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

House Veterans Affairs Committee, Disability Assistance and Memorial Affairs Subcommittee Hearing

November 20, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Ms. Elizabeth Curda: Director of Education, Workforce, and Income Security, Government Accountability Office

• Ms. Mary Glenn: Deputy Executive Director, Medical Disability Examination Office, Veterans Benefits Administration, U.S. Department of Veterans Affairs

• Ms. Tara Flores: Director, Acquisition Service, Office of Acquisition, Logistics and Construction, U.S. Department of Veterans Affairs

Keywords mentioned:

• Benefits, disability claims, medical exams, contractors, Government Accountability Office (GAO), financial incentives, quality assurance, examiner feedback, accessibility issues, technology improvements, oversight gaps, veteran satisfaction

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairman Morgan Luttrell stated that the Subcommittee was conducting oversight of the Medical Disability Examination Office (MDEO), which manages contractors responsible for disability exams that form the basis of veterans’ compensation decisions. He explained that more than 90% of exams were outsourced to contractors and highlighted serious oversight failures identified by the Government Accountability Office (GAO), including miscalculated bonuses, missed quality reviews, and inconsistent examiner guidance. The Chairman warned that errors, delays, and poor-quality exams could lead veterans to be denied the benefits they earned. He called for accuracy, accountability, and proactive oversight to ensure veterans receive timely and correct evaluations.

• Ranking Member Morgan McGarvey claimed that the Compensation and Pension (C&P) exam was the key entry point for most veterans seeking VA benefits and underlined that exams must be timely, accessible, accurate, and conducted by qualified clinicians. He pointed to widespread complaints from veterans about poorly scheduled exams, irrelevant or inappropriate evaluations, inadequate examiner qualifications, and rushed telehealth assessments. He criticized MDEO for failing to adequately monitor vendors and enforce quality standards, as reflected by GAO findings of incorrect incentive payments and minimal penalties for poor performance. The Ranking Member argued that since nearly 90% of exams are conducted by for-profit vendors, stronger oversight and controls were urgently needed to protect veterans and taxpayer dollars.

SUMMARY OF KEY POINTS

• Ms. Elizabeth Curda reviewed VBA’s oversight of contracted disability exams, which now account for over 93% of all exams and cost more than $5 billion annually. She explained that GAO identified weaknesses across prevention, detection, and correction of exam errors, including failures to follow up on corrective actions, inaccurate financial incentive calculations, and a lack of direct feedback channels for examiners. Ms. Curda summarized GAO’s five recommendations aimed at improving exam oversight, contractor accountability, and examiner communication. She noted that although the VA agreed with the recommendations, none had been fully implemented, and further action was required to ensure exam quality and timely, accurate benefits decisions.

• Ms. Mary Glenn testified that VBA had taken significant steps in recent years to improve contract disability exams while managing major workload increases from legislation such as the PACT Act. She reported improvements in exam timeliness, high veteran satisfaction scores, expanded clinician networks, and the benefits of license portability for reaching rural and Native American veterans. Ms. Glenn described efforts to modernize exam processes using new technologies, reduce unnecessary exams, and increase the use of private provider Disability Benefits Questionnaires (DBQs). She acknowledged opportunities for improvement, said that MDEO had corrected financial overpayments and implemented GAO’s recommendations, and reaffirmed the VA’s commitment to enhancing veteran experience and exam accuracy.

• Chairman Luttrell asked Ms. Glenn about the incentive-payment errors, how the discrepancy was discovered, and why the vendors did not notify the VA about the $2.3 million overpayment. Ms. Glenn stated that GAO first alerted them to the miscalculation, after which the VA audited all incentive and disincentive payments dating back to FY22 and found no other discrepancies. She then explained that the VA, not the vendors, determined incentive amounts and that vendors often received revised invoices, making discrepancies less noticeable.

• The Chairman followed up, inquiring about how the process had failed and what checks existed previously. Ms. Glenn replied that invoices were manually reviewed by contracting officer representatives and financial staff, and because the process relied heavily on manual steps, the error was not caught. When pressed again, she responded that the VA’s manual review process failed and that vendors also did not flag it. She claimed that new automated checks, written procedures, and an audit contract were now in place.

• Ranking Member McGarvey asked how much MDEO paid contracted medical exam vendors annually. Ms. Glenn answered that the VA paid the vendors, not individual examiners, and the total cost varied by region and exam type. She did not have the annual total available.

