Department of Veterans Affairs: Claims Process and Compensation and Pension Exams by Contracted Physicians

Department of Veterans Affairs: Claims Process and Compensation and Pension Exams by Contracted Physicians

Department of Veterans Affairs: Claims
June 22, 2022
Process and Compensation and Pension Exams Heather M. Salazar,
by Contracted Physicians
Coordinator
Analyst in Veterans Policy
The Veterans Benefits Administration (VBA) within the Department of Veterans Affairs (VA)

provides a wide range of benefits and programs for veterans and their families. Some of these
Tamar B. Breslauer
benefits and programs include disability compensation, pension and fiduciary services,
Senior Research Librarian
educational benefits, and veteran transition and employment services. The VBA’s Compensation

Service division oversees disability compensation for veterans who have disabilities, illnesses, or
conditions that resulted from their military service. The VBA’s Pension and Fiduciary Service
Carol D. Davis
division oversees needs-based programs for wartime veterans such as veterans’ pensions.
Senior Research Librarian

To apply for these benefits, specifically disability compensation or pension, the veteran will
Michele L. Malloy
submit an application, in paper or electronically, to his or her local VA Regional Office (VARO).
Research Librarian
The application then goes through VA’s adjudication process, and at that point VA has a “duty to

assist” the veteran through the claims process. VA’s “duty to assist” ranges from informing the
Isaac A. Nicchitta
veteran of missing information from the application to assisting the veteran in gathering evidence
Research Assistant
from private and federal entities to providing the veteran with a compensation and pension

(C&P) exam when necessary. A C&P exam is a medical examination conducted by a VA-
contracted medical professional to evaluate the veteran’s disability, illness, or condition and

determine the level of severity. In the past, these exams were all conducted by VA employees in
VA settings. However, over the past several years, VA has transitioned C&P exams to almost all being conducted by
contracted physicians in non-VA settings.
This report provides a description of both VA’s claims process and the C&P exam process. In addition, the report addresses
topics of interest to congressional staff and constituents. These topics include:
 An overview of VA’s claims process and the subsequent appeals process;
 Data and analysis of the number of VBA claims and backlogged claims from January 2004 through May
2022;
 Key dates of the progression of contracted exams;
 Data on and analysis of the number of C&P exams conducted between 2012 and 2022 (along with data
associated with the costs incurred by VBA for the use of contracted physicians);
 Issues and challenges faced in conducting exams and gathering veterans’ records to process claims during
COVID-19;
 Legislative history of the evolution of C&P exams, initially conducted by Veterans Health Administration
(VHA) and VBA and then subsequently conducted by contracted physicians; and
 An overview of the oversight of VBA contract exams by Congress, the VA Office of Inspector General
(OIG), and the Government Accountability Office (GAO).

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Contents
Introduction ..................................................................................................................................... 1
Department of Veterans Affairs (VA) Claims Process ..................................................................... 2
Overview of the Claims Process ............................................................................................... 2
Filing an Appeal ........................................................................................................................ 5
Claims Inventory and Backlogged Claims Data and Analysis ........................................................ 6
Claims Inventory ....................................................................................................................... 6
Backlogged Claims ................................................................................................................... 7
Contracted Compensation and Pension Exams ............................................................................... 9
Dates of Importance ................................................................................................................ 10
VA Management of Contracted C&P Exams: Medical Disability Examination Office
(MDEO) ............................................................................................................................... 12
Oversight of VBA Contract C&P Exams ................................................................................ 13
C&P Exam Data and Analysis ....................................................................................................... 14
Challenges Faced During COVID-19 ........................................................................................... 16
C&P Exams and Benefits ........................................................................................................ 16
National Personnel Records Center (NPRC) .......................................................................... 19

Figures
Figure 1. VBA Disability Compensation Claims Process and Contractor Process for
Completing C&P Exams .............................................................................................................. 3
Figure 2. VA Appeals Process .......................................................................................................... 6
Figure 3. Four-Week Rolling Average of Claims and Backlogged Claims Inventory ..................... 8
Figure 4. Breakdown of Claims by Period of Service ..................................................................... 9
Figure 5. VBA C&P Contract Exam Districts ............................................................................... 13
Figure 6. VBA Contracted Exams vs. VHA In-House Exams....................................................... 15
Figure 7. VBA C&P Contracted Exam Pilot Program Appropriations vs. Overall C&P
Appropriations ............................................................................................................................ 15
Figure 8. Number of Pending Disability Medical Exams and Average Days Pending
Completion by VBA Contractors, January 2020 to February 2021 ........................................... 18

Figure C-1. Screenshot of VBA’s Monday Morning Workload Report ........................................ 33

Tables
Table 1. Chronology of NPRC Operating Status ........................................................................... 19

Table A-1. Abbreviations/Acronyms Used in the Report .............................................................. 22
Table B-1. Pilot Program for Use of Contract Physicians for C&P Exams ................................... 24
Table B-2. Temporary Authority for C&P Exams Conducted by Contract Physicians ................. 25
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Table B-3. Selected Congressional Hearings to Address Contract C&P Exams ........................... 26
Table B-4. Selected VA-OIG Reports on C&P Exams .................................................................. 29
Table B-5. Selected GAO Reports on C&P Exams ....................................................................... 30

Appendixes
Appendix A. Abbreviations ........................................................................................................... 22
Appendix B. Legislative History ................................................................................................... 23
Appendix C. Claims Data Analysis Methodology and Limitations .............................................. 33

Contacts
Author Information ........................................................................................................................ 34

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VA: Claims Process and C&P Exams by Contracted Physicians

Introduction
The Veterans Benefits Administration (VBA) within the Department of Veterans Affairs (VA)
provides a wide range of benefits and programs for veterans and their families. Some of these
benefits and programs include disability compensation, pension and fiduciary services, education
assistance, vocational and employment training, and survivor benefits. Two divisions within VBA
specifically address monetary benefits for disabled veterans: The Compensation Service oversees
disability compensation for veterans who have disabilities, illnesses, or conditions that resulted
from military service, and the Pension and Fiduciary Service oversees the needs-based benefit
program for wartime veterans such as veterans’ pensions.
To apply for these benefits, specifically disability compensation or a pension, the veteran submits
an application, either via paper or electronically, to his or her local VA Regional Office (VARO).
The application then goes through VA’s adjudication process, and at that point VA has a “duty to
assist” the veteran through the claims process.1 VA’s “duty to assist” ranges from informing the
veteran of missing information from the application to assisting the veteran in gathering evidence
from private and federal entities to providing the veteran with a compensation and pension (C&P)
exam when necessary. Since the fall of 2016, VA transitioned from C&P exams being conducted
by VA employees in VA settings to almost all C&P exams being conducted by contracted
physicians in non-VA settings.2
Within each VARO, the veteran service representative (VSR) is the primary contact with the
veteran. The VSR receives the claim, gathers additional needed evidence, and assists in
scheduling the veteran’s C&P exam. A C&P exam is a medical examination conducted by a
licensed physician to evaluate the veteran’s disability, illness, or condition and determine the
level of severity. Upon the completion of these exams, the physician is to send the information to
the VARO, where it is reviewed for eligibility of benefits. The medical professional who conducts
this exam, however, does not rule on whether the veteran’s condition is service connected and
eligible for VA benefits. Rather, that is the responsibility of VA employees at the VAROs. A rating
veteran service representative analyzes and reviews claims, medical records, and C&P
assessments to determine if a veteran’s condition is service-connected and, if so, the disability
rating for the claimed disability. Following the determination, the VSR then enters the necessary
data to generate the notification letter describing VA’s decision.
This report provides an overview of both VA’s claims process and C&P exams, as well as other
topics of interest to congressional staff and constituents. This report includes the following topics:
 An overview of VA’s claims process and the subsequent appeals process;
 Data and analysis of the number of VBA claims and backlogged claims from
January 2004 through May 2022;
 Key dates of the progression of contracted exams;
 Data on and analysis of the number of C&P exams conducted between 2012 and
2022 (along with data associated with the costs incurred by VBA for contracted
physicians);

1 38 U.S.C. §5103A and 38 C.F.R. §3.159.
2 Throughout this report, the terms contracted physician, contract physician, contracted examiner, and contract
examiner are used interchangeably to reflect the language used in the various VA, Government Accountability Office
(GAO), and VA Office of Inspector General (OIG) reports; congressional language in legislation and hearings; and
media reports. The four terms all mean a non-VA employee who is contracted by VBA to perform a veteran’s C&P
exam.
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 Issues and challenges faced in conducting exams and gathering veterans’ records
to process claims during COVID-19;
 Legislative history of the evolution of C&P exams, initially conducted by
Veterans Health Administration (VHA) and VBA and then subsequently
conducted by contracted physicians; and
 An overview of the oversight of VBA contract exams by Congress, the VA Office
of Inspector General (OIG), and the Government Accountability Office (GAO).
Department of Veterans Affairs (VA) Claims Process
Overview of the Claims Process3
VA’s claims process for compensation and pension benefits is a multi-step process. Figure 1
provides a high-level overview of the process and illustrates the point at which contracted C&P
exams occur.4 There are five key steps in the claims process:
1. The veteran submits a compensation or pension claim through either (1) an
online intake system, which, when completed, creates a fully developed claim
(FDC) that includes all claim application questions, relevant medical
information, current contact information, and completed disability benefit
questionnaires (DBQs); or (2) a paper Form 21-526EZ Application for Disability
Compensation and Related Compensation Benefits through a regional office or
mailed through the U.S. Postal Service.5
2. A VSR reviews the veteran’s claim and determines if additional information is
required or if a C&P exam can be scheduled. A VA employee or a VA-contracted
physician may send a letter or call the veteran to schedule the exam as part of the
evidence-gathering stage of the process.
3. Unless otherwise told, VA requires a veteran to attend a C&P exam, where
supplemental information is collected by a licensed health professional and
provided to VBA to help adjudicate the veteran’s claim.6 Upon the completion of
the C&P exam, the medical professional reviews the veteran’s medical records
and completes an exam report. This report is submitted to the VSR and added to
the veteran’s electronic claim file.
4. A veteran’s entire claim file is sent to the rating veteran service representative,
who reviews the veteran’s entire application, medical records, supporting
documents, C&P results, and any other supporting information to make a
decision on the veteran’s claim.

