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VA Disability Exams: Opportunities Remain to Improve Program Planning and Oversight

GAO-23-106939 Published: Jul 27, 2023. Publicly Released: Jul 26, 2023.
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Fast Facts

The Department of Veterans Affairs may require medical exams to determine veterans' eligibility for disability compensation. The COVID-19 pandemic contributed to a backlog of these exams.

This testimony discusses VA's and contracted examiners' efforts to manage workloads. Poor communication and oversight may hinder these efforts. For example, VA gave wrong information to contractors on "temporary license portability"—leading to unauthorized providers giving exams in states where they weren't licensed.

VA said there's little to no risk to veterans' claims, but hasn't formally assessed the situation. In a related report, we recommended it do so.

An image of a stethoscope and military ID tags on an American flag.

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What GAO Found

In recent years, the Department of Veterans Affairs (VA) increasingly has transferred its disability exam workload from Veterans Health Administration (VHA)-employed examiners to Veterans Benefits Administration (VBA) contracted examiners. In light of growing exam workloads and backlogs, GAO recommended in March 2021 that VBA use sound planning practices to develop and document plans for future workload allocations between VHA and contracted examiners. VBA developed a workload allocation plan that incorporated some of the sound planning practices GAO identified, but other information was missing. For example, it did not include information on potential volumes or timeframes for future transfers of disability exam workloads from VHA medical facilities to contracted examiners, or detailed assessments of potential risks associated with VA's increased reliance on contracted examiners.

In a June 2023 report, GAO found that VHA did not provide medical facilities with clear information to inform examiner staffing decisions. For example, although legislation was enacted that required VA to temporarily suspend efforts to eliminate disability examiner positions, the guidance VHA provided to its facilities did not include clear instructions on how to comply with this requirement. As a result, officials at the five facilities GAO selected for review had different interpretations of whether and how the guidance applied to them. Without VHA clarifying the guidance, facilities may not implement it as intended, and they risk not being positioned to help address veterans' exam needs.

GAO also found that VA used available flexibilities to help meet exam demand during the COVID-19 pandemic. For example, VBA's contracted exam vendors and VHA increased their use of telehealth during the pandemic. Additionally, VBA and its vendors said that they used a temporary expansion of license portability—which allows contracted examiners in certain specialties to conduct exams in states other than where they are licensed—and that this flexibility helped expand access to exams in underserved areas. However, the guidelines VBA provided to its vendors included inaccuracies, and VBA conducted inadequate monitoring of the vendors. This contributed to vendors allowing ineligible examiners to conduct exams using license portability. During the course of GAO's review, VBA took steps to address these deficiencies, including clarifying its guidance on eligible examiners. However, VBA has not yet completed, as GAO recommended, a formal assessment of exams that were erroneously completed under license portability and any potential risks to veteran claim decisions. Completing such an assessment will help VBA identify and take any necessary corrective actions to ensure veterans' claims have been properly decided.

Why GAO Did This Study

In June 2023, GAO issued a report entitled VA Disability Exams: Actions Needed to Clarify Program Requirements Regarding Examiners (GAO-23-105787). This testimony summarizes the findings and recommendations from that report, which included relevant updates from prior reporting on disability medical exam workload management (GAO-21-444T).


GAO recommended in June 2023 that VHA clarify guidance to facilities to define key terminology and that VBA develop formal procedures to monitor license portability use and conduct an assessment of exams erroneously completed under license portability. VA generally agreed with the recommendations. GAO made a prior recommendation in March 2021 that VA better plan for disability exam workload allocations between VBA and VHA, with which VA agreed. GAO is continuing to monitor VA's implementation of these recommendations.

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