[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
DEFINED EXPECTATIONS: EVALUATING VA'S PERFORMANCE IN THE SERVICEMEMBER
TRANSITION PROCESS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, MAY 29, 2014
__________
Serial No. 113-71
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.fdsys.gov
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman CORRINE BROWN, Florida
DAVID P. ROE, Tennessee MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
JEFF DENHAM, California DINA TITUS, Nevada
JON RUNYAN, New Jersey ANN KIRKPATRICK, Arizona
DAN BENISHEK, Michigan RAUL RUIZ, California
TIM HUELSKAMP, Kansas GLORIA NEGRETE McLEOD, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
PAUL COOK, California TIMOTHY J. WALZ, Minnesota
JACKIE WALORSKI, Indiana
DAVID JOLLY, Florida
Jon Towers, Staff Director
Nancy Dolan, Democratic Staff Director
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JON RUNYAN, New Jersey, Chairman
DOUG LAMBORN, Colorado DINA TITUS, Nevada, Ranking Member
GUS BILIRAKIS, Florida BETO O'ROURKE, Texas
MARK AMODEI, Nevada RAUL RUIZ, California
PAUL COOK, California GLORIA NEGRETE McLEOD, California
DAVID JOLLY, Florida
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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Thursday, May 29, 2014
Page
Defined Expectations: Evaluating VA's Performance in the
Servicemember Transition Process............................... 1
OPENING STATEMENTS
Hon. Jon Runyan, Chairman........................................ 1
Hon. Dina Titus, Ranking Member.................................. 3
Prepared Statement........................................... 41
Hon. Jeff Miller, Chairman of the Full Committee................. 5
WITNESSES
Ms. Nancy E. Weaver, Deputy Assistant Secretary of Defense,
Warrior Care Policy DoD........................................ 7
Prepared Statement........................................... 42
Accompanied by:
Mr. Dave Bowen, Director of Health Information
Technology, Defense Health Agency DoD
Ms. Diana Rubens, Deputy Under Secretary for Field Operations,
Veterans Benefits Administration, U.S. Department of Veterans'
Affairs........................................................ 8
Prepared Statement........................................... 47
Accompanied by:
Thomas Murphy, Director of Compensation Service, VBA,
U.S. Department of Veterans' Affairs
Ms. Linda A. Halliday, Assistant Inspector General for Audits and
Evaluations, Office of Inspector General, U.S. Department of
Veterans Affairs............................................... 19
Prepared Statement........................................... 50
Accompanied by:
Ms. Nora Stokes, Director, Bay Pines Benefits Inspection
Division, OIG, U.S. Department of Veterans' Affairs
And
Mr. Ramon Figueroa, Project Manager, Bay Pines Benefits
Inspection Division, Office of Inspector General,
U.S. Department of Veterans' Affairs
Mr. Eric Jenkins, Rating Veterans Service Representative, Winston
Salem Regional Office, American Federation of Government
Employees, AFL-CIO and the AFGE National VA Council............ 27
Prepared Statement........................................... 61
Ms. Debra J. Gipson, Individual Servicemember.................... 29
Prepared Statement........................................... 66
Mr. Gerardo Avila, National MEB/PEB Representative, The American
Legion......................................................... 31
Prepared Statement........................................... 68
Mr. Paul Raymond Varela, Assistant National Legislative Director,
DAV............................................................ 32
Prepared Statement........................................... 73
Mr. Brendon Gehrke, Senior Legislative Associate, Veterans of
Foreign Wars of the United States.............................. 34
Prepared Statement........................................... 83
DEFINED EXPECTATIONS: EVALUATING VA'S PERFORMANCE IN THE SERVICEMEMBER
TRANSITION PROCESS
----------
Thursday, May 29, 2014
U.S. House of Representatives
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, D.C.
The subcommittee met, pursuant to notice, at 2:35 p.m., in
Room 334, Cannon House Office Building, Hon. Jon Runyan
[chairman of the subcommittee] presiding.
Present: Representatives Runyan, Bilirakis, Cook, Jolly
Titus, and O'Rourke.
Also Present: Representative Miller.
OPENING STATEMENT OF CHAIRMAN JON RUNYAN
Mr. Runyan. Good afternoon and welcome, everyone. The
oversight hearing of the Subcommittee on Disability Assistance
and Memorial Affairs will now come to order.
Today's hearing will focus upon VA's role in the transition
from servicemember to veteran with a particular focus on the
Integrated Disability Evaluation System commonly known as IDES,
as well as the Benefits Delivery at Discharge and Quick Start
programs.
We will seek information on VA resources and production as
well as timeliness and quality of VA's components in the
process.
Further, I would like to hear today about the quality of
communication both within transitioning members as well as
between the Department of Defense and the Department of
Veterans Affairs in this process.
First to address IDES, while I understand that time lines
are improving, we want to start off by making it clear that
while this continuing improvement matters, I am frequently
contacted by servicemembers who are frustrated with the
process. They do not know how long it is going to take, when
they will get answers, and they do not know when they can make
plans for their future.
I understand that the DoD reports quite high satisfaction
from servicemembers undergoing IDES, but it does not reflect
the stories that have recently been shared with me.
I have also gotten the sense that the IDES process may not
be a top priority to VA because VA has chosen to place what
seems to be a fairly exclusive focus on eliminating the backlog
of claims to the detriment of these transitioning
servicemembers.
So let's begin the understanding that if this belief exists
at VA, it is not okay. These transitioning servicemembers have
served in recent years during a decade plus of wars in Iraq and
Afghanistan and with multiple deployments and many with
service-connected injuries that prevent their continued
military service.
Here I have correspondence from the past couple of months
received from soldiers who are awaiting the start of their post
military lives.
One soldier frustrated with his inability to plan for the
future wrote, and I quote, ``It has been four years since I
have shared a Christmas with my family. It would mean the world
if I could finally spend Christmas with them this year. I have
gone through the MEB board processes and am currently awaiting
ratings,'' end quote.
Another reads, quote, ``I have been awaiting my rating for
a long time now. I have also been trying to contact my VA reps
and the only way I can talk to them is if I go down to their
office. I call and call and leave messages and emails but never
get anything back unless I am in their office. This entire
waiting game has been putting a very big strain on my family
and I have been trying to convince my family that it is going
to come any day now. Well, it hasn't and now my wife wants to
get a divorce. I do not know what I would do without my two
daughters and my wife. If there is anything you can do to help
me out or get me some information, that would be great,'' end
quote.
And another infantryman wrote, quote, ``I am losing my mind
trying to find out why it is taking my rating so long to come
back from the VA. I honestly wouldn't reach out if it weren't
very important, but I have been under so much stress lately
that my blood pressure has shot through the roof. My whole MEB
board process has been putting me through hell more so than my
trip to Afghanistan in 2009. If there is anything you could do
to assist me in figuring out what is taking the VA so long to
rate me and possibly expedite the process, I would forever be
grateful,'' end quote.
These pleas are for assistance and disgusting, and we must
do better.
Today's hearing is entitled Defined Expectations:
Evaluating the VA's Performance in Servicemember Transition
Process. And if nothing else, I want that to be the takeaway,
defined expectations.
These men and women have served honorably during a very
difficult time in the military. At the very least, they deserve
an open line of communication and deserve reasonable, defined
expectations as their time lines, their futures, their
transition to the civilian world, more must be done to define
expectations.
In addition to the IDES updates at the forefront of today's
hearing, we will also seek information on the process including
the uses of brokering as well as time lines and accuracy of the
Benefits to Delivery at Discharge and Quick Start programs. We
will hear about the VA's anticipated new pre-discharge program
which may consolidate the existing BDD and Quick Start
programs.
I look forward to hearing from today's witnesses. And with
that, I will begin introductions.
Seated at the witness table, we have all members from the
first panel. From the Department of Defense, we have Ms. Nancy
Weaver, deputy assistant secretary of Defense, Warrior Care
Policy, who is accompanied by Mr. Dave Bowen, Director of
Health Information Technology, Defense Health Agency.
And from the Department of Veterans Affairs, we have Ms.
Diana Rubens, deputy under secretary for Field Operations with
the Veterans Benefits Administration, who is accompanied by Mr.
Thomas Murphy, Director of Compensation Services.
Upon conclusion of the first panel, we will see two
subsequent panels which include for panel two Ms. Linda
Halliday, the assistant inspector general for Audits and
Evaluations for the Office of Inspector General, U.S.
Department of Veterans Affairs, accompanied by Ms. Nora Stokes,
director of the Bay Pines Benefits Inspection Division, and Mr.
Ramon Figueroa, project manager with the Bay Pines Benefits
Inspection Division.
Panel three will consist of Mr. Eric Jenkins who is here in
representation of the American Federation of Government
Employees, AFL-CIO, and the AFGE National VA Council.
Ms. Debra Gipson is here today and is an individual member
and she will be introduced shortly by Congressman O'Rourke.
Mr. Gerardo Avila, national MEB/PEB representative with The
American Legion; and Mr. Paul Varela, assistant national
legislative director with Disabled American Veterans; and Mr.
Brendon Gehrke, senior legislative associate with the Veterans
of Foreign Wars of the United States.
One final point, all of the named witnesses are present. I
must advise that pursuant to Title 18, United States Code
Section 1001 known as the False Statement Act, this is a crime
to knowingly give false statements in federal jurisdiction
including a congressional hearing.
With that acknowledgment, I thank you all for being with us
today.
I now yield to the ranking member, Ms. Titus, for her
opening statement.
OPENING STATEMENT OF DINA TITUS, RANKING MINORITY MEMBER
Ms. Titus. Thank you, Mr. Chairman. Thank you for holding
this hearing today.
Thank all of you for coming to provide us with some needed
information.
As you heard the chairman describe today, we are going to
look into the performance of programs that VA and DoD utilize
for determining fit for duty status for ill or injured
servicemembers, as well as programs that are designed to
expedite the adjudication of claims submitted by separating
servicemembers.
Particularly we are going to focus on the Integrated
Disability Evaluation System, IDES, the Benefits Delivery at
Discharge program, BDD, and the Quick Start program. All of
these programs have now been up and running for a number of
years.
IDES was initiated in 2007 as a follow-up to the poor
conditions and fragmented care that were exposed at Walter Reed
Army Hospital.
BDD was launched back in 1995 as a pilot program and then
became fully operational in 1998. The intent of BDD was to
assist disabled servicemembers in making a seamless and
successful transition to civilian life by allowing them to get
their claims completed as early as possible while they have all
their medical information readily available.
Quick Start was launched in 2008 and it is similar in
nature to BDD. And it was established to provide an expedited
disabilities benefit process to servicemembers who are going to
be discharged within 59 days.
Now, despite having long been established and having enough
time to get over growing pains and any other problems in the
early stages, all of these programs continue to face
challenges, are performing far below expectations.
The one similarity that they seem to have is that they
suffer from a continued poor performance in the adjudication of
the claims in each of the three programs.
Of particular interest to me is the number of claims under
the BDD and Quick Start that has dropped off. There are many
fewer claims now than there used to be and I am concerned that
the reason for that is that servicemembers are choosing to
bypass these programs that are designed to provide an expedited
system over concerns that participation actually delays the
process of receiving benefits.
In fact, Quick Start has been known to be called Quick
Start and slow finish as a result of that.
So we have had highlighted for us by the VA's OIG about
eliminating the benefits backlog has kind of shifted priorities
and come at the expense of other benefits and claims such as
IDES and Quick Start which have been moved to the back burner,
and that is unfortunate.
You heard the chairman read some of the emails that we have
been receiving. They all generally have the same ask. I am in
the army. I am waiting for a decision. My family and I need to
get on with our lives.
Our staff has witnessed firsthand the poor culture that is
often present at these IDES stations and wounded warrior
battalions.
I want to thank Ms. Gipson, who is an army veteran, who
recently went through the process and came to be with us today
to talk about some of the negative culture that is in these
program and how we might address it.
It is just a concern that these programs that are supposed
to be so helpful really end up being harmful because they hold
our servicemembers' lives in bureaucratic limbo.
An army reservist who enters IDES today won't complete the
program until August 17th, 2015. A hundred and eighty-one days
of this 443 day period will be spent waiting for a VA rater to
pick up the claim and provide him or her with a rating. Just to
get a rating it takes that long.
So as our servicemembers wait for a rating decision, they
are forced to delay critical aspects of their transition. They
and their spouses are hesitant to relocate, to buy a home, to
enter a school program, to find a new job because they just
don't know what is going to happen to them.
Now, we know that servicemembers face obstacles when they
are transitioning out of the Armed Services. That is already
difficult enough. The VA should be an asset, not a hindrance to
that process.
So I think we need to take a hard look at the resources
that we are dedicating to these programs and figure out how we
can meet their goals today and not tomorrow. So we need to take
a fresh look at these programs.
We with the staff recently looked at this and found that 95
percent of servicemembers who enter the IDES program are found
not to be fit to serve because of an illness or an injury, so
they know they are going to be discharged, 95 percent.
If we know that many are not going to go back into the
service but are going to be discharged, shouldn't we be taking
a different approach offering them some flexibility, some
options while they are making that transition?
So I hope that those are the kind of things that we will
look at today in this hearing and see if we can't re-prioritize
and shift some of our emphasis on being flexible and making
this work as opposed to just having families sit around waiting
for the rating.
Thank you. I yield back.
[The prepared statement of Hon. Dina Titus appears in the
Appendix]
Mr. Runyan. Thank the gentle lady.
With that, I will recognize the chairman of the full
committee, Mr. Miller, for a statement.
OPENING STATEMENT OF HON. JEFF MILLER
Mr. Miller. Thank you very much, Mr. Chairman. I appreciate
the indulgence. I want to make a few remarks on the
servicemember transition process, particularly in regards to
IDES.
Currently the time line of IDES induction to receipt of
benefits is targeted not to exceed 295 days, but recent DoD and
VA reports place the average time line at over 350 days. That
is an average, but that average means that there are many
servicemembers that take much longer to complete.
In an effort to address IDES inefficiencies, I recently
introduced an amendment to the fiscal year 2015 National
Defense Authorization Act that would do the following:
First, it would require the use of a standardized form set
which would be approved by both the secretaries of DoD and VA
as was envisioned by the Dole-Shalala commissioners'
recommendations.
Second, it would collocate certain DoD and VA personnel to
allow for great interdepartmental collaboration and to reduce
delays in transfers of information.
Third, it would compel the usage of a bridging software
solution between DoD's MY IDES and VA's ebenefits dashboards to
allow servicemembers greater transparency as to where they are
in the process at the current time.
Finally, the amendment would establish a working group
comprised of various personnel of DoD and VA as well as private
industry leaders to reevaluate the program itself.
The working group would then make recommendations on how to
better serve those who are going through this process as well
as how to better utilize the resources that are allocated.
I do want to take a moment to emphasize that the goals of
my IDES amendment are twofold. First, increased transparency to
the servicemembers and increased accountability for the
respective departments.
So I think everybody in this room is already aware the
issues of transparency and accountability are of utmost
importance, particularly as we continue to investigate the
ongoing delays in accessing care at the VA healthcare
facilities across this great Nation.
Since the transition process, whether through IDES, BDD,
Quick Start, or the traditional claims process, is a
servicemember's first exposure to the VA system, and we want to
ensure that it is a positive experience for all who use it and
those that it was designed to serve, those very people that
have served our country.
Mr. Chairman and to Members of the committee, thank you for
your indulgence and I yield back my time.
Mr. Runyan. Thank the gentleman.
And now I want to recognize Mr. O'Rourke. I believe he has
a statement, opening statement.
Mr. O'Rourke. Thank you, Mr. Chairman.
I just wanted to actually introduce someone who is going to
be on one of the later panels, Debra Gipson. I am sad to say,
Mr. Chairman, a former constituent of mine, she just moved out
of El Paso in March of this year. We are going to miss her. But
prior to that, she was stationed at Fort Bliss, a former
captain in the U.S. Army.
And during her time as a commissioned officer, she served
as the executive officer for the Warrior Transition Unit, Bravo
Company at Fort Bliss, Texas. She was medically separated from
service through the Integrated Disability Evaluation System or
IDES.
And she is here today again in a later panel to deliver a
statement about her experience with IDES and offer
recommendations to improve the system.
And so, Mr. Chairman, I just wanted to be here to welcome
her and introduce her to the rest of this committee.
With that, I yield back.
Mr. Runyan. Thank you.
And I don't believe any other Members have a statement. So
at this time, I welcome our first panel. And your complete and
written statements will be entered into the hearing record.
And, Ms. Weaver, you are now recognized for five minutes.
STATEMENTS OF NANCY E. WEAVER, DEPUTY ASSISTANT SECRETARY OF
DEFENSE, WARRIOR CARE POLICY, DEPARTMENT OF DEFENSE,
ACCOMPANIED BY DAVE BOWEN, DIRECTOR OF HEALTH INFORMATION
TECHNOLOGY, DEFENSE HEALTH AGENCY, DEPARTMENT OF DEFENSE; DIANA
RUBENS, DEPUTY UNDER SECRETARY FOR FIELD OPERATIONS, VETERANS
BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS,
ACCOMPANIED BY THOMAS MURPHY, DIRECTOR OF COMPENSATION SERVICE,
VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS
STATEMENT OF NANCY E. WEAVER
Ms. Weaver. Thank you.
Chairman Runyan, Ranking Member Titus, and distinguished
Members of the subcommittee, thank you for the opportunity to
appear before you today to discuss the Integrated Disability
Evaluation System, also known as IDES.
Since 2007, the Departments of Defense and Veterans Affairs
have collaborated to create an integrated and transparent
disability evaluation system for servicemembers who have
illnesses or injuries that may impede their ability to perform
their military duties.
Today IDES accounts for about 97 percent of all DoD
disability evaluation cases. In IDES, servicemembers receive a
set of disability examinations conducted according to VA
protocols and disability ratings prepared by VA.
Military departments determine fitness for duty and only
compensate servicemembers for conditions that compromise their
ability to perform their military duties. VA compensates for
all conditions incurred or aggravated during military service.
The advantages of IDES compared to Legacy systems include
the elimination of duplicate medical exams, consistency between
DoD and VA disability ratings, and reduce wait times for VA
disability benefits since rating determinations are completed
prior to servicemembers' separation. These advantages have
contributed to improved servicemember satisfaction within the
IDES process.
We are continuing to implement process enhancements such as
improved policy, increased staffing levels, and new training
requirements for caseworkers. These and other improvements have
enabled us to achieve and remain below our IDES core processing
goal of 105 days for the past several months.
Information technology can also help us gain more
efficiency within the IDES process. That is why we are working
to develop a system that will support end-to-end case
management, tracking, reporting, and a bidirectional electronic
case file transfer.
We will continue to work with VA to ensure system interface
requirements are identified early. The Department of Defense is
working diligently to support an integrated disability system
that ensures servicemembers receive timely and transparent
compensation for injuries or illnesses incurred by the line of
duty today, tomorrow, and in the future.
Thank you, and we look forward to your questions.
[The prepared statement of Nancy E. Weaver appears in the
Appendix]
Mr. Runyan. Thank you, Ms. Weaver.
And now next we will hear from Ms. Rubens. Ms. Rubens, you
are now recognized for five minutes.
