▶ 0:24:43Good morning. How is everyone today?
▶ 0:24:48We're great.
▶ 0:24:48Not bad, huh? Okay. Thank you, Miss Glenn. I appreciate you. I usually try to, you know, be welcoming into the committee. Thank you for coming in today. General, you ready? The subcommittee will come to order. The chair may declare a recess at any time.
▶ 0:25:04And once again, good morning to This morning, the subcommittee is conducting oversight on one of the Veterans Benefits Administration's most critical offices supporting and overseeing the disability claims process, the Medical Disability Examination Office, or the MOO. This is the office responsible for managing contractors who conduct medical disability exams for veterans nationwide.
▶ 0:25:29Those 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've earned for their service. That's what we are going to focus on today. Accuracy, accountability, and a positive for our brothers and sisters.
▶ 0:25:54When a veteran files a claim for disability compensation, Veterans Affairs is responsible for helping the veteran prove their eligibility for benefits. And for years, 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.
▶ 0:26:20Today, more than 90% 90% of all exams are done outside the VA through contractors sourced out of four major contractor four major contractors. These multi-year contracts cover more than 9 million exams and a multi-year budget ceiling of $13 billion. A contracted medical examiner uses a dis uses a disability benefits questionnaire or DBQ to document the veteran symptoms and medical findings.
▶ 0:26:49Mio 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 taxpayers investment is delivering for our veterans. According to a recent report from the government um not affairs accountability government accountability office that might not have happened over the past couple years.
▶ 0:27:13The accountab account accountability office found that Mio wrongly awarded millions of dollars in financial incentives in 2024 to vendors who did not meet performance Production customer satisfaction exam quality timeliness in scheduling and timeliness in completion as well. When vendors meet a meet or exceed these metrics, they can earn a bonus or face financial penalties if they fall short.
▶ 0:27:41Accountability Office found that Mio used a manual process to calculate these incentives which had no standardized checks or formal written procedure to verify the accuracy of payments. Apparently, Miss Mio 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.
▶ 0:28:12Accountability office recommended Mio develop written procedures and automated verification tools. Mio says they've started doing which is obviously a great step forward. The account als the accountability office also found that MO has fallen short in meetings in meeting its own schedule for special focus reviews known as S SFRS.
▶ 0:28:34These these reviews are supposed to happen every two years for complex claims such as traumatic brain injury, military sexual trauma and Gulf War illness. These are the these are the cases most prone to error where exam quality can make or break a veteran's claims. Two are overdue. And the third one, a start date has not been provided from what I Let me be perfectly clear.
▶ 0:28:58If there is one area where you can't cut corners, it's in the cases uh revolving around post-traumatic stress, post-traumatic stress disorder, and traumatic brain injury. Without these reviews, Mio has no way to know if it's previous corrective actions are working or if the exam quality is improving. without understanding if exam quality is improving. It is also it also means MO can't cannot update examiner training or identify and correct DBQ errors. The same errors keep happening leaving some veterans with delays or incorrect decisions.
▶ 0:29:29This is a systematic failure. The accountability off also identified new areas for improvement suggesting that Mio 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.
▶ 0:29:59Therefore, depending on which contractor a veteran is scheduled with, their exam might be completely different even though it's for the same condition. That kind of disconnect undermines the trust in the system. Mio is the office for Mio is the office responsible for ensuring exam consistency and to their credit MO 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.
▶ 0:30:29This issue points out a broader issue with Mio. Of course, there is always more to do. We need a proactive, not a reactive VA. And with that, I will yield to the ranking member.
▶ 0:30:40Thank you, Mr. Chairman, and thank you all for being here today. Uh we often say, and I think it's true, there's no wrong door into the VA. Whenever, wherever, and however a veteran comes into the VA, they are all welcome there. And we know that their health and financial well-being will be better for it. However, it's 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.
▶ 0:31:08That's the most common door that veterans walk through to get into the VA. And the key to that doorway for most veterans is the compensation and pension exam or the CMP exam, which documents their medical conditions and provides the basis for a claim's decision. So, 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.
▶ 0:31:39And it is extremely important for VA and specifically the medical disability exam office or MD MDO to ensure all that happens correctly. Unfortunately, in too many instances, it seems that our current system of contracted exams fails a lot of veterans and MDEO fails to oversee it properly.
▶ 0:31:59You 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 or the family to get to. We hear tons of stories about veterans being sent to an exam that has nothing to do with air condition or veterans sent to doctors who don't have the specialy training needed for their injury or illness or a less than 10 minute mental health exam or orthopedic exams conducted via teleaalth. The stories are endless.
▶ 0:32:29VA is supposed to be monitoring the conduct of these examiners and holding contract vendors accountable. Unfortunately, it doesn't 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, and that assessment just doesn't match up with what we're 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.
▶ 0:32:57I don't 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. So, today I hope that you all can help us square that circle because I I look forward to hearing about the progress that the MDO has made after the significant backlog experienced during the 2020 pandemic.
▶ 0:33:20And I look forward to an honest discussion about where MDO is falling short and not living up to its mission to serve veterans because that's what we do here. Our mission is to serve veterans. And 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. So, we want to continue to see a pattern uh as we continue to see a pattern of challenges with oversight quality and assurance and adequate control over these contracted exams, we want to get to the bottom of it.
▶ 0:33:46Since about 90% of disability exams are done outside the VA by for-profit thirdparty contracted examiners, it's 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. So, as we continue to work on behalf of veterans, we must hold VA and those it contracts to conduct exams to a high standard. That is the work we embark on today.
▶ 0:34:17I really appreciate you all being here and look forward to hearing your remarks. Mr. Chair, I yield back to you.
