[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
IMPROVING OUTCOMES FOR
DISABLED VETERANS: OVERSIGHT OF VA'S
MEDICAL DISABILITY EXAMINATION OFFICE
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY
ASSISTANCE AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
THURSDAY, NOVEMBER 20, 2025
__________
Serial No. 119-35
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
------
U.S. GOVERNMENT PUBLISHING OFFICE
62-605 WASHINGTON : 2026
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MORGAN LUTTRELL, Texas, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MORGAN MCGARVEY, Kentucky, Ranking
American Samoa Member
JACK BERGMAN, Michigan CHRIS PAPPAS, New Hampshire
NANCY MACE, South Carolina MAXINE DEXTER, Oregon
KEITH SELF, Texas KELLY MORRISON, Minnesota
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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THURSDAY, NOVEMBER 20, 2025
Page
OPENING STATEMENTS
The Honorable Morgan Luttrell, Chairman.......................... 1
The Honorable Morgan McGarvey, Ranking Member.................... 3
WITNESSES
Panel I
Ms. Elizabeth Curda, Director, Education, Workforce, and Income
Security, U.S. Government Accountability Office................ 4
Ms. Mary Glenn, Deputy Executive Director, Medical Disability
Examination Office, Veterans Benefits Administration, U.S.
Department of Veterans Affairs................................. 6
Accompanied by:
Ms. Tara Flores, Director, Acquisition Service, Strategic
Acquisition Center, Office of Acquisition, Logistics and
Construction, U.S. Department of Veterans Affairs
APPENDIX
Prepared Statements Of Witnesses
Ms. Elizabeth Curda Prepared Statement........................... 27
Ms. Mary Glenn Prepared Statement................................ 38
Statements For The Record
Veterans of Foreign Wars of the United States Prepared Statement. 41
Paralyzed Veterans of America Prepared Statement................. 44
National Organization of Veterans' Advocates, Inc. Prepared
Statement...................................................... 48
IMPROVING OUTCOMES FOR
DISABLED VETERANS: OVERSIGHT OF VA'S
MEDICAL DISABILITY EXAMINATION OFFICE
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THURSDAY, NOVEMBER 20, 2025
Subcommittee on Disability Assistance &
Memorial Affairs,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 12 p.m., in
room 360, Cannon House Office Building, Hon. Morgan Luttrell
(chairman of the subcommittee) presiding.
Present: Representatives Luttrell, Bergman, Self, McGarvey,
Pappas, Dexter, and Morrison.
OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN
Mr. Luttrell. The subcommittee will come to order. The
chair may declare a recess at any time. Once again, good
morning to everyone.
This morning, the subcommittee is conducting oversight on
one of the Veterans Benefits Administration's (VBA) most
critical offices, supporting and overseeing the disability
claims process, the Medical Disability Examination Office, or
the MDEO. This is the office responsible for managing
contractors who conduct medical disability exams for veterans
nationwide.
Those exams form the foundation of the medical evidence
used by VBA to evaluate a veteran's claims for disability
compensation. If an exam is wrong, incomplete, or inaccurate,
or delayed, the veteran, obviously, may not receive the
benefits they have earned for their service.
That is what we are going to focus on today. Accuracy,
accountability, and a positive outcome for our brothers and
sisters.
When a veteran files a claim for disability compensation,
Veterans Affairs is responsible for helping the veteran prove
their eligibility for benefits. For years, U.S. Department of
Veterans Affairs (VA) has relied heavily on its own clinicians
at VA medical centers to perform these exams. As demand has
increased, VA turned to vendors to help handle the workload to
ensure quicker process rates and shorter wait times.
Today, more than 90 percent, 90 percent, of all exams are
done outside the VA through contractors. Sourced out of four
major contractors, four major contractors, these multi-year
contracts cover more than 9 million exams and a multi-year
budget ceiling of 13 billion dollars. A contracted medical
examiner uses a disability benefits questionnaire, or DBQ, to
document the veteran's symptoms and medical findings. MDEO, the
VA office responsible for exam oversight, ensures DBQs meet
quality standards, that vendors are held--and that vendors are
held accountable, and that the taxpayer's investment is
delivering for our veterans.
According to a recent report from the government of--not
affairs--accountability, the Government Accountability Office
(GAO), that might not have happened over the past couple years.
The Accountability Office found that MDEO wrongly awarded
millions of dollars in financial incentives in 2024 to vendors
who did not meet performance standards. Production, customer
satisfaction, exam quality, timeliness in scheduling, and
timeliness and completion as well. When vendors meet or exceed
these metrics, they can earn a bonus or face financial
penalties if they fall short.
The Accountability Office found that MDEO used a manual
process to calculate these incentives, which had no
standardized checks or formal written procedure to verify the
accuracy of payments. Apparently, MDEO miscalculated
performance scores and overpaid vendors again by millions of
dollars. The office charged with maintaining quality assurance
and disability claims for veterans did not--did not
consistently apply the standards that are necessary.
The Accountability Office recommended MDEO develop written
procedures and automated verification tools. MDEO says they
have started doing that, which is obviously a great step
forward. The Accountability Office also found that MDEO has
fallen short in meetings--in meeting its own schedule for
special focus reviews, known as SFRs.
These reviews are supposed to happen every 2 years for
complex claims such as traumatic brain injury (TBI), military
sexual trauma, and Gulf War illness. These are the cases most
prone to error, where exam quality can make or break veteran's
claims. Two are overdue and the third one, a start date, has
not been provided, from what I understand.
Let me be perfectly clear, if there is one area where you
cannot cut corners, it is in the cases revolving around post-
traumatic stress, post-traumatic stress disorder, and traumatic
brain injury. Without these reviews, MDEO has no way to know if
its previous corrective actions are working or if the exam
quality is improving. Without understanding if exam quality is
improving, it also means MDEO cannot update examiner training
or identify and correct DBQ errors. The same errors keep
happening, leaving some veterans with delays or incorrect
decisions. This is a systematic failure.
The Accountability Office also identified new areas for
improvement, suggesting that MDEO gather more feedback from the
field. Contracted examiners told the Accountability Office they
often have no direct line of communication with the VA.
Instead, they are told to send the feedback through their
vendors. This sounds harmless, but make no mistake, it is not.
One examiner told the Accountability Office that different
vendors have conflicting instructions on how to fill out the
DBQ. Therefore, depending on which contractor a veteran is
scheduled with, their exam might be completely different, even
though it is for the same condition.
That kind of disconnect undermines the trust in the system.
MDEO is the office for--MDEO is the office responsible for
ensuring exam consistency. To their credit, MDEO says they are
developing a direct feedback line so examiners can raise issues
directly to the office.
A pattern of manual errors, misreviews, and broken
communications are being fixed. This issue points out a broader
issue with MDEO. Of course, there is always more to do. We need
a proactive, not a reactive VA.
With that, I will yield to the Ranking Member.
OPENING STATEMENT OF MORGAN MCGARVEY, RANKING MEMBER
Mr. McGarvey. Thank you, Mr. Chairman, and thank you all
for being here today.
We often say, and I think it is true, there is no wrong
door into the VA. Whenever, wherever, and however a veteran
comes into the VA, they are all welcome there. We know that
their health and financial well-being will be better for it.
However, it is also true that for most veterans, the entry
point into the VA benefits is the compensation and pension
system. Applying for disability benefits and then receiving a
disability rating and the VA healthcare that follows, that is
the most common door that veterans walk through to get into the
VA. The key to that doorway for most veterans is the
compensation and pension exam, or the C&P exam, which documents
their medical conditions and provides the basis for a claims
decision. Ensuring that this exam process operates in a way
that best serves the veteran is crucial.
To me, that means that the exam can be scheduled quickly
and happens close to home, is conducted by a competent,
qualified medical professional, and is completed thoroughly and
accurately. It is extremely important for VA, and specifically
the Medical Disability Exam Office, or MDEO, to ensure all that
happens correctly. Unfortunately, in too many instances, it
seems that our current system of contract exams fails a lot of
veterans, and MDEO fails to oversee it properly.
You can just come to my office and take some of the calls
or go on social media and just look through and be flooded with
stories of veterans having exams scheduled without their
knowledge or in locations that are hugely inconvenient for the
veteran and the family to get to. We hear tons of stories about
veterans being sent to an exam that has nothing to do with
their condition, or veterans sent to doctors who do not have
the specialty training needed for their injury or illness, or a
less than 10-minute mental health exam, or orthopedic exams
conducted via telehealth. The stories are endless.
VA is supposed to be monitoring the conduct of these
examiners and holding contract vendors accountable.
Unfortunately, it does not seem as though this is happening as
thoroughly as it should. In fact, MDEO seems to think that
everything is running smoothly with these vendors. That
assessment just does not match up with what we are seeing out
here in the real world.
A recent Government Accountability Office report noted that
$2.3 million in incentive pay was incorrectly given to
contracted examiners. I do not know about you, but I find that
alarming, especially as only a half million in penalties were
imposed on contracted examiners who did not meet quality
standards. To me, that seems low based on what we hear from our
constituents.
Today, I hope that you all can help us square that circle,
because I look forward to hearing about the progress that the
MDEO has made after the significant backlog experienced during
the 2020 pandemic. I look forward to an honest discussion about
where MDEO is falling short and not living up to its mission to
serve veterans. That is what we do here. Our mission is to
serve veterans. On this committee, we come together to honor
that promise we made to take care of the men and women who put
on a uniform for us.
We want to continue to see a pattern--as we continue to see
a pattern of challenges with oversight, quality, and assurance,
and adequate control over these contract exams, we want to get
to the bottom of it. Since about 90 percent of disability exams
are done outside the VA by for-profit third-party contracted
examiners, it is really about time we get a better handle on
this program and put stronger rules and quality checks in
place. A program this large and this hard to oversee is open to
abuse or even just mistakes that ended up costing our veterans
time and our taxpayers' money. As we continue to work on behalf
of veterans, we must hold VA and those in contracts to conduct
exams to a high standard.
That is the work we embark on today. I really appreciate
you all being here and look forward to hearing your remarks.
Mr. Chair, I yield back to you.
Mr. Luttrell. Thank you, Mr. McGarvey.
I will introduce the witnesses.
From the Government Accountability Office, we welcome Ms.
Elizabeth Curda, Director of Education, Workforce, and Income
Security. Good morning.
Our lead witness from VA is Ms. Mary Glenn, Deputy Director
of the Medical Disability Examination Office at the Veterans
Benefits Administration. Good morning.
She is joined by Ms. Tara Flores, Director of Acquisitions
Service at the Strategic Acquisition Center within the Office
of Acquisitions, Logistics, and Construction. Did you write
that? That is impressive. Thank you for being here today.
I ask that the witnesses please stand and raise your right
hand.
[Witnesses sworn.]
Mr. Luttrell. Thank you. Let the record reflect that the
witnesses have answered in the affirmative. You may be seated.
Thank you.
Ms. Curda, you are now recognized for 5 minutes to deliver
your opening statement on behalf of the Government
Accountability Office.
STATEMENT OF ELIZABETH CURDA
Ms. Curda. Good morning. Chairman Luttrell, Ranking Member
McGarvey, and members of the subcommittee, I am pleased to
discuss GAO's work on VBA's oversight of the quality of
contracted disability examinations.