STATEMENT OF DIANA RUBENS
Ms. Rubens. Good afternoon, Chairman Runyan, Ranking Member
Titus, Members of the subcommittee.
My testimony today will focus on the status of the
Integrated Disability Evaluation System or IDES, Benefits
Delivery at Discharge, BDD, and the Quick Start programs.
With respect to IDES, VA and DoD's joint efforts over the
past six years have resulted in changes and improvements in our
disability evaluation system. Together the departments have
created an integrated process for servicemembers who are being
medically retired or separated.
This joint process was designed to eliminate the
duplicative, time-consuming elements of the separating
disability determination processes within VA and DoD.
The goals of our integration were to provide a seamless
transition of benefits and healthcare for separating
servicemembers through IDES. As a result of our collaborative
efforts, we have worked to achieve these goals.
Currently there are approximately 29,000 servicemembers.
For the four combined core steps, VA average processing time in
April 2014 was 183 days, the lowest core time since April of
2013. Our target for those combined core steps is 100 days of
that 295 day combined VA/DoD target.
In an effort to continue to improve, we created a plan to
improve IDES timeliness that involved a phased approach. The
first phase of that plan was to meet benefit notification
timeliness standards by March of 2014 which we have done.
This portion of the IDES process is focused on ensuring
servicemembers who are transitioning into the civilian world as
veterans receive timely benefits to which they are entitled.
The second phase of the plan is to meet the timeliness
standards for the proposed ratings by October of 2014. We are
on track to meet that goal and will do.
Our continued partnership with DoD is critical. VA and DoD
are committed to supporting our Nation's wounded, ill, and
injured servicemembers through the IDES process.
The BDD and Quick Start programs are important elements of
VBA's strategy to provide transitional assistance to separating
or retiring servicemembers and engage those servicemembers in
the disability claims process prior to discharge.
VBA's goal is to ensure that each servicemember separating
from active duty who wishes to file a claim with VA for
service-connected disability benefits will receive assistance
to do so.
Participation in the BDD program is available to
servicemembers who are within 60-180-days of being released
from active duty and are able to report for a VA exam prior to
discharge.
Quick Start made pre-discharge claim processing available
to 100 percent of transitioning servicemembers including those
who are within 59 days of separation.
Like many of our regular non-pre-discharge claims work, VBA
has made tremendous progress in the past 12 to 15 months, but
we recognize we have work left to do.
As of April of 2014, the average days pending for our Quick
Start claims is 98.3 days, an improvement of 137 days since May
of 2012. As of April of 2014, the average days pending for our
BDD claims is 136 days, an improvement of 55 days since April
of 2013.
Claims accuracy is a key element of VBA's transformation
plan overall, and we continue to improve in that arena as well,
but currently it is not measured specifically for our BDD or
Quick Start claims process at the three rating activity sites.
Instead, the accuracy is measured for each regional office
as a whole including the BDD and Quick Start claims that we are
processing.
As of April of 2014, our three regional offices processing
BDD and Quick Start claims and their rating activities have
three-month, issued-based quality between 96 and 98 percent.
VBA is now working to redesign the pre-discharge claim
process by building on lessons through the execution of our BDD
and Quick Start programs. The new pre-discharge program will
consolidate and replace the existing BDD and Quick Start
programs.
We will be leveraging functionality now available in our
Veterans Benefits Management System and in our ebenefits system
to add convenience to both the application process and
efficiency throughout the claims process.
VBA is committed to supporting our Nation's servicemembers
through improvements in our pre-discharge programs. We believe
that the continued enhancements are critical to program
success, nothing less than our servicemembers and future
veterans deserve.
That concludes my statement. I am happy to answer any
questions you might have.
[The prepared statement of Diana Rubens appears in the
Appendix]
Mr. Runyan. Thank you, Ms. Rubens.
And I will begin a round of questioning alternating between
Members at their arrival times. My first is for both the VA and
the DoD.
Ms. Weaver, you indicated throughout the process that DoD
and VA caseworkers keep servicemembers informed of progress in
their cases. While this streamlined communication may exist in
isolated cases, we know from speaking to large groups and
several examples in my opening statement that for
servicemembers at numerous installations, this communication is
simply not occurring as a matter of routine.
How is this communication going to prove, and I would like
both perspectives from both you at the DoD, Ms. Weaver, and Ms.
Rubens at the VA?
Ms. Weaver. Thank you, sir.
We have recently increased our manpower in the PEBLOs, and
we find that we have also improved the training. We have
minimal training standards and required training for each of
the PEBLOs, providing them more information.
As far as keeping the individual aware at the beginning of
the process, each member who is enrolled or referred to IDES is
given a caseworker or a PEBLO. That individual interacts with
the servicemember throughout all phases.
At the beginning of the process, the member is told
approximately how long the process would take and is updated as
they move from phase to phase and keeps them aware of what they
need to do. And they are encouraged to keep their family
members updated or bring them in so that they are aware of what
is going on through the process also.
Mr. Runyan. Ms. Rubens.
Ms. Rubens. Our military services coordinators are located
at the intake sites along with the DoD PEBLOs in an effort to
ensure not only referred conditions that DoD is referring to
the MEB/PEB process, but any claimed conditions that veteran
wants to claim, our military services coordinators are there to
help walk them through that application process and understand
the process.
They are also there, frankly, to serve, if you will, as a
touch point or a reach back to our rating activity sites so
that as that veteran has questions, we are capable of also
getting back to that rating activity site to share information
with that servicemember and/or their family.
Mr. Runyan. I want to go back to Ms. Weaver. You said the
interactions happen typically as they move from phase to phase.
Are there huge gaps in timing of different phases, or are
they pretty standard as they fall in a time line? Say there are
three phases in the process. Does one take three-quarters of
the year; the next one take a month typically?
Ms. Weaver. Each phase that they go through has a goal in
the process.
Mr. Runyan. Are the servicemembers made aware of the time
line in the phase or just the overall process?
Ms. Weaver. They are told of the overall as well as each
phase. And as they go through each phase, they can tell them
where the next phase should be.
However, we don't have a case tracking system that will
tell them where in the phase they are, if their claim is being
adjudicated, and how long it is going to take before that is
done or when the informal PEB is going to be completed and
moved to the next one, next phase.
Mr. Runyan. I have one last question, and I am going to go
over a little bit. It is actually for Mr. Murphy.
As accuracy is an overarching matter of importance, I would
like to ask you a question about VBA's quality component STAR.
VBA's STAR program has several classifications of error
such as benefit entitlement decision documentation/notification
and administrative. However, VBA's national rating agency is
based solely on benefit and entitlement error.
My understanding is that STAR does not count errors, for
instance, with potential to affect veterans' benefits such as
when a claims folder lacked required evidence including a
medical examination or opinion needed to make an accurate
decision.
Can you comment on any of that?
Mr. Murphy. I would say that that is not an accurate
statement, that the absence of an examination when one was
needed would be called a benefit entitlement error for us. So
we do have the classifications of error that you just
described, which is a benefit entitlement error.
Part of that is that if there is something that should have
been gained, evidence that should have been included in the
file or reviewed that would have affected the outcome, that
would require a benefit entitlement error to be called.
Mr. Runyan. Okay. With that, I recognize Ms. Titus for her
questions.
Ms. Titus. Thank you, Mr. Chairman.
I would just ask Ms. Rubens if you have an explanation for
why the number of people going into these programs has dropped
off. Only a third of the transitioning servicemembers elect to
use these programs do you think that if the VA made the same
kind of investment that the Department of Defense made in
personnel and also some of the made changes described by Ms.
Weaver, would that help with the backlog?
Ms. Rubens. Certainly. I would tell you that I have heard
particularly some of the concerns about the Quick Start not
getting as many referrals as we anticipated. I would tell you
that we know we had some challenges with timeliness.
We made some dramatic changes to the resources that we
provided to both the BDD and Quick Start processing in July of
2012 in an effort to ensure that we closed on those
performance, particularly around timeliness, numbers that we
were seeing then.
I reflected in my statement the improvements we have made,
and we continue to look for those to be not only sustained but
grown upon as we work to merge BDD and Quick Start from the
standpoint of the expectation that servicemember transitioning,
whether they have one to 59 days and perhaps not able to get to
a VA exam prior to discharge or whether the 60-180-day mark and
can, in fact, complete the exam process to ensure timely
processing of those claims as they transition to civilian life.
Ms. Titus. The deadlines that you have, though, for meeting
the goals keep getting pushed back, don't they? Hadn't one now
been pushed back to October for meeting some of those time
lines that were supposed to be met in August?
Ms. Rubens. Ma'am, the time lines that you are referring
to, I believe, are for the IDES program versus the BDD and
Quick Start. And we do look at those somewhat differently
because of the nature of that servicemember and the IDES
program being boarded out for disease or injury.
From that standpoint, in August for the proposed ratings,
we will close the inventory capacity that we need to. By
October, we will hit our deadline for providing the proposed
ratings. And we are all ready for the final notification to
that servicemember. We are now meeting 30 days for that time
period.
Ms. Titus. Okay. With an average of 48 days, I think, but--
all right. I would like to ask you about the fact that 95
percent of the people in this program are going to be
discharged.
Is there not some way to address that? We have heard a lot
about segmented lanes and express lanes for other kinds of
benefits. Is there not some way to look at some more
flexibility there? If we know 95 percent are not going to go
back into active duty, can't we figure out some way to
prioritize those cases and move them out faster?
Ms. Rubens. You know, ma'am, I think that particularly
around the IDES program, it has been a joint process with DoD.
We want to ensure that we are meeting the spirit and the
intent, which is to move that along as quickly as possible.
And I will turn to Ms. Weaver to correct me to a hundred
percent, but I also think that there is the obligation of
ensuring we have gotten them to the point where they are ready
to be discharged and want to ensure that we work with DoD and
the requirements that they have established for ensuring that
servicemember is ready for transition.
Ms. Weaver, I don't know if you would add to that.
Ms. Weaver. We are working with VA to look at other
opportunities and concepts to expedite the process. We do have
an expedited process for catastrophically injured or ill
personnel.
To date, after briefing each member who was qualified, we
have had no one who has opted to take that process, but we are
looking to see if we can broaden that concept to those that
aren't catastrophically, but too seriously, and see if we can
expedite it. These are in concept stages, and we are working
with the VA on that.
Ms. Titus. Okay. Thank you, Mr. Chairman.
Mr. Runyan. Thank the ranking member.
With that, the chair recognizes Mr. Cook.
Mr. Cook. Thank you, Mr. Chair.
Just a couple of comments and probably the same ones I had
when I was chair of the Veterans Committee and I was in
California. And I look at it from the perspective of the
veterans and the people that you are dealing with.
You know, just going through this paper right now, we are
looking at BDD, IDES, PEBLO, MSC, MEB, DBQs, CAVC, ADC. I know
that one. That is assistant division commander. And I knew MEB.
That's marine expeditionary brigade. The PEBLO was the spy ship
that was captured by the North Koreans. I thought it was BDA,
which is battle damage assessment. NARSUM, DBQ, I could go on
and on and on.
You know, I think I know more about Klingon and that
vocabulary than these acronyms, which just keep multiplying
over and over. You use them all the time. I think I know most
of them. I tried to forget most of them, you know, after 26
years in the marine corps, and then I got an education, and you
learn all kinds of things.
The point I am making is that trying to communicate with
the people that you serve by using this foreign language, at
least from my perspective, is very, very difficult. And a lot
of people don't get it, particularly the seniors. They have
serious problems.
Ms. Titus talked about that 95 percent. When I see 95
percent, I think that is something that we can make to
streamline the process. We can do that. You know, airlines
notify people when their plane is going to be late or what have
you.
The technology now, and I tell you, I am probably the worst
one to talk about technology because I am horrible at it. You
know, thank God I am married. I have a wife who is very bright
and I have grand kids who fix my computer.
But a lot of people are just brain dead when it comes to
technology, but you have to have a respect for some of these
things that can streamline that and make the system more
efficient.
Now, it just upsets me that it takes so long. And I look at
it, and this is a statement more than a question, that when
World War II started, you know, where people had to enlist, go
through the physicals, get trained, be on the front line
almost, you know, so that we wouldn't lose the war, they did
it. And getting people in there, same thing with Korea and
other times where you get people in and you can expedite the
process.
And now we have the system on the back end where people--I
spent 26 years, lot of people spent a lot of years. It is a
very, very cumbersome process that--and I think part of it is
that it is very complex, at least, and I don't think I am the
dumbest person. In this group, maybe I am.
But trying to understand all this stuff when you are going
through it, I think we have got to at least make it more user
friendly so that you can have that feedback easily and right
now the process starting with the language is very, very
cumbersome.
Everybody that works, they have their comfort set of
acronyms and vocabulary. The average person is too nice to say
what does that mean or what is the impact on it. I am dumb, so
I have to ask what the acronym is and give me an explanation.
But the average veteran that comes in there that are used
to--a lot of them are used to taking orders and what have you,
they are relying on that gunnery sergeant, that staff sergeant,
that master sergeant who they are vital. And then you come out
of that and we are talking about a bureaucratic nightmare.
So I understand what you are trying to do and I applaud it.
I just want to throw my two cents into, hey, let's get it down
to where at least somebody like me could understand it and
other veterans. I think you would have much more cooperation
and they could understand what is going on.
Thank you. I yield back.
Mr. Runyan. Thank the gentleman.
With that, the chair recognizes the gentleman from Texas,
Mr. O'Rourke.
Mr. O'Rourke. Thank you, Mr. Chair.
And, Mr. Cook, you made me feel a lot more comfortable with
my ignorance. And so if you can admit it, then I feel a lot
more comfortable in admitting my own.
But, Mr. Chair, earlier I had the privilege of introducing
Ms. Gipson who will be testifying in a later panel. I first met
her in El Paso when she was at the WTU. She had organized a
tour of that facility for me.
And in getting to tour that facility and meeting some of
the servicemembers who were there, we first learned that we had
soldiers at Fort Bliss at the WTU who had literally been
languishing there for months and years because of delays within
this IDES system and specifically the DRAS in Seattle.
And, Ms. Rubens, when we last had a chance to speak about
this in February of this year, I talked about the VA rating
goal being 15 days and for the Fort Bliss soldier at the WTU,
it was actually 143 days. The benefits goal being 30 days at
that time. It was 87 days in reality.
That was my focus then. It is still my focus today because
what I think I have heard you all say is that we are now
meeting our benefits goal as of April of this year.
But when I look at the latest data which is 18th May of
this year, it shows that for the army, we are at 48 days
instead of the goal of 30. And the Fort Bliss soldier is at 49
days.
When I look at what you are committing to doing by August
slash October in the rating getting to 15 days, we are
currently at 132 days army-wide and we are at 131 for the
soldiers at the WTU at Fort Bliss.
So explain to me the inconsistencies on the benefits goal
that you say that you have already achieved and the numbers
that I am seeing here for May and then how you can possibly
achieve the goal for October given the wide variance between
where you are supposed to be and where you are today.
Ms. Rubens. Yes, sir. And I would tell you that I think
that we are talking about the work that we are completing in
the current month versus the numbers you are reflecting are for
the entire year, the average of everything that we have
completed.
What we know about the work we are completing today as we
look, if you will, behind it in the system, that work that is
coming down the path is much younger. And so as we are now
achieving for the benefits notification phase, we are now in a
timely position. The capacity that we have will continue to
maintain that timely output for those claims that are coming to
us in that component of the phase.
As we continue to work for the proposed ratings, similar
issue, the capacity with which we are tackling the volume of
work come August, we will now marry up the work flowing to
those folks and going out the door will put us into a timely,
15 day for a proposed rating decision time frame as well
allowing us for the October number to catch up, if you will, on
the average for the entire year.
Mr. O'Rourke. Let me see if I can understand this because
this is a difficult concept for me to get and it is similar to
the way that you explained to us the backlog numbers when it
comes to disability claims for veterans and how we should be
measuring that backlog.
So if someone enters the system today, we will just use
Fort Bliss as an example, at the WTU there, at the benefit
stage, they will wait no longer than 30 days; is that correct?
Ms. Rubens. At the end of the process, the final
notification when we get that final package back from DoD, the
time it will take us then to finally promulgate that benefits
notification on average for the army is at 30 days.
I will need to go and look to see if Fort Bliss is outside
of that, but I believe we are now looking at a timely situation
across the benefits phase.
Mr. O'Rourke. Okay. And I have got limited time, but the
reason then that I am showing 48 days army-wide versus 30 days
which is what you are saying is that you still have those older
cases in the system and as soon as they move out, you will be
at that 30 day?
Ms. Rubens. And/or you are looking at information, and that
is why I need to go perhaps to sit with one of your staffers to
look at. Are you looking at the average processing time across
the entire course of the year which as we work the older ones
out meant that days to complete had gone higher and as we look
at the work coming in, it is now timely.
Mr. O'Rourke. Okay. My time has elapsed. This is something
that I am going to ask my staff through this hearing to
memorialize in a letter to you and get a written response back
from you so I fully understand it can go back to the WTU at
Fort Bliss and explain it in my own words which I am not yet
able to do given your answer. I think you are saying what I
want you to say and what they want to hear, but I want to make
sure that we are absolutely clear on what the expectation is
and what we are delivering.
So appreciate that in advance for getting back to us.
Ms. Rubens. Happy to do that and/or sit with anybody you
might to have us sit with to look at the Bliss statistics.
Mr. O'Rourke. Thank you.
Thank you, Mr. Chair.
Mr. Runyan. Thank the gentleman.
With that, I recognize the gentleman from Florida, Mr.
Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate you
holding this hearing as well.
And I think Mr. Cook is right on with his acronyms, but,
you know, he has been saying it now for months, years really,
and let's sit down and work on this because it is so very
important to the veteran.
And I am 51 and to tell you the truth, I have to read these
things twice to understand what they are. So, I mean, just for
the good of the veterans, so we owe them that, so that they can
look at it and not have to have the computer training, what
have you, and not have to go to--it is nice for them to spend
time with their grandchildren, but my kids fix my computer,
too. So, I mean, let's get serious about this.
And I have a couple questions here. Ms. Weaver, you noted
that by the summer of 2014, the military departments will be
able to work from a much improved set of policy documents that
will provide better guidance.
When exactly will these policy documents be issued?
Ms. Weaver. They are in the final processing and they will
start being published hopefully next month through the end of
August.
Mr. Bilirakis. Okay. Will you be able to quantify their
impacts on both quality and consistency of the decisions and
how will that occur?
Ms. Weaver. We are implementing a quality assurance program
and that is one of the new policies that we have that will help
the department measure accuracy and consistency, particularly
in how policy is applied across the services. Services
performed to evaluations, OSD performs one. We analyze the
results and then we can see if policy has been applied or if
policy needs to be revised.
Mr. Bilirakis. Thank you.
Ms. Weaver, you noted that 83 percent of servicemembers are
satisfied with the IDES, here we go with the IDES, experience.
Could you tell us more about that? Elaborate, please.
Ms. Weaver. Each quarter, we do a customer satisfaction
survey. The survey is done at a sampling of nine of the major
locations where IDES is--where the members are enrolled and
consensus at the remaining 131 MTFs. The survey is done after
the medical evaluation board and again after the physical
evaluation board.
