VES General Knowledge

What You Will Learn

The purpose of this course is to prepare you for your role as a VES disability examiner and familiarize you with our expectations and processes.

This course is required for certification as a VES disability examiner.

This basic VES certification training is designed to help you master the following concepts:

  • Basic overview of VA programs
  • Appropriate Interaction with Veterans in a C&P Setting vs. Treatment
  • The Disability Benefits Questionnaires (“DBQs”) and Compensation and Pension Examination (“C&P”) worksheets
  • Completing a Quality Report
  • Assessing and documenting pain
  • Maintaining and protecting Veterans’ privacy
  • Medical Records
  • Diagnostic Testing and Providing appropriate notification to the Veteran for follow up on any abnormal findings
  • Examination quality review process
  • Maintaining an Appropriate Attitude Toward Your Veterans
  • Additional Resources for Veterans
  • Following state laws for medical and psychiatric emergencies

Target Audience

This training is designed for physicians, nurses, psychologists, Integrated Disability Evaluation System (“IDES”) providers and other health care providers seeking certification to conduct C&P examinations through VES.

Length of the Course

This course requires approximately 30 minutes to complete.

 

Compensation and Pension Terminology

This course will provide basic information about the requirements of a VES disability examiner. This course relies on many terms and definitions you learned in previous VA DMA modules.

Course Objectives

Previous DMA modules provided the base knowledge concerning the Compensation and Pension process and DBQs. This course goes into the finer details of performing your examination and DBQs and includes several tips to help you along the way.

Introduction

Thank you again for joining the VES team! You’re well on your way to helping Veterans get the benefits they deserve. We will begin by reviewing some core concepts which should greatly increase your chances for success. As you continue to learn about VES processes and the exam work itself, please keep these core concepts in mind and let us know if you ever have questions or concerns.

Basic Overview of VA Programs as Related to Our Contract

Here at VES, we are contracted to perform independent medical evaluations for Veterans seeking monetary compensation from VA; these exams are commonly referred to as Compensation and Pension, or C&P Exams, which are just two of the many programs offered to Veterans by VA.

  • Compensation is a monetary benefit paid to Veterans to compensate for average loss of earning potential due to service-connected (SC) conditions, meaning conditions which were incurred or aggravated in active military service.
  • Pension is a needs-based monetary benefit paid to wartime Veterans who are too disabled to work. Their disabilities may or may not be due to military service. VES does not receive many requests for pension exams as VA can often grant pension benefits without examining the Veteran.

Appropriate Interaction with Veterans in a C&P Setting vs. Treatment

You will be performing a non-treatment disability evaluation and producing an exam report, which is a legal document used by VA for adjudication of the Veteran’s claim for benefits. Other than the obvious differences of not being required to render treatment, write prescriptions, or offer a prognosis for your VES Veterans, you may find C&P work differs in other important ways; most notably in terms of VA’s diagnostic criteria and the VA-recommended verbiage and formatting which should be followed in your exam report.

The DBQs and C&P Worksheets

The forms you will be completing, called DBQs, were designed by VA to capture their specific rating criteria and standardize how Veterans’ evaluations are performed. It is essential all DBQ instructions are followed, including any instructions to add a diagnostic test or add and complete an additional DBQ based on the examination findings. VES has added many helpful items within our electronic DBQs to assist with answering questions you may have and offer best practices.

Completing a Quality Report

All required questions must be answered completely, even those which may appear redundant or unnecessary. All written portions of your report should be clear, with proper grammar, spelling, and punctuation, and VA recommended language should always be used when opining on a Veteran’s claim (you’ll learn more about VA’s required language for medical opinions in the Medical Opinions module).

Note each of a Veteran’s claimed conditions and symptoms must always be fully and clearly addressed in the diagnosis section of your report. This means if you are ever unable to render a current diagnosis for a condition which the Veteran is claiming, you must include a statement in your report that you were unable to diagnose the claimed condition due to a present lack of objective evidence. If the Veteran is currently service connected for a condition, and no evidence was found on examination to support keeping this diagnosis, you must state if you believe the condition has resolved or was initially incorrectly diagnosed. Generally, even if there is no evidence on exam, if the Veteran still reports ongoing symptoms of a service connected condition you should retain the service connected diagnosis.

Consistency is the key to a good exam report—any section which corresponds with a rendered diagnosis must be completed, and all diagnoses addressed in the body of your report must be formally listed in the diagnosis section.

Keep in mind the diagnostic criteria for C&P exams is often different than you may expect, but VA makes their expectations clear to us at VES and these expectations must always be followed. This means you are required to document any required evidence to support a diagnosis which you’ve rendered, and it also means a diagnosis must be rendered when there are abnormal findings on physical exam or on current diagnostics. If you are ever unsure whether VA will accept a diagnosis, or what type of supporting evidence they would expect for a given condition, please reach out to VES support staff for clarification via our provider assistance line at 1-800-994-2054. You may also contact us by E-mail at VESPhysiciansHelp@vesservices.com.

