[Senate Hearing 111-913]
[From the U.S. Government Publishing Office]
S. Hrg. 111-913
REVIEW OF THE VA AND DOD INTEGRATED DISABILITY EVALUATION SYSTEM
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
NOVEMBER 18, 2010
__________
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana Scott P. Brown, Massachusetts
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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November 18, 2010
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 2
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 3
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 4
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 47
Brown, Hon. Scott, U.S. Senator from Massachusetts............... 53
WITNESSES
Bertoni, Daniel, Director of Education, Workforce, and Income
Security Issues, U.S. Government Accountability Office......... 4
Prepared statement........................................... 7
Campbell, John R., Deputy Under Secretary, Office of Wounded
Warrior Care and Transition Policy, U.S. Department of Defense. 25
Prepared statement........................................... 27
Response to requests arising during the hearing by Hon.
Richard Burr...........................................46, 56, 58
Medve, John, Executive Director of VA/DOD Collaboration Service,
Office of Policy and Planning, U.S. Department of Veterans
Affairs........................................................ 30
Prepared statement........................................... 31
Response to post-hearing questions submitted by:
Hon. Daniel K. Akaka....................................... 33
Hon. Richard Burr.......................................... 36
Hon. Mark Begich........................................... 43
Response to request arising during the hearing by Hon.
Sherrod Brown.............................................. 48
REVIEW OF THE VA AND DOD INTEGRATED DISABILITY EVALUATION SYSTEM
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THURSDAY, NOVEMBER 18, 2010
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:05 a.m., in
room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Brown of Ohio, Burr, Isakson,
Johanns, and Brown of Massachusetts.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. This hearing of the U.S. Senate Committee
on Veterans' Affairs will come to order.
Aloha to all of you and welcome to today's hearing on the
joint VA and DOD Disability Evaluation System.
VA and DOD used to operate two separate disability
evaluation systems. With many individuals being evaluated for
the same condition by both agencies, the redundancy in medical
examinations and the separate rating processes produced varying
results and left many servicemembers confused. Since 2007, VA
and DOD have been testing a streamlined program to integrate
the two processes. At the heart of this effort is the Joint
Disability Medical Examination that would replace DOD's Medical
Evaluation Board Physical Evaluation Board process and VA's
Disability Compensation Claim process.
The purpose of today's hearing is to examine how well the
new system is working. Our review of the program is
particularly important now because VA and DOD are planning to
expand the program worldwide. While streamlining the two
systems is important, the implementation of this joint program
has not been without problems. At a few pilot sites, VA
staffing shortages due to a lack of personnel to conduct
disability medical examinations caused significant delay in the
processing of servicemembers. There were also personnel
shortages at DOD among those responsible for guiding
servicemembers through the new process. Issues of servicemember
satisfaction and quality-of-life are also of concern.
Other issues have been identified through committee staff
oversight and by the GAO in its draft report on the new
processes. These include problems with integrating VA staff at
military installations, difficulty in having various IT systems
work together, and ensuring that an adequate number of DOD
physicians serve on medical evaluation boards. The Committee
needs to hear from VA and DOD on how these challenges are being
addressed.
I also want to know how the new joint program will affect
veterans who are waiting to have their claims adjudicated by
VA. VA is already facing a backlog of claims and medical
examinations. I am concerned that veterans already in the VA
system could be adversely affected by the resources being
diverted to support the new program.
I want to thank the witnesses for being here today and look
forward to their testimony.
Senator Burr, your opening statement please.
STATEMENT OF HON. RICHARD BURR,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Thank you, Mr. Chairman. I thank you for
holding this hearing and I welcome all that are here today. I
want to take just a moment to go off script, if I can.
Mr. Chairman, you and I have devoted a great deal of time
to ensuring that VA honors the veterans who served at Camp
Lejeune during the three decades when the base water was highly
contaminated with carcinogens. While that has not been easy,
there have been some signs of slow progress at the Veterans
Administration. In September, VA informed the Congress that out
of approximately 200 claims of exposure its office received
from Lejeune veterans since March of this year, only 20 have
been granted. When my staff asked the VA for the justification
behind the 180 denials, VA said they did not have the
information that was needed.
Then last week, I learned that the VA plans to centralize
the Lejeune claims review process in one regional process in
Louisville, KY. While this is possibly welcome news, VA did not
proactively inform me or any member of this significant change
in the process, and my staff only learned about it from a
constituent.
Mr. Chairman, some of us on this Committee have expressed
concerns and even frustrations with the lack of communication
and transparency that this Committee receives out of the
Veterans Administration. This latest episode is another example
of the broader problem we face with a bureaucratic culture at
VA that does not welcome oversight and resists information
sharing. If this Committee is to fulfill its mission to serve
our Nation's veterans, we need the VA to do a better job of
holding up their end of the bargain.
That is my commentary this morning, but this is not
something that will end with this hearing.
Now, let us turn to the issue at hand. For any
servicemember whose medical conditions keep them from
continuing their service in the military, there must be an
effective, hassle-free process to get them the benefits and
services that they need and help them to smoothly transition to
civilian life.
But several years ago, it became clear that the disability
system at the Department of Defense and at the VA was not
living up to that standard. In 2007, the news reports as well
as several panels of experts detailed how injured
servicemembers had to go through a long bureaucratic process at
DOD, followed by a similar process at the VA, to find out what
disability benefits they would receive. Wounded servicemembers
and their families were becoming frustrated, confused, and
disappointed with both systems.
Since then, DOD and VA have joined efforts to improve this
process by piloting an Integrated Disability Evaluation System.
This allowed injured servicemembers to find out what benefits
they will get from both agencies before being discharged from
the military. A single set of medical examinations are used by
both agencies and VA assigns the disability ratings that govern
what benefits are provided by both VA and DOD.
Our witnesses today will testify that this joint process
has shown potential to reduce delays and confusion in getting
benefits from both agencies. In fact, DOD and VA believe the
pilot was a success and plan to roll out the program to sites
worldwide, including several bases in North Carolina.
But as we will discuss today, this pilot did have a number
of significant challenges. Pilot sites ran into logistics
problems, staffing shortages, surges in caseload, and other
issues that led to long delays for servicemembers. On top of
that, servicemembers have expressed concerns about the quality
of their life while going through this process. Some have
pointed out that they were not given meaningful work to do and
spent too much time being idle. Others are frustrated that they
cannot accept civilian jobs, enroll in school, or otherwise
plan for civilian lives because they just do not know how long
the process will take. As one Marine from Camp Lejeune put it,
DOD and VA should, ``set a time and date so we can plan our
lives.''
Mr. Chairman, I realize that DOD and VA are taking steps to
address many of these challenges and I look forward to hearing
about those efforts today, particularly now as these agencies
plan to expand this process to more sites. We need to be sure
that these sites would be ready with the staff, with the
facilities, and the other tools they need to provide wounded
servicemembers with the high level of service that they have
earned, and more importantly, they deserve. More importantly,
we must make sure that whatever system is in place meets the
needs of wounded servicemembers and their families and actually
helps improve their lives.
With that in mind, Mr. Chairman, I hope that we will have a
candid discussion today about how to best move forward with
improving the Disability Evaluation System for our Nation's
injured veterans. I thank the Chair once again. I yield.
Chairman Akaka. Thank you very much, Senator Burr.
Senator Burr, we have worked so well together. He has been
a leader in the Camp Lejeune issue. I just want him to know
that I will continue to work with him in all oversight issues.
Now, we will hear the opening statement of Senator Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEVADA
Senator Johanns. Mr. Chairman, thank you. Mr. Chairman and
Ranking Member, thank you for your efforts to put this hearing
together. To our witnesses, I really appreciate you being with
us today.
I am sure all of us would agree it is important to make the
process by which our servicemembers access the benefits they
deserve as straightforward as we can. I am always going to be
willing to support efforts to streamline that process and I
commend all those with the VA who have spent countless hours
attempting to solve this backlog issue which we never get too
far away from on this Committee.
I participated in the Senate Veterans' Affairs Committee
hearing in July 2009 when we heard an assessment of the pilot
program and I look forward to hearing the testimony today about
progress, improvements, and what next steps might be.
I am encouraged that the pilot program has the potential to
effectively assess servicemembers' fitness and provide
disability ratings. I am concerned that some of the problems
associated with the pilot maybe have not yet been resolved, and
I am anxious to hear about that. It is my hope that DOD and VA
are working hard to implement some of the lessons learned from
the pilot program so we can provide our veterans with benefits
quickly and efficiently.
To our witnesses, again, thank you for being here. I look
forward to the testimony. I know we are all working hard to
deal with these issues and my hope is we continue to see
progress.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Johanns.
Now we have the opening statement of Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Thank you, Mr. Chairman, for calling this
hearing. Thank you, Mr. Chairman, for calling this hearing. I
look forward to hearing from our witnesses and having a good
discussion on how we can improve the disability evaluation
system for our Nation's injured servicemembers.
Chairman Akaka. Thank you very much, Senator Isakson.
I want to welcome the witnesses on today's panel. In the
interest of opening a dialog amongst our witnesses, we have
only one panel.
First, we have Daniel Bertoni, Director of Education,
Workforce, and Income Security Issues at the Government
Accountability Office; next, we have John R. Campbell, Deputy
Under Secretary, Office of Wounded Warrior Care and Transition
Policy at the Department of Defense; and we have John Medve,
Executive Director of VA/DOD Collaboration Service, Office of
Policy and Planning of the Department of Veterans Affairs.
I thank all of you for being here this morning. Your full
testimony will appear in the record.
Mr. Bertoni, you are now recognized for 5 minutes, and then
we will move to Mr. Campbell and Mr. Medve. Mr. Bertoni?
STATEMENT OF DANIEL BERTONI, DIRECTOR OF EDUCATION, WORKFORCE,
AND INCOME SECURITY ISSUES, U.S. GOVERNMENT ACCOUNTABILITY
OFFICE
Mr. Bertoni. Mr. Chairman, Members of the Committee, good
morning. I am pleased to comment on the Departments of Defense
and Veterans Affairs' efforts to integrate and streamline their
Disability Evaluation Systems.
More than 40,000 servicemembers have been wounded or
injured in Iraq and Afghanistan, and many who cannot continue
their military service must navigate complex Disability
Evaluation Systems in both DOD and VA. GAO and others have
identified problems with these systems, including delayed
decisions, duplication of processes, and confusion among
servicemembers.
In 2007, DOD and VA designed and piloted an Integrated
Disability Evaluation System, or IDES, with a goal of improving
and expediting the delivery of benefits to servicemembers. My
statement today will briefly summarize key findings of our
pending report, which examined the agency's evaluation of the
pilot results, implementation challenges to date, and DOD and
VA's effort to mitigate those challenges.
In summary, in their August 2010 evaluation report, the
agencies noted that the pilot has improved servicemember
satisfaction relative to the legacy system and met their target
goals for delivering VA benefits to active duty and reserve
members within 295 and 305 days, respectively. Despite meeting
the overall timeliness goals, we found that not all service
branches achieved the same results. Only the Army, which
represents about 60 percent of all IDES cases, was successful,
while average processing times for the Navy, Air Force, and
Marines were substantially higher.
We also found that as caseloads have increased, processing
times have also steadily increased, with most recent data
showing average processing times for active duty and reserve
members at 317 and 310 days, respectively. Despite this trend,
the current processing time is likely an improvement over the
540 days the agencies estimate that it takes to obtain VA
benefits under the legacy system.
DOD and VA have encountered several implementation
challenges with the pilot that contributed to delays in
processing claims. For example, nearly all the sites we visited
experienced staffing shortages to some degree, often due to
workloads exceeding original projections. Shortages and delays
were most severe at large pilot sites. Caseload surges related
to deployments at one location due to the VA medical staff
shortages took 140 days to complete the single disability exam,
well in excess of the pilot's 45-day goal.
We identified other issues and delays associated with the
single exam, such as problems with the completeness and clarity
of exam summaries and disagreements between DOD and VA medical
staff on some diagnoses. Pilot sites also experienced
logistical challenges, such as incorporating VA staff into
military facilities and housing servicemembers awaiting
decisions on their case.
As DOD and VA prepare for rapid expansion worldwide, they
are taking steps to address several key challenges. This
includes increasing exam and case management personnel via
additional hiring, staff reallocations, and increased
contracting; requiring local facilities to develop contingency
plans for addressing caseload surges; and making policy and
procedural changes to improve the quality of exam summaries.
While these initiatives are promising, DOD and VA still lack
strategies for ensuring enough military physicians are in place
to handle projected workloads and a systemwide mechanism to
monitor and address local-level challenges, such as sudden
staffing changes or problems with medical diagnoses.
In conclusion, by integrating two duplicative Disability
Evaluation Systems, the IDES shows promise for expediting the
delivery of benefits to returning wounded warriors. However,
the pilot has revealed challenges that require careful
management attention and oversight. It is unclear whether these
challenges will be sufficiently addressed prior to worldwide
implementation. Accordingly, our final report will include
recommendations to further improve DOD and VA's planning for
expansion of the new system going forward and we look forward
to continuing to work with the agencies on this important
issue.
Mr. Chairman, this concludes my statement. I am happy to
answer any questions that you and other Members of the
Committee may have. Thank you.
