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Compensation and Pension (C&P) Examinations: The Urgent Need for Process Improvement

Compensation and Pension (C&P) examinations are foundational to the Veterans Benefits Administration (VBA)’s mission of delivering accurate and timely disability benefit determinations. These exams, culminating in Disability Benefits Questionnaires (DBQs), directly influence the outcomes of veterans’ claims. However, the current process—from scheduling to finalizing DBQs—is often hampered by complexity, inefficiency, and inconsistency.

In a July 2024 letter to Secretary of Veterans Affairs Denis McDonough, Senator Elizabeth Warren highlighted widespread frustrations among veterans regarding C&P contractors and systemic flaws in the examination process¹. Examiners often require years of experience to achieve proficiency in conducting high-quality evaluations, yet current oversight and operational standards fail to support sustainable excellence.

Key Findings from the VA Office of Inspector General (OIG)

The VA OIG’s 2022 report² revealed critical deficiencies in the Contract Medical Exam Program, overseen by the VBA:

  • Deficient Oversight: The VBA’s governance structures lack the rigor necessary to hold contract vendors accountable, leading to lapses in exam quality.

  • Risk of Inaccurate Claims Decisions: Poor oversight forces claims processors to rely on flawed or incomplete medical evidence, undermining the integrity of veterans’ benefits decisions.

OIG Recommendations:

  • Implement robust oversight mechanisms to ensure vendors produce accurate, comprehensive examinations.

  • Strengthen governance structures to enforce accountability and drive continuous quality improvement.

  • Enhance transparency and program accountability to protect veterans from substandard medical evaluations.

Given the essential role these exams play in veterans’ lives and the significant taxpayer investments involved, the OIG underscores the need for immediate, decisive corrective actions.

Persistent Systemic Challenges

Despite these reports, the C&P process continues to be plagued by:

  • High examiner turnover due to inadequate training and support.

  • Substandard examinations resulting in insufficient DBQs.

  • Repeat exams and supplemental medical opinions necessitated by initial deficiencies.

  • Delayed benefits delivery, increasing the burden on veterans and taxpayers alike.

Without a strategic overhaul—centered on leadership, standardized procedures, and resource allocation—these systemic inefficiencies will persist, compromising service delivery and fiscal responsibility.

Bluestone Healthcare Services: A Partner for Process Transformation

Bluestone Healthcare Services brings over 30 years of combined expertise in C&P examinations, supporting the nation’s largest C&P departments and providing specialized contractor services. Our capabilities include:

  • Conducting clarifications and reworks for insufficient exams nationwide.

  • Performing comprehensive practice reviews to diagnose operational gaps.

  • Delivering tailored audit services that streamline workflows and elevate exam quality.

Our mission aligns directly with the VBA’s objective: to ensure veterans receive accurate, timely benefit evaluations. Through a rigorous, data-driven approach, Bluestone addresses inefficiencies at every stage of the C&P process—from initial scheduling to exam execution and documentation completion.

The Path Forward: Quality, Efficiency, Accountability

Our process begins with a comprehensive environmental assessment, evaluating the entirety of your operations—including appointment scheduling, claim submissions, and provider support throughout the exam process, both pre- and post-exam. Based on this assessment, we will deliver actionable environmental considerations to facilitate meaningful improvements.

Without urgent reforms, veterans will continue to face prolonged delays and inaccuracies in their benefits determinations. Furthermore, the VBA risks escalating operational costs due to repeat exams, inefficiencies, and avoidable rework. Bluestone Healthcare Services is uniquely positioned to support transformational improvements, ensuring the system functions as intended—for veterans, taxpayers, and the nation’s long-term interests.

References:

  1. Warren, Elizabeth. Letter to Secretary of Veterans Affairs Denis McDonough regarding VA Compensation & Pension Contractors. July 2024. Quoted in U.S. Medicine, www.usmedicine.com/non-clinical-topics/legislation/sen-elizabeth-warrens-letter-constituents-frustrated-with-va-disability-exams/. Accessed 26 July 2025.

  2. U.S. Department of Veterans Affairs, Office of Inspector General. (2024). Contract medical exam program limitations put veterans at risk for inaccurate claims decisions (Report No. 22-00024-153). https://www.va.gov/oig/pubs/VAOIG-22-00024-153.pdf