The Department of Veterans Affairs often uses medical exams to determine if disability benefits are warranted. We reported in March 2021 that VA has increasingly shifted this work from VA medical centers to contractors. Contractors performed about 1.1 million of the 1.4 million such exams completed in FY 2020.
We testified about how VA has not applied sound planning practices in transferring this work to contractors. For example, VA has not developed timelines or assessed potential risks. In addition, VA does not conduct targeted reviews to check contractor work on more complex exams, such as those for Gulf War Illness.
What GAO Found
In recent years, the Department of Veterans Affairs (VA) has significantly expanded the Veterans Benefits Administration's (VBA) use of contractors to perform disability medical exams instead of relying on Veterans Health Administration (VHA) medical centers. According to VBA officials, VA's policy is to continue using contractors for most exams. GAO previously identified sound practices agencies can use to plan for significant programmatic changes. However, VBA has not applied several of these practices to its plans for allocating workloads among its contractors and VHA medical centers. For example, VBA has not assessed potential risks to capacity and exam quality in allocating the bulk of exams to contractors. Employing such practices could help VBA identify potential risks stemming from this long-term program change and better plan for addressing future workload needs.
Percent of Disability Exams Performed by VBA Contractors and by VHA Medical Centers, Fiscal Years 2017-2021
Over time, VA has also permitted contractors to complete exams for more complex disability claims—such as Gulf War Illness—according to VBA officials, but VBA does not conduct targeted reviews specifically to assess the quality of the exam reports completed for these exams. VBA data show that exam reports for selected complex claims were returned to examiners for correction or clarification at about twice the rate that exam reports were returned overall. Disability medical examiners told GAO that these types of exams can be challenging. Without specifically assessing how well contractors perform on exams for complex claims, VBA is missing an opportunity to identify actions that could help ensure veterans receive high quality exams and that exam reports are completed correctly.
Why GAO Did This Study
This testimony summarizes the information contained in GAO's March 2021 report, entitled VA Disability Exams: Better Planning Needed as Use of Contracted Examiners Continues to Grow (GAO-21-444T). This testimony also builds upon prior GAO reporting on VBA's contract exam program in October 2018 (GAO-19-13).
GAO's October 2018 and March 2021 reports made a total of six recommendations to VA to improve its oversight of contracted examiners. GAO made two recommendations in March 2021 that VBA develop plans for its allocation of disability medical exam workloads using sound planning practices and assess the quality of exam reports completed by contractors for selected complex claims. VA has taken steps to implement the four recommendations GAO made in 2018. However, VA has not yet fully implemented any of the six recommendations. Continued efforts by VBA to improve its planning for and oversight of the contract exam program, in line with GAO's recommendations, should help ensure veterans receive high quality and timely exams.