Advisory Committee on Disability Compensation

This page explains the purpose of the Advisory Committee on Disability Compensation;  provides regular updates about Committee meeting dates; post-meeting summaries; and links to the official Committee meeting minutes.

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Table of Contents

φ Introduction: What does this Advisory Committee on Disability Compensation Do?

φ June 2021 Meeting

• June 2021 ACDC Meeting - Review
  
  
• Positive Aspects of the June 2021 ACDC Meeting
  
  
• Positive Aspect: VASRD Mental Disorders Update
  
  
• Concerning Aspect of the June 2021 ACDC Meeting
  
  
• Committee Wants More Info on VBA Quality Assurance Program
  
  
• VA Office of Inspector General also takes issue with VBA's claim that they measure disability claims outcome
  
  
• VA Office of Inspector General reports about VBA's quality assurance program
  
  
• My Letter to the Committee re: VA's Misleading "Accuracy" Metric
  
  
• VA's Misleading "Accuracy" Metric (opens new window; 5-page PDF document)
  
  
• The Board of Veterans Appeals also publishes a misleading "accuracy" statistic
  

φ April 2021 Meeting Cancelled

φ December 2020 Meeting

φ Removal of DBQs from VA Website: Update

φ Federal Advisory Committee Questions Removal of DBQs from VA Website 

• Key Points 
  
  
• Federal Advisory Committee, May 2020 - Brief summary and an extended quote re: removing the DBQs from the VA website. 
  
  
• VA Inspector General's Report - The VAOIG report that recommended removing DBQs from the public VA website.

φ Committee Questions VA's Prohibition Against Private Practitioner Telemental (Tele-C&P) Exams [10 Sep 2020]

φ Meeting Minutes for the Advisory Committee on Disability Compensation - links to PDF copies of all meeting minutes since May 2020.

φ Receive An Email Message When New (Upcoming) ACDC Meeting Dates Are Announced in the Federal Register [2 Dec 2020]

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Introduction: What Does this Advisory Committee Do?

The Advisory Committee on Disability Compensation is a "statutory" federal advisory committee, which means it is specifically authorized by a United States statute: 38 U.S.C. § 546.

The Committee's purpose, defined in the statute, is to advise the Secretary of Veterans Affairs regarding the maintenance and periodic readjustment of the schedule for rating disabilities [VASRD]; and to:

• assemble and review relevant information relating to the needs of veterans with disabilities; 
  
  
• provide information relating to the nature and character of disabilities arising from service in the Armed Forces;
   
• provide an on-going assessment of the effectiveness of the schedule for rating disabilities [VASRD]; and 
  
  
• provide on-going advice on the most appropriate means of responding to the needs of veterans relating to disability compensation in the future.
  
  

Note: VASRD = VA Schedule for Rating Disabilities, which is located at 38 C.F.R. chap. 1, pt. 4.

There are a total of 27 VA advisory committees; 17 statutory, and 10 nonstatutory, all of which are designed to provide advice on selected VA programs and policies.

Links to Department of Veterans Affairs website pages related to the Committee.

• Advisory Committee for Disability Compensation web page va.gov

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U.S. General Services Administration (GSA) Committee Management Secretariat

If you serve on the Advisory Committee for Disability Compensation, I highly recommend reviewing services provided by the GSA Committee Management Secretariat, such as:

• Two-day training program from Federal Advisory Committee Act (FACA) subject matter experts.
  
  
• Individual consultation with Committee Chairs and and Members (of a Federal Advisory Committee).
  
  
• Advice and guidance on establishing and managing federal advisory committees.

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Advisory Committee on Disability Compensation Meeting: June 22–23, 2021

June 2021 ACDC Meeting - Review

I was able to watch and participate (via the chat function) both days of the June 2021 Advisory Committee on Disability Compensation (ACDC) meeting.

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Positive Aspects of the June 2021 ACDC Meeting

Here's a list of positive aspects of the meeting:

* The chat function (new for the Committee) gives the public a chance to submit comments and questions during the meeting. The Committee does not have time to address every chat comment or question, but they responded to a few.