3 VA, “Your VA Claim Exam: Know What’s Next,” https://www.benefits.va.gov/COMPENSATION/docs/claimexam-
stepbystep.pdf.
4 A list of abbreviations used throughout this report can be found in Appendix A.
5 VA, “How to File a VA Disability Claim,” April 1, 2022, https://www.va.gov/disability/how-to-file-claim/.
6 Due to COVID-19, VA suspended all contracted C&P exams from mid-April 2020 through August 2020, when VA
began to gradually resume exams in locations where it was safe to do so. This caused veterans to have their C&P exams
delayed, cancelled, or rescheduled. The VA issued a fact sheet for how a veteran or servicemember should approach
C&P exams during COVID-19. See VA, “Claim Exam Fact Sheet for Veterans and Service Members During the
Coronavirus Pandemic,” https://www.benefits.va.gov/COMPENSATION/docs/VSM_COVID-
19_Communication_Final_Approved.pdf.
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5. VBA then issues an initial decision on the veteran’s claim and sends out a
decision notification packet with details of the decision. The packet also contains
instructions on the next steps a veteran can take should he or she disagree with
the decision. See “Filing an Appeal” section of this report for a veteran’s appeal
options.
Figure 1. VBA Disability Compensation Claims Process and Contractor Process for
Completing C&P Exams

Source: GAO, VA Disability Exams: Improved Performance Analysis and Training Oversight Needed for Contracted
Exams, GAO-19-13, October 2018, p. 5.
Fully Developed Claims (FDC)
The FDC system is a voluntary system in which the veteran submits all required VA forms,
evidence and supporting documents, income and net worth information (for pension claims only),
and all relevant medical information from both VA and private health providers into VA’s
electronic claims portal.7 By a veteran submitting all the proper documentation, VBA can move
forward with adjudicating the claim without the need to request additional records or information.
The veteran has one year to complete the FDC, and if VBA approves the claim, benefits will be
backdated to the day the veteran began the application in the system. However, if VBA
determines that additional nonfederal records are required to decide a claim, VBA will “remove
the claim from the Fully Developed Claims program and process it as a standard claim.”8
The FDC process was intended to quicken the claims process and address the claims backlog. A
claim is considered backlogged when it has been pending in VBA’s claims inventory for over 125
days from the date of submission. According to VA’s FDC website, as of June 11, 2022, the
average number of days to process an FDC was 118.1 days and, for a non-FDC, 141.9 days.9 As
of the same date, there were 591,422 claims pending a decision, with 188,579 of these claims

7 For a step-by-step overview on how to submit this type of claim, see VA, “Fully Developed Claims: FDC
Walkthrough,” https://www.benefits.va.gov/FDC/walkthrough.asp.
8 VA, “VA Fully Developed Claims Program,” https://www.va.gov/disability/how-to-file-claim/evidence-needed/fully-
developed-claims/.
9 VA, “Fully Developed Claims,” Veterans Benefits Administration Reports, June 6, 2022, https://www.benefits.va.gov/
reports/mmwr_va_claims_online.asp.
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considered backlogged because they had been pending for more than 125 days. See “Claims
Inventory” of this report for further details and explanation on VA’s claims inventory.
VA’s “Duty to Assist” and the National Personnel Records Center (NPRC)
Current law and regulation require VA to assist veterans in developing their claims through the
“duty to assist.”10 The “duty to assist” may be applied to assistance in accessing records from
either a federal or nonfederal entity, such as the National Personnel Records Center (NPRC) or
private physicians. It also applies to other functions, such as providing a C&P exam. Generally,
this obligation is used to assist a veteran in filing a claim for disability compensation, disability
pension, or health care.
Per Title 38, Section 5103A(c), of the U.S. Code, VA shall provide assistance to a veteran to
obtain records relevant to a disability compensation claim, and Section 5103A(d) directs VA to
provide medical examinations for claims. This section of United States Code states that assistance
provided by the Secretary:
(a) shall include providing a medical examination or obtaining a medical opinion when
such an examination or opinion is necessary to make a decision on the claim. (2) The
Secretary shall treat an examination or opinion as being necessary to make a decision on a
claim.11
VHA-employed physicians originally fulfilled VA’s “duty to assist” in providing medical
examinations. However, VA began to contract out these exams following a pilot program
implemented through the authority granted in Section 504(b) of the Veterans’ Benefits
Improvements Act of 1996 (P.L. 104-275). See Table B-1 for the legislative history of this
authority.
VA also assists in contacting the Department of Defense (DOD) and NPRC for a veteran’s
military personnel file. NPRC is part of the National Archives and Records Administration
(NARA) and is the main repository for military and civil service personnel-related records.12
Generally, DOD transfers to NARA the management of a servicemember’s records 62 years after
the servicemember’s separation from the military.13 Some DOD records can be requested by
either the veteran or VA through the various service branches directly. In addition, in many cases,
records for servicemembers who separated after 2002 are digitally accessible by the service
branches and can be electronically sent to VA.
According to NPRC, as a result of the COVID-19 pandemic, a significant backlog of records
requests to submit for VA benefits has accumulated. Unlike DOD, which maintained operational
status throughout the pandemic, NPRC closed for a period of time and had few staff on site. This
is described in further detail in the “National Personnel Records Center” subsection of
“Challenges Faced During COVID-19.”

10 38 U.S.C. §5103A and 38 C.F.R. §3.159.
11 38 U.S.C. §5103A(d).
12 NARA, “National Personnel Records Center (NPRC),” June 22, 2021, https://www.archives.gov/personnel-records-
center.
13 NARA, “National Personnel Records Center: Archival (Accessioned) OMPFS and EMFS,” last updated January 6,
2021, https://www.archives.gov/personnel-records-center/division. For more information on NPRC see the “National
Personnel Records Center (NPRC)” section of this report.
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Filing an Appeal
The Veterans Appeals Improvement and Modernization Act of 2017 (P.L. 115-55) redesigned the
veterans benefit appeals system, and the new system went into effect on February 19, 2019.14
Under this system, a veteran has three options or “lanes” for his or her claim to be reviewed. A
veteran is able to select only one lane of appeal at a time. Each lane of review is described below
and is also seen in Figure 2.
1. Supplemental claim: A veteran is able to add any new evidence that is relevant
to the veteran’s claim. VA is to assist in gathering additional information if
needed. A VSR is to then review all the evidence and decide if a change in the
initial decision is required.
2. Higher-level review: A veteran’s claim is to receive a new review by a senior
VSR. The senior VSR is to review all the evidence already in the claimant’s file
to determine if the initial decision should be changed. A claimant is unable to add
any new evidence to the claim in this means of appeal.
3. Board of Veterans’ Appeals (BVA): A veteran may request this type of appeal
via three options:
i.
Direct review: The veteran does not want to submit any additional evidence
and there is no hearing held. A veterans law judge will review the appeal
directly.
ii.
Evidence submission: The veteran chooses to submit additional evidence,
which must be done within 90 days of receiving a Notice of Disagreement.
This appeal will also be completed without a hearing but with a judge
reviewing all information (both original and additional evidence) directly.
iii.
Hearing with a veterans law judge: The veteran decides to submit
additional evidence and requests to testify before a judge. A hearing will be
scheduled and all new evidence or documentation can be submitted ahead of
time but no later than 90 days following the hearing.
If the veteran is satisfied with the VA’s decision after pursuing an appeal via any of these lanes,
the veteran is done. However, if a veteran receives an unfavorable decision in any of the lanes,
the veteran may select another lane for further review, but a veteran may not seek review in
multiple lanes simultaneously. In addition, after receiving a decision in any lane, a veteran may
file a new supplemental claim by submitting new and relevant evidence. Thus, if a veteran
disagrees with VA’s decision on a supplemental claim, he or she can submit additional evidence
as a new supplemental claim or may request higher-level review or BVA review. Similarly, if a
veteran disagrees with VA’s higher-level review, the veteran may request BVA review or submit
additional evidence as a supplemental claim. Finally, if a veteran disagrees with a BVA decision,
the veteran may submit additional evidence as a supplemental claim or file an appeal to the U.S.
Court of Appeals for Veterans Claims.15

14 VA, “VA’s Appeals Modernization Act Takes Effect Today,” press release, February 19, 2019, https://www.va.gov/
opa/pressrel/pressrelease.cfm?id=5207.
15 See CRS In Focus IF11365, U.S. Court of Appeals for Veterans Claims: A Brief Introduction, by Jonathan M.
Gaffney.
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Figure 2. VA Appeals Process

Source: CRS; 38 U.S.C. §5104C. Additional information can be found on VA’s Board of Veterans Appeals
website at https://www.bva.va.gov/.
Claims Inventory and Backlogged Claims Data and
Analysis
Claims Inventory
VBA’s claims inventory includes claims that specifically require a rating decision, such as
disability compensation and pension, along with survivor benefits, such as dependency and
indemnity compensation and survivor’s pension. The inventory counts both original and
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supplemental claims. A claim is removed from the inventory once the claim is decided or if the
veteran appeals a decision. The appealed claim is tracked separately.16
Figure 3 presents the inventory, including certain time periods in which there was a significant
increase and/or decrease in claims. These data were calculated using VA’s Monday Morning
Workload Report (MMWR), and an explanation of the methods and limitations for this analysis
are found in Appendix C. First, the MMWR for November 1, 2010, noted that “as of 10/30/10
Agent Orange presumptive claims (End Product [EPs] 681, 687 and 405) are counted as
entitlement rating claims.”
Second, the number of claims continued to rise from 2010 to 2015, at which time VA
implemented the FDC process and a national work queue. This approach was created to “move
claims electronically across regional office boundaries through the National Work Queue—an
electronic workload management initiative designed to improve VBA’s overall production
capacity.”17 This did not remove VAROs out of the processing of claims; rather, it expanded the
capacity of offices that did not have significant queues of claims to assist other regional offices
that had backlogs of claims. By launching this national approach along with FDC electronic
claims processing, VBA decreased the backlog of disability claims by 87%.18
Finally, the number of claims began to increase again in 2020 and has continued to increase. This
increase was in response to the expansion of statutory and regulatory presumptions of service
connection for Vietnam-era veterans and Persian Gulf and post-9/11 veterans. Following the stay
on the implementation of the Blue Water Navy Vietnam Veterans Act of 2019 (P.L. 116-23),
newly eligible Vietnam-era veterans began submitting claims for presumptive conditions on
January 1, 2020.19 Then, in 2021, two expansions of presumptive service connected conditions
also led to an influx in claims. The William M. (Mac) Thornberry National Defense Authorization
Act of 2021 expanded the presumptive conditions for exposure to Agent Orange during the
Vietnam era to include bladder cancer, hypothyroidism, and Parkinsonism.20 VA then announced
that through the rulemaking process it would grant presumption of service connection for asthma,
rhinitis, and sinusitis for exposure to particulate matter (such as burn pit emissions) to Gulf War
veterans.21 In April 2022, VA announced it would begin adjudicating claims for nine rare
respiratory cancers as presumptive conditions for certain Persian Gulf and post-9/11 veterans. The
gradual increase of claims in 2020 to the present is seen in Figure 3.
Backlogged Claims
Currently, VBA identifies a backlogged claim as one that has been pending VBA adjudication for
more than 125 days. However, prior to October 2009, a claim was considered to be backlogged