[The prepared statement of Mr. Bertoni follows:]
Prepared Statement of Daniel Bertoni, Director of Education, Workforce,
and Income Security Issues, Government Accountability Office
Chairman Akaka. Thank you very much, Mr. Bertoni.
Mr. Campbell, will you please proceed with your statement.
STATEMENT OF JOHN R. CAMPBELL, DEPUTY UNDER SECRETARY OF
DEFENSE (WOUNDED WARRIOR CARE AND TRANSITION POLICY), U.S.
DEPARTMENT OF DEFENSE
Mr. Campbell. Good morning, Mr. Chairman, Ranking Member
Burr, and Members of the Committee. Thank you for the
opportunity to be here this morning with Mr. Bertoni from the
Government Accountability Office and John Medve from the
Department of Veterans Affairs. I am pleased to discuss the
current status of the Integrated Disability Evaluation System
and the plans DOD and VA have for its worldwide expansion. We
appreciate the opportunity to explain where we have been and
where we are going with regards to IDES, formerly the
Disability Evaluation System Pilot. All DES programs are joint
efforts between DOD and VA.
Until recently, the non-VA Integrated DES, known as the
legacy system, was relatively unchanged until public and
Congressional concern arose regarding its perceived
inadequacies. Some are legitimate, verifiable, and required
response. DOD and VA chartered the Wounded, Ill, and Injured
Senior Oversight Committee in November 2007, and the SOC
immediately recommended that a new DES pilot be created. The
SOC's vision for the pilot was to create a servicemember-
centric seamless and transparent DES. The goal is simplifying
and improving the transparency of the disability evaluation
process, reducing case processing times, and increasing
consistency of ratings. This is accomplished, in part, by
employing a single medical exam process and single source
disability rating.
On July 30, 2010, the SOC co-chairs, the Deputy Secretary
of Defense and the Deputy Secretary of Veterans Affairs,
directed worldwide implementation of the process, beginning in
October 2010 and to be completed at the end of September 2011.
The decision to move forward with expansion of the pilot,
subsequently named IDES, was based on the high satisfaction
rate of servicemembers, demonstrated efficiency, and lessons
learned from the pilot.
In preparation for the IDES expansion, VA and DOD will
conduct joint site planning conferences for each stage. The
conferences will bring together the local VA and DOD site
officials responsible for the implementation of the IDES in
their own geographic areas. These joint conferences will
engender frank discussions of the goals and milestones that
must be met prior to each site's initial operating capability.
In addition, training will occur for Patient Administration
Personnel, PEBLOs, Military Services Coordinators, and
physicians. Detailed site assessment matrices and checklists
will be completed and signed by DOD and VA officials. Strict
certification procedures will be followed and approved by
senior levels of leadership in VA and military departments
before a site may implement the IDES. Last, sites will also
provide 30-day post-implementation written assessment
``hotwashes.''
The DES pilot process has proven to be a success. It was
faster, more transparent, more understandable, and provided
more consistent, equitable outcomes than the legacy DES. As a
result, both DOD and VA are fully committed to the successful
worldwide expansion of IDES within the timelines discussed in
my written statement. DOD will continue to work closely with
VA, monitoring every facet of the expansion and making
adjustments as necessary.
Although IDES is a demonstrated process improvement over
the legacy system, we can and will continue to improve. We are
also in the process of thoroughly reviewing the recent
Government Accountability Office draft report related to the
Disability Evaluation System. Although we will be providing
official comment at a later date, we are likely to concur with
their initial findings.
In closing, I would like to thank the Committee for its
continued interest and leadership in this very important
program. We are mindful of the concerns raised by the Committee
in recent months and are taking them into account as we move
forward with the expansion.
Mr. Chairman, this concludes my statement. On behalf of
recovering and transitioning men and women in the military
today and their families, I thank you and the Members of the
Committee for your steadfast support. I am happy to answer any
questions you may have at this time.
[The prepared statement of Mr. Campbell follows:]
Prepared Statement of John R. Campbell, Deputy Under Secretary, Office
of Wounded Warrior Care and Transition Policy, U.S. Department of
Defense
Mr. Chairman and Members of the Committee: Thank you for the
opportunity to discuss the current status of the Integrated Disability
Evaluation System (IDES) and Department of Defense (DOD), and
Department of Veterans Affairs (VA) plans for worldwide expansion of
IDES. We appreciate the chance to explain where we have been and where
we are going with regards to the IDES, formerly the Disability
Evaluation System (DES) Pilot.
The IDES integrates DOD and VA DES processes. During the IDES
process, the member receives a single set of physical disability
examinations conducted according to VA examination protocols, and then
disability ratings are prepared by VA. During the IDES, both
Departments are conducting simultaneous case processing--this ensures
the timely and quality delivery of disability benefits. Both
Departments use the VA protocols for disability examination and the VA
disability rating to make their respective determinations. DOD
determines fitness for duty and provides compensation ratings for
unfitting conditions incurred in the line of duty under title 10,
United States Code (U.S.C.), while VA provides compensation ratings for
all disabilities incurred or aggravated during military service for
which a disability rating is awarded and thus establishes eligibility
for other VA benefits and services, in accordance with title 38,
U.S.C.. The systems are integrated, not merged. The IDES requires the
Departments to complete their disability determinations before DOD
separates a Servicemember so that both Departments can validly
determine a Servicemember's disability and provide disability benefits
at the timeliest point allowed under both titles. Servicemembers who
separate or retire (non-disability) may still apply to the VA for
service-connected disabilities and be compensated by the VA, in
accordance with current policies and processes.
background
The genesis of the current Disability Evaluation System is the
Career Compensation Act of 1949. Until recently, the legacy system (the
non-VA integrated DES) was relatively unchanged until public concern
arose regarding perceived inadequacies of the DES. As a result of
public concern and congressional interest, DOD and the VA chartered the
Wounded, Ill and Injured (WII) Senior Oversight Committee (SOC) in
November 2007. The SOC immediately recommended that a new DES Pilot be
created. The SOC vision for the DES Pilot was to create a
``Servicemember Centric'' seamless and transparent DES, administered
jointly by the DOD and VA. The SOC intended the DES Pilot to:
Simplify the disability evaluation process: Make the
process easier for Servicemembers, veterans, and families by
eliminating the duplicate requirements placed on them so the process is
less complex and non-adversarial.
Improve the Transparency of the disability evaluation
process: Employ a recognized, impartial disability evaluation process.
Increase Consistency: Ensure Servicemembers and veterans
with similar levels of disability receive similar benefits outcomes by
standardizing processes and increasing oversight.
Ensure Appellate Procedures: Protect the due process
rights of Servicemembers and veterans.
Reduce Case Processing Time: Reduce the wait
Servicemembers and veterans experience between the point they are
referred to the DES until they receive VA benefits.
Employ a single medical exam and single-source disability
rating.
Ensure seamless transition to Veteran status.
Ensure a continuum of care--advocacy and expectation
management.
des pilot performance
As we reported to Congress in August of this year, Active component
members completed the IDES in an average of 291 days, 46 percent faster
than a sample of legacy DES cases, and Reserve component members
completed the IDES in an average of 281 days. A single VA examination
and rating source for Servicemembers streamlined the process, reducing
the gap between separation/retirement from Service to receiving VA
benefits. There has also been increased transparency through better
information flow to Servicemembers and their families. Moreover, DES
Pilot surveys reflect a higher Servicemember satisfaction with the IDES
compared to the legacy DES. The DES Pilot is a demonstrated process
improvement over the legacy, but we can, and will, continue to improve.
lessons learned
Of the current 27 DES Pilot locations, most have successfully
implemented the DES Pilot and are examples of efficiency. However, both
DOD and VA have examined improvement opportunities identified during
the Pilot and have taken appropriate action to address them. Site
Certification procedures, conducted by DOD and VA senior leadership,
were developed to ensure each future IDES location is prepared to
implement the IDES. Site certification ensures appropriate exam
coverage, a completed Memorandum of Agreement (MOA) between VA and DOD,
sufficient resources (Physical Evaluation Board Liaison Officers
(PEBLOs), Military Services Coordinators (MSCs), provider staffing),
adequate facilities (sufficient space and equipment for VA and DOD
personnel), sufficient IT resources, required IDES training, and a
comprehensive communications plan. VA is also planning for increased
exam capacity before a site is declared open for IDES, and Military
departments will work closely with local VA facilities on unanticipated
surges in demand while VA will develop additional exam capacity for
demand spikes.
In order to improve awareness of Servicemember progress in the
IDES, improvements are being made to the current tracking system, the
Veteran Tracking Application (VTA), so that it collects performance
data in a more timely and efficient manner. Shortages of PEBLOs are
also being addressed DOD-wide through funding and improved force
management. We are also refining operational and performance objectives
to more clearly address potential problem areas at the operational and
tactical levels. Findings from the DES Pilot are being utilized to
inform the setting of improved performance objectives that are
realistic and reflective of the actual IDES experience. DOD is also
studying conditions that cause referral to the IDES, with the intent of
tightening policy or aligning toward capability assessments, in order
to reduce superfluous referrals in which Servicemembers were returned
to duty more often than not.
Additionally, VA is adding supplemental medical examination
contract capability to be in place by December 31, 2010. Virtual
Lifetime Electronic Record (VLER), interoperability between DOD's and
VA's electronic health records (AHLTA and VISTA, respectively), and
IDES IT initiatives will increase health record sharing and build DOD/
VA interfaces, pertinent to more efficient handoffs between VA and DOD.
case study of success--fort riley, kansas
While we have noted areas that are improving based on opportunities
identified during the DES Pilot, we would also like to single out one
location that we hold up as an example of DES Pilot success, Fort
Riley, Kansas. This location is an example of the impact that dedicated
and energized leadership has on the DES Pilot. At Fort Riley, key
senior leaders were intimately involved from the early onset of the DES
Pilot. Leaders took lessons learned from the conferences, hotwashes,
and after-action-reports and liaised directly with VA counterparts to
develop a joint common operating concept and conducted joint
contingency site planning before initiation of the DES Pilot. Monthly
Fort Riley/DOD/VA meetings enabled development of crucial working
relationships, and review of DES Pilot procedures allowed for
identification of issues and established a schedule for resolution of
action items prior to implementation of the DES Pilot on February 1,
2010. Fort Riley developed a ``one-stop'' Medical Evaluation Board
(MEB) clinic. This clinic performs a thorough case evaluation before
referral to the DES Pilot, thus preventing cases from starting the DES
Pilot prematurely and reducing potential delays. The MSCs and Army Out-
Reach Counselors are co-located with the Army PEBLOs, greatly improving
process workflow and communications between the VA and DOD. As a result
of these concerted efforts, the current average days to complete IDES
processing at Fort Riley is 231 days, which is a savings of 309 days
over the 540-day legacy DES benchmark and a 60-day savings over the
IDES average of 291 days. Fort Riley has emerged as the model for other
sites to emulate.
worldwide ides expansion
Based on the high satisfaction rate of Servicemembers, demonstrated
efficiency, and lessons learned from the DES Pilot, the SOC Co-chairs
(Deputy Secretary of Defense and Deputy Secretary of Veterans Affairs)
on July 30, 2010, directed worldwide implementation of the process
beginning in October 2010 and to be completed at the end of
September 2011. Because it is no longer a pilot, the name was changed
to IDES. The Under Secretary of Defense (USD) for Personnel and
Readiness (P&R) signed a memorandum on August 16, 2010 asking Service
Secretaries to take action to expand the IDES.
The DES Pilot's 27 locations cover about 47 percent of
Servicemembers (12,735) who enter the DOD disability evaluation system
annually. The impact of each stage of the IDES expansion and cumulative
DES population is shown below:
Stage I--West Coast & Southeast (October-December 2010)--
28 Sites--58%
Stage II--Mountain Region (January-March 2011)--24 Sites--
74%
Stage III--Midwest & Northeast (April-June 2011)--33
Sites--90%
Stage IV--Outside Continental United States (OCONUS)/CONUS
(July-September)--28 Sites--100%
Total IDES locations when expansion is complete: 140
In preparation for the IDES expansion, VA and DOD will conduct Site
Planning Conferences for each stage. These conferences will bring
together the local VA and DOD site officials responsible for the
implementation of the IDES in their own geographic areas. These joint
conferences will engender frank discussions of the goals and milestones
that must be met prior to each site's Initial Operating Capability
(IOC). In addition, training will occur for Patient Administration
personnel, PEBLOs, MSCs and Physicians. Detailed Site Assessment
Matrices and Checklists will be completed and signed by the DOD and VA
officials and strict certification procedures will be followed and
approved by senior levels of leadership in VA and the Military
Departments before a site may implement the IDES. Sites will also
provide 30 day Post-IOC written assessment ``hotwashes.''