It is a volunteer survey. July through December, we did
have 8,000 individuals who participated in the survey. And from
the 30 questions, four related to customer satisfaction, 83
percent indicated they were satisfied with the process.
Mr. Bilirakis. Okay. Now 8,000 of how many participated in
the process? So what percentage would that be? You said 8,000
participated. How many are in the process? Eight thousand
participated in the survey, but what would you say percentage
is?
Ms. Weaver. I don't have that number, sir, but I can
certainly get it for you.
Mr. Bilirakis. Please, or would you like to estimate
approximately?
Ms. Weaver. I don't have any number of how many.
Mr. Bilirakis. Okay. Can you please get that to me and
maybe, you know, the chairman?
Ms. Weaver. Absolutely.
Mr. Bilirakis. The rest of the panel might want that
information as well. Thank you.
Ms. Weaver, you highlighted the Electronic Case File
Transfer System that DoD piloted in 2012, but you know that
until VA develops its end of the technology, it will not yield
benefits and it is not going to be timely, in other words.
Please elaborate on this and what has DoD developed and
what does VA need to do?
Ms. Weaver. We have used the electric transfer and it was--
--
Mr. Bilirakis. See what I mean?
Ms. Weaver. Yeah. And it was successfully that we made the
transfer in December of 2013. But what we are working on is a
joint system, case management system called Joint Disability
Evaluation System that will allow us to track cases, monitor
exactly where they are at so that we can go from phase to phase
and know exactly where the case is and do a transfer to and
from internal within the service from the MEB or medical
evaluation board to the physical evaluation board and from DoD
to VA.
We are in the concept phase identifying the requirements
and we think it is going to gain major efficiencies for a
modern and efficient system.
Mr. Bilirakis. All right. Thank you very much.
I yield back, Mr. Chairman. Appreciate it.
Mr. Runyan. Thank the gentleman.
With that, I recognize the other member from Florida, Mr.
Jolly.
Mr. Jolly. No questions, Mr. Chairman. Thank you.
Mr. Runyan. Thank the gentleman.
I am going to ask one follow-up. I actually had a couple,
but Mr. Bilirakis got to them all. So thank you.
This is the kind of question in the mold of Colonel Cook
over here. We hear everything that is going right. I want to
hear from Ms. Weaver and Ms. Rubens what isn't going right.
What do we really need to fix that would make a huge
difference in the process? I mean, what can really tackle? What
are we going to get out of this hearing? I mean, as Colonel
Cook over here identified his flaws in front of everyone. That
is what we want to know from you. So what is the one thing that
could change the trajectory of this whole process?
Ms. Weaver. I think what DoD is hearing from the hearing is
that we need to go back and look at our survey. We have a
significant number of people who are participating in the
survey and we are getting results that say as of December, 83
percent were satisfied with the process. As of the end of
March, 4,000 more surveys, 84 percent were satisfied with the
process.
And we are trying to make changes from the information that
we get to the survey. We may need to look and see whether or
not we--how we can reach out and touch the individuals who are
expressing concern with either the time or the counseling that
they are getting.
Mr. Runyan. Ms. Rubens.
Ms. Rubens. I would echo some of those sentiments and
obviously it sounds as if our ability to communicate with the
servicemember, soon to be veteran could be improved.
VBA has worked in the last year to pick up, if you will,
another component of that transitioning servicemember who as he
or she begins to think about what next by placing our
vocational rehabilitation and employment counselors at many
IDES sites as well in an effort to continue to build that, if
you will, system around that transitional servicemember.
And I would tell you that obviously we want to continue to
work together in that electronic interface to ensure that as
DoD across the services builds that integrated case management
system, it marries up, if you will, sir, into our new Veterans
Benefits Management System, our paperless environment to ease
the process by which we share information not only internally
but with that transitioning servicemember as well as if they
have selected a veteran service officer as we roll out our new
stakeholder enterprise portal functionality in July of this
year so that they will have the ability to also support that
servicemember and that communication standpoint.
Mr. Runyan. I think you touched on a little bit there, it
goes back, Ms. Rubens, to Mr. Bilirakis's question. What does
the VA need to do on your end of the electronic case transfer,
file transfer to make it optimal?
Ms. Rubens. I would tell you that as far as making ECFT
optimal, there are some things that we need to do from a--the
MSC, the military services coordinator, at that intake site and
their ability to work within that environment as well as from
an electronic standpoint, the functionality of incorporating
ECFT into that, if you will, interface with VBMS to ensure that
is occurring.
And it is our roadmap to accomplish that. And as DoD
continues to build their new case management system, we want to
make sure that we are there to incorporate that as well into
VBMS.
Mr. Runyan. And what part of what fiscal year is that
happening?
Ms. Rubens. Sir, I will have to take that one for the
record. I am not sure where it is on the roadmap. There are a
number of things that we are trying to import, if you will, or
build into the functionality for VBMS.
Mr. Runyan. And one last question for Ms. Weaver. You said
that an 83 percent satisfaction rating. What was the 17 percent
on the other side, what was the kind of overall disappointment
in the system?
Ms. Weaver. It ranged. A lot of the comments were that they
did not get the information they needed. It was varying with
the medical evaluation board and the physical evaluation
including the unsatisfactory rating that they got. They would
like a different rating and move from there.
Mr. Runyan. Any other Member? Mr. O'Rourke.
Mr. O'Rourke. Thank you, Mr. Chair.
I would like to follow-up with Ms. Rubens on the line of
questioning that I was pursuing earlier about IDES. And I think
I may have some questions that can hopefully clarify this
issue.
On the benefits backlog portion of the DRAS process, you
said that in March, you eliminated the backlog and by April,
you were hitting your target of 30 days; is that correct?
Ms. Rubens. Yes, sir. We closed the capacity gap between
what we had to work and what we had the capacity to do in
March. And in April, the work that we then began to see flow
through was meeting that timeliness target.
Mr. O'Rourke. And the number I referred to earlier or I
showed that army-wide, we are at 48 days, not 30, that is the
last three months. So that might explain the difference.
So my question to you is, if we take this same measure
three months from today, it will show 30 or under?
Ms. Rubens. Yes, sir.
Mr. O'Rourke. Okay. Great.
Ms. Rubens. We have built this in our projection, in our
capacity, in our modeling to ensure that as we move forward, we
maintain achievement of the target.
Mr. O'Rourke. So I want to ask the same set of questions as
it pertains to the VA rating part of this which is that the
goal is 15 days. Today the last three month average shows army-
wide 132 days.
Are you saying that by August, you will relieve the backlog
and by October, you will meet that 15 day goal?
Ms. Rubens. Yes, sir.
Mr. O'Rourke. Okay. And then three months from October when
we look at the rolling three month average, we will see 15?
Ms. Rubens. And 15 for the proposed and 30 for the final
notification, yes, sir.
Mr. O'Rourke. Wonderful. And would you mind if, again, we
were able to get that commitment from you in writing?
Ms. Rubens. Not at all, sir.
Mr. O'Rourke. Okay. I really appreciate that. Thank you.
That is all, Mr. Chair.
Mr. Runyan. Thank the gentleman.
And no other Members have any further questions.
I ask that any of the questions that you all were taking
for the record, please submit them in writing. Thank you very
much. Thank you all again. I think it is particularly helpful
to have both the VA and the DoD at the table when discussing
IDES.
You are now excused from the witness table, and we seat our
second panel from VAOIG.
Welcome the members of the VA's Office of Inspector
General. We appreciate your attendance today. Your complete and
written statements will be entered into the hearing record.
Ms. Halliday, you are now recognized for five minutes to
begin your testimony.
STATEMENT OF MS. LINDA A. HALLIDAY, ASSISTANT INSPECTOR GENERAL
FOR AUDITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY MS. NORA STOKES,
DIRECTOR, BAY PINES BENEFITS INSPECTION DIVISION, OFFICE OF
INSPECTOR GENERAL, U.S. DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY MR. RAMON FIGUEROA, PROJECT MANAGER, BAY PINES
BENEFITS INSPECTION DIVISION, OFFICE OF INSPECTOR GENERAL, U.S.
DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF LINDA HALLIDAY
Ms. Halliday. Thank you. Chairman Runyan and members of the
subcommittee, thank you for the opportunity to discuss the
OIG's review of VBA's pre-discharge program. Our testimony
offers an independent assessment of VBA's Quick Start Program,
one component of VBA's pre-discharge program. With me today is
Mr. Kent Wrathall, the Director in our Atlanta Audit Office;
and two managers from OIG's Benefits Inspection Division in Bay
Pines, Florida, Ms. Nora Stokes, the Director, and Ramon
Figueroa, who collectively have over 40 years of VBA work
experience. Notably they have experience working in key
positions such as Veterans Service Representative, Ratings
Specialist, Decision Review Officer, certification test writer,
STAR quality reviewer, as well as a Veterans Service Center
manager.
The Quick Start Program was designed to provide a seamless
transition from DoD to VA's Healthcare and Benefits System.
Servicemembers can submit claims up to 180 days prior to
discharge under the program. Further, the program makes it
possible for veterans to receive VA disability benefits soon
after leaving military service. To assess the program's
performance we reviewed Quick Start claims completed in 2011
and then again in 2013, and we found improvement in claims
processing timeliness. During the period VBA reduced the
average days to complete Quick Start claims from 291 to 249
days. However, while timeliness improved additional improvement
is needed if VBA is to achieve the VA Secretary's fiscal year
2015 target of processing disability claims in 125 days.
Delays in processing Quick Start claims resulted from
inadequate program controls and the redirection of resources to
process other claims processing priorities. Adequate resources
and the proper allocation of resources are paramount for VA to
realize the benefits of its transformational initiatives.
Delays also occurred due to a lack of training to ensure staff
properly identified Quick Start claims, which is the first step
to initiate timely processing actions.
Our review results support that the Quick Start claims were
at risk of processing errors, such as erroneous disability
evaluations or improper grants or denial of benefits. We
projected VBA staff accurately processed 62 percent of the
Quick Start claims in 2011, while the accuracy rate for 2013
improved to 69 percent. These rates are still well below the
Secretary's 98 percent accuracy goal for fiscal year 2015.
Delays and errors impact veterans' receipt of disability
benefit payments in two ways. First, the processing delays in
2011 resulted in a number of veterans waiting an additional 196
days to receive about $88 million in benefits payments. By 2013
the same type of processing delays were reduced but still
caused veterans to wait about 99 days to receive approximately
$20 million in benefits payments. Unfortunately processing
delays also impact other entitlement decisions, such as
veterans preferences, delayed care at VA medical centers, and
participation in vocational rehabilitation efforts.
Secondly, the claims processing errors have a direct
financial impact on the amount of benefits a veteran receives
in monthly recurring entitlement payments. We projected claims
processing errors resulted in veterans being underpaid about
$2.8 million. Projected overpayments were valued at
approximately $463,000 for the same period. Additionally,
claims processing errors that do not affect current monthly
benefits have the potential to affect future benefits if left
uncorrected.
While VBA is making incremental progress in areas
specifically targeted through this initiative, much more work
needs to be done. We will continue to look for ways to promote
improvements in benefits delivery operations during our future
national audits and our VARO inspections. Mr. Chairman, that
concludes my statement and we would be happy to answer any
questions you or the committee has.
[The prepared statement of Linda A. Halliday appears in the
Appendix]
Mr. Runyan. Thank you, Ms. Halliday. And we will begin a
round of questions. First question, as you know while VBA is
reporting timeliness an equal if not greater concern is the
accuracy of the outcome for each veteran. VBA is looking at
hundreds of thousands of claims and the veteran is looking at
one and only one. Ms. Halliday, as accuracy as highlighted in
your testimony is a serious area of concern, I would like to
also ask you the question about VBA's quality component, STAR.
You noted that VBA's STAR program has several classification
errors such as benefit entitlement, decision documentation/
notification, and administrative. Mr. Murphy responded to an
inquiry as to STAR's failure to count error for incidents with
potential to affect veterans' benefits, such as when a claims
folder lacked required evidence including medical examination
or opinion needed to make an accurate decision. Can you comment
on that?
Ms. Halliday. Yes, I would appreciate that. The OIG uses a
broader definition of what constitutes an error. We report
errors that affect veterans benefits as well as those that have
the potential to affect veterans benefits in the future if left
uncorrected. We think this is important. It is a veteran-
centric approach. We do not feel that the STAR program counts
all of its errors. There is a disagreement between what OIG
considers an error and how VBA calculates its accuracy rate.
I have a couple of examples here that we think might help
you understand. VBA does not consider an incorrect disability
evaluation to be a benefit entitlement error unless the error
impacted the veteran's overall combined disability evaluation.
However, OIG would identify this case as an error because it
has the potential to affect the future benefits if left
uncorrected and that it also has a corresponding potential to
affect other programs as the ratings change.
Also, cases where VBA staff simply do not request or
significantly delay requesting the mandatory routine future
examination to determine whether the temporary 100 percent
disability determination should continue we clearly call an
error. We see a significant financial impact associated with
not managing those claims appropriately.
Mr. Runyan. Thank you. Next question, is VA working with
the OIG to make the improvements identified in the audit
process?
Ms. Halliday. This past year there have been significant
challenges to us to address the oversight that we are expected
and charged with to look in the benefits inspections and to
perform national audits. I finally raised this issue to the
Under Secretary Allison Hickey. She has agreed to try to ensure
that we do not have these obstacles or have this resistance and
that we work toward a facilitated process so that OIG can help
VBA get it right.
This is important. To spend so much time dealing with a
nuance of a technical issue technically how you say something
versus trying to fix the big picture is not the way to go. I
think you need to look at what are we saying. Why are we saying
it? How does it affect veterans? And then go make the changes
you need in these programs.
Mr. Runyan. Last question. In your view, given the
challenges VA faces addressing the longstanding backlog of
claims, do you feel the VA has control over its remaining
workload?
Ms. Halliday. At this time we see that VBA's pending
backlog in compensation claims is dropping. However, I have
significant concerns that they do not have a good handle on
some of the workload in their other areas. For example, in the
area of dependency issues. As of May 15, 2014 their own VOR
report, which is the VETSNET Operations Report, shows almost
253,000 disability claims that will impact benefits. On average
the claims are pending over 315 days. For eligibility
determinations, the same report shows approximately 110,000
adjudication decisions relating to benefits that have been
pending on average 361 days. And in predetermination notices we
see approximately just over 81,000 predetermination notices
affecting benefits that have been pending for 177 days.
There are definitely problems in managing the workload. The
priorities, we hear time and time again the priority is to
bring down the pending backlog in compensation at the expense
of not addressing some of the other issues. The Quick Start
program is a perfect example within our audit where resources
were redirected away from that program. And you can see in the
audit there is a table that the workload, the timeliness spiked
in 2012. And I know VBA is working hard now and has put
resources back in the program, but you have to keep resources
dedicated to significant transformational initiatives if you
want to achieve success.
Mr. Runyan. Thank you for that answer. And I had that
precise discussion with Chairman Miller this morning. So, thank
you. With that, I will recognize the Ranking Member Ms. Titus.
Ms. Titus. Thank you, Mr. Chairman. I was going to ask that
question, too. Do you think that these programs are being hurt
by the focus on just reducing the backlog no matter what? And
the veterans who are in these programs do not count as part of
those figures that are used to show the backlog, even though
they are waiting those long periods of time. Is that accurate?
Ms. Halliday. That is my understanding, yes.
Ms. Titus. Another thing that does not seem to count, and
you mentioned that the VA does not count the processing time
that occurs prior to leaving the service when they are talking
about the amount of time it takes to process one of these
claims. Would you expand on why that would be an important
aspect of this whole backlog?
Ms. Halliday. In the simplest of terms, if I am a veteran
and I file a claim, I start counting from that day.
Ms. Titus. Yes.
Ms. Halliday. Now I understand that VBA is very concerned
that they have upfront processing at a point where the active
servicemember has not become entitled to the benefit. But when
you are looking at a process you must look at the process
throughout the entire processing cycle so that you can
understand where you have dedicated your resources and to what
extent you are getting the appropriate outcomes from that
resource. So, and I feel that if you go with a veteran-centric
approach you would count that time. You would not start the
payments for entitlement until they were released from active
duty and came into VA care.
Ms. Titus. And would that help you to understand the whole
process and the procedure?
Ms. Halliday. Right.
Ms. Titus. And make needed adjustments?
Ms. Halliday. Absolutely. I think that in the many
discussions I have had with Ms. Rubens and Mr. Murphy, I know
that resources are needed and you have to make good decisions
on where those resources are. So I think it is very important
to measure all of your resources and track those. It is
obviously an area where the Under Secretary had not concurred
with us in our report, and we are going to stand pat with what
we have said.
Ms. Titus. Okay. Well, thank you. And going back to the
first point about these programs failing because so many are
doing less well than expected, because so much emphasis is put
on the backlog, isn't it really kind of a matter of robbing
Peter to pay Paul?
Ms. Halliday. I have said that a number of times.
Ms. Titus. Okay. Well great minds think alike. Thank you,
Mr. Chairman.
Mr. Runyan. The chair recognizes Mr. Cook.
Mr. Cook. Thank you very much. And I will not say too much
more about acronyms, maybe. The, your report, very sensitive,
because I used to be an IG. And I looked at your
recommendations. And by the way, IG, that is a thankless job.
How to lose friends and not influence people, I used to say.
But it is one that you have to have in an organization. And
your job is not to make friends. You already know that.
It bothered me a little bit, and maybe if you could help me
out, where the, in two cases it had the VBA, which is, help me
here? That is the Veterans Benefits Administration?
Ms. Halliday. Yes.
Mr. Cook. They disagreed with your opinion. And then you
had the other one where it was actually the Under Secretary, is
that the same individual for all intents and purposes?
Ms. Halliday. I would consider it the same.
Mr. Cook. You know these are, I was looking at them, you
know, particularly one where the Under Secretary non-concurred
but basically went along with it anyway. Did this go all the
way up to the Secretary? Or is this something, is that a
command decision that an Under Secretary would, because we are
getting into some dicey stuff in the last few days on this. And
I am trying to figure out on who is going to make these command
decisions. These are pretty important. And maybe it is just my
sensitivity with IG reports but 26 years in the Marine Corps,
or what have you, everybody kind of gets a little nervous about
IG reports and they pay attention to them, at least I used to.
Maybe because I used to write them. But any comment on that at
all? I do not mean to put you on the spot. But you know what I
am saying, I think.
Ms. Halliday. It is the responsibility of the Under
Secretary for Benefits to provide the official signed comments
to an IG report. I believe that the Secretary does get copies.
He gets copies at the point of when we issue the draft report
for review and to obtain those comments, and then gets copies
of the final reports. If a report is significant we certainly
brief, I would think we follow traditional audit processes that
has an exit briefing, where we have a discussion with the VBA
officials that are charged with the governance of the specific
program. I have had many briefings with that team. And they
feed up to their USB.
Mr. Cook. Well this is an important point, at least to me.
In the military you used to have two things. One was you would
have by direction authority, in other words it is a commanding
officer but somebody in the command could sign their signature
by direction. That means that, you know, by signing by
direction that the commander approves this. The other was
releasing authority. Releasing authority means you can go out
with a message that you are the Commanding General 2nd Marine
Division. Very, you do not give those, that authority away. And
that is why I brought up that point that whoever signs that
basically the Secretary, the way I understand it, is concurring
with all those decisions that are made. It is on his or her
watch. Correct me if I am wrong.