When veterans file claims for disability benefits, VBA
claims processors may request medical exams for veterans before
making decisions on their claims. These exams help determine
whether disability benefits are warranted, and if so----
Mr. Luttrell. Ms. Curda, I apologize. Is your microphone
on?
Ms. Curda. Can you hear me better now?
Mr. Luttrell. There you go. Thank you. I apologize. Can you
kind of lean into it?
Ms. Curda. Yes. Do you want me to start again?
Mr. Luttrell. Nope.
Ms. Curda. Okay.
Mr. Luttrell. I could vaguely hear you. You are good to go.
Thank you.
Ms. Curda. The responsibility for performing these exams
has largely shifted from VA medical centers to contractors who
provide the medical professionals called examiners. In 2024,
they performed 93 percent of the exams at a cost of over $5
billion. Robust oversight of contractors is important for
ensuring quality exams because errors can result in incorrect
decisions, costly rework, and delays for the veteran.
To oversee contracted exam performance, in 2016, VBA
established the Medical Disability Exam Office.
My testimony today discusses first, VBA's processes for
overseeing exam quality and second, GAO's five recommendations
for improving these processes.
Since 2016, VBA has refined its processes for overseeing
contracted exams and implemented numerous GAO and VA Inspector
General (IG) recommendations along the way. VBA oversees exam
quality using a variety of techniques that fall into three
categories.
Prevention. These techniques aim to prevent errors or low-
quality work from occurring during exams. These include things
like training and guidance. Second, detection. These techniques
aim to identify exam errors that do occur. These are things
like using checklists to review completed exam paperwork for
errors. Third, correction. These techniques respond to exam
errors. Things like contractor quality action plans, and
imposing financial incentives for performance.
While VBA has put in place these oversight processes, our
recent work has identified opportunities to strengthen them.
Specifically, in our 2024 and 2025 reports, we found first,
breakdowns and procedures for tackling the most frequent or
complex problems with contracted exams. Second, incorrect
financial incentive payments to contractors. Third, a gap in
obtaining firsthand perspectives from examiners, a key
stakeholder group.
To address these issues, GAO made five recommendations. The
VA agreed or agreed in principle with each recommendation and
has described plans to address them. As of today, VA has made
some progress, but none of the five have been fully
implemented. VA needs to fully address these recommendations to
improve exam quality. Let us look at each of these
recommendations now.
Two of our five recommendations focus on VBA's efforts to
correct the most frequent exam errors and address the most
complex problems, such as claims dealing with military sexual
trauma and traumatic brain injury. For example, we found VBA's
oversight of contractors planned corrective actions lacked
procedures to follow up to determine whether they were
implemented and effective. Effectively addressing root causes
is critical for correcting the identified problems and
preventing future reoccurrences, all while fostering a culture
of a continuous improvement.
Two other recommendations deal with VBA's efforts to hold
contractors accountable by assigning financial incentives to
contractors based on their performance, which includes exam
quality. We found that VBA did not have written procedures for
checking the accuracy of its calculations for these incentives,
resulting in some mistakes. For instance, VBA overpaid almost
$2.3 million in financial incentives in the first quarter of
Fiscal Year 2024.
Our fifth recommendation focuses on collecting and
addressing feedback directly from examiners who perform these
exams and who provide a key perspective on exam quality issues.
We found that VBA did not collect feedback directly from
examiners. Five of the six examiners we randomly selected and
interviewed said that they would like the opportunity to
provide feedback directly to VBA. All six said unaddressed
concerns about quality made it harder to provide quality high
quality exams.
In summary, fully implementing our five recommendations
would help VBA improve exam quality, particularly by
identifying and correcting the most frequent errors and
tackling the most complex issues. Ultimately, improving the
contracted exam process would support accurate decisions on
claims and help veterans receive benefits they are entitled to
without delays.
This concludes my prepared statement, and I am happy to
address your questions.
[The Prepared Statement Of Elizabeth Curda Appears In The
Appendix]
Mr. Luttrell. The written statement of Ms. Curda will be
entered into the record.
Ms. Glenn, you are now recognized for 5 minutes to deliver
your opening statement on behalf of the Department of Veterans
Affairs.
STATEMENT OF MARY GLENN
Ms. Glenn. Thank you, sir. Good morning, Chairman Luttrell,
Ranking Member McGarvey, and distinguished members of the
subcommittee. Thank you for the opportunity to appear before
you today to discuss disability examinations administered by
the Department of Veterans Affairs. I am joined today by Tara
Flores, Director of Acquisition Service, Strategic Acquisition
Center.
Over the last several years, VBA has made concerted efforts
to improve the contract exam experience for our veterans while
simultaneously improving output and accuracy. During this same
period, several landmark pieces of legislation, such as the The
Sergeant First Class Heath Robinson Honoring our Promise to
Address Comprehensive Toxics (PACT) Act, were signed into law.
These pieces of legislation led to unprecedented increases in
the number of exams requested for veterans. Due to the
unexpected increase in volume, VBA took actions to address
these challenges, such as adjusting projections and contractual
obligations. This included collaborating with the GAO, internal
partners, Congress, veteran organizations, and others to
identify problems and generate solutions.
In Fiscal Year 2025, VBA completed over 3.3 million
examination scheduling requests. This resulted in over 4
million appointments and nearly 9 million disability benefits
questionnaires, or DBQs. During the fiscal year, the average
time to complete exams was 26.4 days, a marked improvement from
the 35.7 days in the prior fiscal year. Further, VBA's overall
veteran satisfaction score remained high among those who
completed the after visit survey. While we are proud of these
accomplishments, we recognize there is always room for
improvement. Therefore, VBA continues to enhance our internal
controls, grow our network of clinicians, and explore
opportunities to leverage new and existing technologies.
Recently, Congress extended the license portability
provision of the Isakson Roe Act, which allows contract
examiners to provide services in any State or U.S. territory
without having to obtain multiple licenses. This flexibility
has allowed VBA to extend service to rural veterans, Native
American communities, and support claims clinics throughout the
country. We want to extend our sincere thanks to the committee
and Congress for passing this provision. This provision is
critical to the success of our ability to perform examinations
closer to where the veteran lives.
VBA is most excited about the opportunity to modernize the
disability exam process by evaluating advanced tools and
technologies and reducing administrative burdens. A key area of
focus is to enhance our processes so that we can make more
decisions based on the information we already have. VA is
looking to leverage new technology to accomplish this. This
would enhance veterans' experience by reducing the potential
need to attend examinations.
Another area of interest is to increase the use of private
provider DBQs that are completed by local examiners. This could
help reduce the need to travel to an examination, thereby
improving veteran experience. Collaboration across the entire
enterprise and with our stakeholders is essential to ensuring
an efficient veteran-focused service. While VBA continues to
innovate and improve veteran experience, we must also realize
that there are additional improvements to be made.
We continue to partner with GAO to identify issues and
challenges and provide recommendations to improve our business
processes. In August 2025, GAO issued a report on improving the
quality of contract exams for veterans. I am pleased to report
that MDEO has recouped the overpayments mentioned in the
report, enhanced our methodology to prevent future errors, and
implemented all recommendations. As a result, we will be
requesting closure.
Mr. Chairman and Ranking Member McGarvey, I want to express
my appreciation for your continued support of veterans, their
families, caregivers, and survivors. We remain dedicated to
continually improving medical disability examinations, and we
are grateful for the authority Congress has given us to obtain
contract examinations for veterans and transitioning service
members.
This concludes my testimony. My colleagues and I are happy
to respond to any questions you or the subcommittee may have.
[The Prepared Statement Of Mary Glenn Appears In The
Appendix]
Mr. Luttrell. Thank you, Ms. Glenn. The written statement
will be entered into the hearing record.
We will now move to questioning.
Ms. Curda, MDEO failed to improperly implement quality
checks. As far as incentive pays, when was the first GAO report
asking VA to do that? What year?
Ms. Curda. We developed that finding in a report that was
issued this year in September.
Mr. Luttrell. This year?
Ms. Curda. Yes.
Mr. Luttrell. From what I understand, Ms. Glenn, you told
me that that is being taken care of, correct?
Ms. Glenn. Yes, sir.
Mr. Luttrell. How far along were we and how did we find
the--how did we find that discrepancy? That payment? I mean,
how did that show up? It went outbound. Who was looking at it
and found it?
Ms. Glenn. Actually, it was brought to our attention by
GAO. Based on that, we went back and audited all of our
incentives and disincentives that were paid since we changed
the incentive and disincentive structure. The structure was
changed in a modification in September 2021. We went all the
way back to Fiscal Year 2022 and checked everything and found
no other discrepancies.
Mr. Luttrell. Okay. Why did not the vendor say something?
Ms. Glenn. We determine----
Mr. Luttrell. Well, I mean, I got it. I probably would not
say anything either if you overpay me. $2 million. However----
Ms. Glenn. Yes, we determine how much money the vendor will
get or not get. The vendor does not tell us how much money they
should get for incentives. We tell them we have a quarterly
report, performance report, with them every quarter. We provide
them with the information and the details of their performance.
At that point, we tell them how much they should get, either an
incentive or how----
Mr. Luttrell. I asked you this question earlier.
Ms. Glenn [continuing]. disincentives.
Mr. Luttrell. How much should they have gotten?
Ms. Glenn. It was that $2.3 million was over two different
contracts. It varied based on the contract. I can get you the
specifics after this.
Mr. Luttrell. Okay, that has got to be interesting to see
how that happened. As far as course correcting this, my
question earlier was, is this one specific individual? Your
response was no.
Ms. Glenn. Yes, sir.
Mr. Luttrell. I want you to walk the committee through
that, please.
Ms. Glenn. The invoices come in from the vendors. They are
immense. That is beside the point. They are reviewed by the
contracting officer representatives, who then pass it on to
their lead for approval. Once that approval is done, the
funding packages are--are sent forward through a portal, and
they go to the Office of Financial Management, who controls the
portal. They do not do a check on it. Then it goes straight to
the Treasury.
Mr. Luttrell. The way I understand it, for our
conversation, is now there is a series of checks and balances,
internal----
Ms. Glenn. Yes, sir.
Mr. Luttrell [continuing]. internal to the VA.
Ms. Glenn. Yes, sir. Previously, this was----
Mr. Luttrell. That way, this problem does not happen again.
Now, my question is, two contracts for 2.3 million, plus or
minus, and incentive pay is--is for them to complete their job,
which we pay them to do anyway. Is that bonus included in the
initial contract? Or is that something that the VA say, hey,
this is a great idea. We are going to give you this to keep
going.
Ms. Glenn. No, sir. The incentive and disincentive
structure is built into the contract. If that is what you are
asking me.
Mr. Luttrell. It is, but you told--explain to me how that
works. You told me earlier, the VA creates that number that you
pay the specific corporation. If it was----
Ms. Glenn. Yes, it is based on----
Mr. Luttrell [continuing]. already in there----
Ms. Glenn. It is based on their----
Mr. Luttrell. Hold on for a second. If the number is inside
the contract, they would know how much they are supposed to
receive.
Ms. Glenn. They----
Mr. Luttrell. Correct?
Ms. Glenn. The number in the contract is a percentage. A
percentage of their invoice. So,----
Mr. Luttrell. Which is laid out in, I am assuming, phases.
They hit phase one and completed phase one, they would know the
percentage of the incentive pay that is coming their way?
Ms. Glenn. Yes, sir.
