Better Oversight Needed of Accessibility, Safety, and Cleanliness at Contract Facilities Offering VA Disability Exams

When a veteran files a claim for disability benefits, a medical exam may be necessary. If the nearest VA medical center cannot conduct the exam, a contract exam vendor is utilized. Medical Disability Exam contracts require contract exam facilities to comply with the American with Disabilities Act (ADA) and Occupational Safety and Health Administration (OSHA) standards. In response to accessibility, safety, and cleanliness concerns documented in customer satisfaction surveys, the VA Office of Inspector General (OIG) directly inspected facilities and reviewed Medical Disability Examination Office (MDEO) oversight of vendors. The OIG identified one or more ADA and OSHA deficiencies at 114 of the 135 exam facilities visited. MDEO relied on vendors to self-certify compliance with ADA and OSHA standards; however, MDEO did not provide necessary oversight. The OIG noted four specific oversight deficits. First, MDEO lacked independent access to facilities, depending on vendors for locations to assess compliance issues. Second, MDEO relied on vendors to distribute their own exam satisfaction survey cards. Third, at the time of the review, MDEO lacked formal standardized procedures and training for inspections. Fourth, MDEO required exam vendors to inspect and self-certify facilities, yet vendors stated they relied on self-reporting or photos from subcontractors. Further, MDEO did not verify ADA and OSHA compliance despite receiving complaints from veterans. While the OIG acknowledges the improvement plans MDEO leaders shared during the review, the OIG made nine recommendations to the under secretary for benefits, including that MDEO more closely monitor inspections, visit sites, use a revised inspection checklist, maintain a facilities inventory, and have independent access. MDEO and vendors should also ensure accessibility prior to scheduling. Finally, inspection processes and training should be standardized and vendor contracts enforced. Until oversight improves, veterans are at risk of harm and benefits compensation may be delayed.