16 VA, “Claims Inventory,” Veterans Benefits Administration Reports, April 25, 2022.
17 VBA, Office of Corporate Communications, “VA’s National Workload Approach to Processing Disability Claims,”
VAntage Point, February 16, 2016, https://blogs.va.gov/VAntage/25819/vas-national-workload-approach-to-
processing-disability-claims/.
18 Danny Pummill, Acting Under Secretary for Benefits, “VBA Improves the Veterans Experience: Goes Electronic on
Claims, Reduces Backlog and Improves Accuracy,” VAntage Point, June 14, 2016, https://blogs.va.gov/VAntage/
28401/vba-improves-the-veterans-experience-goes-electronic-on-claims-reduces-backlog-and-improves-accuracy/.
19 Blue Water Navy veterans are those individuals who served on U.S. Navy or Coast Guard vessels within 12 nautical
miles offshore of the Republic of Vietnam between January 9, 1962, and May 7, 1975. For more information, see CRS
In Focus IF11368, Expansion of Benefits to Blue Water Navy Vietnam Veterans.
20 For more information, see CRS Insight IN11718, VA Begins Adjudicating Claims for New Agent Orange
Presumptions Included in NDAA FY2021.
21 For more information, see CRS Insight IN11724, VA Now Processing Gulf War Veterans’ Disability Claims for New
Respiratory Presumptive Conditions.
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when it was pending for 180 days. The October 3, 2009, MMWR introduced a new format where
the number of days pending for a claim to be classified as backlogged changed from 180 days
pending to 125 days pending.
The backlogged claims data presented in Figure 3 parallels the data on VBA’s claims inventory.
The significant increase of backlogged claims in 2009 is due to both the change in the backlog
threshold (as previously discussed in this section) and the change in the categorization of Agent
Orange claims in 2010, as discussed in the “Claims Inventory” section. Then, beginning in 2020
and continuing to today, there has been a significant increase in the number of backlogged claims
due to a number of factors. First, an influx of claims was submitted by newly eligible Vietnam-era
veterans beginning January 1, 2020, in addition to those claims that were submitted when the law
was enacted (June 2019) but had not yet been adjudicated. Second, VA closed regional offices and
temporarily suspended the C&P exam process from mid-April 2020 through August 2020 due to
the COVID-19 pandemic. Finally, the expansion of presumption of service connection for
Vietnam-era veterans and Persian Gulf and post-9/11 veterans, as described in the “Claims
Inventory” section, continues to contribute to the increase of backlogged claims.
Figure 3. Four-Week Rolling Average of Claims and Backlogged Claims Inventory
January 2004 to June 2022

Source: CRS based on information from VBA, “Monday Morning Workload Report,” last updated June 11,
2022, https://www.benefits.va.gov/REPORTS/detailed_claims_data.asp.
In addition to tracking the number of claims and backlogged claims, VBA also breaks down the
number of pending and backlogged claims by period of military service, which can be seen in
Figure 4. Note that the claims by period of service data displayed in Figure 4 are provided as raw
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numbers, as opposed to the four-week rolling average that CRS calculated to create Figure 3. The
numbers graphed in both Figure 3 and Figure 4 are updated regularly at VA’s website.22
Figure 4. Breakdown of Claims by Period of Service
Data as of June 11, 2022

Source: CRS. Data from VBA’s Characteristics of Claims web page at https://www.benefits.va.gov/REPORTS/
characteristics_of_claims.asp.
Notes: According to VA, the periods of service for this data are explained as follows: Gulf War is the 1990s
conflict; Iraq & Afghanistan are the conflicts post 9/11; Peacetime is the end of the Vietnam era to the beginning
of Persian Gulf; Vietnam is the entire era; and Other makes up Korea, World War II, and any remaining World
War I veterans.
Contracted Compensation and Pension Exams
Over the past 25 years, the use of contracted physicians to perform C&P exams for veterans filing
claims with VBA has expanded from 10 regional offices, in the initial stages of the pilot program,
to all regional offices. In addition, the use of VHA health professionals has significantly decreased.
At one point VHA health professionals conducted all C&P exams. Now, they perform only the
exams that are statutorily required to be conducted by VA employees.23 This section of the report
will highlight major “Dates of Importance” of the contracted exam program. An extensive
legislative history on the authorization and use of contracted physicians is in Appendix B.

22 VA, “Detailed Claims Data: Claims Inventory and Claims Backlog,” Veterans Benefits Administration Reports, April
25, 2022, https://www.benefits.va.gov/reports/detailed_claims_data.asp; and VA, “Characteristics of Claims,” Veterans
Benefits Administration Reports, April 25, 2022, https://www.benefits.va.gov/REPORTS/characteristics_of_claims.asp.
23 These include former prisoner of war protocol examinations; exams that require hospitalization or surgical evaluation
(i.e., colonoscopy or laparoscopy); exams for veterans who are inpatients at VHA facilities, nursing homes, or extended
care facilities; and exams for veterans who are employees of the contract exam vendors. VA, “Contract Exam
Exclusion List,” M21-1 Adjudication Manual, https://www.knowva.ebenefits.va.gov/system/templates/selfservice/
va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000056862/Contract-Exam-
Exclusions-List.
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Dates of Importance
October 1996—Authorization of Pilot Program
Section 504(b) of the Veterans’ Benefits Improvements Act of 1996 (P.L. 104-275)24 granted the
VA Secretary discretionary authority to establish a pilot program in no more than 10 regional
offices to conduct veterans’ disability examinations through persons other than VA employees.
The act specified that funding for the contracted physicians come from the funds allocated to VA
for the administration of compensation and pension payments. Section 504(d) of the act also
required the Secretary to submit a report to Congress within three years of enactment on cost,
timeliness, and thoroughness of the exams. In the July 16, 1996, issue of the Congressional
Record, House Members explained that authorizing the pilot was, in part, due to the
recommendations of the Blue Ribbon Panel on the Adjudication of Claims, which found that “in
some instances, VA medical centers were not responsive to VBA requirements for thorough
medical exams.”25 Representative Lane Evans described that “by giving VA regional offices the
authority, on a pilot basis, to choose someone other than an unresponsive VA medical center for
its medical examinations, we hope to improve the quality and timeliness of compensation and
pension examinations.”26 Consensus within the discussion explained that the pilot program was
anticipated to speed up the examination-gathering process for the adjudication of claims.27
December 2003—Temporary Authority for Use of Contract Physicians
Section 704 of the Veterans Benefits Act of 2003 (P.L. 108-183) extended the temporary authority
for the pilot program. This temporary authority was in addition to the authority initially granted
under Section 504(b) of P.L. 104-275. In addition, Section 704 of P.L. 108-183 stated that the
expanded authority would expire on December 31, 2009, and that “no examination may be
carried out under the authority provided in that subsection after that date.” Congress also required
the Secretary to submit a report to Congress within four years from the date of enactment that
included an assessment of the cost, timeliness, and thoroughness of said examinations. S.Rept.
108-169, published in conjunction with the proposed legislation, included a discussion on the
background and purpose of the contract disability exams. While the committee noted the success
of the pilot program in providing “adequate and timely disability examinations at locations near
their home,” the committee also expressed its desire to see VA continue its work, stating that “the
expanded contract authority specified in this provision would serve as a complement to, and not a
substitute for, examinations performed by VHA staff.”28

24 Section 504 of P.L. 104-275, “Veterans’ Benefits Improvements Act of 1996,” Explanatory Statement on S. 1311, As
Amended: Compromise Agreement, Congressional Record, vol. 142 (September 28, 1996), p. S11791.
25 Rep. Terry Everett and Rep. Benjamin Gilman, “Veterans’ Compensation and Readjustment Benefits Amendments
of 1996,” remarks on H.R. 3673, Congressional Record, vol. 142, part 104 (July 16, 1996), pp. H7554-H7555.
26 Rep. Lane Evans, “Veterans’ Compensation and Readjustment Benefits Amendments of 1996,” remarks on H.R.
3673, Congressional Record, vol. 142, part 104 (July 16, 1996), pp. H7555.
27 Rep. Terry Everett and Rep. Benjamin Gilman, “Veterans’ Compensation and Readjustment Benefits Amendments
of 1996,” remarks on H.R. 3673, Congressional Record, vol. 142, part 104 (July 16, 1996), pp. H7554-H7555.
28 U.S. Congress, Senate Committee on Veterans’ Affairs, Veterans’ Benefits Enhancements Acts of 2003, Report to
accompany S. 1132, 108th Cong., 1st sess., October 3, 2003, S.Rept. 108-169, pp. 22-23.
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December 2014—Expansion of Contract Authority
The Consolidated and Further Continuing Appropriations Act, 2015 (P.L. 113-235), directed the
Secretary to expand the program to no more than 12 regional offices in FY2015 and 15 regional
offices in FY2016. This section also granted the Secretary the authority to expand the use of
medical disability contracts beginning FY2017 and each following fiscal year to as many VA
regional offices as deemed appropriate. Funding for these new contracts would come from VA’s
compensation and pension appropriated funds.
October 2016—VBA Controls All Contract C&P Exams
In preparation for the expansion of these contracted exams, in March 2016, VA announced the
“award of 12 major contracts to be managed by VBA, consisting of a $6.8 billion enterprise-wide
MDE program.”29 VA created the Medical Disability Examination Program Office to oversee
contract C&P exams and enhance the ability to provide these exams promptly to veterans. Upon
the announcement of these contracts, VBA divided the contract exam program into seven
districts, five of which aligned with MyVA, a 2015 initiative to divide the U.S into regions as a
way to improve internal coordination and interaction with veterans. The other two districts of the
exam program provide coverage outside the United States, as detailed in Figure 5.30 According to
VA, this transition was made to allow VHA to increase its focus on providing timely and adequate
medical care for veterans.
October 2020—VA Announces All C&P Exams Contracted Out
According to both congressional press releases and multiple news articles, VA announced a plan
to shift the entire C&P exam program to contract physicians.31 In her letter to then-VA Secretary
Robert Wilkie, Representative Elaine Luria, chair of the House Veterans’ Affairs Committee
Disability Assistance and Memorial Affairs Subcommittee, stated that the decision was made
without notifying Congress and noted that “VA privately advised my staff of the decision after it
was made, without a press release or communication to the affected veterans, advocates, or labor
representatives.”32 Jon Tester, then-ranking member of the Senate Veterans’ Affairs Committee
(SVAC), along with several of his Senate colleagues, also expressed concern in an additional
letter to then-Secretary Wilkie:
We were alarmed to learn that VA’s vision for the future of the C&P program is to fully
utilize private contractors to take over the VA personnel’s workload, which we believe has

29 Steve Bracci, et al., Veterans Benefits Administration: Inadequate Oversight of Contracted Disability Exam
Cancellations, VA OIG, June 10, 2019, p. 26, https://www.va.gov/oig/pubs/VAOIG-18-04266-115.pdf.
30 Bracci et al., Veterans Benefits Administration, p. 19; and VA, “VA Announces Single Regional Framework Under
MyVA Initiative,” press release, January 26, 2015, https://blogs.va.gov/VAntage/16786/va-announces-single-regional-
framework-under-myva-initiative/.
31 See Nikki Wentling, “VA Plans to Outsource All Compensation and Pension Exams,” Military.com, October 21,
2020, https://www.military.com/daily-news/2020/10/21/va-plans-outsource-all-compensation-and-pension-exams.html;
and Leo Shane III, “VA Moving Ahead with Plans to Outsource All Compensation and Pension Exams,” Military
Times, November 16, 2020, https://www.militarytimes.com/news/pentagon-congress/2020/11/16/va-moving-ahead-
with-plans-to-outsource-all-compensation-and-pension-exams/.
32 Office of U.S. Congresswoman Elaine Luria, “Congresswoman Elaine Luria Urges VA to Provide Timely, High
Quality C&P Exams,” press release, October 21, 2020, https://luria.house.gov/media/press-releases/congresswoman-
elaine-luria-urges-va-provide-timely-high-quality-cp-exams; and letter from Rep. Elaine Luria to VA Secretary Robert
Wilkie, October 20, 2020.
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the potential for serious long-term negative impacts on the services and benefits provided
to our nation’s veterans.33
The letter continued by reinforcing Congress’s intent to establish the pilot program for contracted
C&P exams “to supplement VA’s internal capacity to perform exams to help veterans, not
supplant it.”34
January 2021—VA’s Medical Disability Examinations
Section 2002 of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (P.L. 116-315) expanded license portability for physician assistants,
nurse practitioners, audiologists, and psychologists to allow for these contracted professionals to
conduct C&P exams across state lines. Another provision placed a temporary hold on VA
eliminating internal health professional positions related to C&P exams until the wait time for
veterans who need exams is lower than it was on March 1, 2020. For contracted health care
professionals conducting C&P exams that are underperforming, this section grants the Secretary
the authority to hold those individuals accountable.
VA Management of Contracted C&P Exams: Medical Disability
Examination Office (MDEO)
Effective October 1, 2020, the start of FY2021, the Medical Disability Examination Program
Office was realigned within VBA and is now a separate entity called the Medical Disability
Examination Office (MDEO). This realignment is intended to provide better oversight and
management of the contracted exams.35 VBA reassigned two senior executives from other VBA
entities to lead this office and tasked them with modernizing and improving the process of C&P
contracted exams. On December 6, 2020, VBA opened the MDEO. MDEO now manages all
main vendor contracts and the additional ancillary contracts. The main vendor contracts support
sites throughout the United States, in 37 foreign and U.S. territories, and at 121 pre-discharge
sites. These contracts are divided into districts, which can be seen in Figure 5. The ancillary
contracts (not pictured) will provide support for vendor credentialing, financial audits, customer
satisfaction, and independent validation and verification.36
During the December 2020 VA Advisory Committee on Disability Compensation meeting, Mary
Glenn, then-deputy executive director of MDEO, explained that MDEO has its own staff that
works within the office’s four main divisions: (1) data and operations, (2) medical disability exam
quality, (3) policy and program management, and (4) acquisitions and budget.37 In addition,
Glenn explained that when VA suspended in-person examinations during the COVID-19
pandemic, all contracted physicians were directed to use acceptable clinical evidence (ACE)38