Mr. Luttrell. Okay, great. When they got $1.5 million more
than what that contract stated, you are telling me they did not
call you up and say, hey, you overpaid us $1.5 million?
Ms. Glenn. No, sir, because there are changes to the
invoice quite frequently. Some of the charges that they put on
the invoice may be erroneous, and we make them go back and
either correct them or----
Mr. Luttrell. Apparently, we missed that.
Ms. Glenn. Well----
Mr. Luttrell. If we paid them $2.3 million.
Ms. Glenn. How did the vendor miss it?
Mr. Luttrell. No, we did. I am sorry. The proverbial we.
The VA.
Ms. Glenn. Oh, yes, sir. It was at that point in time, a
manual process being reviewed by, as I said, a couple of
people. We have changed that now. We have an automated process
that is put into place. We have a statement of operations that
everybody will follow. It is a written statement. We have
checks in place. We also have an audit contract now.
Mr. Luttrell. Okay, Ms. Glenn, I will come back to that
question. Apologies. Ranking Member.
Mr. McGarvey. [inaudible].
Mr. Luttrell. Thank you. Continue.
Ms. Glenn. We have an audit contract in place, and we are
working with VA's data team to further refine our reports and
provide us with an additional check on the invoices.
Mr. Luttrell. Okay. We just created this recently and we
have been doing this for a very long time?
Ms. Glenn. Yes, sir. That has been something that we have
been trying to do.
Mr. Luttrell. Okay. Thank you. Mr. McGarvey, sir, you are
recognized.
Mr. McGarvey. Thank you, Mr. Chairman. Ms. Glenn, we will
just stick with you. How much money does MDEO pay contracted
medical examiners annually?
Ms. Glenn. Sir, we do not pay the examiners. We pay the
vendors, and the examiners are subcontracted through the
vendors.
Mr. McGarvey. How much do you pay the vendors?
Ms. Glenn. It is dependent upon how many exams they
complete for us. It varies by region and by location. Rural
areas will not cost as much as New York City, for example. It
depends on the type of examination.
Mr. McGarvey. What is the total?
Ms. Glenn. The total for exams, let me get back to you on
that, sir.
Mr. McGarvey. Okay. How many exams are they conducting per
year?
Ms. Glenn. Last year, we did 3.3 million exams.
Mr. McGarvey. 3.3 million exams. That is nationwide?
Ms. Glenn. Yes, nationwide and internationally.
Mr. McGarvey. Okay. You are telling me that there can be
different costs depending on where those services are. Fine. We
do want to know how much you are paying total, every year, in
this. Do you know roughly what the cost is per exam?
Ms. Glenn. I do not, off the top of my head.
Mr. McGarvey. Okay.
Ms. Glenn. Let me take that back.
Mr. McGarvey. Do you know what--do you know whether it
would be cheaper, or the same price, or more expensive if those
exams are done by Veterans Health Administration (VHA)
employees?
Ms. Glenn. I do not have that information right now, sir. I
will say that every exam request that comes in hits against VHA
first, and it only comes to the contract if VHA does not have
the capacity to complete that examination close to the
veteran's home.
Mr. McGarvey. Right. You will get us the information----
Ms. Glenn. Yes, sir.
Mr. McGarvey [continuing]. about the difference and how
much it costs? Okay, good. The program you are overseeing is
really large, and we are getting that by some of the answers
you do not have today. Do you have everything you need to
properly oversee this program at this point?
Ms. Glenn. Yes, sir. I mean, there is a lot of improvements
that we want to make. As I pointed out in my opening statement,
there is a lot of technology that we want to check out and see
if it can help us improve our process. We thank you so much for
the license portability extension. That is a major thing for
us, and it really helps us be able to provide exams in rural
areas and across the country.
Mr. McGarvey. I asked you if you have everything you need.
You said yes, and then you told me the things you want. I am
going to ask you again, do you have everything you need to
properly oversee this program?
Ms. Glenn. There is always room for improvement, sir.
Mr. McGarvey. Okay. Okay. Let us know what those are.
Ms. Glenn. Okay.
Mr. McGarvey. You know, we--we want to make sure that our
veterans are being taken care of and that taxpayer money is
being taken care of, and we can do both of those things at the
same time.
I understand that MDEO lost a lot of staff at the beginning
of the year. Have you all replaced those employees?
Ms. Glenn. We have enough staff right now to continue to do
our primary mission. We did lose some people. Some were
expected retirements. We--we are still keeping on and we
continue to be able to provide examinations for veterans and
keep track of those examinations.
Mr. McGarvey. That was a government answer. You have lost
employees, you say--I get it. We are not--we want to take care
of our veterans. We want to give you the tools you need to take
care of our veterans. What happened? What do you need?
Ms. Glenn. Again, I would say that we are going to be able
to do that. We are hopeful that a new organization chart will
be coming out shortly, and we will see what that looks like.
We--but we have enough people right now to continue our primary
mission.
Mr. McGarvey. Okay. We will keep hitting on some of this
stuff. We want to get to the bottom of it, not just have the
government speak here in this committee.
There are a lot of cuts because of Department of Government
Efficiency (DOGE) earlier this year, and there are a lot of
contracts that were cut. MDEO had several significant contracts
canceled, including one to conduct financial audits and invoice
validations, and one to collect data from veterans and their
experiences. Has the VA restored any of these contracts and or
otherwise replaced the capacity to do so?
Ms. Glenn. Yes, sir. We were able to restore the financial
audit contract. It is now in place. We are working with the
Veterans Experience Office, and they have helped us develop a
new survey, which started going out to veterans the first week
in September.
Mr. McGarvey. Okay. Ms. Curda, I am going to ask you a
question really quickly. I understand that you all were
tracking those cancellations as well in your August 2025 GAO-
25-107843 report. GAO said VA should do a better job making
sure its contractor incentive payments are calculated
correctly. Does that answer line up with what you all are
seeing? Do you feel that MDEO needs those services, whether
contracted or in-house, to do proper oversight? You have very
little time, and I apologize.
Ms. Curda. Yes, I think those contracts are necessary. They
factor into the incentive payments, which consists of quality,
timeliness, and customer experience. If you are missing the
people who validate the timeliness measures, if you are missing
the customer experience measure, then you are--you are not
going to be able to calculate the performance incentive payment
and or they may be incorrect. I think they are important. Just
I want to point out that the Veteran Experience Survey was
recommended by the IG as to be done externally to the agency. I
do not know, I think, maybe now it is being done internally.
Mr. McGarvey. Thank you. Mr. Chairman, I yield back.
Mr. Luttrell. Thank you, Mr. McGarvey. General, you are
recognized for 5 minutes, sir.
Mr. Bergman. Thank you, Mr. Chairman. Let me make a generic
statement here first. Bureaucracies, good bureaucracies, are
necessary and Okay. We need that. Stovepipes, not so much. What
I am hearing here is seems to be some really solid effort
within a bureaucracy to look at and manage stovepipes that
detract from the value of the outcome.
In recent months, I have heard from veterans and Veterans
Service Organizations (VSO) in my district that critical
medical evidence meant to support a veteran's claim is not
consistently reaching compensation and pension examiners at the
VA. When a veteran's service representative flags certain files
for an examiner, I have heard that these files reach the
medical examiners enlarged, unorganized, dense, basically,
packets that show no level of help for that person who is going
to look at them next. When that evidence does not reach the
examiner or is not properly organized, exams are conducted
without key facts. I think we would all agree, DBQs could be
completed inaccurately, leading to a denial by the VBA.
Combined with GAO's findings on exam oversight gaps and delayed
quality reviews, it is clear that there is some systemic
breakdowns affecting those veterans' outcomes.
I am trying to understand what causes the breakdown, you
know, as a, I guess, thinking as a pilot, we have to do things
in certain orders. Checklists, complete checklists, to ensure
that the flight is flown safely. Then after it is flown, we do
a maintenance log to make sure that that plane is ready for the
next crew.
Along those lines, Ms. Curda, is VA's Medical Disability
Examination Office responsible for overseeing the DBQs?
Ms. Curda. Yes, they are.
Mr. Bergman. Okay. Based on your audit work at GAO, to what
extent might missing evidence contribute to DBQ errors,
inaccurate exams, or improper denials?
Ms. Curda. Yes, it would contribute to those things if that
is occurring. Yes.
Mr. Bergman. Okay. Ms. Glenn, when a compensation and
pension examiner is assigned a case, what information that may
be submitted by a veteran or VSO are they able to see?
Ms. Glenn. Yes, sir. If it is in the veteran's claim
folder, everything is sent over to the examiner.
Mr. Bergman. Okay. Then what quality controls are in place
to verify that required evidence appears in the exam packet
before the examiner conducts the evaluation? Have they got the
whole maintenance log on this veteran?
Ms. Glenn. Yes, sir. It is done automatically. As soon as a
veteran is scheduled for an examination, it is an automatic
push to the vendor. The entire file goes over.
Mr. Bergman. The push is automatic. How is the vendor's
evaluation of the data in front of verified that they had it
all?
Ms. Glenn. To your point about marking things, the claims
processors review, also review the file, and they do tab
evidence that could be relevant. It is the examiner's job to
review the entire file. We do check and make sure that the
entire file goes over.
Mr. Bergman. Is it a random check or 100 percent check?
Ms. Glenn. I could not tell you that, sir. I will have to
get back to you.
Mr. Bergman. Okay. Well, Ms. Glenn, will MDEO commit to
reviewing the process and form in which medical examiners
receive a veteran's supporting documents? It would be basically
standing there looking when that uniquely organized packet
shows up?
Ms. Glenn. Yes, sir.
Mr. Bergman. Okay. Well, again, I see my time is about to
run out. We know one thing for sure, veterans never quit. We
cannot quit on the veterans. We have to continue to refine the
oversight and the detail of that oversight in an ever-changing
world where we use the processes available to us now to be
better at what we do on the veterans' behalf, because they are
counting on us.
With that, Mr. Chairman, I yield back.
Mr. Luttrell. Thank you, General. Mr. Pappas, sir, you are
recognized for 5 minutes.
Mr. Pappas. Thank you very much to the Chairman and Ranking
Member for holding this session.
Ms. Glenn, if I can start with you. We heard from Ms. Curda
before about a recommendation around the non-collection of
feedback from examiners who want to offer it to make sure that
they are giving feedback to VA, that things are moving ahead
for veterans as quickly as possible, and that processes are
being improved. You said that you implemented all
recommendations. Can you speak to how you are collecting
feedback from examiners and what value you think that is going
to provide?
Ms. Glenn. Yes, sir. Thank you. Yes, we have established a
portal for the examiners to be able to come directly to MDEO
and provide us with feedback. The portal was announced on the
learning management system that we give--that all the examiners
have access to. As well as we had the vendors put out an
announcement that the portal was live and ready to go. We also
sent emails to each of the examiners and told them individually
that the portal was live and here was the link. The portal was
live by the end of September. I have a staff of people who are
regularly reviewing the questions or answers. We have even
gotten compliments coming through the portal. We are looking at
all of those as they come in. If there is anything that needs
action, we are referring it to the proper place. So far, it has
been successful.
Mr. Pappas. You are not proactively soliciting that
feedback by going to the examiners. It is sort of like a
suggestion box where examiners can just submit on their own?
