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Hon. Jeff Miller

The Honorable Jeff Miller, Chairman, House Committee on Veterans' Affairs

[Gavel down.]

During this morning’s full committee hearing entitled, “VBA and VHA interactions: ordering and conducting medical examinations” we will examine the relationship that exists between VHA and VBA as to their respective efforts to conduct medical examinations on veterans’ claims for disability benefits, known as “C&P exams.” 

And there are several reasons that we will focus on this specific medical, but non-treatment related, VA function. 

The first is based upon the fact that VHA has failed…it has failed its paramount mission, I quote, “to honor America's veterans by providing exceptional health care that improves their health and well-being.” 

The rampant corruption, dishonesty, and cowardice brought to light by this committee shocks the conscience of everyone in this room, and of this Nation. 

This week’s newest whistle-blower allegation, regarding the falsification of deceased veterans’ records, yet again underscores the bureaucratic arrogance that subsists within this department. 

The consequences of VA’s failures did not fall on the unscrupulous manager, or the willfully ignorant facility leadership; instead, the consequences fell squarely on the shoulders of those individuals who stood up and swore commitments to this nation… commitments that center on fidelity, honor, and duty. 

And, veterans died.

Over the course of recent weeks, this committee has held many hearings targeted to address comprehensive VA reform, and there will be more hearings to come. 

I still believe that the majority of VA’s workforce - the doctors, nurses, claims processors, and veteran service representatives - truly do endeavor to provide quality service to veterans.  But, VA’s epidemic lack of accountability --- lack of mission focus--- requires a wholesale systematic reform of the department… a massive, massive, cultural shift is necessary. 

I have listened to VA’s responses to this committee’s questions in recent weeks…and what I hear are frequently institution-centered, not veteran-centered, responses.   And so, in setting the tone for this hearing, and future hearings, let me begin by cautioning that any equivocation --- any excuse --- provided by VA that seeks to protect the establishment, to the detriment of the veteran, will fall on deaf ears.  The time for excuses is long past.

Today’s hearing will explore the current division of labor between VBA and VHA on provision of C&P exams for disability adjudications, as well as the various contract tools that each administration maintains.  

Given the recent VHA failures, and issues raised by VHA to include space limitations, and staff shortages, I would like to hear your thoughts on whether the thousands of VHA employees assigned to performing C&P examinations could be better used to treat veterans. 

VHA currently has nearly eight thousand two hundred registered and certified C&P examiners, which include physicians, nurse practitioners, physician assistants, and psychologists, as well as additional administrative support staff necessary to administer this function, many who work closely with VBA solely to perform C&P disability examinations. 

Transferring some or all of the VHA C&P staff to treatment jobs would significantly increase the number of appointments available to veterans.

Now, I am aware that VA has voiced some initial resistance to this concept, and has objected on the basis that many C&P exam providers at VHA have either not maintained the necessary credentials to transition into patient treatment roles, or that some prefer to work on a part-time schedule, and thus must remain within a C&P examiner capacity at VHA.   I would point out that this is a prime opportunity to demonstrate that culture shift I spoke about:

The mission is to provide quality and timely healthcare to veterans, not to accommodate the status- quo.  And, in any event, I am curious why VA does not require more of their healthcare providers to maintain their qualifications.

Based on the high level of satisfaction with the contractors who perform medical disability examinations for purposes of adjudicating disability claims, VA has supported expansion of its contract authority in the past. 

However, we are also aware that VBA and VHA do not award or administer contracts uniformly; the ordering processes are different, the scheduling systems are different, the workflow processes are different, and the billing and collection processes are different. 

Accordingly, today we are going to take a detailed look at the big picture. 

We will look for sensible solutions, and best practices, to achieve both the most effective access to medical treatment, as well as assurance of timely, high-quality C&P exams for disability adjudication.