▶ 0:34:21Thank you, Mr. McGarvey. I'll introduce the witnesses from the Government Accountability Office. We welcome Miss Elizabeth Curta, director of education, workforce, and income security. Good morning. Our lead witness from VA is Miss Mary Glenn, deputy director of the medical disability examination office at the Veterans Benefits Administration. Good morning. And she is joined by Miss Tara Flores, director of acquisition service at the strategic acquisition center within the office of acquisitions, logistics, and construction. Did you write that? That's impressive.
▶ 0:34:52Thank you for being being here today. I ask that the witnesses um please stand and raise your right hand. Do you solemnly swear that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth. So, help you God. Thank you. And let the record reflect that the witnesses have answered in the affirmative. You may be seated. Thank you, Miss Curry. You're now recognized for five minutes to let to deliver your opening statement on behalf of the Government Accountability Office. Good morning, Chairman Lutrell, Ranking Member McGarvey, and members of the subcommittee.
▶ 0:35:23I'm pleased to discuss GAO's work on VBA's oversight of the quality of contracted disability 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, Miss Curt, I apologize. Is your microphone on? Uh, can you hear me better now?
▶ 0:35:49There you go. Thank you. I apologize. Can you kind of lean into it? We're
▶ 0:35:54Do you want me to start again?
▶ 0:35:55Nope. Okay.
▶ 0:35:56I can vaguely hear you're you're you're good to go. Thank you.
▶ 0:35:59The responsibility per 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% of the exams at a cost of over $5 Robust oversight of contractors is important for ensuring quality exams because errors can result in incorrect decisions, costly rework, and delays for the veteran.
▶ 0:36:26To oversee contracted exam performance, in 2016, VBA established the medical disability exam office. My testimony today discusses first VBA's processes for overseeing ZAM exam quality and second GAO's five recommendations for improving these Since 2016, VBA has refined its processes for overseeing contracted exams and implemented numerous GAO and VA inspector general recommendations along
▶ 0:36:56the way. VBA oversees exam quality using a variety of techniques that fall into three categories. Prevention. These techniques aim to prevent or prevent errors or lowquality 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. And third, correction.
▶ 0:37:25These 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 in procedures for tackling the most frequent or complex problems with contracted exams.
▶ 0:37:53Second, incorrect financial incentive payments to contractors. And third, a gap in obtaining firsthand perspectives from examiners, a key stakeholder group. To address these issues, GAO made five recommendations. VA agreed or agreed in principle with the each recommendation and has described plans to address them.
▶ 0:38:14As of today, VA has made some progress uh but none of the five have been fully VA needs to fully address these recommendations to improve exam quality. Let's 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 For example, we found VBA's oversight of contractor's planned corrective
▶ 0:38:45actions 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 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.
▶ 0:39:12We 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.
▶ 0:39:42Five of the six examiners we randomly selected and interviewed said that they would like the opportunity to provide feedback directly to VBA. And all six said unressed concerns about quality made it harder to provide quality um 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.
▶ 0:40:07Ultimately, 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.
▶ 0:40:22The written statement of Miss Curt will be entered into the record. Miss Glenn, you're now recognized for five minutes to deliver your opening statement on behalf of the Department of Veterans
▶ 0:40:30Thank you, sir. Good morning, Chairman Latrell, 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'm joined today by Tara Flores, director of acquisition service, strategic acquisition center.
▶ 0:40:51Over 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 PAC Act were signed into law. These pieces of legislation led to unprecedented increases in the number of exams requested for veterans.
▶ 0:41:15Due 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 FY 2025, VBA completed over 3.3 million examination scheduling requests.
▶ 0:41:42This resulted in over four 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 C 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.
▶ 0:42:13Therefore, 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 Isaxen Row Act, which allows contract examiners to provide services in any state or US territory without having to obtain multiple licenses.
▶ 0:42:37This 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.
▶ 0:43:00VBA 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.
▶ 0:43:30Another 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.
▶ 0:43:54While VBA continues to innovate and improve veteran experience, we must also realize that there are 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.
▶ 0:44:20I 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.
▶ 0:44:44We 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.
▶ 0:45:04Thank you, Miss Glenn. The written the written statement will be entered into the hearing record. We will now move to Uh Miss Curta Mio failed to improperly implement quality checks as far as incentive pays. What when was the first GAO report asking VA to do that? What year?
▶ 0:45:30Um we we developed that finding in a report that was issued uh this year in
▶ 0:45:34This year?
▶ 0:45:35And from what I understand, Miss Glenn, you told me that that's that's being taken care of, correct?
▶ 0:45:39Yes, sir. How far how far along were we and how did we find the the how did we find that discrepancy that payment? How I mean how did that show up? We it went out it went outbound. Who was looking at it and found it?
▶ 0:45:56Um so actually it was brought to our attention by GAO. Uh but based on that, we went back and audited all of our incentive and disinccentives that were paid since we changed uh the incentive and disincentive structure. The structure was changed in a modification in September 2021. So we went all the way back to FY22 check and checked everything and found no other
▶ 0:46:21Okay. So why didn't the vendor say something?
▶ 0:46:26Uh we determined
▶ 0:46:27Well, I mean, I got it. I probably wouldn't say anything either if you if you overpay me $2 million. However,
▶ 0:46:32yes, we determine how much money the vendor will get or not get. Um the vendor does not tell us how much money they should get for incentives. We tell them we have a quarterly uh report performance report with them every quarter and we provide them with uh the information and the details of their performance and at that point we tell them how much they should get uh either an incentive
▶ 0:47:00I asked you this question earlier how much should have should have they should they have gotten
▶ 0:47:07so uh it was that $2.3 million was over two different contracts. So, it varied based on the contract and I can get you those specifics um after
▶ 0:47:21Okay, that's got to be interested to see how that happened. And as far as course correcting this, my question earlier was is this one specific individual? Your response was no.