Ms. Halliday. If it is signed for General Hickey by one of
her staff, yes. This is the official comments.
Mr. Cook. Okay. All right. The, in terms of your role, and
I think it is very, very important to go back to, how would you
even be more proactive in light of some of the things? Do you
have any recommendations in regards to that? I am not asking
you to do more work but, yes, I am asking you to do more work.
Ms. Halliday. I think that we plan the audits appropriately
based on the risks in the programs. I think if you were to ask
me about being more proactive I think there needs to be more
discussion at the senior levels as work is completed to really
how are you going to fix the problem? And as I alluded to
before, worrying about the little technical nuances in getting
everything just letter perfect really does not get you there.
You really have to address the overall problem and how veterans
are affected with the process and what is happening in whatever
objective of the audit you are dealing with.
Mr. Cook. Thank you. I yield back.
Mr. Runyan. The chair recognizes the gentleman from Texas,
Mr. O'Rourke.
Mr. O'Rourke. Thank you, Chairman. The BDD, the Benefits
Delivery Discharge claims and the Quick Start claims I think
year to date are under 25,000. So if we are measuring that in
the thousands or maybe tens of thousands, and then all other
claims moving through the VBA we are measuring in the hundreds
of thousands or millions. So when you were responding to Ms.
Titus' question earlier about robbing Peter to pay Paul, and
you also mentioned that we need to make better decisions about
how resources are allocated, do you have some recommendations
for the VBA or for the committees of oversight in terms of how
we should be spending that money in a smarter fashion?
Ms. Halliday. I would like to see that you ask VBA to do a
good staffing analysis for its initiatives and for its current
work in house. There are too many areas that are being
underaddressed at this point, or what I would consider
undermanaged. I think at some point if you were to put the
right resources on some of these things, such as temporary 100
percent disability evaluations not being managed effectively
and the association financial impact that we report in our
reports, that would start to reduce and you would have a better
operation. Not only from the fact that veterans would be served
quicker with whatever decisions and reviews that were needed to
make sure their claims were accurate. And then we would be
saying that you have a stronger, you are making a stronger
position as far as the financial stewardship that you are
charged with VBA to ensure the entitlement decisions are
accurate and timely.
Mr. O'Rourke. And the, thank you for that, the chairman
brought up a good question about why the VA's score for
accuracy is better than your score. And you said one difference
in the methodology is you look at potential adverse impacts to
benefits down the road and perhaps the VBA does not. Is there
any other difference in how you assess and the VBA assesses
accuracy?
Ms. Halliday. Yes, I believe there are. I would like to ask
Nora Stokes to talk to the technical aspects of that.
Ms. Stokes. As you mentioned there are some definite
differences as far as the potential to affect benefits. And we
do call oftentimes errors that relate to that. And that is
particularly when things are missing from the file. And as Mr.
Murphy had indicated in his response, I believe the specific
question had to do with whether or not a VA examination if it
were missing would that constitute an error. What we find in
our benefits inspections are the VA examinations may be not
necessarily missing, some are missing, some are inadequate, but
they are used to evaluate cases with anyway. Our position is
according to VBA policy those examinations should be returned.
If an examiner notes something during a physical examination
and another disability questionnaire is required and it is not
completed and we consider that an error as well because you
cannot come to the point where you can make a decision on a
disability evaluation if you do not have medical evidence to go
one way or the other. So those are some stark differences in
the methods that we would determine an error versus VBA.
Mr. O'Rourke. And Ms. Halliday, I hate to ask you to speak
for the VBA, and I certainly want to follow up with Ms. Rubens
and her team, but what is their response to that distinction
and the assertion that those exams should be returned or should
be counted differently than they are right now?
Ms. Halliday. We have agreed to disagree----
Mr. O'Rourke. Got you.
Ms. Halliday [continuing]. At that point. That is why it is
documented in this audit.
Mr. O'Rourke. Okay. And then my last question, I do not
know if you heard the exchange over IDES and where we are
against backlog and goal for benefits and backlog and goal for
rating. Did you have any concerns or questions? Or do you agree
with the assessment provided by VBA about where we are at and
where we are likely to be by October?
Ms. Halliday. I cannot comment to that, sir. I do not have
any ongoing work addressing that.
Mr. O'Rourke. Thank you. Thank you, Mr. Chair.
Mr. Runyan. Mr. Jolly.
Mr. Jolly. Thank you. I want to follow up just on a little
bit of what we have discussed. And I understand the
disagreement on timeliness issues seems somewhat jurisdictional
and a couple of other matters. But on accuracy, you report that
the accuracy rate is about 69 percent and one of the areas of
non-concurrence is something that seems pretty benign, which
was insufficient oversight and training. Can you elaborate a
little bit on that? And, I mean, I will put my cards on the
table. In many ways you are providing a little bit of oversight
into reasons for the inaccuracy it appears. One of the reasons
you identified was insufficient internal training and
oversight. We are engaged in the same issue right now with the
department obviously on healthcare deliver. Can you elaborate
to the extent you are permitted to on the disagreement on the
interpretation about the department's ability to provide the
oversight and training in this specific area?
Ms. Halliday. Yes. I would like to ask Kent Wrathall, who
led the audit. But I do believe as you looked at the training
issue it spoke specifically to how you identify a Quick Start
claim. And I would like him to----
Mr. Wrathall. The department actually agreed with the
training recommendation on the identification of the Quick
Start claims. Where they disagreed was on the clarification of
policy concerning the nexus between servicemembers, the
disability incurred during service and the claimed disability.
And actually our accuracy experts here are Ms. Stokes and Mr.
Figueroa, so I will turn it over to Ms. Stokes.
Ms. Stokes. Yes. One of the areas that we where the
oversight was lacking had to do with just the local quality
reviews. So at the local level we did find that the accuracy
reviews that most regional offices would conduct on a monthly
basis for individual performance was lacking. While they did
have some we did find it to be inadequate. When we discussed
with the staff in the CPS sites that process Quick Start claims
they told us that they were busy, they had other
responsibilities, and that they did not have the time to
conduct the comprehensive review.
At the national level we found there was a lack of
oversight in that the method that STAR uses to select their
samples was lacking in that it did not sufficiently identify
enough cases that you could actually get a feel for what the
accuracy rate was for Quick Start claims. Or they co-mingled
the results of the Quick Start cases with the results of the
regional office. As an example, the Winston-Salem office had I
believe for the year of fiscal year 2011 they had 255 reviews
but only six of those claims that were reviewed were related to
Quick Start. So we found that the method they are using was not
sufficient to observe any sort of training deficiencies. And
the other part of that is not only at the local and the
national level were they not able to have a valid sample that
might point to some of these training deficiencies, at the
local level when they did conduct their quality reviews they
also did not track and trend those types of errors so that they
could address those training deficiencies by tailoring training
to those particular areas.
Mr. Jolly. I see. One of the reasons given was busy. I
mean, I guess the part that concerns me is specifically the use
of the word training because of what that means for the ability
of an employee to perform. Oversight in one way is a little
less concerning if that is where it is deficient. But if
training is where it is deficient, you know, that just breeds a
more systemic problem as case loads go up and the number of
cases go up, failure in training just continues to build upon
itself and create a larger problem. I appreciate your answer to
the question. Thank you. Thank you, Mr. Chairman.
Mr. Runyan. I thank the gentleman. Do any members have any
further questions? With that, thank you all again and you are
now excused from the witness table and we ask the third panel
to come forward.
Good afternoon, everyone. As I noted in prior panels all of
your complete and written statements will be entered into the
hearing record. I know I did this earlier, but I want to
recognize Mr. O'Rourke if he would like to make his
introduction again.
Mr. O'Rourke. Thank you, Mr. Chair. The person I want to
introduce deserves a second introduction. Ms. Gipson is a
Retired Captain from the U.S. Army, was the Executive Officer
at the
Warrior Transition Unit in El Paso at Fort Bliss, a former
constituent of mine recently until March. She was instrumental
in ensuring that I understood some of the issues at the WTU by
arranging a tour there and I think will speak very eloquently
to some of her personal challenges that can be extrapolated
against the challenges that many transitioning servicemembers
face. And so we are very glad and grate for her presence here
today. Thank you, Mr. Chair.
Mr. Runyan. I thank the gentleman. With that, we are going
to start with Mr. Jenkins. Mr. Jenkins, you are now recognized
for five minutes for your testimony.
STATEMENTS OF MR. ERIC JENKINS, RATING VETERANS SERVICE
REPRESENTATIVE, WINSTON-SALEM REGIONAL OFFICE, AMERICAN
FEDERATION OF GOVERNMENT EMPLOYEES, AFL-CIO AND THE AFGE
NATIONAL VA COUNCIL; MS. DEBRA J. GIPSON, INDIVIDUAL
SERVICEMEMBER; MR. GERARDO AVILA, NATIONAL MEB/PEB
REPRESENTATIVE, THE AMERICAN LEGION; MR. PAUL RAYMOND VARELA,
ASSISTANT NATIONAL LEGISLATIVE DIRECTOR DISABLED AMERICAN
VETERANS; AND MR. BRENDON GEHRKE, SENIOR LEGISLATIVE ASSOCIATE,
VETERANS OF FOREIGN WARS OF THE UNITED STATES
STATEMENT OF ERIC JENKINS
Mr. Jenkins. Chairman Runyan, Ranking Member Titus, and
distinguished members of the subcommittee, thank you for the
opportunity to testify before the subcommittee on the critical
issues surrounding the BDD, Quick Start, and IDES programs.
I am a 15-year veteran of the United States Marine Corps
who served in both Operation Enduring Freedom and Iraqi
Freedom. I am an RVSR in the Winston-Salem regional office
where I have worked for the past nine years. I am proud to
serve veterans every day and I am also a disabled veteran.
As an RVSR I work both BDD and Quick Start claims and I
would like to begin my testimony by stating my dedication as
well as AFGE's dedication to all of these programs. These
programs are critical for providing recently discharged
veterans their benefits as soon as possible and it is essential
that these programs are functioning at their highest capacity.
My regional office has a history of brokering claims to
other regional offices in an effort to reduce the backlog. In
doing so it has created a lack of sufficient cases that are
ready for decision. We have brokered out approximately 20,000
cases in the last three years and now claims processors are
struggling to receive adequate amounts of work to meet their
production standards. Supervisors have been left scrambling to
find work for the Quick Start employees. Due to brokering RSVRs
are relegated to completing tasks traditionally done by VSRs.
Due to the lack of work, management recently instructed
employees in BDD to begin a practice called pre-rating. Pre-
rating consists of rating a case that is not in fact ready for
decision because we are awaiting VA exams or additional
evidence. Management instructed the raters to rate these claims
as if the medical evidence had already been received yet told
the employees to not finalize the rating. This raises serious
questions for both the veteran and VBA employees processing the
claim. Employees could potentially receive quality errors if
medical evidence arrives and does not coincide with the
employee's pre-rating decision which also could lead to PIPS.
Veterans should be concerned about this method used by VBA
management and its effect on their rating decision. AFGE urges
Congress to hold VBA senior management accountable for their
brokering methods and potential effects it has on veterans and
their dependents.
As with BDD and Quick Start, employees in the IDES programs
report the same dedication to IDES process. However, they did
outline several issues that consistently appear. IDES claim
processors expressed their frustrations with the lack of
communication and training issues with MSCs, or military
service coordinators as they are called. MSCs are scattered at
military bases all around the world and when a claims processor
at a VBA office is attempting to locate additional information
about a claim it is often difficult to locate the original MSC.
When the claim is sent to the regional office it is supposed to
be ready for decision. However, our reports say that oftentimes
this is not the case. This slows down the process for the VBA
employee but most importantly increases wait times for the
veteran. AFGE believes that more detailed training for MSCs
will significantly reduce this issue.
IDES processors also expressed issues with the National
Guard and Reserve claims, the issue being not having complete
military records and as they come to the regional office not
ready for decision as well. At times when attempting to receive
medical records the rater cannot locate the records or the unit
the veteran is currently assigned to. All of these issues
translate to major concerns with IDES production levels. Claims
processors are also told not to defer cases, even though a
decision cannot be made due to a lack of necessary evidence.
There is constant pressure from the VA's Office of Field
Operations and the production quotas established by OFO are
arbitrary and unfair.
AFGE also heard issues regarding resources for processing
BDD, Quick Start, and IDES claims. Claims levels have
skyrocketed while regional offices have seen minimal growth in
staffing. AFGE urges VBA to hire additional claims processors
and provide more in depth and relevant training for current
employees.
AFGE also urges VBA management to conduct a time motion
study to determine how long each task takes to complete while
working a claim. With the recent transfer to VBMS this time
motion study is more applicable and necessary than ever.
Once again, I would like to thank the committee for
providing AFGE the opportunity to share our views and I would
be happy to answer any questions.
[The prepared statement of Eric Jenkins appears in the
Appendix]
Mr. Runyan. Thank you, Mr. Jenkins. With that, Ms. Gipson,
you are now recognized for five minutes for your testimony.
STATEMENT OF DEBRA J. GIPSON
Ms. Gipson. Thank you, Chairman Runyan. I would also like
to thank Congressman O'Rourke for inviting me to speak today.
In 2011 while training to deploy to Afghanistan I received
a severe back injury. By the time my Reserve detachment reached
the active duty training site, Fort Bliss, Texas, I was
confined to a wheelchair, earning me the nickname, ``The
Wheelchair Soldier.'' Days later I was prescribed a cocktail of
drugs which allowed me to walk but not without excruciating
pain. Placed in the warrior transition program, efforts to
rehabilitate my injury were unsuccessful requiring surgical
intervention.
Before my back surgery could be performed I required a
surgical procedure to treat uterine fibroids, tumors on my
uterus. I did not receive a follow up gynecological
appointment.
Placed in IDES, I was determined to be medically unfit to
serve, received a 20 percent disability rating, medically
separated, and received separation pay. Within days of signing
paperwork agreeing to the rating, it was determined that I
urgently needed a hysterectomy. I want to be clear that had I
received a follow up to the original gynecological procedure,
my hysterectomy would have been performed at least a year
earlier and my disability rating would have been 70 percent.
Instead of being medically retired, I was medically separated
from the United States Army on January 11, 2014.
In my opinion a strong democracy requires two professions,
the legislator and the servicemember, each the weapon of the
other. Healthy servicemembers are the weapons of the legislator
while the legislator is the weapon of wounded, injured, and ill
servicemembers. We have served as your weapon. On behalf of
disabled and medically separated veterans we respectfully
request that you harness your arsenal's full potential to fix
the IDES system and maintain the strength of our democracy.
I would like to present to you both short and long term
recommendations. Please note that I participated in IDES as an
end user, and please forgive me for any policy recommendations
which overlap those of previous presenters.
The first, establish a consolidated disability evaluation
system. The IDES system is tiresome, timely, burdensome, and
inefficient. The VA and DoD must consolidate the departments'
disability systems with the shared goal to promulgate policy
and prescribe uniform guidelines, procedures, and standards to
eliminate redundancy inherent in adjudicating claims.
Second, create a sole source disability rating. The
military rates only fitting conditions while the VA rates all
service connected injuries resulting in two different rating
systems for servicemembers. The DoD and VA will need to reach a
consensus on the definition of qualifying conditions and the
rate at which those conditions and events are to be
compensated. Understandably a bias in the favor of the more
generous VA system will result in a corresponding rise in both
retirement and medical costs.
Information sharing. Plans to roll out shared use
technology will enhance and improve agency accessibility to
healthcare records. The plan is both necessary and ambitious.
However, the current lack of available technology I believe is
only part of a much larger problem. Government agencies, among
them DoD and VA, must generate memoranda of agreement allowing
agencies to openly share information. This will likely create a
change in agency cultures from one of independence to
interdependence when sharing information and resources.
My interim recommendations are as follows. First, I
recommend a fiscal set aside. Veterans in the servicemember
transition process frequently complain about the receipt of
timely payments once his or her claim has been adjudicated. To
date, the receipt of benefit payments can take from 90 days to
a year or more to process. While uncertain of the legal or the
tax implications, I recommend that once a servicemember enters
federal service, active duty, Guard or Reserve, a percentage of
the servicemember's salary be escrowed until the IDES or
retirement process is completed. The funds set aside could then
be automatically reimbursed to the veteran as a lump sum
payment used to bridge the gap between the date of retirement
or separation and receipt of any long or short term benefits.
An emergency rating reconsideration. Servicemembers who
require emergency surgeries within 60 to 90 days of being rated
should receive an automatic disability rating reconsideration.
Thirdly, complete a comprehensive staffing needs
assessment, which I believe has been covered by other members
of the panel.
Fourth, reduce waste, fraud, and abuse. The system is
replete with opportunities for fraud, waste and abuse. The
underlying premise of the adjudication process is to provide
compensation and benefits for long term injury and illnesses.
Any system which compensates servicemembers for injuries and
illnesses must also incentivize healing and recovery. It is not
a politically popular notion, however if the looming costs are
to be reduced and full recovery is to be achieved this must
also be a corresponding goal. A comprehensive assessment then
must be performed about where opportunities exist to eliminate
fraud, waste, and abuse.
And finally, organizational change. We have got to change
the organizational culture which punishes servicemembers either
directly or indirectly for wounds, injuries, or illnesses. In
the current climate servicemembers deemed unfit to fight or
conduct acts of physical fitness are cast aside and labeled,
often unfairly, as lazy or cowardly. I do not advocate
battlefield group hugs. However, leadership training must
encourage compassion, dignity, and respect. Likewise service
providers, whether military or civilian, must receive similar
training. Toxic leaders, both military and civilian, must be
either retrained or moved out of leadership positions or
positions of authority to mitigate damage to wounded and/or
recovering servicemembers.
In conclusion the recommended suggestions to improve IDES
will each require a cross benefit analysis to determine
feasibility. Such analysis is beyond the scope of this
presenter. What is certain is that each cost and benefit must
be assessed using both qualitative and quantitative analysis.
It is my belief that undertaking such analysis, however
painstaking, would improve IDES to the benefit of retiring
servicemembers. Thank you.
[The prepared statement of Debra Gipson appears in the
Appendix]
Mr. Runyan. Thank you. And with that, I recognize Mr. Avila
for his testimony.
STATEMENT OF GERARDO AVILA
Mr. Avila. Good afternoon, Chairman Runyan, Ranking Member
Titus, and members of the committee. On behalf of our National
Commander Dan Dellinger and the 2.4 million members of the
American Legion, I want to thank you for bringing to the
attention of America the transition of these servicemembers. I
think it is especially important that you are paying close
attention to the words of the veterans service organizations.
Veterans service organizations such as the American Legion
bring experience to the claims process and are critical
stakeholders who can help the government meet its obligation to
the veteran. The VA has recognized this on the civilian side of
the dividing line of service and through their programs like
the Fully Developed Claims Initiative capitalized on the
partnership to improve the claims process and help veterans get
the disability benefits they earned through their sacrifice in
a more timely fashion.
In my current position as Medical Board and Fiscal Board
Representative, I have the privilege of assisting
servicemembers who might not be able to continue their military
career due to a medical condition. These individuals represent
some of the most at risk transitioning servicemembers due to
their current medical needs.
