Fact or Rumor: Will most C and P exams be contracted out in the near future?


Rep. Elaine Luria, Chair of the Subcommittee on Disability Assistance and Memorial Affairs (DAMA), Committee on Veterans’ Affairs, is not happy with Sec. Wilke.
And she wants a response to her letter of 10/20/20 by Nov. 16th. Why? It seems as if C & P exams by VHA employees are going away. She writes (Link to letter):

“During last year’s Subcommittee hearing on contract C&P examinations, VA testified that contract exams were intended to supplement the existing VHA C&P program, providing local examinations to rural veterans and prompt
appointments when VHA facilities had long wait times. Now, VA says full migration of C&P examinations to contractors was always the plan.

Luria is worried about a number of issues if VA retires the VHA C&P program. About 60% of C & P exams are outsourced now. She mentions the Covid backlog, the GAO report which noted that oversight of contractors was lacking, and potential lay-offs of VHA employees.

Luria writes, “For many veterans, thorough and accurate C&P examinations are crucial to securing service-connected benefits.” That is true but is she unaware that both VHA and contracted C & P exam results fail to be in the best interest of the majority of ill veterans? After twenty years of active service in the Navy, she retired at the rank of Commander (Link). It’s hard to say how much contact she had with VA during her career. But after her election in 2018, she is in the thick of VA shenanigans. As Stars and Stripes puts it, “

During a hearing she led last year, the VA said it would contract with more outside medical providers to perform C&P exams. Lawmakers were led to believe the contracted examiners merely supplemented the existing program, primarily to help rural veterans and those veterans facing long wait times, Luria said.

Recently, however, VA staff told Luria’s office about the department’s plan to shutter the C&P program at the VA and contract with the private sector for 100% of the exams.

What would be a fairer system? I think a veteran or representative should receive an allowance towards the cost of an IMO, equal to that which they pay to a contractor. The veteran could be issued a “kit.” If VA finds it doesn’t meet standards, they could buy a contracted C & P exam. The format and information in the kits should be exactly the same for the IMO and contracted providers. VA can and does still ignore favorable evidence and information in exams to deny claims.

At this moment, I’m not sure if new C & P contractors will have access to a veteran’s medical and/or military records. I remember reading about many veterans’ concerns about former Sec. Shulkin’s belief that eye exams should be outsourced because there “was a LensCrafters on every corner.” There were fears of privatization. And of course, LensCrafters are not situated on every corner. It may be that providers who join the VA Community Care Network, will also be conducting C & P exams–so wait and watch.

Laura (Guest author)

2nd District of Virginia. (Love this region.)

Update: Link to 2017 article about LHI Court Case mentioned in reply to Lem’s 3rd comment–scroll.

https://www.businesswire.com/news/home/20170615006298/en/Federal-Court-Upholds-Contract-Awards-LHI-Provide/?feedref=JjAwJuNHiystnCoBq_hl-RLXHJgazfQJNuOVHefdHP-D8R-QU5o2AvY8bhI9uvWSD8DYIYv4TIC1g1u0AKcacnnViVjtb72bOP4-4nHK5ieT3WxPE8m_kWI77F87CseT

This entry was posted in All about Veterans, C&P exams, Congressional Influence, Food for thought, Future Veterans, General Messages, Guest authors, IMOs/IMEs, Nexus Information, Uncategorized, VA BACKLOG, VA Health Care, vA news. Bookmark the permalink.

11 Responses to Fact or Rumor: Will most C and P exams be contracted out in the near future?

  1. asknod says:

    We got a VBA briefing and notice in September that, due to the exigencies of the pandemic and the changing face of the “New and Improved” VAMCs/CBOHs, that henceforth the VA would be sending out all c&p requests to either QTC, LHI or VES. If they don’t have the requisite specialist on site, you get a 76-yr. old senile proctologist instead of the recommended neurologist to opine on the residuals. They have been doing this with disastrous results.
    I caught them on it this week. A QTC GP did one on s/p gastroenteritis residuals and ignored all the six decades of subjective symptoms as unrelated; the anxiety/nervous disorder was “probably” due to SC PTSD. He never did identify any subjective residuals like facial numbness/slurred speech.

    I looked up the rater and the Coach via VA Outlook (.va.gov) and kited off an email to them to ask since when did VA start using the equivocal “probably” in their IMOs and moreover, since when did GP’s get to opine on psychiatric sequelae?

    Bingo. I see a new request for a peripheral nerves c&p scheduled for… where else…the Seattle VAMC. You have to be inventive. I cc:’d the email to VASEC Wilkie. They got so spooked they uploaded it into the Vet’s documents. Win or Die.

