DBQs and Outsourced C&P Exams
Robert Chisholm: Welcome to CCK live. Joining me today are Brad Hennings and Courtney Ross. Welcome. And today we are going to be talking about accessing VA Disability Benefits Questionnaires. We are going to call those DBQs. We use a lot of acronyms here at the CCK because VA used a lot of acronyms. And we are also going to be talking about how VA is outsourcing their compensation and pension examinations. So compensation and pension examinations are crucial to the veterans' disability claims and disability questions or DBQs have been a part of the compensation and pension examination process for a long time. And so we have some interesting information on both of these topics. So, Courtney, I am going to turn to you first and ask you what are the DBQs used for in the VA disability claims process.
Courtney Ross: Thanks, Robert. So, DBQs first are a downloadable form in the format of them is a checkbox style and they are designed to mirror VA's rating criteria that they use when they are rating a veteran's condition that they applied for benefits for. As you mentioned, they are used at compensation and pension examinations. So the examiner will often use the appropriate DBQ as they are examining the veteran. So for example, there are DBQs that are for very specific conditions, something like hypertension. There are others that are a bit more general. For example, service connection for– or DBQ for heart conditions, then an examiner will use if they are doing an assessment on any type of heart diagnosis and they were created to answer questions about the aspects of the disability that VA is going to be looking at.: Symptoms of the condition, severity, possible causes, any link to other disability that the veteran might have, and is already service-connected for. They are also meant to capture the information that VA's looking at in the rating criteria. So a lot of the same language from the rating criteria for the condition that is being assessed is actually included in the DBQ, which makes it easier for adjudicators when they are looking at the DBQ and the condition that is being claimed to do the assessment.
It also helps doctors or examiners who are completing the DBQ's quickly move through the information and it provides standardized form so that all examiners who are completing these compensation and pension examinations for VA are using the same form for the same conditions.
Robert: Brad, I would like to ask you what are some of the benefits of DBQs for veterans?
Brad Hennings: One of the great things about these publicly available DBQs are they allowed veterans to complete examinations with their own private health care providers outside of the VA. And this allows veterans to have more insight into the evaluation process and they can see exactly what the examiners are looking for in relation to their specific disability. It also allows veterans a form to seek private medical opinion. Perhaps from their own doctor or specialist who is already familiar with their medical history and knows the course of their disability.
And finally, there is an increased efficiency because of the veterans' disability via the DBQ, the Disability Benefits Questionnaires were evaluated in relation to the rating schedule. And why that is important is because so often medical providers are focused on a treatment plan and on a treatment report and the DBQs allow these private providers to provide all the information that is necessary for the VA raters to properly evaluate the veterans' disability.
Robert: So Brad, what I am hearing is that these DBQs made it easier for first, the examiners conducting these examinations whether there is a private physician who has the forms to use or a VA doctor and for the veterans themselves who are claiming to see– what it is a doctor actually looking at and what questions are being answered? So transparency, this was a good thing from a transparency perspective. But recently we have learned that these DBQs that were once publicly available starting really– and covid they became unavailable. So VA has removed them from the website, which makes this process a little less transparent and VA's reason for removing them from the public-facing website, these DBQs, the VA said it was updating the rating schedule and review process for public-facing documents and that process takes too long. VA says that they are safeguarding against fraud. Though this happens in every system and the reported fraud has been minimum. And DBQs were being performed remotely VA says, "They should be completed in person."So all of these excuses for VA, and this is my interpretation for removing the public-facing DBQs ring hollow. First of all, there is very little fraud in the system, especially with respect to DBQs because licensed doctors are not going to commit fraud and lose their medical license in answering questions for a VA disability questionnaire.
Second, there is no law that says the examination has to take place in person. You can do it virtually. In fact, VA examiners are using the DBQs virtually. They are not conducting examinations in person and they are using the DBQs. So those reasons that VA gave, ring hollow. What impact Courtney does this have on the claims process the removal of these DBQs?