▶ 0:47:32Yes, sir.
▶ 0:47:32So, I want you to walk the committee through that, please.
▶ 0:47:36So, the invoices come in from the vendors. Uh they are immense. Uh but beside the point, uh they are reviewed by the contracting officer who then pass it on to their lead um for approval and once that approval is done uh the funding packages are up are sent forward through a portal and uh they go to the office of financial management uh
▶ 0:48:06who controls the portal. The they don't do a check on it. uh but then it goes uh straight to the treasury.
▶ 0:48:14So the way I understand it for our conversation is now there's a series of checks and balances internal to the VA.
▶ 0:48:21Yes sir. Previously
▶ 0:48:22that way this problem does not happen again. I now my question is two contracts for 2.3 million plus or minus and incentive pay is is for them to 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 this is a great idea we're going to give you this to keep
▶ 0:48:45Uh no sir the the incentive and disincentive structure is built into the
▶ 0:48:52if that's what you're asking me
▶ 0:48:54it is but you told explain to me how that works because you told me earlier the VA creates that number that you pay the specific corporation. So if it was already in
▶ 0:49:04it's based on their
▶ 0:49:05if they hold on for a second. So if the number is inside the contract, they would know how much they're supposed to
▶ 0:49:13They correct
▶ 0:49:14the number in the contract is a percentage a percentage of their
▶ 0:49:20which is laid out in I'm I'm assuming phases. So they hit phase one and completed phase one. They would know the percentage of the incentive pay that's coming their way.
▶ 0:49:30Yes, sir.
▶ 0:49:31Okay, great. And so when they got $1.5 million more than what that contract stated, you're telling me would they didn't call you up and say, "Hey, you overpaid us $1.5 million."
▶ 0:49:47Uh, no, sir. Because there are changes to the invoice quite frequently. Um, some of the charges that they uh put on the invoice may be erroneous and we we make them go back and either correct them or Apparently, we missed that
▶ 0:50:04if we paid them $2.3 million.
▶ 0:50:07How did the vendor miss it?
▶ 0:50:09No, we did. I'm sorry. The proverbial we the VA.
▶ 0:50:12Oh, yes sir. Uh it was a it's a it was at that point in time a manual process uh being reviewed by as I said a couple of people. Uh we have changed that now. We have an automated process that is put into place. We have a a statement of operations uh that everybody will follow. It is a written statement. We have checks in place. Uh we also have an audit contract now.
▶ 0:50:37Okay, Miss Miss Glenn, I I'll I will come back to that question. Apologies, ranking member. You're Oh, thank you. Um, we we have an audit contract in place and we're working with VA's data team to further refine our reports and provide us with an additional check on the invoices.
▶ 0:50:58Okay. And we just created this recently and we've been doing this for a very long time.
▶ 0:51:06Yes, sir. That has been something that we've been trying to do.
▶ 0:51:10Okay. Thank you, Mr. McGarvey. You're
▶ 0:51:13Thank you, Mr. Chairman. Um, Miss Glenn, we'll just stick with you. How much money does MDEO pay contracted medical examiners annually?
▶ 0:51:21Uh sir, we do not pay the examiners. Um we pay the vendors and the examiners are subcontracted through the vendors.
▶ 0:51:29How much do you pay the vendors?
▶ 0:51:30Uh it is dependent upon how many uh exams they complete for us and it varies by region and by location. uh rural areas uh will not cost as much as New York City for example. It depends on the type of examination.
▶ 0:51:51So what's the total?
▶ 0:51:53Uh the total for exams let me get back to you on that sir.
▶ 0:51:58Okay. Um how many exams are they conducting per year?
▶ 0:52:03Uh last year we did 3.3 million exams.
▶ 0:52:063.3 million exams. And that's
▶ 0:52:09Yes. nationwide and internationally.
▶ 0:52:11Okay. And you're telling me that there can be different costs depending on where those services are. Fine. But we do want to know how much you're paying um total every year in this. Uh do you know roughly what the cost is per
▶ 0:52:26I do not off the top of my head. So let me take that back. Do you know what uh do you know whether it would be cheaper or the same price or more expensive if those exams are done by VHA employees?
▶ 0:52:40Uh I do not have that information right now, sir, but I will say that every exam request that comes in um 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 veterans home.
▶ 0:52:57Right. But you'll get us the
▶ 0:52:59Yes, sir. about the difference in and and how much it costs. Okay, good. Um program you're overseeing is really large and we're getting that by some of the the answers you don't have today. Do you have everything you need to properly oversee this program? Um at this point, yes, sir. I mean, there's a lot of improvements that we want to make as I pointed out in my opening statement. Uh there's a lot of technology that we want to check out and see if it can help us improve our process.
▶ 0:53:28Uh we thank you so much for the license portability uh extension if uh that is a major thing for us and it really helps us be able to provide exams in rural areas and across the country.
▶ 0:53:43So I asked you if you have everything you need. You said yes and then you told me the things you want.
▶ 0:53:48I'm ask you again. Do you have everything you need to properly oversee this program?
▶ 0:53:52There's always room for improvement,
▶ 0:53:54Okay. Okay. Um let us know what those are. Okay.
▶ 0:53:57Um because, 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 we can do both of those things at the same time. Um I understand that MDO lost a lot of staff at the beginning of the year. Have you all replaced those employees?
▶ 0:54:12Uh we have enough staff right now to continue to do our primary mission. We did lose some people. Some were expected retirements. Um, but uh we we are still keeping on and we continue to be able to provide examinations for veterans and keep track of those examinations. That was a government answer. Um, so you've lost employees. You say, I get it. We're not We want to take care of our veterans.