    • Kiedove says:

      –Pathetic: Is it possible to look up the outsourced providers credentials first, and if incorrect, protest before the apt. to get an appropriate one?
      –I just updated this post with a LHI article from 2017. Can anyone locate the court documents? Why did the gov. want to cancel the original award?

      • asknod says:

        Negative on the early look up. VBMS users can see the author after the fact.

        • Lem says:

          When making the QTC Appointment, I ask the physician’s office clerk what the qualifications of the physician and what the orders for the examination were. When the reply was that the Orthopedic Physician was not allowed to examine the articulation of the thumb carpal-metacarpal joint of the wrist and only the fingers, I cancelled and emailed the ordering DRO the reason. Copied the phone record of call to go with a copy of the email for my record to be used at my BVA Hearing. Also used it in response to the VAGC’s filing at the now moot Bray v Wilkie 20-1415 Rule 21 Petition.

          Working on the VA 10182 Legacy Appeal Form for submission directly to BVA as suggested by the BVA Decision (which waited until after 10/1/020 to make it possible) now.

          • Kiedove says:

            You are on top of these challenges. Thanks for the details.
            There are two audio to transcript sites I came across that might help when we need to document phone calls. These two create transcripts. Haven’t tried the services yet.
            The fees are reasonable and service quick.

            https://scribie.com/
            https://www.temi.com/

  2. Lem says:

    The BVA Judges Remand examinations done by NP or PA on any challenge. The VA does not have enough “Specialists” to do the examinations or have you not noticed you rarely get to see and MD anywhere, even at the “interconnected urgent care contract facilities” or CBOC facilities.

    My 05/11/2017 BVA Decision Remanded all examinations stipulating things that should not have had to be stipulated, but were, to get compliance with 38 CFR 4.42. TBI exam all records in possession of the VA. Wrist injury to include thumb carpal metacarpal joint articulation and surgery record from the Navy. Spine injury to include all records to include all records in possession of the VA. Items that had repeatedly been requested by FOIA, etc.

    • Lem says:

      BVA Remands reason for contract C&P examinations. But because of the limitations in the examination orders, I will have to ask for new remands because the old remands were not followed.

      In response to my Petitions to the CAVC for delay which included a request for enforcement of the Remands the VA GC attempted to deceive the CAVC by issuing the partially corrected orders after issuing the SOC and SSOC.

      The CAVC delayed the decision until after the new “legacy” appeals were submitted directly to the BVA without certification and dismissed stating I could file a legacy appeal rendering Rule 21 Petitions for delays in certification essentially moot. This puts me in the circle of having to go back to the BVA for new Remanded examinations before I can get fact finding on my claims necessary to be done before you can appeal to the CAVC or CAFC because they cannot rule on facts, only on application of law and the Constitution.

      The first point of review before the CAVC is a dispute of the Record before the Agency (RBA). My experience is a clerk held a hearing and the clerk tried to bully me into accepting the RBA as complete when my seizure clinic Progress Notes and Back Clinic Progress Notes were not in the record for review of the TBI claim and Spinal Disc Disease claim.

      I immediately appealed to the CAFC and the CAVC Court Manager refused to forward the Appeal to the CAFC. Had to wait for a CAVC Decision to make the Appeal to the CAFC. The CAVC issued a Memorandum decision ignoring the RBA Dispute. Waiting on a CAFC Decision. It has finally been referred to a Panel of 3 Judges for Decision.

      Will see if the BVA Remand to complete the record is enforced by the CAFC. At issue was an increase of the TBI rating. In a way I have received that through TDIU in the BVA remand to the VA for completion of my 1987 claim for extra-schedular TDIU. The Director, Compensation Services essentially ordered TDIU from September 1985, 2 years before my claim, from the last day of my full time employment.

      Not withstanding this I am still fighting for the appropriate organic brain syndrome ratings and spinal disc disease ratings including associated conditions like temporal lobe epilepsy, arthritis etc.

      I am continuing my activism on behalf of others which includes a never developed 11/26/1994 Next of Friend claim for other veterans for the “traumatic brain disease” rating (since changed to “organic personality disorder under the same numerical code, 8045-9304), of 30% that was awarded to me as of 1984. I want to see veterans with records of TBI and problems with employment prior to the 2008 limiting law granted minimally the award I was given in 1984 back to my initial next of friend claim for them in 1988 or the date of their discharge for the service, whichever is the later date.