With regards to Stage I, the Military Departments are reporting
December 31 as the Stage I IOC date for the next 28 sites. Seventeen of
the 28 Stage I expansion sites will rely on VA contracts for medical
exam coverage; as a bridge to other in-house services, VA contracts for
medical exams have been awarded and are available for sites to meet the
December 31 IOC. The Deputy Secretary of Defense tasked the Assistant
Secretary of Defense, Health Affairs, to develop a plan for overseas
IDES exams with an estimated completion date of December 15, 2010.
closing
We appreciate the Committee's continued interest and leadership in
this very important program and we are mindful of the concerns raised
by the Committee in recent months as we move forward with the
expansion. Under the Legacy DES, the Departments administered duplicate
disability examinations and ratings. The DES Pilot improved and
streamlined the overall process that Servicemembers and their families
navigate to reach Veteran status to receive the compensation and
benefits they have earned. The DES Pilot process has proven to be a
success; it was faster, more transparent, more understandable, and
provided more consistent, equitable outcomes than the legacy DES. As a
result, both DOD and VA are fully committed to the successful worldwide
expansion of IDES within the timelines discussed in this statement. DOD
will continue to closely work with VA, monitoring every facet of the
expansion and making adjustments as necessary. We are also in the
process of thoroughly reviewing the recent Government Accountability
Office (GAO) draft report, ``Military and Veterans Disability System:
Pilot has achieved Some Goals, Further Planning and Monitoring Needed''
and will be providing official comments at a later date.
Mr. Chairman, this concludes my statement. On behalf of the men and
women in the military today and their families, I thank you and the
Members of this Committee for your steadfast support. We will continue
to provide regular updates on our progress.
Chairman Akaka. Thank you very much, Mr. Campbell.
Mr. Medve, will you please proceed with your statement.
STATEMENT OF JOHN MEDVE, EXECUTIVE DIRECTOR OF VA/DOD
COLLABORATION SERVICE, OFFICE OF POLICY AND PLANNING, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Mr. Medve. Good morning, Chairman Akaka, Ranking Member
Burr, and Members of the Committee. My name is John Medve and I
am the Executive Director of the Department of Veterans Affairs
and Department of Defense Collaboration Service within VA's
Office of Policy and Planning. I am pleased to join Mr. Daniel
Bertoni with GAO and Mr. John Campbell, Deputy Under Secretary
of Defense, Wounded Warrior Care and Transition Policy, and
provide the Committee with an overview of VA and DOD plans for
the way forward with the Integrated Disability Evaluation
System.
I welcome today's opportunity to share with you a good news
story with respect to the improvements VA and DOD have made to
the DOD Disability Evaluation System. When we started the DES
pilot in 2007 within the National Capital Region, the
Departments recognized that by working together and through an
improved process, we could provide more consistent evaluations,
faster decisions, and more timely delivery of VA benefits. I
believe that we have achieved those goals and I would like to
highlight two points.
First, through the improved DES process, now referred to as
the Integrated Disability Evaluation System, we are providing a
more seamless transition for participating servicemembers to
veteran status. We have also virtually eliminated the pay gap
felt by veterans under the legacy Disability Evaluation System
resulting from delays in the delivery of VA compensation. These
results led the Senior Oversight Committee in July of this year
to approve expansion from the original 27 pilot sites to an
enterprise-wide IDES implementation.
Second, through the DES pilot and with the implementation
of IDEA, VA and DOD have developed, instituted, and are
sustaining a positive collaborative relationship at all levels,
focused on both solving the challenges of the rise during this
implementation, improving the overall process in a manner that
will ensure our servicemembers are treated with the dignity and
respect they deserve, and receive the benefits they have earned
in a timely manner.
Implementing a process enterprise-wide is never without its
challenges, and IDES has proved to be no exception. The key
point I would like to make is that, together, VA and DOD are
taking a critical eye to each stage of the implementation,
identifying issues, and working toward resolving them. The
draft GAO report which Mr. Bertoni described in his opening
statement and to which VA is currently responding highlighted
several of these issues, including timeliness of examinations
at Fort Carson. I am pleased to report that we have made
tremendous progress at Fort Carson with respect to the time
needed to complete examinations, which have gone from an
average of 140 days, as outlined in the report to, in this
latest report, 62 days, and is projected to be within the 45-
day goal by the end of December.
We are also taking into consideration GAO's concerns about
staffing levels and are evaluating a mechanism for reporting
staffing levels from the various sites on a regular basis. We
are applying the lessons learned from the pilot experiences we
expand to ensure that new sites have the resources and a plan
for implementation in place before they go live with IDES. Of
note, we now have a much better understanding of the number of
MEBs each site expects monthly and annually, and this is
translating into appropriate staffing levels. We believe that
through our improved site assessment and certification process,
we will reduce the likelihood of the staffing shortages found
at some pilot sites. In addition, we are going back to the
existing 27 sites and ensuring that they meet the same
standards as the new sites as we move forward.
I would like to thank the Committee for their concern and
oversight of this important issue. You and the Committee staff
have helped us to improve this process. At the end of the day,
we should not lose sight of the fact that this is all about
taking care of servicemembers and veterans.
The chart on page four of GAO's testimony is very
demonstrative of what we have achieved by integrating the VA
into the DOD disability process by eliminating the need for a
separate and distinct evaluation process for the purpose of
receiving VA benefits. Thank you again for your support of our
wounded, ill, and injured servicemembers, veterans, and their
families.
Mr. Chairman, this concludes my opening statement. I will
be happy to respond to any questions that you, Ranking Member
Burr, or other Members of the Committee may have.
[The prepared statement of Mr. Medve follows:]
Prepared Statement of John Medve, Executive Director of VA/DOD
Collaboration Service, Office of Policy and Planning, U.S. Department
of Veterans Affairs
Good morning, Chairman Akaka and Members of the Committee. My name
is John Medve, and I am the Executive Director of the Department of
Veterans Affairs (VA)/Department of Defense (DOD) Collaboration Service
for VA's Office of Policy and Planning. I am pleased to join my
colleague Deputy Under Secretary Campbell from the DOD and provide the
Committee with an overview of VA's and DOD's plans for the way forward
with the Integrated Disability Evaluation System (IDES).
First, I want to acknowledge and thank you, Mr. Chairman, and the
other Members of this Committee for the leadership role you have taken
on the issues of seamless transition for our wounded, ill, and injured
warriors and Veterans.
The IDES is central to Secretary Shinseki's efforts to transform
the Department into a high performing 21st century organization focused
on our Nation's Veterans as its clients. IDES, along with our work on
the Virtual Lifetime Electronic Record (VLER), will improve the
seamless transition of our Servicemembers from active duty to Veteran
status. The end goal is for Veterans to be able to easily enter the VA
health and benefits system and receive the care and services they have
earned.
Before going into our plans for the way forward, I think it would
be helpful to start with how we got to where we are today.
Through the leadership of Congress, in collaboration with VA and
DOD, in early 2007, the Departments realized that changes were needed
to the existing process in DOD's disability evaluation system (DES).
The VA/DOD DES Pilot was launched in November 2007 and was intended to
simplify and increase the transparency of the DES process for the
Servicemember while reducing the processing time and improving the
consistency of ratings for those who are ultimately being medically
separated. The National Defense Authorization Act (NDAA) 2008 further
energized our efforts when it was signed into law and authorized the
creation of a pilot program to make changes and improve DOD's DES.
Through these changes, the Departments hoped to provide a more
effective transition of Servicemembers from DOD to VA care and a
smoother transition to Veteran status. We believe that the resulting
DES Pilot, currently operational at 27 sites nationwide, has largely
achieved those goals. I acknowledge that there have been bumps in the
road and many lessons learned, but I look forward to sharing with you
how VA has worked with its DOD partners to create a more transparent,
consistent and expeditious disability evaluation process for
Servicemembers who are being medically retired or separated. While we
recognize that challenges remain, overall this is a good news story for
Servicemembers and Veterans.
From the outset, we recognized that the DES Pilot Model was
preceded by a maligned legacy process that was in some cases cumbersome
and redundant. The Pilot Model originally was launched as a joint VA/
DOD process at three operational sites in the National Capital Region
and was recognized as a significant improvement over the legacy
process. As a result of the desire by both Departments to expand the
benefits of the Pilot to more Servicemembers, VA and DOD expanded the
Pilot, starting in the fall of 2008 and ending in March 2010, from the
original 3 to the current 27 Pilot sites covering 47 percent of the DES
population.
In contrast to the DES legacy process, the Pilot Model provides a
single disability examination and a single-source disability rating
that are used by both Departments in executing their respective
responsibilities. This results in more consistent evaluations, faster
decisions, and timely benefit delivery for those retired or separated,
while empowering Servicemembers with essential information to better
enable them to transition to civilian life. I would like to highlight
the improvements we have made to compensation delivery. VA prepares a
proposed rating decision for use by DOD in determining fitness for duty
for Servicemembers enrolled in the DES. As a result, VA benefits are
delivered within the shortest period allowed by law following
discharge, and we have eliminated the ``pay gap'' that previously
existed under the legacy process, i.e., the lag time between a
servicemember separating from DOD due to disability and receiving his
or her first VA disability payment.
Concrete examples of how our integrated approach has eliminated
much of the sequential and duplicative processes found in the legacy
system include reduction of the overall processing time for the
delivery of DOD disability benefits from 540 days to 291 days while
shortening the period until delivery of VA disability benefits after
separation from an average of 166 days to near 30 days.
Based on these successes and after carefully addressing your IDES
expansion concerns, the co-chairs of the Senior Oversight Committee
agreed in July 2010 to expand the pilot and rename it IDES. Senior
leadership of VA, the Armed Services, and the Joint Staff strongly
supported this plan and the need for all Servicemembers to receive the
benefits of this improved pilot model. We are now working together to
launch IDES enterprise-wide. While we are very proud of the successes
of this model, we are also aware of remaining challenges. We recognize
that despite the overall reduction in combined processing time, VA can
do better by improving exam timeliness. We also recognize that as we
expanded outside of the National Capital Region, we had not yet
developed robust business processes to certify each site's preparedness
before it became operational. This was a lesson learned at Ft. Carson,
where the Departments have aggressively worked to remediate the issues
of an unanticipated demand for disability exams. We also recognize that
there have been successes, such as Ft. Riley, Kansas, where VA and Army
leadership took steps to avoid such problems as those experienced at
Ft. Carson. Through these efforts, and our analysis of lessons learned,
we have developed Initial Operating Capability (IOC) readiness criteria
that stress quality over expedience to ensure that future sites are
operationally ready for IDES. For a site to be deemed ready it must:
(1) be able to provide exam coverage through either the Veterans Health
Administration, DOD, or contracted services; (2) have sufficient space
and equipment for DOD and VA personnel; (3) meet VA information
technology requirements; and (4) have local staff who have completed
IDES training. If any of these criteria is not met, then IDES cannot
operate at that proposed site.
In developing the plan for expansion, we will launch new sites in
four stages over the course of fiscal year 2011. This will be done in
quarterly increments between October 2010 and October 2011. Stage I of
this expansion includes 28 locations on the West Coast and in the
Southeast United States. Of the 28 locations, 16 will initially use
contracted exam providers, and the remainder will provide exams in
conjunction with a VA medical facility. Let me assure you that as we
transition from the DES Pilot to IDES, we are jointly addressing the
challenges I have highlighted and have taken active, concrete steps to
ensure that we have the best, most effective program possible.
On September 27-30, 2010, VA and DOD hosted a joint Training/
Planning conference that set the stage for the roll-out of the next 28
sites. The conference resulted in improved communications between VA
and DOD at each site, individual site assessment analyses and
evaluations, and development of joint local plans to meet IOC
requirements. This conference will be followed by similar events over
the next few months as we prepare for the remaining stages of IDES
implementation. In fact, VA and DOD began a conference on November 16,
2010, which is wrapping up its work today.
As we move forward, we are mindful of the concerns and
recommendations of the Government Accountability Office (GAO) in its
recent draft report currently entitled ``Military and Veterans
Disability System: Pilot has Achieved Some Goals but Further Planning
and Monitoring Needed.'' VA is currently drafting responses to the GAO
recommendations.
VA and DOD have jointly worked on improving and expanding the DES
pilot so that Servicemembers can benefit from a uniform and integrated
program. Secretary Shinseki and Secretary Gates continue to provide
leadership, commitment, and support to ensure a successful transition
from the legacy DES process to the IDES without compromising quality
for expediency. In fact, on a recent visit to Ft. Drum, Secretary
Shinseki held a roundtable with Servicemembers and received feedback on
IDES. We are incorporating his findings into IDES.
While we are pleased with the joint efforts and progress made,
there is much more to do. VA and DOD are committed to providing more
support for our Nation's wounded, ill, and injured warriors and
Veterans through an improved IDES. As such, we believe that continued
partnership with DOD is critical and no less than our Servicemembers
and Veterans deserve.
Thank you again for your support to our wounded, ill, and injured
Servicemembers, Veterans, and their families. Mr. Chairman, this
concludes my testimony. I will be happy to respond to any questions
that you or other Members may have.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
John Medve, Executive Director of VA/DOD Collaboration Service, Office
of Policy and Planning, U.S. Department of Veterans Affairs
Question 1. Please provide an organizational chart for the
management of IDES within VA.
Response. IDES VA Operational Model and a copy of the Deputy
Secretary's memo appointing Office of Policy and Planning as the lead
office are attached.
Attachment
Question 2. What are the anticipated challenges foreseen at each
site scheduled to roll out by December 31, 2010?
Response. Of the 28 sites scheduled to achieve Initial Operating
Capability (IOC) by December 31, 2010, all sites have achieved IOC.
Prior to achieving IOC, some sites encountered minor challenges such as
obtaining approval to access VA systems over DOD network, finalizing
Memorandum of Agreements (MoA), facilities, resourcing, and
transportation requirements.