▶ 0:54:41We want to give you the tools you need to take care of our veterans. What happened? What do you So again, um I would say that we we are going to be able to do that. We're hopeful that a new organization chart will be coming out shortly and uh we'll see what that looks like and we but we have enough people right now to continue our primary mission.
▶ 0:55:05Okay, we'll keep we'll keep hitting on some of this stuff. Um we want to get to the bottom of it, not just not just have government speak here in this committee. Um there were a lot of cuts because of Doge earlier this year and there were a lot of contracts that were cut. MDO 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 replace the capacity to do so?
▶ 0:55:33Uh yes sir, we were able to restore the financial audit contract. So, it is now in place and we are working with the veterans experience office uh and they have helped us develop a new survey which started going out to veterans uh the first week in September.
▶ 0:55:49Okay. Um Miss Curt, I'm going to ask you a question really quickly. I understand that you all were tracking those cancellations as well and your August 2025 GAO 25107843 report. GAO said VA should do a better job making sure it's contractor incentive payments are calculated correctly. Does the answer line up with what y'all are seeing? And do you feel that MDO MDEO needs those services whether contracted or in-house to do proper oversight? And you have very little time and I apologize.
▶ 0:56:16Yes, I think I think those contracts are necessary. Um they they factor into the incentive payments um which consists of quality, timeliness and customer experience. And so if you're missing um the the people who validate the timeliness measures, if you're missing the customer experience measure, then you're you're not going to be able to um calculate [music] the performance um incentive payment and or or they may be incorrect. So I think they are important.
▶ 0:56:41And I just I want to point out the veteran experience survey was recommended by the IG as to be done externally [music] to the agency. Um and I I don't know. I think maybe now it's being done internally.
▶ 0:56:50Thank you, Mr. Chairman. I yield back.
▶ 0:56:53Thank you, Mr. McGarvin. General,
▶ 0:56:55you're recognized for five minutes, sir.
▶ 0:56:56Thank you, Mr. Chairman. Um, let me make a a generic statement here first. Bureaucracies, good bureaucracies are necessary and okay. We need that. Stove pipes, not so much.
▶ 0:57:11And what I'm hearing here seems to be some um solid effort within a bureaucracy to look at and manage stove pipes that detract from the value of the outcome.
▶ 0:57:29So, um, in recent months, I have heard from veterans and VSOs 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.
▶ 0:57:45When a veteran service representative flags certain files for an exam examiner, I've heard that these files reach the medical examiner's enlarged, unorganized, dense packets that show no level of of help for that person who's going to look at them next. When that evidence doesn't reach the examiner or is not properly organized, exams are conducted without key facts.
▶ 0:58:13I think we'd all agree DBQs can be comp completed inaccurately leading to a denial by the VBA. So, combined with GAO's findings on exam oversight gaps and delayed quality reviews, it's clear that there's some systemic breakdowns affecting those veterans outcomes. So, I'm trying to understand what causes the breakdown.
▶ 0:58:41Um, you know, as a I guess thinking thinking as a pilot, we have to do things in certain orders. Checklist, complete checklist to ensure that the flight is flown safely. And then after it's flown, we do a maintenance log to make sure that that plane is ready for the next crew. So along those lines, uh, Miss Curta, is VA's medical disability examination office responsible for overseeing the the DBQs?
▶ 0:59:13Uh, yes, they are.
▶ 0:59:14Okay. And based on your audit work at GAO, to what extent might missing evidence contribute to DBQ errors, inaccurate exams, or improper denials?
▶ 0:59:28Yes, it would it would contribute to those things if that is occurring. [music] Yes.
▶ 0:59:32Okay. Uh, Miss 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?
▶ 0:59:45Yes, sir. If it's in the veteran's claim folder, everything is sent over to uh the examiner.
▶ 0:59:51Okay. So, 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?
▶ 1:00:04Uh yes sir. It is done automatically. As soon as a veteran's uh is scheduled for an examination, it's an automatic push to the vendor. The entire file goes
▶ 1:00:16The push is automatic. How is the vendor's evaluation of the data in front of verified that they had it all? So to your point about um marking things, the claims processors review also review the file and they do tab evidence that could be relevant, but it is the examiner's job to review the entire file and we do check and make sure that the entire
▶ 1:00:46file goes over.
▶ 1:00:48Is it a random check or 100% check?
▶ 1:00:51Uh I could not tell you that, sir. I'll have to get back to you.
▶ 1:00:54Okay. Well, um, will, Miss Glenn, um, will MDEO commit to reviewing the process and form in which medical examiners re receive a veteran supporting documents. So, basically standing there looking when that uniquely organized packet shows up.
▶ 1:01:16Yes, sir.
▶ 1:01:17Okay. Well, again, I uh I see my time is about to run out. We know one thing for sure. Veterans never quit. We can't quit on the veterans.
▶ 1:01:30And we have to continue to refine the oversight and the detail of that oversight in an everchanging world where we use the processes available to us now to be better at what we do on the veterans behalf because they're counting on us. So with that, Mr. Chairman, I yield back. Thank you, General. Mr. Abser, you're recognized for five minutes.
▶ 1:01:56Thank you very much to the chairman and ranking member for holding this session. Uh, Miss Glenn, if I can start with you. Uh, we heard from Miss Curta before about a recommendation around uh the non-collection of feedback from examiners um who want to offer it to make sure that um they're giving feedback to VA that things are uh moving ahead for veterans as quickly as possible and that processes are being improved. So, um you said that you implemented all recommendations.
▶ 1:02:21Can you speak to how you're collecting feedback from examiners and what value you think that's going to provide?