Ms. Glenn. Well, you know, we did send them an email and
let them know that it was live, and we had the vendors tell
them all on in their chain. We also it is a flag across the top
of the learning management system with the link that they can
click on and give us the extra information.
Mr. Pappas. Okay. Well, I would be interested to see how
that is working and if that is giving you some constructive
information that you can then use to help improve processes.
I want to ask about another thing that is a pain point for
veterans. We hear about it all the time in our office, and that
is scheduling. In September of this year, a Navy veteran from
the town of Freedom, New Hampshire, who is 100 percent service-
connected and battling cancer, contacted our office because she
was in pain, needed medication, could not get her exam
rescheduled. Days later, she contacted us again because another
appointment was suddenly canceled because VA failed to send the
medical records to the contract examiner. Her experience is not
unique. We hear routinely from veterans experiencing roadblocks
and trying to secure, reschedule an appointment. Contracting
out the exams was supposed to speed things up to get benefits
to veterans faster. This is not what a lot of veterans who are
reaching out are experiencing.
Ms. Glenn, what options do veterans have when they are
assigned an appointment at a time or location that they cannot
attend? Why is rescheduling so difficult when we know that
veterans are going to bear the consequences if they cannot make
it?
Ms. Glenn. Yes, sir. We realize that it is a pain point,
and we are working very hard to try to make it a better place.
We are looking at some automation, some technology that would
allow us to see across the board all appointments that would be
available to a veteran in a specific time and date, so that
they could then choose the appointment that is most convenient
to them. This is something that VHA is already using, and we
are working very hard to plug into that piece of technology.
Mr. Pappas. You mentioned location of exams, too, and we
hear about this from veterans. Driving 50 or 100 miles does not
work for some veterans. The veteran I referenced earlier
experiences hip issues and long car rides bring her significant
pain. We should be making this process easier. I am wondering
if you can speak to the ways that VA monitors coverage gaps in
terms of geographic areas and how you evaluate those? What
steps VA can take to get these exams closer to home for
veterans?
Ms. Glenn. Yes, sir. One of the things that we do, the
contract allows 50 miles for a general medical exam and 100
miles for a specialty exam. If the veteran has to travel beyond
those limits, they have to have consent from the vendor--to the
vendor, to us, that they are willing to travel those additional
miles.
We have done all kinds of things. We have--the vendors have
mobile units, medical mobile units, that travel circuits
throughout rural communities so that they can provide exams
where the veterans live. I talked about the License Portability
Act and how important that is to us. We are looking at every
way possible to try to make this more convenient and less
stressful for veterans.
Mr. Pappas. Appreciate the feedback. My time is up, so I
yield back.
Mr. Luttrell. Thank you, sir. Dr. Morrison, you are
recognized for 5 minutes.
Ms. Morrison. Thank you, Mr. Chair, and thank you to our
witnesses for being here today as we discuss the Medical
Disability Exam Office and consider what its best practices
should be moving forward. We know the PACT Act was a huge step
forward in providing our veterans with the care and benefits
that they have earned and deserve. We also know that it greatly
increased the administrative burden on the VBA and MDEO. I am
looking forward to hearing more about how VA has navigated
these and other challenges over recent years.
Ms. Glenn, in your testimony, you referenced that MDEO is
evaluating advanced clinical and evidence review tools that
have the potential to reduce in-person examinations, improve
consistency, and accelerate outcomes for our veterans. Could
you share more about what tools you are looking at and how you
plan to streamline the claims process while also ensuring that
every veteran continues to get a fair review of their claim?
Ms. Glenn. Our intent is to reduce the number of in-person
examinations that are needed. We want to be able to rate or
make a decision for the veteran based on the evidence that they
submit to us, that is already of record. That is one of the
things that we are looking at, technology-wise, on how to do
that best. We are actively pursuing and looking at different
options and talking to the experts about the best way to move
forward.
Ms. Morrison. Okay, thank you. VSOs can play a critical
role in helping transitioning veterans apply for and obtain
their benefits. You know, as I was reading through The Veterans
of Foreign Wars of the U.S. (VFW) statement for the record,
their observation about multi-year MDEO contracting caught my
eye. Their case was that moving from a 2-year contract cycle to
a longer-term model could save money and improve outcomes for
veterans by reducing contractor turnover and incentivizing
contractor investment, improved technology, and workforce
development. I guess this is to all of you. Do you agree with
VFW's assessment and what are your impressions of the current
contracting model versus a multi-year model?
Ms. Glenn. Yes. Yes, to a certain degree. Often, there are
technological changes that will require us to get a new
contract. Traditionally, yes. I will tell you, we are already
working on what will be considered a multi-year contract.
Ms. Morrison. Ms. Curda.
Ms. Curda. That was my understanding as well that they are
have started on a contract that I think goes for 10 years. Is
that correct?
Ms. Glenn. That is still up.
Ms. Curda. Oh, still up. Okay. Sorry.
Ms. Morrison. Okay.
Ms. Curda. Yes.
Ms. Morrison. Okay. Ms. Glenn, I want to close by asking
you about an Inspector General report from September that found
that 29 out of 100 VHA medical opinions reviewed were provided
before the examiner had completed PACT Act training. What steps
are being taken to ensure examiners complete their PACT Act
training and that any erroneous claims are being reviewed and
rectified?
Ms. Glenn. Yes, ma'am. I can speak to VBA. I believe there
were only three contract examiners who were found to have not
completed their training. To your point, we review all VBA
contract examiners' training on a monthly basis. The vendors
are required to provide us a list of all of their active
examiners every month, and we run that against our learning
management system to ensure that all of the examiners have
completed their training before they start to complete exams.
Ms. Morrison. Thank you, ma'am. Thank you, Mr. Chair. I
yield back.
Mr. Luttrell. Thank you, ma'am. How much, Ms. Glenn, how
much money did the VA collect in penalties last year?
Ms. Glenn. Sir, I do not have that information. We are
still going through fourth quarter information. As soon as we
have completed that, I will let you know.
Mr. Luttrell. There is no, well, we found all the incentive
pays that we do not--we are not tracking that in parallel?
Ms. Glenn. Well, the incentive payments for fourth quarter
have not been awarded yet.
Mr. Luttrell. The 2.3 million that went maybe--Okay, let me
back the year up then. The 2.3 million overpayments----
Ms. Glenn. Was from 2024.
Mr. Luttrell [continuing]. you would have found the--you
would have found the penalty--penalties as well, correct?
Ms. Glenn. Yes, sir.
Mr. Luttrell. How many were there?
Ms. Glenn. For 2024?
Mr. Luttrell. Yes.
Ms. Glenn. Okay, I will have to get back to you.
Mr. Luttrell. What is the probability--did the two
corporations, or the two companies, or the two vendors, excuse
me. Did the two vendors that received the overpayment, were
they ever hit with penalties?
Ms. Glenn. Yes, sir.
Mr. Luttrell. They were? That magic number would not happen
to be the same amount as the overpayment, would it?
Ms. Glenn. No, sir.
Mr. Luttrell. Are we certain?
Ms. Glenn. I am positive. almost positive that it is not
the exact same number, but it----
Mr. Luttrell. Plus or minus $5, maybe?
Ms. Glenn. Sir, I cannot say off the top of my head. I will
be happy to get that for you and give it back to you.
Mr. Luttrell. Okay. I just want to make sure that the
vendors are not taking advantage of the situation.
Ms. Glenn. Yes, sir. Understand.
Mr. Luttrell. I am sure you can appreciate that.
Ms. Glenn. Yes, sir.
Mr. Luttrell. As far as examiners go, when they respond to
the portal, who is the staff, your staff, responding directly
to the examiners?
Ms. Glenn. Oh, yes, sir. In some instances, we have, if the
situation warrants. As I said, a lot of, I mean, as I said,
some of the things that we have gotten have been compliments.
Some of it has been suggestions. Some of it--there is just a
whole wide variety of things that they are----
Mr. Luttrell. Are the examiners----
Ms. Glenn [continuing]. about.
Mr. Luttrell [continuing]. apprehensive about responding to
the portal in fear of--I should not say it that way--because of
maybe retribution from the vendors?
Ms. Glenn. The vendors--the vendors do not get this
feedback unless we give it to them, and we----
Mr. Luttrell. Well, they are going to have to eventually,
because if the examiners are contacting the VA about a problem
set, the vendors are going to eventually have to find out of it
because they are the ones telling the examiners what to do.
Ms. Glenn. Right. The examiners have the ability to come
back to us through the portal anonymously if they choose to.
Mr. Luttrell. Sure.
Ms. Glenn. There is a text box where they can type out
whatever they feel like they need to say.
Mr. Luttrell. I got it. I am kind of worst-case scenario in
this, which usually has a tendency of playing out around here.
If you go to a vendor and say, hey, we recognize there is a
problem, well, the first question the vendor is going to ask is
like, well, how did you know about that?
Ms. Glenn. Right. We would tell them we got it through the
exam portal. I do not believe----
Mr. Luttrell. You cannot say that because then they are
going to know who sent it.
Ms. Glenn. Well, not necessarily, sir. They have thousands
and thousands of examiners that work for them.
Mr. Luttrell. Okay. Probability, got it. Okay. Do you have
any further questions?
Mr. McGarvey. [inaudible].
Mr. Luttrell. Okay, I recognize you. Go ahead. Yes, sir.
Mr. McGarvey. Thanks, Mr. Chairman. I appreciate that. I
have got a few questions for you. First, I mean, look, I am
just going to tell you how it feels up here a little bit today
because our mission is taking care of veterans. It feels a
little bit like you all just want to write a check and say that
these exams happened, and then not really figure out everything
that is happening with them or how they are benefiting our
veterans. We want to make sure that this is working and that is
working for our veterans. That is the point of this hearing.
That is what we want to see happen. We need you all's help with
that.
Ms. Glenn, I am going to go back to you with a couple of
specific questions. The Paralyzed Veterans of America wrote in
their statement for the record today that their concerns
regarding the accessibility of exam locations. In the wake of a
2024 Office of Inspector General (OIG) report on the matter,
they cited that more than half of the 135 facilities they
visited had accessibility barriers. This is obviously a problem
when you were talking about screening for veterans with
disabilities, not having accessibility at the places where they
are going for the screening. What actions is the VA taking to
ensure that they are providing adequate oversight to the
contractors and the facilities that they occupy?
Ms. Glenn. Yes, sir. We, well, it is twofold. First of all,
we require that the vendors examine each facility that they
send veterans to. Second, we then go back and do site visits,
surprise site visits to these facilities. In Fiscal Year 2025,
we were able to do 159 site visits. We plan on doing more in
Fiscal Year 2026. We have a plan in place, and we will
hopefully be able to soon execute it.
Mr. McGarvey. Okay. Again, this is an OIG report. This is a
statement in the record today, that of the 135 they visited,
half had accessibility issues.
Ms. Glenn. Yes, sir.
Mr. McGarvey. You are telling me that the vendors are
certifying that these--these venues do not have accessibility
issues? I mean, half? That is a pretty big statistical sample
out of 135 locations.
Ms. Glenn. Yes, sir.
Mr. McGarvey. I am not saying that that carries out across
all locations. Then your answer kind of says, we are doing
these things, we are doing these things, but half are not. How
are you getting feedback directly from our veterans who use
mobility aids? How are you actually finding out about this? Was
this OIG report a surprise?
