Statement for the Record submitted for Senate Committee on Veterans’ Affairs hearing ‘Putting Veterans First; Is the Current VA Disability System Keeping Its Promise?’
Necessary reforms to the U.S. Department of Veterans Affairs (VA) claims process were the subject of a Statement for the Record (SFR) submitted for an Oct. 29 hearing of the U.S. Senate Committee on Veterans’ Affairs.
American Legion Veterans Claims Disability Specialist Marty Callaghan submitted the SFR for the committee’s hearing, “Putting Veterans First: Is the Current VA Disability System Keeping Its Promise?” Read the entire statement here.
Callaghan noted that in fiscal 2024, The American Legion’s VA-accredited service officers assisted veterans with filing over 1 million new VA benefits claims, resulting in a combined award amount of $21 billion, and surpassed that number by August of this year. Meanwhile, the Legion’s Board of Veterans’ Appeals Unit worked on more than 10,000 appeals from veterans whose original claims had been denied by VA, bringing in over $57 million in retroactive benefits for veterans and their families.
“From this work and our over 100 years of serving veterans, we know the claims and appeals process intimately, and we say with confidence that the cornerstone of this process – the Compensation and Pension Examination (C&P exam) - is failing veterans,” Callaghan wrote. “The system is in urgent need of reform, not because veterans are gaming the claims process, but rather because government has allowed its complexity to increase unnecessarily. The VA claims process has grown in complexity over the years, becoming a labyrinth designed for administrative convenience, rather than serving veterans.
“VA made bureaucratic decisions, such as eliminating the informal claims process and instituting a more complicated ‘intent to file’ process, even though both processes provide the exact same purpose of establishing an effective date. VA determined it was easier for staff to process a standardized form, rather than easier for a veteran to use less formal methods of notification such as a handwritten letter or an email that contains the exact same necessary information.”
VA’s Disability Benefits Questionnaires (DBQs) are filled out by VA-contracted examiners, and Callaghan noted VA’s lack of oversight of these contracted examiners focuses too narrowly on timeliness and form completion, and not on the quality and adequacy of exams. The Legion has found the No. 1 reason for the Board of Veterans’ Appeals remanding cases is inadequate medical examination of the claimed disability.
“It is no wonder the quality and adequacy are called to question by the Board when DBQs for skin diseases is 12 pages long, the one for back conditions is 14 pages long, for foot conditions it is a whopping 16 pages long,” Callaghan wrote. “The examiners are looking for responses to the form, not for their assessment of the disability.
“Yet the problems with VA forms pale next to the much larger difficulty our veterans face with the C&P exam itself, which is a requirement for granting a claim for disability benefits. Without an adequate C&P exam, a veteran’s claim will be denied, setting into motion unnecessary reviews or appeals, or examinations being reordered. In fact, a great deal of time is wasted in the claims adjudication process because so many C&P exams are not adequate and require repeat exams.”
For example, Callaghan cited the Legion’s ROAR visit to VA Regional Office San Juan, P.R., where the Legion was told incomplete or inaccurate DBQs are among the leading causes of delayed claims, especially in post-traumatic stress disorder claims due to military sexual trauma. Many DBQs are not being fully completed, forcing VARO staff to return C&P exams to vendors for clarification. Examiners for one vendor consistently demonstrate inaccuracies, poor exam quality and a lack of attention to detail – particularly due to “the overly lengthy and repetitive DBQ format.”
The San Juan VARO suggested that the Medical Disability Examination Office, or MDEO, consider providing a direct contact line for elderly veterans who often miss important phone calls from VA vendors due to their caller ID labels such as “SPAM” or “Unknown.” This communication barrier causes missed appointments and delays, especially in an environment where the scamming of veterans has become a nationwide issue.
Callaghan’s SFR offered three recommendations to make VA’s complex claims process more veteran-friendly:
· Simplify the instructions on VA forms.
· Amend DBQs to streamline processing and allow for additional details as needed.
· All VA vendors should use a single, easily recognizable caller ID when contacting veterans. For example: “VA examiner’s office.”
Callaghan also addressed a lack of transparency when claims are adjudicated by VA. He shared that on Nov. 14., 2024, The American Legion and other veteran service organizations received a briefing from the executive director of the Medical Disability Examination Office (MDEO). “He explained his office’s quality review process for VA-contracted examiners and repeatedly referred to quality ‘targets’, and not ‘standards’ as is typical for federal contracts,” Callaghan wrote. “This casual language reflects VA is satisfied with approximation to quality - as opposed to standards - when overseeing multiple billions of dollars in contracted examinations. The American Legion is unaware of any instance in which VA has canceled or substantially modified a contractor’s contract for poor performance, despite repeated deficiencies identified and reported by Government Accountability Office (GAO) and the VA Office of Inspector General (OIG).