* The Committee included chat comments in the meeting minutes.

* Jeffrey A. Moragne, Director, VA Advisory Committee Management Office gave a presentation on a Federal Advisory Committee's duties. His presentation was not only very informative, he delivered it with aplomb. It was crisp, articulate, and personable.

Positive Aspect: VASRD Mental Disorders Update

* We learned a bit of new information about the revision to the Mental Disorders portion of the VA Schedule for Rating Disabilities (VASRD) "will now evaluate based on impairment in five facets of life rather than simply based on symptoms. Ms. Che added that mental disorders are now rated based on WHO standards for functional impairment so that portion is more aligned with current medical standards."

Ms. Che is Jane Che, Director, Veterans Affairs Schedule for Rating Disabilities (VASRD) Program Management Officer (PMO), Regulations Staff, Compensation Service, VBA.

I commented in the chat, "the members of VA’s Mental Disorders VASRD Work Group included some very knowledgeable and experienced VA psychologists."

Note that the Mental Disorders section of the VASRD has a unique name: General Rating Formula for Mental Disorders.

The VASRD is a federal regulation found at 38 C.F.R., pt. 4, subpt. B.

The General Rating Formula for Mental Disorders is found at 38 C.F.R. § 4.130, below the list of VBA Diagnostic Codes (DC)—the last DC in the list is "9440 Chronic adjustment disorder"—you will find the General Rating Formula immediately below that.

VA has a helpful explanation for veterans:  About VA disability ratings.

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Concerning Aspect of the June 2021 ACDC Meeting

On the first meeting day (22 Jun 2021), VBA leaders Beth Murphy and Laurine Carson gave a presentation titled (in the minutes), "VA/VBA 101 - Compensation Service". During the presentation a Committee member, Al Bruner, asked for more information on the VBA quality assurance program. From the meeting minutes:

Al Bruner stated the Committee should receive more information on Compensation Service’s QA (Quality Assurance) program.

Ms. Carson [I think it was actually Beth Murphy] replied that the STAR (Systemic Technical Accuracy Review) program has been used to measure for quality, but more than one method is needed moving forward to include procedural compliance not just the end result.

Chair Pamperin stated that when evaluating procedure there is a need to identify what effect the process really has on the outcome to make sure that proper and effective changes are made.

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Committee Wants More Info on VBA Quality Assurance Program

Kudos to Mr. Bruner for asking the question! And Mr. Pamperin's comment is spot on: Outcome (the ultimate decision regarding a veteran's disability claim) is the crucial variable to measure.

Unfortunately VBA's response gave erroneous information. I faxed a letter to the Committee expressing my concern.

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My Letter to the Committee re: VA's Misleading "Accuracy" Metric

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My Concern Shared with Committee Members

From the meeting minutes:

Chair Pamperin read the first page and made reference to remaining pages of a letter submitted by a clinical and forensic psychologist, Dr. Mark D. Worthen.

The letter stated that yesterday Ms. Murphy misspoke when she said the STAR program was the yardstick they use regarding the Quality Assurance program.

Dr. Worthen wrote that STAR measures policy and procedural compliance.

Chair Pamperin stated they will need to get more information regarding specifically what STAR is measuring when they next have a STAR briefing. He informed all members that they would receive a copy of the letter.

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VA Office of Inspector General also takes issue with VBA's claim that they measure disability claims outcome

From the meeting minutes (p. 10):

Hello everyone. I am Brent Arronte, Deputy Assistant Inspector General for Audits and Evaluations for the Department of Veterans Affairs.

As there seems to be interest in VBA's STAR program, I would like to bring to everyone's attention that the OIG conducted a review of VBA's 4 major quality assurance components.

In addition, we issued a report summarizing our work on those components that identified the weaknesses found during those reviews.

Once read, you will see the OIG does not only look at procedural issues as indicated by Ms. Murphy yesterday.

These reports are found on the OIG public facing website.

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VA Office of Inspector General reports about VBA's quality assurance program

I found four reports that include the statement, "This review is one in a series of five VA OIG reports regarding VBA’s quality assurance program." Here are those four reports, with a selected quote from each report.