Ms. Glenn. Yes, sir, I would say so. One of the things that
we have done is we have required the vendors, when they contact
the veteran, to make sure that they ask them do they have any
accessibility issues. That they should not be sending a veteran
with accessibility issues to a facility that cannot handle. We
look at this--we take this very seriously, which is why we send
in-house staff who have taken U.S. Occupational Safety Health
Administration (OSHA) and The Americans with Disabilities Act
(ADA) training to go out and look at these facilities and make
sure that anything that is wrong, such as the fire escape map
is not on the wall, is corrected immediately, if not----
Mr. McGarvey. We want that, but there still seem to be
major problems. You are mentioning, like, even a fire escape
map on the wall. We are hearing what I would consider to be
horror stories about exams being conducted in inappropriate
locations, such as hotel rooms. Can you confirm that these
types of practices have been stopped completely? If not, why?
If they have, what is VA doing to find out about these and
address them? How did you do it?
Ms. Glenn. We have tightened up quite a lot on what our
requirements are for the examination space. I have not heard
anything lately. I would welcome anything that any of you see
along this issue to be brought to our attention so that we can
take action. We do have a plan. We do have a way of
investigating. You know, we want our veterans to feel safe and
accommodated when they go to the exams.
Mr. McGarvey. This is a massive program, and we are hearing
way too many stories of how it is not working for our veterans
and that we have a bunch of vendors out there who may or may
not be getting you all the information you need. There needs to
be more oversight.
Really quickly, VA conducts special focus reviews to try
and reduce errors on exams from most complex claims, including
traumatic brain injury, military sexual trauma, and Gulf War
illness. Ms. Curda, you testified that VA plans to change the
tempo of these reviews from a 2-year to a 3-year schedule. Will
the 3-year schedule allow the MDEO to meet its oversight goals?
Ms. Curda. Well, according to their own analysis, they--
they would have preferred to keep this to a 2-year schedule. We
were told due to staffing reductions, they could--they could
not do that. We were happy to see it change to a 3-year
schedule rather than no schedule or, you know, erratic
schedule.
I think the, you know, on the con side, you know, the
purpose of these things is continuous improvement. If you wait
another year to look to see if what happened in the first round
of reviews is corrective actions that were identified. If you
wait another year to see if they have been implemented and
whether they are effective, you lose that opportunity to take
course corrections and make changes. I think there is a
downside to waiting another year. You miss opportunities and it
could result in inaccurate claims.
Mr. McGarvey. I have a hard time believing less is more in
this case. I also want to say that you said part of this is
about staffing issues. It seems like, as part of this hearing,
you guys are telling me you do not have staffing issues. This
is a problem. Our veterans need to find the front door to the
VA, and this is often the way it happens. We need to make it
easier for them to walk in and get the care that we promised
them. They put on the uniform, and we have seen what our
veterans have done for us in the last 20-25 years and what they
have sacrificed for us. In exchange for that, we made them a
promise. It is not just a legal promise; it is a moral promise
that we would take care of them. It sounds like they are not
living up to that with this program right now. We need to do
better.
Mr. Luttrell. Thank you, sir. Mr. Self, you are recognized
for 5 minutes, sir.
Mr. Self. Thank you, Mr. Chairman. I want to get at the
errors and the payments. What is the max percentage of the
contract that can be rewarded?
Ms. Glenn. The max percentage is 3 percent of the invoice.
Mr. Self. Of the invoice. Okay. On the two--the two errors
that resulted in overpayments, what was the total invoice
amount of those two errors?
Ms. Glenn. Sir, I do not have that information at hand.
Mr. Self. Okay.
Ms. Glenn. I will get back to you.
Mr. Self. Okay. I did the--I did the backward math. If you
paid out $2.3 million and 3 percent of the invoice amount--was
it the full 3 percent?
Ms. Glenn. I am not sure, sir.
Mr. Self. Okay, let us assume that was full 3 percent. That
means that the invoice amount for those two contracts was $76
million.
Ms. Glenn. Yes, sir.
Mr. Self. We have got $76 million contracts that were--did
not have enough oversight. This is indeed a problem. I think
you have already addressed this about the time I left, how many
people were reprimanded for the 2.3 million overpayment?
Ms. Glenn. The people involved are no longer employed with
VA, sir.
Mr. Self. That is a pretty good reprimand. Have you changed
vendors because of it?
Ms. Glenn. No, sir.
Mr. Self. What is the total? If these two contracts are $76
million, which had errors that got rewarded for $2.3 million,
what is the total contract on those two vendors? Is it two
vendors or two mistakes and one vendor?
Ms. Glenn. I will have to get back to you on that. I told
Chairman Luttrell that I would get him the amount spent on
examinations. Two contracts for sure.
Mr. Self. Two contracts. Might be one vendor, two
contracts. Chairman, I yield back.
Mr. Luttrell. Thank you, sir.
Ms. Curda, explain to me the TBI scheduling that you and
the Ranking Member were speaking on from 2 to 3 years, please.
Ms. Curda. This is part of MDEO's quality control process,
is to feed to the contractors the most frequent errors in a
given quarter. Oh, actually, I am sorry.
Mr. Luttrell. Specifically, around traumatic brain injury.
Ms. Curda. Yes, yes. Those were the special focus reviews.
This is a review that they planned to do every 2 years. What
they do is they take a deep dive on the traumatic brain injury,
and to see what are the root causes of the errors in those
types of exams, and then work on corrective actions with the
vendors. The idea being that then they would come back after 2
years and see, Okay, what is happening with those errors.
Then,----
Mr. Luttrell. Wait a minute. Explain an error to me,
please.
Ms. Curda. In the exam. An examiner filling out the DBQ for
traumatic brain injury would make errors, and they would--these
particular types of exams and these particular types of DBQs
are more prone to error. It is getting at the root causes of
those frequent errors and correcting them.
Mr. Luttrell. Let me ask you this. I have a background in
neuroscience. Right now, it is every 2 years advancements in
neuroscience. It flexes its muscle every day. Matter of fact,
when I went through grad school, everything that I learned in
grad school is no longer correct. We have built off of that
information. We have the ability to identify traumatic brain
injuries at the granular, more toward the granular level. Okay?
In depth, at scale. If an individual walks in with or submits a
DBQ this year with neurological scans and assessments,
cognitive assessments, and the examiner says you are good to
go. He has, he or she, most likely will have to wait 2 years
for--in 2 years, that scan may show something that is 100
percent debilitating. Is that how long we have to wait?
Ms. Curda. Are you asking me or Ms. Glenn?
Mr. Luttrell. I am asking the panel this question. If you
are not interested, if you do not understand what I am asking
you, I will clarify it. My concern is you are trying to kick it
out to 3 years. Now, there is things that we can identify today
that will kill somebody in 3 years that we did not know about 2
years ago. Is it that MDEO's office request to kick it out the
3 years?
Ms. Glenn. Yes, sir. These special focus reviews do not
prohibit us from--we do not have to wait for the special focus
review if there are medical changes that are happening that are
going to change the way we look at a veteran's disability. You
know, our doctors, our examiners----
Mr. Luttrell. The special focus review will be handled by
an examiner, pushed back up to the vendor through the VA for
the claim, and if the examiner does not find anything, sends it
back to the vendor and back into the VA, and the claim is shot
down?
Ms. Curda. Just to clarify, the special focus reviews do
not look at--are not about individual claims. It is about
trends.
Mr. Luttrell. Trends.
Ms. Curda. It is like looking across----
Mr. Luttrell. Even better.
Ms. Curda. [continuing]. all of the exams that were done
and what were the most frequent errors. It is sort of like a
continuous improvement process.
Mr. Luttrell. Do we have any idea if the special focus
reviews that were conducted 4 years ago, have there been--have
we noticed any change in those compared to veterans today that
have a neurological disorder or neurological disease or a
traumatic brain injury?
Ms. Curda. Well, that is what we are saying has not
happened because they have not done the next round.
Mr. Luttrell. We still think bumping it up for 3 years
instead of 2 is a good idea?
Ms. Curda. Uh----
Mr. Luttrell. Ms. Glenn. You are in charge.
Ms. Glenn. Yes, sir. We are doing what we can with our
resources and----
Mr. Luttrell. No. No, no, no. You are walking around the
question. You are actually dancing where Mr. McGarvey is
hitting you on. Do not give me the political answer. I am
literally trying to save lives here.
Ms. Glenn. Yes, sir. I will tell you that there are
additional things that we use besides the special focus review.
We do monthly----
Mr. Luttrell. Oh, you are walking around it again. I am
asking you about the 3-to-2-year. Matter of fact, I think you
should bump it back to 6 months or a year when it comes to
traumatic brain injury. That is my opinion. My opinion only. I
want you to take a hard--cannot ask you to do that. I disagree
with 3 years.
Ms. Glenn. Yes, sir. Understood.
Mr. McGarvey. I appreciate Mr. Chairman's line of
questions. I just want to ask really simply, and I want a
simple answer because it is a--it is an important question.
Just simple to me. It is not (phonetic) important. Is it better
or worse for our veterans to go from 2 years to 3 years?
Ms. Curda. I would say worse.
Mr. McGarvey. Thank you. Mr. Chairman, I yield back.
Mr. Luttrell. Mr. Self, you are recognized now for 5
minutes.
Mr. Self. Thank you, Mr. Chairman. I want to follow up on
your trends comment because apparently, four out of the six
examiners that they examined said they no longer elevate
challenges to their vendors because their vendors do not listen
to them. How then do you establish trends if your examiners are
not sending their feedback to the vendors? How do you develop
trends? Is this a paperwork drill or is this actual feedback
from the field?
Ms. Curda. Well, I will let Ms. Glenn answer. I mean, our
observation is they do have processes in place to identify
errors within MDEO through their review processes and so forth.
It is--but it is a perspective that is missing, the examiner's
perspective. They felt that they were not being listened to by
their contractors. They were not always given good advice. They
felt they knew more sometimes than the contractor's quality
assurance staff knew, and they--that they would like to give
that feedback to VA.
Mr. Self. Then, once again, that is pretty damning
testimony. Once again, how do you establish trends if you are
not accepting feedback from your examiners?
Ms. Glenn. Based on the GAO recommendation, we did develop
an examiner portal, which is live as of the end of September.
We have been collecting feedback from the examiners. It is an
open text box. They can type in whatever they feel like they
want us to know.
Mr. Self. You have got 2 months of data. Mr. Chairman, I
yield back.
Mr. Luttrell. Thank you. Ranking Member, you are
recognized, sir.
Mr. McGarvey. Thank you, Mr. Chairman. I appreciate this.
This is a really important hearing because we are spending
billions of taxpayers' dollars every single year on this
program, covering millions of exams for our veterans and paying
out millions in incentives, nearly 20 percent of which were
wrong.
Right before this, I had a Small Business Committee hearing
this morning. I will put the small business hat on here. Can
you imagine if you were running a small business, let us say a
diner or something, and 20 percent of the meals you sent out
from the kitchen were wrong? The business is not going to last
very long, or at the very least, the cook is going to get
fired. That is a massive problem to have 20 percent wrong, and
we cannot tolerate that level of inaccuracy when it comes to
serving America's veterans and protecting our taxpayers.