Courtney: Yes. I think this relates directly back to what Brad was just saying about how when they were publicly facing veterans could download the forms and provide them to their own private treating physicians who would be able to fill them out. Now that they are no longer publicly-facing and veterans do not have direct access to them. It is not as easy for them to get the form to be able to provide it to their treating doctors who typically know their conditions and have seen them on a consistent basis.So given that it makes it more challenging for veterans to gather evidence to submit in support of the conditions that they are claiming to VA. And this is a particularly important note because, under AMA, the Appeals Modernization Act, in the new appeal system, certain parts of the procedural process require additional evidence if you want to choose that procedural lane. Specifically, if you want to file a supplement or claim for your condition, you are required to submit new and relevant evidence. And so by removing the DBQs from the public, it makes it more challenging for veterans to gather that evidence and submit it in support of their claim.
Robert: And Brad, the other thing that is happening along with the removal of the DBQs and examination process is, VA is outsourcing all of the compensation pension examinations. Can you talk a little bit about that?
Brad: Robert, assume that they are eliminating the in-house C&P exam program, they are outsourcing all of the exams. What that means is that previously, VA was outsourcing about sixty percent of exams meaning VHA, Veterans Health Administration doctors would be conducting about forty percent. Historically they conducted most of them and VA has slowly moved into the world of outsourcing these over the last ten or fifteen years. So all of these new examinations are not going to be conducted by VA employees, by Veterans Health Administration employees. They will be conducted by private contractors on the outside. And so all the new instructions about the exams that we are doing now it says VA contract medical examiner will contact the veteran conduct the examination and issue the report to the VA. Now, this is significant because there is already a large backlog of C&P examinations due to COVID where the examinations were not able to happen.
There is a concern that there is a lack of medical professionals familiar with the kinds of veterans' specific issues and illnesses, disabilities such as Gulf War illness, PTSD. There is a number of things that are very specialized within the VA system and there is concern that there will not be enough knowledge as to these veterans' specific issues.
And honestly, most importantly VA has a history of lacking oversight for these contractors. The government accountability office has reported that VA contract examiners had not met quality or timeliness standards and only about half the exams met their own standards between 2017 and 2018. And that the department has not really had the tools to effectively manage this Outsourcing Program.
Moreover, members of Congress say that VA still has not implemented the recommendations made by the GAO. And so this is all very concerning because these examinations are the linchpin of a veteran's disability claim, typically. They are very important and the veterans are already waiting a very long time throughout the VA claims and appeals process. So anything that will slow things down and that is not going to be timely or of good quality is a problem.
Robert: So Brad, you raised an interesting point. So first of all VA is outsourcing all these examinations where historically they had been performed by VA doctors at VA medical centers who had the expertise and quite frankly, the experience of treating veterans over the years. They would be the ones answering these questions. Now, they are going to outside doctors, not part of the VA system probably paid a flat fee. We do not know the answer to that but we are assuming it is not an hourly fee. They are played a flat fee. So how much time and energy are they going to give into consideration? So if a veteran now wants to go to his or her private doctor, they do not have the public-facing DBQs to bring. So when we here at CCK learned about this, we did something called a FOIA requests. And would you share with our audience what a FOIA request means?
Courtney: Yes, FOIA stands for Freedom of Information Act. It is a law that essentially allows anybody to request documents that are in the custody of a Federal Agency. So we submitted a request to VA for copies of all of the current DBQs that are being used and we did receive a response from them with copies of those DBQs,
Robert: So this is important because when we learned at CCK that VA was no longer and have used these are public-facing documents, we used the Freedom of Information Act as Courtney pointed out and we requested copies of the DBQs that VA is using presently. And they release them to us and we now are putting these DBQs on our website at cck-law.com and there will be a link during the broadcast that you can use or you can just search for DBQ on our website at cck-law.com and you can use these DBQs and bring them to your private examiner to hopefully get the questions answered that need to be answered for your specific disability claim.Any final closing thoughts, Brad or Courtney?
Brad: The number one thing is that this is about transparency and the more transparent that VA is, the better it is for veterans. And sometimes VA is more interested in doing that than others and we are just doing our best to provide as much information to veterans and their dependents as we can as a firm.
Courtney: And I will just add that despite the fact that he has taken the DBQs or made them no longer available to the public, nothing has changed about the ability of a veteran to submit a DBQ and have VA or VA is still required to review it if the letter does have one completed by their private physician. So nothing has changed about that. It is just more difficult to get the DBQ from VA.
Robert: That is a really good point because VA is going to have to look at that evidence and consider that evidence in a claim. Very good points. Courtney, Brad, thank you for joining us today. This Robert Chisholm, signing off from cck – law.com. Please follow us on Facebook and other social media platforms, and thank you.
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