The Systematic Technical Accuracy Review Program Has Not Adequately Identified and Corrected Claims-Processing Deficiencies, Report #19-07059-169 (22 Jul 2020), https://www.va.gov/oig/pubs/VAOIG-19-07059-169.pdf

"The OIG team examined a statistical sample of 100 claims from which it estimated that about 55 percent of claims had deficiencies, including:

· Benefit-entitlement errors that could affect veterans’ disability compensation payments, and

· Procedural deficiencies such as having to report for an unnecessary examination."

Deficiencies in the Quality Review Team Program, Report #19-07054-174 (22 Jul 2020), https://www.va.gov/oig/pubs/VAOIG-19-07054-174.pdf

"The OIG found that QRT specialists did not identify a significant number of claims-processing errors that should have been identified. Based on a statistical sample, the OIG estimated that 9,900 of the 28,400 quality reviews (35 percent) completed during the review period contained missed claims-processing errors that should have been identified."

Site Visit Program Can Do More to Improve Nationwide Claims Processing, Report #19-07062-230 (18 Aug 2020), https://www.va.gov/oig/pubs/VAOIG-19-07062-230.pdf

"Limitations with VBA’s oversight of the site visit program prevented it from driving nationwide improvements in disability claims processing. ... The deputy under secretary for field operations expected regional office managers to be aware of issues raised in other regional office site visit reports, but no written policy required managers to review or address error trends."

Greater Consistency Study Participation and Use of Results Could Improve Claims Processing Nationwide, Report #19-07062-255 (29 Sep 2020), https://www.va.gov/oig/pubs/VAOIG-19-07062-255.pdf

"The OIG concluded that with VBA’s emphasis on production, which can undermine overall accuracy, it is especially important for the Office of Field Operations to require regional office managers to follow up on the results of consistency studies taken by their personnel and take corrective action as needed. By not following up on the consistency study results, the Office of Field Operations has not taken advantage of available options to improve staff performance."

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Links to relevant documents

Here are links to relevant material (all PDF documents):

June 2021 Advisory Committee on Disability Compensation Meeting Minutes

Letter from Dr. Worthen to the Advisory Committee on Disability Compensation (22 Jun 2021)

VA's Misleading "Accuracy" Metric (the 5-page PDF document I mentioned in my letter)

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The Board of Veterans Appeals also publishes a misleading "accuracy" statistic

Here is a quote about research on the Board of Veterans Appeals (BVA) quality assurance program and its misleading "accuracy" numbers.

Measuring accuracy or gaming statistics?

The reasons for the ineffectiveness, [Stanford Professor] Ho explained, are the cross-purposes of quality review. The same agency charged with its own quality review faces a competing interest in trying to keep case numbers and accuracy high for its performance measures, which in turn affect its funding allocations. For over a decade, the BVA has published and touted its “accuracy rate” to Congress and the public as being between 91 and 95 percent.

In their analysis, however, researchers found that BVA deployed an extremely deferential way of counting errors, inflating the agency’s measure of accuracy. When the quality review team deemed the decision error-free and the case was appealed further, it was still remanded – sent back to the agency – nearly three-fourths of the time.

“It is well-known in the social science literature that creating your own performance measures poses conflicts of interest,” Ho said. “We found that over time, the quality review process was used to generate the appearance of effectiveness [rather] than to actually improve performance.” [emphasis added]

That quote is from:

Wong, May. "New Research Finds Flaws in Veterans' Claims System." Stanford Institute for Economic Policy Research (6 Mar 2019).

Here is the citation for the research article:

Ho, Daniel E., Cassandra Handan-Nader, David Ames, and David Marcus. "Quality Review of Mass Adjudication: A Randomized Natural Experiment at the Board of Veterans Appeals, 2003–16." Journal of Law, Economics, and Organization 35, no. 2 (2019): 239-288. https://doi.org/10.1093/jleo/ewz001 [paywall]

An author's prepublication copy of the article is available here:

https://siepr.stanford.edu/sites/default/files/publications/19-005.pdf

See also:

Ames, David, Cassandra Handan-Nader, Daniel E. Ho, and David Marcus. "Due Process and Mass Adjudication: Crisis and Reform." Stanford Law Review 72, no. 1, 1–78 (January 2020). 

