 Good morning everyone. My name is Tony DeFalco. I'm the Vice President of International Services at BES and I run our international ops serving our fellow vets around the world and this is Dr. Bill D'Atnes and we're going to introduce ourselves when we're here in a second. We want to get started and do an overview really to start the conversation of the contract, the conversation of the pension exam process and once we're done talking we're going to get a new Q&A which I think will be really helpful and give you a whole chance to ask questions about that process as well. So we appreciate everybody coming. You know, it's kind of like the standard governance slide. We'll learn about the military here you can see. We've got Entros. We'll talk a little bit about our new parent company Maximus and about Veterans Evaluation Services. The names you all probably know now for the last 14 years. Do a quick C&P overview and then like I said a Q&A session here. My name is Tony DeFalco. I'm the VP of International Ops. I'm also proud of the life member of the BAB and it's good to be back doing these again after the last couple of years. It's great to see everybody in person. It's great to be here with you all again. Just getting out there. It's been great meeting folks. I'll apologize at the front. I'm a little jet lagged. I got in at about 1am this morning. I was overseas from Mosnia. Didn't have to connect to Germany and things were delayed. All that stuff you hear in the news about the flight and the chaos. It's true. I'm highly caffeinated and if I have a hard time or something then not below me out here. But everybody that's been great at going around the door seeing everybody. Actually there was a breakfast. Folks having a very intense conversation about which service that the coolest former members and coolest most famous members. That's the kind of stuff that's really important. And obviously it's Air Force because we have really awesome engineers. Half the place was setting these technologies. So it takes me a while on these slides here. We're going to talk about Maximus who's been around a long time and is our proud parent company now. They acquired VES in May of 2021. They're the largest provider of government-sponsored benefit field programs in the U.S. And we've got over 40,000 employees around the world. Not to mention our over 2,000 VES now following the Maximus umbrella to help serve our fellow veterans. And Maximus has brought a lot to the table for us. Expanded IT infrastructure, call centers. We're going to be ramping up and rolling out a new webpage. It's going to look a lot more modern than the one we have now. Which is going to be great to help serve veterans and offer better feedback from all immediate contact. And it's brought a lot to the table for us to help expand our services to the veterans. With VES we've been doing this since 2008. We have literally helped hundreds of thousands of vets and service men and women receive their hard earned disability benefits that they deserve. With global network providers, which I talked about, it's not just in the U.S. You serve honorably. You get those benefits wherever you live. It's a great challenge. I've enjoyed it. I've been running our international ops and seeing sessions all year ago. And it's amazing where some vets go and where we have to do exams, but it's really fun. I mean, we just did some x-rays of one in Tehran, for example. We just got some done in Baghdad. We even got vets in the Ukraine right now that were keeping track of and thankfully they're all safe. So we are literally around the world helping vets here. And really, our sole bread and butter VES is to conduct those MPEs, those medical disability evaluations, and get those EDQ forms. You'll hear that a lot today, EDQ, disability questionnaires. For those of you that aren't familiar with that, and a doctor is much more of an expert on that than I am, and he's going to talk about that. And with that, I will introduce the doctor, because you want to hear him talk, not me. And he can introduce himself and all the right sides. My name is Dr. Davis. I'm a family practitioner. I've been working as a Phoenix for about nine years now. We're a little out of the world. We're happy to have you. All right, how's that? All right. Sorry about that. My name is Dr. Bill Davis. I'm a family physician at Phoenix. And I've been with the VES for just a little bit over nine years now. I tried to count on the last time. I think I've done about 7,000 of these DBQ cases. So I had a little experience doing some of these, and really enjoyed it to the point that I actually sold my practice to do this more full-time. It just came down to a matter of the way you burned out the family vests on Sunday night going to a clinic. It was always difficult to go to see veterans. The night before, actually, was a better thing. So I chose, you know, a better life now to help you guys out over my practice. You know, you miss a few things. We'll talk about the difference between a CMP exam and what I did as a family practitioner. A little bit of a continuity period that sometimes we miss, but I'll be honest, the way things are changed in life, is to get thank you to you guys. I don't get something like that in practice anymore, so thank you guys for all that. So we'll go