Chairman Luttrell, I look forward to continuing to working
with you to do something, an upcoming roundtable, or some sort
of event. Maybe we can hear directly from the contracted
companies. I think with these for-profit companies controlling
90 percent of the exams, we need to hear from them what
controls they have in place and how they are fixing these
problems, as well as hearing from you all.
Mr. Chairman, we have all heard concerns in this room,
because in this room, we get together to help our veterans
about the need to sell veterans on the VA. Numerous veteran
service organizations and veterans themselves have spoken to us
about the challenges that veterans face with the C&P exams. If
we want to ensure that veterans have trust in the VA and are
comfortable seeking it out for care, then we should start by
ensuring that their very first interaction with the system is a
welcoming and assuring one.
I think about the veteran who is transitioning to civilian
life, showing up to a compensation exam for military sexual
trauma, and walking into a hotel room for their exam. This
might sound far-fetched, but it has happened. We are getting
these stories. Yet, in that exact scenario, a military sexual
trauma survivor walking into a hotel room for an exam, if the
contracted provider gets the paperwork right, and they get it
in, they will get their incentive pay. Is this the standard of
care that our veterans should experience or that we want to
incentivize? I want to ask the contractor providers what
controls they--not the VA reviewing numbers from the central
office--but what controls they themselves have done to
adequately ensure our veterans are safe, cared for, and being
seen in an appropriate professional setting.
I also want to make sure that our veterans are getting the
reviews and care they need. When we hear today that reviews are
moving from every 2 to 3 years and that that is, by your own
testimony, worse for veterans, we have to do something about
that. Let us bring in the heads of these companies, let us get
together, let us make sure that our veterans, the men and women
who were willing to sacrifice everything for our safety,
security, and freedom, received the promise we gave them that
when they took that uniform off, we would take care of them. It
is exactly what we want to do. It is exactly what we need to
get done on this committee.
Thank you, Mr. Chairman. I yield back.
Mr. Luttrell. Ms. Glenn, your office has a very large
responsibility. I am sure you are--you are kind of feeling that
right now in this hearing. I want to thank all three of you for
what you do for our veterans. I say this every committee
hearing, you wake up every day, you go in and you do and you do
what you can for us. We pay attention. Myself to that veteran
sitting right there, to the other veterans that are on this
committee and abroad, I have almost 40,000 veterans in my
district. I can assure you, the most aggressive group in my
district are my veterans, are my brothers and sisters. They
talk to us because they have every right to get what they have
earned by putting on that uniform and fighting for this
country. Every one of them.
There is always going to be mistakes. The human element and
the human error. It exists. It does. Your office is
responsible. You in charge are responsible for oversight in
your office. Ms. Curda has pointed out quite a few, and I know
that you are working on it, and I appreciate that. We will
never let that be enough. It will never be perfect. We will not
stop fighting for perfection because of those that we are
responsible for taking care of, because they never asked
anything of anyone when a round was going by their head, or
they were dragging their buddy or brother or sister out. They
never did that. That is why we do what we do. That oversight
goes a long way.
You will be back here in front of us. We will ask these
questions again. I expect it will not be the same answers. Ms.
Curda will keep us read in. I hate to tell you this, but you
are absolutely pinging hard on my radar because of every
veteran that you touch, do not ever forget that is what you are
doing. Okay? Staff included.
I ask unanimous consent that all members have 5 legislative
days to revise and extend their remarks and include extraneous
material. Without objection, so ordered. This hearing is
adjourned.
[Whereupon, at 1:09 p.m., the subcommittee was adjourned.]
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A P P E N D I X
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Prepared Statements of Witnesses
----------
Prepared Statement of Elizabeth Curda
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Mary Glenn
Chairman Luttrell, Ranking Member McGarvey, and distinguished
members of the Subcommittee, I appreciate the opportunity to appear
before you today to discuss the medical disability examinations (MDE)
conducted by VA. Accompanying me today is Tara Flores, Director,
Acquisition Service, Strategic Acquisition Center.
Today, I will provide updates on VBA's oversight of Compensation
and Pension (C&P) examinations, including how we hold contract vendors
accountable. I will also provide an update on implementing
recommendations made by the U.S. Government Accountability Office
(GAO).
Medical Examination Production
Under a new Administration, VBA had a record-breaking year for
disability compensation claims processed, with over 3 million claims
completed in Fiscal Year (FY) 2025. To support this high volume of
production, VBA also completed a historic number of medical exams.
Notably, over 93 percent of exams are conducted by VBA contract medical
disability examination vendors. We remain committed to ensuring
Veterans and Service members receive high quality and timely disability
claim decisions, supported by high quality medical examinations. During
Fiscal Year 2025, VA completed over 3.3 million examination scheduling
requests, a 5.5 percent increase from the same period in Fiscal Year
2024. The average days to complete exams in Fiscal Year 2025 was 26.4
days, an improvement from 35.7 days compared to the prior year.
Contractual Oversight
Vendors are evaluated on performance metrics such as timeliness,
production, and quality. Vendors receive positive incentives for
exceeding benchmarks and negative incentives for when performance
targets are not met. The August 2025 GAO report, entitled VA Disability
Benefits: Additional Oversight and Information Could Improve Quality of
Contracted Exams for Veterans, identified two erroneous incentive
payments in Fiscal Year 2024. The erroneous payments have been
recouped, and our methodology has been enhanced to prevent future
errors.
Quality Compliance
VA conducts monthly quality audits using a statistically valid
sample. In Fiscal Year 2025, VBA's aggregate quality score for MDE
Vendor Disability Benefits Questionnaire reviews was 97.2 percent, with
positive performance incentives applied for scores above 96 percent.
Training Requirements
All contract medical examiners must undergo foundational training
and certification equivalent to that of Veterans Health Administration
examiners. Training includes general certification, specialty courses,
and supplemental courses. Recertification training is required every 5
years or if the examiner has not conducted an exam in the past year.
VBA MDEO is also developing training based on error trends, special
focused reviews, and Disability Benefits Questionnaire changes to
improve exam quality.
Vendors must submit an annual training plan covering examiners and
support staff, ensuring compliance with VA standards and quality
assurance. These plans are reviewed by VBA to confirm they meet all
contract requirements. VBA validates completion of training before
examiners are permitted to perform exams. VBA also conducts monthly
audits to ensure all active examiners adhere to training requirements,
ensuring training standards are maintained by active examiners.
Initiatives and Improvements to the Veteran Experience:
We recognize that there are clear opportunities to strengthen and
modernize portions of the disability examination process, and we are
committed to addressing those areas. For example, we are evaluating
advanced clinical and evidence-review tools designed to help identify
when existing medical information is sufficient to support a claims
decision. These capabilities have the potential to reduce in-person
examinations, improve consistency, and accelerate outcomes for our
Veterans, while ensuring that all decisions comply with VA regulations
and clinical standards.
We are also prioritizing a more Veteran-centric approach to
scheduling and overall exam coordination. VBA has begun integration
between the Veterans Benefits Management System (VBMS) and VHA's
External Provider Scheduling platform. This collaboration is expected
to improve and streamline the Veteran experience, giving Veterans more
options, while allowing VA to maximize utilization of the entire
network of providers supporting C&P examinations nationwide. A
centralized scheduling platform will make the process simpler to
navigate, improve consistency in communication, and ensure that
examinations are accessible to all Veterans.
In parallel, we are focused on identifying ways to streamline and
modernize business processes, reducing administrative burden for both
Veterans and the workforce. This includes assessing multiple avenues to
leverage technology and refine workflows in order to reduce reliance on
examinations where appropriate.
While some progress can be achieved within the exam space alone,
the full benefit of these improvements will depend on close partnership
across VBA and VA, as well as stakeholders. We remain committed to
these collaborative efforts to ensure a more efficient, Veteran-focused
experience.
GAO Recommendations
In August 2025, GAO issued a report entitled VA Disability
Benefits: Additional Oversight and Information Could Improve Quality of
Contracted Exams for Veterans. To begin addressing these
recommendations, VBA has formalized the standard operating procedures
(SOP) for the financial incentive calculation process detailing roles,
responsibilities, objectives, and reporting. This SOP is currently in
use. In addition, VBA has recalculated all financial incentives since
2022 as requested by GAO and did not identify any errors that impacted
the previously calculated percentages. Further, VBA has completed the
Fiscal Year 2025 Military Sexual Trauma (MST) Complex Case Review (CCR)
and updated the CCR SOP to reflect the projected completion of CCRs. An
MST Special Focused Review (SFR) was completed in Fiscal Year 2025, a
Gulf War SFR is planned for completion in Fiscal Year 2026, and a
Traumatic Brain Injury SFR will be completed in Fiscal Year 2027, with
the MST SFR cycle restarting in Fiscal Year 2028. VBA is dedicated to
conducting these SFRs to ensure oversight and improve the quality of
these critical medical disability exams. Finally, VBA has created a
form to collect feedback from examiners who conduct contract medical
examinations, established a monitored email account to receive the
forms, created SOPs to ensure feedback forms received are reviewed
timely and maintained, with notice of the new feedback mechanism
provided to all current contract exam providers and vendors.
Conclusion
I want to express my appreciation for your continued support of
Veterans and their families, caregivers, and survivors. VBA appreciates
the authority provided by Congress to obtain contract examinations for
Veterans and transitioning Service members. VBA remains committed to
providing timely and accurate disability examinations to Veterans and
Service members, while improving their examination experience. Chairman
Luttrell, and Ranking Member McGarvey, this concludes my statement. We
would be happy to answer any questions you or the other Members of the
Subcommittee may have.
Statements for the Record
----------
Prepared Statement of Veterans of Foreign Wars of the United States
Chairman Luttrell, Ranking Member McGarvey, and members of the
subcommittee, on behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and its Auxiliary, I am pleased to
provide input on this important topic that we have addressed in
previous hearings, both as a witness or by similar submissions.
The VFW approaches this hearing with the utmost seriousness, as the
issues before us affect every veteran seeking fair and timely access to
earned benefits. We have raised concerns about the Department of
Veterans Affairs (VA) disability examination system in numerous
settings, including recent congressional roundtables where the
challenges surrounding the current examination structure once again
became part of the discussion. The VFW firmly believes that the
disability examination is the single most critical step in the claims
process. It is also, regrettably, the step that generates the greatest
number of obstacles and inconsistencies. Since as far back as 2017, we
have repeatedly expressed concerns about the manner in which
examination contracts are awarded and the profound impact these
decisions have on the efficiency, accuracy, and fairness of the claims
process.
Over the years, we have identified several persistent issues within
the examination and contracting framework that demand focused attention
and action. These challenges range from contract instability and
provider shortages to uneven examiner qualifications and inconsistent
service delivery across regions. The VFW believes that implementing our
recommendations, many of which have been reiterated for years, would
significantly strengthen the disability evaluation process. These
improvements would not only streamline operations but also enhance
outcomes for veterans, caregivers, family members, and survivors who
rely on VA for critical support.
Despite our ongoing efforts to offer workable solutions, the
examination system remains overly complex, burdensome, and difficult to
navigate. It places unreasonable strain on veterans, especially those
attempting to navigate the process without representation or guidance.
For some, the system is not merely challenging, it is functionally
inaccessible. The VFW urges Congress and VA leadership to act
decisively to modernize and stabilize the examination infrastructure.
Veterans deserve a system that supports them, not one that hinders
them, and meaningful reform is both urgently needed and long overdue.