• The Ranking Member asked how many exams the vendors conducted each year. Ms. Glenn reported that vendors performed 3.3 million exams in the previous year, both domestically and internationally.

• Ranking Member McGarvey questioned whether Ms. Glenn had all the resources necessary to properly oversee the program. Ms. Glenn initially said yes, but then clarified that although the VA could meet its primary mission, it still sought improvements and awaited a new organizational structure. She stated that MDEO had enough staff to perform core duties despite retirements and staffing losses. She also confirmed that the audit contract had been restored, and the Veterans Experience Office helped develop a new survey distributed beginning in early September.

• The Ranking Member then asked whether GAO believed MDEO needed the previously canceled audit and survey contracts to conduct proper oversight. Ms. Curda responded that those contracts were essential because they influenced the accuracy of incentive-payment calculations and compliance with Inspector General (IG) recommendations.

• Rep. Jack Bergman asked whether missing medical evidence contributed to DBQ errors, inaccurate exams, or improper denials. Ms. Curda replied that missing evidence could indeed lead to errors or improper decisions if it was not reviewed by examiners.

• Rep. Bergman mentioned the information C&P examiners received when evaluating a claim and asked whether they saw all the evidence submitted by veterans or veteran service officers. Ms. Glenn stated that all documents in the veterans’ claim folder were automatically sent to examiners, and claims processors also tabbed relevant evidence.

• Rep. Bergman inquired about the quality controls to ensure examiners actually received the required documents. Ms. Glenn said that the transfer of claim files to vendors occurred automatically, but she could not confirm whether the file checks were performed randomly or comprehensively. When prompted, she committed to reviewing how examiners receive and organize veterans’ supporting materials.

• Rep. Chris Pappas asked how the VA implemented GAO’s recommendation regarding feedback collection from examiners and what value that feedback would provide. Ms. Glenn replied that MDEO created a portal allowing examiners to submit comments directly. They announced it through the learning management system, vendor communications, and individual emails, then assigned staff to review and route submissions. She reported that the portal had already received questions, suggestions, and compliments, and that it was functioning successfully.

• Rep. Pappas asked whether the VA proactively solicited feedback or simply offered the portal as a suggestion box. Ms. Glenn explained that the VA notified examiners through multiple channels and placed a visible link on the learning management system, allowing examiners to submit feedback at any time.

• Rep. Pappas described a veteran facing canceled and delayed exams and asked why rescheduling was so difficult and what options veterans had if an appointment time or location was not feasible. Ms. Glenn acknowledged that scheduling was a major pain point and pledged that the VA was working to implement new technology that would allow veterans to view all available appointments and choose convenient times, similar to VHA systems.

• Rep. Pappas then questioned how the VA monitored geographic coverage gaps and ensured exams occurred closer to home. Ms. Glenn responded that vendors must obtain veteran consent for travel beyond 50 miles for general exams or 100 miles for specialty exams and described efforts including mobile medical units, expanded licensing flexibility, and various initiatives to bring services closer to veterans.

• Rep. Kelly Morrison brought up MDEO’s evaluation of advanced clinical tools designed to reduce in-person exams and improve consistency. Ms. Glenn stated that MDEO aimed to make more decisions based on existing evidence without requiring additional exams and was actively exploring technologies and expert guidance to achieve that goal.

• Rep. Morrison asked all witnesses whether they agreed with the VFW’s recommendation for longer-term MDEO contracts to reduce turnover and improve outcomes. Ms. Glenn acknowledged that multi-year contracts offered advantages but said that technological changes sometimes required new contracts; she added that VA was already working on a multi-year model. Ms. Curda confirmed her understanding that work on a long-term contract was underway.

• Rep. Morrison pointed to an IG finding that some VHA examiners completed medical opinions before completing PACT Act training. Ms. Glenn addressed the subject, claiming that only three contract examiners lacked complete training and that the VA required vendors to submit monthly lists of active examiners. The VA then cross-checked them against training systems to ensure compliance before exams were conducted.

• Chairman Luttrell asked how much money the VA collected in penalties last year. Ms. Glenn did not yet have fourth-quarter data and said she would provide the total once the review was complete.

• The Chairman asked whether the vendors who were overpaid had also received penalties and whether those penalties matched the overpayment amount. Ms. Glenn confirmed that both vendors had been penalized but that the penalty amounts did not match the $2.3 million overpayment; she offered to provide exact figures later.