over what a compensation and pension exam is, and how it's a little bit different than what I would do as a family practitioner. And you might be neurologists, psychiatrists, all the different kinds of physicians, nurse practitioners, PAs, et cetera. So our main goal, how I kind of translate this for veterans and for new people who are training, our job is to translate the information from what's going on in your medical file, what's going on with you, what you tell us is going on to what the VA is looking for in their DVQs. So we're not treating, we're not there to prescribe medications. It's just hard a little bit sometimes for new providers as well as new veterans as well. But we're there to translate and give the VA the picture of what's going on in drugs. So there are certain exams that we don't have to do a full exam. Again, there's a difference, right? Somebody comes in to the office and you talk about having a heart attack, I'm not just going to go, okay, you said you had a heart attack, right? There's more to it, more testing. With these exams, we might not have a full exam, but the perfect example is someone who comes in and complains about reflux. We have a lot of reflux, right? We're going to go based on what's called the subjective history. So we'll be discussing with you what the symptoms are, how the medication you took didn't help. That's going to give us an idea of what's going on versus I'm not sticking a scope down your throat in the office, everybody wants that. As far as who's conducting the exam, all of us are trained. The VES recently, Maximus, recently started up a new training program for our new providers, which has been kind of nice because we have a lot of variants in how we do things. And the DBQs, the CMP exams are a really different language than what most of us are used to. So being able to kind of get everybody together at the same page has been very helpful. And just to piggyback on that, some questions that came in ahead of time. I can touch on one now. We get this a lot from veterans that they call in. Why can't I just go to my doctor down the street? Well, as the doctor said, we have to vet, train, do a background check. There's all sorts of foods to jump through to get providers qualified to join our network. There's a full background check. There can't be any sort of body fraud or hits or anything of that nature. There's robust training and DNA process that the VA runs that all the doctors have to go through. Then they go through another training with us at VES. So that's part of the reason why you can't just, for our exams, go down to any old doctor. Now we'd love to get your doctor on our network if they're good. So feel free to give us their contact info and we can have a recruit reach out. We're always looking to recruit great doctors. But one of the most common questions, why can't I just go to my doctor? That's why. They have to go through the vetting and training to understand the uniqueness of that process. And our providers in our network have already gone through that. So what do you all have to do here for this? I'm going to say the main thing for me, when I come in, we have most of the records. I say most because I just never know what to do. So whatever you bring is always helpful. It's never a negative. I've always said to people that we're training, if I were to bring something in that they think is important, it's kind of your duty to at least look at it. I know some people just want to go based on what they see in the computer, but this is your life. This is your record. Nobody knows your body better than you. So if you bring me a piece of information, I want to at least take a look and see how that might affect the case. Otherwise, honesty is the best policy. I've always talked to a couple of vets who accepted me before talking about a back exam. They'll say, do you want me to stop when it hurts? Or do you want me to push through what you want? And I said, listen, I don't want you to stop because it's going to end white-hunt. But I also don't need you to give me that extra 5-10 degrees that's going to drop when it needs you. I want to see a good daily effect. How do you feel? What's your back like during the work, during the day, during the long day? I'll push you back with your wife, et cetera. I don't want you to think too much of it. I just want you to do the best I can. And I think that's where sometimes there's a little misconception at least some of the matters. It's there to hurt right here. I get that. I get where it hurts. But there's a section in the DBQ that says here's the range of motion that you gave us. What would it be if, what's your estimate, what's your medical opinion? How would it be if you did too much work during the day? So I'll be there to compensate that number and change that number is to hear how I feel a further effect and more repetitive useful effect. So for you guys, it's just a matter of just do your best for these exams. That's all I have to ask. Okay, so we've talked about this. We reviewed the file. It's difficult sometimes. When some people have 10,000 file pages, it's hard to go through every piece of the file completely beforehand. But I've looked at the most I can, especially imaging past exams are very important. So we'll go through as much as I can before and