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Meeting Announcement (posted in April 2021)

The next meeting of the Advisory Committee on Disability Compensation is scheduled for:

Tuesday, 22 June 2021 from 0900 to 1200 EDT; and

Wednesday, 23 June 2021 from 0900 to 1200 EDT.

Both sessions last for three hours, beginning at 9:00 AM Eastern Daylight Time (EDT) and concluding at 12:00 noon EDT.

→ See the chart below for the start time in your location.

You can listen to the Committee Meeting (on both dates) by calling 800-767-1750, and then enter this access code: 75937#

Update (18 May 2021): The call-in number for those who would like to listen to the meeting is 1– 404–397–1596; access code: 199 374 5143.

Reference: Advisory Committee on Disability Compensation, Notice of Meeting, Amended, 86 Fed. Reg. 26605 (May 14, 2021), https://www.federalregister.gov/documents/2021/05/14/2021-10193/advisory-committee-on-disability-compensation-notice-of-meeting-amended

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Submit a Public Statement by 15 June 2021

If you wish to submit a Public Statement to the Committee, here are the instructions:

Time will not be allocated at this virtual meeting for receiving oral presentations from the public. However, interested individuals may submit a 1–2 page written statement for the Committee's review.

Written statements must be received by 15 June 2021 for inclusion in the official meeting record.

Please email public statements to Sian Roussel of the Veterans Benefits Administration, Compensation Service: Sian.Roussel[at]va[dot]gov

[edited for grammar/usage, syntax, and clarity]

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Meeting Agenda

Click here to download the Advisory Committee on Disability Compensation Meeting Agenda for June 22 and 23, 2021.

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Meeting Start Times in Various U.S. Locations*

The table below shows the start times for the Advisory Committee on Disability Commission meeting on Tuesday, June 22, and Wednesday, June 23, 2021 in several United States locations.

Consult the table below or the Event Time Announcer on timeanddate.com

Location	Start Time	Time Zone
Honolulu	0300	HST
Anchorage	0500	AKDT
San Francisco	0600	PDT
Phoenix	0600	MST
Denver	0700	MDT
Chicago	0800	CDT
Washington, DC	0900	EDT
Puerto Rico	0900	AST
U.S. Virgin Islands	0900	AST
Guam	2300	ChST

*Each of these locations has a Veterans Benefits Administration (VBA) office.

Remember you will not be able to speak during the meetings, but you can listen to the proceedings. 

The call-in number for those who would like to listen to the meeting is: 1– 404–397–1596; access code: 199 374 5143.

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April 2021 Meeting CANCELLED

23 Mar 2021 - The Advisory Committee on Disability Compensation virtual meeting originally scheduled for April 20–21, 2021 has been cancelled and rescheduled to June 22–23, 2021 (see above).

Reference: Advisory Committee on Disability Compensation, Notice of Meeting, Rescheduled, 86 Fed. Reg. 15556 (Mar. 23, 2021), https://www.govinfo.gov/content/pkg/FR-2021-03-23/pdf/2021-05980.pdf

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December 2020 Meeting

Advisory Committee on Disability Compensation: Virtual Meeting, December 1–2, 2020 | Open to Public | Agenda

22 Nov 2020 – You can listen to these ACDC meeting sessions by calling 800-767-1750, and then enter access code 75937#, shortly before 0900 EST on Tuesday (1 Dec 2020) and again on Wednesday (2 Dec 2020), if you want to hear both sessions of the Committee proceedings.

The Department of Veterans Affairs (VA) Advisory Committee on Disability Compensation (ACDC) will meet on December 1–2, 2020. These will be a virtual meeting, open to the public.

Click here to review the Agenda for the meeting (PDF file).

If you submitted a Public Statement, note that public statements will be read (or mentioned?) at the beginning of each session, i.e., at about 0905 EST. (See table below for meeting start times in different U.S. time zones.)