33 Senate Committee on Veterans Affairs, “Tester, Colleagues Slam VA Privatization of Compensation and Pension
Exams for Disabled Veterans,” press release, November 20, 2020, https://www.veterans.senate.gov/newsroom/
minority-news/tester-colleagues-slam-va-privatization-of-compensation-and-pension-exams-for-disabled-veterans.
34 Ibid.
35 VA Advisory Committee on Disability Compensation Meeting Minutes, December 1-2, 2020, p. 5,
https://www.va.gov/ADVISORY/MINUTES/Minutes-ACDCDec2020.pdf.
36 Email from VA Office of Congressional and Legislative Affairs, July 16, 2021.
37 VA Advisory Committee on Disability Compensation Meeting Minutes, December 1-2, 2020, p. 5.
38 ACE exams are those in which an examiner can review a veteran’s medical file and complete a DBQ in place of an
in-person exam to expedite the disability rating process.
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exams and tele-C&P exams to the greatest extent possible. As VA gradually began to resume in-
person exams, if a tele-C&P exam or ACE was feasible for a veteran’s claim, the physicians were
encouraged to continue to use that option. She also assured the committee that MDEO followed
the Centers for Disease Control and Prevention guidelines and implemented “stringent procedures
for vendors.”39 Additional adjustments to C&P exams during COVID-19 are described in
“Challenges Faced During COVID-19.”
In 2021, MDEO contract exam vendors completed more than 1.7 million C&P requests for
veterans domestically and internationally, which is a 56% increase over 2020, despite challenges
posed by the COVID-19 pandemic. With this increase in completed exams, in 2021, the VBA’s
pending inventory for C&P exams was reduced from 351,000 to 258,000. MDEO estimates that
contract exam vendors will complete over 2.21 million exams for veterans and servicemembers in
2022 and over 2.36 million exams in 2023.40
Figure 5. VBA C&P Contract Exam Districts

Source: CRS based upon information in U.S. Government Accountability Office, VA Disability Exams: Improved
Performance Analysis and Training Oversight Needed for Contracted Examiners, GAO-19-13, October 12, 2018, p. 7,
https://www.gao.gov/products/gao-19-13.
Oversight of VBA Contract C&P Exams
Over the past two decades, VA’s pilot program to contract out C&P exams has expanded to all
regional offices. As the program expanded, Congress continued to monitor the program through
hearings, VA OIG reports, and reviews of the program by GAO. Appendix B provides a snapshot
of the various methods of oversight conducted specifically for contracted exams over the past 20
years. The tables focus on this time period because it is when the expansion of contracted C&P
exams began in earnest. Table B-3 provides a selected list of congressional hearings on the status
of the contracted exams as VA’s authority for granting contracts was either reauthorized or

39 VA Advisory Committee on Disability Compensation Meeting Minutes, December 1-2, 2020, p. 5.
40 VA, FY2023 Budget Submission, Benefits and Burial Programs and Departmental Administration, vol. 3 of 4, March
2022, p. VBA-69.
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expanded. Table B-4 provides a selected list of VA OIG reports that focus on the challenges VA
faced in providing contracted C&P exams and ways VA can improve the implementation of the
program. Table B-5 provides an overview of GAO reports that were requested by the committees
of jurisdiction and that provide specific recommendations to VA as ways to improve the program.
In addition, this table includes some testimony by GAO to the committees.
C&P Exam Data and Analysis41
As a result of the legislation passed by Congress, discussed in the “Contracted Compensation and
Pension Exams” section and Appendix B, there has been a significant increase in the number of
contracted C&P exams. The increase in C&P exams correlates to the increase in overall disability
claims submitted to VA for adjudication as described in “Claims Inventory.” Figure 6 shows the
increase in the number of VBA contracted exams from FY2013 through FY2021 compared to the
correlated decrease in the number of exams performed by VHA medical staff. As the number of
contracted C&P exams increased, so did the amount of appropriations required to fund the
program. Figure 7 shows the increased cost of C&P exams compared to the overall C&P program
budget allocations from FY2006 through FY2021.
Figure 6 displays data on VBA contracted C&P exams and VHA in-house C&P exams that CRS
obtained through direct communication with VA liaisons. The VA data for both VBA contracted
C&P exams and VHA in-house C&P exams covered FY2013-FY2021. VA explained that VBA
officially took over the contracts once held by VHA in FY2017 and in essence took over all
contract C&P exams.
Figure 7 provides the cost incurred for certain years for contracted C&P exams by VBA only.
This is due to the inconsistent nature of reporting by VHA on the costs incurred to conduct the
contracted exams. In November 2001, the House Committee on Veterans’ Affairs held a hearing
to receive the “VA Claims Processing Task Force Report to the Secretary of Veterans Affairs,”
which described challenges in the program’s implementation and inconsistent recordkeeping. The
report stated that “VHA does not specifically monitor costs for its C&P medical examination
program, thus making comparisons with private contractors difficult.”42 Therefore, CRS did not
include VHA appropriations and costs in this analysis.
The data included in both charts in Figure 7 were taken from VA’s annual budget request and
compares the appropriations for VBA contracted exams with the overall C&P appropriations
(calculated as the sum of the “Total Compensation Obligations” and “Total Pensions Obligations”
line items). Burial appropriations are not included in the calculation of overall C&P
appropriations. Given the difference in scale, VBA contracted exam appropriations and overall
C&P appropriations are graphed on separate axes.

41 Data calculations for this section were conducted by CRS Research Assistant Isaac Nicchitta.
42 U.S. Congress, House Committee on Veterans’ Affairs, Hearing to Receive the Report of the VA Claims Processing
Task Force (Cooper Report), 107th Cong., 1st sess., November 6, 2001, H.Hrg 107-16 (Washington: GPO, 2002), p. 80.
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Figure 6. VBA Contracted Exams vs. VHA In-House Exams
FY2013-FY2021

Source: Data provided to CRS by VA Congressional Liaison Office.
Figure 7. VBA C&P Contracted Exam Pilot Program Appropriations vs. Overall C&P
Appropriations
FY2006-FY2021

Source: VA, Annual Budget Submissions, Benefits and Burial Programs and Departmental Administration, vol. 3
of 4, FY2008-FY2023.
Notes: Amounts are in nominal (i.e., non-inflation-adjusted) dollars.
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Challenges Faced During COVID-1943
C&P Exams and Benefits
Facing the COVID-19 pandemic, on March 18, 2020, VBA announced via Facebook and Twitter
that all regional offices would close to the public starting March 19, 2020.44 Most VA employees
would telework to ensure the continuity of processing claims. However, offices would no longer
be accepting walk-ins for claims assistance, scheduled appointments, counseling, or other in-
person services. VBA directed veterans who had claims-specific questions or any other questions
to use the Inquiry Routing and Information System or to call 1-800-827-1000.
In a March 26, 2020, interview, then-VA Under Secretary for Benefits Dr. Paul Lawrence
addressed the issue of veterans who needed C&P exams completed as part of their benefits
applications. Due to travel restrictions and social distancing policies, Dr. Lawrence explained
VBA’s attempt to provide exams without in-person contact:
So we’re trying to do more, a lot more through telehealth. You know phone call or a Skype
session or something. We can get these exams done that we’re flexing in new ways. Where
once things were done in person … now they’re being done electronically.45
Following Dr. Lawrence’s interview, on March 31, 2020, VA announced changes to several in-
person meetings and programs to ensure the safety of both the staff and VA benefit recipients
during this time. Some of these changes included:
 providing educational counseling through online and telephone services;
 using teleconferencing and VA Video Connect for case management, general
counseling, and connecting veterans to Veteran Readiness and Employment
services;
 conducting informal conference hearings by telephone or video conferencing;
 providing virtual briefings and individualized counseling for transitioning
servicemembers; and
 conducting examinations for disability benefits using tele-C&P exams. (If an in-
person examination was required, the veteran would be notified for scheduling by
a contract physician.)46
On April 6, 2020, VBA announced via email that it was “suspending in-person C&P examinations
until further notice and will continue to conduct C&P exams through ACE and Tele-C&P, when
possible.”47 The email provided guidance on filing claims and information to assist veterans with

43 For additional information on VA’s response to COVID-19, see CRS Report R46340, Federal Response to COVID-
19: Department of Veterans Affairs.
44 This announcement was included as a banner on the VBA regional offices web page. However, this banner was not
permanent and has since changed to reflect the latest status.
45 Federal News Network, “Coronavirus Hits Just as VBA Was Getting Claims Backlogs Under Control,” March 26,
2020, https://federalnewsnetwork.com/veterans-affairs/2020/03/coronavirus-hits-just-as-vba-was-getting-claims-
backlogs-under-control/.
46 VA, “VA Expands Virtual Services to Support Veterans Due to COVID-19 Pandemic,” press release, March 31,
2020, https://www.blogs.va.gov/VAntage/73202/va-expands-virtual-services-support-veterans-due-covid-19-pandemic/
; and VA, “VA Expands Virtual Services to Support Veterans Amid Regional Office Closures Due to COVID-19
Pandemic,” press release, March 31, 2020, https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5408.
47 Email from VBA, Monday, April 6, 2020, “Your Virtual C&P Examination Alternatives During the Pandemic.”
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submitting medical documentation without appearing in person. On April 3, 2020, VA announced
that claimants who need extensions in filing their paperwork “can simply submit [the request]
with any late-filed paperwork and veterans do not have to proactively request an extension in
advance.”48
On April 9, 2020, VA issued an update to its “Coronavirus FAQ’s: What Veterans Need to Know”
with directions on how to switch an appointment or a C&P exam from an in-person appointment
to a telehealth appointment.49 In addition, VBA released a series of documents to provide veterans
clearer guidance on how to handle their claims—and especially their C&P exams—during the
pandemic.
At the end of May 2020, VBA resumed in-person C&P contracted exams where the local
conditions permitted, and by December 31, 2020, the majority of C&P exam locations were
beginning to schedule or had already resumed scheduling and providing C&P exams. However, it
was not until June 1, 2021, that exams requiring the removal of the veteran’s personal protective
equipment were able to resume at all U.S. exam locations.50
As a result of the suspension of in-person C&P exams, closures of regional offices, and delays in
accessing records through NPRC, a significant backlog of claims and C&P exams developed, as
further explained in the next section. Due to concerns by veterans, survivors, various veterans
service organizations (VSOs), and congressional officials, the House and Senate Veterans’ Affairs
Committees have held hearings on the status of veterans’ claims and C&P exams during the
pandemic. On March 23, 2021, Elizabeth Curda, director of GAO’s Education, Workforce and
Income Security, testified before the House Committee on Veterans’ Affairs, Subcommittee on
Disability Assistance and Memorial Affairs that the days pending for completion of contract C&P
exams increased from 23 days in January 2020 to 91 days in February 2021.51 Curda provided
Figure 8 to the House Subcommittee in her written testimony, demonstrating the number of
pending exams in correlation to the average number of days pending for the exams. The
significant increase in both the number of pending exams and days pending is a result of the
suspension of in-person C&P exams for several months during 2020. Additional highlights of her
testimony to both the House and Senate committees can be found in the tables included in
Appendix B.