Question 3. For each site scheduled to roll out by December 31,
2010, please provide information on whether VA or a contractor will
perform medical examinations at that particular location. If there is a
contractor providing examination support at an individual location,
please provide the name of the contractor and the number of
examinations anticipated in 2011 for the locations.
Response. The following chart reflects the sites scheduled to roll
out during the first quarter of fiscal year 2011, examination provider,
and anticipated annual caseload. Examinations performed by VHA
Providers are performed internally. Those performed by QTC contractor
providers are under an external contract.
------------------------------------------------------------------------
Military Treatment Facility/
Installation Exam Provider Annual Caseload
------------------------------------------------------------------------
Beale Air Force Base (AFB)............ QTC and VHA 80
Charleston AFB........................ QTC 27
Edwards AFB........................... QTC 51
Eielson AFB........................... VHA 22
Fairchild AFB......................... QTC 89
Hickam AFB............................ QTC 230
Langley AFB........................... VHA 300
Los Angeles AFB....................... VHA 12
Maxwell AFB........................... VHA 43
McChord AFB........................... QTC 63
Moody AFB............................. VHA 68
Mountain Home AFB..................... VHA 137
Patrick AFB........................... VHA 98
Pope AFB.............................. VHA 22
Robins AFB............................ QTC 160
Seymour Johnson AFB................... QTC 163
Shaw AFB.............................. VHA 219
Vandenberg AFB........................ QTC 58
Tripler AMC........................... QTC 389
29 Palms Marine Hospital.............. QTC and VHA 164
Beaufort Naval Hospital (NH).......... QTC 171
Charleston NH......................... QTC 63
Cherry Point NH....................... QTC 131
Jacksonville NH....................... QTC 333
Lemoore NH............................ QTC 16
Oak Harbor NH......................... QTC 59
Pearl Harbor NH....................... QTC 166
Quantico NH........................... VHA 78
------------------------------------------------------------------------
Question 4. What are the training requirements for the launch of
any new IDES site? What is the Agency's plan to conduct ongoing
training for staff involved with IDES?
Response. All personnel are required to attend the IDES Planning
Conference, and receive Veterans Tracking Application (VTA) and IDES
overview training from a VA and DOD training team. The team travels to
Army and Navy sites to conduct on-site training for VA and DOD
stakeholders. The Air Force conducts a centralized training course
annually with VA and DOD trainers participating.
Prior to launching a new IDES site, local representatives from
military treatment facilities, VHA, and VBA attend a joint planning
conference where they are trained on the IDES process. Before sites
begin the integrated process, VA provides onsite training to Military
Service Coordinators (MSCs) with respect to the IDES process and
tracking application, the VTA. Additionally, new MSCs participate in
centralized MSC training that includes IDES-specific training. The
training curriculum is available on the Compensation and Pension (C&P)
Service Training Web site, and questions concerning MSC training are
answered regularly through the C&P Training mailbox.
In fiscal year 2012, VBA will begin visiting IDES sites as part of
its routine site visit rotation to its 57 regional offices, where
onsite feedback and training are provided.
Question 5. Please describe the overall staffing requirements for
the adjudication of IDES claims. When will Providence begin processing
IDES claims? Will additional staff need to be hired in Providence to
process these claims?
Response. The projected annual caseload for IDES is 27,000 claims.
The Providence Regional Office will process 14,000 claims and the
Seattle Regional Office will process 13,000 claims once full expansion
is accomplished.
The Providence Regional Office began processing paperless claims
for the National Capital Region Paperless IDES Pilot in October 2010.
Providence has hired 50 FTE to support IDES claims processing. As this
staff reaches journey-level performance, it is anticipated they can
support full expansion processing requirements. Seattle has 38 FTE
dedicated for this special mission. We will continue to compare and
monitor projected caseload to actual caseload to determine whether
additional staff will be required in the future.
Question 6. During the IDES hearing, December 15, 2010, was
mentioned as the deadline for the overseas IDES roll out plan. Please
provide the overseas IDES roll out plan.
Response. VA defers to DOD.
Question 7. For each site scheduled to roll out by December 31,
2010, please provide information for how each site is being funded--for
both the current and next fiscal year.
Response. VHA requested, obtained and distributed funding to sites
implementing IDES during FY 2011. IDES supplemental funding allocations
for FY 2011 were based on projected Medical Evaluation Board (MEB)
workload data provided to VHA by DOD. The Integrated Disability
Evaluation System (IDES) has budgeted $18M for FY 2011 and $18M for FY
2012.
This distribution of funding has not yet occurred and will be based
on a comprehensive evaluation of IDES workload anticipated by the
facilities. Specific determinants to be used in this process will
include: review of FY 2011 completed IDES workload, forecasted MEB
workload projections to be provided by the DOD and VISN/VAMCs
Director's assessments and requests for funding. Funding provided was
distributed to cover Services and Facilities Costs. This supplemental
funding effort was primarily designed to provide support for the
conduct of IDES examinations requests without sacrificing performance
of C&P examinations. VA facilities are also eligible for reimbursement
by DOD when performing examinations for Servicemembers for referred
conditions.
VBA provides Military Service Coordinator (MSC) support for each
IDES site. Generally, DOD provides the MSC(s) with office space and
access to their equipment such as facsimile and copier machines. Costs
associated with medical examinations are shared by VA and DOD, whereby
DOD bears the costs associated with conditions that are potentially
unfitting for further military service while VA bears the costs of
other conditions claimed as part of the VA claim for compensation.
Question 8. What specific efforts are underway to improve the
interoperability of VistA and AHLTA to support the IDES process?
Response. Advancements in the area of the Electronic Health Record,
such as Single Sign On, laboratory and radiology portability and the
joint registration capability continue to highlight the progress made
toward transactional interoperability between AHLTA and VistA. These
continued successes, will certainly be advantageous to the IDES process
as it continues to evolve.
Question 9. The draft GAO report on IDES indicated that case
management software was in development. What projects toward this end
are underway and what are their time lines for delivery? How will costs
be allocated between VA and DOD?
Response. VA defers to DOD. We believe the question refers to the
following language from the draft GAO report: ``DOD officials also said
that they are developing two new IT solutions. According to officials,
one system currently being tested would help military treatment
facilities better manage their cases. Another IT solution, still at a
preliminary stage of development, would integrate the Veterans Tracking
Application with the services' case tracking systems so as to reduce
multiple data entry.''
Question 10. Please provide the cost--for both the current and next
fiscal year--of disability examination contracts to support IDES.
Please provide the costs to VBA and VHA separately.
Response. The VHA Disability Evaluation Management (DEM)
Performance Work Statement was posted in the Federal Business
Opportunities Web site (FedBizOpps.gov) on 22 November 2010. This
contract remains in the acquisition source selection process and has
yet to be awarded. Once awarded, this contract will be managed by VHA.
Estimated costs for VBA are $13 million in fiscal year 2011 and $20
million in fiscal year 2012. If additional IDES sites are added to the
VBAu, the cost will increase.
______
Response to Post-Hearing Questions Submitted by Hon. Richard Burr to
John Medve, Executive Director of VA/DOD Collaboration Service, Office
of Policy and Planning, U.S. Department of Veterans Affairs
Question 1. According to testimony provided by the Government
Accountability Office (GAO), some officials have said that
servicemembers going through the Disability Evaluation System Pilot
(DES Pilot) or Integrated Disability Evaluation System (IDES) are not
given meaningful work by their units and, if they are idle while going
through the process, they might be more likely to engage in behavior
that could lead to a discharge due to misconduct.
A. As requested at the hearing, please identify how many of the
approximately 600 servicemembers who have been ``removed'' from the
IDES process have been discharged from the military due to misconduct.
B. Of the remaining servicemembers who have been removed from the
IDES process, what were the reasons for their removal?
C. As requested at the hearing, please explain what steps, if any,
the Department of Defense takes to monitor whether individuals in the
IDES process are given meaningful work by their units.
D. As requested at the hearing, please explain whether IDES sites
are asked to provide a plan for ensuring that servicemembers in the
process will be given meaningful work.
E. As requested at the hearing, please explain whether any survey
questions address the extent to which idleness is seen as a problem
during the IDES process and provide any relevant survey information or
data.
Response. VA defers to DOD.
Question 2. The Department of Defense set a goal of having no more
than 20 servicemembers for each Physical Evaluation Board Liaison
Officer (PEBLO). But, as of October 2010, there were a number of DES
Pilot sites, including Fort Bragg and Camp Lejeune in North Carolina,
that had at least 85 servicemembers for each of those case managers.
A. As requested at the hearing, please describe what factors have
led to these heavy caseloads for some PEBLOs.
B. What impact do these high caseloads have on the timeliness of
the IDES process or on servicemembers' satisfaction with the process?
C. As requested at the hearing, please provide a timeline for when
the sites in North Carolina will have enough staff to bring those sites
in line with the staff-to-servicemembers goal.
D. Nation-wide, what is the timeline for bringing PEBLO caseloads
in line with the goal?
E. As requested at the hearing, please explain whether a ratio of
20 servicemembers per PEBLO is the proper staffing goal.
F. In total, how many additional PEBLOs would be needed to roll the
IDES process out worldwide with a 1 to 20 ratio?
G. Do you foresee problems being able to hire or maintain
sufficient PEBLOs at the additional sites you plan to convert to the
IDES process?
Response. VA defers to DOD.
Question 3. In response to a customer satisfaction survey, one
servicemember going through the DES Pilot noted that he ``went thru 3
PEBLOs and they changed without me being notified.''
A. What was the turnover rate among PEBLOs at the DES Pilot sites?
B. What process should be followed when a PEBLO leaves an IDES site
or is reassigned? Is there a ``warm hand-off'' to the incoming case
manager?
Response. VA defers to DOD.
Question 4. As of November 7, 2010, over 15,600 servicemembers had
entered the IDES and 11,295 were still enrolled in that process.
Question 4A. Please provide a list of how long, on average,
servicemembers have been pending in the process at each location that
participated in the DES Pilot.
Response. DOD and VA have established a joint goal that 50 percent
of active component Servicemembers will complete the IDES process
within 295 days in fiscal year 2011. The development of more aggressive
processing goals is under senior leadership review.
Attached is a copy of December 26, 2010 monthly IDES report by
phases and components (AC/RC).
Attachment
Question 4B. In total, how many of the approximately 11,295
enrolled individuals have been pending in the IDES process for longer
than 295 days, the goal for completing the process?
Response. As of February 3, 2011, 3,895 Servicemembers were
enrolled in IDES for longer than 295 days.
Question 4C. How many individuals at Fort Bragg or Camp Lejeune
have been pending in the IDES process for longer than 295 days?
Response. As of February 3, 2011, 668 Servicemembers at Camp
Lejeune and 46 Servicemembers at Fort Bragg have been enrolled in IDES
for longer than 295 days.
Question 4D. In total, how many of the approximately 11,295
enrolled individuals have been pending in the IDES process for longer
than 540 days?
Response. As of February 3, 2011, 878 Servicemembers have been
enrolled in IDES longer than 540 days. This number includes those
pending longer than 295 days in responses 4B and 4C above.
Question 4E. What steps do your agencies currently take to flag and
resolve long-pending cases?
Response. Cases are flagged and an Overarching Integrated Product
Team (OIPT) started reviewing performance metrics by site on
February 9, 2011. Monthly progress reports are posted on the Veterans
Tracking Application (VTA) homepage and are available to all users. The
reports highlight older cases and cases pending at each stage for
longer than standard times.
Each case is unique and requires joint efforts from central office
and local level. Central office establishes assignments and
periodically conducts after action reviews with staff to identify
systemic issues that may require resource, policy, or procedural
changes. At the local level, Military Service Coordinators (MSC) work
with their military counterparts to resolve processing delays. For
example, case-specific delays are often due to scheduling conflicts for
illness, surgery, or family emergencies. The Physical Evaluation Boards
and rating sites conduct weekly reviews to identify the case status and
develop joint solutions for delays.
Question 4F. If this process is expanded globally, what additional
steps would be taken to monitor long-pending cases?
Response. VA defers to DOD.
Question 5. During the DES Pilot, customer satisfaction surveys
have been taken at various stages throughout the process.
A. Do your agencies use those surveys to identify areas of the
process or specific facilities that might need improvements? If so,
please provide examples.
B. Are the results of those surveys provided to each military
installation using the IDES process? If so, how frequently is that
information provided and in what format?
C. Is any follow-up done on specific complaints listed on those
surveys?
Response. VA defers to DOD.
Question 6. In expanding the IDES worldwide, VA case managers are
expected to provide services using only video-conferencing or
teleconferencing at some sites.
Question 6A. If the IDES is expanded worldwide, which specific
sites would have only remote services from VA case managers?
Response. IDES expansion to overseas locations is in the planning
phase. VA understands that DOD plans to transfer Servicemembers
referred into the IDES to a location within the continental United
States. As such, MSCs would be available to all Servicemembers enrolled
in IDES. Should Servicemembers remain overseas, VA expects to use video
conferencing for case management.
Medical Evaluation Boards are currently being conducted by the
military services at the following overseas sites.
