848they are giving feedback to VA, that things are moving ahead849for veterans as quickly as possible, and that processes are850being improved. You said that you implemented all851recommendations. Can you speak to how you are collecting852feedback from examiners and what value you think that is going853to provide?854    Ms. Glenn. Yes, sir. Thank you. Yes, we have established a855portal for the examiners to be able to come directly to MDEO856and provide us with feedback. The portal was announced on the857learning management system that we give--that all the examiners858have access to. As well as we had the vendors put out an859announcement that the portal was live and ready to go. We also860sent emails to each of the examiners and told them individually861that the portal was live and here was the link. The portal was862live by the end of September. I have a staff of people who are863regularly reviewing the questions or answers. We have even864gotten compliments coming through the portal. We are looking at865all of those as they come in. If there is anything that needs866action, we are referring it to the proper place. So far, it has867been successful.868    Mr. Pappas. You are not proactively soliciting that869feedback by going to the examiners. It is sort of like a870suggestion box where examiners can just submit on their own?871    Ms. Glenn. Well, you know, we did send them an email and872let them know that it was live, and we had the vendors tell873them all on in their chain. We also it is a flag across the top874of the learning management system with the link that they can875click on and give us the extra information.876    Mr. Pappas. Okay. Well, I would be interested to see how877that is working and if that is giving you some constructive878information that you can then use to help improve processes.879    I want to ask about another thing that is a pain point for880veterans. We hear about it all the time in our office, and that881is scheduling. In September of this year, a Navy veteran from882the town of Freedom, New Hampshire, who is 100 percent service-883connected and battling cancer, contacted our office because she884was in pain, needed medication, could not get her exam885rescheduled. Days later, she contacted us again because another886appointment was suddenly canceled because VA failed to send the887medical records to the contract examiner. Her experience is not888unique. We hear routinely from veterans experiencing roadblocks889and trying to secure, reschedule an appointment. Contracting890out the exams was supposed to speed things up to get benefits891to veterans faster. This is not what a lot of veterans who are892reaching out are experiencing.893    Ms. Glenn, what options do veterans have when they are894assigned an appointment at a time or location that they cannot895attend? Why is rescheduling so difficult when we know that896veterans are going to bear the consequences if they cannot make897it?898    Ms. Glenn. Yes, sir. We realize that it is a pain point,899and we are working very hard to try to make it a better place.900We are looking at some automation, some technology that would901allow us to see across the board all appointments that would be902available to a veteran in a specific time and date, so that903they could then choose the appointment that is most convenient904to them. This is something that VHA is already using, and we905are working very hard to plug into that piece of technology.906    Mr. Pappas. You mentioned location of exams, too, and we907hear about this from veterans. Driving 50 or 100 miles does not908work for some veterans. The veteran I referenced earlier909experiences hip issues and long car rides bring her significant910pain. We should be making this process easier. I am wondering911if you can speak to the ways that VA monitors coverage gaps in912terms of geographic areas and how you evaluate those? What913steps VA can take to get these exams closer to home for914veterans?915    Ms. Glenn. Yes, sir. One of the things that we do, the916contract allows 50 miles for a general medical exam and 100917miles for a specialty exam. If the veteran has to travel beyond918those limits, they have to have consent from the vendor--to the919vendor, to us, that they are willing to travel those additional920miles.921    We have done all kinds of things. We have--the vendors have922mobile units, medical mobile units, that travel circuits923throughout rural communities so that they can provide exams924where the veterans live. I talked about the License Portability925Act and how important that is to us. We are looking at every926way possible to try to make this more convenient and less927stressful for veterans.928    Mr. Pappas. Appreciate the feedback. My time is up, so I929yield back.930    Mr. Luttrell. Thank you, sir. Dr. Morrison, you are931recognized for 5 minutes.932    Ms. Morrison. Thank you, Mr. Chair, and thank you to our933witnesses for being here today as we discuss the Medical934Disability Exam Office and consider what its best practices935should be moving forward. We know the PACT Act was a huge step936forward in providing our veterans with the care and benefits937that they have earned and deserve. We also know that it greatly938increased the administrative burden on the VBA and MDEO. I am939looking forward to hearing more about how VA has navigated940these and other challenges over recent years.941    Ms. Glenn, in your testimony, you referenced that MDEO is942evaluating advanced clinical and evidence review tools that943have the potential to reduce in-person examinations, improve944consistency, and accelerate outcomes for our veterans. Could945you share more about what tools you are looking at and how you946plan to streamline the claims process while also ensuring that947every veteran continues to get a fair review of their claim?948    Ms. Glenn. Our intent is to reduce the number of in-person949examinations that are needed. We want to be able to rate or950make a decision for the veteran based on the evidence that they951submit to us, that is already of record. That is one of the952things that we are looking at, technology-wise, on how to do953that best. We are actively pursuing and looking at different954options and talking to the experts about the best way to move955forward.956    Ms. Morrison. Okay, thank you. VSOs can play a critical957role in helping transitioning veterans apply for and obtain958their benefits. You know, as I was reading through The Veterans959of Foreign Wars of the U.S. (VFW) statement for the record,960their observation about multi-year MDEO contracting caught my961eye. Their case was that moving from a 2-year contract cycle to962a longer-term model could save money and improve outcomes for963veterans by reducing contractor turnover and incentivizing964contractor investment, improved technology, and workforce965development. I guess this is to all of you. Do you agree with966VFW's assessment and what are your impressions of the current967contracting model versus a multi-year model?968    Ms. Glenn. Yes. Yes, to a certain degree. Often, there are969technological changes that will require us to get a new970contract. Traditionally, yes. I will tell you, we are already971working on what will be considered a multi-year contract.972    Ms. Morrison. Ms. Curda.973    Ms. Curda. That was my understanding as well that they are974have started on a contract that I think goes for 10 years. Is975that correct?976    Ms. Glenn. That is still up.977    Ms. Curda. Oh, still up. Okay. Sorry.978    Ms. Morrison. Okay.979    Ms. Curda. Yes.980    Ms. Morrison. Okay. Ms. Glenn, I want to close by asking981you about an Inspector General report from September that found982that 29 out of 100 VHA medical opinions reviewed were provided983before the examiner had completed PACT Act training. What steps984are being taken to ensure examiners complete their PACT Act985training and that any erroneous claims are being reviewed and986rectified?987    Ms. Glenn. Yes, ma'am. I can speak to VBA. I believe there988were only three contract examiners who were found to have not989completed their training. To your point, we review all VBA990contract examiners' training on a monthly basis. The vendors991are required to provide us a list of all of their active992examiners every month, and we run that against our learning993management system to ensure that all of the examiners have994completed their training before they start to complete exams.995    Ms. Morrison. Thank you, ma'am. Thank you, Mr. Chair. I996yield back.997    Mr. Luttrell. Thank you, ma'am. How much, Ms. Glenn, how998much money did the VA collect in penalties last year?999    Ms. Glenn. Sir, I do not have that information. We are1000still going through fourth quarter information. As soon as we1001have completed that, I will let you know.1002    Mr. Luttrell. There is no, well, we found all the incentive1003pays that we do not--we are not tracking that in parallel?1004    Ms. Glenn. Well, the incentive payments for fourth quarter1005have not been awarded yet.1006    Mr. Luttrell. The 2.3 million that went maybe--Okay, let me1007back the year up then. The 2.3 million overpayments----1008    Ms. Glenn. Was from 2024.1009    Mr. Luttrell [continuing]. you would have found the--you1010would have found the penalty--penalties as well, correct?1011    Ms. Glenn. Yes, sir.1012    Mr. Luttrell. How many were there?1013    Ms. Glenn. For 2024?1014    Mr. Luttrell. Yes.1015    