Improving Outcomes for Disabled Veterans: Oversight of VA’s Medical Disability Examination Office

House Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs

2025-11-20

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Source: Congress.gov

Summary

This meeting focused on the oversight of the Veterans Benefits Administration's (VBA) Medical Disability Examination Office (MEO), which manages contractors responsible for conducting medical disability exams for veterans nationwide. The discussion highlighted critical issues regarding the accuracy, accountability, and overall quality of these exams, which are fundamental to veterans receiving their earned benefits. [ 00:32:27-00:32:43 ]

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Themes

Oversight of Contracted Medical Disability Exams

The MEO is tasked with overseeing contractors who perform over 90% of medical disability exams for veterans, representing contracts with a multi-year budget ceiling of $13 billion. [ 00:32:27 ]

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 These exams are critical for evaluating disability claims, and any errors, inaccuracies, or delays can significantly impact a veteran's ability to receive their rightful benefits. [ 00:32:34 ]

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 A Government Accountability Office (GAO) report identified significant shortcomings in MEO's oversight, including incorrect financial incentive payments to contractors and delayed Special Focus Reviews (SFRs). [ 00:33:59 ]

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 While the VA agreed to implement the GAO's five recommendations, none have been fully addressed, though MEO claims to have recouped overpayments and enhanced its methodology.

Financial Mismanagement and Accountability

The GAO found that MEO incorrectly awarded millions of dollars in financial incentives to vendors in 2024 who did not meet performance standards. [ 00:34:08 ]

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 This was attributed to a manual process for calculating these incentives that lacked standardized checks and formal written procedures to verify payment accuracy. [ 00:34:20 ]

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 MEO has since recouped the identified $2.3 million in overpayments and states it has implemented an automated process, written procedures, and an audit contract to prevent future discrepancies. Concerns were raised by committee members about the vendors' failure to report overpayments and the overall transparency of financial oversight for these substantial contracts. [ 00:49:51 ]

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Exam Quality and Consistency

Inconsistencies in exam quality and process were highlighted, with contracted examiners reporting conflicting instructions from different vendors on how to complete Disability Benefits Questionnaires (DBQs). This issue can lead to disparate exam outcomes for veterans based on their assigned contractor. To address this, MEO has developed a direct feedback portal for examiners, which went live in September, allowing them to raise issues directly to the office rather than through vendors. The timely conduct of Special Focus Reviews (SFRs) for complex claims such as traumatic brain injury (TBI) and military sexual trauma (MST) was also a point of concern, as two reviews are overdue, and a proposed shift from a two-year to a three-year schedule was criticized as being detrimental to continuous improvement and veteran care.

Veteran Experience and Accessibility

The Compensation and Pension (C&P) exam often serves as the primary entry point for veterans seeking VA benefits, making the experience crucial for their overall trust in the system. [ 00:34:30 ]

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 Veterans frequently encounter difficulties with scheduling, inconvenient exam locations, and being assigned to medical professionals lacking specialized training for their conditions. [ 00:34:52 ]

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 MEO acknowledged scheduling as a "pain point" and is investigating technological solutions to offer veterans more control over appointment times and locations. [ 01:05:46 ]

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 Furthermore, an Inspector General (OIG) report revealed significant accessibility barriers at over half of the visited exam facilities, prompting VA to require vendors to inquire about accessibility needs and conduct surprise site visits.

Tone of the Meeting

The tone of the meeting was largely serious and critical, particularly from the subcommittee members. There was clear frustration expressed regarding the identified shortcomings in MEO's oversight, especially concerning financial mismanagement and the negative impact on veterans' access to care and benefits. [ 00:32:38-00:32:57 ]

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 While Ms. Glenn provided updates on implemented improvements, subcommittee members often met her responses with skepticism, pressing for more specific details and greater transparency, particularly regarding staffing and the efficacy of new protocols. An overarching message from the committee was the paramount importance of ensuring veterans receive their earned benefits, coupled with a strong emphasis on continuous accountability and improvement in MEO's operations.

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Transcript

Good morning.  How is everyone today?
M
Ms. Mary Glenn
We're great.
Not bad, huh?  Okay, thank you, Ms. Glenn.  I appreciate you.  I used to 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.  And once again, good morning to everyone.   This morning's 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 MEO.  This is the office responsible for managing contractors who conduct medical disability exams for veterans nationwide.  Those 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 gonna focus on today.  Accuracy, accountability and a positive outcome   for our brothers and sisters.  When 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.   Today, more than 90%, 90% of all exams are done outside the VA through contractors.  Sourced out of four major contractors, 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 disability benefits questionnaire or DBQ to document the veteran's symptoms and medical findings.
MEO, 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 taxpayer's investment is delivering for our veterans.  According to a recent report from the government of, not affairs,   Accountability, Government Accountability Office, that might not have happened over the past couple years.  The Accountability Office found that MEO wrongly awarded millions of dollars in financial incentives in 2024 to vendors who did not meet performance standards.   Production, customer satisfaction, exam quality, timeliness in scheduling, and timeliness in completion as well.  When vendors meet or exceed these metrics, they can earn a bonus or face financial penalties if they fall short.  Accountability office found that MEO used a manual process to calculate these incentives, which had no standardized checks or formal written procedure to verify the accuracy of payments.   Apparently MEO 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 consistently apply the standards that are necessary.  Accountability office recommended MEO develop written procedures and automated verification tools.  MEO says they've started doing that   which is obviously a great step forward.  The accountability office also found that MEO has fallen short in meeting its own schedule for special focus reviews known as SFRs.  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 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 understand.  Let me be perfectly clear.  If there's one area where you can't cut corners, it's in the cases revolving around post-traumatic stress, post-traumatic stress disorder, and traumatic brain injury.  Without these reviews, MEO has no way to know if its previous corrective actions are working or if the exam quality is improving.   Without understanding if exam quality is improving, it also means MEO cannot update examiner training or identify and correct DBQ errors.  The same errors keep happening, leaving some veterans with delays or incorrect decisions.  This is a systematic failure.  The accountability office also identified new areas for improvement, suggesting that MEO 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.

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