I posted my public statement online (PDF file): Worthen Public Statement: VBA's Tele-C&P Exam Rule is Biased Against Veterans.

Click here for the December 2020 Advisory Committee on Disability Compensation meeting minutes. (PDF file)

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Removal of DBQs from VA Website: Update

NOTE: A new law requires that VA put the Disability Benefits Questionnaires (DBQs) back on the VA website. The new law is:

Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020, Pub. L. No. 116-315, 134 Stat. 4932.

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30 Sep 2020 – More C&P exam news from the Advisory Committee on Disability Compensation ...

The Department of Veterans Affairs recently posted the Committee's July 14–15, 2020 meeting minutes.

The Committee received a presentation from Earl Hutchinson, Director, Medical Disability Exam Quality & Program Management Office, Compensation Service, Veterans Benefits Administration (VBA) about the removal of Disability Benefits Questionnaires (DBQs) from the VA website.

Here are excerpts from Mr. Hutchinson's presentation (from the minutes) with » my comments:

"The availability of DBQs created an industry characterized by abusive business practices that harmed Veterans. After Veterans had paid for these exams, they were often unusable by VA and delayed the claims process."

» From what I've heard this has certainly occurred, although VBA did not present any statistics in this regard, so it is not clear what percentage of DBQs from third-party firms were unusable and caused delays. That number would be helpful to know.

"The requirements of the Paperwork Reduction Act made it impossible for VBA to synchronize internal DBQs with external, or public, ones."

» This has been a problem for a while. Apparently, the OPM review process for all federal forms—new or revised—is onerous.

"Medical records from a Veteran’s treating physician were more influential to the outcome of a claim than a DBQ completed by a business established for the purpose of profiting off of claimants for VA benefits."

» This pejorative characterization is probably true for most such organizations, but not necessarily all of them. In other words, we should not assume that every organization that charges a fee to assist veterans prepare their disability claim exhibits unsavory or illegal business practices.

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Federal Advisory Committee Questions Removal of DBQs from VA Website

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Federal Advisory Committee, May 2020

At the May 2020 meeting of the federal Advisory Committee on Disability Compensation, members responded to a letter received for the Public Comments portion of the meeting.¹

Ann G. Knowles, Director of Sampson County Veterans Services (North Carolina) wrote the Committee to express her opposition to VA’s recent decision to remove DBQs from its public-facing website.

Here is an extended quote from the May 2020 Advisory Committee on Disability Compensation minutes:

Acting Chairman Pamperin read the VA response email from Machelle Harrell, an analyst in [the VBA] Compensation Service.

Ms. Harrell cited three reasons why VA decided to discontinue making DBQs available for public use:

(1) the VASRD [Veteran Affairs Schedule for Rating Disabilities] update had left many of the DBQs outdated, and updating them required a formal process that could take more than a year; 

(2) VA had increased its capacity to conduct compensation and pension (C&P) exams; and

(3) VA was safeguarding against fraud.

She [v] added that discontinuing public-use DBQs had no impact on the rating process or a Veteran’s ability to support medical evidence in support of his/her claim. 

Mr. Hazell felt VA’s justifications for removal were rather thin. The time required to update the VASRD negated any lag time for updating the DBQs, and VA had never provided satisfactory evidence that fraud was a significant problem.

Acting Chairman Pamperin agreed that VA did not provide much detail to support its position.

Mr. Lorraine thought the Committee should respond to Ms. Knowles’ email and that VA should provide DBQs on its public website, citing the need for transparency in the current environment. [emphasis & line breaks added to facilitate online reading]

VA Inspector General's Report

The Department of Veterans Affairs removed the Disability Benefits Questionnaires (DBQs) from the VA website after this VA Office of Inspector General (VAOIG) report was published:

Off. Inspector Gen., Dep't Veterans Aff., Rep. No. 19-07119-80, Telehealth Public-Use Questionnaires Were Used Improperly to Determine Disability Benefits (Feb. 18, 2020).

The VAOIG summarized their findings as follows.