Ms. Glenn. Okay, I will have to get back to you.1016    Mr. Luttrell. What is the probability--did the two1017corporations, or the two companies, or the two vendors, excuse1018me. Did the two vendors that received the overpayment, were1019they ever hit with penalties?1020    Ms. Glenn. Yes, sir.1021    Mr. Luttrell. They were? That magic number would not happen1022to be the same amount as the overpayment, would it?1023    Ms. Glenn. No, sir.1024    Mr. Luttrell. Are we certain?1025    Ms. Glenn. I am positive. almost positive that it is not1026the exact same number, but it----1027    Mr. Luttrell. Plus or minus $5, maybe?1028    Ms. Glenn. Sir, I cannot say off the top of my head. I will1029be happy to get that for you and give it back to you.1030    Mr. Luttrell. Okay. I just want to make sure that the1031vendors are not taking advantage of the situation.1032    Ms. Glenn. Yes, sir. Understand.1033    Mr. Luttrell. I am sure you can appreciate that.1034    Ms. Glenn. Yes, sir.1035    Mr. Luttrell. As far as examiners go, when they respond to1036the portal, who is the staff, your staff, responding directly1037to the examiners?1038    Ms. Glenn. Oh, yes, sir. In some instances, we have, if the1039situation warrants. As I said, a lot of, I mean, as I said,1040some of the things that we have gotten have been compliments.1041Some of it has been suggestions. Some of it--there is just a1042whole wide variety of things that they are----1043    Mr. Luttrell. Are the examiners----1044    Ms. Glenn [continuing]. about.1045    Mr. Luttrell [continuing]. apprehensive about responding to1046the portal in fear of--I should not say it that way--because of1047maybe retribution from the vendors?1048    Ms. Glenn. The vendors--the vendors do not get this1049feedback unless we give it to them, and we----1050    Mr. Luttrell. Well, they are going to have to eventually,1051because if the examiners are contacting the VA about a problem1052set, the vendors are going to eventually have to find out of it1053because they are the ones telling the examiners what to do.1054    Ms. Glenn. Right. The examiners have the ability to come1055back to us through the portal anonymously if they choose to.1056    Mr. Luttrell. Sure.1057    Ms. Glenn. There is a text box where they can type out1058whatever they feel like they need to say.1059    Mr. Luttrell. I got it. I am kind of worst-case scenario in1060this, which usually has a tendency of playing out around here.1061If you go to a vendor and say, hey, we recognize there is a1062problem, well, the first question the vendor is going to ask is1063like, well, how did you know about that?1064    Ms. Glenn. Right. We would tell them we got it through the1065exam portal. I do not believe----1066    Mr. Luttrell. You cannot say that because then they are1067going to know who sent it.1068    Ms. Glenn. Well, not necessarily, sir. They have thousands1069and thousands of examiners that work for them.1070    Mr. Luttrell. Okay. Probability, got it. Okay. Do you have1071any further questions?1072    Mr. McGarvey. [inaudible].1073    Mr. Luttrell. Okay, I recognize you. Go ahead. Yes, sir.1074    Mr. McGarvey. Thanks, Mr. Chairman. I appreciate that. I1075have got a few questions for you. First, I mean, look, I am1076just going to tell you how it feels up here a little bit today1077because our mission is taking care of veterans. It feels a1078little bit like you all just want to write a check and say that1079these exams happened, and then not really figure out everything1080that is happening with them or how they are benefiting our1081veterans. We want to make sure that this is working and that is1082working for our veterans. That is the point of this hearing.1083That is what we want to see happen. We need you all's help with1084that.1085    Ms. Glenn, I am going to go back to you with a couple of1086specific questions. The Paralyzed Veterans of America wrote in1087their statement for the record today that their concerns1088regarding the accessibility of exam locations. In the wake of a10892024 Office of Inspector General (OIG) report on the matter,1090they cited that more than half of the 135 facilities they1091visited had accessibility barriers. This is obviously a problem1092when you were talking about screening for veterans with1093disabilities, not having accessibility at the places where they1094are going for the screening. What actions is the VA taking to1095ensure that they are providing adequate oversight to the1096contractors and the facilities that they occupy?1097    Ms. Glenn. Yes, sir. We, well, it is twofold. First of all,1098we require that the vendors examine each facility that they1099send veterans to. Second, we then go back and do site visits,1100surprise site visits to these facilities. In Fiscal Year 2025,1101we were able to do 159 site visits. We plan on doing more in1102Fiscal Year 2026. We have a plan in place, and we will1103hopefully be able to soon execute it.1104    Mr. McGarvey. Okay. Again, this is an OIG report. This is a1105statement in the record today, that of the 135 they visited,1106half had accessibility issues.1107    Ms. Glenn. Yes, sir.1108    Mr. McGarvey. You are telling me that the vendors are1109certifying that these--these venues do not have accessibility1110issues? I mean, half? That is a pretty big statistical sample1111out of 135 locations.1112    Ms. Glenn. Yes, sir.1113    Mr. McGarvey. I am not saying that that carries out across1114all locations. Then your answer kind of says, we are doing1115these things, we are doing these things, but half are not. How1116are you getting feedback directly from our veterans who use1117mobility aids? How are you actually finding out about this? Was1118this OIG report a surprise?1119    Ms. Glenn. Yes, sir, I would say so. One of the things that1120we have done is we have required the vendors, when they contact1121the veteran, to make sure that they ask them do they have any1122accessibility issues. That they should not be sending a veteran1123with accessibility issues to a facility that cannot handle. We1124look at this--we take this very seriously, which is why we send1125in-house staff who have taken U.S. Occupational Safety Health1126Administration (OSHA) and The Americans with Disabilities Act1127(ADA) training to go out and look at these facilities and make1128sure that anything that is wrong, such as the fire escape map1129is not on the wall, is corrected immediately, if not----1130    Mr. McGarvey. We want that, but there still seem to be1131major problems. You are mentioning, like, even a fire escape1132map on the wall. We are hearing what I would consider to be1133horror stories about exams being conducted in inappropriate1134locations, such as hotel rooms. Can you confirm that these1135types of practices have been stopped completely? If not, why?1136If they have, what is VA doing to find out about these and1137address them? How did you do it?1138    Ms. Glenn. We have tightened up quite a lot on what our1139requirements are for the examination space. I have not heard1140anything lately. I would welcome anything that any of you see1141along this issue to be brought to our attention so that we can1142take action. We do have a plan. We do have a way of1143investigating. You know, we want our veterans to feel safe and1144accommodated when they go to the exams.1145    Mr. McGarvey. This is a massive program, and we are hearing1146way too many stories of how it is not working for our veterans1147and that we have a bunch of vendors out there who may or may1148not be getting you all the information you need. There needs to1149be more oversight.1150    Really quickly, VA conducts special focus reviews to try1151and reduce errors on exams from most complex claims, including1152traumatic brain injury, military sexual trauma, and Gulf War1153illness. Ms. Curda, you testified that VA plans to change the1154tempo of these reviews from a 2-year to a 3-year schedule. Will1155the 3-year schedule allow the MDEO to meet its oversight goals?1156    Ms. Curda. Well, according to their own analysis, they--1157they would have preferred to keep this to a 2-year schedule. We1158were told due to staffing reductions, they could--they could1159not do that. We were happy to see it change to a 3-year1160schedule rather than no schedule or, you know, erratic1161schedule.1162    I think the, you know, on the con side, you know, the1163purpose of these things is continuous improvement. If you wait1164another year to look to see if what happened in the first round1165of reviews is corrective actions that were identified. If you1166wait another year to see if they have been implemented and1167whether they are effective, you lose that opportunity to take1168course corrections and make changes. I think there is a1169downside to waiting another year. You miss opportunities and it1170could result in inaccurate claims.1171    Mr. McGarvey. I have a hard time believing less is more in1172this case. I also want to say that you said part of this is1173about staffing issues. It seems like, as part of this hearing,1174you guys are telling me you do not have staffing issues. This1175is a problem. Our veterans need to find the front door to the1176VA, and this is often the way it happens. We need to make it1177easier for them to walk in and get the care that we promised1178them. They put on the uniform, and we have seen what our1179veterans have done for us in the last 20-25 years and what they1180have