▶ 1:02:27Yes sir. Thank you. Um yes, we have established a portal for the examiners to be able to come directly to uh MDEo and provide us with feedback. The portal was announced um on the learning management system that we give to that all the examiners have access to as well as we had the vendors uh put out an announcement that the portal was live and ready to go and we also sent emails
▶ 1:02:57to each of the examiners and told them individually that the portal was live and here was the link. So the portal was live uh by the end of September. Uh I have a staff of people who are regularly reviewing the uh questions or answers. We've even gotten compliments coming through the portal. Um so we are looking at all of those as they come in. If there's anything that needs action, we are referring it to the proper place.
▶ 1:03:25Uh so so far it's been successful.
▶ 1:03:28So you're not proactively soliciting that feedback by going to the examiners. It's sort of like a suggestion box where examiners can just submit on their own.
▶ 1:03:37Well, we 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 and we also it is a flag across the top of the learning management system with the link um that they can click on and give us the extra
▶ 1:03:57Okay. Well, I'd be interested to see how that's working and if that's 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's scheduling. Uh in September of this year, a Navy veteran from the town of Freedom, New Hampshire, who's 100% service connected and battling cancer, contacted our office because she was in pain, needed medication, couldn't get her exam rescheduled.
▶ 1:04:21days 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 isn't unique. We hear uh routinely from veterans experiencing roadblocks and um trying to secure reschedule an appointment. Um and so contracting out the exams was supposed to speed things up to get uh benefits to veterans faster, but this isn't what a lot of veterans who are reaching out are experiencing.
▶ 1:04:48So, Miss Glenn, what options do veterans have when they're assigned an appointment at a time or location that they can't attend? And why is rescheduling so difficult when we know that veterans are going to bear the consequences if they can't make it?
▶ 1:05:00Uh, yes sir. We realize that is a pain point and we are working uh very hard and to try to make it a better place. Uh we are looking at some automation, some technology uh that would allow us to see across the board all appointments that would be available to a veteran for in a specific time and date. Um so that they could then choose the appointment that is most convenient to them.
▶ 1:05:26Uh this is something that VHA is already using and we are working very hard to plug into that uh piece of technology. Uh you mentioned location of of um exams too and we hear about this from veterans. Driving 50 or 100 miles um doesn't work for some veterans. The veteran I referenced earlier experiences uh hip issues and long car rides uh bring her significant pain. So we should be making this process easier.
▶ 1:05:55I'm wondering if you can speak to the ways that VA monitors coverage gaps uh in terms of geographic areas and how you evaluate those and what steps VA can take to get these exams closer to home for veterans.
▶ 1:06:08Yes, sir. So, one of the things that we do, the contract allows uh 50 miles for a general med exam and 100 miles for a specialty exam. If the veteran has to travel beyond those limits, they have to have uh consent f from the vendor to the vendor to us that they are willing to travel those additional miles. Uh we have done all kinds of things.
▶ 1:06:33Uh if we have uh the vendors have mobile units, medical mobile units that travel circuits throughout rural communities so that they can provide uh exams where the veterans live. Uh, I talked about the license portability act and how important that is to us. Um, we are looking at every way possible to try to make this more convenient and less stressful for veterans.
▶ 1:07:00Appreciate the feedback. My time's up, so I yield back.
▶ 1:07:05Thanks, sir. Dr. Morrison, you're recognized for five minutes.
▶ 1:07:08Thank 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 PAC Act was a huge step forward in providing our veterans with the care and benefits that they've earned and deserve. We also know that it greatly increased the administrative burden on the VBA and MDO. And I'm looking forward to hearing more about how VA has navigated these and other challenges over recent years.
▶ 1:07:37Miss Glenn, in your testimony, you referenced that MDO 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're 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?
▶ 1:08:03So, our intent is to reduce the number of in-person examinations that are needed. Uh, we want to be able to uh rate or make a decision for the veteran based on the evidence that they submit to us that's already of record.
▶ 1:08:19uh that is one of the things that we are looking at technology-wise on how to do that best and uh we are actively pursuing and looking at different options and talking to the experts about the best way to move forward.
▶ 1:08:36Okay, 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 VFW's statement for the record, their observation about multi-year MDO contracting caught my eye. Their case was that moving from a two-year contract cycle to a longerterm model could save money and improve outcomes for veterans by reducing contractor turnover and incentivizing contractor investment and improve technology and workforce development. Uh, I guess this is to all of you.
▶ 1:09:06Do do you agree with VFW's assessment and what are your impressions of the current contracting model versus a multi-year model? So, yeah. Yes, to a certain degree. Um, often there are techn technological changes that will require us to uh let a new contract, but traditionally, yes. And I I will tell you we are already working on what will be considered a multi-year contract.
▶ 1:09:40Miss Curt,
▶ 1:09:41that was my understanding as well that they are and have started on a a contract that I think goes for 10 years. Is that correct?
▶ 1:09:50That's still up.
▶ 1:09:50Oh, still up. Okay. Sorry.
▶ 1:09:54Okay. Uh, Miss 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 PACDAC training. What steps are being taken to ensure examiners complete their PACD training and that any erroneous claims are being reviewed and rectified?
▶ 1:10:18Uh, yes, ma'am. I can speak to VBA. Um I believe there were only three contract examiners who were found to have not completed their training. Um but to your point, we review all VBA contract examiners training on a monthly basis.
▶ 1:10:36uh 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 uh to ensure that all of the examiners have completed their training before they start to complete exams.
▶ 1:10:52Thank you, ma'am. And thank you, Mr. Chair. I yield back.
▶ 1:10:55Thank you, ma'am. How much, Miss Glenn? How much money did the VA collect in penalties last year?
▶ 1:11:05Uh, sir, I do not have that information. Uh, we are still going through fourth quarter information. So, as soon as we have completed that, I will let you
▶ 1:11:15There's no Well, we found all the incentive pays that we don't we're not tracking that in parallel.
