Question:
What is the story with the independent-contractor C&P exams. Are they more favorable to the veterans than the VA supplied C&P exams?
Jim's Reply:
A timely and important question...thanks!
In recent social media where veterans get together there's a lot of chatter about who is the more favorable contractor during a C & P exam...or is the VA employee doctor a better bet? Now that VA has decided to outsource all C & P exams to contract groups like QTC and VES, the discussions have become ever more interesting. Some vets are even trying to manipulate who they may be assigned as their examiner...way over the top.
I'm a bit (!) of a cynic so I'm not buying the official reasons that VA is offering for this sudden shift. VA would like you to believe that after considerable thought and analysis of all the available data that they're transitioning to an all contractor exam system to streamline the process and improve outcomes for the veteran. I believe that the truth is that VA is so very desperate for professional health provider (and other) employees that they simply can't afford to both care for the patients they have and also do the needed C & P exams.
The VHA is always short of employees.
The harsh fact is that there isn't a line of highly skilled, top of the class medical professionals knocking down the doors to work at your VA health care facility. Physicians, physician assistants, and advance care nurses don't want to face the unfathomable, rigid bureaucracy that is the VA. There is a recurring myth that highly skilled professionals want to be able to make sacrifices to care for America's heroes and that simply isn't true. Many professionals avoid employment at VHA unless they are interested in medical research (VA is the largest medical research organization in America) or unless they may have a ding or two on their resume/CV and they're having trouble finding work elsewhere.
VHA has a reputation of hiring anyone, troubled record or not. https://www.gao.gov/assets/700/697173.pdf
Most contract C & P examiners are doing it as a side gig to earn extra money...there aren't many VA contract C & P examiners who pursued that as a career choice. Who are the C & P examiners you're likely to meet? Many are highly skilled professionals who are picking up extra income...the job pays well as a part time gig. In fact, this function of outsourcing unnecessary C & P exams pays so well it will cost the VA a lot more than keeping the job in-house. Most contract examiners are physicians and you'll find a number of RNPs and PAs and other varieties of 'physician extenders' there too. The person who examines you may or may not be particularly well qualified or certified to conduct your exam.
There is no doctor-provider/patient relationship established so you won't be treated or prescribed medicines. The C & P examiner will follow an order from a regional office to examine a specific body part or record review and that's it, the examiner won't add to the exam in any way.
Although I hear all the rumors, I've never seen any evidence that any given resource will grant a more favorable C & P exam to any veteran. It's a real crap shoot and you may draw the examiner who is very professional and crosses t's and dots i's or you may confront the person who wants to be somewhere else having a couple of cold ones and who will have you in and out in 5 minutes.
Knowing all that, you still have to go to the exam and stoically endure whatever you may find. If you miss an exam, VA will default to denial and you return to start.
I always advise that you never miss an exam for any reason...don't reschedule or skip it, just go and get it done. If you're sure it's not necessary and you'll have to reschedule your wedding, go anyhow. Be prepared...bring copies of documents you think may be important and be prepared to leave those with the examiner...or not. The examiner is not obligated to accept any evidence from you so don't be offended if they decline. You can make notes to yourself so that you don't forget anything you want to say.
The examiner isn't obligated to allow you to have a visitor with you so you may ask but if denied, don't get all hurt. Don't attempt any clandestine video or audio recordings...there's just no point to all of that no matter what you may have heard. Be courteous. Don't even think of faking a symptom. When you walk in the door your credibility is at 100% and only you can detract from that.
When you walk away from the exam, stop thinking about it right then. If you think about it, you'll want to correct all the errors that happened both by you and the examiner and you'll become anxious trying to get copies and none of this flurry of angst will help. The proper step to take after the exam is to wait for a decision. If the decision is favorable, you're done. If not, you appeal. Whatever you do, you don't try to fix the C & P that you know went wrong...you follow the process.
The C & P exam is a ritual that is unnecessary in the great majority of claims as there is already plenty of Acceptable Clinical Evidence in the record to make a claims decision but the C & P is so entrenched in the process that everyone will get at least one C & P whether needed or not. Many of these C & P exams will be so poorly done that the 'inadequate exam' is a primary reason for a lengthy appeal. For example, an otherwise well credentialed (in neurology) RNP may be tasked to do an exam that is rooted in a complex orthopedic injury and that examiner isn't likely to catch all the details a more focused orthopedic or disability medicine specialist would.
All this adds up to the reason that I've been urging veterans to have an Independent Medical Opinion (IMO) done by an experienced physician or psychologist as they file their claim. The veteran pays for the IMO out of pocket and in exchange will receive a thoughtful and detailed medical opinion in support of your claim...if the practitioner is able to do that and support the conclusions with science. In other words, if there is no service connection or secondary cause nexus, the IMO doctor can't create one for you.
The favorable IMO written by a board certified practitioner who is familiar with the VA ratings system will almost always outrank any opinion from a VA contract or employee C & P examiner and will help to avoid the lengthy appeals process.
You may learn more about an IMO here https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html