then I'll finish up the rest afterwards. Every now and again, that prompts a question. So I'll have to work a lot. Hey, I just saw something that, you know, what's the point when we talk about, we'll be cut away and explain this to them. So that doesn't happen too often. And then we'll have the physical assessment, the assessment of that. That's the range of motion testing, hard lung exam, et cetera. Time wise? That's a rough one. I've been in exams that have been as short as 10 minutes and I actually haven't wanted to look at it next Thursday. It's probably a day by six hours. The complexity. How many different kinds there are. And for some people, I mean, like I said, we're easy. We can discuss that really quick. But when the back leads to the hips, the knees leads to the ankles, that's a little bit more complex. So the story has just started at a different time. So again, fingers crossed on that six hours. The vet manager got lunch together probably. And that's another question that came on the FAQs. I'll jump in now. Exactly, we get questions. Well, my exam is only 15 minutes. Well, and then we look at it and it was a scar worksheet that, you know, you have the scar and they look at it to measure it. That's a very quick exam, for example, where it's something like diabetes or other things that are going on as the doctor said it takes longer. And also, frankly, doctors have been doing this a long time like Dr. Gatnes. They're quicker because they know the forms of water. They're all vetted and trained the same way. For all of us, once you've been doing something for a long time, you can't get more familiar with those forms and everything. So you can see a slight difference in exam times based on each individual person, how often they are, what's in their records, and things of that nature. But don't be alarmed. If you ever have a question about that, please ask the provider while you're there. Some of our younger vests, especially sometimes are afraid to ask questions. The biggest takeaway, giveaway I can tell those folks is please ask the questions. Ask, ask, ask. If you forget afterwards, call us. We have a dedicated call so we have real people that answer the phone and real people on emails. Let us know because we want to sort it right then and there and not have it, you know, way longer. So please, please, please tell your fellow vests that they have any questions. Ask. And Dr. Bill, when you get a lot of questions, you know, as far as the questions are concerned, I know that's difficult for a lot of people even in regular medicine, you know, especially guys, like, you know, or way different. That's why when you heard the response comes with it, I always call the spouse the truth zero. But especially for guys. It doesn't matter military. I don't know, I don't want to know yet. But I always handle all my cases with how do I do, do I gloss over anything, anything I forgot or any questions. Do we have to kind of give people the opportunity to take out that question or give them the little anxiety that you might have to ask a question? I consider myself a regular person. I know sometimes people are gonna be like, ooh, ooh, ooh, ooh, ooh, ooh, ooh, ooh, ooh, ooh. I just don't see that anymore. They do this for a long enough time. But I don't see it and I forget that I think there's not on the table sometimes we do. So try to make it as easy going as we can. And to go back to that question about the time wise, we don't get to see a lot of the better ones to be here. I had one brother in the kingdom for the start of the EQ and it was a matter of the start of the Olympics. Super simple, went through the exam, we talked for a little bit, talked about his experiences, believes, that comes back a month later with that McDonald's EQ. And he says, I've been mad at you for a month. I said, well, what did I do? And he said, I told you it hurts. And at the start of the EQ you wrote that there was no discomfort. And I said, yes. The start of the EQ asks, is there pain on the scar? So when I rubbed on the scar, there was no discomfort. On the endowment of the EQ it says, is there pain in my coach? So now we're here for a different EQ. So sometimes that gets lost in time, but as you can say, I've been mad at you for over a month, but I'm glad you got back to me so we can talk about this and then we have a great conversation on that. So again, we're answering questions. The difference between private practice and doing these worksheets are specific questions we have to answer that only pertain to one subject versus when you're in the office seeing me as a private practitioner, the whole body matters. Here we're working with specific body parts, so certain questions don't transfer. So after the exam, and here's again where we all differ, something else that I forgot being here for nine years, I can do these DQs in my mind, so I can actually pick up the questions in my mind. So I do go a little faster than some of the new people who we train, and I might take them an hour to do the reflex Q and Q. But what happens afterwards, this is for all the information that we have put together. So anything I haven't seen from a file that I might need, old records, maybe something from the service, maybe something else that I need to create a nexus to say, hey, you've had this problem