-----------------------------------------------------------------------
Military Treatment Facility/Installation State/Country
------------------------------------------------------------------------
Andersen AFB......................................... Guam
Aviano AFB........................................... Italy
Incirlik AFB......................................... Turkey
Kadena AFB........................................... Japan
Kusan AFB............................................ Korea
Lajes AFB............................................ Portugal
Misawa AFB........................................... Japan
Osan AFB............................................. Korea
RAF Lakenheath....................................... UK
Ramstein AFB......................................... Germany
Spangdahlem AFB...................................... Germany
Yokota AFB........................................... Japan
Camp Zama............................................ Japan
Ft. Buchanan......................................... Puerto Rico
Heidelberg MEDDAC.................................... Germany
Landstuhl AMC........................................ Germany
Vincenza............................................. Italy
Guam NH.............................................. Guam
Guantanamo NH........................................ Cuba
Naples NH............................................ Italy
Okinawa NH........................................... Japan
Rota NH.............................................. Spain
Sigonella NH......................................... Italy
Yokosuka NH.......................................... Japan
------------------------------------------------------------------------
Question 6B. What impact would it have on the level of service
provided to servicemembers if case managers are not physically on site?
Response. Working closely with PEBLOS, VA's MSCs will be able to
meet the needs of Servicemembers using video conferencing, electronic
mail, telephone, and facsimile.
Question 6C. Would co-locating PEBLOs and VA case managers at the
IDES sites be preferable?
Response. Efficiencies would be gained by co-locating PEBLOs and VA
Case Managers. The biggest advantage would be the improvement in
communication between PEBLOs, Case Managers, and Servicemembers. Co-
locating would also improve the movement of documentation between the
Departments. VA is committed to providing the highest quality of
services, regardless of how services are delivered.
Question 7. In the Senior Oversight Committee's August 2010 report
on the DES Pilot, officials from both agencies highlight that the DES
Pilot ``provides consistent, equitable outcomes.''
Question 7A. What steps have your agencies taken to gauge whether
the ratings provided through this process are consistent?
Response. In the legacy DES, some stakeholders believed outcomes
were inconsistent across military services as well as between military
services and VA. Providing a single disability examination and a single
preliminary rating evaluation ensures a consistent rating by both
departments and a more transparent process to the Servicemember. VA
uses the results of DOD's satisfaction surveys of Servicemembers to
gauge their perceptions of the fairness and consistency of the DOD
disability evaluation system.
Question 7B. Please provide a summary of any data or other
information your agencies have collected regarding the issue of
consistency.
Response. IDES is inherently more consistent as it provides a
single examination and a single preliminary rating, replacing
duplicative examinations and ratings by each department. DOD provides
periodic analyses of its satisfaction surveys. Pilot participant
respondents reported that the IDES MEB and PEB processes were
significantly fairer than did legacy DES participants. Soldiers,
Sailors, and Marines in the IDES reported that IDES MEB and PEB
processes were significantly fairer than their legacy DES counterparts
reported. However, Airmen reported no difference in the fairness of MEB
and PEB IDES and legacy DES processes.
Question 8. Your agencies are currently planning to implement the
IDES at 140 locations worldwide.
Question 8A. How many of those sites generally would have less than
24 individuals per year entering the disability evaluation system?
Response. VA defers to DOD.
Question 8B. Please describe the plans for providing medical
examinations and VA case management at each of those sites?
Response. The decision for how medical examinations are provided is
determined locally by the site leadership. This decision is normally
made 60 days prior to the Initial Operating Capability date. The
examination provider is determined on an individual site basis based on
local resources and site location. If local resources are available,
VHA examiners provide medical examinations for IDES. Where a VHA
facility or examiners are not available, contract examiners are
utilized.
IDES sites are staffed with MSCs based on anticipated annual
caseload. Sites that do not warrant a full time case manager have MSCs
assigned on a temporary basis.
Question 9. For purposes of the DES Pilot, rating decisions were
provided by a limited number of VA regional offices.
Question 9A. How many rating decisions have each of those offices
provided to date for purposes of the DES Pilot or IDES?
Response. Since the inception of the DES Pilot, rating decisions
have been provided at the following VA regional offices: St.
Petersburg, Baltimore, Seattle, and Providence. St. Petersburg provided
rating decisions until March 2009, when Baltimore and Seattle assumed
responsibility for providing rating decisions. Providence began
assisting Baltimore in providing rating decisions in October 2010.
As of February 3, 2011, the Baltimore Regional Office completed
4,428 preliminary IDES ratings and 2,027 final ratings, while the
Seattle Regional Office completed 3,397 preliminary IDES ratings and
1,915 final ratings. The data cited for the Baltimore Regional Office
includes ratings completed by the St. Petersburg Regional Office early
in the Pilot phase and ratings completed by the Providence Regional
Office since October 2010.
Question 9B. How long, on average, does it take each office to
provide a rating decision for purposes of the IDES or DES Pilot?
Response. As of February 3, 2011, the Baltimore Regional Office's
average decision time was 35 days for preliminary IDES ratings and 38
days for final ratings, while the Seattle Regional Office's average
decision time was 15 days for preliminary IDES ratings and 29 days for
final ratings. Due to the heavy IDES workload in Baltimore, the
Providence RO is assisting Baltimore with preliminary ratings. It is
expected that this assistance will improve timeliness.
Question 9C. To the extent the rating decisions are not being
provided within the target timeframe, what factors lead to delays?
Response. The primary factors that lead to delays are obtaining
complete medical records from National Guard/Reservists and timely
receipt of separation documents (DD Form 214).
Question 10. At the hearing, we discussed a screening process being
used at Fort Riley to prevent cases from being referred to the IDES
prematurely.
A. At Fort Riley, how many individuals have gone through that
screening process and how many of those individuals were referred to
the IDES?
B. How long, on average, does it take to complete this screening
phase at Fort Riley?
C. If a servicemember goes through this type of screening process
and is ultimately referred to the IDES, is the time spent in the
screening process counted in determining how long in total the IDES
process takes?
Response. VA defers to DOD.
Question 11. GAO pointed out in its testimony that some sites
experienced shortages of examiners needed to provide the comprehensive
set of medical examinations used for the IDES process.
Question 11A. Of the approximately 11,295 servicemembers currently
enrolled in the IDES process, how many are awaiting medical
examinations?
Response. Data is not available on the precise number of
Servicemembers waiting for examinations. However, data does show that,
as of February 3, 2011, 2,314 Servicemembers are in the examination
stage of IDES. This stage begins when the Military Service Coordinator
(MSC) enters the request for examination into electronic systems. This
stage ends when the examination is completed and the provider releases
the examination results electronically to the MSC. An additional 48
Servicemembers were interviewed by MSCs and did not have examination
requests entered into electronic systems. The data represents a snap
shot in time. There will always be a slight lag time between the
Servicemember interview, examination request, and VTA data entry.
Question 11B. In total, how many medical examination requests are
currently pending?
Response. As of February 3, 2011, 2,314 cases were in the
examination stage of IDES.
Question 11C. How long on average is it currently taking for a
servicemember to complete the necessary medical examinations?
Response. To date, the examination stage of IDES is taking an
average of 61 days to complete. This measures the time from when the
MSC enters the examination request to the time when the examination
results are released by the provider. No data is being recorded to
specifically measure the time from examination request to the date the
Servicemember is actually examined.
Question 12. As requested at the hearing, before finalizing plans
to implement the IDES at sites overseas, please provide the Committee
with a comprehensive proposed plan for handling that expansion.
Response. VA defers to DOD.
______
Response to Post-Hearing Questions Submitted by Hon. Mark Begich to
John Medve, Executive Director of VA/DOD Collaboration Service, Office
of Policy and Planning, U.S. Department of Veterans Affairs
Question 1. Mr. Campbell or Mr. Medve, I understand one of the
goals of the Integrated Disability Evaluation System was to expedite
the VA benefits for the Servicemembers. Have you received feedback from
the Servicemembers (the patient) on how this program is working? Do you
have a good measure of what the patient perceives to be success? Can
you explain why the Air Force members are less satisfied?
Response. VBA defers to DOD. However, the language below can be
incorporated into DOD's response: VA has developed a customer
satisfaction survey for Veterans who complete the IDES process. Plans
to implement the survey are underway.
Question 2. Mr. Campbell and Mr. Medve, can you talk briefly about
VA staffing requirements to support the Integrated Disability
Evaluation System? Do you believe the hiring and training of new staff
will be able to keep up with the worldwide expansion plan?
Response. At this time, VA believes we will be able keep up with
the hiring and training requirements to support worldwide IDES
expansion. VA has explored several options to address increased
staffing requirements to support the IDES expansion. For example, in
the event of a surge, VA will temporarily assign Veteran Service
Representatives from the local Regional Office to serve as Military
Service Coordinators (MSCs) for the impacted Military Treatment
Facility (MTF).
VBA currently has 93 Military Services Coordinators (MSC) that
participate in a national curriculum for technical training related to
claims development. They must complete developmental training specific
to the IDES process to enhance their skill sets.
During the last quarter of 2010, two developmental training
sessions were conducted for approximately 90 participants. A third
training session will be held in March for the remainder of new hires.
We anticipate the need to hire an additional 15-25 FTE, and all
training will be completed prior to full expansion.
Question 3. In your testimony, you mentioned how in Stage I of the
expansion 16 of the 28 locations will initially use contracted exam
providers and the remainder will provide exams in conjunction with a VA
medical facility. Can you briefly explain how these contracted
providers are certified?
Response. Certification is obtained after completing online
training provided by VHA. The contractor must also provide an
orientation and instructions to examiners based on the requirements
provided in the C&P examination worksheets. The contractor must provide
training to the examiners to:
Explain the differences between VA disability examination
protocol versus the examination protocol for treatment purposes;
Ensure that examiners have appropriate attitudes toward
Servicemembers and their unique circumstances;
Ensure that examiners understand the VA's use of the term
``at least as likely as not'' in the formation of any requested medical
opinions;
Explain the concept of presumptive diagnoses in view of
unique circumstances of military service;
Ensure that examiners understand how to assess and
document pain in accordance with VA regulations;
Follow state laws where medical or psychiatric emergencies
arise;
Provide appropriate notification to follow-up on abnormal
findings;
Obtain CPEP certification (available from VA) as
appropriate; and
Maintain and assure privacy protection under Federal and
state laws, including but not limited to the Privacy Act and HIPAA.
Question 4. Mr. Campbell or Mr. Medve, in your opinion, do you feel
the worldwide expansion plan is too aggressive or just right when
taking technology and the appropriate level of staffing into
consideration?
Response. VA and DOD believe the IDES worldwide expansion is
appropriate. Leaders at each site have the ability to request an
adjustment to their Initial Operating Capability date if the site is
not ready. Additionally, VA and DOD require local site leaders to
jointly certify they are ready before launching IDES.
Chairman Akaka. Thank you very much, Mr. Medve.
Mr. Bertoni, in your opinion, are the Departments
adequately addressing all of the major problems that were
identified during the pilot? I ask this because I am concerned
that some issues may not be fully addressed before it is rolled
out to the rest of the military.
Mr. Bertoni. As noted in our statement, I think they have
made progress in several areas, especially in regard to getting
out in front of the staffing issues. That is a big one. I
cannot stress that enough. There are a lot of moving parts, a
lot of specialized services and skills they need, and there is
at least an acknowledgment that the staffing portion or
component of this is critical to success; and we would agree
with that. How are they going to get there? That is the
question from us. You can reallocate, you can hire, you can
bring in additional contractors, but we would really need to
see sort of a service delivery plan or an operations plan going
forward to discern how that is going to happen.
I appreciate the comment that you all may be looking back
at the original 27 sites to sort of look at those issues
because I think there are still lingering issues out there in
regard to staffing that are very important.
Beyond that, certainly the issue of monitoring. I think
having good MI data at the local level as to what is happening
with these particular sites, if things start to go awry--
staffing shifts, attrition, problems with diagnoses, problems
with exam summaries--you can know this sooner rather than
later, get out in front of that problem and come into play with
remedial training, guidance, et cetera to sort of prevent some
of these issues from getting worse.
So there is an acknowledgement. There appears to be a plan.
We have not seen that operational plan, but at least there is
an acknowledgement that there are some issues to work on.
Chairman Akaka. Thank you.
Mr. Campbell and Mr. Medve, are you both able to track
individual sites to determine if there are problems with
staffing and insufficient medical exams? Mr. Campbell?
Mr. Campbell. Yes, sir. I would like to make the point that
no site will go into IOC unless it passes a series of strict
tests. We have checklists. We are looking at these sites
weekly, those that are in preparation for the expansion. We are
looking at them weekly to make sure that they pass these tests.
And once the sites go live, we will be monitoring them, as
well. So I believe that it is probably fair to say that no
servicemember is going to be endangered. We are not racing to
get the sites complete so we can adhere to some timeline. This
is really a criterion-driven basis and we feel comfortable that
we have sufficient safeguards built in that the sites will not
go live until they are ready.
Chairman Akaka. Mr. Medve?
Mr. Medve. Senator, thank you for the question. I would
like to echo what Mr. Campbell said. I mean, we have instituted
as a base the lessons learned from the pilot sites, a
certification process that now has a much more robust
understanding of the requirement that will inform staffing
decisions. During the pilot site, I think we used about a
year's worth of data, and it turned out not to include things
like how many deployment cycles sites had gone through, which
had an impact on the number of cases and the type of cases that
sites went in, which impacted the type of examinations that
need to be done. So we now use a multi-year view of that.
