VA Perfects Self-Licking Ice Cream Cone

In March I showed you that contract examiners don’t get your whole C-file. Six months and one FOIA later, I can show you something worse: VA’s self-licking ice cream cone.

There’s an old term that floats around the Pentagon (and maybe NASA) for a program that has stopped serving its mission and started serving itself. A self-licking ice cream cone. The machine’s output is the machine’s own continued existence. Everybody stays busy. Everybody gets paid. Nothing gets done. A real merry-go-round.

I’ve been writing about VA’s contract exam system since 2023. I used to think it was broken. I don’t think that anymore. Broken things get fixed, or at least somebody files a ticket. This thing runs beautifully. It just doesn’t run for you. And since these contracts have the contracts on lock, and Congress never has a shortage of funds, the ice cream stand is always full of stock.

The Call

Let me start with a phone call I had yesterday afternoon, because it explains this better than I can.

My client is a Navy Veteran. Vietnam era. Hull tech, which is how VA finally conceded he ate asbestos for breakfast and inhaled it on his way to bed. He’s got ischemic heart disease, hypertension, gut problems, and a mental health claim. He also has dementia and aphasia, diagnosed this past May. He understands most of what you say to him. He can’t always find the words to answer.

So, I wasn’t really talking to him. I was talking to his wife. They’ll hit twenty years in January. Don’t find those types of marriages these days (maybe 20 months). She manages his medications, drives him to the ER when his pressure spikes, and watches the back door because, as with dementia, he walks into a room in his own house and tells her he’s lost.

His claim has been on remand from the Board for two years. Three different exam contractors have taken a swing at scheduling him. The first two spent months hunting for a physician before somebody figured out the remand never required one. The exams were finally set for next week.

She called me for exam prep. That’s what she wanted. Tell me what to say. Tell me what to bring. Give me the list. Help me help my husband.

I had to tell her there isn’t one.

We ask them to go. We just can’t seem to read the paperwork when they get back.

It Isn’t What You Say. It’s What They Already Have.

Here’s the part of the call that stuck with me. I’m going to give it to straight, as always.

MeThere’s nothing you can say — and I don’t mean that sarcastically — because we’re not the medical professionals giving the medical opinion. The examiner is going to give an opinion on whether it’s as likely as not, or less likely, solely based on their opinion. There’s nothing that you or I could say, or get into an exam and say, that is going to affect that part of the exam.

HerI know it’s going to be her opinion. But it’s not based on anything that’s said in the exam.

MeNo ma’am. Because we’re not medical professionals. You can show up and say he was exposed to asbestos. The examiner knows that, because VA already conceded it. So then it becomes a question of whether the examiner is going to give an opinion of less likely or at least as likely based on that concession. And there’s nothing you or I could say or do or give to affect that opinion.

Read her line again. But it’s not based on anything that’s said in the exam. That’s a woman who has read every page of her husband’s file, kept a symptom log for four conditions, and been told by everyone from a prior law firm to a chat bot that the exam is the big moment — figuring out in real time that the big moment was already over.

Because it was. The exam request went out on August 18th. Here’s what I had to tell her that means:

MeThe VA transmits the files they have (though not all) as of the date of the exam request. So, anything we put in the file — if VA did a brand new exposure memo today and said yes, we concede all these exposures — the examiner just wouldn’t have it. That’s stupid. VA needs to fix this. Believe me, I’ve been on them to fix it. But until they fix it, that’s the reality of how these contract exams work.

MeIt really comes down to what they see on their computer that the VA transmitted them. That’s really it. This is a broken system.

She had a nexus letter from his cardiologist sitting in a folder at the house. Never uploaded. I told her to email it to me and to hand a copy to the examiner if she’d take it — and to be ready for “I can’t look at that.”

“You can say, hey, this was just submitted, so you probably can’t see it on your computer.”

That is a sentence I said out loud, to a wife, a caregiver, about a disability examination in 2026. Not because the doctor is lazy. Because the record was frozen on August 18th and nobody has built a way to thaw it out or fix the contract exam system. Why would you when it is keeping contractors rich?

Now the Enigma

Back in March I published MDEO’s September 7, 2023, email. It’s the one that started all this:

MDEO — September 7, 2023“When requesting an examination, the regional office determines what available information is relevant to the exam and specifies that information in the exam request. Only the information specified by the RO is provided to the examiner for review as part of the examination. Due to privacy issues, the examiner is not granted access to the Veteran’s entire claims file.”

So, I filed a FOIA. I asked a simple question: how does a contract examiner actually get to a Veteran’s file? Portal? VBMS? Show me the documents.

The answer came back May 29, 2026. And buried in it is a sentence I have not been able to stop chewing on:

VBA FOIA 26-15162-F — May 29, 2026“Prior to September 2023, MDE Vendors accessed and downloaded the eFolder in its entirety through a secure system called eFolder Express.”

Well now. That is interesting.

Because eFolder Express isn’t some contractor product. It’s a VA tool, built by VA’s own Digital Service, and VA’s own training material describes it as a web application that lets authorized VA employees bulk download documents from the VBMS eFolder. To use it you have to be on the VA network and sign in with VA credentials.

So, walk that out with me. Either the vendors held VA network credentials — which is to say VA had already decided contractors could be trusted inside the house — or VA employees were running the downloads and handing them over. Take your pick. Both answers blow a hole in the September 2023 excuse. It just don’t make no sense.

