On His Way Out the Door, Trump Privatizes Another Critical VA Service

Compensation & Pension exams are the critical precursor to vets getting help. The private sector hasn't proven itself proficient in running them.

After four years of thoroughly outsourcing veterans’ healthcare, the Trump administration has concocted one final scheme to enrich the private sector at the cost of those who’ve served: moving all compensation and pension (C&P) exams outside of VA walls.

For the uninitiated, a quick explainer: most veterans must undergo C&P exams in order to qualify for VA care and benefits. During these appointments, medical staff peer over military health records and conduct tests to understand whether certain injuries — both physical and mental — are connected to time in the ranks. Roughly 1.4 million of these exams occur every year, each one of them vital to the future of a veteran and their family. A good examiner will ensure a patient is provided adequate support for their time in the service; a bad one can improperly deny them help.

Over the years, more and more of these exams have been farmed out to the private sector. Before the pandemic began, just 25 percent of these exams were done in-house. Today that number stands at just 15 percent. In an interview this week with Military Times, Under Secretary for Benefits Paul Lawrence said total privatization “is just the evolution of the process.”

He further contended that the VA needed to direct all available medical staff towards dealing with the COVID-19 pandemic, not performing these exams. “Right now, contractors are already doing the bulk of them,” he said. “We think the value of having contractors available to do them is flexibility and the ability to surge.”

Lawrence’s argument begins to fall apart in light of the fact that the VA has redirected untold numbers of clinical staff away from clinical care to nettlesome administrative work carrying out the president’s massive privatization agenda. As Suzanne Gordon and I reported earlier this year for The American Prospect, the VA has gone so far as to “embed” its nurses in private hospitals taking in veteran patients so as to lighten their administrative load.

Moreover, VA Secretary Robert Wilkie long contended that filling the tens of thousands of clinical care vacancies across the VA system was not a top priority. After the pandemic hit, Wilkie changed his tune. Yet there remain massive vacancy gaps. If Lawrence and his fellow VA leaders were truly concerned about adequate clinical staffing levels they’d pause VA outsourcing work and fill more jobs inside the department.

In his interview, Lawrence didn’t acknowledge the numerous concerns over private C&P exams, chief of which is that they’re often not very good. Should this policy go into full effect, the VA will end up sinking billions of dollars into companies that face little oversight and often mess up. These mistakes are largely owed to the fact that some private examiners have little knowledge of the unique wounds of war wounds – whether it’s PTSD, Gulf War Illness or military sexual assault. 

One vivid example comes in the case of Essam Attia, who told me he was funneled into a shoddy-looking medical clinic in New York City run by the IMA Group. Not only were the floors, chairs and walls grimy — with a dead cockroach on the floor in the exam room — but the assessment seemed out of the ordinary. As his examiner was evaluating him on his mental health, for instance, a second staffer exploded through the door behind in a way that visibly triggered him and seemed staged to observe his mental response. “It was an unprofessional and bizarre experience to say the least,” Attia said. 

Serious concerns over private C&P exams have been expressed by numerous lawmakers over the years. Recently, Rep. Elaine Luria, a Virginia Democrat and the head of the House Veterans' Affairs Committee’s panel on disability compensation, wrote Lawrence with a number of urgent questions. “I need your commitment that VA will ensure all contractors provide timely, high-quality C&P examinations to our disabled veterans,” she wrote. “For many veterans, thorough and accurate C&P examinations are crucial to securing service-connected benefits.”

While Lawrence had the time to talk with Military Times, he’s apparently been too busy to respond to Luria’s letter.

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As the Forever Wars have dragged on, the VA’s faced sharply rising demand for both VA care and benefits, as well as precursive C&P exams. For a time, the department was totally overwhelmed, and could not offer these assessments in a timely manner. Thus, they relied more heavily on the private sector.

Yet the situation has stabilized, in large part due to additional hiring inside the Veterans Benefits Administration (VBA). However, VA has not brought this work back inside department walls. Instead, leaders have preferred to pay out more money to private contractors.

Many of these companies have poor track records. A 2018 report from the Government Accountability Office (GAO) found that the major C&P contractors routinely subjected veterans to long wait times and made significant errors in exam reports. The GAO also found that the VA was unable to oversee how efficient, effective, and costly these private contractors were in their work. A year later, the GAO said the VA was still unable to effectively gauge these metrics.

This followup report further found that the department “has not been able to implement an automated invoicing system that it plans to use to validate the accuracy of contractors’ invoices” which meant that officials “still cannot ensure that it is paying contractors the correct amounts based on the terms of the contracts.” In short, the VA is perhaps paying far too much for these exams. (Of the four major C&P policy recommendations first issued by the GAO in 2018, none have been fully addressed.)

One of the companies previously called out by the GAO is Veterans Evaluation Services (VES). In 2015, the Tampa Bay Times reported that the company sent dozens of veterans to a Tampa doctor who was under federal investigation. The company has also been the target of many troubling allegations on the employer review website Glassdoor, including that the quantity of evaluations is prioritized over quality. Margaret Rajnic, a nurse who worked briefly for VES in early 2018, told me that the organization is poorly run and that many of its reviewers had no familiarity with basic medical terms or procedures. Rajnic said she was fired after raising questions over the company’s business practices

“Their operational efficiency is poor, they are bad at providing necessary medical records, and it’s failing veterans,” she said. “It’s a money-making machine, and the VA is not evaluating the true outcomes of their spent money.”

Other contractors have faced similar allegations. A former Marine with hearing loss was recently sent to VetFed Resources after requesting an increase in his 10 percent disability rating. VetFed required he drive an incredibly far distance (he doesn’t have a car) then threatened to cut off his benefits altogether if he didn’t show up. (VetFed, like VES, has similarly racked up complaints that it improperly denies medical benefits to vets.) These issues are so endemic that an entire Washington law firm Bergmann & Moore today focuses on remedying poor veteran benefit outcomes.

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In light of sustained problems in private C & P exams, one must ask: Why are we expanding their prevalence? Well, from outward appearances, it seems that this monumental policy shift was secured, in part, by an army of well-connected lobbyists.

One them is Jeff Miller, the former Republican chairman of the House Veterans Affairs Committee. In his work as a lobbyist, Miller represents VES, which, under Trump secured a $205 million contract.

Another major contractor, QTC Services, was long led by former VA Secretary Anthony Principi, now a lobbyist and 2020 Trump campaign surrogate. (QTC was once owned by Lockheed Martin in an arrangement that ensured the massive military contractor could not only profit from weapons that kill, but also from the exams assessing the wounds spawned by the tools of war.)

Way back in 2008, QTC was flagged by the VA’s Office of Inspector General for over-billing. (A more recent inquiry found no irregularities.) Amid QTC’s many mixed reviews on Glassdoor, one anonymous users claims that “people do not know where to report ethics issues and when they do report them then there is retaliation.”

One of QTC’s top lobbyists today is Kristy Park, who previously worked for the House Veterans Affairs Committee. Last year, as Park was hitting the halls of Congress and the Executive Branch, QTC which is now owned by Leidos, secured a $7 billion VA contract.

VetFed, meanwhile, counts among its lobbyists Joseph Lai, a former Trump advisor. Over the last four years, VetFed has taken in tens of millions in contracts, far more than what it was awarded under the Obama administration. As I’ve previously reported, the influence of these and many other private entities in VA policy today is unprecedented. President Trump has made a swamp out of veterans’ policymaking. Now it must be drained.