Veteran Experience and Satisfaction with the Department of Veterans Affairs Compensation and Pension Claims Examination Survey

OMB Control No: 2900-0770

Respondent Burden: 7 minutes

Expiration Date: 08/31/2017

Compensation and Pension Examination Feedback

VETERANS AFFAIRS:  SURVEY PARTICIPANT CONSENT Thank you for taking the time to provide us with your feedback.  Please read below before proceeding. This consent relates to the satisfaction survey about your recent VA claim exam. Please read this page carefully before agreeing to take part in our survey. Taking part is voluntary: Participation in this survey is completely voluntary. You may close out of the survey at any point if you do not wish to complete it.   Confidentiality: We will take necessary and appropriate precautions to protect your confidentiality. You will not be asked to disclose any private details beyond. We respect your privacy. Your responses will be handled as carefully as possible. But we cannot promise you complete confidentiality, since the purpose of the survey is to share aspects of your experiences with others so that we may improve the services we provide to you and other Veterans.  VETERANS AFFAIRS: SURVEY PARTICIPANT CONSENT Thank you for taking the time to provide us with your feedback. Please read below before proceeding. This consent relates to the satisfaction survey about your recent VA claim exam. Please read this page carefully before agreeing to take part in our survey. Taking part is voluntary: Participation in this survey is completely voluntary. You may close out of the survey at any point if you do not wish to complete it. VETERANS AFFAIRS:  SURVEY PARTICIPANT CONSENT Thank you for taking the time to provide us with your feedback.  Please read below before proceeding. This consent relates to the satisfaction survey about your recent VA claim exam. Please read this page carefully before agreeing to take part in our survey. Taking part is voluntary: Participation in this survey is completely voluntary. You may close out of the survey at any point if you do not wish to complete it.   Confidentiality: We will take necessary and appropriate precautions to protect your confidentiality. You will not be asked to disclose any private details beyond. We respect your privacy. Your responses will be handled as carefully as possible. But we cannot promise you complete confidentiality, since the purpose of the survey is to share aspects of your experiences with others so that we may improve the services we provide to you and other Veterans. VETERANS AFFAIRS:  SURVEY PARTICIPANT CONSENT Thank you for taking the time to provide us with your feedback.  Please read below before proceeding. This consent relates to the satisfaction survey about your recent VA claim exam. Please read this page carefully before agreeing to take part in our survey. Taking part is voluntary: Participation in this survey is completely voluntary. You may close out of the survey at any point if you do not wish to complete it.   Confidentiality: We will take necessary and appropriate precautions to protect your confidentiality. You will not be asked to disclose any private details beyond. We respect your privacy. Your responses will be handled as carefully as possible. But we cannot promise you complete confidentiality, since the purpose of the survey is to share aspects of your experiences with others so that we may improve the services we provide to you and other Veterans.
Statement of Consent: I have read the above information. I consent to take part in this survey and to have any information I provide be used in the manner described above. I expressly release the Department of Veterans Affairs from and against any and all claims which I have or may have for invasion of privacy, defamation, or any other cause of action arising out of the production, distribution, display or publication of the results of the survey, so long as the conditions of use described above are met. Yes No
Think about your most recent Compensation and Pension examination. Please tell us how you feel about the following statements.
Which doctor did you see for your appointment?	What was the date of your appointment? (MM/DD/YYYY)
Please check the box that applies for the following questions:
How long from your scheduled appointment time did you wait to see the doctor? Less than 30 minutes 30 minutes 45 minutes 1 hour Greater than 1 hour
Performance of Administrative Staff Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Reasonableness of appointment time and place Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Cleanliness of examiner’s office Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Concern and attention demonstrated by the examiner Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Overall satisfied with the services provided Very Satisfied Somewhat Satisfied Neither Somewhat Dissatisfied Very Dissatisfied
Please list any specific things that made you dissatisfied with the overall process. Please do not include any personal health information or personally identifiable information in your response. (You will have a chance to provide other comments at the end of the survey)
Please provide any comments you have about your most recent Compensation and Pension examination. Please do not include any personal health information or personally identifiable information in your response. (You will have a chance to provide other comments at the end of the survey)
Did you receive a rating decision for the recently examined condition? Yes No I don’t know
Do you plan to appeal your decision? Yes No I don’t know
Now think about your experience with all the services provided by the Department of Veteran Affairs (which include healthcare, benefits programs, or memorial services). Please tell us how you feel about the following statements. Please check the box that applies:
I got the service I needed Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
It was easy to get the service I needed Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I felt like a valued customer Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I trust VA to fulfill our country’s commitment to Veterans Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
Please provide any additional comments/suggestions
If we may contact you about your responses please include your contact information here Name: Email Address: Phone Number:
If you are in immediate need of help please contact the Veteran Crisis Line at https://www.veteranscrisisline.net/, 1-800-273-8255 and press 1 or send a text message to 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year.
The Department of Veterans Affairs appreciates your time and feedback.
The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 7 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this survey will lead to improvements in the quality of service delivery by helping to improve primary care services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.