48 VA, “VA Extends Financial, Benefits and Claims Relief to Veterans,” press release, April 20, 2020,
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5412.
49 VA has continued to update this factsheet throughout the pandemic with the status of VA medical facilities, claims
and debt submission guidelines, and status of VA national cemeteries and burials. VA, “Coronavirus FAQs: What
Veterans Need to Know,” August 3, 2021, https://www.va.gov/coronavirus-veteran-frequently-asked-questions/.
50 VA, “VA Claim Exam Resumption Fact Sheet,” last updated June 14, 2021, p. 1, https://benefits.va.gov/
COMPENSATION/docs/claimexam-resumption-factsheet.pdf#.
51 GAO, VA Disability Exams: Better Planning Needed as Use of Contracted Examiners Continues to Grow, GAO-21-
444T, March 23, 2021, pp. 6-7, https://www.gao.gov/assets/gao-21-444t.pdf.
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Figure 8. Number of Pending Disability Medical Exams and Average Days Pending
Completion by VBA Contractors, January 2020 to February 2021

Source: GAO, VA Disability Exams: Better Planning Needed as Use of Contracted Examiners Continues to Grow, GAO-
21-444T, March 23, 2021, pp. 6-7, https://www.gao.gov/assets/gao-21-444t.pdf.
On May 12, 2021, Acting Under Secretary for Benefits Thomas J. Murphy testified:
As of April 2021, approximately 65% of the total claims inventory is awaiting an
examination and 10% is waiting pending Federal records. VBA is making every effort to
process as many disability compensation claims as possible during the pandemic and will
not deny a claim due to the pandemic-related inability to complete in-person exams or
receive Federal records…. Currently, there are over 58,000 non-actionable exams because
Veterans have not yet elected to appear for their C&P examinations.52
The non-actionable exams were part of the discussion in the April 2021 meeting between VBA
and VSOs in which VBA said that the status of these exams is due to veterans being unwilling to
meet for their C&P exams, even virtually, or that VBA is unable to establish communication with
the veterans. VBA informed the VSOs that these claims “will be held in abeyance until the
veteran engages with the contract vendor or 60 days following the declared end of this national
medical emergency.”53
Virtual C&P Exams
While in-person exams were suspended, VHA and VBA trained contracted examiners to use
telehealth technology to conduct virtual exams. This training included expanding the use of ACE

52 U.S. Congress, Senate Committee on Veterans’ Affairs, Statement of Thomas J. Murphy, Acting Under Secretary for
Benefits Veterans Benefits Administration Department of Veterans Affairs Before the Committee on Veterans’ Affairs,
United States Senate, 117th Cong., 1st sess., May 12, 2021, pp. 3-4, https://www.veterans.senate.gov/services/files/
6B9FFC5E-B16D-42B4-B229-0D3EF8E12BF2
53 Paul Frost, “VA Updates MOAA, Other Groups on Compensation and Pension Exam Status,” MOAA.org, April 5,
2021, https://www.moaa.org/content/publications-and-media/news-articles/2021-news-articles/va-updates-moaa,-other-
groups-on-compensation-and-pension-exam-status/.
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exams in which the examiner reviews a veteran’s medical file and completes a disability benefits
questionnaire (DBQ) in place of an in-person exam to expedite the disability rating process.54 To
increase the use of tele-C&P and ACE exams, VA expanded the number of examinations eligible
for use of telehealth technology from 19 to 34. This change allowed VBA contracted examiners to
complete 114,749 ACE exams and 110,746 tele-C&P exams between April 2020 and April
2021.55 As a result, in June 2020, VA announced a significant increase in telehealth video
appointments through VA Video Connect, which allows veterans and their caregivers to meet with
the veteran’s health care team virtually on any device with internet access. Between February and
May 2020, VA saw more than a 1,000% increase in the program’s use, with appointments
increasing from approximately 10,000 to 120,000 per week.56
In VA’s FY2023 budget submission, MDEO provided data on the contract C&P exam inventory
and also the number of contracted exams that were completed using either ACE or Tele-C&P. At
the height of the backlog of pending C&P exams in 2021, there were 351,000 exams pending.
MDEO was able to reduce that inventory to 258,000 as “contract vendors continue[d] to increase
their volume of completed [exam scheduled requests] each month, resulting in a decrease in the
excess inventory of examinations.”57 In addition, MDEO reported that in 2021 over 115,000, or
approximately 7%, of C&P exams were completed using ACE with an additional 85,000, or
approximately 5.1%, of exams completed using Tele-C&P.58
National Personnel Records Center (NPRC)59
NPRC, located in St. Louis, MO, is the main repository for the federal government’s military and
civil service personnel-related records. NPRC holds more than 4 million cubic feet of records and
stores these documents permanently in accordance with the Federal Records Act. The significant
majority of these records are in paper format, requiring staff to be on-site to complete research
and requests. Due to the COVID-19 pandemic, NPRC closed in March 2020, leaving only
minimal staff on site to complete emergency requests, such as records needed for death/burial
benefits or for medical procedures such as surgery. Table 1 is a chronological overview of
NPRC’s timeline of operating status throughout the pandemic based upon the banner postings on
NPRC’s website.60
Table 1. Chronology of NPRC Operating Status
March 2020
NPRC closes with only a few staff on site to address emergency veteran records
requests.
June 24, 2020
NPRC entered Phase One of a gradual reopening, which included an on-site staffing
capacity of 10%.

54 Frost, “VA Updates MOAA.”
55 U.S. Congress, Senate Committee on Veterans’ Affairs, Statement of Thomas J. Murphy, Acting Under Secretary for
Benefits Veterans Benefits Administration Department of Veterans Affairs Before the Committee on Veterans’ Affairs
United States Senate, 117th Cong., 1st sess., May 12, 2021, p. 4, https://www.veterans.senate.gov/imo/media/doc/
VA%20Testimony%2005.12.21.pdf.
56 VA, “VA Video Connect Visits Increase 1000% During COVID-19 Pandemic,” press release, June 12, 2020,
https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5467.
57 VA, FY2023 Budget Submission, p. VBA-69.
58 Ibid., p. VBA-70.
59 For more information on NPRC and record requests during COVID-19 pandemic see CRS In Focus IF11950,
COVID-19 Impact on Access to Military Service Records; and CRS Insight IN11668, VA, HHS to Vaccinate NARA
National Personnel Records Center Staff.
60 NPRC, https://www.archives.gov/personnel-records-center.
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October 5, 2020
NPRC entered Phase Two of reopening, adding additional staff for on-site operations.
November 7, 2020
NPRC reduced on-site staff to less than 10% due to increase of COVID cases.
March 8, 2021
NPRC increased on-site staffing to 20% capacity.
March 29, 2021
NPRC announces it will increase staffing capacity to 25%.
April 1, 2021
VA announces agreement with NARA and Department of Health and Human Services to
help vaccinate NPRC staff.
May 10, 2021
NARA chief archivist sends letter to the Secretary of Defense requesting assistance for
“pandemic recovery operations” at NPRC.
August 2, 2021
NPRC returned to COVID-19 Phase 0 due to community transmission rate, which
reduced the number of on-site staff to 10% capacity.
September 27, 2021
NPRC increased on-site staffing to 25% of pre-pandemic capacity.
October 18, 2021
NPRC increased on-site staffing capacity to 45%.
January 6, 2022
NPRC decreased on-site staffing to 25%.
March 7, 2022
NPRC resumed normal operations.
In early fall 2020, additional staff began to return to the building to process non-emergency
requests. However, NPRC closed down again due to a spike in COVID-19 cases among staff.61
NPRC continued to work on processing both emergency requests and records requests from
veterans, their survivors, and VBA. In doing so, NPRC worked directly with VBA to complete
requests submitted through VA’s “duty to assist” obligation on behalf of claimants for the proper
and necessary paperwork. During the first year of the pandemic, as of March 8, 2021, NPRC staff
had responded to over 172,000 requests directly from VA to assist with the processing of veterans
claims. In addition, NPRC processed over 116,000 urgent requests which included 45,000 burial-
related requests, assistance for 7,500 homeless veterans, and 18,000 medical emergencies.62
Identified as one of the top management challenges by the National Archives’ OIG, as of March
31, 2022, NPRC reported that the backlog of records requests stood at more than 500,000. The
OIG’s report states that while all services to VBA have been restored, “the backlog of public
requests continues to grow.”63
The backlog of requests increased due to the limited staff on site but also because the majority of
records being requested are in paper form. These records are housed in close quarters and require
staff to access materials on-site, without social distancing. The number of digital service records
are limited in scope and are generally available only for those servicemembers who separated
after 2002. VA Secretary Denis McDonough testified at the House Veterans’ Affairs Committee
hearing on March 25, 2021, on the need and importance of staff returning to work to process
veterans requests. VA announced on April 1, 2021, the agreement between NARA and VA to
expedite vaccinating NPRC staff, due to the limited number of vaccines available at the time, to
allow for more staff to return on-site.64 VA also temporarily assigned 60 staff members to NPRC