Additionally, the relationship of any and all abnormal findings to a diagnosis rendered must be made clear in your report. Failure to properly document diagnostic evidence or to provide a diagnosis for abnormal findings would result in VA returning an exam report to VES for additional evidence or clarification. As contractors, we are held to the strictest of standards in terms of quality and timeliness. Returned exam reports cause delays and directly affect our standing with the VA and the Veteran community. Therefore, it is crucial providers on our team do their absolute best to proactively avoid exam report returns.

Assessing and Documenting Pain

Many of the DBQs will require you to assess and document a Veteran’s pain. You will need to fully describe any subjective reports of pain in the medical history section, and note any findings of objective pain found in the examination. Objective signs of pain include visible wincing or groaning by the Veteran, guarding of the painful area, and findings of tenderness, redness, or swelling. You will also need to offer your expertise on whether you believe the Veteran’s diagnosed conditions cause a functional impairment on the Veteran’s daily life, to include his/her ability to be gainfully employed. This information is vital to the Veteran’s final rating decision.

Maintaining and Protecting Veterans’ Privacy

For security purposes, you and your office staff must follow all HIPAA laws and regulation, as well as the Privacy Act. For our part, all DBQs and examination related documents (including medical records, testing results, etc.) are accessible only on the VES Secure Provider Portal. VES does not accept paper reports or exchange paper medical records or testing results through any other means, including facsimile or E-mail. Our portal is available 24 hours a day and 7 days a week, with occasional downtime for updates and repairs. You will be provided your own login and password and will only see your examinations and communications. The portal is extremely user friendly and even providers who are not fully comfortable with computers have found it to be quite easy to utilize. Prior to your first examination, a VES New Provider Liaison (NPL) will guide you through the portal navigation process. In addition we also have VES Secure Provider Portal-specific instructional screencast videos available in your VES Provider Portal.

Medical Records

Depending on the VA’s examination request and requirements, medical records may not always be provided. Sometimes this lack of medical records may be considered somewhat counterintuitive when compared to the type of information you typically have available during treatment examinations. Please note if there are no medical records available, the VA has deemed them unnecessary for the examination. This is a VA decision and not a VES decision. Please simply complete the DBQ(s) to the best of your ability without the medical records. In cases where medical records are deemed necessary, VES will provide both an annotated or “book marked” version of the records including only the records directly related to the conditions being examined, as well as the complete file for your perusal. VES ensures those files are available on the portal well in advance of your examination so you may have time to review prior to the examination taking place.

Diagnostic Tests and Notifying Veterans of the Need to Follow Up on Abnormal findings

Concerning diagnostic tests, VES will suggest the diagnostic tests VA generally expects for the condition being evaluated. VES will also be responsible for scheduling the testing and paying the testing facilities. However, it is ultimately your final decision, as the provider, to disapprove any suggested tests based on your judgment concerning medical necessity. The only exceptions to this rule would be invasive testing, MRIs, or other involved or higher level testing the VA does not allow within the context of a C&P exam. The VES Provider Portal allows you to approve or disapprove of a test with a simple click of a button. For questions related to tests that the VA will not approve or any other questions concerning diagnostic testing, please call our provider assistance line at 1-800-994-2054. You may also contact us by E-mail at: VESPhysiciansHelp@vesservices.com

Should any abnormal findings be found on a Veteran’s evaluation or diagnostic test that he/she may not already be aware of, it is your responsibility to report the finding to the Veteran in a timely manner. This may involve alerting the Veteran at the time of the evaluation, or notifying VES of the need to contact the Veteran after the evaluation.

  • Critically abnormal test results: VES’s Medical Director, Dr. Jeffrey Middeldorf, will call the Veteran immediately, and the results will be sent to him/her with a follow up letter same day.
  • Abnormal but not critical test results: These must be communicated to the Veteran at the time of the evaluation or via a follow up letter.

All communication must include a copy of the test result and a recommendation to follow up with the Veteran’s PCP.

Examination Quality Review Process

In order to make understanding VA expectations as easy as possible, and to avoid sending reports to VA which we know through experience will be returned to us, we have a very helpful preparation and review process in place.

Prior to your first examination, a VES New Provider Liaison (NPL) will reach out to you and preview your upcoming examinations and the associated DBQs. This will allow you an opportunity to ask pertinent questions and to become more familiar with the requirements. These Exam-Prep sessions are extremely helpful and greatly increase the odds of success with your first examinations.

Immediately following your first day of examinations, the same New Provider Liaison will guide you through the submission of your first DBQs and ensure that your first DBQs are submitted correctly. For a new provider, these Up Front QA sessions are invaluable and VES has seen incredible results with providers adapting quickly and becoming 100% self-sufficient with both VES portal navigation and DBQ submission.