• Chairman Luttrell turned to the issue of MDEO staff responding directly to examiners who used the new feedback portal. Ms. Glenn replied that her staff responded when needed and that submissions ranged from compliments to suggestions and general questions. When asked whether examiners might fear retribution from vendors for submitting concerns, Ms. Glenn said that vendors did not have direct access to feedback unless the VA shared it and claimed that examiners could submit comments anonymously. She added that vendors employed thousands of examiners, making identification unlikely.

• Ranking Member McGarvey noticed that the program appeared to prioritize processing payments over ensuring exam quality and asked what the VA was doing in response to an OIG finding that over half of examined facilities had accessibility barriers for disabled veterans. Ms. Glenn stated that vendors were required to inspect facilities before use and that the VA conducted its own surprise site visits. She reported that the VA performed 159 site visits in FY25 and planned additional reviews in FY26.

• The Ranking Member expressed concern that half of the facilities surveyed had barriers and asked how the VA collected feedback directly from veterans with mobility issues and whether the OIG’s findings were a surprise. Ms. Glenn acknowledged the findings were surprising and explained that the VA now required vendors to ask veterans about accessibility needs prior to scheduling. She added that the VA had tightened requirements for exam sites, had not received recent reports of hotel-room exams, and welcomed documentation from members so the VA could investigate and take corrective action.

• Ranking Member McGarvey asked whether shifting special focus reviews from every two years to every three years would allow MDEO to meet its oversight goals. Ms. Curda replied that the VA originally preferred a two-year cycle but moved to three years due to staffing reductions. She emphasized that extending the cycle risked missing opportunities for timely course correction and could lead to inaccurate claims decisions.

• Rep. Keith Self asked what the maximum percentage of a contract invoice could be paid out as an incentive and what the total invoice amount was for the contracts associated with the $2.3 million in overpayments. Ms. Glenn responded that the maximum incentive was 3% of the invoice amount, but she did not have the figures on hand for the second inquiry. Rep. Self shared his math that a $2.3 million overpayment at 3% implied $76 million in invoiced work.

• Rep. Self then asked how many personnel were reprimanded for the overpayments. Ms. Glenn said that the individuals involved were no longer employed by VA, but the department had not changed vendors as a result of the errors.

• Chairman Luttrell asked Ms. Curda to explain how traumatic brain injury (TBI) special focus reviews worked and why they were being extended from two years to three. Ms. Curda explained that the reviews examined the root causes of frequent TBI exam errors by analyzing DBQs and contractor performance, and that extending the schedule delayed continuous-improvement efforts.

• The Chairman challenged the extension, citing rapid scientific advances and the need to identify neurological deterioration sooner. He asked whether the VA had requested the change to three years. Ms. Glenn confirmed that MDEO requested the three-year cycle due to resource constraints.

• The Chairman pressed again, arguing that veterans could suffer worsening conditions while waiting and that a three-year cycle was dangerous. Ms. Glenn stated that the VA used additional processes outside the special focus reviews to monitor quality, though she acknowledged the concern.

• Ranking Member McGarvey continued the Chairman’s line of questioning, asking for a simple answer about whether changing from two years to three years was better or worse for veterans. Ms. Curda responded that it was worse for veterans.

• Rep. Self asked how trends could be properly identified when four of six examiners interviewed by GAO said they no longer elevated concerns to vendors because vendors did not listen. Ms. Curda stated that while MDEO had internal processes to track errors, the absence of examiner perspectives was a significant gap. She also relayed that examiners felt their feedback was disregarded by contractor quality staff.

• Rep. Self questioned how the VA could establish trends if examiner feedback was not being incorporated. Ms. Glenn said that the VA had implemented the examiner portal in late September and had collected two months of open-text feedback submissions. She reiterated that examiners could now provide information directly to the VA.

• Ranking Member McGarvey underscored that 20% of incentive payments being incorrect would be unacceptable in any private business and argued that similar performance in a small business would lead to firings. He urged the Committee to hold a roundtable with contracted companies to hear directly from them about their quality controls and exam conditions. He stressed that veterans’ first interaction with the VA system should inspire trust and noted disturbing reports as examples of unacceptable contractor conduct. He concluded that moving special focus reviews from two to three years was harmful and demanded stronger oversight to fulfill the nation’s promise to veterans.

• Chairman Luttrell emphasized the weight of responsibility borne by MDEO and thanked the witnesses while reiterating that oversight must improve. He warned that the VA would return before the Committee and be held accountable for progress. He restated that veterans deserved perfection because they sacrificed without hesitation.

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