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. Robert: 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. Robert: 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. Courtney: 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.
Courtney: 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. Courtney: 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. Brad: 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. Robert: 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."
Robert: 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.
Robert: 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. Courtney: 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.
Brad: 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. Brad: 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. Brad: 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. Brad: 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? Robert: 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. Robert: 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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