And look at the dates. MDEO told us on September 7, 2023, that examiners are not granted access to the entire claims file due to “privacy issues.” VA now tells me that on that exact date, vendors were downloading the eFolder in its entirety.

Both statements are about the same week. They cannot both be true.

Unless — and here it is — they were never talking about the same thing at all. The vendor had the whole file. The examiner didn’t. That gap isn’t a contradiction. It’s the business model. And it lines up exactly with that VES job posting I showed you in March: the “Medical Record Bookmarker,” high school diploma or GED, daily quota, whose job is to go “through an entire medical record and determining what is pertinent to the case.”

You can’t determine what’s pertinent unless you’ve got the whole thing. Somebody had the whole thing. It just wasn’t the examiner.

Somebody is always standing watch. Just not over this.

So, What Happens Now?

Here’s VA’s description of the current process, from the same FOIA response:

VBA FOIA 26-15162-F — May 29, 2026“As of September 24, 2023, VA securely transmits all records contained in the Veteran’s eFolder, including all bookmarks and annotations added by claim processors, to the vendor electronically, when the examination request is submitted. MDE vendors then make those records available to the examiner assigned to complete the Veteran’s examination.”

Three things in that deserve your attention. Hey, no one at the VA is paying attention, so we might as well.

One. “When the examination request is submitted.” There it is in VA’s own words — the snapshot. That’s August 18th for my client. Everything after that date might as well not exist. Not for this exam.

Two. “Including all bookmarks and annotations added by claim processors.” VA is proud of this. VA should not be proud of this. The bookmarks are the filter. If the whole file goes over but the doctor’s attention is steered by tabs a non-clinician placed — and the vendor’s own bookmarker gets a second pass at it — then transmitting everything accomplishes nothing. You didn’t fix the funnel. You moved it downstream and put a contractor’s logo on it. Then you adopted whatever that opinion is, lock, stock, and barrel. The self-licking ice cream cone.

Three. “MDE vendors then make those records available to the examiner.” Make available. Not “provide.” Not “the examiner receives the complete eFolder.” Available. That verb is carrying more weight than a mule.

And one last thing about that FOIA. Read what the FOIA officer says about the search itself: MDEO reviewed the request and provided “a one-page Word document” that was responsive.

One page. A Word document. Not a directive, not a standard operating procedure, not a contract clause, not a system design document, not a training module. I asked the second largest federal agency in the world (second to the Department of War … wonder if that is trademarked yet?) to produce the records governing how contract physicians access Veterans’ medical files, and the office that oversees contract exams typed up a page for the occasion.

You know what that tells me? There isn’t a policy. There’s a practice. And a practice nobody wrote down is a practice nobody can be held to.

The Cone Licks Itself

Now put the whole thing together, and you’ll see why I stopped calling it broken.

The Cycle

1. VA freezes the record on the exam request date and sends the vendor a file steered by a non-clinician’s tabs.
2. The vendor’s bookmarker trims it again. The examiner opines on what’s left.
3. The opinion is insufficient — because it was built on an incomplete record.
4. The Veteran appeals. Or the Board remands. Or a quality reviewer catches it (rare now days), which is how I got the “our opinion request was insufficient” admission in the first place.
5. VA orders a new exam. A new exam is a new order. A new order is a new invoice.
6. New snapshot. New tabs. New bookmarker. Go to step three.
7. Lick ice cream cone.

Look at where the money sits. The contractor does not get paid for a correct opinion. The contractor gets paid for an opinion. An insufficient exam and a brilliant one bill the same. And when the insufficient one comes back around as a remand, that’s not a penalty — that’s a reorder.

The vendor gets paid twice for the same Veteran and calls it volume. VA gets to report an exam completed, then another one completed. Every player in this system is rewarded by the failure except the one person the system exists for.

The cone licks itself. The Veteran is left holding a broken waffle cone and bills that can’t be paid.

My client has been at this two years since the remand. Three contractors. Two prior exams, one of them so bad the examiner never evaluated the condition the judge ordered evaluated. And here’s the detail that will stay with me: the document that finally forced VA to start developing his radiation exposure? His wife found it. In a box of records a VSO gave her in 2018. She put a sticky note on it, took a picture with her phone, and uploaded it herself this past January.

Not the VA. Not the contractor. Not the bookmarker who researches “common and uncommon medical conditions” on a quota. A wife, desperate for help, with a phone camera and a shoebox.

She’s also been asking Copilot what to say at the exam. She apologized to me for it — told me not to laugh at her. I didn’t laugh. What was she supposed to do? Every professional in her orbit either gave her bad information or gave her none. So, she went and found a machine that would at least answer the question.

Putting This One Out

I told her the truth, which is that on September 10th none of it is up to her. I hate that answer. Some of you reading this may disagree. I gave it anyway, because she deserves a straight one more than she deserves a comfortable one.

But it shouldn’t be true. There is no technical reason a physician rendering a medical opinion should be working from a record frozen three weeks earlier and curated by two people who never examined anybody. VA can transmit updates. VA can give the examiner the whole eFolder and let a doctor decide what’s pertinent. VA can write down what its actual policy is, so somebody can be held to it.

I’ve put these questions to the Under Secretary in writing. I’ll publish the response, or I’ll publish the silence.

Until then: if you’ve got an exam coming, get your evidence in before the exam request goes out. Not after. Not the day of. Ask your representative when the request was submitted, because that date is the wall. Everything on your side of it, the examiner sees. Everything past it, they don’t.

That’s not advocacy advice. That’s a workaround for a system that shouldn’t need one.

Godspeed.