Obviously, our understanding as we have gone through has
increased and we are developing robust staffing plans for the
oncoming sites.
And again, just to reiterate what Mr. Campbell said, we
made it clear to all sites that unless there is the capability
and capacity to move forward, they are not to move forward with
this.
Chairman Akaka. Thank you.
Mr. Campbell, I am concerned that VA may bear a
disproportionate burden in administering this program. Can you
respond with your thoughts on that?
Mr. Campbell. Yes, sir. I would be happy to. We have
signed--the DOD and the VA have signed a Memorandum of
Understanding, an agreement to share these costs equitably. The
process is one where the costs will be allocated as they become
live costs, then at the end of this period we will look at
whether we owe the VA money or they owe us money.
Chairman Akaka. Senator Burr, your questions.
Senator Burr. Thank you, Mr. Chairman.
Mr. Bertoni, VA and DOD have estimated that the IDES system
is faster than the old legacy disability process. Now, their
estimate is that the old legacy process was 540 days, but you
noted, ``the extent to which the IDES is an improvement over
the legacy system cannot be known because of the limitations in
the legacy data,'' and that the 540-day estimate, ``is based on
a small, non-representative sample of cases.''
First of all, can you explain for the record how many cases
were used to come up with the 540-day estimate?
Mr. Bertoni. I believe that originated with the original
tabletop exercise way back in 2007, where I think there were 70
cases across all services where they went in and looked at the
average processing time for those cases and came up with a
number for DOD's side of the shop, and that was about 300 days.
Then they extrapolate to the VA side, with an average of--it
can take up to 200 days to process a VA claim--and tacked that
onto the overall total. So they came up with the 540-day
average.
We had some concern with that. It is not as rigorous as we
would like. We tried to reconstruct it on our own and we found
very quickly that it was very--it was an apples to oranges
comparison by trying to bring in the various services plus the
Army. It really was not possible in terms of the quality and
integrity of the data.
We did do our own analysis of the Army data, which we felt
was sufficient to do this type of analysis, with Army
representing 60 percent of IDES cases, it is pretty substantial
if we could verify that. We did our analysis and were able to
determine that it came out to about 369 days to complete the
IDES portion of the process. Recognizing that it would be
reasonable to assume that it could possibly take up to 200 days
to complete the VA rating side. So, a fairly reasonable
estimate though not entirely rigorous.
Senator Burr. Mr. Campbell, according to GAO's testimony,
some officials have said that the servicemembers going through
the IDES are not given meaningful work by their units and they
are idle while they are going through the process. They might
be more likely to engage in behavior that could lead to
discharge due to misconduct.
Of the 600 servicemembers that have been removed from the
IDES process, how many have been discharged due to misconduct?
Mr. Campbell. Senator, I do not know.
Senator Burr. Is that not something we track?
Mr. Campbell. I will have to take that question for the
record, Senator.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Richard Burr to
John R. Campbell, Deputy Under Secretary, Office of Wounded Warrior
Care and Transition Policy, U.S. Department of Defense
Response. As of December 5, 2010, the current tracking indicates
that 112 Service members (2.8% of those completing the IDES) were
involuntarily separated for non-disability reasons (Administrative
Discharge/Court Marshal).
Senator Burr. I would appreciate it. Let me also ask you,
do we monitor whether they are given meaningful work,
meaningful assignments?
Mr. Campbell. My understanding is that the military
departments, within their programs of Warrior Transition Units
or the Wounded Warrior Brigades, have programs. I have been in
this job for 3 months. I visited a number of these
organizations. My view is that they appear to be giving these
young men and women sufficient work and keep them active, very
busy. I was at Camp Lejeune. I saw the facility there and the
program which I thought was just fabulous.
Senator Burr. Do we have a written integrated plan for
these individuals?
Mr. Campbell. I will have to get back to you, Senator. I do
not know.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Richard Burr to
John R. Campbell, Deputy Under Secretary, Office of Wounded Warrior
Care and Transition Policy, U.S. Department of Defense
Response. At this time, DOD does not have an integrated written
plan for these individuals. However, the Department of Defense (DOD)
intends to publish a new operations guide for IDES sites. In the guide,
DOD will clarify that commanders at all levels are required to ensure
IDES referred Servicemembers are gainfully employed during the duration
of the IDES process. Alternatively, Commanders may indicate that a
Recovery Care Plan has been instituted in lieu of full time employment
for such Servicemembers.
Senator Burr. Let me ask you, do we survey any of the
individuals to find out if, in fact, idleness is a concern that
they have?
Mr. Campbell. I know we have surveys and we track those. We
monitor those.
Senator Burr. Let me ask you to provide as much information
from those surveys as it relates----
Mr. Campbell. Yes, sir.
Senator Burr [continuing]. To the views that they have.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Richard Burr to
John R. Campbell, Deputy Under Secretary, Office of Wounded Warrior
Care and Transition Policy, U.S. Department of Defense
Response. In an ongoing effort beginning in January 2008, the
Defense Manpower Data Center (DMDC) administers voluntary surveys to
IDES participants at the completion of the three major phases of the
IDES process: the Medical Evaluation Board (MEB), the Physical
Evaluation Board (PEB), and the Transition Phase just prior to
transition to veteran status. Timeliness of the IDES process is
assessed in each of these surveys by asking Servicemembers the
following question: ``How would you evaluate the timeliness of the IDES
process since entering it?'' Based on feedback from over 5,000 IDES
survey participants across the MEB, PEB, and Transition surveys, the
average satisfaction score was 3.1 on a Likert scale of 1 (``Very
Poor'') to 5 (``Very Good''). While this does not specifically address
``idleness'', Servicemember comments on the survey still indicate a
need for the IDES to be more efficient. We have embarked on numerous
continuous improvement efforts to shorten the time a Servicemember
spends in the total IDES queue. As we work on these efforts, our line
and warrior transition commanders are encouraged to gainfully employ
IDES Servicemember while they matriculate through the system.
Senator Burr. Mr. Bertoni, would you like to comment on
that at all?
Mr. Bertoni. I would talk very quickly, first, about those
who were removed. We get weekly tracking sheets and we look at
that number very closely each week. If they are in the
``removed'' category, that can mean a lot of things. It could
be family hardship, conscientious objection, a number of
factors that go into that category, including misconduct. You
cannot tease out that particular issue from the way they are
capturing data now. We have asked about that and thought about
sort of digging down deeper, but we could not get to it in
terms of the scope of our review this go-around.
As far as idleness, we did see and have heard at various
locations folks who are in an extended period of evaluation. As
designed, on average, folks are in this process almost 40 days
more than the legacy system. So finding constructive things for
these folks to do rather than to go back to their rooms and
play video games is certainly something that should be on the
radar screen going forward.
Senator Burr. Mr. Chairman, my time has expired, we will
have a second round, I take for granted----
Chairman Akaka. Yes.
Senator Burr [continuing]. So then I am going to give you
the first question, this simple question, and let you think
about it between now and then but not answer it now. And it is
simply this, in this further expansion--the plan is to expand
overseas--if we have got servicemembers that are in the process
of evaluation to transition from active duty to non-active duty
to be integrated into the VA system, why would we keep them
assigned overseas and not transferred back to the United
States? Obviously, with the VA system, any services provided
would be remotely because we do not plan to stand up VA
facilities outside the country. I will ask you to think about
that and then expand on it.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Burr.
Senator Brown of Ohio?
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown of Ohio. Thank you very much, Mr. Chairman.
Thank you for your leadership in spearheading the integration
of disability evaluations. It is vital to ending this ongoing
problem that affects so many of our Nation's veterans. Thank
you to the panel.
Veterans too often have to navigate a complex Disability
Evaluation System not once but twice to get the benefits they
earned. They should not have to do that. If the Disability
Evaluation System--if it is a question of money, if that is the
problem, we need to know that and we need to understand that
better. If it is a question of staff, we need to know that.
Everyone in this room, certainly, regardless of party, wants
this program to succeed. That is why we are here today.
I would like to ask all three panel members a pretty simple
question that affects my home State. Ohio is consistently, as
you have heard me say and others say, at the bottom of the
benefit ratings, and my question is, why is a bum knee in San
Diego not the same as a bum knee in Cleveland? How are you
addressing this issue to fix that discrepancy? Let us start
with Mr. Campbell.
Mr. Campbell. I am sorry. I did not understand the
question.
Senator Brown of Ohio. Well, Ohio is consistently at the
bottom in these benefit ratings. I guess it is more a VA than a
DOD problem, so I'll ask one of the other witnesses to start.
We have asked this question and we have not seen this fixed. We
are continuing to find this disparity happening too often.
Mr. Medve. Senator, thanks for the question. I cannot speak
specifically right now to Ohio, but on principle, there should
be no difference. I mean, a rating is a rating; and we are
working diligently to ensure that there is a standardized
process of how those are evaluated in place.
Senator Brown of Ohio. Mr. Bertoni, any thoughts?
Mr. Bertoni. We have done limited reviews here. I guess I
agree. Like impairments should receive like ratings and VA has
some things in place from a quality assurance standpoint to
look at that. I know they are doing what are known as inter-
rater reliability studies, where they take one case, a similar
case, give it to multiple examiners, and see how they come out
in terms of the rating. Then they try to sort of delve into
that to determine causes the discrepancy, and then conduct
wider training across particular issues, like back pain, knee
pain, mental impairments--I think those are the three big ones.
They should be doing that. I cannot speak to the whys in Ohio,
but I know there are efforts underway at VA to try to get at
the inconsistency across locations.
Senator Brown of Ohio. GAO has seen this happening with VA
for some time. I guess I am still not clear why this persists.
Mr. Medve or Mr. Bertoni, why does it continue to exist? I
mean, it does not seem difficult to make this standard
throughout the VA.
Mr. Medve. Senator, I will have to take that for the
record, go back and delve in to get you an answer, to
understand why there is a difference between what constituents
in Ohio are getting.
Senator Brown of Ohio. All right. Thanks, Mr. Chairman.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Sherrod Brown to
John Medve, Executive Director of VA/DOD Collaboration Service, Office
of Policy and Planning, U.S. Department of Veterans Affairs
Question. Ohio is consistently, as you've heard me say and others
say, at the bottom of the benefit ratings. My question is, why is a bum
knee in San Diego not the same as a bum knee in Cleveland? How are you
addressing this issue to fix that discrepancy?
Response. Disability benefits are provided to Veterans according to
the regulatory scheme embodied in 38 Code of Federal Regulations, Part
4-Schedule for Rating Disabilities (rating schedule). This rating
schedule provides an organized and coherent system for evaluating
disabilities and for providing equitable and consistent compensation
for service-connected injuries and diseases to our Nation's Veterans.
The rating schedule is the basis for all rating decisions regardless of
location.
VA contracted with the Institute for Defense Analyses (IDA) to
study the variance in average payments among states and determine if a
significant correlation to one or more variables could be indentified
that contributes to the variance. IDA found that relative variability
across states has existed at or near the current level over the past 35
years. IDA identified the major factors that individually contribute to
the observed variation in average compensation, including the
distribution of Veterans with ratings of 100 percent, the types of
disabilities, county of residence, median family income, percent of the
population with physical or mental disability, population density,
representation by power of attorney, and period of service. According
to IDA, application rates appear to also be a key driver for the
percent of veterans receiving compensation. Much of the variation
across states (over 40 percent) is associated with differences in the
recipient populations. IDA found that the percent of compensation
recipients in a particular area who are military retirees is also a
major contributing factor.
It is important to understand that the average payments being
compared cover all Veterans currently receiving disability compensation
benefits, and the VA decisions that awarded these benefits have been
made over a period of more than fifty years. The average payments for
all recipients are therefore not necessarily reflective of the
experience of veterans currently applying for disability compensation
benefits. In order to assess differences in benefits currently being
awarded to recently separated veterans, VA looks at average payments to
veterans who are added to VA's disability compensation rolls during the
year. It is significant to note that when comparing average payments to
Veterans newly awarded compensation, the average amount awarded to Ohio
Veterans in 2010 was 92 percent of the national average ($573.81 per
month for Ohio vs. $624.69 per month for the Nation) and 40th overall.
To achieve greater consistency and accuracy in decisionmaking, it
is critical that employees receive the essential guidance, materials,
and tools to meet the ever-changing and increasingly complex demands of
their responsibilities. VBA has established a comprehensive national
training program that includes pre-requisite, centralized, and home-
station training phases. The integration of a national training program
has resulted in standardized training modules for all phases of claims
processing. Additionally, VBA created training modules for recurring
training for journey-level claim processors. This national training
program allows VBA to increase both accuracy and production as
employees continue to increase their individual knowledge and
proficiency.
Chairman Akaka. Senator Isakson?
Senator Isakson. Thank you, Mr. Chairman.
Mr. Campbell, I understand that of the first some 3,700
servicemembers evaluated in the DES pilot system, nearly 1,000
of them were returned to active duty and not determined to be
disabled. That is 26 percent of all the evaluations. That just
appears to me on the surface to say that we do not have a very
good early evaluation system before they get to the
determination system. Am I right or am I wrong?