sacrificed for us. In exchange for that, we made them a1181promise. It is not just a legal promise; it is a moral promise1182that we would take care of them. It sounds like they are not1183living up to that with this program right now. We need to do1184better.1185    Mr. Luttrell. Thank you, sir. Mr. Self, you are recognized1186for 5 minutes, sir.1187    Mr. Self. Thank you, Mr. Chairman. I want to get at the1188errors and the payments. What is the max percentage of the1189contract that can be rewarded?1190    Ms. Glenn. The max percentage is 3 percent of the invoice.1191    Mr. Self. Of the invoice. Okay. On the two--the two errors1192that resulted in overpayments, what was the total invoice1193amount of those two errors?1194    Ms. Glenn. Sir, I do not have that information at hand.1195    Mr. Self. Okay.1196    Ms. Glenn. I will get back to you.1197    Mr. Self. Okay. I did the--I did the backward math. If you1198paid out $2.3 million and 3 percent of the invoice amount--was1199it the full 3 percent?1200    Ms. Glenn. I am not sure, sir.1201    Mr. Self. Okay, let us assume that was full 3 percent. That1202means that the invoice amount for those two contracts was $761203million.1204    Ms. Glenn. Yes, sir.1205    Mr. Self. We have got $76 million contracts that were--did1206not have enough oversight. This is indeed a problem. I think1207you have already addressed this about the time I left, how many1208people were reprimanded for the 2.3 million overpayment?1209    Ms. Glenn. The people involved are no longer employed with1210VA, sir.1211    Mr. Self. That is a pretty good reprimand. Have you changed1212vendors because of it?1213    Ms. Glenn. No, sir.1214    Mr. Self. What is the total? If these two contracts are $761215million, which had errors that got rewarded for $2.3 million,1216what is the total contract on those two vendors? Is it two1217vendors or two mistakes and one vendor?1218    Ms. Glenn. I will have to get back to you on that. I told1219Chairman Luttrell that I would get him the amount spent on1220examinations. Two contracts for sure.1221    Mr. Self. Two contracts. Might be one vendor, two1222contracts. Chairman, I yield back.1223    Mr. Luttrell. Thank you, sir.1224    Ms. Curda, explain to me the TBI scheduling that you and1225the Ranking Member were speaking on from 2 to 3 years, please.1226    Ms. Curda. This is part of MDEO's quality control process,1227is to feed to the contractors the most frequent errors in a1228given quarter. Oh, actually, I am sorry.1229    Mr. Luttrell. Specifically, around traumatic brain injury.1230    Ms. Curda. Yes, yes. Those were the special focus reviews.1231This is a review that they planned to do every 2 years. What1232they do is they take a deep dive on the traumatic brain injury,1233and to see what are the root causes of the errors in those1234types of exams, and then work on corrective actions with the1235vendors. The idea being that then they would come back after 21236years and see, Okay, what is happening with those errors.1237Then,----1238    Mr. Luttrell. Wait a minute. Explain an error to me,1239please.1240    Ms. Curda. In the exam. An examiner filling out the DBQ for1241traumatic brain injury would make errors, and they would--these1242particular types of exams and these particular types of DBQs1243are more prone to error. It is getting at the root causes of1244those frequent errors and correcting them.1245    Mr. Luttrell. Let me ask you this. I have a background in1246neuroscience. Right now, it is every 2 years advancements in1247neuroscience. It flexes its muscle every day. Matter of fact,1248when I went through grad school, everything that I learned in1249grad school is no longer correct. We have built off of that1250information. We have the ability to identify traumatic brain1251injuries at the granular, more toward the granular level. Okay?1252In depth, at scale. If an individual walks in with or submits a1253DBQ this year with neurological scans and assessments,1254cognitive assessments, and the examiner says you are good to1255go. He has, he or she, most likely will have to wait 2 years1256for--in 2 years, that scan may show something that is 1001257percent debilitating. Is that how long we have to wait?1258    Ms. Curda. Are you asking me or Ms. Glenn?1259    Mr. Luttrell. I am asking the panel this question. If you1260are not interested, if you do not understand what I am asking1261you, I will clarify it. My concern is you are trying to kick it1262out to 3 years. Now, there is things that we can identify today1263that will kill somebody in 3 years that we did not know about 21264years ago. Is it that MDEO's office request to kick it out the12653 years?1266    Ms. Glenn. Yes, sir. These special focus reviews do not1267prohibit us from--we do not have to wait for the special focus1268review if there are medical changes that are happening that are1269going to change the way we look at a veteran's disability. You1270know, our doctors, our examiners----1271    Mr. Luttrell. The special focus review will be handled by1272an examiner, pushed back up to the vendor through the VA for1273the claim, and if the examiner does not find anything, sends it1274back to the vendor and back into the VA, and the claim is shot1275down?1276    Ms. Curda. Just to clarify, the special focus reviews do1277not look at--are not about individual claims. It is about1278trends.1279    Mr. Luttrell. Trends.1280    Ms. Curda. It is like looking across----1281    Mr. Luttrell. Even better.1282    Ms. Curda. [continuing]. all of the exams that were done1283and what were the most frequent errors. It is sort of like a1284continuous improvement process.1285    Mr. Luttrell. Do we have any idea if the special focus1286reviews that were conducted 4 years ago, have there been--have1287we noticed any change in those compared to veterans today that1288have a neurological disorder or neurological disease or a1289traumatic brain injury?1290    Ms. Curda. Well, that is what we are saying has not1291happened because they have not done the next round.1292    Mr. Luttrell. We still think bumping it up for 3 years1293instead of 2 is a good idea?1294    Ms. Curda. Uh----1295    Mr. Luttrell. Ms. Glenn. You are in charge.1296    Ms. Glenn. Yes, sir. We are doing what we can with our1297resources and----1298    Mr. Luttrell. No. No, no, no. You are walking around the1299question. You are actually dancing where Mr. McGarvey is1300hitting you on. Do not give me the political answer. I am1301literally trying to save lives here.1302    Ms. Glenn. Yes, sir. I will tell you that there are1303additional things that we use besides the special focus review.1304We do monthly----1305    Mr. Luttrell. Oh, you are walking around it again. I am1306asking you about the 3-to-2-year. Matter of fact, I think you1307should bump it back to 6 months or a year when it comes to1308traumatic brain injury. That is my opinion. My opinion only. I1309want you to take a hard--cannot ask you to do that. I disagree1310with 3 years.1311    Ms. Glenn. Yes, sir. Understood.1312    Mr. McGarvey. I appreciate Mr. Chairman's line of1313questions. I just want to ask really simply, and I want a1314simple answer because it is a--it is an important question.1315Just simple to me. It is not (phonetic) important. Is it better1316or worse for our veterans to go from 2 years to 3 years?1317    Ms. Curda. I would say worse.1318    Mr. McGarvey. Thank you. Mr. Chairman, I yield back.1319    Mr. Luttrell. Mr. Self, you are recognized now for 51320minutes.1321    Mr. Self. Thank you, Mr. Chairman. I want to follow up on1322your trends comment because apparently, four out of the six1323examiners that they examined said they no longer elevate1324challenges to their vendors because their vendors do not listen1325to them. How then do you establish trends if your examiners are1326not sending their feedback to the vendors? How do you develop1327trends? Is this a paperwork drill or is this actual feedback1328from the field?1329    Ms. Curda. Well, I will let Ms. Glenn answer. I mean, our1330observation is they do have processes in place to identify1331errors within MDEO through their review processes and so forth.1332It is--but it is a perspective that is missing, the examiner's1333perspective. They felt that they were not being listened to by1334their contractors. They were not always given good advice. They1335felt they knew more sometimes than the contractor's quality1336assurance staff knew, and they--that they would like to give1337that feedback to VA.1338    Mr. Self. Then, once again, that is pretty damning1339testimony. Once again, how do you establish trends if you are1340not accepting feedback from your examiners?1341    Ms. Glenn. Based on the GAO recommendation, we did develop1342an examiner portal, which is live as of the end of September.1343We have been collecting feedback from the examiners. It is an1344open text box. They can type in whatever they feel like they1345want us to know.1346    Mr. Self. You have got 2 months of data. Mr. Chairman, I1347yield back.1348    Mr. Luttrell. Thank you. Ranking Member, you are1349recognized, sir.1350    Mr. McGarvey. Thank you, Mr. Chairman. I appreciate this.1351This is a really important hearing because we are spending1352billions of taxpayers' dollars every single year on this1353program, covering millions of exams for our veterans and paying1354out millions in incentives, nearly 20 percent of which were1355wrong.1356    Right before