in my case, I've been here for eight years, proof that it's still there, 85, we're here today, that all goes together. There's a process with the EPS where there's some checks, all the work that we did right, follow the guidelines, make sure that you go right, right on one side, left on the other, I've done that before, and you flip everything around. And then once everything looks well, follow the guidelines, and we're happy to sign off and we'll get it sent off to the EPS. And everything for us is electronic. Since the beginnings, if you start this in 2008, we digitized every DQ form that the VA has, and that's in our system. So we don't use any paper, it's kind of like if you're going in and booking an airline ticket or something, it won't let me go if you don't put a certain cost, and that's to help make sure that providers don't accidentally miss anything, they aren't human too. And the goal of course is to get a quality, complete, readable exam back to the VA in a timely fashion, so you all get your benefits faster, and then that opens up the world of treatment faster, and all those good things that come from the DQ. So all that's digitized, and as the doctor said every single case that comes in, we quality check. We have a team of 500 plus QAs that are quality analysts that go through, and they're trained, it takes months for them to get trained with our providers to go through and check those reports. And the reports are a lot, they can't change anything or anything like that. But if the doc says left from one and right from the other or maybe, you know, they'll send an email and say, can you check on this? Is this what you meant to say? Because they know what the VA needs that we're able to report and the doctor will look at it and say, yeah, I meant that, I know you're right, let me let me fix it. And that way, we have far through reverence and have to come back to setting exams where the VA gets back to the board or anything like that. So that really helps get a reasonable report to the RDSRs and the VA faster for you all. I don't know if it's forced at all here. Yeah, nothing worse than wasting time and having things start over for some reason. Adam and Simon, on these 10 takeaways, it's very important to attend your CMP exam. Please, please, please attend your CMP exam. If you can't make it, call us and let us know. We don't want to have to report people as a no-show. That's never good for anyone. And I'm not thinking on younger vets. I used to be one, I guess I'm not anymore. But they, we had a vet, it was like long-going fishing. Let's reschedule that and get you in to do this important exam so you can get your benefits. And every case that comes in to us, the first thing we do is attempt to contact the veterans, call a day one call. We email and do a phone call to the info that the VA has given us to get the veterans scheduling availability so we can plug it in as close as possible to their home within that time frame. Now the VA wants us to get these things done in less than three weeks. So we are on the rest of our time. That's what sometimes the vet tells us, well, I'm out of town for two months or something. Then we have to send that back to the VA and then they'll resubmit it two months later, for example. But that's very important to attend the exam. If you need to reschedule, as I said, call us. Please make sure the VBA has your current contact information, both the VHA and the VBA. Those systems do not always talk to each other. And the VA, that's a direct quote from the VA. It's not a spear, it's just how the VHA and the VBA work. Frankly, they never talk to each other in a way. Because we'll get vets and say they were just at the VA medical center. Why just gave them my new address? Well, that didn't blow over to the VA regional office, for example. So when you're updating your addresses, keep coming to the VA, make sure VHA gets it and VBA. For those who don't know, VHA, the better teleministration around those hospitals curing everybody, treatment, etc. VBA benefits administration side, handles the money and benefits and everything in the home loans and GI bills and most important what we're talking about today, the C&P process for you all. So they don't always talk to each other. So please, please, please let them know that. Don Ray talked about the medical history. He had submitted the evidence and everything. Multiple appointments. We want to hit on that. Some vets are like, well, I just went to the appointment. If you've got a large plane or something from like Agent Orange that's going to trigger an OPTO exam or other exams, we're going to schedule you with multiple specialist based on what the VA sent in. So you'll see Dr. Daphnis for the general medical part, but then you might go to an ophthalmologist for the division test and all that gets packed together and you can see that. Yeah, along with first TBI has to be a neurologist or a physiatrist, etc. so yeah, dental vision, which I think psychiatry, what else do we do? Yeah, dental, audio, work though, TBI's are all specialists for that and of course the gym beds. Now, that's another question we can get. Why are I seeing specialists? Well, for the most part, the VA considers the doctors in these DOs first and then specialist second. So for our contract, any doctor that's