▶ 1:11:20Um, well, the incentive payments for fourth quarter have not been awarded
▶ 1:11:25The 2.2 two the 2.3 million that went maybe okay let me back the year up then the 2.3 million overp payments
▶ 1:11:31was from 2020
▶ 1:11:32you would have found the you would have found the penalty um penalties as well
▶ 1:11:37yes sir
▶ 1:11:37how many were there
▶ 1:11:39uh for 2024
▶ 1:11:42okay I will have to get back to you
▶ 1:11:47what is the prob did the two corporations or the two companies or the two vendors excuse me the two vendors that received the overpayment were they ever hit with penalties Yes, sir.
▶ 1:11:56They were That magic number wouldn't happen to be the same amount as the overpayment, would it?
▶ 1:12:01No, sir.
▶ 1:12:02Are we sorting?
▶ 1:12:03Uh, I'm posit almost positive is not the exact same number, but I will be
▶ 1:12:09plus or minus $5 maybe.
▶ 1:12:11No, [laughter] 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.
▶ 1:12:18Okay. I'm just want to make sure that the vendors aren't taking advantage of the situation.
▶ 1:12:22Yes, sir. Understood.
▶ 1:12:23I'm sure you can appreciate that. Yes,
▶ 1:12:25As far as examiners go, and they respond to the portal, who's is the staff, your staff, responding directly to the
▶ 1:12:35Oh, uh, yes, sir. In some instances, we have, if the situation warrants, as I said, um, a lot of I mean, as I said, some of the things that we've gotten have been compliments, some of it has been suggestions. Um, some of it there there's just a whole wide variety of things that they are the examiners us
▶ 1:12:56apprehensive about responding to the portal in fear of I shouldn't say it that way because of maybe retribution from the
▶ 1:13:06The vendors the vendors do not get this feedback unless we give it to them. Um,
▶ 1:13:11well, they're 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're the ones telling the examiners what to do,
▶ 1:13:21but the examiners have the ability to uh come back to us through the portal anonymously if they choose to. Sure.
▶ 1:13:28Um, there is a text box where they can type out whatever they feel like they need to say.
▶ 1:13:34I got it. I'm kind of worst case scenario in this, which usually is has a tendency to play out around here. So, if you go to a vendor and say, "Hey, we we recognize there's a problem." Well, the first question the vendor is going to ask is like, "Well, how did you know about that?"
▶ 1:13:46Right? So, we would tell them, "We got it through the exam portal, but
▶ 1:13:51you can't say that because then then they're going to know who sent it."
▶ 1:13:53Well, not necessarily, sir. They have uh thousands and thousands of examiners that work for them. Probability. Got it. Okay. Do you have anything for
▶ 1:14:05Okay. I recognize you. Go ahead. Yes,
▶ 1:14:08Thanks, Mr. Chairman. I appreciate that. I've got a few questions for you. But first, I mean, look, I I'm 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's happening with them or how they're they're benefiting our veterans. We want to make sure that this is working and that's working for our veterans. And that's that's the point of this hearing. That is what we want to see happen and and and we need your all's help with that. Um, Miss Glenn, I'm going to go back to you with a couple of specific questions.
▶ 1:14:37The Paralyzed Veterans of America wrote in their statement for the record today that their concerns regarding accessibility of exam locations. In the wake of a 2024 IIG 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're going for the screening.
▶ 1:15:02So, what actions is the VA taking to ensure that they are providing adequate oversight to the contractors and the facilities that they occupy?
▶ 1:15:11Yes, sir. We Well, it's twofold. First of all, we require that the vendors examine each facility that they send veterans to, but secondly, we then go back and do site visits, surprise site visits to these facilities. Um, in FY25 we were able to do 159 site visits. Uh, we plan on doing more.
▶ 1:15:37In FY26, we have a plan in place and, uh, we will hopefully be able to soon execute it.
▶ 1:15:44Okay. Again, this is an OIG report. This is a statement in the record today that of the 135 they visited, half had accessibility issues.
▶ 1:15:52Yes, sir. And you're telling me that the vendors are certifying that these these venues don't have accessibility issues? I mean, half that's a pretty big statistical sample out of 135 locations. I'm not saying that that that carries out across all
▶ 1:16:11but then your answer kind of says we're doing these things, we're doing these, but half aren't. So, um, how are you getting feedback directly from our veterans who use mobility aids? Um, how are you actually finding out about this? And and was this was this OIG report a
▶ 1:16:30Yes, sir. I would say so. Uh, one of the things that we have done is we have require the vendors or when they contact the veteran to make sure that they ask them do they have any accessibility issues and that they should not be sending a veteran with accessibility issues to a facility that cannot handle.
▶ 1:16:50Um, we look at this, we take this very seriously, which is why we send um, in-house staff who have taken OSHA and ADA training to go out and look at these facilities and make sure that any, uh, anything that is wrong, such as the fire escape map is not on the wall, uh, is corrected immediately if not.
▶ 1:17:14We want that, but there still seem to be major problems. And you're mentioning like even a fire escape map on the wall, but we're hearing what I would consider to be horror stories about exams being conducted in inappropriate locations such as hotel rooms. Um, can you confirm that these types of practices have been stopped completely? And if if not, why? And if they have, what is VA doing to find out about these and address them? And how did you do it?
▶ 1:17:42So we have tightened up quite a lot on what our requirements are for the examination space and uh I have not heard anything lately. I would welcome anything that any of you see um along this issue to be brought to our attention so that we can take action. We do have a plan.
▶ 1:18:03we do have a way of investigating and uh you know we want our veterans to feel safe [snorts] and accommodated when they go to the exams.