this, I had a Small Business Committee hearing1357this morning. I will put the small business hat on here. Can1358you imagine if you were running a small business, let us say a1359diner or something, and 20 percent of the meals you sent out1360from the kitchen were wrong? The business is not going to last1361very long, or at the very least, the cook is going to get1362fired. That is a massive problem to have 20 percent wrong, and1363we cannot tolerate that level of inaccuracy when it comes to1364serving America's veterans and protecting our taxpayers.1365    Chairman Luttrell, I look forward to continuing to working1366with you to do something, an upcoming roundtable, or some sort1367of event. Maybe we can hear directly from the contracted1368companies. I think with these for-profit companies controlling136990 percent of the exams, we need to hear from them what1370controls they have in place and how they are fixing these1371problems, as well as hearing from you all.1372    Mr. Chairman, we have all heard concerns in this room,1373because in this room, we get together to help our veterans1374about the need to sell veterans on the VA. Numerous veteran1375service organizations and veterans themselves have spoken to us1376about the challenges that veterans face with the C&P exams. If1377we want to ensure that veterans have trust in the VA and are1378comfortable seeking it out for care, then we should start by1379ensuring that their very first interaction with the system is a1380welcoming and assuring one.1381    I think about the veteran who is transitioning to civilian1382life, showing up to a compensation exam for military sexual1383trauma, and walking into a hotel room for their exam. This1384might sound far-fetched, but it has happened. We are getting1385these stories. Yet, in that exact scenario, a military sexual1386trauma survivor walking into a hotel room for an exam, if the1387contracted provider gets the paperwork right, and they get it1388in, they will get their incentive pay. Is this the standard of1389care that our veterans should experience or that we want to1390incentivize? I want to ask the contractor providers what1391controls they--not the VA reviewing numbers from the central1392office--but what controls they themselves have done to1393adequately ensure our veterans are safe, cared for, and being1394seen in an appropriate professional setting.1395    I also want to make sure that our veterans are getting the1396reviews and care they need. When we hear today that reviews are1397moving from every 2 to 3 years and that that is, by your own1398testimony, worse for veterans, we have to do something about1399that. Let us bring in the heads of these companies, let us get1400together, let us make sure that our veterans, the men and women1401who were willing to sacrifice everything for our safety,1402security, and freedom, received the promise we gave them that1403when they took that uniform off, we would take care of them. It1404is exactly what we want to do. It is exactly what we need to1405get done on this committee.1406    Thank you, Mr. Chairman. I yield back.1407    Mr. Luttrell. Ms. Glenn, your office has a very large1408responsibility. I am sure you are--you are kind of feeling that1409right now in this hearing. I want to thank all three of you for1410what you do for our veterans. I say this every committee1411hearing, you wake up every day, you go in and you do and you do1412what you can for us. We pay attention. Myself to that veteran1413sitting right there, to the other veterans that are on this1414committee and abroad, I have almost 40,000 veterans in my1415district. I can assure you, the most aggressive group in my1416district are my veterans, are my brothers and sisters. They1417talk to us because they have every right to get what they have1418earned by putting on that uniform and fighting for this1419country. Every one of them.1420    There is always going to be mistakes. The human element and1421the human error. It exists. It does. Your office is1422responsible. You in charge are responsible for oversight in1423your office. Ms. Curda has pointed out quite a few, and I know1424that you are working on it, and I appreciate that. We will1425never let that be enough. It will never be perfect. We will not1426stop fighting for perfection because of those that we are1427responsible for taking care of, because they never asked1428anything of anyone when a round was going by their head, or1429they were dragging their buddy or brother or sister out. They1430never did that. That is why we do what we do. That oversight1431goes a long way.1432    You will be back here in front of us. We will ask these1433questions again. I expect it will not be the same answers. Ms.1434Curda will keep us read in. I hate to tell you this, but you1435are absolutely pinging hard on my radar because of every1436veteran that you touch, do not ever forget that is what you are1437doing. Okay? Staff included.1438    I ask unanimous consent that all members have 5 legislative1439days to revise and extend their remarks and include extraneous1440material. Without objection, so ordered. This hearing is1441adjourned.1442    [Whereupon, at 1:09 p.m., the subcommittee was adjourned.]14431444=======================================================================14451446                         A  P  P  E  N  D  I  X14471448=======================================================================14491450                    Prepared Statements of Witnesses14511452                              ----------14531454                 Prepared Statement of Elizabeth Curda14551456[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]14571458                    Prepared Statement of Mary Glenn14591460    Chairman Luttrell, Ranking Member McGarvey, and distinguished1461members of the Subcommittee, I appreciate the opportunity to appear1462before you today to discuss the medical disability examinations (MDE)1463conducted by VA. Accompanying me today is Tara Flores, Director,1464Acquisition Service, Strategic Acquisition Center.1465    Today, I will provide updates on VBA's oversight of Compensation1466and Pension (C&P) examinations, including how we hold contract vendors1467accountable. I will also provide an update on implementing1468recommendations made by the U.S. Government Accountability Office1469(GAO).14701471Medical Examination Production14721473    Under a new Administration, VBA had a record-breaking year for1474disability compensation claims processed, with over 3 million claims1475completed in Fiscal Year (FY) 2025. To support this high volume of1476production, VBA also completed a historic number of medical exams.1477Notably, over 93 percent of exams are conducted by VBA contract medical1478disability examination vendors. We remain committed to ensuring1479Veterans and Service members receive high quality and timely disability1480claim decisions, supported by high quality medical examinations. During1481Fiscal Year 2025, VA completed over 3.3 million examination scheduling1482requests, a 5.5 percent increase from the same period in Fiscal Year14832024. The average days to complete exams in Fiscal Year 2025 was 26.41484days, an improvement from 35.7 days compared to the prior year.14851486Contractual Oversight14871488    Vendors are evaluated on performance metrics such as timeliness,1489production, and quality. Vendors receive positive incentives for1490exceeding benchmarks and negative incentives for when performance1491targets are not met. The August 2025 GAO report, entitled VA Disability1492Benefits: Additional Oversight and Information Could Improve Quality of1493Contracted Exams for Veterans, identified two erroneous incentive1494payments in Fiscal Year 2024. The erroneous payments have been1495recouped, and our methodology has been enhanced to prevent future1496errors.14971498Quality Compliance14991500    VA conducts monthly quality audits using a statistically valid1501sample. In Fiscal Year 2025, VBA's aggregate quality score for MDE1502Vendor Disability Benefits Questionnaire reviews was 97.2 percent, with1503positive performance incentives applied for scores above 96 percent.15041505Training Requirements15061507    All contract medical examiners must undergo foundational training1508and certification equivalent to that of Veterans Health Administration1509examiners. Training includes general certification, specialty courses,1510and supplemental courses. Recertification training is required every 51511years or if the examiner has not conducted an exam in the past year.1512VBA MDEO is also developing training based on error trends, special1513focused reviews, and Disability Benefits Questionnaire changes to1514improve exam quality.1515    Vendors must submit an annual training plan covering examiners and1516support staff, ensuring compliance with VA standards and quality1517assurance. These plans are reviewed by VBA to confirm they meet all1518contract requirements. VBA validates completion of training before1519examiners are permitted to perform exams. VBA also conducts monthly1520audits to ensure all active examiners adhere to training requirements,1521ensuring training standards are maintained by active examiners.15221523Initiatives and Improvements to the Veteran Experience:15241525    We recognize that there are clear opportunities to strengthen and1526modernize portions of the disability examination process, and we are1527committed to addressing those areas. For example, we