61 National Archives and Records Administration, “Veterans’ Service Records: Emergency Requests and Deadlines,”
June 22, 2021, https://www.archives.gov/veterans/military-service-records/emergencies.
62 National Archives and Records Administration, “Improvement in Public Health Outlook Holds Promise for
Increased Service to Veterans,” press release, March 8, 2021, https://www.archives.gov/press/press-releases/2021/nr21-
30
63 Office of Inspector General, National Archives and Records Administration, Semiannual Report to Congress:
October 1, 2021 to March 31, 2022, pg. 12, at https://www.archives.gov/files/oig/nara-oig-sar22a-1oct21-to-
31mar22.pdf#page=12.
64 Department of Veterans Affairs, “VA Partners with National Archives to Vaccinate NARA Staff,” press release,
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to locate, retrieve, and scan paper records into digital files. These hiring efforts led to a decrease
in the number of days needed to respond to requests.65
As the number of pending requests continued to increase, on May 10, 2021, NARA wrote a letter
to the Secretary of Defense requesting assistance in “pandemic recovery operations at NPRC in
St. Louis.”66 The request for help included three key objectives: (1) “off-site sorting and batching
of approximately 400,000 Official Military Personnel Folders (OMPF)” to prepare for and refile
records back on site; (2) conducting “on-site searching and retrieval of OMPFs to support
eliminating a backlog of 500,000 public reference requests;” and (3) “on-site digitization or
photocopying of DD Forms 214 from these records and the dispatch of reproductions.”67 While a
portion of the documents are requested from VBA to assist veterans with claims, the majority of
these requested documents are from veterans’ families as they attempt to file claims themselves
with VA.
Despite NPRC’s phased return to on-site work and a request for help, on August 10, 2021, VA’s
National Cemetery Administration notified those on its listserv, including funeral directors, that
NPRC returned to COVID Phase 0 level due to the high level of community transmission rate of
COVID-19.68 NPRC announced that this reduction went into effect August 2, 2021, and the on-
site workforce decreased to 10% capacity. On NPRC’s website, a statement was posted that
explained they would “continue to service emergency requests associated with medical
treatments, burials, and homeless veterans trying to gain admittance to a homeless shelter. Please
refrain from submitting non-emergency requests such as replacement medals, administrative
corrections, or records research until we return to pre-COVID staffing levels.”69
By early fall 2021, NPRC reopened operations as conditions continued to improve in and around
the St. Louis, MO, region. On October 18, 2021, NPRC announced that it was able to increase
on-site staffing to 45% with the hope of continuing to increase on-site status. Despite a need to
decrease on-site staffing in January 2022, NPRC announced on its website that as of March 7,
2022, it has resumed normal operations and is staffed at the pre-pandemic, full capacity. This
enhanced staffing is likely to increase the number of requests that can be completed in a shorter
period of time.70

April 1, 2021, at https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5652. See also CRS Insight IN11668, VA, HHS
to Vaccinate NARA National Personnel Records Center Staff, by Heather M. Salazar and Meghan M. Stuessy.
65 Patricia Kime, “VA Adds Staff, Boosts Funding to Tackle Claims Backlog That Nearly Tripled During Pandemic,”
Military.com, June 14, 2021, https://www.military.com/daily-news/2021/06/14/va-adds-staff-boosts-funding-tackle-
claims-backlog-nearly-tripled-during-pandemic.html.
66 Letter from William J. Bosanko, Chief Operating Officer, NARA, to Executive Secretary, Office of the Secretary of
Defense, May 10, 2021, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/
DoD%20RFA%20for%20NPRC%2005%2010%202021.pdf.
67 Ibid. DD Forms 214 are the military discharge papers provided to a separating servicemember as proof of service.
68 Email from National Cemetery Administration, August 10, 2021.
69 NARA, “Temporary Reduction in Onsite Operations at the National Personnel Records Center (NPRC) in St. Louis,”
updated August 5, 2021, https://www.archives.gov/personnel-records-center/civilian-personnel/federal-agencies.
70 National Archives and Records Administration, “Check the Status of a Request for Military Service Records,”
updated November 5, 2021, at https://www.archives.gov/personnel-records-center/forms. In addition, NPRC explains
that individuals who have already submitted records requests can check the status of their requests online, 10 days after
submission.
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Appendix A. Abbreviations
Table A-1. Abbreviations/Acronyms Used in the Report
Acronym
Description
ACE
Acceptable Clinical Evidence
C&P
Compensation & Pension
C&P Exam
Compensation & Pension Examinationa
DBQ
Disability Benefit Questionnaires
DOD
U.S. Department of Defense
FDC
Fully Developed Claims
GAO
U.S. Government Accountability Office
HVAC
House Committee on Veterans Affairs
MDE
Medical Disability Examinationb
MDEO
Medical Disability Examination Office
MMWR
Monday Morning Workload Report
NARA
National Archives and Records Administration
NPRC
National Personnel Records Center
SVAC
Senate Veterans Affairs Committee
tele-C&P
Telehealth Compensation & Pension Exams
VA
U.S. Department of Veterans Affairs
VARO
U.S. Department of Veterans Affairs Regional Office
VBA
Veterans Benefits Administration
VHA
Veterans Health Administration
Source: CRS.
Notes:
a. These are also referred to as medical disability examinations, medical disability exams, C&P examinations,
C&P exams, disability examinations, or disability exams.
b. These are also referred to as C&P examinations, C&P exams, disability examinations, or disability exams.
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Appendix B. Legislative History71
Methodology and Limitations
To conduct this legislative history, CRS examined two notes that appear in Title 38, Section 5101,
of the U.S. Code, “Claims and forms:”
1. Pilot Program for Use of Contract Physicians for Disability Examinations, and
2. Temporary Authority for Performance of Medical Disabilities Examinations by
Contract Physicians.
CRS traced the history of these notes from authorization until the most recent amendment. CRS
used research databases to identify relevant reports, hearings, and committee materials. CRS
examined the source credits that appear after the text of the U.S. Code section and consist of
citations to each law that enacted, amended, or otherwise affected the section. A list of laws
related to the pilot program for the use of contracted physicians can be found in Table B-1. A list
of laws related to the temporary authority for C&P exams conducted by contract physicians can
be found in Table B-2.
CRS searched each of these laws in ProQuest Legislative Insight, a database that compiles digital
full text publications associated with the enactment of public laws. CRS searched across these
publications using keywords such as contract physicians, medical examinations, C&P exams,
contract disability exams, and similar terms. CRS identified relevant committee reports,
committee prints, hearings, and related documents from these keyword searches to inform the
legislative discussion for each public law.
In addition, CRS conducted separate searches in the GAO’s website, the Government Publishing
Office’s Govinfo database, the VA OIG’s database, and the ProQuest Congressional database.
These four sources helped identify additional hearings and reports that were not directly
connected to the enactment of specific public laws but did reflect issues of concern to Congress
about veterans’ claims and C&P examinations.
Selected hearings related to the laws can be found in Table B-3. Selected OIG reports can be
found in Table B-4. Selected GAO reports can be found in Table B-5.
Because keyword searching was used to identify digital documents, it is possible some relevant
resources were inadvertently missed as not all digital copies are fully machine readable. As the
vocabulary used to describe these examinations evolved over time, CRS attempted to capture
pertinent resources with a relevant set of terms. However, it is possible that some relevant terms
were not included. In addition, results were necessarily limited by the scope of the databases, the
electronic availability of relevant documents, and the fact that not all committee materials were
publicly accessible.
Legislative Timeline
The following two tables provide a timeline of legislative action for VA’s pilot program and
temporary authority to contract physicians to conduct C&P exams.

71 Research for this section was conducted by CRS Research Librarians Tamar Breslauer, Carol Davis, and Michele
Malloy.
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Table B-1. Pilot Program for Use of Contract Physicians for C&P Exams
Date
Public Law
Title
Brief Summary
October 9, 1996
P.L. 104-275
Veterans’ Benefits
Section 504(b) granted the VA Secretary
Improvements Act of 1996
discretionary authority to establish a pilot
program to provide disability examinations to
veterans through contracted non-VA
physicians.
December 16,
P.L. 113-235
Consolidated and Further
Section 241 amended Section 504(b) of the
2014
Continuing Appropriations
Veterans’ Benefits Improvements Act of 1996
Act, 2015
by directing the VA Secretary to carry out the
pilot program in a limited manner. The pilot
program could expand to not more than 10
VA regional offices before FY2015 and to not
more than 15 regional offices in FY2016. In
FY2017 and each fiscal year after, the VA
Secretary could carry out the pilot program in
regional offices that he or she deems
appropriate.
December 16,
P.L. 114-315
Jeff Miller and Richard
Amended Section 704(c) and (d) of the
2016
Blumenthal Veterans Health
Veterans Benefits Act of 2003 by inserting
Care and Benefits
additional sections to improve the use of
Improvement Act of 2016
contracted physicians. Section 109 of the act
granted the ability of licensed, VA-contracted
physicians to conduct disability examinations at
any location in any state; the District of
Columbia; or any U.S. commonwealth,
territory, or possession so long as the
examination is authorized under VA’s contract.
March 23, 2018
P.L. 115-141
Consolidated Appropriations
Section 256 amended Section 504(d) of the
Act, 2018
Veterans’ Benefits Improvements Act of 1996
to direct expenses associated with carrying out
the pilot program, including “payments for
pilot program examination travel and incidental
expenses,” to be reimbursed to accounts for
VBA’s general operating expenses from
amounts available for payment of
compensation and pensions.
December 31,
P.L. 115-407
Veterans Benefits and
Section 702 made technical corrections to P.L.
2018
Transition Act of 2018
104-275 by “redesignating the second
subsection (c) as subsection (d).” This
correction led to the previous subsection (d)
to become subsection (e).
January 5, 2021
P.L. 116-315
Johnny Isakson and David P.
Title II, Section 2002(f), provided: “The
Roe, M.D. Veterans Health
Secretary shall take such actions as may be
Care and Benefits
necessary to hold accountable the providers of
Improvement Act of 2020
medical examinations pursuant to contracts
under section 504 of the Veterans’ Benefits
Improvements Act of 1996 (P.L. 104-275; 38
U.S.C. §5101 note) who are underperforming
in the meeting of the needs of veterans
through the performance of medical
examinations pursuant to such contracts."
Source: CRS. Based upon U.S. Code and Congress.gov.
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Table B-2. Temporary Authority for C&P Exams Conducted by Contract Physicians
Date
Public Law
Title
Brief Summary
December 16,
P.L. 108-183
Veterans Benefits Act of 2003
Section 704 granted temporary authority (in
2003
addition to the authority granted in Section
504(b) of P.L. 104-275) to the VA Secretary
to provide disability examinations through
non-VA employees using the appropriated
funds other than those in the C&P program.
The temporary authority granted under this
section was set to expire on December 31,
2009.
October 10, 2008
P.L. 110-389
Veterans’ Benefits Improvement
Amended Section 704(c) of the Veterans
Act of 2008
Benefits Act of 2003 by extending VA’s
authority for contract disability exams for one
year from December 31, 2009, to December
31, 2010.
October 13, 2010
P.L. 111-275
Veterans’ Benefits Act of 2010
Section 809 extended VA’s authority to use
appropriated funds to contract with non-VA
providers to conduct disability examinations
through December 31, 2012. The
examinations were conducted pursuant to
contracts entered into and administered by
the Under Secretary for Benefits.
October 5, 2012
P.L. 112-191
VA Major Construction
Amended Section 704(c) of the Veterans
Authorization and Expiring
Benefits Act of 2003 by extending VA’s
Authorities Extension Act of
authority for contract disability exams for one
2012
year from December 31, 2012, to December
31, 2013.
December 20,
P.L. 113-59
VA Expiring Authorities
Amended Section 704(c) of the Veterans
2013
Extension Act of 2013
Benefits Act of 2003 by extending VA’s
authority for contract disability exams for one
year from December 31, 2013, to December
31, 2014.
September 26,
P.L. 113-175
Department of Veterans Affairs
Amended Section 704(c) of the Veterans
2014
Expiring Authorities Act of 2014
Benefits Act of 2003 by extending VA’s
authority for contract disability exams for one
year from December 31, 2014, to December
31, 2015.
September 30,
P.L. 114-58
Department of Veterans Affairs
Amended Section 704(c) of the Veterans
2015
Expiring Authorities Act of 2015
Benefits Act of 2003 by extending VA’s
authority for contract disability exams for one
year from December 31, 2015, to December
31, 2016.
September 29,
P.L. 114-228
Department of Veterans Affairs
Amended Section 704(c) of the Veterans
2016
Expiring Authorities Act of 2016
Benefits Act of 2003 by extending VA’s
authority for contract disability exams for one
year from December 31, 2016, to December
31, 2017.
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Date
Public Law
Title
Brief Summary
December 16,
P.L. 114-315
Jeff Miller and Richard
Amended Section 704 of the Veterans
2016
Blumenthal Veterans Health
Benefits Act of 2003 by inserting additional
Care and Benefits Improvement
sections to improve use of contracted
Act of 2016
physicians. Section 109 of the act granted the
ability of licensed, VA-contracted physicians
to conduct disability examinations at any
location in any state; the District of Columbia;
or any U.S. commonwealth, territory, or
possession so long as the examination is
authorized under VA’s contract.
December 12,
P.L. 115-91
National Defense Authorization
Amended Section 704(c) of the Veterans
2017
Act for Fiscal Year 2018
Benefits Act of 2003 by extending VA’s
authority for contract disability exams for one
year from December 31, 2017, to December
31, 2018.
Source: CRS based upon U.S. Code and Congress.gov.
Table B-3. Selected Congressional Hearings to Address Contract C&P Exams
Senate Committee on Veterans’ Affairs (SVAC) and House Committee on Veterans’ Affairs (HVAC)
Committee
Date
Hearing Title and URL
Highlights
HVAC
November
H.Hrg 107-16 Hearing to
Admiral Daniel L. Cooper, chairman of VA’s Claims Processing
6, 2001
Receive the Report of the
Task Force, and task force member Carolyn Hunt presented
VA Claims Processing Task
the study and findings of the task force. The task force made
Force (Cooper Report)
34 recommendations to the VA Secretary, of which 20 could