qualified can do these and the VA in 99.8% of the cases does not request a specialist to do those in two forms. So that's why, you know, if it's a scar or a cheek, you're not necessarily going to see a dermatologist in fact, I guarantee you're not going to see a dermatologist. You're going to see a gym bed provider that's been trained on everything and you can go through and do that and that's the way the VA has the system set up. Now there are some appeal cases and some others that come in where the VA will ask us if we have a specialist and then we work to find one in our network to get the veterans there. But that's a big question. Why am I going to see, you know, this kind of specialist? It's not how the VA has CMP contracts in the process of gym meds or gym meds first. And here's where the not treating part comes in, right? It fits. I don't know what's a good example is, but if we're talking with a specialist, well, I'm not going to do surgery in the office so you don't need a specialist. We're just kind of traveling and putting everything together. As long as your provider knows this ability with the medicine, what gets radiation cameo therapy that's a cancer, for example. And I think there's a question about time just before we had a burning order in Phoenix. We were breaking out of the dieters. So nothing was better than to the veteran coming in and is, what do you use a dieters? Go on my heart. I'm like, not a dieters. We're just branding out space. And so, yeah, I understand that question, but I think it's a matter of understanding that we're not going as deep as a specialist would need to. We're trying to get the superficial point to making sure we understand how treatment went, how you're doing right now, etc. Absolutely. And that's another, we get those questions, because we, yes, we try to get the exams as close to the veterans as possible. So we have a network of breaking order actual clinics. It's APS on them in major cities all around the country and in a couple spots in the world, in the long and how influential some other places. But in areas of lower volume, we will go out to smaller communities and rent that, you know, podiatrist office, because maybe they're only using it three days a week or even some other facilities where we come in and take it over, we have a portable exam tape and all that. So we'll actually travel to doctors around the West Texas as a good example. We've got a kind of circuit doctor to go to San Angelo, we've got an office, we've got an airport space and we go to Abilene, we've got a separate space in North Midland, Odessa. So Monday and one, Tuesday and another, Wednesday and another. That's how we get closer to the veterans. So you won't have to travel as much and we can get things done but then have free time for it. So just because you go up to a building that looks like a business, it doesn't look like a doctor's office, that's okay. Once you get in there, you're going to see the clinics, you'll see a provider with all the equipment and everything they need to do that exam and that's very common for us around the country, especially in old rural areas. We don't touch on them right, be truthful and honest when answering. Number nine, get this a lot. Our doctors don't know the status of your lines and we don't either. Other than we can tell you when we send the completed report back to the VA. You can call us and ask us that anytime and we'll be happy to walk you through it. But once we get it back to the VA, it's in the VA's hands. Now I can tell you the VA is working very hard and we've seen this over the years they've gotten much better. They're bringing in more staff and as they've outsourced the C&Ps now they have more staff to rate them. Their goal is to get it rated as quickly as possible and the feedback we get from our fellow vets is that wow, we've got that rating in a few weeks usually and that's a great thing. But once we send it back to the VA, we don't know how long it takes to rate it. We do not control in the money or the rating percentage as that is, while that is a VA function there and so we call them for those updates because they're welcome to call us to find out when the report was sent. Also vets I want a copy of my report. We are not allowed to give a copy of the Q and Q directly to the veteran. That is a VA contractual thing and it's because the VA legally is a custodian of records is the way they explain it to us. So sometimes vets like oh you got to give me a copy of that. We are prohibited by the VA from doing that. That final copy goes to the VA and we are entitled to a copy of it and our teams get this question a lot and they've got contacts where they can direct you to get that copy but you have to get it from the VA. We cannot give you a copy of the report. That's not what we don't want to that's just in black and white and how they've had that contract in the past 14 years. Now there are some diagnostic testing that you all do. We can give you copies of that. Let's say a surgeon, blood work, or an x-ray. You want to copy that to your doctor. Absolutely. It's called and we can get that to you because that's the diagnostic testing. The actual electronic PDQs we do go to the VA and then they have to provide you a copy once you ask for it. And we talked about the exam links as well.