Each year a consortium of four major veterans service organizations (VSOs), American Veterans (AMVETS), Disabled Veterans of America (DAV), Paralyzed Veterans of America (PVA), and Veterans of Foreign Wars of the U.S. (VFW), publish the Independent Budget–recommendations for Congress and the Department of Veterans Affairs to consider in the upcoming fiscal year. The group published their Independent Budget for FY2016 on 15 January 2015 (website | PDF).
The FY2016 Independent Budget authors clearly conduct extensive research, and they produce a well-written, thoughtful analysis of veterans’ needs and ways in which the Department of Veterans Affairs (VA) can best meet them.
But something is missing.
I really can’t blame the Independent Budget authors though because what they missed, everyone misses when advocating for improved VA services.
Here’s what’s missing: Analysis of the VHA C&P exam program, particularly with regard to how C&P exam accuracy (or lack thereof) affects VBA rating accuracy.1
The Independent Budget offers smart recommendations regarding the disability claims process, at least as far as VBA goes:
The VBA must openly and honestly reassess whether the target goal established five years ago—that all claims would be completed within 125 days with 98 percent accuracy by the end of 2015—remains realistic and achievable. If the VBA confirms these goals are not reachable, it must work in a transparent and collaborative manner with Congress and its veterans service organization (VSO) partners to set new goals, revise current strategies, or request new resources.
But what about the Veterans Health Administration’s role in reaching these goals? Assuming that the timeliness and quality of VA disability claims processing rests solely on VBA’s shoulders misses the fact that VBA relies heavily on VHA to conduct independent medical evaluations (IMEs), i.e., C&P exams, for most claimed conditions, particularly for PTSD and other mental disorders.2
VBA and VHA Work Together to Process Veterans’ Disability Claims
Consequently, VBA cannot complete veterans’ disability claims within 125 days with 98 percent accuracy without VHA’s help.
VHA has done an admirable job of completing compensation and pension examinations faster, while also handling a significantly increased volume of C&P exam requests from VBA. Thus, VHA and VBA have worked together quite effectively to reduce claims processing time.
On the other hand, VHA has largely ignored C&P exam quality as they have focused on C&P exam productivity. This neglect lowers the accuracy rate for VBA rating decisions (and decisions about service connection).
VBA service connection and rating decisions are only as accurate as the C&P exams on which they are based. Of course, VBA Rating Veterans Service Representatives (RSVRs) consider all relevant evidence, i.e., not just the C&P exam, when adjudicating a veteran’s disability claim. But most would agree that in general, C&P exam results exert more influence than any other piece of evidence.
Even with VBA’s current laudable achievement of 90% accuracy of rating decisions according to STAR criteria, this number represents only half the equation. Since VBA rating decisions are based in large part on C&P examiner’s conclusions, one must also factor in C&P exam accuracy. At least in the mental health realm, it’s not a pretty picture. If mental health C&P exam accuracy is 65% (a generous assumption), then the overall accuracy rate for VA disability decisions is only 58.5%.
Predicted VHA Response
When presented with this concern, VHA management will likely respond, “But how do you know that mental health C&P exam accuracy is so low?”
My answer: “I believe mental health C&P accuracy suffers for reasons I have outlined elsewhere. However, it is not my job to determine the mental health C&P exam accuracy rate–it is yours. But, conveniently, VHA has never conducted program evaluation studies, rigorous quality assurance reviews, or empirical research to ascertain the mental health C&P accuracy rate, and as far as I can discern, there are currently no plans to do so.”
There are sins of commission, and sins of omission. VHA’s failure to ensure C&P exam accuracy is a sin of omission that will eventually undermine confidence in the VA’s disability benefits program.
1. My comments concern Mental Health C&P exams. Some of what I say might also apply to other C&P exams, but I do not possess the expertise to comment on those exams specifically.
2. I recognize that many VSOs and veterans do not believe C&P exams are independent medical examinations since the same agency that makes the disability determination conducts the medical evaluation. That argument has merit. Unfortunately, the VSOs’ preference is that the veteran’s treating psychologist or psychiatrist conduct the disability evaluation, a ‘solution’ that introduces equally problematic conflict of interest problems.