While the current Improvised Disability Evaluation System,
known as IDES, a joint program by DoD and VA, is an improvement
over the previous system of doing medical evaluations, we can
always make it better. The American Legion maintains a national
staff at the Benefits Delivery Discharge location at Winston-
Salem, North Carolina and Salt Lake City, Utah, as well as out
processing sites at Joint Base Lewis-McChord in Washington
State, and the Washington, D.C. Capital Region. What we found
is that servicemembers could benefit from better information.
This is perhaps better illustrated by members of the Reserve
and National Guard who might be going through the process by
themselves back at their home state. They do not have the
access to the same information and resources as their active
duty counterparts.
These veterans going through transition are making
decisions that will impact their entire civilian lives and
often they are being asked to do so with little understanding
of what that impact will be. As American Legion service
officers we can bring insight to what benefits they are
entitled or not entitled to. We can also help them understand
the importance of their medical exams. Helping servicemembers
manage expectations and understanding the timelines is
critical. Helping them understand what job training and
resources are available, what short discharge or retirement
options are best suited to them. The kind of guidance is still
hit or miss without good counseling.
The American Legion helps over 500 servicemembers a quarter
with their BDD and Quick Start claims but thousands of veterans
still go unrepresented. It is often difficult for service
organizations to communicate directly with servicemembers on
post. When you consider a report issue on May 20th by the IG,
VA is making errors on these claims with only around a 69
percent accuracy rate.
Veterans need advocacy at every stage of the process. The
American Legion hopes to continue working with the Department
of Defense and the Department of Veterans Affairs to ensure
that all veterans have advocacy throughout their transition
process. The system exists to serve those who wear the uniform
of the United States of America. But the American Legion exists
to be a veteran serving veterans organization. And we can best
do that when we bridge the gap between our veterans and
servicemembers and the services provided by DoD and the VA.
Thank you for inclusion of the stakeholders. We are happy
to answer any questions.
[The prepared statement of Gerardo Avila appears in the
Appendix]
Mr. Runyan. Thank you. And we will recognize Mr. Varela for
his testimony from DAV.
STATEMENT OF PAUL RAYMOND VARELA
Mr. Varela. Thank you, Chairman Runyan. Good afternoon,
Ranking Member Titus, and members of the subcommittee. DAV
appreciates the opportunity to testify today at this hearing to
examine more closely the IDES program and other aspects
affecting active duty servicemembers participating in the BDD
or Quick Start programs, commonly referred to as the pre-
separation process. My oral remarks will address three issues
we find particularly important.
First, time frames and benchmarks established within the
IDES program. The IDES program was constructed with the
expectation of servicemember reaching finality within 295 days
and we will highlight several critical points along this
transition path. Proposed rating decisions by D-RAS locations
are required to be issued within 15 days of receiving
notification that a servicemember has been deemed unfit for
duty. DAV service officers in the field do report delays in the
proposed rating process, in some areas ranging anywhere from
three to six months. Once separated from service and now
considered a veteran their disability compensation payments are
expected to begin within 30 days of discharge. DAV service
officers have reported delays in the processing of finalized
IDES claims in Providence, Rhode Island and previous delays in
Seattle, Washington. At Seattle, Washington D-RAS sites
improvements have been noted within the past few months due
mostly to consolidation and reorganization of resources. Delays
are also reported out of D-RAS sites in Rhode Island, not only
affecting final rating board determinations but also the
proposed rating board determination.
DAV finds most reports of delays are personnel related,
specifically a lack thereof, a situation where demand has
outpaced resources. A thorough evaluation is needed to
determine exact resource and personnel requirements and whether
a proper case to staff ration model exists. Of critical
importance is when an active duty servicemember crosses the
threshold and becomes a veteran. A delay here could have
serious consequences as compensation benefits may in fact be
their sole source of income.
Second is VSO access and support. DAV's transition service
officers have earned a renowned reputation for their services
within the active duty and veteran community. Despite their
reputable attributes and proven track records the launch of the
new TAP/GPS program, whether deliberate or not, has adversely
affected the level of service DAV TSOs have been able to
provide during the pre-sep process. Prior to TAP/GPS DAV was
heavily engaged in the pre-sep process. TSOs routinely provided
briefings to class participants, many times at the insistence
of military installations. They screened personnel medical
records and performed one on one counseling to provide
information and answer any questions posed by the participants.
Unfortunately our role continues to diminish and is met
with some resistance at some military installations. In some
cases there have even been attempts to remove the VSO presence
and functions entirely. What is presently occurring seems
counterintuitive. In some instances VSOs' assistance is
promoted, whether through the IDES process itself during the
physical evaluation board proceedings, but most certainly while
engaged with the VA during the claim and appeal process. VSOs
represent roughly 60 percent of claimants and 70 percent of
appellants before the VA. Collaborative efforts between VSOs
and program affiliates would serve as a benefit to our
separating servicemembers.
Third, vocational rehabilitation and employment services.
Servicemembers proceeding through IDES with ratings of 20
percent or greater have direct access to voc rehab counselors
stationed at military installations where IDES is performed.
Bear in mind this IDES mission parameter is staffed with voc
rehab counselors that are drawn away from daily regional office
VR&E operations. DAV has testified on many occasions regarding
the benefits of the VR&E program. VR&E can provide
opportunities for immediate transition to employment upon
separation, career counseling, and supportive services and
plans if employment is not aligned prior to separation. VR&E
benefits may not be realized by pre-sep personnel as their
focus could be on the use of Post-9/11 G.I. Bill benefits.
However, DAV and our independent budget partners have
recommended that Congress remove the 12-year delimiting period
to use this earned benefit to ensure it is available when
needed, regardless of when that need arises. With the wide
range of benefits offered through the voc rehab program it is
imperative that servicemembers have as complete an
understanding of this benefit as possible. It could prove
critical at some point in the future if circumstances in their
lives change.
In conclusion resource needs must be comprehensively
identified, procured, and utilized. Programmatic goals and
parameters must be aligned to meet or exceed this servicemember
and veteran-centric mission. VSO involvement during the pre-sep
process is vital and should receive greater support by all
program partners. VR&E eligible participants must continue to
be identified. Availing these services during the active duty
phase assures program understanding and gives our wounded, ill,
and injured servicemembers and their families the best
advantage by leveraging all available tools and resources
needed to successfully transition out of the military.
Again, Chairman Runyan, Ranking Member Titus, and members
of the subcommittee, we thank you for the opportunity to
present this testimony today.
[The prepared statement of Paul Raymond Varela appears in
the Appendix]
Mr. Runyan. Thank you. And with that I would recognize Mr.
Gehrke for the VFW testimony.
STATEMENT OF BRENDON GEHRKE
Mr. Gehrke. Mr. Chairman and members of the subcommittee,
on behalf of the men and women of the Veterans of Foreign Wars,
I would like to thank you for the opportunity to testify at
today's hearing on VA's performance in the servicemembers
transition process. This past Memorial Day many Americans
displayed pride in the veterans who fought in America's wars.
Surveys show 91 percent of Americans say that they are proud of
military servicemembers. Unfortunately the pride America has
for its servicemembers still is not fully matched by the
government agencies charged with supporting their transition
back to civilian life.
The 2007 Walter Reed scandal was a wake-up call to
Americans that the government was not properly caring for our
wounded warriors. The public was outraged that Marines and
soldiers were living in disparaging conditions, forced to deal
with inattentive management and woefully inadequate care
delivery. Equally concerning was that veterans were being
shortchanged on the disability and retirements they have
earned.
As a result Congress and the President conducted fierce
oversight over the military's and veterans healthcare and
disability benefits system. Congress concluded that the care,
coordination, and reintegration services provided by the
agencies were fragmented, leaving the public, servicemembers,
and their families to question the government's commitment to
those who carry the burden of battle. In 2008, Congress forced
DoD and VA to create policies to ensure that the disability
evaluation systems which determined their military and veterans
benefits were streamlined and fair. As a result, DoD and VA
collaborated to create the Integrated Disability Evaluation
System, which simplified the disability evaluation process by
eliminating duplicative disability examinations, ratings, and
placing VA counselors in military transition facilities. The VA
has also responded by expanding the Benefits Delivery at
Discharge and Quick Start Programs to allow servicemembers to
submit claims before their discharge date.
The VFW believes these promising programs are a step in the
right direction. However, we recognize that these programs are
far from perfect. Servicemembers still suffer from the Defense
Department's disjointed policies and leadership, which govern
wounded warrior care; inadequate VA and DoD staffing dedicated
to the benefits evaluation process; no integrated electronic
healthcare system; and poor communication. The result of DoD's
and VA's shortcomings is that servicemembers are waiting too
long in wounded transition units as VA processes their
disability claims.
To reduce claims processing times we recommend that DoD
collaborate with VA to reduce red tape and that VA expedite the
adjudication of BDD and Quick Start claims. To ensure DoD
creates and enforces the policies that ensure servicemembers
are not shortchanged on benefits and that all policies are
equitable, we recommend that Congress give the Under Secretary
of Personnel and Readiness the sole authority to develop policy
to improve the care and services provided through IDES.
To say the transition process is seamless for
servicemembers or that DoD and VA have an integrated disability
evaluation process would be inaccurate. It is impossible to
have an integrated disability evaluation process without an
integrated electronic healthcare record system. Therefore it is
imperative that Congress use their complete authority to ensure
DoD collaborates with VA to create a fully integrated
electronic healthcare record system. Also communication between
DoD and VA senior officials must increase and the departments
must conduct better outreach to servicemembers, family
caregivers, and VSOs.
In conclusion we acknowledge that both the Departments of
Defense and Veterans Affairs are delivering quality care to
servicemembers and veterans when accessible. We give them
credit for addressing the disability evaluation system and
setting ambitious timeliness goals for delivery and benefits so
long as those goals are achievable. Timeliness is drastically
improved from the estimated 540 days it took to complete a
claim with the legacy system and VA and DoD continue to shorten
the amount of time it takes to process disability claims.
However, VA and DoD do not have the policies, procedures, and
resources to address the influx of servicemembers who will be
transitioning to civilian life as forces draw down. It is
imperative that Congress not only boost its aggressive
oversight over the agencies to ensure that they properly plan
for the future, but they also must provide the fiscal resources
to improve the access to care and benefits that our
servicemembers have earned.
Mr. Chairman, this concludes my testimony and I look
forward to answering any questions the committee may have.
[The prepared statement of Brendon Gehrke appears in the
Appendix]
Mr. Runyan. Thank you. And with that we will begin a round
of questioning. And my first question is going to be for Mr.
Avila. You note in your testimony that in a recent audit by the
VAOIG on the Quick Start program VA responded that a lack of
timeliness was due to an increase in Agent Orange claims.
Unfortunately this seems to be a pattern from the VA in that
they do not adequately project their future workload and divert
attention from problems focusing on the unrelated issues. Can
you please elaborate on this statement and how it negatively
impacts a substantive focus on the improvement of pre-discharge
claims?
Mr. Avila. Mr. Chairman, when I work as an MEB/PEB issue in
the IDES, I myself went through the pre-discharge claim. I
retired two years ago and I used the pre-discharge claim. I
used the BDD because I filed when I had over, I think I did it
at 180 days. And that was a program that was currently being
pushed by the VA. They said if you file this way your claim
will be processed and you will receive benefits as soon as you
exit the military.
Maybe some of the issue is that these claims go to certain
regional offices and a lot of members started filing the claims
and either Winston-Salem or Utah would start receiving the
claims. And what we started seeing is that the BDD and the
Quick Start claims became a backlog because every servicemember
that was transitioning was advised that this would be the most
advantageous way. And by everybody filing we created a backlog.
I believe now that BDD and the Quick Start claims have come
down a bit. I mentioned the Benefits Deliver at Discharge,
which was another initiative that started. Basically you are
submitting a claim along with all your medical documentation
and asking the VA to adjudicate the claim because they have all
the information available. And I believe right now these claims
are being adjudicated, depending on the regional office,
between 130 and 135 days. And like I said, I deal with the IDES
and maybe some of the issues with IDES too is all Army cases go
to the Seattle Regional Office, all the other services go to
Providence, Rhode Island. And I know right now the issue on
that is the Seattle Regional Office, the Army, if you look at
the number, they have the majority of the IDES cases. So maybe
this is, I do not know, do they switch them off to another
office? Or maybe there is another, we have got to look at
another system to get these members their ratings a little bit
quicker so we can definitely process them out.
Mr. Runyan. Thank you. And my next question is for Mr.
Jenkins. You note in your written testimony that pre-discharge
employees experienced difficulties with communication with
MSCs. Two-part question, what suggestions do you have to
improving communication between MSCs and VSRs? And do you
believe that greater VSO involvement in pre-discharge claims
would help alleviate some of the concerns?
Mr. Jenkins. Well to answer your question, chairman, any
time we can have a VSO involved that is going to assist, they
have direct contact with the veteran, they are interacting on a
regular basis, and sometimes they can even speak for the
veteran when it comes to a claim so they can speed the process
along. As far as communication between MSCs and VSRs, training
has a lot to do with it. Some of the MSCs that have been hired
do not have previous development training. So they have a lack
of understanding of the process. It all has to do with
staffing, training. Those are the bottom lines to it all. They
have to be trained properly and they have to understand the
process between, how it works between the regional office and
the IDES locations as well.
Mr. Runyan. Thank you. And with that, I yield to the
Ranking Member Ms. Titus.
Ms. Titus. Thank you, Mr. Chairman. I would just say first,
Ms. Gipson, my colleague Mr. Beto O'Rourke was certainly right.
Yours is a power and eloquent voice for change and I thank you
very much for being here. I would just ask you if at any point
during the process were you asked by anybody, or did you take a
survey, about how it was working? What could have been done
better, if you were satisfied? Did you get, did you feel like
anybody was asking for your feedback?
Ms. Gipson. Yes, ma'am. I do. The issue with the survey is,
you, I have some familiarity with surveys. And when you survey
people makes a difference in what their response will be.
Ms. Titus. Yes.
Ms. Gipson. So for example if you survey a servicemember
who has recently entered the IDES process and they are within
the first 30-day window, their comment about the VA, or about
the IDES system, is not going to be negative at all because
they have only participated in the process for 30 days. If
however you survey that same servicemember, say for example
within six months of them exiting the service, when they have
had an opportunity to sort of reflect back upon when or what
happened to them, I think that the numbers may look very
different.
Ms. Titus. Yes.
Ms. Gipson. And so to answer your question more
specifically, yes, we were surveyed. But at the time, for
example, that I took the survey, I was about six months into
the process and that did not seem very daunting to me. Had I
been surveyed again at month 15 my answers very likely would
have changed.
Ms. Titus. So you think the results are skewed based on
when people take the survey----
Ms. Gipson. Yes, ma'am.
Ms. Titus [continuing]. And what has happened to them?
Ms. Gipson. Yes, ma'am.
Ms. Titus. I suspect that is true. It is pretty easy to
manipulate numbers like that.
Ms. Gipson. Yes, ma'am. Yes, ma'am.
Ms. Titus. I would also ask the VSOs, starting with Mr.
Avila, if you have ever heard that term Quick Start, Slow
Finish, or Quick Start, No Finish? And have you, have you ever
discouraged any soldiers from going through any of these
programs, as we have heard of anecdotally? And then finally, I
think Mr. Varela mentioned this, what specifically can we do to
enhance your role to help soldiers before they are discharged
like you help them after they become veterans that might
facilitate this process?
Mr. Avila. I have heard of the term, the Fast Start. What I
currently do, I deal mainly with the MEB/PEB. I do assist
servicemembers. And I know the other VSOs have representatives
at installations. What I am currently advising somebody that is
getting out is do not do BDD. I ask them to do an FDC. Right
now that is what is getting results a little bit quicker. So
they wait until they retire, they go through their transition
course and gather all of the information and then once you are
retired, or you can do it before, fill out all your paperwork,
and then on your first day of retirement you go and submit it
to the VA and use the FDC method. It depends on the regional
office as well.
What can we do? I think TAPS, there was focus on TAPS
several years ago, to put different resources out there for
veterans that are transitioning. So for my point on the IDES, I
think we need to do the same part. Because yes. So these
soldiers, as you know, they have legal rights. Once they get
the MEB results they have so many days to seek legal counsel.
They can use the JAG offices on the installation. They can use
the DSOs. The issue is that not a lot of DSOs are doing
specific IDES cases. They are doing your transitional VA claim.
So I think maybe speaking with DoD, and I did have a meeting
with DoD, Bret Stevens who is the Director of the IDES, and
trying to see what the American Legion can do. We have service
officers. Can we assist? What can we do to get the word out to
these members so they can make the best decisions as they go
through the process?
Mr. Varela. Thank you, Congresswoman. Yes, we have heard of
that term before, Quick Start, Slow Finish. We have discouraged
some servicemembers from going through BDD or Quick Start,
depending on their individual circumstances. What can we do?
VSOs used to have broader access. And then all of a sudden with
the implementation of TAP/GPS, we just became more and more
marginalized. It is a collaborative effort. I mean, we are all
in it together. We understand the active duty component, and we
understand the veteran component. And we have transition
service officers. I like to call them translation service
officers, because we can translate a lot of what is happening
in terms that they can understand.
Mr. Gehrke. Thank you, ranking member, for the question. I
think the numbers on the Quick Start speak for itself. It is
249 days on average, I think. Members receive their benefits
eight months after they discharge. So that is definitely not
delivery on discharge. In regards to Quick Start, we will
recommend to some servicemembers, veterans, that they not
submit a Quick Start claim. It depends on where they are going
home to. So if they are going home to St. Paul or Columbia,
which regional office operates faster than the others, then we
will say, no, wait until you get home and we will send a fully
developed claim in. If they are going to, say, Waco or Houston,
which is not well at all, we will say, no, let us do a Quick
Start now and start the process because once you go home it is
going to be horrendous.
One thing that we recommended in the testimony is to treat
Quick Start claims like you would a fully developed claim. The
only thing different from a fully developed claim and a BDD or
a Quick Start--well, I would say a BDD claim, is a DD-214. So
theoretically they get to the rating officer fully developed
and you theoretically should be able to rate that day. However,
they are kind of pushed to the side and kind of waited on as
they work their other cases. So if you treated them as the same
process you would an FDC claim, you would likely see a fall in
the processing times. But it is also important to recognize
that if you shift the resources there you are essentially
taking resources from elsewhere. But we believe these
servicemembers are in need of the benefits the most. They are
transitioning, they are wounded, they are still maybe looking
for a job. So they are going through a lot of transition
process and they really need that income to help them through
that process. So I think it is appropriate to prioritize those
claims.
Ms. Titus. Well, thank you for your help. Thank you, Mr.
Chairman, for the time.
Mr. Runyan. I thank the gentlelady, and recognize the
gentleman from Texas, Mr. O'Rourke.
Mr. O'Rourke. Thank you, Mr. Chairman. I would like to
begin by just noting for the record that Ms. Rubens from the
VBA is still here and was here to listen to the OIG and to the
testimony from veterans and VSOs and those who are working
within the system to serve veterans, and also note that Ms.
Halliday and her team from the OIG are here to listen. So I
really appreciate their attention and respect to the members
who are here giving their testimony.