Mr. Campbell. I think that percentage is higher than one we
track, but beyond that the fact is the effort is to try to
return young men and women who can serve and want to continue
to serve back to active duty; that is really an objective, an
important objective. But in terms of the issue of whether it
takes away from the resources for exams for other veterans,
other servicemembers, we are monitoring that right now and
trying to figure out how to best ensure that only those that
should be examined are examined.
Senator Isakson. Was Fort Gordon in Augusta, GA, one of the
test sites? Does anybody know?
Mr. Medve. I am not sure----
Senator Isakson. That is the Charlie Norwood VA----
Mr. Medve. No, sir, I do not think it was.
Senator Isakson. It was not? I was there with Under
Secretary Duckworth from the VA just a month or so ago and have
followed up over the last 3 years on their seamless transition
for Wounded Warriors and they have focused at Fort Gordon and
at the Charlie Norwood VA on early identification for soft
tissue, PTSD, TBI type of injuries, and I would guess, it is
just a guess, that of those that go for evaluation and then
subsequently are returned, many of them end up being people who
suffer from that type of a problem that end up being corrected.
They have done some wonderful work at the Norwood VA and Fort
Gordon, with early identification of PTSD and TBI. So I would
encourage as you expand--I think you all said you were going to
expand the test sites. Is that right?
Mr. Campbell. Yes, sir.
Senator Isakson. I would encourage you, if they want to do
it, to see if Fort Gordon and the Charlie Norwood VA in
Augusta, GA, are not a part of that, because General Schoomaker
started the seamless transition at that facility before he left
to come to Walter Reed which has been very successful. There is
a tremendous support center there.
Just one other question for Mr.--is it Medve?
Mr. Medve. Yes, Senator.
Senator Isakson. Is that close enough? I am Isakson and
that is hard to pronounce.
Mr. Medve. Sir, I have lived with that through my entire
life.
Senator Isakson. So have I. I understand that VA Service
Coordinators who give services in terms of benefit advice to
those entering the VA system and the overseas veterans who are
getting ready to enter the system do that by long-distance
teleconference. Is that correct?
Mr. Medve. That is my understanding, Senator.
Senator Isakson. The thing that worries me about that is
the effectiveness of a teleconference versus a personal contact
one-on-one so the veteran can really ask further questions. Do
you have any input on the success or if there has been a
``falling through the cracks problem'' because of the use of
teleconference versus personal interviews?
Mr. Medve. Sir, I personally do not know. I also know we do
have essentially circuit riders overseas, as well, that also
back that up.
Senator Isakson. Well, I have seen the value of those
coordinators one-on-one, again, at the Norwood VA in Augusta,
GA, I think circuit riders are an excellent solution to what
otherwise could be a problem of a more impersonal evaluation
being by long-distance videoconference rather than one-on-one.
Mr. Medve. And Senator, just to follow up, Fort Gordon is
on the planning for Stage 2, which is January through March of
next year when it is planned to go into the DES system.
Senator Isakson. Thank you very much. Thank you, Mr.
Chairman.
Chairman Akaka. Thank you very much, Senator Isakson.
Senator Johanns?
Senator Johanns. Thank you, Mr. Chairman.
Let me, if I might, ask maybe a couple nuts and bolts sorts
of questions. How pervasive is the issue of a differing
diagnosis between VA and DOD? How much are we running into
that? I am not sure who is equipped to handle that, but jump
in.
Mr. Bertoni. I can handle it from the standpoint of our
audit. We do not know how pervasive it is and we--and VA and
DOD do not know because they are not specifically tracking this
at a macro level. We heard it enough, I believe in four of ten
sites. We did meet with high-level officials in terms of the
folks who are planning and implementing the pilot. There was an
acknowledgement that there might be a structural issue here in
terms of the two entities coming to terms on diagnoses. So it
is an emerging issue, something that we have identified and we
think they need to get their hands around. We will likely ask
them to do that.
Senator Johanns. So what happens to the servicemember once
that happens? You have got DOD out here saying X. You have got
the Veterans Administration saying Y. Are they just caught in
limbo?
Mr. Bertoni. The case sits. They have to wait for that to
be resolved. If the Medical Evaluation Board physician and the
VA examiner disagree, there is an issue there that has to be
resolved. That can take time. Down the road, if you get
discrepancy between the Physical Evaluation Board and the VA
rating staff, that has to be resolved which takes time. Right
now, there is no specific DOD-wide guidance as to how that is
to be resolved.
Senator Johanns. That seems to be a significant problem to
me. I do not know if this is 5 percent of the cases or 50
percent of the cases, and I guess nobody else knows that,
either, but it seems to me if we do not solve that problem,
then no matter what we do with systems, you are still going to
have people out there waiting. And if there is no guidance, how
does one even know which direction to go to solve the problem?
Mr. Bertoni. I have been doing this a long time, and the
issue of developing the medical record is a thorny issue across
all Federal disability programs. This is just something that
really could be important--or detrimental to the program,
depending on how large it is.
Senator Johanns. OK. Does either one of you want to weigh
in on that?
Mr. Medve. Senator, I know it was part of the GAO report.
As we are finalizing our response to it, we acknowledge the
issue, and I think what we will put in place as part of our
answer back to the GAO report will help address that. It really
comes into play in many cases with issues of mental health and
PTSD ratings as opposed to what may be on the service side a
diagnosis of depression or anxiety or something like that, and
that is where the largest--and those are complex cases. So Mr.
Bertoni is right, and it is something that we acknowledge and
we are going to work to fix.
Senator Johanns. OK.
Mr. Campbell. Sir----
Senator Johanns. Go ahead. I am sorry.
Mr. Campbell. I would like to add that we, as well, concur
with Mr. Bertoni's recommendation and we are behind the study
to assess the issue and see what can be done.
Senator Johanns. This leads me to another question. You
have these recommendations. You are responding to them. Is
there coordination in that response?
Mr. Medve. Yes, sir. When we review the report--because, I
mean, obviously, I consider Mr. Campbell to be my battle buddy
in this endeavor, and we at least look at each other's
responses to make sure that we are both looking at the issues
in the same way, and we are looking at the solutions in the
same way.
Senator Johanns. OK. Let me go to another area. Again, I
think, Mr. Bertoni, you are probably the guy I call on, and
this will be a little bit inartful because I am trying to
figure this out. It seems to me we can spend a lot of time and
effort on the right system, et cetera, but then it always seems
that there are locations that do better than others. Do you
know what I am saying? Did you see that, and walk me through
your sense of why that happens. Is that management? Tell me
what you think about that.
Mr. Bertoni. I think you cannot downplay the importance of
good management. I have seen across numerous programs folks who
get it, understand what needs to happen, are good managers, put
the pieces in play to make things happen. You can do a lot with
that. There are folks who streamline or redesign processes that
can lead to efficiencies. At some locations, it just comes down
to volume. You have low-volume locations. You can work harder
with a system that is not quite perfect and still get the work
done. It is only when you start to pour more cases and
servicemembers into the process that the bottlenecks start to
reveal themselves.
So I think one thing is to really look at folks who have
figured it out in terms of redesigned processes, which I think
this whole effort, the pilot, is designed to do just that.
There is an evaluation loop to identify problematic areas and
the entities that are administering it should be looking to
best practices, redesigned processes to make it better beyond--
you can invest people and IT systems into this to the n-th
degree, but it comes down to how you designed it, in many ways,
and managed it.
Mr. Medve. Senator, absolutely, leadership is key and
teamwork is a key in high-performing versus low-performing
sites. One of the things that we have done is that as each of
the iterations of the expansions role out, we host a
conference, and we bring the site teams, both DOD and VA, here.
As a matter of fact, there is one completing today here at
Bethesda.
Part of that conference is we bring both representatives
who are involved in the Fort Carson rollout and the Fort Riley
rollout, because Carson represents a site that obviously had
challenges, and they are working through them. Fort Riley was
very proactive and did a superb job in organizing themselves.
So we expose the oncoming teams to both of those sets of
experiences.
Additionally, we have brought some Lean Six Sigma
expertise, especially at Carson. We are sharing those lessons
with those oncoming sites. I hope very soon to be able to
deploy process teams to both the oncoming sites and also to the
ones that are in existence now to do a deep dive into their
processes for improvement.
But again, the number 1 lesson is if the team is not fully
engaged, if the leadership is not engaged, then we are going to
have challenges. I think it is even more of a challenge with
some of the smaller sites because the low volume--there may be
a view that maybe we can just not have to focus so much there;
but, in fact, that is where we end up having problems, so we
are putting an effort there, as well.
Senator Johanns. OK. Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Johanns.
Senator Brown of Massachusetts?
STATEMENT OF HON. SCOTT P. BROWN,
U.S. SENATOR FROM MASSACHUSETTS
Senator Brown of Massachusetts. Thank you, Mr. Chairman.
It seems like several years now that the DOD and the
Department of Veterans Affairs are kind of playing a blame game
when it comes to the DES pilot program. Meanwhile, military
members are trying to move on with their lives, and frankly,
from what I have heard, the hurdles seem very high for them.
They are waiting, hoping that doctors' appointments do not get
canceled. Months and sometimes years go by.
As a result of that, I am a little uneasy with the
declaration made by the DOD that plans to conduct a global
rollout of this program by the end of next fiscal year is
something that they are focused on actually doing. It seems
like a decision of this magnitude, in my view, requires a
better understanding of the measurable verified factual basis
upon which the DOD has made the decision to launch a worldwide
program. Because unless I am wrong, there seems to be a lack of
personnel, really, and resources to do that.
So I guess with that being said, my question is, will this
program require more medical exam doctors and nurses throughout
the country and across the globe? Mr. Campbell?
Mr. Campbell. Senator, I think it is better--the medical
piece of it is probably better answered by Mr. Medve, but I
think what we would like to say is that nothing will roll out
unless we are convinced, both VA and DOD, that these sites are
ready. We are certainly not going to put a site out there that
will bring into question----
Senator Brown of Massachusetts. Well, at this point, do you
have the appropriate amount of medical examination folks to do
that or not?
Mr. Medve. Senator, we have had some areas where we have
had staff shortages. We are addressing those now. We have added
contract examination capabilities to give us some additional
bandwidth in that area. So, yes, I am confident that from VA's
standpoint, we are going to be ready as we roll out each one of
these sites. And again, just to echo what Mr. Campbell said, it
is criteria-based. If a site does not have its required
capability, it is not going live.
Senator Brown of Massachusetts. Do you envision any--with
all the private contracted medical examination folks, do you
think they will readily agree to travel across the globe and to
every military installation to serve in this capacity? Have you
noticed any push-back at all?
Mr. Medve. Senator, I want to be clear. If you are talking
about the overseas rollout aspect of it, if I am not mistaken,
I believe there is a plan that is due the 15th of December that
will specifically address the overseas rollout of this, and so
I will have to----
Senator Brown of Massachusetts. OK. How many psychiatrists
or psychologists does the DOD need right now to accomplish this
mission? Any thoughts on that? Do you have a number, or do we
have the amount?
Mr. Medve. Senator, I do not in terms of what DOD needs for
that.
Senator Brown of Massachusetts. OK. Maybe I have to refocus
my question. But let me just follow up on something that Mr.
Bertoni said. You mentioned idleness among the servicemembers
that occurs while they wait. I know there was a little back and
forth on it, and it is concerning. I am glad it was brought up.
To what extent are we allowing nonprofits, NGO's, Fortune 500
companies, and corporate America into the installations to help
these Wounded Warriors find a job while they are getting
treated? Mr. Secretary?
Mr. Campbell. Sure----
Senator Brown of Massachusetts. Is there any cooperation?
Is there any foresight, while they are sitting around, to get
some folks in there to help them find employment once they get
out?
Mr. Campbell. Well, we have our TAP program, which
introduces these transitioning servicemembers to----
Senator Brown of Massachusetts. I know, but has there been
anything outside the box a little bit to letting other folks in
there, the actual job creators and hirers to get in there and
help, as well? Is there any program or anything like that in
place right now?
Mr. Campbell. Senator, at the moment, no.
Senator Brown of Massachusetts. All right. Thank you, Mr.
Chairman.
Chairman Akaka. Thank you very much, Senator Brown.
Mr. Medve and Mr. Campbell, what will you do at the
headquarters level if you get an indication from the field that
a site is not ready to go?
Mr. Medve. Senator, thank you for the question. What we
have done, actually, to date is when there have been issues
raised, we have convened a conference call with all the players
involved and made sure we understand what the specific issue
is. If it is an issue that requires a solution from VA
headquarters, then we will apply those resources to it. If it
is one where we find out that there are just communications
issues between the localities, then we have actually dispatched
people to the local areas to work that out and to ensure that
those problems get solved.
Chairman Akaka. Mr. Campbell?
Mr. Campbell. I would just agree with that. There is really
nothing more to add. Those issues come very quickly to our
attention because everybody has got my e-mail address. So when
there is a problem, I hear about it or Secretary Stanley does
and we act on it immediately, working with the VA to try to
come up with a solution.
Chairman Akaka. Mr. Campbell, I am following up on Senator
Isakson's question. I know that DOD is working to tighten
eligibility for IDES to reduce return-to-duty rates.
Mr. Campbell. Mm-hmm.