Once you are fully trained as a VES provider, you will work with a small group of Quality Analysts (QAs) assigned to you. We have found that limiting the number of individuals interacting with providers and designating “go to” contacts for providers is the most efficient way to ensure quality and provider satisfaction. QAs review all exam reports before they are sent to VA. Our QAs are not medical professionals, but they are experts when it comes to VA requirements for compensation and pension exams. QAs and NPLs are not in place to question the diagnosis you’ve rendered, or otherwise evaluate your medical expertise. The function of QAs and NPLs is to help you understand VA expectations and avoid VA returning your exam as insufficient due to factors that you may not encounter in treatment situations.

The QA who reviews your submitted DBQs is not authorized to make any changes to the DBQs without your approval. It is important to keep this in mind if and when you receive clarification requests via QA addendums for what you might consider as simple adjustments. Only after your report has been reviewed and formatted per VA requirements with all required issues addressed can VES submit your completed DBQs to the VA.

Providing quality exam reports is only part of what we do; we must also adhere to VA’s strict timeliness goals which must be met in order for VES to meet our obligation to the Veterans and the VA. The clock is ticking from the moment we receive an exam request from VA, so in order for us to meet the necessary deadlines, it is important that you submit your exam report to VES within two business days following a Veteran’s exam, and that you respond to any correspondence from our QA staff within two business days. We do recognize that this may not always be possible, but you should always reach out to VES support staff if you are ever unable to meet this deadline so that those awaiting the case can be notified.

Maintaining an Appropriate Attitude Toward Your Veterans

Please be sure to maintain an appropriate attitude towards the Veterans whom you evaluate and their unique circumstances. Introduce yourself, offer a brief overview of what the evaluation will involve, and patiently listen to the Veteran throughout the exam. Make sure you don’t turn away a Veteran who appears to be homeless; on the contrary, do your best to provide a quality and timely evaluation to expedite getting the Veteran the benefits of which he/she may clearly need to improve their circumstances. Also, keep in mind many Veterans may have underlying psychological issues, such as PTSD or exhibit symptoms associated with TBI or other conditions that may affect their interpersonal communication. As such, it is important to be kind and patient at all times. Please do not discuss politics or share your views on world events. Please do not discuss the VA or any perceived governmental inadequacies. If possible, please refrain from playing loud or violent television programs in your waiting area. Please make sure you see your Veterans as close to the scheduled time as possible and spend an appropriate amount of time with them. Do not rush or make them feel rushed. The providers who have received the best feedback over the years have been providers willing to listen, answer questions and take their time with each Veteran they examine. Treat each Veteran with dignity and respect and you will receive a great deal of personal satisfaction along with a positive reputation within VES, the VA, and with the Veterans Service Organizations.

Additional Resources for Veterans

At one time or another, a Veteran may ask you about the additional resources VA offers Veterans. Here is a brief list of those we believe are most helpful:

    1. VA’s website: www.va.gov
    2. VA’s toll free benefits hotline: 1-800-827-1000. This number rings to the VA Regional Office closest to the Veteran’s home, and is staffed to answer most of a Veteran’s questions about the C&P claims process.
    3. Many states and counties provide assistance to Veterans – i.e., Texas Veterans Commission (TVC), Harris County Veterans Service Officer, etc.
    4. Private Veterans Service Organizations, such as VFW (“Veterans of Foreign War”), AL (“American Legion”), and DAV (“Disabled American Veterans”).
    5. “Ebenefits” link: www.ebenefits.va.gov where Veterans can check the status of their claims online.
    6. Inquiry Routing and Information System: https://iris.custhelp.com/ which has access to the Veterans’ crisis line, benefits status link, and “MyHealtheVet” where Veterans can speak to a doctor online.
    7. VA benefits line for female Veterans: 1-855-VA-WOMEN. This line is intended to receive and respond to questions from Veterans, their families and caregivers about the many VA services and resources available to women Veterans.
    8. The National Crisis Line: 1-800-273-TALK. This is a 24/7 free and confidential, nationwide network of crisis centers. VES equips all of our providers with this phone number so they can pass it on to Veterans they evaluate as appropriate.
    9. The website for the Veterans Crisis Line is https://www.Veteranscrisisline.net/ForVeterans.aspx. It offers confidential text (838255) and online support.
    10. VA’s homeless Veterans hotline number: 1-877-424-3838.

 

Following Your State Laws for Medical and Psychiatric Emergencies

This one is straightforward; should any medical or psychiatric emergency arise during your VES evaluation with a Veteran, follow all applicable state laws and ensure the Veteran’s safety is a top priority. Please notify VES at the earliest opportunity of the emergency and outline all steps taken so we may share this important information with the VA.

 

Closing Remarks

Thank you for your time and attention today. We look forward to working with you! Below, you will find a ten question quiz that will test your knowledge of the VES processes and requirements.

Should you require further education prior to your first NPL Exam-Prep Session, please let us know. VES has a number of educational web links and video tutorials that will help you further prepare for your examinations. These include instructions on specific DBQs, VES Provider Portal navigation, and many other valuable resources for your edification. Please contact 1-800-994-2054 or VESPhysiciansHelp@vesservices.com for more details.


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