Ms. Gipson, you came up with a number of really good
recommendations for us and VBA and DoD to follow. One of them
was to change a culture that can seem as though it is punishing
servicemembers. And I have heard this directly from
servicemembers at the WTU at Fort Bliss in El Paso. We have
read of some really egregious cases where it seems that the
punishment is punitive, overly punitive if not downright
humiliating. And I hope those are the exceptions and not the
norm. And it is part of the pressure I feel to get that wait
time down, which back in February was 185 additional days over
the goal down to what Ms. Rubens has committed to in terms of
what the VBA can control. Can you talk about from your own
experiences what you have seen or witnessed within that
culture, and how we might go about changing it? And I will have
one additional question. So if you could answer that within the
span of about a minute or two that would be great.
Ms. Gipson. Yes, sir. It has been my experience that
soldiers are often treated with if not open hostility then at a
minimum a sort of dismissive attitude. It is not, I think that
you have to start with the premise that soldiers deserve this,
the wounded warrior programs and they deserve to have their
illnesses and injuries treated. I think if you start there then
that is a great springboard to build, around which to build
policies and procedures that will advocate on behalf of the
soldier.
What I think happens is that there is a sort of consensus
that these programs are there simply for soldiers to take
advantage of and to get as many benefits as they possibly can
before they exit the system. And there is a resentment that
builds up. And I think if there can be policies that can abate
that mentality, I think you can go a long way in changing the
culture.
Mr. O'Rourke. And I should also say that I have had a
chance to speak with some of the commanders at the WTU, and you
know from their perspective they have this obligation and
responsibility to maintain discipline and readiness and there
is this understandable tension between people who are on the
verge of transitioning out and their commanders who may have
them for, you know, in the case of El Paso a period approaching
200 days longer than they should have. So it gives us added
impetus to try to reform this system and as you say reform the
culture within it.
Mr. Gehrke, I wanted to follow up on some of the comments
that you made and ask you a question that I asked the OIG about
where we might better commit resources and staffing. We heard
from Mr. Jenkins that one potential byproduct of brokering is
that we have some regional offices looking for work or creating
new or different kinds of work that may not be as effective or
as efficient. You have heard my concerns about the wait times
in the IDES process. What are your views on how we could
improve staffing levels, resourcing? What are we missing and
where are we missing that?
Mr. Gehrke. Thank you for the question. I think Ms. Gipson
was right on in saying that there needs to be some sort of
staffing reassessment. I mean, we hear in all of these VAOIG
reports or GAO reports that, one, there has been mismanagement.
But two, it is always coupled with that there is a lack of
staff. And so I would like to personally know what the formula
is for deciding staffing levels, whether they have such a
formula and what it consists of, and then how often they do
those staff assessments. And not just for VBA, for VHA as well,
and DoD as well. Because we always hear that they are missing
physicians, they are missing rating officers, PEBLOs, across
the board. And so there is a lack of resources. But it is hard
to decide where to put the money and where to allocate those
resources if there is not a proper formula for deciding what
those staffing levels should be, and where it is missing, and
where maybe it might be too much.
Mr. O'Rourke. You know, from my perspective as long as VBA
is able to meet their stated goals for timeliness and accuracy,
I am very happy for them to decide where those resources are
placed. When they are unable to then it seems as though they
may need some help from either oversight bodies or VSOs that
work directly with them. I would just welcome you and the other
VSOs who are here to continue to stay in touch with us, where
you might see deficiencies, where we are not meeting our goals
when it comes to accuracy and timeliness, and where we might
recommend additional resources being placed. So I appreciate
your perspective on this.
And it looks like I am out of time, but I would like to
follow up with you if you have additional comments. And with
that, Mr. Chair, I will yield back.
Mr. Runyan. Do you want another minute or two?
Mr. O'Rourke. Well, Mr. Gehrke, it looked like you were
about to say something else. And so with the chair's indulgence
I would love to get your answer on that.
Mr. Gehrke. I was just going to say I think in the VAOIG
report on Quick Start they pointed out that I believe it was
San Diego or Salt Lake City that they had requested additional
staff and VA provided those staff, and then that facility went
and used the staff for other purposes. So we see that quite
often. Where they say that we are going to use all this hundred
people for Quick Start and they cut them in half and use them
for Nehmer cases or some sort of other cases. Which shows that
they may need even more staff than they are asking for or that
is being allocated to them.
Mr. O'Rourke. Thank you, Mr. Chair.
Mr. Runyan. I thank the gentleman, and I thank everyone for
being with us today, and the panel is excused. I appreciate the
time and attention you spent preparing your remarks.
It is obvious that there is still much to be done in IDES
as well as the transitioning disability benefits programs. I do
not want anyone here to lose sight of these transitioning
servicemembers, our newest veterans, with any false argument
that the VA has more important priorities until 2015. VA has
always had to maintain multiple priorities and now through 2015
is no different.
I ask unanimous consent that all members have five
legislative days to revise and extend their remarks and include
any extraneous material. Hearing no objection, so ordered. I
thank the members for their attendance today and the hearing is
now adjourned.
[Whereupon, at 4:52 p.m., the subcommittee was adjourned.]
APPENDIX
Prepared Statement of Ranking Member, Dina Titus
Thank you, Mr. Chairman for holding this hearing today on behalf of
our nation's veterans.
Today, we will look into the performance of programs that VA and
DoD utilizes to determine ill or injured servicemembers fit for duty
status, as well as programs designed to expedite the adjudication of
separating servicemembers claims. Particularly we will focus on the
Integrated Disability Evaluation System (IDES), the Benefits Delivery
at Discharge program (BDD) and the Quick Start Program.
All of these programs have now been up and running for a number of
years. IDES was initiated in 2007 in follow-up to poor conditions and
fragmented care that our Servicemembers were receiving at Walter Reed
Army Hospital.
BDD was launched in 1995 as a pilot, and fully launched in 1998.
The intent of BDD is to assist disabled servicemembers in making a
seamless and successful transition to civilian life by allowing them to
get their claim completed as early as possible while they have their
medical information readily available and it is clear that there is a
nexus between their disability and military service.
Quick Start was launched in 2008, is similar in nature to BDD, and
was established to provide an expedited disability benefits process to
servicemembers that will be discharged within 59 days.
Despite having been long established, and the intent and need to
assist our servicemembers transition into civilians, all three of these
programs continue to be fraught with challenges and are performing far
below expectations.
The one similarity that all of these programs have is that they all
suffer from continued poor timeliness on behalf of VBA in adjudicating
these claims. BDD and Quick Start have particularly seen a drop off in
the number of claims filed under the program. In our Committee
oversight travel, we have heard VA employees and VSO's alike suggest
that participating in these programs will actually increase the time it
takes for a veteran to receive an outcome on their case versus their
intent to reduce it. The programs have also started to draw their own
mantras amongst employees and veteran advocates such as ``Quick Start,
Slow Finish.''
In meeting with the VAOIG they have highlighted that eliminating
the backlog has started to come at the price of other benefits and
claims such as IDES, Quick Start and BDD, being moved to the back
burner. The IG also highlights concerning disparities between VA's
internal determinations of accuracy via STAR reviews and the accuracy
levels that they have found in their reviews. I believe the timeliness
metrics in combination with the VAOIG's findings speak for themselves,
BDD, IDES, and Quick Start are simply not a VA priority.
With regards to IDES, our committee continues to receive constant
emails from servicemembers. They all generally have the same ask, ``I
am in the Army, and I am waiting for a rating decision from the DRAS
(D-RAZ) in Seattle, Washington, I need my VA rating so that I can get
out of the military so that my family and I can move on with our
lives.'' Many of them have emphasized a negative impact that the IDES
process has had on them and their relationships with their families.
Our staff has witnessed firsthand the poor culture that is often
prevalent at IDES stations and Wounded Warrior Battalions. I want to
thank Ms. Gipson, an Army veteran who recently went through the
process, and is with us here today, for highlighting the negative
culture in IDES, amongst other issues, in her testimony.
I want to be clear about something with regards to the IDES
process. There is no other process whereby VBA is holding individuals'
lives, our Nation's injured servicemen and women, in bureaucratic limbo
based on their need to reach a decision. An Army Reservist that enters
the VA Rating stage of the IDES process today will not get her decision
back from the Seattle DRAS (D-RAZ) until November 26th. She likely
joined the IDES process around February 17th, 2014 and will not
complete the process until June 23rd, 2015.
As our servicemembers wait for a VA rating decision, they are often
disconnected from their families who may be at the place they call
home, which is often not the same location as the IDES processing
facility.
As our servicemembers wait for a VA Rating decision, they and their
spouses are often hesitant to take college courses or technical
training as they do not know when or how the IDES process will end.
As our servicemembers wait for a VA rating decision, they and their
spouses are often unable to accept or seek employment as they do not
know when they will be discharged and when they will get back to the
place they call home.
For all of these reasons, and most all because it is the right
thing to do, VA needs to take a hard look at their resources pointed at
IDES and say how do we get to our goals today and not tomorrow.
VA's timeliness issues aside, I would also like to start the
dialogue on looking at the IDES process from a new perspective. An
angle that emphasizes the servicemembers, their families, and their
transition, over the current process that emphasizes DoD's need to
determine if the servicemember is found ``physically and mentally fit
to perform their military duties,'' or not.
My staff recently sat down to discuss this idea with DoD and we
were surprised to learn that 95% of our nation's servicemembers that
enter into IDES are discharged through the program. Knowing that 19 out
of 20 Servicemembers are going to be discharged how could we offer
servicemembers that are selected to go into IDES with an alternative
option?
An option that would allow them more geographic flexibility in
their transition, an option that would give them more flexibility to
accept a new employment position or pursue an educational degree.
Again, with 95% of IDES servicemembers getting out, I think we have to
ask ourselves are we focused on the right outcomes.
I think the 378 days that soldiers spend in IDES would be better
utilized emphasizing transition through the right mixture of healing,
education, and employment with fewer DoD requirements and increased
access to assistance. A way that allows Servicemembers to heal from
their injuries while growing their capacity for civilian employment.
In closing, these programs have been around for a long time for the
right reasons. It is time that we prioritize these programs to do right
by those who need it most, our ill and injured servicemembers that are
transitioning.
I thank all of our esteemed witnesses for joining us today and look
forward to hearing their testimony.
Prepared Statement of Ms. Nancy E. Weaver
Summary
Since 2007, the Department of Defense has collaborated with the
Department of Veterans Affairs in an integrated and transparent
disability evaluation system for Servicemembers who have any illnesses
or injuries that may compromise their ability to perform military
duties.
In the Integrated Disability Evaluation System (IDES),
Servicemembers receive a single set of examinations and disability
ratings that DoD uses to determine fitness-for-duty and compensation
for unfitting conditions and VA uses to compensate for all conditions
incurred or aggravated during military service. Determinations are
completed before a Servicemember is separated so both Departments
provide disability benefits at the earliest point allowed by law.
The advantages of IDES, compared to previous legacy systems,
include: elimination of separate examinations and disability ratings;
consistency between DoD and VA disability ratings; and, a reduction of
post-separation wait time for VA disability benefits. The IDES reduces
the administrative burden on Servicemembers who undergo a single exam
and complete VA claim paperwork before discharge, and has resulted in
improved Servicemember satisfaction, disability benefits timeliness,
and rating transparency.
DoD has continued to implement process enhancements to include:
improved policy; increased staffing levels; and, training standards for
counselors. These and other improvements have enabled DoD to achieve
and remain below its core IDES processing goal of 105-days for the past
several months.
DoD is also looking at technology to gain more efficiency. We are
working a joint system that will leverage existing IT capabilities
where appropriate, as well as new capabilities, to support end-to-end
case management; tracking, reporting; and, a bi-directional electronic
IDES case file transfer. We will continue to work with VA to ensure
system interface requirements are identified and planned for from
design through deployment.
In support of VBA's transition to a fully digital environment for
claims processing, DoD achieved the goal to implement a secure
interface to allow VA to query the Health Artifact and Image Management
Solution repository for relevant Service Treatment Records by January
2014 in accordance with the DoD--VA Joint Strategic Plan.
We have worked diligently to develop and support a disability
evaluation system that ensures our Nation's wounded, ill and injured
servicemembers receive timely, transparent, and fair compensation for
injuries and illnesses incurred in the line of duty.
Introduction
Chairman Runyan, Ranking Member Titus, distinguished Members of the
Subcommittee, thank you for the opportunity to appear before you today
to discuss the Integrated Disability Evaluation System, also known as
the IDES.
Over the past several years, the IDES has greatly improved the way
the Department of Defense (DoD) and the Department of Veterans Affairs
(VA) evaluates our seriously wounded, ill, and injured Servicemembers.
From 1949 to 2007, medically discharged Servicemembers have been
processed through separate DoD and VA disability evaluation programs.
Each department administered their own disability examinations and
ratings and seriously wounded, ill, or injured Servicemembers had to
wait until after they left military service to apply for VA benefits,
even when DoD had already examined and rated their disabilities. In
2007, those separate departmental disability processes took about 540
days end to end, including 300 days for DoD and 240 days after
separation from military service for VA. Separate examinations and
ratings by the departments led to inconsistent and confusing results.
The results of DoD and VA efforts to modernize disability
evaluation are that since 2007, over 82,000 Servicemembers have
benefited from IDES. Our joint processing times have decreased from a
total of 540 days under the previous disability evaluation system to
353 days total in April 2014, and currently 83 percent of
Servicemembers in IDES express satisfaction with their IDES experience.
Although the IDES improves on the previous disability processes, we
must continue to enhance this system in order to be flexible in
response to the changing demands of the 21st century. DoD is improving
the IDES to meet those demands and be faster, fairer, and more
consistent and transparent than the Departments' previous processes.
The Department of Defense is committed to continuously evaluate and
implement enhancements that will improve the IDES.
IDES Benefits
At its core, IDES remains a fitness for duty evaluation process,
with the primary objective of determining whether a Servicemember is
physically and mentally fit to perform their military duties. But, the
IDES process also offers a number of improvements and benefits compared
to the previous legacy disability evaluation environment. Integrating
the previously separate, sequential processes allowed the departments
to eliminate duplicate disability examinations and ratings, co-locate
many process administrators, share full medical records, and capitalize
on VA's disability rating expertise. IDES also provides several direct
benefits to Servicemembers. IDES introduces disabled Servicemembers to
VA's health care and disability benefits system sooner, provides more
consistent access to accurate and timely information about the process
to Servicemembers, their families and caregivers, provides disabled
Servicemembers their proposed VA disability rating prior to leaving the
military, and provides more consistent, understandable outcomes for
Servicemembers going through the process. And, the Servicemember
retains all of his or her rights to due process in both Departments.
These benefits were achieved through successful collaboration between
DoD and VA.
In the past, the two Departments used their own examinations to
determine medical conditions incurred or aggravated by military
service. They also developed separate ratings for the degree of
disability caused by those medical conditions. This often led to
different results between DoD and VA for disabling conditions,
disability ratings and compensation levels, fostering confusion and
objections over the outcome. Now, DoD provides VA the member's service
treatment record. VA conducts the disability examinations, which are
then added to create a complete service treatment record. DoD uses the
completed service treatment record to determine whether each condition
makes a Servicemember unfit for continued service. VA uses the Veterans
Affairs Schedule for Rating Disabilities (VASRD) to establish a
proposed rating for each disability incurred or aggravated by military
service. VA shares those results with DoD and each Department then uses
the results to establish a Veteran's disability determination. The IDES
process ensures consistent disability evaluations and ratings for the
set of medical conditions that make a member unfit for service.
Use of a common form and co-located resources also contribute to a
faster, fairer, and more consistent and transparent process. The
Departments share the VA/DoD Joint Disability Evaluation Board Claim
form, VA Form 21-0819, to refer, track, and identify outcomes
throughout the IDES process. Another advantage the IDES offers is in
the area of communication. Wherever practical, DoD and VA case workers
are co-located in the same building on DoD installations. This improves
information flow and timeliness, and is more convenient for the
Servicemember. Throughout the process, DoD and VA case workers keep
Servicemembers informed of the progress of their case, what events and
activities are coming next, and their rights and responsibilities. DoD
case workers strongly encourage the Servicemember to include family
members and caregivers during education and counseling sessions. This
approach ensures that the Servicemember's personal support structure is
well informed as to expectations and requirements.
Throughout the IDES process, the use of a standardized form, co-
located process administrators, and the conduct of a single set of
examinations to support the disability decisions of each Department
help reduce the overall amount of time required for a Servicemember to
progress from a disabling wound, illness, or injury through the
disability evaluation process to the point where they have their DoD
disability and benefits decisions, as well as their VA disability
benefits notification. This allows Servicemembers to both better plan
for their future as a veteran, as well as begin receipt of VA benefits
much closer to their date of discharge from military service. By
integrating the two separate disability evaluation processes, DoD and
VA are much better positioned to support the Servicemember's transition
to veteran status and reintegration back into the civilian community.
The measurable improvements have benefitted thousands of seriously
wounded, ill, and injured Servicemembers.
IDES Performance
Over 82,000 Servicemembers have completed IDES since 2007. As of
April, 2014, there were 29,640 Servicemembers enrolled in the IDES (73
percent Army; 8 percent Marine Corps; 7 percent Navy, 11 percent Air
Force).
As of April 2014, integrating the Departments' processes had
reduced the total time from when a DoD physician referrals a seriously
wounded, ill or injured Servicemember for disability evaluation until
receipt of VA disability benefits by 35 percent (an average of 540 days
in the previous disability evaluation system to 353 days). Working
together, the Departments reduced the ``benefits gap'' (time between
discharge from the military and receipt of VA benefits) 86 percent from
240 days in the previous disability evaluation system to 34 days in
April 2014. DoD has demonstrated continuous progress in recent months
by reducing the average time to complete the DoD's required core
activities by 11 percent from 114 days in November 2013 to 101 days in
April 2014. DoD core IDES activities include: physician referral for
evaluation and intake counseling; preparation for and execution of a
Medical Evaluation Board to assess the member's illnesses and injuries;
preparation for and execution of a Physical Evaluation Board to
determine whether the member is fit to remain in the military or must
be separated or retired; and, a transition period to out-process and
separate or retire those who must leave their Service, against a goal
of 105 days. DoD has met the 105-day core process timeliness goal for
the last three consecutive months. Among the Military Departments, the
Army has successfully met DoD's core timeliness goal for the last six
consecutive months; the other Services are continuing to improve their
timeliness.
However, more work is needed to meet the overall IDES timeliness
goals. In April 2014, a Servicemember's case file averaged 353 days to
complete the integrated DoD and VA process against 295-day (Active
component) and 305-day (Reserve component) timeliness goals. Days to
complete VA core processes improved 25 percent from 250 days in
November 2013 to 187 days against a goal of 100 days. However, DoD and
VA cannot achieve the IDES overall 295- and 305-day goals until both
Departments reach their respective performance goals. VA has shared
their improvement plan to meet its timeliness goal by October 2014.
Together, the Departments anticipate meeting the overall goal by the
end of this year.
The integrated nature of the IDES means that each Department can
gain efficiency in their core processes, but must be attentive of how
these efficiencies affect both Departments' processes so they do not
inhibit the smooth transition between IDES stages. DoD's improved case
processing efficiency resulted in more cases being transferred to VA
than could be completed, extending the time Servicemembers remained in
the IDES process and on active duty.