Scheduling
As an accredited Veterans Service Organization (VSO)
representative, we hold a professional and regulatory obligation to
fully understand the VA disability claims process and the VA business
systems that enable delivery of benefits. However, navigating the
process remains unnecessarily frustrating. The contracted disability
examination process used to inform claimants of ratings decisions is
not transparent, efficient, or customer focused.
Examination requests are assigned to VA's contracted vendors.
Because of the rigidity of VA's contracts and the emphasis on speed-
driven metrics, initial examination assignments are repeatedly returned
to VA as unschedulable. Under current contracts, veterans generally
receive only one opportunity to reschedule an examination before a
vendor is required to return the request to VA. This presents many
challenges and avoidable cancellations.
We recently assisted an 80-year-old veteran who filed a claim for
hearing loss. The claim was established, and examinations were
requested by a VA-contract vendor. While this may sound routine and of
no concern, the examination provider was 143 miles away. The veteran
would have had to travel nearly 300 miles round trip for an examination
that likely could have been completed closer to his home. Since he will
be unable to report, we anticipate the examination will likely be
reported to VA as a ``no show,'' and the veteran will be denied much-
needed benefits.
In some cases, we have learned that vendors have made offers to
provide transportation to a scheduled examination, which is a great
improvement from how business was previously conducted. However, it is
not always practical. Some veterans have issues with mobility that will
not allow them to sit for long periods of time, others may need
assistive devices such as walkers or wheelchairs that can prove to be
cumbersome or impractical. There is no guarantee that the service with
which the contract examiner engages will have the proper vehicle type
available to take the claimant to the scheduled examination.
Once again, we are asking that veterans be given greater agency
over their claims. Allowing the claimant to be able to choose when and
where the examinations will take place will greatly reduce the no show
and denial rate. Veterans want their claims to be accurate. They want
them to be timely. VA has proven this is possible. As we noted in
testimony before the Senate Committee on Veterans' Affairs, during the
COVID-19 pandemic, VA suspended the process for veterans unwilling or
unable to report for examinations due to concerns of being exposed to
the virus.
VA's own contract examiners agree that giving veterans greater say
in how their claims are processed will lead to better customer
experiences for the claimants. It will also improve efficiency and help
reduce waste.
Overdevelopment
Overdevelopment of disability claims, particularly through the
ordering of unnecessary medical examinations, continues to slow the
claims process and generate avoidable frustration for veterans seeking
timely decisions. This issue is especially pronounced in claims
involving contentions of toxic exposure where the evidentiary standards
are already well defined in statute and regulation. When a presumption
of service connection applies and a claimant's service records confirm
presence in the qualifying location, the requirement for a medical
opinion is already satisfied. In these cases, ordering an additional
examination does not enhance the evidentiary record, it instead
introduces needless delay.
For example, a veteran exposed to burn pits in a qualifying
location is entitled to the presumption of service connection for
chronic obstructive pulmonary disease (COPD). Under this framework, VA
should automatically grant the claim without attempting to determine
alternative causes such as smoking history. Similarly, requesting a
toxic-exposure-related screening for a contention wholly unrelated to
toxic exposure, such as a musculoskeletal knee injury, adds no
substantive value and extends wait times for a decision. In both
instances, the additional steps are superfluous, create administrative
inefficiency, and undermine the very purpose of presumptive policy.
To reduce these delays and ensure veterans receive the timely
benefits they have earned, the VFW recommends that VA fully leverage
existing claims data and medical records, cross-referencing prior
submissions before ordering any new examinations. This approach would
help prevent redundant development actions and preserve resources for
cases where additional evidence is actually necessary. We also
recognize that VA itself has acknowledged overdevelopment as a systemic
problem and, in 2021, created an internal task force to address it.
Continued attention, training, and accountability in this area are
essential to eliminating unnecessary examinations, and improving claims
timeliness and overall accuracy.
Examiner Qualifications
A critical driver of avoidable delay within the VA claims system is
the practice of routing medical opinions from qualified physicians to
lesser-credentialed medical professionals such as nurse practitioners
for confirmation or certification. This additional step is unnecessary,
adds no medical value, and undermines the credibility of the original
expert opinion. When a licensed physician has already provided a clear,
competent, and comprehensive medical assessment, re-review by a
provider with less specialized training only creates bottlenecks.
Worse, this redundant review can give the appearance that evidence is
being developed not to assist the veteran but to find grounds to deny
the claim, which is contrary to VA's statutory obligation to extend the
benefit of reasonable doubt to the veteran.
The time lost by sending a physician's medical opinion into this
secondary loop contributes directly to prolonged adjudication times,
all without increasing the accuracy, quality, or completeness of the
claim decision. Veterans routinely wait weeks or months for these
additional reviews, only to receive decisions based on the lesser-
credentialed practitioner's reinterpretation of the evidence rather
than the physician's original conclusion. This practice not only delays
justice, it also increases the likelihood of improper denials as
medical nuances documented by the examining physician may be
overlooked, minimized, or mischaracterized. In multifaceted claims,
particularly those involving toxic exposures, traumatic brain injury,
or other neurological conditions, this unnecessary layer of review can
create significant harm to the veteran by introducing avoidable errors.
To ensure timely, accurate, and fair outcomes, VA must rely on the
most qualified examiners necessary for the medical issue at hand and
must accept competent medical opinions. Eliminating redundant
certification practices would shorten adjudication timelines, reduce
improper denials, and reinforce confidence in the claims process.
Veterans deserve a system that respects their time, honors their
service, and ensures that well-supported claims are not slowed down or
jeopardized by unnecessary procedural obstacles.
Record Review
A complete and accurate review of each veteran's record is
essential to ensure the timely, fair, and efficient adjudication of
claims. Yet in too many cases, VA's Veterans Service Representatives
(VSRs) focus primarily on the first contention listed in the file and
build development actions such as medical examinations or evidence
requests around that single issue. This narrow approach fails to
acknowledge the interconnected nature of many claims. Veterans rarely
submit claims involving only one condition, and each contention must be
considered within the broader context of service history, medical
evidence, and previously documented conditions. When VSRs do not fully
review the entire claim at the outset, the resulting development plan
is incomplete and misaligned with the veteran's actual needs.
Ordering examinations without a full review has cascading
consequences. Once additional facts or contentions come to light that
should have been clear from the beginning, new or sometimes duplicate
medical examinations are ordered to correct earlier oversights. This
repetition not only wastes VA resources but also prolongs the veteran's
wait for a decision. In complex cases, especially those involving
multiple service-connected conditions, these missteps can force
veterans into a cycle of repeated examinations, conflicting medical
opinions, and avoidable frustration. The veteran is ultimately
penalized for a process failure that could have been prevented with a
comprehensive record review at the outset.
Unnecessary examinations and fragmented development actions
contribute to a disjointed claims process, adding avoidable delays and
increasing the likelihood of improper or incomplete decisions. Ensuring
that VSRs conduct a full, holistic review before initiating any
development is critical to breaking this cycle. The VFW urges VA to
strengthen training, oversight, and accountability to ensure that all
relevant evidence is reviewed up front and that development actions
reflect the totality of the veteran's claim. Only by doing so can VA
deliver the timely, accurate, and veteran-centered service that
claimants deserve.
Disability Benefits Questionnaires
Across our nationwide network of more than 2,300 accredited
representatives, we consistently hear that the Disability Benefits
Questionnaire (DBQ) system is in urgent need of modernization and
accountability. Despite VA's assurances that its physicians routinely
complete DBQs, the overwhelming reality is that most refuse to do so.
Veterans are frequently told, incorrectly, that VA providers are
prohibited from offering medical opinions or completing DBQs, or that
doing so constitutes a conflict of interest. When this recurring
problem is raised with VA leadership, it is often dismissed or met with
vague promises of future review, with no meaningful progress.
Compounding the issue, many veterans are shuffled through a constantly
changing roster of VA physicians who claim unfamiliarity with the
patient's history and refuse to complete the forms, leaving veterans
without the medical documentation required for a fair and fully
developed claim.
As a result of this persistent refusal, veterans are regularly
advised to seek assistance from private providers who often lack
familiarity with VA's evidentiary standards and do not understand how
to properly complete a DBQ. Faced with confusion, discouragement, or
financial barriers, many veterans abandon their claims altogether, or
worse, turn to predatory Claim Sharks who charge high fees and produce
questionable or fraudulent medical opinions. Even when these private
opinions are exaggerated or fabricated, VA must treat them as valid
medical evidence unless the provider is already identified as
fraudulent, leading to inaccurate ratings and improper awards. In the
most troubling cases, veterans who had no knowledge of wrongdoing could
later face criminal exposure when the claim is deemed fraudulent. This
is an outcome that no veteran should endure, and one that stems
directly from VA's failure to provide reliable, accessible, and
accurate DBQ support from its own medical staff.
A practical and effective solution is clear: VA must require its
medical providers to complete DBQs upon a veteran's request and update
all DBQ forms to include an integrated medical opinion section.
Developing a comprehensive single form would ensure that qualified VA
medical professionals, not untrained or unfamiliar private providers or
predatory actors, are supplying accurate, ethical, and legally sound
evidence. This reform would reduce the number of unnecessary
compensation and pension (C&P) examinations, allow more claims to be
rated on the evidence of record as provided for in the Code of Federal
Regulation, and significantly accelerate the processing timeline. The
VFW also strongly urges additional oversight of the DBQ program and
requests continued involvement in any updates to ensure reforms align
with the needs of veterans and the realities observed in the field.
Veterans deserve a system that supports them, not one that pushes them
toward confusion, exploitation, and risk.
Contract Renewals
The VFW strongly opposes VA's continued use of 2-year contracts for
Medical Disability Examination Office (MDEO) vendors. Short-term
contracting cycles create unnecessary instability, undermine program
performance, and fail to leverage the efficiencies that Federal
acquisition policy is designed to promote. Instead, the VFW urges VA to
adopt multi-year contracts consistent with the intent and advantages as
outlined in Federal Acquisition Regulation (FAR) 17.105-2. Multi-year
agreements would better support the complex, high-volume nature of MDEO
operations and ultimately improve service delivery to veterans.
Multi-year contracting provides numerous benefits that are lost
under the current 2-year model. These advantages include reduced costs
for both VA and contractors by eliminating recurring startup expenses;
greater standardization of services and processes; and a significant
reduction in administrative workload associated with frequent
recompetes, negotiations, and renewals. Longer-term agreements also
promote continuity of operations by minimizing disruptions caused by
repeated transitions, preproduction testing, and phaseouts. Further,
multi-year contracts support workforce stability, encourage contractor
retention and expertise, and eliminate the need to develop new quality-
assurance processes with each contract turnover. They broaden
competition by enabling participation from vendors with higher initial
investment requirements, and create incentives for contractors to
invest in advanced technology, infrastructure, and workforce
development, leading to sustained improvements in productivity and
service quality.
Given the operational demands and national importance of medical
disability examinations, VA should prioritize stability, efficiency,
and long-term performance by transitioning to multi-year contracting.
Such an approach reflects Federal acquisition best practices,
strengthens the quality and reliability of examinations, and ensures
that vendors are positioned to deliver consistent, veteran-centered
services. Multi-year contracts will reduce administrative burdens,
enhance program continuity, and better serve veterans who depend on
timely and accurate disability evaluations.