be implemented within a six-month period (identified as short-
term recommendations), while those identified as medium-
https://www.govinfo.gov/
term recommendations could take two or more years to
app/details/CHRG-
implement. Some of these recommendations include reducing
107hhrg53323/CHRG-
the backlog, improving the process of gathering records from
107hhrg53323
NPRC, extending the time frame for routine C&P re-
examinations, redefining claims processing errors, and
strategizing and implementing one integrated VA system.
Admiral Cooper testified that all of the recommendations they
made were unanimously agreed upon by all members of the
task force.
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Committee
Date
Hearing Title and URL
Highlights
SVAC
September
S.Hrg. 111-327 Hearing on
Joseph A. Williams Jr., Acting Deputy Under Secretary for
30, 2009
VA Contracts for Health
Operations and Management, VHA, testified that VA provides
Services
veterans’ care (1) directly in a VA medical center, (2) through

fee-based care, or (3) through contracts with local providers.
The written testimony included a detailed overview of VHA’s
https://www.govinfo.gov/
oversight of contract health care services as well as VBA’s C&P
app/details/CHRG-
Service’s oversight of contract exams. Williams also explained
111shrg53066/CHRG-
that, while the majority of C&P exams are conducted by VHA,
111shrg53066
VBA’s C&P Service has the authority to contract with outside
medical providers for C&P exams. Williams explained that,
during FY2008, approximately 24% of C&P exams were
performed by either QTC Medical Services or MES Solutions,
the two contracted examiners.a C&P Service evaluates the
performance of the contracts through (1) quality, which
requires at least a 92% accuracy rate; (2) timeliness, which
requires a 38-day turnaround from exam request to final
report; and (3) customer satisfaction, which is based upon a
survey questionnaire and requires a satisfaction standard of at
least 92%.
HVAC
June 25,
H.Hrg. 113-77 VBA and
Thomas Murphy, Director of Compensation Service, VBA,
2014
VHA Interactions: Ordering
testified that C&P exams are performed under specific clinical
and Conducting Medical
requirements that are the same if the exam is provided by a
Examinations
VA medical professional or a VA contracted medical
https://www.govinfo.gov/
professional. For a VHA clinician to conduct a C&P exam, VBA
app/details/CHRG-
must refer the veteran’s case to VHA for examination. At the
113hhrg89376/CHRG-
time, VHA had nearly 8,200 registered and certified C&P
113hhrg89376
examiners, which included full-time and part-time VHA
employees, residents, fee-for-service examiners, contractors,
and specialty providers.
HVAC -
November
H.Hrg 115-81 Exploring
GAO presented findings from its October 2018 report
Subcommittee
15, 2018
VA's Oversight of Contract
(highlights included in Table B-5) on the quality and timeliness
on Disability
Disability Examinations
of VBA contracted exams, the extent of VBA’s monitoring of
Assistance and

contractor performance, and how VBA ensures contractors
Memorial
are qualified and well-trained. Margarita Devlin, Principal
Affairs
https://www.govinfo.gov/
Deputy Under Secretary for Benefits, VBA, testified that, as
app/details/CHRG-
the contract exam program expanded, VBA regional offices
115hhrg35835/CHRG-
used an online tool to provide real-time data to determine if
115hhrg35835
VHA had the capacity to conduct a specific C&P exam. If not,
the office directed the veteran’s exam to a contracted
provider. Devlin explained that the contracts are organized
into five districts in the continental United States with two
venders per district, with an additional overseas contract and
one contract serving transitioning servicemembers. Devlin also
testified about the challenges implementing these contract
exams, including system limitations on managing exam requests
and one vendor—no longer working under a VBA contract—
that was underperforming.
SVAC
May 22,
S. Hrg. 116-179, Hearing
VA officials commented and provided statements on S. 1101,
2019
on Pending Legislation
“Better Examiner Standards and Transparency for Veterans

Act of 2019,” which would authorize VA to contract with non-
physician health care providers to conduct disability exams.
https://www.veterans.sena
te.gov/services/files/
F0B051E2-71F5-4323-
9922-D8ED12A502CE
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Committee
Date
Hearing Title and URL
Highlights
HVAC -
March 23,
VA Compensation and
David McLenachen, executive director of the Medial Disability
Subcommittee
2021
Pension Exams During the
Examination Office within VBA, testified that VBA contractors
on Disability
COVID-19 Pandemic: A
have increased their exam capacity 20% above pre-pandemic
Assistance and
Path Forward
levels in response to the large number of pending exams and
Memorial

the large number of exams requiring in-person evaluation.
Affairs
McLenachen explained that each examiner must hold an active
https://docs.house.gov/
state license to practice, and VBA is monitoring the
Committee/Calendar/
qualifications of over 12,000 contracted examiners. VBA
ByEvent.aspx?EventID=
created a new learning management system for contractors to
111370
complete required training and obtain required certification.
Deputy Assistant Inspector General for Audits and Evaluations
Brent Arronte testified at the hearing regarding the increase in
VA’s disability exam inventory caused by the pandemic.
Because VA canceled in-person disability exams as a protective
measure, a backlog of exams mounted quickly. In addition,
some claims were improperly denied due to canceled
appointments during the pandemic. Arronte’s testimony
mentioned the OIG’s November 2020 report and VBA’s failure
to create a documented plan to reduce the exam inventory to
pre-pandemic levels.
SVAC
May 12,
Supporting Disabled
Thomas Murphy, Acting Under Secretary for Benefits, testified
2021
Veterans: The State of
that, at the onset of the pandemic, VBA initiated mass
Claims Processing During
telework to minimize potential COVID-19 exposure to
and After COVID-19
veterans and employees. In addition, VBA revised the claims

process to allow veterans to wait until in-person C&P exams
were available with the assurance that VBA would not take
https://www.veterans.sena
action on the veterans’ claims until their exams were
te.gov/hearings/
completed. These processes remain the same way to date.
supporting-disabled-
Murphy also explained that VBA increased the number of
veterans-the-state-of-
exams capable of being completed via telehealth from 19 to 34
claims-processing-during-
and is in the process of centralizing all military sexual trauma
and-after-covid-19
claims into five regional offices as a way to deliver higher
quality, more consistent claims.
SVAC
November
Hearing on Pending
Both VA officials and VSOs testified during the hearing to
17, 2021
Legislation
discuss pending legislation, including S. 3163, the Rural Exam