Timeliness is important, but DoD is also concerned with whether
Servicemembers are satisfied with their IDES experience. DoD monitors
Servicemember satisfaction with IDES through surveys at two key
points--after Servicemembers complete their Medical Evaluation Board
and after they receive the results of their Physical Evaluation Board.
Seeking feedback after the Physical Evaluation Board is important to
DoD because after that board, the Servicemember has been informed of
their proposed disability rating and the results of the DoD fitness
decision--return to duty, separate, temporary disability retirement, or
permanent disability retirement. Servicemember feedback received
between July and December 2013 indicate that 83 percent were satisfied
with their overall IDES experience. Servicemembers reported even higher
levels of satisfaction with IDES DoD customer service (88 percent).
IDES Enhancements
As IDES matures, DoD has continued to work to refine and enhance
the process. In 2011, the Warrior Care Policy Office began drafting DoD
policy to combine thirteen separate policy documents, disability
evaluation issuances, and directive-type memoranda. This is the first
comprehensive rewrite of IDES policy and procedures issuances. By
summer 2014, the Military Departments will be able to work from a much
improved set of policy documents that provides simpler, clearer
guidance to the individuals administering the program. This should, in
turn, lead to more consistent interpretation and implementation of
policy and more consistent outcomes. DoD appreciates the quality
assurance program guidance in the National Defense Authorization Act
for Fiscal Year 2013 (Public Law 112-239) and is preparing a
comprehensive disability evaluation quality assurance program to fully
implement Congress' guidance in October 2015. Implementing the quality
assurance program will standardize the way DoD compares and reports the
accuracy and consistency of DoD disability decisions. Analyses from
these reviews will allow DoD to identify best practices and areas
needing improvement. DoD will institutionalize the quality assurance
program in policy to ensure long-term improvements to the accuracy and
consistency of the process.
DoD increased its IDES staff levels by approximately 700
individuals (127 percent) between 2011 and 2013 to ensure it has
sufficient case managers, doctors, lawyers, and adjudication staff to
improve timeliness and sustain the performance of DoD core functions
for Servicemembers in the process. Increased staff helps ensure
Servicemembers, their families and caregivers receive more frequent and
meaningful communication about the IDES and where the member is in the
process at any given point, which makes the significant life event of
transitioning to Veteran status somewhat easier. These actions ensure
that the IDES is more transparent to participants and their families.
DoD issued enhanced training requirements for Service Physical
Evaluation Board Liaison Officers. These new requirements provided
minimum standards for training program content and performance
objectives for Physical Evaluation Board Liaison Officers to ensure
their consistent performance and that Servicemembers receive the best
possible counseling and support while in IDES.
DoD verifies the Servicemember's service treatment record includes
all available information prior to providing the record to VA. This
ensures VA has all necessary medical information and can complete their
medical examination and rating processes faster without searching for
additional information. A complete service treatment record also
increases the accuracy of medical examinations and helps the
Servicemember retain an accurate assessment of his or her own health
and fitness. While this change could result in an increase in time for
a minority of cases referred into the IDES, it is in the best interest
of the Servicemember that DoD provides VA all available medical
documentation. Having the complete file ensures that all medical
evidence is available for consideration and can prevent future case
rework.
DoD is continuing to make the necessary improvements to ensure we
are using the best possible evaluation system. The IDES has been in
place since 2007, and although we review processes regularly, DoD is
conducting a follow-up study to a Fiscal Year 2012 National Defense
Authorization Act (Public Law 112-239) requirement to provide critical
analysis and recommendations for consolidating the organizations that
execute the IDES. DoD expects to deliver the results of this analysis
to Congress this summer.
In the area of information technology enhancements, over the past
year, the Warrior Care Policy Office and the Military Departments have
been collaborating to identify business needs for a Joint Disability
Evaluation System (JDES) IT solution. Each Service has varying degrees
of IT maturity and none have the functionality required to fully meet
Service's needs for disability evaluation. A JDES IT solution will
provide DoD the capability to manage a flexible and adjustable DES to
respond to the next contingency operation or war that drives more
seriously wounded, ill, or injured, and reduce delays in transitioning
Servicemembers from active duty to Veterans status or reintegration
back to their units. It will enable the Department to leverage existing
IT capabilities where appropriate, and include new capabilities to
support end-to-end case management: tracking, reporting, and electronic
IDES case file transfer in a twenty-first century environment.
The current electronic Case File Transfer (eCFT) system is Phase I
of JDES; it has been operating as a pilot at two locations since 2012.
In December 2013, DoD tested an interface between eCFT and the VA Data
Access Service (DAS), which allowed the transfer of files
electronically to the VA. However, this information technology solution
will only yield benefits in timeliness when VA can successfully
establish a bi-directional case file transfer capability. Currently, it
takes approximately 14 days of the IDES process to mail records within
the Military Departments and between VA and DoD.
DoD also revised the IDES satisfaction surveys in July 2013 to
better capture and report Servicemembers' feedback. Additionally, the
department recently conducted a survey of DoD personnel who administer
the IDES process to gauge policy effectiveness, as well as satisfaction
with training and resources.
DoD expects these enhancements to lead to further improvement in
IDES performance and the department will continue to monitor current
performance and prepare for future challenges.
Although not part of the IDES, you requested that we provide
information as to the status of DoD and VA's agreement to provide
electronic Service Treatment Records (STR) within 45 days of
separation.
In January 2013, in support of VBA's transition to a fully digital
environment for claims processing, DoD committed to accelerate the
deployment of the Health Artifact and Image Management Solution (HAIMS)
for the purpose of transferring electronic STRs to VA. Specifically,
DoD committed to and achieved the goal to develop and implement a
secure interface to allow VA to query the HAIMS repository for relevant
STRs effective not later than January 2014 in accordance with the
Fiscal Year 2013-2015 DoD-VA Joint Strategic Plan.
As of December 31, 2013, the Services stopped mailing hard copies
of STRs to the VA and the STR scanning process commenced on January 2,
2014. The process for digitizing a Servicemember's STR and making it
retrievable by VBA begins with authorized DoD personnel scanning the
paper-based elements of a newly separating Servicemember's STR. The
digitized STR, comprised of the scanned information and digital content
from the Servicemember's DoD electronic health record, is submitted
into the HAIMS repository and made available to the VA as a single
record.
The current process entails the MTF conducting a Quality Assurance
check on the STRs and within 45 days of separation/discharge, sending
them to a designated scanning location--Central Cells--for each
Service. The staffs at the Central Cells receive and track all incoming
STRs. They also do the document preparation and metadata tagging needed
for successful upload into HAIMS. Based on the MTF's QA check, the last
document scanned into HAIMS is the DD Form 2963 (STR Transfer or
Certification Form), certifying that all due diligence has be done to
ensure the STR is complete.
The Army and Air Force were initially operating at contingency
sites and have just taken possession of a co-located scanning location
in San Antonio, Texas. The Navy is using a contract facility in
Chantilly, Virginia which is augmented by four additional Navy MTFs
within CONUS. When a separated Servicemember or Veteran files a claim,
a VBA rating specialist establishes a claim in VBMS on behalf of that
individual. VBMS initiates an automated request for the STR. As of May
12, 2014, the Services have scanned and uploaded over 44,000 STRs into
HAIMS.
Conclusion
An efficient disability evaluation system is key to ensuring a fit
force and assuring fair compensation for a career cut short because of
service-related wound, illness, or injury. Since piloting IDES in 2007,
DoD and VA have made significant strides improving disability
evaluation for our most seriously wounded, ill, and injured
Servicemembers. Together DoD and VA have eliminated duplication,
reduced paperwork and administrative burden, increased transparency and
consistency in benefits outcomes, and accelerated delivery of
disability benefits to eligible Servicemembers. As a result, IDES
processing times have decreased, system efficiency has increased, and
83 percent of Servicemembers report they are satisfied with their IDES
experience. Despite these advances, DoD will continue to enhance the
process to improve timeliness, fairness, consistency, and transparency
in the IDES.
Thank you for your support of the brave men and women that serve
our nation, and your dedication to ensuring DoD has the most efficient
systems in place to evaluate Servicemembers' ability to continue
military service after a wound, illness, or injury and ensure the
timely receipt of DoD and VA disability benefits for those who are
medically discharged.
Prepared Statement of Diana Rubens
Good morning Chairman Runyan, Ranking Member Titus, and Members of
the Subcommittee. My name is Diana Rubens, Deputy Under Secretary for
Field Operations, in the Veterans Benefits Administration (VBA). I am
pleased to be joined by Thomas Murphy, Director of VBA's Compensation
Service and [TBD], Department of Defense (DoD). My testimony will focus
on the status of the Integrated Disability Evaluation System (IDES),
Benefits Delivery at Discharge (BDD), and Quick Start programs.
With respect to IDES, VA and DoD's joint efforts over the past six
years have resulted in changes and improvements to DoD's Disability
Evaluation System. These changes and improvements began in 2007 in the
wake of the issues identified at the Walter Reed Army Medical Center.
IDES originated as a pilot authorized by the National Defense
Authorization Act of 2008 and was approved for enterprise-wide
implementation in 2010, which was completed in October 2011. Since that
time, IDES has been DoD's enterprise-wide disability evaluation system.
Together the Departments have created an integrated disability
process for Servicemembers who are being medically retired or
separated. This joint process was designed to eliminate the
duplicative, time-consuming, and often confusing elements of the
separate and consecutive disability determination processes within VA
and DoD. The goals of the process were to: (1) Develop a single set of
medical exams used by VA and DoD for disability rating; (2) eliminate
the benefits delivery gap from separation to receipt of VA benefits;
(3) increase transparency and consistency of the disability evaluations
for Servicemembers; (4) reduce the combined processing time; (5)
develop a less complex and non-adversarial process; and (6) provide a
seamless transition of benefits and health care for separating
Servicemembers through IDES. As a result of our collaborative efforts,
we have met these goals.
In contrast to the legacy process for disability evaluations, IDES
provides a single set of disability examinations and a single-source
disability rating that are used by both Departments in executing their
respective responsibilities. IDES has resulted in more consistent
disability ratings, faster decisions, and more timely delivery of
benefits for those personnel being medically retired or separated.
Following discharge, VA can deliver disability benefits in the shortest
period allowed by law, thus reducing the ``benefit gap'' that
previously existed under the legacy process. Through the integration of
VA's Military Service Coordinators (MSC) into the claims process prior
to separation, Servicemembers no longer have to navigate the VA
disability system on their own to apply for VA benefits. The VA and DoD
integrated approach has eliminated the duplicate medical exam and
rating processes found in the legacy system.
VA and DoD continually track and monitor IDES performance.
Additionally, VA's IDES Program Office conducts monthly internal video
teleconferences with all VA senior executives involved in the execution
of IDES. VA also conducts bi-weekly teleconferences with DoD and the
military Departments to monitor performance, resolve problems, and
discuss process improvements. Recently VA participated in the first
Army IDES training symposium.
Currently in IDES, there are approximately 29,000 Servicemembers.
Within IDES, VA is responsible for four core process steps: Claim
development, medical examination, proposed rating, and benefit
notification. For the combined four core steps, VA average processing
time in April 2014 was 183 days. This is a 29-day improvement from
March 2014 and the lowest VA core time since April 2013. VA's target
for the combined core steps is 100 days of the 295-day combined VA-DoD
target.
VA created a plan to improve IDES timeliness that involved a phased
approach. The first phase of the plan was to meet benefit notification
timeliness standards by March 2014. This portion of the IDES process is
focused on ensuring Servicemembers who transition into the civilian
world as veterans timely receive benefits to which they are entitled.
The second phase of the plan is to meet timeliness standards for
proposed ratings by October 2014. To meet these timeliness standards,
VA trained and promoted 36 raters at the Seattle, Washington,
Disability Rating Activity Site (DRAS); brokered 250 proposed ratings
per month from Seattle to Providence, Rhode Island from August 2013
through December 2013; instituted mandatory overtime; and implemented
Disability Benefits Questionnaires (DBQ) at all sites. In addition, the
Army provided 21 soldiers to VA to assist in preparing case files for
rating at the Seattle DRAS.
VA achieved its intermediate goal of eliminating excess inventory
in the Benefits Notification stage in March 2014. In April 2014, VA met
the performance goals for three of the four core steps: Claims
development, medical examinations, and benefit notification. VA is
still working on meeting the standard for completing the proposed
rating.
Mandatory overtime for claims processors remains in effect. VA and
DoD also remain in close communication, discussing referral rates and
production expectations. VA is on track to eliminate excess inventory
in the proposed rating stage by August 2014 and meet all timeliness
standards by October 2014. VA continues to collaborate with DoD on ways
to improve IDES execution, while remaining focused on meeting
timeliness standards. Our continued partnership with DoD is critical.
VA and DoD are committed to supporting our Nation's wounded, ill, and
injured Servicemembers through the IDES process.
Benefits Delivery at Discharge (BDD) and Quick Start
The BDD and Quick Start programs are important elements of VBA's
strategy to provide transitional assistance to separating or retiring
Servicemembers and engage Servicemembers in the disability claims
process prior to discharge. VBA's goal is to ensure that each
Servicemember separating from active duty who wishes to file a claim
with VA for service-connected disability benefits will receive
assistance in doing so. Just as IDES provides Servicemembers facing
medical discharges with the opportunity to initiate a claim for
disability benefits, BDD and Quick Start provide this opportunity to
Servicemembers who are transitioning via traditional or ``non-medical''
separation.
Participation in the BDD program is available to Servicemembers who
are within 60 to 180 days of being released from active duty and are
able to report for a VA examination prior to discharge. BDD's single
cooperative examination process meets the requirements of a military
separation examination and a VA disability rating examination.
VBA established the BDD program in 1995 at three VA regional
offices and three Army installations. Today, there are 96 BDD memoranda
of understandings (MOU) covering BDD operations at 131 military
installations. The MOUs facilitate the collaboration between local VA
regional offices and local military installations by streamlining
processing of pre-discharge claims. In April 2007, in an effort to
promote processing consistency and quality decisions, VBA consolidated
BDD rating activity to the VA Regional Offices in Winston-Salem, North
Carolina, and Salt Lake City, Utah.
In July 2008, VA introduced the Quick Start pre-discharge claim
process. Quick Start made pre-discharge claim processing available to
100 percent of transitioning Servicemembers, including those who are
within 59 days of separation, and those who are within 60-180 days of
separation but are unable to complete all required examinations prior
to discharge. In 2010, Quick Start claim processing was consolidated to
the VA Regional Offices in San Diego, California, and Winston-Salem,
North Carolina.
VA's and DoD's marketing efforts, outreach activities with
transitioning Servicemembers, and the support of Veterans Service
Organizations, who promote the benefits of these programs, have
resulted in high levels of Servicemember participation in the BDD and
Quick Start Programs. By 2010, approximately 60,000 of the 181,000
transitioning Servicemembers elected to utilize the BDD or Quick Start
claim processes to submit VA disability claims each year.
In August 2010, VA published its Final Rule establishing new
presumptions of service connection for three disabilities associated
with Agent Orange exposure: Ischemic heart disease, Parkinson's
disease, and hairy cell and other chronic B-cell leukemias. From 2010
to 2012, VBA devoted significant resources to readjudicating over
90,000 previously denied claims for these three conditions, which was
required by the order of the U.S. District Court for the Northern
District of California in Nehmer v. U.S. Department of Veterans
Affairs. Additionally, over 50,000 claims received after the decision
to establish the new presumptive conditions was announced, but before
the effective date of the final regulation implementing the decision,
were also subject to Nehmer review. During this effort, VBA's 13 Day
One Brokering Centers (D1BC) were dedicated exclusively to this
readjudication. During this same period, there were significant
increases in claim receipts for BDD.
As the Nehmer mission ended, VBA utilized the D1BCs that were
processing Nehmer claims to reduce the inventory of BDD and Quick Start
claims. This effort took place from February 2012 to March 2014 and
resulted in significant timeliness improvements. As of April 2014, the
average days pending for Quick Start claims is 98.3 days, an
improvement of 137.3 days since May 2012, and the average days to
complete a Quick Start claim is 158 days fiscal year to date (FYTD), an
improvement of 200 days since June 2012. As of April 2014, the average
days pending for BDD claims is 136.7 days, an improvement of 55.8 days
since April 2013, and the average days to complete a BDD claim is 198.2
days, an improvement of 116 days since May 2013.
Beginning in 2012, we began to see new trends in claims received,
including a significant drop in claims for the Quick Start program,
from 32,990 in Fiscal Year (FY) 2010 to 21,375 in FY 2013. As of May
2014, a little over 11,000 Quick Start claims have been received FYTD,
with less than five months remaining. As of April 2014, there are 6,649
Quick Start claims pending, a decrease of 77 percent from January 2012,
when there were 29,130 Quick Start claims pending. Receipts for BDD
have declined steadily from a high of 30,893 in FY 2011, to 30,381 in
FY 2012, and 27,333 in FY 2013. This FY through mid-May 2014,
approximately 13,000 BDD claims have been received.
Claims accuracy is not specifically measured for BDD or Quick Start
claims processed at the three Rating Activity Sites. Instead, accuracy
is measured for each regional office as a whole. As of April 2014,
Winston-Salem's three-month issue-based accuracy is 98.7 percent and
claim-level accuracy (12-month) is 89.5 percent; San Diego's three-
month issue-based accuracy is 96.1 percent and claim-level accuracy
(12-month) is 85.2 percent; and Salt Lake City's three-month issue-
based accuracy is 98.6 percent and claim-level accuracy (12-month) is
91.7 percent. As part of our transformation plan to eliminate the
backlog of claims older than 125 days and increase quality to 98
percent, VBA began paperless processing all Quick Start and BDD claims
in December 2012. In October 2013, VBA began the use of the separation
health assessment DBQs to expedite the rating process.
VBA continually monitors claim accuracy and provides substantial
training and oversight for claim processing personnel. Benefits
Delivery at Discharge and Quick Start claims are included in the
statistically random sample selected for the regional office's
Systematic Technical Accuracy Review. Compensation Service Quality
Assurance Program Review Staff also conducts special focused reviews of
pre-discharge claims.
VBA is now working to redesign the pre-discharge claim processes by
building on lessons learned through the execution of the BDD and Quick
Start Programs. The new pre-discharge program will consolidate and
replace the existing BDD and Quick Start programs. VBA is leveraging
functionality now available in the Veterans Benefit Managements System
and eBenefits, to add convenience to the application process and
efficiency throughout the claims process. Servicemembers can currently
submit pre-discharge claims electronically through eBenefits; VBA is
developing programming that will route these electronic applications
directly to dedicated personnel who specialize in pre-discharge claim
processing.
VBA is also working to maximize the use of electronic record-
sharing in the pre-discharge claims process, and eliminate the
requirement for pre-discharge claimants to gather and submit
photocopies of their service treatment records as part of their
application package. Pre-discharge rating sites will capitalize on
DoD's commitment to provide VA with 100 percent of separating
Servicemembers' ``gold standard'' service treatment records within 45
days of discharge, which will serve to support more timely decisions on
pre-discharge claims. This is accomplished via the Health Artifact and
Image Management Solution (HAIMS) to VBMS interface, which was
implemented January 1, 2014. The service treatment record ``gold
standard'' contains the complete medical record, complete dental
record, and DD Form 2963--Certification Form. All of these need to be
available in HAIMS for transmission to VA in a complete package within
45 days of separation/retirement from the military.