▶ 1:18:13This is this is a massive program and we're hearing way too many stories of how it's 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 and there needs to be more oversight. Um uh really quickly uh VA conducts special focus reviews to try and reduce errors on exams for most complex claims including traumatic brain injury, military sexual trauma, gulp or inj illness.
▶ 1:18:41Miss Curta, you testified that VA plans to change the tempo of these reviews from a two-year to a three-year schedule. Will the three-year schedule allow the MDE to meet its oversight goals? Well, um, according to their own analysis, they they would have preferred to keep this to a two-year schedule. We were told due to staffing reductions, they could they couldn't do that.
▶ 1:19:05Um, so we were happy to see it change to a a three-year schedule rather than no schedule or um, you know, erratic schedule. Um I think the you know on the the con side um you know the purpose of these things is continuous [music] improvement.
▶ 1:19:23So if you wait another year to um look to see if what happened in the first round of reviews is corrective actions that were identified if if you wait another year to see if they've been implemented and that they are whether they are effective you you lose that opportunity to make um to take course corrections and make changes. And so I think there is a downside to waiting another year. um you miss miss opportunities and it could result in inaccurate claims.
▶ 1:19:48I 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 and it seems like as part of this hearing you guys are telling me you don't have staffing issues. Um this is a problem. Our veterans need to find the front door to the VA and this is often the way it happens and we need to make it easier for them to walk in and get the care that that we promised them.
▶ 1:20:11They put on the uniform and we've seen what our veterans have done for us in the last 20 25 years and what they have sacrificed for us and in exchange for that we made them a promise. It's not just a legal promise. It's a moral promise that we would take care of them and it sounds like they are not living up to that with this program right now. We need to do
▶ 1:20:28Thanks sir. Mr. Sil,
▶ 1:20:30you recognize from sir.
▶ 1:20:32Thank you Mr. Chairman. I I want to get at the errors and the payments. What is the max percentage of the contract that can be uh rewarded?
▶ 1:20:46Uh the max percentage is 3% of the
▶ 1:20:50of the invoice. Okay. So on the two the two errors that resulted in overpayments, what was the total invoice amount of those two errors?
▶ 1:21:03Um sir, I do do not have that information at hand. Okay. So,
▶ 1:21:06I'll get back to you.
▶ 1:21:08Okay. So, I did the I did the backwards math. So, if you paid out $2.3 million and 3% of the invoice amount, was it the full
▶ 1:21:21I'm not sure, sir.
▶ 1:21:22Okay. Let's assume that it was full 3%. That means that the invoice amount for those two contracts was $76 million.
▶ 1:21:34Yes, sir. So, we've got $76 million contracts that were didn't have enough this this is indeed a problem. I won't I can see I think you've already addressed this about the time I left.
▶ 1:21:57How many people were reprimanded for the 2.3 million Uh, the people involved are no longer employed with VA, sir.
▶ 1:22:07That's a pretty good reprimand.
▶ 1:22:13have you changed vendors because of it?
▶ 1:22:16No, sir.
▶ 1:22:17What is the total if if these two contracts are $76 million uh that had errors that got rewarded for 2.3 million, what's the total contract on those two vendors? Is it two vendors or two mistakes in one vendor?
▶ 1:22:34Um, I'll have to get back to you on that. And I told Chairman Latrell that I would get him uh the amount spent on
▶ 1:22:46Two contracts for sure.
▶ 1:22:48Two contracts might be one vendor. Two chairman, I yield back. Thanks sir. Uh Miss Curt, explain to me the TBI scheduling that you and and the ranking member were speaking on from two to three years, please.
▶ 1:23:10So um this is what part of uh MDEO's um quality control process is to feed to the contractors the most frequent errors in a given quarter. Um and um Oh, actually, I'm sorry.
▶ 1:23:24Specifically around traumatic brain
▶ 1:23:25Yeah. Yeah. Um those were the special focus reviews. Um and so um this is reviews that they planned to do every two years and what they do is they take a deep dive on the traumatic braiding injury and to see what are the root causes of the errors in those types of exams and then uh work on corrective actions with the vend vendors. So um the idea being that then they would come back after two years and see okay what's happening with those errors and
▶ 1:23:52what what explain an error to me please
▶ 1:23:55in the exam. So um an examiner fielding out the DBQ for traumatic brain injury would make errors um and they would the these particular types of exams and these are particular types of DBQs are more prone to error um and so it's getting at the root causes of those frequent errors and correcting.
▶ 1:24:12So let me ask you this. I have a background in neuroscience. So right now it's every two years. Advancements in 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.
▶ 1:24:38So we have the ability to identify traumatic brain injuries at the granular more towards the granular level. Okay. In depth at scale. So if an individual walks in with or or submits a DBQ this year with neurological scans and assessments, cognitive assessments, and the examiner says you're good to go.
▶ 1:25:05He has he or she most likely will have to wait two years in two years that scan may show something that is 100% debilitating. Is that how long we have to wait?
▶ 1:25:23Are you asking me or
▶ 1:25:24I'm asking the panel this question? And if you're not if you don't understand what I'm asking you, let I'll clarify it. But I my concern is you're trying to kick it out to three years.
▶ 1:25:36Now there's things that we can identify today that will kill somebody in three years that we didn't know about two years ago.
▶ 1:25:43And is it that Mio's office request to kick it out the three years?
▶ 1:25:51Um 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. um you know our doctors our examiner
▶ 1:26:07so 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 doesn't find in anything sends it back to the vendor and back into the VA and the claim is shot
▶ 1:26:23um just to clarify the special focus reviews don't look at are not about individual claims it's about trends um trends it's like looking across
▶ 1:26:31all of the exams that were done and what were the those frequent errors. So, it's it's sort of like a continuous improvement process.