are evaluating1528advanced clinical and evidence-review tools designed to help identify1529when existing medical information is sufficient to support a claims1530decision. These capabilities have the potential to reduce in-person1531examinations, improve consistency, and accelerate outcomes for our1532Veterans, while ensuring that all decisions comply with VA regulations1533and clinical standards.1534    We are also prioritizing a more Veteran-centric approach to1535scheduling and overall exam coordination. VBA has begun integration1536between the Veterans Benefits Management System (VBMS) and VHA's1537External Provider Scheduling platform. This collaboration is expected1538to improve and streamline the Veteran experience, giving Veterans more1539options, while allowing VA to maximize utilization of the entire1540network of providers supporting C&P examinations nationwide. A1541centralized scheduling platform will make the process simpler to1542navigate, improve consistency in communication, and ensure that1543examinations are accessible to all Veterans.1544    In parallel, we are focused on identifying ways to streamline and1545modernize business processes, reducing administrative burden for both1546Veterans and the workforce. This includes assessing multiple avenues to1547leverage technology and refine workflows in order to reduce reliance on1548examinations where appropriate.1549    While some progress can be achieved within the exam space alone,1550the full benefit of these improvements will depend on close partnership1551across VBA and VA, as well as stakeholders. We remain committed to1552these collaborative efforts to ensure a more efficient, Veteran-focused1553experience.15541555GAO Recommendations15561557    In August 2025, GAO issued a report entitled VA Disability1558Benefits: Additional Oversight and Information Could Improve Quality of1559Contracted Exams for Veterans. To begin addressing these1560recommendations, VBA has formalized the standard operating procedures1561(SOP) for the financial incentive calculation process detailing roles,1562responsibilities, objectives, and reporting. This SOP is currently in1563use. In addition, VBA has recalculated all financial incentives since15642022 as requested by GAO and did not identify any errors that impacted1565the previously calculated percentages. Further, VBA has completed the1566Fiscal Year 2025 Military Sexual Trauma (MST) Complex Case Review (CCR)1567and updated the CCR SOP to reflect the projected completion of CCRs. An1568MST Special Focused Review (SFR) was completed in Fiscal Year 2025, a1569Gulf War SFR is planned for completion in Fiscal Year 2026, and a1570Traumatic Brain Injury SFR will be completed in Fiscal Year 2027, with1571the MST SFR cycle restarting in Fiscal Year 2028. VBA is dedicated to1572conducting these SFRs to ensure oversight and improve the quality of1573these critical medical disability exams. Finally, VBA has created a1574form to collect feedback from examiners who conduct contract medical1575examinations, established a monitored email account to receive the1576forms, created SOPs to ensure feedback forms received are reviewed1577timely and maintained, with notice of the new feedback mechanism1578provided to all current contract exam providers and vendors.15791580Conclusion15811582    I want to express my appreciation for your continued support of1583Veterans and their families, caregivers, and survivors. VBA appreciates1584the authority provided by Congress to obtain contract examinations for1585Veterans and transitioning Service members. VBA remains committed to1586providing timely and accurate disability examinations to Veterans and1587Service members, while improving their examination experience. Chairman1588Luttrell, and Ranking Member McGarvey, this concludes my statement. We1589would be happy to answer any questions you or the other Members of the1590Subcommittee may have.15911592                       Statements for the Record15931594                              ----------15951596  Prepared Statement of Veterans of Foreign Wars of the United States15971598    Chairman Luttrell, Ranking Member McGarvey, and members of the1599subcommittee, on behalf of the men and women of the Veterans of Foreign1600Wars of the United States (VFW) and its Auxiliary, I am pleased to1601provide input on this important topic that we have addressed in1602previous hearings, both as a witness or by similar submissions.1603    The VFW approaches this hearing with the utmost seriousness, as the1604issues before us affect every veteran seeking fair and timely access to1605earned benefits. We have raised concerns about the Department of1606Veterans Affairs (VA) disability examination system in numerous1607settings, including recent congressional roundtables where the1608challenges surrounding the current examination structure once again1609became part of the discussion. The VFW firmly believes that the1610disability examination is the single most critical step in the claims1611process. It is also, regrettably, the step that generates the greatest1612number of obstacles and inconsistencies. Since as far back as 2017, we1613have repeatedly expressed concerns about the manner in which1614examination contracts are awarded and the profound impact these1615decisions have on the efficiency, accuracy, and fairness of the claims1616process.1617    Over the years, we have identified several persistent issues within1618the examination and contracting framework that demand focused attention1619and action. These challenges range from contract instability and1620provider shortages to uneven examiner qualifications and inconsistent1621service delivery across regions. The VFW believes that implementing our1622recommendations, many of which have been reiterated for years, would1623significantly strengthen the disability evaluation process. These1624improvements would not only streamline operations but also enhance1625outcomes for veterans, caregivers, family members, and survivors who1626rely on VA for critical support.1627    Despite our ongoing efforts to offer workable solutions, the1628examination system remains overly complex, burdensome, and difficult to1629navigate. It places unreasonable strain on veterans, especially those1630attempting to navigate the process without representation or guidance.1631For some, the system is not merely challenging, it is functionally1632inaccessible. The VFW urges Congress and VA leadership to act1633decisively to modernize and stabilize the examination infrastructure.1634Veterans deserve a system that supports them, not one that hinders1635them, and meaningful reform is both urgently needed and long overdue.16361637Scheduling16381639    As an accredited Veterans Service Organization (VSO)1640representative, we hold a professional and regulatory obligation to1641fully understand the VA disability claims process and the VA business1642systems that enable delivery of benefits. However, navigating the1643process remains unnecessarily frustrating. The contracted disability1644examination process used to inform claimants of ratings decisions is1645not transparent, efficient, or customer focused.1646    Examination requests are assigned to VA's contracted vendors.1647Because of the rigidity of VA's contracts and the emphasis on speed-1648driven metrics, initial examination assignments are repeatedly returned1649to VA as unschedulable. Under current contracts, veterans generally1650receive only one opportunity to reschedule an examination before a1651vendor is required to return the request to VA. This presents many1652challenges and avoidable cancellations.1653    We recently assisted an 80-year-old veteran who filed a claim for1654hearing loss. The claim was established, and examinations were1655requested by a VA-contract vendor. While this may sound routine and of1656no concern, the examination provider was 143 miles away. The veteran1657would have had to travel nearly 300 miles round trip for an examination1658that likely could have been completed closer to his home. Since he will1659be unable to report, we anticipate the examination will likely be1660reported to VA as a ``no show,'' and the veteran will be denied much-1661needed benefits.1662    In some cases, we have learned that vendors have made offers to1663provide transportation to a scheduled examination, which is a great1664improvement from how business was previously conducted. However, it is1665not always practical. Some veterans have issues with mobility that will1666not allow them to sit for long periods of time, others may need1667assistive devices such as walkers or wheelchairs that can prove to be1668cumbersome or impractical. There is no guarantee that the service with1669which the contract examiner engages will have the proper vehicle type1670available to take the claimant to the scheduled examination.1671    Once again, we are asking that veterans be given greater agency1672over their claims. Allowing the claimant to be able to choose when and1673where the examinations will take place will greatly reduce the no show1674and denial rate. Veterans want their claims to be accurate. They want1675them to be timely. VA has proven this is possible. As we noted in1676testimony before the Senate Committee on Veterans' Affairs, during the1677COVID-19 pandemic, VA suspended the process for veterans unwilling or1678unable to report for examinations due to concerns of being exposed to1679the virus.1680    VA's