VA is committed to supporting our Nation's Servicemembers through
improvements in pre-discharge programs. VA believes its continued
enhancements are critical to program success--and are nothing less than
our Servicemembers and future Veterans deserve.
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Prepared Statement of Debra J. Gipson
I would like to thank Chairman Runyan for holding this important
hearing on the Integrated Disability Evaluation System (IDES). I am
honored to have been asked to participate.
History
In 2011, while training to deploy to Afghanistan, I sustained a
severe back injury. By the time my Reserve detachment reached the
Active Duty training site, Fort Bliss, Texas, I was confined to a wheel
chair earning me the nickname, ``The Wheel Chair Soldier.'' Days later,
I was prescribed a cocktail of drugs which allowed me to walk but not
without excruciating pain. Placed in the Warrior Transition Program,
efforts to rehabilitate my injury were unsuccessful and required
surgical intervention.
Before my back surgery could be performed, I required a surgical
procedure to treat uterine fibroids; tumors on my uterus. I did not
receive a follow-up gynecological appointment. Placed in IDES, I was
determined medically unfit to serve, received a 20% disability rating,
medically separated and received separation pay. Within days of signing
paperwork agreeing to the rating, it was determined that I urgently
needed a hysterectomy. I want to be clear that had I received a follow-
up to the original gynecological procedure the hysterectomy would have
been performed earlier and my disability rating would have been 70%.
Instead of being medically retired, I was medically separated from
the United States Army on January 11, 2014.
Introduction
In my opinion, a strong democracy requires two professions: the
Legislator and the Servicemember; each the weapon of the other. Healthy
Servicemembers are the weapons of the Legislator while the Legislator
is the weapon of wounded, injured and ill Servicemembers. We've served
as your weapon. On behalf of disabled and medically separated Veterans,
we respectfully request that you harness your arsenal's full potential
to fix this system and maintain the strength of our democracy.
I present the following long and short term recommendations:
Long-Term Recommendations
1. Establish a Consolidated Disability Evaluation System
The Integrated Disability Evaluation System (IDES), the disability
ratings process by which Servicemembers are evaluated and declared
eligible for compensation, is timely, burdensome and inefficient. The
VA and DoD must consolidate the Departments' disability systems with
the shared goal to promulgate policy and prescribe uniform guidelines,
procedures and standards to eliminate redundancy inherent in
adjudicating claims using dual disability rating systems.
2. Create a Sole Source Disability Rating
The military rates only ``fitting'' conditions while the VA rates
all service connected injuries resulting in two different ratings for
qualifying Servicemembers. The DoD and VA will need to reach a
consensus on the definition of qualifying conditions and events and the
rate at which those conditions and events are to be compensated.
Understandably, a bias in favor of the current, more generous VA system
will result in a corresponding rise in retirement and medical costs.
3. Information Sharing
Plans to roll-out shared use technology by 2017 will enhance and
improve agency accessibility to health care records. The plan is both
necessary and ambitious. However, the current lack of available
technology is only part of a much larger problem. Government agencies,
among them the DoD and the VA, must generate Memoranda of Agreement
allowing agencies to openly share information. This will likely require
a change in agency culture from one of independence to interdependence
on sharing information and resources.
Interim Recommendations
1. Fiscal Set Aside
Veterans in the Servicemembers Transition Process frequently
complain about the receipt of timely payments once his or her claim has
been adjudicated. To date, the receipt of benefit payments can take
from 90 days to a year or more to process. While uncertain of the legal
or tax implications, I recommend that once a Servicemember enters
Federal service (Active Duty, Reserve or Guard) a percentage of the
Servicemember's salary be escrowed until the IDES or (retirement)
process is complete. The funds set aside could then be automatically
reimbursed to the Veteran as a lump sum payment used to bridge the gap
between the date of retirement (or separation) and receipt of any long-
term or separation benefits.
2. Emergency Surgery Rating Reconsideration
Servicemembers who require emergency surgeries within sixty (60) to
ninety (90) days of being rated should receive automatic disability
rating reconsideration.
3. Complete a Comprehensive Staffing Needs Assessment
The Office of Personnel Management must undertake a comprehensive
staffing needs assessment to: a) properly assess the cost/benefit of
properly staffing the IDES system, and b) research areas where
backlogged claims exist to determine whether problems of redundancy and
inefficiency are functions of process or staffing related to
organizational behavior, poor training, and/or a lack of incentives.
Staffing at the appropriate level will go a long way towards: a)
eliminating the current claims backlog and, b) reducing the amount of
time it takes to assess individual claims. Increasing staff means a
short-term increase in personnel costs offset by a reduction in both
the amount of time it takes to process claims and the number of
Servicemembers anxiously awaiting claims adjudication.
4. Manage Fraud, Waste and Abuse
The system is replete with opportunities for fraud, waste and
abuse. The underlying premise of the adjudication process is to provide
compensation and benefits for long-term injuries and illnesses. Any
system which compensates Servicemembers for injuries and illnesses must
also incentivize healing and recovery. It isn't a politically popular
notion. However, necessary if ballooning costs are to be reduced and
full recovery a goal.
A comprehensive assessment of where opportunities for fraud, waste
and abuse exist must be conducted and measures put in place to mitigate
such opportunities. Examples include: encouraging physician second
opinions, eliminating redundancy in paperwork, and information sharing
not just between agencies but within.
5. Organizational Change.
We have got to change the organizational culture which punishes
Servicemembers (directly or indirectly) for sustaining wounds, injuries
or illnesses. In the current climate, Servicemembers deemed unfit to
fight or conduct acts of physical fitness are cast aside and labeled;
often unfairly, as lazy or cowardly. I do not advocate group hugs on
the battlefield. However, leadership training must encourage
compassion, dignity and respect. Likewise, service providers, whether
military or civilian, must receive similar training.
Toxic leaders (military and civilian) and service providers must be
either retrained or moved out of leadership or positions of authority
to mitigate damage to wounded and/or recovering Servicemembers.
Conclusion
The recommended suggestions to improve IDES will each require a
cost-benefit analysis to determine feasibility. Such analysis is beyond
the scope of this presenter. What is certain is that each cost and
benefit must be assessed using both quantitative and qualitative
analysis. It is my belief that undertaking such analysis, however
painstaking, will improve IDES to the benefit of retiring
Servicemembers.
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Prepared Statement of Brendon Gehrke
Mr. Chairman and Members of the Subcommittee:
On behalf of the men and women of the Veterans of Foreign Wars of
the United States (VFW) and our Auxiliaries, I would like to thank you
for the opportunity to testify on today's hearing regarding VBA's role
in veterans transition as it relates to the Integrated Disability
Evaluation System, the Benefits Delivery at Discharge and the Quick
Start Program.
In the 2008 National Defense Authorization Act Congress required
DoD and VA to create policies to ensure that the disability evaluation
system, which determines military and veterans benefits, is streamlined
and fair. As a result, DoD and VA collaborated to create the Integrated
Disability Evaluation System (IDES) which simplified the disability
evaluation process by eliminating duplicate disability examinations and
ratings, and placing VA counselors in Military Transition Facilities
(MTF) to ensure a smooth transition to veteran status. The VA and DoD
also responded by improving the Benefits Delivery at Discharge (BDD)
program and created Quick Start programs to allow servicemembers to
submit a disability claim before their discharge date.
The VFW believes these programs are a step in the right direction
to fulfil the country's promise to our wounded warriors, but we
recognize that these programs are far from perfect. Servicemembers
still suffer from the Defense Department's disjointed policies and
leadership which govern wounded warrior care, inadequate VA and DoD
staffing dedicated to the benefits evaluation process, no Integrated
Electronic Healthcare System, and poor communication. We encourage the
Committee to evaluate and implement the suggestions made by the
Government Accountability Office (GAO), Recovering Warrior Task Force
(RWTF) and Veterans Service Organizations (VSO).
Processing Times
Currently, the Veterans Affairs' Benefits Delivered at Discharge
and Quick Start programs are not living up to their names. The BDD
program rarely delivers benefits within 60 days of discharge, and the
Quick Start program may allow servicemembers to submit claims earlier,
but the adjudication of those claims are anything but quick. As
indicated in the latest VAOIG report on the Quick Start program, VBA
reduced the average days to complete a Quick Start claim from 291 days
in 2011, to 249 days for the period of April through June 2013.
However, VBA needs to cut the amount of time to adjudicate a claim in
half to achieve the VA Secretary's goal to have no claim pending more
than 125 days. Likewise with BDD, the Salt Lake City Regional Office,
who adjudicates 56 percent of BDD claims, takes an average of 266 days
to deliver benefits. This means that a servicemember who applies 60
days prior to discharge will not receive payment for at least eight
months after their discharge.
The amount of time it takes to process a claim through IDES
frustrates wounded warriors and their commands. As of May 11th, it
takes 284 days to process through IDES, although that number has grown
as high as 376 days in the past year. It is important to note that
processing times change daily and differ dramatically from facility to
facility; Fort Knox has taken longer than 423 days to process claims,
Fort Riley takes upwards of 336 days to process claims, while claims in
Fort Gordon may process in less than 161 days. The processing time is
even higher for reserve component servicemembers. Minnesota's National
Guard Command reports that the average time to complete the IDES
process for its soldiers is 581 days. Of Minnesota's active cases, the
average soldier has been waiting in processing for 258 days; 43 percent
have already exceeded the military's Medical Command standard of 204
days to finish a claim.
It is clear that the VA backlog is also creating a backlog in IDES
cases. The longest phase in the IDES process is the VA disability
rating portion, where 59 percent of cases pending are awaiting a VA
rating decision. VA's goal is to process IDES claims within 100 days,
but it takes 230 days on average to process claims. The VA's inability
to process IDES claims is adversely affecting wounded warriors recovery
and their transition process. The backlog creates unnecessary extended
separations and financial burdens on families causing stress on an
already vulnerable family. Moreover, it prohibits servicemembers from
finding civilian employment and/or causes them to miss college
enrollment dates.
Unlike the BDD, Quick Start, or IDES claims, Fully Developed Claims
(FDC) are close to meeting the Secretary's goals of adjudicating claims
within 125 days. In 2010, Under Secretary Hickey refined the FDC
program and encouraged veterans and VSOs to submit claims that do not
require development of non-governmental evidence. Between the first and
second quarter of this year, FDC submission increased from 12 percent
to 18.5 percent, 25 percent of the claims VSOs submit are FDC, and the
average amount of time to complete an FDC claim was only a 150 days.
Despite the dramatic difference in the number of days it takes to
adjudicate an FDC claim compared to a pre-discharge or IDES claim, the
only document included in an FDC claim that isn't in a pre-discharge or
IDES claim is a DD-214. Therefore, we recommend VA allocate resources
to work pre-discharge claims as they would a FDC claim.
Inconsistent Management Policies
It is difficult to evaluate the Department of Veterans Affairs role
in the transition from servicemember to veteran without mentioning the
Department of Defense's role in the transition process. The two
agencies are inextricably connected; one agency cannot fulfill its
responsibilities to the transitioning servicemembers without the other.
Ultimately, the agencies share equal responsibility to ensure
servicemembers successfully transition back to civilian life.
In regards to IDES, DoD is responsible for guiding servicemembers
through the entire process to ensure they are aware of their options
and the many decisions they or their families need to make. In regards
to the pre-discharge benefits program, DoD is responsible for managing
all entry point sites and implementing the cooperative exam process--a
key aspect of BDD to streamline access to benefits. DoD's lack of
leadership, standard policies, and oversight has created large
discrepancies in the standard of service and treatment servicemembers
receive from one site to the next.
Despite recommendations from VSOs, RWTF and GAO, the Defense
Department still maintains a disjointed leadership structure for
wounded warrior care. The Deputy Under Secretary of Defense for
Personnel and Readiness is responsible for establishing health and
benefit policies. However, the Deputy Under Secretary can develop the
best policy possible to ensure continuum care and transition services
but without the authority to force the military branches to implement
DoD's guidance, as is the current situation, the policies are inept.
Our concern is that these inconsistencies in the services'
interpretation and application of the laws governing IDES affect
servicemembers adversely.
Therefore, the VFW recommends that Congress give the Under
Secretary of Personnel and Readiness the sole authority to develop
policy to improve the care and services provide through IDES. Only then
will the Under Secretary be able to improve management of pre-discharge
benefits sites, provide proper oversight, and most importantly force
services to comply with DoD directives. Empowering senior civilian
leaders will allow for the long-standing problems plaguing the process
to be addressed and promote accountability.
Staffing Resources
Insufficient staffing and budget allocations on both DoD's and VA's
part contribute to poor case management and protracted disability
determinations. servicemembers continue to complain that the military
Physical Evaluation Board Liaison Officers, who are responsible for
guiding the servicemember through the IDES process, are often
overburdened and poorly trained. The same goes for the VA case managers
who assist some servicemembers through the VA rating phase. Although VA
and DoD officials said they added case managers to its IDES rating
sites to handle the high demand, we have not seen an improvement in
processing times or increased attentiveness to servicemembers and their
family's needs.
However, no matter how many case managers they hire, the long
waiting times will persist unless VA and DoD ensure adequate physician
staffing levels. DoD must ensure proper physician staffing levels to
identify conditions and write narrative summaries that are used to
determine the servicemembers' fitness for duty. Likewise, VA needs an
adequate number of physicians to complete the Compensation and Pension
(C&P) examinations used to determine both DoD and VA disability rates.
Appropriations for VA have not kept pace with the demand created by
thousands of severely wounded servicemembers returning home, resulting
in staff shortage across the Veterans Health Administration.
Compounding the problem is that sequestration limits DoD's ability to
hire more doctors for the pre-discharge benefit sites and the MEB. The
Administration (and previous Administrations) has requested
insufficient resources to meet the ever-growing need for health care
and transition services. It is now incumbent upon Congress to provide
the staffing, facility resources, and technology software needed to
help VA address the claims backlog, including the backlog in BDD, Quick
Start and IDES claims.
Integrated Electronic Health Care Records
To say the transition process is seamless for servicemembers, or
that DoD and VA have an integrated disability evaluation process, would
be inaccurate, although the agencies have drastically improved
collaboration efforts. It is impossible to have an integrated
disability evaluation process without an Integrated Electronic
Healthcare Records System. For the past ten years, Presidential
Commissions, Congressional Task Forces, VSOs and the GAO have described
the need for an Integrated Electronic Healthcare Record System; yet
veterans are not any closer to having one today than they were ten
years ago.
Since VA and DoD providers lack the ability to share health records
for servicemembers instantaneously, they have to result to more archaic
measures of sharing information, such as fax or snail mail. For
example, one National Guard unit reported that they continue to ship
hardcopy health records via FedEx to Reserve Components Soldier Medical
Support Centers, and they are notified by mail when the MTF receives
the packet. Furthermore, DoD uses different records keeping systems for
inpatient, outpatient, and behavioral health records, making it
difficult for servicemembers to ensure all their records are fully
compiled and transferred. VA compounds the problem by brokering IDES
claims; for example, one servicemembers' records were individually sent
to Baltimore, Vermont, Maine, and Seattle before it was adjudicated and
sent back to the MTF.
The VA and DoD entered into a Memorandum of Understanding that
required DoD to provide complete copies of Service Treatment Records
(STR) to VA. Although the MOU went into effect early this year, a high
level VBA official recently stated that 81 percent of Gold Standard
STR's are overdue by 45 days.
In addition, reserve component members face unique difficulties
when obtaining scattered and often incomplete records because of
members' multiple, nonconsecutive deployments. VA disproportionately
denies Reservist and National Guardsmen benefits because they cannot
establish that their condition is service-connected due to the missing
Line of Duty (LOD) statements. An LOD determination is an
administrative tool for determining a member's duty status at the time
of injury, illness, disability, or death, and is the gateway to VA
benefits. The VFW encourages Congress to urge the National Guard Bureau
to create a uniformed LOD policy and implement a single electronic
processing system to ensure all eligible reserve component members have
access to earned healthcare and benefits.
Similar to the lack of an Integrated EHR system, servicemembers
need a singular transparent system to monitor IDES. Multiple system
accesses are still required to obtain and track necessary data. The
Veterans Tracking Application (VTA) is a joint VA/DoD application that
tracks the initial arrival of a servicemember into the VA health system
and monitors benefits applications and administrative details. VTA also
tracks servicemembers that have been referred to a Medical Evaluation
Board (MEB).
We consistently hear from servicemembers, who are frustrated that
they do not know the status of their IDES case because access is
granted to a limited amount of staff. As a result, servicemembers
cannot plan for the future because they don't know when the next exam
will be or their discharge date. We recommend that VA work with DoD to
broaden VTA access to those supporting wounded warriors to include, MEB
attorneys, Community Based Warrior Transition Units and authorized
veteran advocates.
Outreach
The VOW to Hire Heroes Act established a requirement that all
servicemembers, participate in the Transition Assistance Program by
November 2012. Since the universal implementation of TAP, the VFW has
gone from having an entire day to brief servicemembers on the benefits
and resources available to them to five minutes in some locations. More
so, VA continues to push servicemembers and veterans to the e-benefits'
portal, which is not regularly updated, or does it allow veterans to
share information with service officers. As a result of the TAP
changes, we have found servicemembers are less aware of the BDD or
Quick Start Program and are not seeking assistance with claims. In
addition, when servicemembers use e-benefits they feel as if their
claim enters into the abyss. Our fear is that if servicemembers do not
seek VSO help they will ultimately end up filing appeals as veterans.
We also understand that the TAP process introduces a variety of
information resources, web sites, and call centers to servicemembers so
that they can education themselves on their benefits. Much of the
services provided to servicemembers by DoD are redundant, which can
overwhelm and confuse servicemembers causing them to underutilize the
services. An RWTF focus group, ``revealed significantly unmet needs for
information'' at various points in the recovery or transition process.
More so, we receive complaints from family caregivers and surviving
spouses that DoD does not properly inform them of programs and benefits
created by Congress to support them.
While DoD has developed a means of tracking members' involvement,
it has not established an accurate means to measure participation in
TAP including VA benefit briefings. We believe that DoD and VA must
establish a policy to promote the accuracy, timeliness, availability,
and relevant information; they must also establish the method to gauge
servicemembers' participation and satisfaction with TAP, and work to
include community partners in the TAP process.
Conclusion
The VFW acknowledges that both the Departments of Defense and
Veterans Affairs are delivering quality care to servicemembers and
veterans. We also give them credit for setting ambitious timeliness
goals for delivering benefits and addressing issues with the disability
evaluation system; timeliness has drastically improved from the
estimated 540 days it took to complete a claim with the legacy system,
and VA and DoD continue to shorten the amount of times it takes to
process all disability claims.
However, VA and DoD do not have the management, policies,
procedures, and resources to address the influx of servicemembers who
will be transitioning to civilian life once forces withdraw from
Afghanistan and DoD cuts its force structure. It is imperative that
Congress not only continue its aggressive oversight over the agencies
to ensure they properly plan for the future, but they must also provide
the fiscal resources to improve the delivery of care and benefits that
our servicemembers have earned.
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