I revised this reply on 3/9. My previous reply was incorrect.
There are two serious errors in the command file that you posted.
Did you create or edit the command file?
1. There are spaces before and after your commands, e.g.,
2. Your command file is missing the first line, the style information: "<?xml version="1.0" encoding="utf-8" standalone="yes"?>", so the system doesn't recognize it as a legit file.
I could post a corrected file but it'd be much better if you deleted the "my_custom_cmds1.xml" file from the 'C:ProgramDataVoiceTeachVoiceComputerCommandsCustom' directory and then start over again and name your commands through "Configure VoiceComputer" and "Name your Overlay (My Intag) Commands.
If you didn't create or edit the command file, let me know what version of VoiceComputer you're using ( Say, "Show VoiceComputer Version") and upgrade before you create a new command file.
1) You're using single word commands like 'vitals'. Generally speaking, you'll get better accuracy and fewer false positives if you use 2 or 3-word commands, e.g., "vitals macro".
2) If you want to create commands like 'sp' or 'ros', first dictate the acronym; see what Dragon recognizes; then use the text that Dragon recognizes as the exact command name. For example, if you say, 'sp' and Dragon recognizes 'SP', use 'SP' as the command name.