This review was prompted by veterans’ benefits claims transmitted from VBA’s Medical Disability Exam Quality and Program Management Office as part of an effort by VA to identify potentially fraudulent claims in response to prior OIG report recommendations.

Moreover, VA regional office staff had related allegations to the OIG hotline.

At issue were healthcare providers who did not practice in the state, territory, or country where the veterans reside allegedly being paid to complete the public-use questionnaires and document conditions meriting disability benefits without ever seeing the veteran in person.

These questionnaires were being completed via “telehealth”—health care provided remotely through telecommunications technologies. The use of private provider telehealth examinations for rating purposes is prohibited.

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Committee Questions VA's Prohibition Against Independent Examiners Using Video Technology

Key Point

• The Committee questioned why VA-contracted examiners in the private sector have been encouraged to conduct telehealth C&P exams, whereas VA forbids the use of telehealth technology by veteran-requested examiners.

Brief Summary

10 Sep 2020 – Members of the Advisory Committee on Disability Benefits discussed VBA's policy to encourage VA-employed and VA-contracted examiners to utilize telemental exam capabilities, but to forbid non-VA psychologists and psychiatrists from using the same technology. 

Veterans have a right to submit IME (independent medical exam) or IPE (independent psychological exam) findings to support their claim.

Veterans are thus at a disadvantage because in many instances if they (or their attorneys) wish to retain an independent expert, the veteran might have to travel hundreds or thousands of miles and incur significant expenses for travel, lodging, and food costs, as well as lost time from work. 

Here is what Advisory Committee members had to say about this unjust VA policy:

Mr. Wunderlich cited an Office of Inspector General (OIG) report that only 81 claims from April 2017 to September 2018 were deemed potentially fraudulent, and of those, only three were referred to OIG.

Furthermore, he argued that VA’s response did not really address Ms. Knowles’ concerns.

Mr. Hazell noted that the OIG report also mentioned the improper use of telehealth by private providers, but added that neither U.S. Code (U.S.C.) nor regulation prohibited [use of telehealth by private providers].

[Mr. Hazell] added that it was odd that VA was discouraging telehealth by private providers while expanding the ability of VHA and contract examiners to perform telehealth exams. Acting Chairman Pamperin agreed.

Dr. Sprague noted that his local Veterans Integrated Service Network had shut down all C&P exams during the COVID-19 pandemic except those that could be conducted by telehealth.

Acting Chairman Pamperin acknowledged VA’s right to make these kinds of policy decisions, but said that there was an obvious disconnect between this decision and what was actually going on, and suggested that the Committee include this topic in its biennial report.

Mr. Hazell offered to spearhead the write-up. Acting Chairman Pamperin pointed out that the topic seemed to have hit a sensitive note with several members, and encouraged Mr. Hazell to coordinate with them. Mr. Hazell said he was willing to do so.

[emphasis & line breaks added to facilitate online reading]

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Advisory Committee on Disability Compensation: Meeting Minutes

The Advisory Committee on Disability Compensation (ACDC) posts meeting minutes on its home page. However, they post only the most recent minutes.

Starting in 2020, I began to post meeting minutes on this website (PTSDexams.net) so that you would have access to previous meeting summaries.

Meeting minutes (PDF files) can be downloaded by clicking on the links below.

• Advisory Committee on Disability Compensation June 2021 Meeting Minutes
  
  
• Advisory Committee on Disability Compensation December 2020 meeting minutes
  
  
• ACDC September 2020 meeting minutes
  
  
• ACDC July 2020 meeting minutes
  
  
• Advisory Committee on Disability Compensation (ACDC) May 2020 meeting minutes
  
  

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Receive An Email Message When New ACDC Meetings Are Announced in the Federal Register

If you wish to receive email messages when the Advisory Committee on Disability Compensation posts notice of the next meeting dates, you can do so on the Federal Register website.

If you are a VIP Member, I posted a 4-page PDF guide—with specific instructions and images—for setting up such email notices on the VIP Downloads page.

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  VA Disability Fraud Cases

  VA disability fraud cases, particularly involving PTSD and other mental disorder claims.

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