VA OIG Report - Contract Medical Exam Program Limitations Put Veterans at Risk for Inaccurate Claims Decisions

[dwilli12]

Contract Medical Exam Program Limitations Put Veterans at Risk for Inaccurate Claims Decisions

[Riplip]

I know this feeling all to well lately. I hope something happens for the good of the veterans.

[Riplip]

After looking it over I didn't see anything about how far away an exam should be. That's all I really had an issue with. So far the exams have been fine except I haven't been able to see any results so who knows. 

[Vync]

It seems like the OIG might be surprised as if this was the first time they were learning of this issue: "Although MDEO identified errors in its quality reviews, the OIG team determined that the errors identified were not shared with claims processors before or after they made their decisions."

After having repeated errors with exams and quality reviews, I repeatedly asked for corrections. With the reconsideration option now gone, I was told I would need to file for review or appeal. I always doubted the examiner or quality reviewer were trained on how to correct their error so they would not repeat the same error with other vets. And when these errors are identified, the VA does not proactively right the wrongs made in prior decisions. If the claim became final, vets lose a potential EED and must rely on the adversarial CUE process which often attributes the error to a judgmental error, further denying benefits.

[Richard1954]

From what I read, the worse thing about contracted C/P exams, is that rating decisions are made based on the exams. When they learn a mistake was made, they take too long to report the errors and correct them. Apparently many veterans receive the worng decisions  because of the bad examinations.  In my opinion, they do not really know how to correct the problems. This requires the veteran to appeal a decision.  Costing the veteran more anguish and time waiting on the correct decision,. 

[Whodat]

I think that's where lots of frustrations come from. That's why it is said repeatedly, if you can, try and get a copy of the exam. Also to save time, go through the decision letter thoroughly. May be an inadequate exam. 

[pacmanx1]

As VYNC noted, this issue has been going on for decades. Some veterans would say they got a bad VAMC medical opinion, but it really boils down to what the regional office ask for and how the regional office request the medical opinion and if they ask for a medical rationale. You see, they don’t always ask for a rationale, but one is needed for a medical opinion. Then again, I filed for two separate EEDs, but the regional office requested that the examiners give a medical opinion on my current level of disabilities. The problem with these requests were that I was already service connected for well over a decade so, one medical opinion would not change my ratings, but I informed the examiners that reviewing my own medical records, I found VAMC medical records that were not included in my current rating decision and those records could most likely change my effective date. The examiners listened to my argument, reviewed my records and then wrote two separate favorable medical opinions with good medical rationales and sent my LHI exams back to the regional office where they ignored both examiners’ opinions. Well, you guessed it, one claim/appeal went back to the BVA where they granted me an earlier effective TDIU date, and I still have one claim/appeal pending. So, it is not always the examiners’ fault. Don’t get me wrong, I did have some jerk examiners that told me as soon as I walked in their office that they did not feel that my claim warrant service connection but that is another story.