      Wish I could get a VA benefits class action law firm to take the case but CC&K refused to take the case. Submitted to Hill and Ponton but do not expect any attorney to take a case that is not a slam dunk like my BVA Remand for TDIU that netted an attorney $80,000.00 for a few days work. Not complaining because that enables the Attorney to pay his bills and take some more risky cases. Just complaining that he dropped me without following through to the end and would not represent me to the CAVC or CAFC. AskNod had an earlier article that probably explains why.

      Pro Se litigants are treated better by the Courts than those represented by attorneys. But if you are going Pro Se to the CAVC and then to the CAFC realize they will not decide facts. Fact determination is done by the BVA. But BVA judges are sometimes “arbitrary and capricious” (a difficult standard) in their decisions and can be overturned on that.

      I expect the CAVC Memorandum decision to be overturned because the CAVC Judge ignored the disputed closure of the RBA dispute on the TBI increase. I messed up by not citing the BVA facts found that the record was incomplete and that her denial of an increase in the TBI rating increase was based upon an incomplete record so that could be a problem but I will be able to ask for a rehearing noting that.

      The Tinnitus rating relies upon the Court finding that the 4.42 examination of hearing in 1975 was incomplete failing to note the tinnitus problem in the record on denial of a Navy forklift operator’s permit 9 years before my release from the Navy in 1974.

    • Lem says:

      The VA is using SSA contract examiners. I’ll look up the contractors assigned my examinations a list them here.

      Quoted from my dispute of the SSOC:

      “The agents for VES and QTC, when questioned about the examinations being scheduled, did not appear to have the BVA Remand orders that now appear issued on 09/14/2020, (bottom of page 1, Exhibit 1 of the Respondent’s Response;

      “This request was initiated on SEP 14, 2020 at 09:14:21” ; 3 days after the cancellations on 09/11/2020 Reports of General Information apparently referred to in the 09/15/2020 SSOC with attachments with the apparent date of 09/14/2020.

      The DRO, in his order, wrongly states the Remands were for increase only and not for insufficient examinations. In the 09/16/2020 VA GC Response to the 08/25/2020 CAVC Judges Order to provide status uses the 09/14/2020 orders for examination (apparently hoping the Judge will miss the hidden date as I did in my emails to the DROs named on the Status Cancellation Reports). The reports appear to claim my lay requests to have the DRO provide the Remanded examination Remands as ordered by the BVA. Contrary to the BVA Remands are invalid and the VES and QTC agents validly rejected my lay statements that the examinations being offered were not compliant with the BVA Judges Remands specifically outlining the examination requirements needed to be done on her finding that the previous examinations were inadequate.

      The Remand examinations cannot be done as Remanded until the first parts of the Remands are fulfilled:

      “1. Obtain and associate with the Veteran’s electronic claims file any outstanding VA treatment records relevant to his claims on appeal including the June 2015 neuropsychological testing from Post and Associates that were addressed by the June 2015 VA examiner as well as any records dated after May 9, 2016.” “…3. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would (be) futile, which should be documented in the claims file. The Veteran must be notified of attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C.A. § 5103A(b)(2) and 38 C.F.R. § 3.159(e).”
      Neither action has been done.”

      • Kiedove says:

        Thank you for your valuable information. One of the reasons I suspect some VA Community Care Network providers will be used are a few possible hints I found. We are in VT, Region 1 CCN. Optum was rewarded the contract. Optum is a UnitedHealth company. And one of Optum’s companies is Logistics Health https://www.logisticshealth.com/.
        This article has been removed from their website:
        Federal Court Upholds Contract Awards to LHI to Provide Medical Exams for Veterans Seeking Disability Benefits
        06.15.17
        LHI does not mention C & P exams on the CCN websites seeking providers.
        LHI is seeking providers. https://www.logisticshealth.com/provider-reasons-to-join.aspx

        “Streamlined Appointments
        No prep time, prior medical record review, filing of insurance claims and no patient billing. Payments are guaranteed for completed services.”

        ====
        I attempted to search PACER for the LHI court case but didn’t find it. I think this is the correct court, but perhaps not:
        https://www.uscfc.uscourts.gov/

        Very important reforms are needed in this C & P process so anyone with experience and finding info., please comment!

  3. Ronald Smith says:

    After years of re-applying and filing notices of disagreements to the then VA’s board I don’t see how it could be any worse. Reading some of their (the board’s) statements seems to be like reading something out of Clockwork Orange or The Happiness Cage manuscripts. Many of their statements were pure nonsense or true bull shit. I don’t know who these people are that were on these boards but they wrote statements that only an idiot could write. Whats that they say?
    “Government intelligence is a contradiction in terms.”

    • Kiedove says:

      And a lot of copy & paste. At least the CAVC opinions Alex has posted on ASKNOD are beautifully written and reasoned.

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