own contract examiners agree that giving veterans greater say1681in how their claims are processed will lead to better customer1682experiences for the claimants. It will also improve efficiency and help1683reduce waste.16841685Overdevelopment16861687    Overdevelopment of disability claims, particularly through the1688ordering of unnecessary medical examinations, continues to slow the1689claims process and generate avoidable frustration for veterans seeking1690timely decisions. This issue is especially pronounced in claims1691involving contentions of toxic exposure where the evidentiary standards1692are already well defined in statute and regulation. When a presumption1693of service connection applies and a claimant's service records confirm1694presence in the qualifying location, the requirement for a medical1695opinion is already satisfied. In these cases, ordering an additional1696examination does not enhance the evidentiary record, it instead1697introduces needless delay.1698    For example, a veteran exposed to burn pits in a qualifying1699location is entitled to the presumption of service connection for1700chronic obstructive pulmonary disease (COPD). Under this framework, VA1701should automatically grant the claim without attempting to determine1702alternative causes such as smoking history. Similarly, requesting a1703toxic-exposure-related screening for a contention wholly unrelated to1704toxic exposure, such as a musculoskeletal knee injury, adds no1705substantive value and extends wait times for a decision. In both1706instances, the additional steps are superfluous, create administrative1707inefficiency, and undermine the very purpose of presumptive policy.1708    To reduce these delays and ensure veterans receive the timely1709benefits they have earned, the VFW recommends that VA fully leverage1710existing claims data and medical records, cross-referencing prior1711submissions before ordering any new examinations. This approach would1712help prevent redundant development actions and preserve resources for1713cases where additional evidence is actually necessary. We also1714recognize that VA itself has acknowledged overdevelopment as a systemic1715problem and, in 2021, created an internal task force to address it.1716Continued attention, training, and accountability in this area are1717essential to eliminating unnecessary examinations, and improving claims1718timeliness and overall accuracy.17191720Examiner Qualifications17211722    A critical driver of avoidable delay within the VA claims system is1723the practice of routing medical opinions from qualified physicians to1724lesser-credentialed medical professionals such as nurse practitioners1725for confirmation or certification. This additional step is unnecessary,1726adds no medical value, and undermines the credibility of the original1727expert opinion. When a licensed physician has already provided a clear,1728competent, and comprehensive medical assessment, re-review by a1729provider with less specialized training only creates bottlenecks.1730Worse, this redundant review can give the appearance that evidence is1731being developed not to assist the veteran but to find grounds to deny1732the claim, which is contrary to VA's statutory obligation to extend the1733benefit of reasonable doubt to the veteran.1734    The time lost by sending a physician's medical opinion into this1735secondary loop contributes directly to prolonged adjudication times,1736all without increasing the accuracy, quality, or completeness of the1737claim decision. Veterans routinely wait weeks or months for these1738additional reviews, only to receive decisions based on the lesser-1739credentialed practitioner's reinterpretation of the evidence rather1740than the physician's original conclusion. This practice not only delays1741justice, it also increases the likelihood of improper denials as1742medical nuances documented by the examining physician may be1743overlooked, minimized, or mischaracterized. In multifaceted claims,1744particularly those involving toxic exposures, traumatic brain injury,1745or other neurological conditions, this unnecessary layer of review can1746create significant harm to the veteran by introducing avoidable errors.1747    To ensure timely, accurate, and fair outcomes, VA must rely on the1748most qualified examiners necessary for the medical issue at hand and1749must accept competent medical opinions. Eliminating redundant1750certification practices would shorten adjudication timelines, reduce1751improper denials, and reinforce confidence in the claims process.1752Veterans deserve a system that respects their time, honors their1753service, and ensures that well-supported claims are not slowed down or1754jeopardized by unnecessary procedural obstacles.17551756Record Review17571758    A complete and accurate review of each veteran's record is1759essential to ensure the timely, fair, and efficient adjudication of1760claims. Yet in too many cases, VA's Veterans Service Representatives1761(VSRs) focus primarily on the first contention listed in the file and1762build development actions such as medical examinations or evidence1763requests around that single issue. This narrow approach fails to1764acknowledge the interconnected nature of many claims. Veterans rarely1765submit claims involving only one condition, and each contention must be1766considered within the broader context of service history, medical1767evidence, and previously documented conditions. When VSRs do not fully1768review the entire claim at the outset, the resulting development plan1769is incomplete and misaligned with the veteran's actual needs.1770    Ordering examinations without a full review has cascading1771consequences. Once additional facts or contentions come to light that1772should have been clear from the beginning, new or sometimes duplicate1773medical examinations are ordered to correct earlier oversights. This1774repetition not only wastes VA resources but also prolongs the veteran's1775wait for a decision. In complex cases, especially those involving1776multiple service-connected conditions, these missteps can force1777veterans into a cycle of repeated examinations, conflicting medical1778opinions, and avoidable frustration. The veteran is ultimately1779penalized for a process failure that could have been prevented with a1780comprehensive record review at the outset.1781    Unnecessary examinations and fragmented development actions1782contribute to a disjointed claims process, adding avoidable delays and1783increasing the likelihood of improper or incomplete decisions. Ensuring1784that VSRs conduct a full, holistic review before initiating any1785development is critical to breaking this cycle. The VFW urges VA to1786strengthen training, oversight, and accountability to ensure that all1787relevant evidence is reviewed up front and that development actions1788reflect the totality of the veteran's claim. Only by doing so can VA1789deliver the timely, accurate, and veteran-centered service that1790claimants deserve.17911792Disability Benefits Questionnaires17931794    Across our nationwide network of more than 2,300 accredited1795representatives, we consistently hear that the Disability Benefits1796Questionnaire (DBQ) system is in urgent need of modernization and1797accountability. Despite VA's assurances that its physicians routinely1798complete DBQs, the overwhelming reality is that most refuse to do so.1799Veterans are frequently told, incorrectly, that VA providers are1800prohibited from offering medical opinions or completing DBQs, or that1801doing so constitutes a conflict of interest. When this recurring1802problem is raised with VA leadership, it is often dismissed or met with1803vague promises of future review, with no meaningful progress.1804Compounding the issue, many veterans are shuffled through a constantly1805changing roster of VA physicians who claim unfamiliarity with the1806patient's history and refuse to complete the forms, leaving veterans1807without the medical documentation required for a fair and fully1808developed claim.1809    As a result of this persistent refusal, veterans are regularly1810advised to seek assistance from private providers who often lack1811familiarity with VA's evidentiary standards and do not understand how1812to properly complete a DBQ. Faced with confusion, discouragement, or1813financial barriers, many veterans abandon their claims altogether, or1814worse, turn to predatory Claim Sharks who charge high fees and produce1815questionable or fraudulent medical opinions. Even when these private1816opinions are exaggerated or fabricated, VA must treat them as valid1817medical evidence unless the provider is already identified as1818fraudulent, leading to inaccurate ratings and improper awards. In the1819most troubling cases, veterans who had no knowledge of wrongdoing could1820later face criminal exposure when the claim is deemed fraudulent. This1821is an outcome that no veteran should endure, and one that stems1822directly from VA's failure to provide reliable, accessible, and1823accurate DBQ support from its own medical staff.1824    A practical and effective solution is clear: VA must require its1825medical providers to complete DBQs upon a veteran's request and update1826all DBQ forms to include an integrated medical opinion section.1827Developing a comprehensive single form would ensure that qualified VA1828medical professionals, not untrained or unfamiliar private providers