“The executive director’s presentation last year, speaking about targets for vendors as if they were optional, was eye-opening for attendees. He said nothing about the process of renewing contracts for the companies that now perform the vast majority of C&P exams. If a robust quality review process were in place, we would expect VA to cancel or modify some contracts over time. However, we have no information about that process because MDEO offers little transparency for operations that affect veterans filing disability claims with VA.”
The SFR also noted that MDEO was directed by the GAO to produce a quality improvement plan for claims processing by Jan. 31, 2025. No plan has been presented to The American Legion, and, to the Legion’s knowledge, none has been submitted to Congress.
“From intake to development and adjudication, we must address the lack of transparency in the claims adjudication process itself, and the continuous pressure being put on VA staff to meet high production quotas,” Callaghan wrote. “The public knows very little about the internal struggle between quality and quantity that VBA employees experience at any VA regional office. Rushing to an incorrect decision costs veterans trust, time, and money. This burden of rushing to errors then requires American Legion or any other accredited service officer to spend more time writing reviews and appeals.
“Rating Veterans Service Representatives (RVSR) have reported to The American Legion that deferred ratings do not provide the RVSR any production points toward their tasked production goal, despite deferrals taking longer for the RVSR to order examinations upon identifying an error. The reasons for these deferrals can be due to an inadequate examination, no exam, or wrong examinations report provided. This practice is frustrating because adjudicating a claim, based on a bad C&P exam, locks in an error that may never be corrected and, in some cases, results in needless appeals.”
Callaghan added that veteran service representatives should never be pressured to take any action that is not in the veteran’s best interest. “Regional office leadership should focus on making sure that inadequate exams are being sent back to vendors for validation as part of the quality review process,” he wrote. “Errors should be called on any rating decision that is based on an exam that is insufficient, incomplete, or inadequate. Adjudicators who correctly return C&P exams as insufficient for rating purposes should be rewarded and not penalized.”
The Legion offered three recommendations to improve transparency in the adjudication process:
· Hold a hearing on MDEO’s operations to determine timeliness, quality, fairness, and cost effectiveness among VA vendors and their C&P examiners.
· Standardized production quotas for VBA Veterans service representatives and ensure that reasonable work credit is given to them for deferred claims.
· Impose statutory penalties on vendors whose examiners fail to complete examinations to VA standards.
In his SFR, Callaghan also addressed lengthy wait times for claims decisions, whether the current disability rating system is serving veterans adequately and whether or not there are adequate protections against fraud and ensuring resources are for those most in need.
He also used the SFR to criticize an October Washington Post article that accused veterans of exploiting the VA service-connected disability claims process. “This reporting is lazy, inaccurate, and extremely harmful,” he wrote. “The American Legion highlights the irony of these journalists painting veterans as fraudsters at a time when private companies are operating outside the law to profit from veterans’ disabilities. These law-breaking companies should be taken to task, not the disabled veterans seeking their earned benefits.
“The authors erroneously suggest that veterans are taking advantage of a $193 billion ‘bonanza’ in disability benefits. Their article reduces legitimate claims for injuries, trauma, and illnesses in uniform and creates a mocking narrative that jock itch, toenail fungus, tinnitus, and erectile dysfunction claims are the root of the growing expenditures in VA disability compensation. Their assertion ignores the fact Congress intentionally required VA to enhance outreach and increase online resources, and it disregards the fact that the veteran population today has far more information than at any point in our nation’s history.”
Callaghan also criticized the article for comparing veterans receiving compensation for tinnitus, migraines and other common disabilities today to the numbers of veterans similarly situated in 2001.
“The authors did not bother to include the fact that between 1.9 and 3 million Americans served in the Global War on Terror (GWOT), with roughly half of them deploying more than once,” he wrote. “The authors did not bother to go beyond a surface-level analysis of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 and discuss the long history behind military toxic exposure advocacy. If they had, the public would have been educated that the law’s deferential approach towards veterans was borne out of the decades of failure by the federal government to recognize Agent Orange as harmful for the Vietnam generation. This failure cost tens of thousands of lives, and the PACT Act provided relief to many veterans and families affected by toxic exposures.
“The authors did not bother to discuss how quickly the Vietnam generation has aged and how their comorbid conditions have grown increasingly complex, or how modern medicine has allowed GWOT veterans to survive previously un-survivable wounds, making healthcare and disability claims all the more complex. And finally, the authors did not bother to discuss how the VA’s ‘duty to assist’ requirement is borne from the federal government’s history of, as far back as the Revolutionary War, failing to award benefits until there is a miniscule number of affected veterans left alive to receive the benefit.”
- Legislative