Act; draft language of the Veterans Benefits Improvement Act
of 2021; and S. 2329, BEST for Vets Act of 2021. VA officials
https://www.veterans.sena
testified that while they can support the three bills,
te.gov/2021/11/hearing-
adjustments would be required to provisions in each of the
to-consider-pending-
bills.
legislation-11-17-21
Source: Table created by CRS based on searches in ProQuest Legislative Insights, ProQuest Congressional, and
GovInfo databases.
Notes:
a. For more information on QTC Services see https://www.qtcm.com/about-us/ and for MES Solutions see
https://www.messolutions.com.
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Selected VA Office of Inspector General (OIG) Reports
Table B-4. Selected VA-OIG Reports on C&P Exams
Date
Report Title and URL
Highlights
June 25, 2009
Audit of VA Incomplete
The OIG conducted an audit to determine ways in which VHA and
Compensation and Pension
VBA could increase the number of C&P exams completed. The audit
Medical Examinations
also examined reasons for veterans canceling their C&P exams. The
(08-01392-144)
audit found inconsistences among VHA’s health care facilities’ methods
in contacting veterans to schedule C&P exams. OIG found that despite
https://www.va.gov/oig/52/
VHA’s policy to contact the veteran (phone call) and mail an
reports/2009/VAOIG-08-
appointment notification letter, many veterans were contacted to
01392-144.pdf
schedule appointments only by letter without any phone call.
Additional inconsistences were found on how requests for
rescheduling exams were handled and how VHA handled C&P exam
requests with multiple exam appointments. The OIG recommended
that VHA and VBA establish clearer requirements and processes for
how employees are to contact veterans and assist in rescheduling
appointments and create a process to ensure VBA employees provide
complete and accurate information for exam requests.
March 17,
Audit of VA’s Efforts to Provide
The OIG conducted an audit to determine whether or not VA
2010
Timely Compensation and
dedicates enough resources to conduct timely C&P exams for
Pension Medical Examinations
veterans. The audit analyzed requests for C&P exams that VBA
(09-02135-107)
referred to both VHA medical staff and to VBA contractors. Upon
completion of the audit, OIG concluded that VA had not established
https://www.va.gov/oig/52/
sufficient procedures to handle the exam workload, account for the
reports/2010/VAOIG-09-
exam costs, and determine a VHA facility’s capacity to complete
02135-107.pdf
exams. The OIG made a total of 10 recommendations for VHA and
VBA.
July 17, 2018
Veterans Benefits
The report found that VBA employees did not follow VA’s policy for
Administration: Unwarranted
requesting medical reexaminations for veterans on a consistent basis.
Medical Reexaminations for
This led to veterans whose cases are considered excluded from
Disability Benefits
reexamination to still be requested by VBA to have medical
(17-04966-201)
reexaminations. VA’s M21-1 Adjudication Manual Part II.iv.3.2.d,
“When Not to Schedule Review Examinations,” explains these
https://www.va.gov/oig/pubs/
exemptions: a veteran who has a permanent disability that is unlikely
VAOIG-17-04966-201.pdf
to improve, a veteran who has a disability without substantial
improvement over five years, an evaluation that is 10% complete or
less, a combined evaluation that would not change even if a
reexamination would reduce one or more disabilities, or a veteran
who is over 55 years old at the time unless required by regulation.
Based upon the six-month review period (March-August 2017), “VBA
spent $10.1 million on unwarranted reexaminations,” of which $5.3
million was spent on VHA clinicians and $4.8 million on VBA
contractors. The OIG explained that these “unwarranted
reexaminations also created unnecessary work for VA employees,”
leading to a reduction in processing benefits claims (from pp. ii, 9).
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Date
Report Title and URL
Highlights
June 10, 2019
Veterans Benefits
This report identified several challenges the MDE staff faced in
Administration: Inadequate
overseeing the contract C&P program. These challenges included, but
Oversight of Contracted
were not limited to, “limitations with VBA’s electronic exam
Disability Exam Cancellations
management systems … inadequate staffing of the MDE program,” and
(18-04266-115)
inability to validate that contractors’ exam scheduling requirements
were completed in accordance with contract requirements. The OIG
https://www.va.gov/oig/pubs/
report indicated that VBA took appropriate actions by not sending
VAOIG-18-04266-115.pdf
new exam requests to contractors who did not meet VBA’s
performance requirements. Additional actions could strengthen VBA’s
oversight, and the OIG made recommendations to do so. VBA
concurred and addressed some of the recommendations OIG made.
For example, VBA transitioned the electronic exam management
system into the overall Veterans Benefits Management System to allow
for scheduling and cancellations to be tracked as a standardized data
point (from pp. i-ii, 6, 9, 13, 30).
March 16,
Office of Acquisition, Logistics,
This report examined the contract of one specific MDE contractor,
2020
and Construction: QTC
QTC Medical Services, to verify compliance with the pricing and billing
Medical Services Complied
aspects of its contract. The OIG conducted the review to follow up
with Medical Disability
on its 2008 audit report (https://www.va.gov/oig/52/reports/2008/
Examination Billing
VAOIG-07-02280-104.pdf) and reports by independent auditors
Requirements
between 2009 and 2015 that raised concerns about QTC’s billing
(19-08397-99)
practices. Following an analysis of the sampled billing data, OIG
concluded that QTC accurately billed VA under the specifications of
https://www.va.gov/oig/pubs/
its contract (from pp. i, 1, 8-9).
VAOIG-19-08397-99.pdf
November
Veterans Benefits
This report explained that VBA took appropriate action to limit
19, 2020
Administration: Enhanced
veterans’ exposure to COVID-19 by discontinuing in-person exams,
Strategy Needed to Reduce
increasing telemental health and ACE exams, and notifying veterans of
Disability Exam Inventory Due
the change in exam processes through the VA website, social media,
to the Pandemic and Errors
and VSOs. VBA gradually resumed in-person exams, but a rise in
Related to Canceled Exams
pending exams continued. OIG stressed that VBA needed to address
(20-02826-07)
the increase in pending exams. OIG recommended that VBA develop
and implement a strategy to reduce exam inventory, develop and
https://www.va.gov/oig/pubs/
implement a plan to increase telehealth exams, and ensure contractors
VAOIG-20-02826-07.pdf
follow telehealth guidance for exams (from pp. v-vi, 5-6).
Source: Table created by CRS based on searches in VA’s OIG database.
Selected Government Accountability Office (GAO) Reports
Table B-5. Selected GAO Reports on C&P Exams
Date
Report Title and URL
Highlights
October 12,
VA Disability Exams: Improved
This report was conducted in response to a request from HVAC
2018
Performance Analysis and
to review VA’s oversight of contracted exams. The review
Training Oversight Needed for
assessed the performance of examiners between July 2017 and
Contracted Examiners
October 2018. GAO concluded that VBA does not have accurate
(19-13)
and up-to-date data on exam contractors’ performance and a new
system is needed for VBA to conduct the proper analyses of
https://www.gao.gov/
trends and challenges facing the program. As a result of this
products/gao-19-13
review, GAO made four recommendations to VBA to improve
performance analysis and training of the examiners (from pp. 2, 4,
12, 20, 21, 26, 28).
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Date
Report Title and URL
Highlights
November 15,
VA Disability Exams: Improved
GAO testified before HVAC’s Disability Assistance and Memorial
2018
Oversight of Contracted
Affairs Subcommittee about the results from GAO’s October
Examiners Needed (Testimony 2018 report and ways VBA can improve its oversight of examiners
to HVAC)
for the contracted C&P exam program. GAO testified to the
(19-213T)
following: (1) VBA has “limited information” on contractors’
quality and timeliness; (2) VBA lacks “adequate oversight of
https://www.gao.gov/
contractors’ performance,” and (3) VBA used “an auditor to verify
products/gao-19-213t
contracted examiner licenses” and does not verify the information
or training completion (from pp. 2, 4, 6).
September 19,
VA Disability Exams:
GAO testified before the HVAC’s Disability Assistance and
2019
Opportunities Remain to
Memorial Affairs Subcommittee to provide an update on VA’s
Improve Oversight of
efforts to “collect more timely and accurate information on
Contracted Examiners
contractor quality and timeliness” and to ensure all examiners
(Testimony to HVAC)
have completed required training. GAO testified that while VBA
(19-715T)
has taken steps to address “incomplete quality information and
inaccurate timeliness data,” VBA has not completed “quarterly
https://www.gao.gov/
performance reports” and has not processed “financial incentives”
products/gao-19-715t
connected to performance. In addition, VBA had not met its target
completion date for implementing a “new exam management
system” to improve oversight of exam contractors. GAO also
testified that while VBA conducted “random audits” of
contractors’ self-reporting of training, VBA is still in the process of
creating a central training system to collect and ensure adherence
to training requirements (from pp. 1-2, 5-6, 8).
September 21,
VA Disability Benefits: VA
GAO reviewed the disability claims and C&P exam process for
2020
Should Continue to Improve
veterans living abroad to identify trends in VBA claims processing,
Access to Quality Disability
challenges VBA faces in processing claims in a timely manner, and
Medical Exams for Veterans
veterans’ ability to access quality C&P exams abroad. GAO
Living Abroad
interviewed VBA officials in the Pittsburgh, Honolulu, Manila, and
(20-620)
San Juan regional offices in addition to VBA headquarters. For
veterans living in U.S. territories and other countries that are
https://www.gao.gov/
covered by the exam contracts, a VBA claims processor can
products/gao-20-620
submit the exam request electronically. For veterans in all other
countries, the claims processor sends the exam request to the
U.S. embassy, which in turn is responsible for locating and
scheduling an examiner. GAO identified several factors that hinder
a veteran’s ability to access a C&P exam while living overseas: the
unknown quality of the exams as they are provided by embassy-
related providers, veterans’ inability to be reimbursed for travel
for their exams, and the fact that embassy-referred examiners’
reimbursement is paid via paper check in U.S. currency and not
always accepted by foreign banks (from pp. 1-3, 6, 16, 23, 28, 29).
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Date
Report Title and URL
Highlights
March 23,
VA Disability Exams: Better
GAO testified before HVAC’s Disability Assistance and Memorial
2021
Planning Needed as Use of
Affairs Subcommittee on VBA’s plans for managing the “disability
Contracted Examiners
exam workload” and how VBA’s “quality review process” is
Continue to Grow (Testimony
designed to evaluate complex exams. This testimony showed that
to HVAC)
COVID-19 led to an increase in pending exams from an average of
(21-444T)
23 days in January 2020 to 91 days in February 2021. In addition,
GAO found that VBA has not implemented several practices
https://www.gao.gov/
recommended by GAO, including assessing risks to capacity and
products/gao-21-444t
exam quality workload as well as assessing the performance of
contractors on complex or specialty claims such as traumatic brain
injury, military sexual assault, and Gulf War Illness. As a result,
GAO recommended that VBA should develop and document a
plan for distributing the exam workload between VHA medical
centers and VBA contractors. GAO also recommended that VBA
create a process to evaluate the quality of exams for complex
claims (from pp. 1, 5, 6-7, 12-13, 15-16).
May 12, 2021
VA Disability Exams: Actions
GAO testified before the Senate Committee on Veterans’ Affairs
Needed to Improve Program
on findings associated with VBA’s plan to allocate exams between
Management (Testimony to
VBA contractors and VHA medical centers and VBA’s assessment
SVAC)
of quality of exam reports for complex claims. GAO concluded
(21-543T)
that VBA has not documented a strategy to allocate exams to VBA
contractors while still maintaining a partial exam capacity at VHA
https://www.gao.gov/
medical centers. In addition, GAO noted that VBA has not
products/gao-21-543t
evaluated any potential risks of an increased use of contracted
examiners. Finally, GAO concluded that “traumatic brain injury,
military sexual trauma, and Gulf War Illness” exam reports were
returned at twice the rate of overall exams. Examiners stated that
they face challenges in identifying veterans’ supporting evidence
and performing the exams, both of which VBA needs to address
(from pp. 5, 6, 7, 8-9).
Source: Table created by CRS based on searches in GAO’s online database, ProQuest Legislative Insights, and
ProQuest Congressional databases.
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VA: Claims Process and C&P Exams by Contracted Physicians

Appendix C. Claims Data Analysis Methodology
and Limitations
To analyze the number of VBA compensation and pension claims and backlogged claims, CRS
downloaded every VBA MMWR from January 5, 2004, to June 6, 2022, and extracted each week’s
number of claims and backlogged claims into one common file.72 Figure C-1 provides a sample
screenshot of the layout for VBA’s MMWR that is posted every Monday morning for the previous
week.73 The available MMWR data separated the number of claims and backlogged claims VBA
adjudicated each week over the past 18 years. For a given week, the four-week rolling average
calculates that data point as the average of the three preceding weeks and that week. The four-week
rolling average was chosen as it represents approximately one month of claims filed. Figure 3
presents C&P claims and backlogged claims as a four-week rolling average based upon VBA’s
publicly available MMWR data on VBA’s website.
Several data issues were identified in earlier versions (2004-2010) of the MMWR. In cases where a
given week was missing in the MMWR database, values were imputed from the “Last Week” row
in the following week’s MMWR, when available. For example, the week of January 9, 2004, was
missing from the MMWR data. To account for this missing week, CRS imputed the “Last Week”
row values for claims and backlogged claims from the week of January 16, 2004. These “Last
Week” rows were also used, when available, during the data compilation process as a quality
control measure to ensure that a previous week’s values matched the following week’s “Last Week”
values. In cases where a week’s values differed from the following week’s “Last Week” values, the
“Last Week” values were used to account for any possible data adjustments or revisions that took
place between the two weeks.
Figure C-1. Screenshot of VBA’s Monday Morning Workload Report

Source: VA, “Detailed Claims Data: Monday Morning Workload Report,” Veterans Benefits Administration
Reports, March 19, 2022, https://www.benefits.va.gov/reports/detailed_claims_data.asp.

72 Data calculations for this section were conducted by CRS Research Assistant Isaac Nicchitta.
73 The layout of the VBA MMWR has changed multiple times. Error! Reference source not found. reflects the c
urrent MMWR layout as of the publication of this report.
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VA: Claims Process and C&P Exams by Contracted Physicians

Author Information

Heather M. Salazar, Coordinator
Michele L. Malloy
Analyst in Veterans Policy
Research Librarian

Tamar B. Breslauer
Isaac A. Nicchitta
Senior Research Librarian
Research Assistant

Carol D. Davis

Senior Research Librarian

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material.

Congressional Research Service
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