or1829predatory actors, are supplying accurate, ethical, and legally sound1830evidence. This reform would reduce the number of unnecessary1831compensation and pension (C&P) examinations, allow more claims to be1832rated on the evidence of record as provided for in the Code of Federal1833Regulation, and significantly accelerate the processing timeline. The1834VFW also strongly urges additional oversight of the DBQ program and1835requests continued involvement in any updates to ensure reforms align1836with the needs of veterans and the realities observed in the field.1837Veterans deserve a system that supports them, not one that pushes them1838toward confusion, exploitation, and risk.18391840Contract Renewals18411842    The VFW strongly opposes VA's continued use of 2-year contracts for1843Medical Disability Examination Office (MDEO) vendors. Short-term1844contracting cycles create unnecessary instability, undermine program1845performance, and fail to leverage the efficiencies that Federal1846acquisition policy is designed to promote. Instead, the VFW urges VA to1847adopt multi-year contracts consistent with the intent and advantages as1848outlined in Federal Acquisition Regulation (FAR) 17.105-2. Multi-year1849agreements would better support the complex, high-volume nature of MDEO1850operations and ultimately improve service delivery to veterans.1851    Multi-year contracting provides numerous benefits that are lost1852under the current 2-year model. These advantages include reduced costs1853for both VA and contractors by eliminating recurring startup expenses;1854greater standardization of services and processes; and a significant1855reduction in administrative workload associated with frequent1856recompetes, negotiations, and renewals. Longer-term agreements also1857promote continuity of operations by minimizing disruptions caused by1858repeated transitions, preproduction testing, and phaseouts. Further,1859multi-year contracts support workforce stability, encourage contractor1860retention and expertise, and eliminate the need to develop new quality-1861assurance processes with each contract turnover. They broaden1862competition by enabling participation from vendors with higher initial1863investment requirements, and create incentives for contractors to1864invest in advanced technology, infrastructure, and workforce1865development, leading to sustained improvements in productivity and1866service quality.1867    Given the operational demands and national importance of medical1868disability examinations, VA should prioritize stability, efficiency,1869and long-term performance by transitioning to multi-year contracting.1870Such an approach reflects Federal acquisition best practices,1871strengthens the quality and reliability of examinations, and ensures1872that vendors are positioned to deliver consistent, veteran-centered1873services. Multi-year contracts will reduce administrative burdens,1874enhance program continuity, and better serve veterans who depend on1875timely and accurate disability evaluations.1876    Chairman Luttrell and Ranking Member McGarvey, this concludes my1877statement. Again, thank you for the opportunity to offer comments on1878this issue.18791880Information Required by Rule XI2(g)(4) of the House of Representatives18811882Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has1883not received any Federal grants in Fiscal Year 2025, nor has it1884received any Federal grants in the two previous Fiscal Years.18851886The VFW has not received payments or contracts from any foreign1887governments in the current year or preceding two calendar years.18881889          Prepared Statement of Paralyzed Veterans of America18901891    Chairman Luttrell, Ranking Member McGarvey, and members of the1892subcommittee, Paralyzed Veterans of America (PVA) would like to thank1893you for the opportunity to submit our views on the effectiveness of the1894Department of Veterans Affairs' (VA) Medical Disability Examination1895Office (MDEO), and its role in the veteran's disability claims process.1896No group of veterans better understand the importance of timely access1897to VA benefits than veterans who have acquired a spinal cord injury or1898disorder (SCI/D).1899    The MDEO is responsible for overseeing the contract medical1900disability exam process for the Veterans Benefits Administration (VBA).1901One of their principal duties is to, ``monitor and oversee exam vendor1902performance to enforce the terms of the contracts and ensure compliance1903with agency regulations, procedures, program directives, and the law1904including ADA [Americans with Disabilities Act] and OSHA [Occupational1905Safety and Health Administration] requirements.'' The VA has authorized1906contracted medical disability examinations (MDE) to non-VA medical1907providers since 1996. Today, contractors account for more than 851908percent of MDEs.1909    When a veteran files a claim for disability compensation, a medical1910examination is the keystone in the adjudication process. A good,1911thorough examination is critical for an accurate outcome; however, a1912poor examination could lead to years of additional actions, adding to1913the appeals backlog, and could end up being extremely costly to the VA1914in terms of funding and trust. PVA strongly believes medical1915examinations for complex, service-related medical conditions like SCI/D1916and traumatic brain injury (TBI), as well as those related to military1917sexual trauma (MST), should be conducted by a medical practitioner1918working directly for the Veterans Health Administration; however,1919contract exams may be appropriate for other types of claims.1920Regardless, the VA must ensure that any contracted compensation and1921pension (C&P) examiners are qualified to conduct necessary exams and1922any legislative proposals supporting contract exams should include such1923provisions.19241925Inadequate Disability Benefits Questionnaire (DBQ) Quality Assurance19261927    PVA strongly believes that VA should improve the quality control1928review of an incoming DBQ before it is uploaded into a veteran's file,1929which could reduce the risk of fraudulent claims. Currently, VA claims1930processers have the authority ``to evaluate and weigh all evidence of1931record, including privately completed DBQs. If it is determined that a1932privately completed DBQ contains indicator(s) of inauthenticity that1933are substantive enough to deem it potentially inauthentic or1934fraudulent, claims processors have the authority to assign low or no1935probative value to the privately completed DBQ.'' \1\ But if a DBQ is1936completed by a contracted examiner, the claims processors ``are not1937expected to routinely scrutinize or question the credentials of1938clinical personnel to determine the acceptability of their reports,1939unless there is contradictory evidence of record.'' However, according1940to the VA's Clinician's Guide, which informs contract providers, ``It1941is important to remember that VBA Raters are not clinicians and1942therefore may not understand concepts that are considered basic or1943assumed by those educated in the field of medicine.'' \2\ This leads to1944obvious questions of whether the claims processors are actually picking1945up on the adequacy and accuracy of DBQs or the possibility of1946fraudulent/inconsistent findings being recorded by either outside1947providers or contracted examiners.1948---------------------------------------------------------------------------1949    \1\ M21-1, Part IV, Subpart i, 3.A.1.g, General Criteria for1950Sufficiency of Examination Reports.1951    \2\ Veterans Health Administration (VHA) Office of Disability and1952Medical Assessment (DMA) Compensation and Pension (C&P) Disability1953Examinations Clinician's Guide.1954---------------------------------------------------------------------------1955    The MDEO currently employs about 20 quality analysts whose job it1956is to review a random sample size of DBQs that are received from1957contractors and determine whether or not they are ``contractually1958compliant'' by ensuring that the reports include all requested issues,1959do not have any discrepancies, and describe the condition(s) that have1960impacted the veteran's ability to work, among other requirements.1961However, these analysts only have access to the DBQs after they have1962been uploaded to the Veterans Benefits Management System (VBMS), which1963is the same time claims processors receive them. Often, this is too1964late as the processors are waiting to finalize a claim and only need1965the DBQ to finish the rating process.1966    According to a Government Accountability Office (GAO) report from1967August 2025, ``MDEO officials say many claims continue through1968processing and are decided before the office completes its checklist1969review. After MDEO identifies errors, claims processors determine if1970the errors affected their decisions on the claims.'' \3\ In order to1971effectively do their jobs and to provide real oversight to the claims1972process, changes are needed.1973---------------------------------------------------------------------------1974    \3\ VA Disability Benefits: Additional Oversight and Information1975Could Improve Quality of Contracted Exams for Veterans.1976---------------------------------------------------------------------------1977    PVA believes that MDEO should implement two changes to the claims1978process. First, prior to being downloaded to VBMS, all