▶ 1:26:38Do we have any idea if the special focus reviews that were conducted four years ago, has there been have we noticed any change in those compared to compared to veterans today that have a neurological disorder or neurological disease or traumatic brain
▶ 1:26:57Well, that is what we're saying has not happened because they haven't done the next round. And we still think bumping it up for three years instead of two is a good
▶ 1:27:15You're in charge.
▶ 1:27:18Um, yes, sir. We are doing what we can with our resources and
▶ 1:27:24No, no, no, no.
▶ 1:27:26You're walking around the question. You're actually dancing where Mr. McGarvey's hitting you on. Don't give me the political answer. I'm I'm I'm literally trying to save lives here.
▶ 1:27:35Yes, sir. I will tell you that there are additional things that we use besides the special focus review. We do monthly
▶ 1:27:42Oh, you're walking around it again. I'm asking you about the three to two year. Matter of fact, I think you should bump it back to six months or a year. When it comes to traumatic brain injury, that's my opinion, my opinion only. But I want you to take a heart. Can't ask you to do that. I disagree with three years.
▶ 1:28:00Yes, sir. Understood.
▶ 1:28:09I appreciate Mr. Chairman's line of questioning. So, I just want to ask this really simply and I and I want a simple answer because it's a it's an important question. Just simple doesn't mean it's not important. Is it better or worse for our veterans to go from two years to three years? I would say worse. Thank you, Mr. Chairman. I yield back.
▶ 1:28:37You're recognized there for five
▶ 1:28:39Uh thank you, Mr. Chairman. I want to follow up on your trends comment uh because apparently four out of the six examiners that they examined uh said they no longer elevate uh challenges to their vendors because their vendors don't listen to them. How then do you establish trends if your examiners are not sending their feedback to the vendors? How how do you develop trends?
▶ 1:29:06Is this a paperwork drill or is this actual feedback from the field?
▶ 1:29:10Well, I I'll let Miss Glenn answer, but I mean our observation is they do have processes in place um to identify errors within MDO through their review processes and so forth. It is but it is a perspective that's missing um is the examiner perspective. They felt that they were not being listened to by their contractors. They were not always given good advice. Um they felt they knew more sometimes than the contractor's quality assurance staff knew. Um and that they they would would like to give that feedback to VA.
▶ 1:29:39That's a So then once again, that's pretty damning testimony. Once again, how do you establish trends if you're not accepting feedback from your examiners? So based on the GAO recommendation, we did develop a uh examiner portal which is live as of the end of September and we have been collecting feedback from the examiners. It is a open text box.
▶ 1:30:06They can type in whatever they feel like they want us to
▶ 1:30:11So you've got two months of data. Mr. Chairman, I yield back.
▶ 1:30:18Thank you. members, you recognize, sir.
▶ 1:30:20Thank you, Mr. Chairman. I appreciate this. Uh, 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% of which were wrong. So, right before this, I had a small business committee hearing this morning, and I'll put the small business hat on here.
▶ 1:30:41Can you imagine if you were running a small business, let's let's say a diner or something, and 20% of the meals you sent out from the kitchen were wrong, the business isn't going to last very long, or at very least the cook's going to get fired. That is a massive problem to have 20% wrong. And we can't tolerate that level of inaccuracy when it comes to serving America's veterans and protecting our taxpayers.
▶ 1:31:06So, General Latrell, I look forward to continuing to working with you uh to do something at an upcoming round table or some sort of event. Maybe we can hear directly from the contracted companies. I think with these for-profit companies controlling 90% 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. And Mr.
▶ 1:31:25Chairman, you know, we have all heard concerns in this room because this room we get together to help our veterans about the need to sell veterans on the VA and numerous veteran service organizations and veterans themselves has spoken to us about the challenges that veterans face with the CMP exams.
▶ 1:31:43So, 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's 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. It but it's happened. We are getting these stories.
▶ 1:32:13And 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'll get their incentive pay.
▶ 1:32:30Is this the standard of care that our veterans should experience or that we want to I want to ask the contracted providers what controls they, not the VA reviewing numbers from a 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 that our veterans are getting the reviews and care they need.
▶ 1:32:56When we hear today that reviews are moving from every two to three years and that that is by your own testimony worse for veterans, we have to do something about that. Let's bring in the heads of these companies. Let's get together. Let's make sure that our veterans, the men and women who were willing to sacrifice everything for our safety and security and freedom, receive the promise we gave them that when they took that uniform off, we would take care of them.
▶ 1:33:27It's exactly what we want to do. It's exactly what we need to get done on this committee. Thank you, Mr. Chairman. I yield back. Miss Glenn, your office is has a very large responsibility. I'm sure you're you're kind of feeling that right now in this hearing. And I want to thank all three of you for what you do for our veterans. And I say this every committee hearing. You wake up every day. You go in and and you do and you do what you can for us.
▶ 1:33:51And we pay attention to 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 in my district. And I can assure you the most aggressive group in my district are my veterans are my brothers and sisters. And they talk to us because they have every right to get what they've earned by putting on that uniform and fighting for this country. Every one of them. And there's always going to be mistakes.
▶ 1:34:22The human the human element and the human error. It exists. It does. Your office is responsible and you in charge are responsible for oversight in your office. Miss Curta has pointed out quite a few and I know that you're working on it and I appreciate that. We will never let that be enough and it will never be perfect.
▶ 1:34:49But we will not stop fighting for perfection because of those that we were 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 sister their brother or sister out. They never did that. That's why we do what we do. And that oversight goes a long way. You will be back here in front of us. We will ask these questions again. And I expect it will not be the same answers.
▶ 1:35:19Miss Curt 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. Don't ever forget that's what you're doing. Okay? Staff included. I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material. Without objection, so hearing is adjourned.