Chairman Luttrell and Ranking Member McGarvey, this concludes my
statement. Again, thank you for the opportunity to offer comments on
this issue.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has
not received any Federal grants in Fiscal Year 2025, nor has it
received any Federal grants in the two previous Fiscal Years.
The VFW has not received payments or contracts from any foreign
governments in the current year or preceding two calendar years.
Prepared Statement of Paralyzed Veterans of America
Chairman Luttrell, Ranking Member McGarvey, and members of the
subcommittee, Paralyzed Veterans of America (PVA) would like to thank
you for the opportunity to submit our views on the effectiveness of the
Department of Veterans Affairs' (VA) Medical Disability Examination
Office (MDEO), and its role in the veteran's disability claims process.
No group of veterans better understand the importance of timely access
to VA benefits than veterans who have acquired a spinal cord injury or
disorder (SCI/D).
The MDEO is responsible for overseeing the contract medical
disability exam process for the Veterans Benefits Administration (VBA).
One of their principal duties is to, ``monitor and oversee exam vendor
performance to enforce the terms of the contracts and ensure compliance
with agency regulations, procedures, program directives, and the law
including ADA [Americans with Disabilities Act] and OSHA [Occupational
Safety and Health Administration] requirements.'' The VA has authorized
contracted medical disability examinations (MDE) to non-VA medical
providers since 1996. Today, contractors account for more than 85
percent of MDEs.
When a veteran files a claim for disability compensation, a medical
examination is the keystone in the adjudication process. A good,
thorough examination is critical for an accurate outcome; however, a
poor examination could lead to years of additional actions, adding to
the appeals backlog, and could end up being extremely costly to the VA
in terms of funding and trust. PVA strongly believes medical
examinations for complex, service-related medical conditions like SCI/D
and traumatic brain injury (TBI), as well as those related to military
sexual trauma (MST), should be conducted by a medical practitioner
working directly for the Veterans Health Administration; however,
contract exams may be appropriate for other types of claims.
Regardless, the VA must ensure that any contracted compensation and
pension (C&P) examiners are qualified to conduct necessary exams and
any legislative proposals supporting contract exams should include such
provisions.
Inadequate Disability Benefits Questionnaire (DBQ) Quality Assurance
PVA strongly believes that VA should improve the quality control
review of an incoming DBQ before it is uploaded into a veteran's file,
which could reduce the risk of fraudulent claims. Currently, VA claims
processers have the authority ``to evaluate and weigh all evidence of
record, including privately completed DBQs. If it is determined that a
privately completed DBQ contains indicator(s) of inauthenticity that
are substantive enough to deem it potentially inauthentic or
fraudulent, claims processors have the authority to assign low or no
probative value to the privately completed DBQ.'' \1\ But if a DBQ is
completed by a contracted examiner, the claims processors ``are not
expected to routinely scrutinize or question the credentials of
clinical personnel to determine the acceptability of their reports,
unless there is contradictory evidence of record.'' However, according
to the VA's Clinician's Guide, which informs contract providers, ``It
is important to remember that VBA Raters are not clinicians and
therefore may not understand concepts that are considered basic or
assumed by those educated in the field of medicine.'' \2\ This leads to
obvious questions of whether the claims processors are actually picking
up on the adequacy and accuracy of DBQs or the possibility of
fraudulent/inconsistent findings being recorded by either outside
providers or contracted examiners.
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\1\ M21-1, Part IV, Subpart i, 3.A.1.g, General Criteria for
Sufficiency of Examination Reports.
\2\ Veterans Health Administration (VHA) Office of Disability and
Medical Assessment (DMA) Compensation and Pension (C&P) Disability
Examinations Clinician's Guide.
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The MDEO currently employs about 20 quality analysts whose job it
is to review a random sample size of DBQs that are received from
contractors and determine whether or not they are ``contractually
compliant'' by ensuring that the reports include all requested issues,
do not have any discrepancies, and describe the condition(s) that have
impacted the veteran's ability to work, among other requirements.
However, these analysts only have access to the DBQs after they have
been uploaded to the Veterans Benefits Management System (VBMS), which
is the same time claims processors receive them. Often, this is too
late as the processors are waiting to finalize a claim and only need
the DBQ to finish the rating process.
According to a Government Accountability Office (GAO) report from
August 2025, ``MDEO officials say many claims continue through
processing and are decided before the office completes its checklist
review. After MDEO identifies errors, claims processors determine if
the errors affected their decisions on the claims.'' \3\ In order to
effectively do their jobs and to provide real oversight to the claims
process, changes are needed.
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\3\ VA Disability Benefits: Additional Oversight and Information
Could Improve Quality of Contracted Exams for Veterans.
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PVA believes that MDEO should implement two changes to the claims
process. First, prior to being downloaded to VBMS, all DBQs, regardless
of whether they are provided by the veteran or a contractor, should go
into a drop box that is only accessible by the quality analysts.
Second, the quality analysts should be trained and required to review
the forms for contractual compliance and for potential fraud/
inconsistent findings. Only after this review has been done should the
forms be uploaded to VBMS and the claims process be allowed to
continue.
Accessibility Concerns with Contract C&P Exams
Equally important to the qualifications of the provider is an
accessible, barrier-free facility to conduct exams. In May 2024, a VA
Office of Inspector General (OIG) Report (23-01059-72) \4\ found
accessibility barriers at more than half of the 135 facilities they
visited. Of the 135 facilities inspected, 99 had complete inspections
while 36 had partial inspections. OIG cited facilities being closed
with unclear operating hours or exam rooms being occupied and unable to
be accessed as reasons for the 36 partial inspections. According to the
report, VBA lacks a standard operating procedure for contract exam
facilities. Establishing such a standard was a recommendation made in
the report.
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\4\ Better Oversight Needed of Accessibility, Safety, and
Cleanliness at Contract Facilities Offering VA Disability Exams
Department of Veterans Affairs OIG (vaoig.gov).
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PVA members have experienced access barriers when receiving C&P
exams, as well as in accessing community care appointments. Our members
have seen exam rooms that are physically inaccessible and/or lack
overhead patient ceiling lifts. Restrooms often have accessibility
barriers, causing members to pause and wonder why the VA is sending
them to facilities that are ill equipped to accommodate them.
We also receive reports of inaccessible medical diagnostic
equipment, such as medical examination tables, weight scales, dental
chairs, x-ray machines, mammography, and other imaging equipment. A
lack of any one of these diminishes these providers' ability to
accurately evaluate service-related medical conditions. PVA submitted a
statement for the record to this committee in September 2024
highlighting additional accessibility concerns facing veterans with
catastrophic disabilities.\5\
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\5\ PVA Statement for the Record, House Veterans Affairs Committee
Hearing, ``Examining VA's Challenges with Ensuring Quality Contracted
Disability Compensation Examinations,'' September 18, 2024.
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Another barrier encountered by SCI/D veterans is getting to the
contract facility. Several of our members have been expected to travel
more than 100 miles to reach the contracted facility, and occasionally,
even while the veteran is critically ill. Some of our veterans'
injuries are so severe they may be unable to physically appear for an
exam; so, our national service officers (NSOs) request on VA Form 21-
4138 (Statement in Support of Claim) either a telehealth or in-person
visit from a C&P examiner. Many times, these requests are not seen or
are simply ignored. Some NSOs write the request on the VA Form 21-526
(Application for Disability Compensation and Related Compensation
Benefits) but the contractor insists the veteran must attend in person
or they will claim the veteran was a ``no-show,'' causing unnecessary
delays to benefits and services the veteran may be eligible for, which
forces NSOs to file supplemental claims, further adding to the claims
backlog. VA and third-party vendors' policies regarding these
situations need to be scrutinized, and greater use of telehealth exams
and traveling examiners should be made.
Lack of Specialized Contract Examiners
VA's M21-1 Adjudication Procedures Manual states that there are
only four types of examinations that are routinely performed by
specialists (hearing, vision, dental, and psychiatric). Furthermore, it
notes that a specialist examination may be requested, but only if there
are conflicting opinions or diagnoses, in compliance with a Board of
Veteran's Appeals (BVA or Board) remand, or the issue is deemed
``unusually complex.'' \6\ Immediately, this raises concerns.
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\6\ M21-1 IV.i.2.A.6.
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PVA NSOs represent veterans who have some of the most complex cases
likely seen by VA. Complex cases include claims dealing with complete
or incomplete injuries, application of all levels of special monthly
compensation, and eligibility for ancillary benefits associated with
these claims. Many of these conditions are not routinely associated
with a neurological disorder; so, without specialized diagnostic
experience, they could be missed, complicating or even extending the
veteran's claims process. These conditions should be flagged as
``unusually complex.'' However, we have heard from our NSOs in the
field that they routinely see a lack of provider expertise, which
delays the adjudication of claims. For instance, one office reported
that there were several issues with an examiner conducting a peripheral
neuropathy examination for veterans whose claims involved multiple
sclerosis (MS). In cases involving amyotrophic lateral sclerosis (ALS),
this oversight is particularly egregious, as the life expectancy of
those with ALS is so short that any delay in the processing of that
claim is robbing them of what precious little time they have left.
In another ongoing case, a veteran's claim was remanded back to the
regional office (RO) because of an inadequate exam. This veteran had
filed a claim related to mistreatment at the VA that had ultimately
cost him his legs, which were amputated above the knee. After obtaining
a medical opinion from a general practitioner, the Board remanded the
case with instructions to obtain an opinion from either an infectious
disease specialist, wound care expert, vascular surgeon, physiatrist,
neurologist, or orthopedic surgeon. However, when the RO sought to
obtain a specialist's opinion, they were told by the contractor that,
``our contract with VA does not require a specialist to perform this
particular [examination],'' and that they did not have a specialist to
perform it. A general physician provided the exam in defiance of the
remand order. This case will likely be remanded again and will continue
to add to the backlog at the BVA and cost valuable taxpayer dollars,
all because a specialist's opinion was denied by the contracted
examiners.
To help ensure a quality examination is performed correctly the
first time, and to prevent delaying the adjudication or the creation of
an appeal, the VA should expand their guidance on the four conditions
that are mandated to be performed by a specialist (hearing, vision,
dental, and psychiatric) to include the specialties of neurology and
gynecology. These two disciplines deal with disabilities that are
complex in nature but are also extremely personal. No veteran should
have to endure one of these examinations only to be told that it was
insufficient or inaccurate and that a second exam is needed.
PVA would once again like to thank the subcommittee for the
opportunity to submit our views on the effectiveness of the MDEO and
the role the office plays in the VA disability claims process. We would
be happy to take any questions for the record.
Information Required by Rule XI 2(g) of the House of Representatives
Pursuant to Rule XI 2(g) of the House of Representatives, the following
information is provided regarding Federal grants and contracts.
Fiscal Year 2026
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events--Grant to support rehabilitation sports
activities--$368,500.
Fiscal Year 2025
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events--Grant to support rehabilitation sports
activities--$502,000.
Fiscal Year 2023
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events--Grant to support rehabilitation sports
activities--$479,000.
Disclosure of Foreign Payments
Paralyzed Veterans of America is largely supported by donations
from the general public. However, in some very rare cases we receive
direct donations from foreign nationals. In addition, we receive
funding from corporations and foundations which in some cases are U.S.
subsidiaries of non-U.S. companies.
Prepared Statement of National Organization of Veterans' Advocates,
Inc.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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