DBQs, regardless1979of whether they are provided by the veteran or a contractor, should go1980into a drop box that is only accessible by the quality analysts.1981Second, the quality analysts should be trained and required to review1982the forms for contractual compliance and for potential fraud/1983inconsistent findings. Only after this review has been done should the1984forms be uploaded to VBMS and the claims process be allowed to1985continue.19861987Accessibility Concerns with Contract C&P Exams19881989    Equally important to the qualifications of the provider is an1990accessible, barrier-free facility to conduct exams. In May 2024, a VA1991Office of Inspector General (OIG) Report (23-01059-72) \4\ found1992accessibility barriers at more than half of the 135 facilities they1993visited. Of the 135 facilities inspected, 99 had complete inspections1994while 36 had partial inspections. OIG cited facilities being closed1995with unclear operating hours or exam rooms being occupied and unable to1996be accessed as reasons for the 36 partial inspections. According to the1997report, VBA lacks a standard operating procedure for contract exam1998facilities. Establishing such a standard was a recommendation made in1999the report.2000---------------------------------------------------------------------------2001    \4\ Better Oversight Needed of Accessibility, Safety, and2002Cleanliness at Contract Facilities Offering VA Disability Exams2003Department of Veterans Affairs OIG (vaoig.gov).2004---------------------------------------------------------------------------2005    PVA members have experienced access barriers when receiving C&P2006exams, as well as in accessing community care appointments. Our members2007have seen exam rooms that are physically inaccessible and/or lack2008overhead patient ceiling lifts. Restrooms often have accessibility2009barriers, causing members to pause and wonder why the VA is sending2010them to facilities that are ill equipped to accommodate them.2011    We also receive reports of inaccessible medical diagnostic2012equipment, such as medical examination tables, weight scales, dental2013chairs, x-ray machines, mammography, and other imaging equipment. A2014lack of any one of these diminishes these providers' ability to2015accurately evaluate service-related medical conditions. PVA submitted a2016statement for the record to this committee in September 20242017highlighting additional accessibility concerns facing veterans with2018catastrophic disabilities.\5\2019---------------------------------------------------------------------------2020    \5\ PVA Statement for the Record, House Veterans Affairs Committee2021Hearing, ``Examining VA's Challenges with Ensuring Quality Contracted2022Disability Compensation Examinations,'' September 18, 2024.2023---------------------------------------------------------------------------2024    Another barrier encountered by SCI/D veterans is getting to the2025contract facility. Several of our members have been expected to travel2026more than 100 miles to reach the contracted facility, and occasionally,2027even while the veteran is critically ill. Some of our veterans'2028injuries are so severe they may be unable to physically appear for an2029exam; so, our national service officers (NSOs) request on VA Form 21-20304138 (Statement in Support of Claim) either a telehealth or in-person2031visit from a C&P examiner. Many times, these requests are not seen or2032are simply ignored. Some NSOs write the request on the VA Form 21-5262033(Application for Disability Compensation and Related Compensation2034Benefits) but the contractor insists the veteran must attend in person2035or they will claim the veteran was a ``no-show,'' causing unnecessary2036delays to benefits and services the veteran may be eligible for, which2037forces NSOs to file supplemental claims, further adding to the claims2038backlog. VA and third-party vendors' policies regarding these2039situations need to be scrutinized, and greater use of telehealth exams2040and traveling examiners should be made.20412042Lack of Specialized Contract Examiners20432044    VA's M21-1 Adjudication Procedures Manual states that there are2045only four types of examinations that are routinely performed by2046specialists (hearing, vision, dental, and psychiatric). Furthermore, it2047notes that a specialist examination may be requested, but only if there2048are conflicting opinions or diagnoses, in compliance with a Board of2049Veteran's Appeals (BVA or Board) remand, or the issue is deemed2050``unusually complex.'' \6\ Immediately, this raises concerns.2051---------------------------------------------------------------------------2052    \6\ M21-1 IV.i.2.A.6.2053---------------------------------------------------------------------------2054    PVA NSOs represent veterans who have some of the most complex cases2055likely seen by VA. Complex cases include claims dealing with complete2056or incomplete injuries, application of all levels of special monthly2057compensation, and eligibility for ancillary benefits associated with2058these claims. Many of these conditions are not routinely associated2059with a neurological disorder; so, without specialized diagnostic2060experience, they could be missed, complicating or even extending the2061veteran's claims process. These conditions should be flagged as2062``unusually complex.'' However, we have heard from our NSOs in the2063field that they routinely see a lack of provider expertise, which2064delays the adjudication of claims. For instance, one office reported2065that there were several issues with an examiner conducting a peripheral2066neuropathy examination for veterans whose claims involved multiple2067sclerosis (MS). In cases involving amyotrophic lateral sclerosis (ALS),2068this oversight is particularly egregious, as the life expectancy of2069those with ALS is so short that any delay in the processing of that2070claim is robbing them of what precious little time they have left.2071    In another ongoing case, a veteran's claim was remanded back to the2072regional office (RO) because of an inadequate exam. This veteran had2073filed a claim related to mistreatment at the VA that had ultimately2074cost him his legs, which were amputated above the knee. After obtaining2075a medical opinion from a general practitioner, the Board remanded the2076case with instructions to obtain an opinion from either an infectious2077disease specialist, wound care expert, vascular surgeon, physiatrist,2078neurologist, or orthopedic surgeon. However, when the RO sought to2079obtain a specialist's opinion, they were told by the contractor that,2080``our contract with VA does not require a specialist to perform this2081particular [examination],'' and that they did not have a specialist to2082perform it. A general physician provided the exam in defiance of the2083remand order. This case will likely be remanded again and will continue2084to add to the backlog at the BVA and cost valuable taxpayer dollars,2085all because a specialist's opinion was denied by the contracted2086examiners.2087    To help ensure a quality examination is performed correctly the2088first time, and to prevent delaying the adjudication or the creation of2089an appeal, the VA should expand their guidance on the four conditions2090that are mandated to be performed by a specialist (hearing, vision,2091dental, and psychiatric) to include the specialties of neurology and2092gynecology. These two disciplines deal with disabilities that are2093complex in nature but are also extremely personal. No veteran should2094have to endure one of these examinations only to be told that it was2095insufficient or inaccurate and that a second exam is needed.2096    PVA would once again like to thank the subcommittee for the2097opportunity to submit our views on the effectiveness of the MDEO and2098the role the office plays in the VA disability claims process. We would2099be happy to take any questions for the record.21002101  Information Required by Rule XI 2(g) of the House of Representatives21022103Pursuant to Rule XI 2(g) of the House of Representatives, the following2104information is provided regarding Federal grants and contracts.21052106                            Fiscal Year 202621072108Department of Veterans Affairs, Office of National Veterans Sports2109Programs & Special Events--Grant to support rehabilitation sports2110activities--$368,500.21112112                            Fiscal Year 202521132114Department of Veterans Affairs, Office of National Veterans Sports2115Programs & Special Events--Grant to support rehabilitation sports2116activities--$502,000.21172118                            Fiscal Year 202321192120    Department of Veterans Affairs, Office of National Veterans Sports2121Programs & Special Events--Grant to support rehabilitation sports2122activities--$479,000.21232124                     Disclosure of Foreign Payments21252126    Paralyzed Veterans of America is largely supported by donations2127from the general public. However, in some very rare cases we receive2128direct donations from foreign nationals. In addition, we receive2129funding from corporations and foundations which in some cases are U.S.2130subsidiaries of non-U.S. companies.21312132  Prepared Statement of National Organization of Veterans' Advocates,2133                                  Inc.21342135[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]21362137                                 [all]