Chairman Akaka. Will DOD be finished with fixing its
policies before the next set of installations are operational?
And Mr. Bertoni, do you know why there are questions as to what
the actual return-to-duty rate is? I also believe that it is
about 26 percent. But let me call on Mr. Campbell for his
response.
Mr. Campbell. Thank you for the question, Senator. We do
believe that we will have a better sense before the next group
of installations go public, if you will, as to the retention
percentage. We are working with the Departments right now to
see what issues there are and how we can close that or reduce
that percentage.
Chairman Akaka. Mr. Bertoni?
Mr. Bertoni. Sure. Let me just piggyback off that question.
I do believe the referral system is critical to ensuring that
only folks who should be in the IDES system are in the IDES
system. Screening and profiling is done across other Federal
programs. I think it is a way to more precisely assess who is a
good candidate or should be in the process than to divert
resources from being spent on them. The services have to go
through this process for someone who might ultimately be
returned to duty.
In terms of the return-to-duty rate, we are not clear how
they arrived at the 16 percent figure. They may be including
folks who have dropped or did not complete their case. It has
to be some larger population fit into the overall figure.
We went to cases that were completed since inception of the
program. It is intuitive to us to look at folks who came in,
went through the gauntlet of various medical exams, and at the
end of the day got a ``fit'' or ``unfit'' decision. When we
calculate those numbers, the most recent weekly report came to
about 26 percent.
Chairman Akaka. Mr. Medve, as I mentioned during my opening
statement, I am concerned that VA is already stressed as a
result of ongoing conflicts, an aging veteran population, and
the new Agent Orange presumptions. These pressures may
adversely impact those veterans currently going through the VA
claims process. What is the Department doing to mitigate this
concern?
Mr. Medve. Senator, first of all, we need to make sure we
all understand that regarding the IDES cases, the VA would see
them anyway. It is a question of when we would see them. So it
is not an added burden. It is one that we have already got that
we know is coming to us. We are just shifting it a little to
the left from when we do that.
You know, we have some areas that have backlogs for C&P
exams. We have brought on additional exam capabilities to help
eliminate those backlogs, as well. So I think we are taking a
broad-front approach to solving those problems and we will work
over the next year to eliminate them.
Chairman Akaka. Thank you very much.
Senator Burr?
Senator Burr. Mr. Campbell, would you like to take a stab
at the overseas question I asked?
Mr. Campbell. Yes, sir. We are actually working with the VA
and the military departments to decide about the best way to
implement that kind of a strategy. I know myself--I was in
Ramstein 2 weeks ago and heard exactly the same question that
you posed, the question about people in the Wounded Warrior
Units; is there a way that they could be moved back to the
States to be--because finding a job in Germany is not very easy
for them, clearly. It is on my list of things to do and I would
like to get back to you with----
Senator Burr. I would appreciate it. And I hope you
understand the concern that I am expressing. When you look at
this from a common sense standpoint and we hear you are going
to roll out globally----
Mr. Campbell. Yes, sir.
Senator Burr [continuing]. And there is something as
obvious as this--you cannot call it an integrated program if
DOD is the only one there.
Mr. Campbell. Right.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Richard Burr to
John R. Campbell, Deputy Under Secretary, Office of Wounded Warrior
Care and Transition Policy, U.S. Department of Defense
Response. Currently, the Assistant Secretary of Defense for Health
Affairs, together with the my office (Wounded Warrior Care and
Transition Policy), other DOD offices, each of Military Service
Departments and the VA are collaborating to determine the best avenue
to cover our Wounded Ill and injured Servicemembers serving overseas.
The initial discussion has centered on re-assigning referred
Servicemembers back to the Continental United States (CONUS) for their
medical exam and IDES processing. This may have a secondary positive
effect for those who are medically separated and retired. Their final
transition will be closer to home and easier for them to navigate. The
details are being finalized now and DOD and VA we will share the final
plans with the oversight committees before implementation.
Senator Burr. VA, at best, would be a partner through
teleconferencing or telecommunicating in some fashion, but----
Mr. Campbell. I will say that there are VA representatives
in Germany. I know that. I met them.
Senator Burr. I would love to know how extensive the VA
presence is abroad given the challenges we have at home.
Mr. Medve. Well, Senator, as I said before, we have circuit
riders over there that go around to the different bases to give
our portion of the TAP briefings and all that. In terms of
medical--which I think is what you are really getting at--yes,
we do not have that over there. As DOD finalizes its plan that
will come out next month, we are working with them on that to
ensure that there is a solid way forward so that the medical
examinations, if they are done overseas, meet the template
standards that we have for C&P exams.
Senator Burr. Let me ask on behalf of the Committee that
before any decision is finalized, that you mya at least share
with the Committee what the intent of that overseas program
would be. It might save a lot of heartache.
Mr. Medve. Yes, sir, we will.
Senator Burr. Mr. Campbell, in your testimony, which I
think Mr. Medve also highlighted, you have referred to Fort
Riley in your testimony as a model for other sites to follow
because of its screening process, screening people that should
not be in the integrated system. How many people have been
enrolled in the IDES process at Fort Riley to date, do you
know?
[Pause.]
Mr. Bertoni. Sir, I can take that.
Senator Burr. Oh, OK.
Mr. Bertoni. Approximately 200.
Mr. Campbell. Thank you, Dan.
Senator Burr. Of those, how many individuals have found
resolution to their evaluation?
Mr. Bertoni. Only three cases--I am sorry--194 cases at
Riley right now, and as of a month ago, there was only one that
had completed.
Senator Burr. OK. I would sort of ask both DOD and VA, from
a standpoint of highlighting the success of Riley, are we
highlighting just the pre-screening or are we highlighting the
success of the overall program at Riley?
Mr. Bertoni. From our position, we are highlighting the
fact that the leadership was engaged up front. They came up
with a plan of how to approach implementing IDES. They have got
a good track record in terms of how they are moving forward, so
we use them as an example for other sites of how you get
started at the beginning of your planning and pull everybody
together to work toward implementation.
Senator Burr. Am I naive to believe that part of our
assessment should be how many people complete the process in
the agreed-upon timeline?
Mr. Medve. No, sir, you are not.
Senator Burr. At what point does that come into determining
the success or failure of a particular site or a particular
process?
Mr. Medve. We should consistently be looking at that and
figuring out what the issue is with output.
Senator Burr. Let me stop and say that you have no bigger
cheerleader than me for the success of this program. But I
think it is absolutely incumbent on those of us here to ask the
obvious questions to make sure that we have gone through the
thought process, especially as we consider beginning to roll
this program out to additional sites while we currently have it
contained in a number of locations that is somewhat manageable
to begin to address the challenges.
I will not ask this in a question, I will make it in a
statement. I would hope before we roll out to one more site
that we have successfully addressed the challenges, the
legitimate challenges that have been raised and at least have a
plan as to how to resolve those versus a wish, a hope, and a
dream that as we roll this out, these will either get better or
we will find a solution. Roll it out nationally, have the same
number of challenges, have models that we look at that have one
entity or five entities out of several hundred that have
crossed the goal line and our model is--or our matrix of
success was, well, everybody bought into the program but nobody
is going out the other end, we are going to have a screwed up
mess on our hands. So my hope is that we will all get the same
goal in sight and the same tools of measurement.
Mr. Campbell, DOD set a goal of 20 servicemembers per case
manager or PEBLO, I guess?
Mr. Campbell. Yes, sir.
Senator Burr. What is PEBLO? Is that----
Mr. Campbell. It is Physical Evaluation Board Liaison
Officer.
Senator Burr. I am just going to use case manager. It is
easier. At Fort Bragg and Camp Lejeune in my home State, they
had 85 servicemembers for each case manager. What factors led
to that heavy caseload?
Mr. Campbell. I know they exist. I do not know if I know
the reasons----
Senator Burr. Can you give me a timeline as to when there
will be enough staff to bring those numbers in line with the
goal of 20?
Mr. Campbell. We are working on the problem. I know we are
putting some dollars toward that problem, working with the
Departments themselves. But I do not know if I can give you a
specific date when that caseload issue, when we will get that
back down to----
Senator Burr. Share with us in writing what the
expectations are----
Mr. Campbell. Yes, sir.
Senator Burr [continuing]. For resolution of that problem.
And would you take the opportunity to share with us the
methodology you used to come up with 20 per caseworker figure
so that we can understand better----
Mr. Campbell. Sure.
Senator Burr [continuing]. Is that the right number? We are
deeply into a disability problem in this country which we have
thrown money at for, I think, a decade. I think the Chair would
agree with me. And with the last expansion of personnel--I
think 1,900-plus individuals were brought in to process
claims--the one net result we had was the productivity per
claims processor went down. So I am somewhat skeptical to just
adding bodies or throwing money at a problem, believing that
that problem is going to get resolved or go away.
Mr. Campbell. Yes, sir.
[The information requested during the hearing follows:]
Response to Request Arising During the Hearing by Hon. Richard Burr to
John R. Campbell, Deputy Under Secretary, Office of Wounded Warrior
Care and Transition Policy, U.S. Department of Defense
Response. The most recent data provided by the Service Secretaries
indicates that Fort Bragg is hiring three new PEBLO's (Physical
Evaluation Board Liaison Officer's) by 31 December 2010 and Camp
Lejeune is hiring one GS-12 Supervisor, two additional PEBLOs and one
Administrative Support staff by 31 January 2011. The Military
Departments indicate that these hiring actions will bring them to the
DOD required 1:20 PEBLO to case ratio standard.
Regarding methodology, an exact ratio for optimal efficiency is
difficult to identify, as the ratio varies depending on many factors.
These factors can include, but are not limited to, the type of
population the PEBLO is supporting (types of injuries/illness); the
availability of local healthcare resources and additional support
staffing (for example, administrative help to copy records); the burden
of other managerial requirements (multiple data entry, training); and
the use of decision and management support tools (automation tools,
duplicative data entry). Clinical caseload recommendations have varied
from 1:15 to 1:50. Currently, the Office of the Under Secretary of
Defense for Personnel and Readiness is looking at evidence-based
methods to either verify or update the current policy requirement.
Senator Burr. Mr. Chairman, I would ask unanimous consent
to be able to take my further questions and ask them in writing
because there may be a level of detail there that I would
rather our witnesses have the time to research and provide
responses for us.
But I do want to turn to Mr. Bertoni just for 1 second, off
of this subject and onto the legacy VA disability process. I
think you are one of the experts at our system. You referred
earlier to the difficulty at completing the medical records
needed to make evaluations, in other words, incomplete
applications that come in. A complete application is one that
has all of the information, including the medical records that
are needed to make a determination.
If we worked with the VA and created a new program, a
program that said to veterans and to whoever helps that veteran
fill out that application, you send us a complete application
and we will process your claim in X-number of days--30 days, 45
days, 90 days, whatever it is--but setting the goal for that
servicemember, that VSO, that service officer to be: do not
send it until you have got all the information for
qualification of this program. Would that be a game changer?
Mr. Bertoni. I do not know. Overall, I do know there is a
small pilot program, I believe, at VA where it is--I cannot
recall the acronym or the name--where they do just that. They
get the servicemember to agree to submit everything timely
within a specific window and they, in effect, will go sort of
to the front of the line. If you fail to do that or you fail
along the line, then you go back into the regular queue. We
have talked about that as a potential best practice or a way to
triage cases, but I do not know how that is playing out in
terms of success.
Senator Burr. We will follow-up on that. It is my hope that
we will begin to think of something different, and I think you
hit on the key. It starts with having an application, that when
it comes through the door is as complete as it possibly can be
so that you do not have to go through these timelines of
reaching out and trying to access the information needed to
make----
Mr. Bertoni. Absolutely. And looking sort of at the
individual stops along the way on this process, that is where
the Medical Evaluation Board physician, that is where the
Physical Evaluation Board Liaison and others need to be in play
to help develop that case, to build that case. As you said,
ratios do not look great in terms of representatives to
servicemembers. The ratios are pretty bad in some respects, and
in each one of those, those quick stops along the way, I do not
think any of the averages are being met right now in terms of
the goals for the program.
Senator Burr. Once again, let me thank the three of you for
your expertise, your commitment to make these programs
successful and to evaluate them. I thank the Chair for his
willingness to hold this hearing and I look forward to the next
opportunity to get an update. Thank you, Mr. Chairman.
Chairman Akaka. Senator Burr, you made a unanimous consent
request and that is still----
Senator Burr. That I may have the opportunity to ask
questions in writing.
Chairman Akaka. Well, without objection.
Senator Burr. I heard you say, ``So approved.''
[Laughter.]
Chairman Akaka. Thank you very much, Senator Burr.
Mr. Campbell and Mr. Medve, during oversight visits of
individual sites, Committee staff noted some concern--and this
has to do with funding--that funding was being taken from
existing budgets. Will you please explain how the expanded
program is being funded?
Mr. Medve. Sir, for the VA, it is being funded through our
normal process. I mean, as I understand it, it is part of VBA
and VHA and VA's budget.
Chairman Akaka. Mr. Campbell?
Mr. Campbell. My understanding is the same, Senator.
Chairman Akaka. Thank you. Mr. Campbell and then Mr. Medve,
the concern as expressed here by other Members, as well, has
been a concern about implementation. Some believe that the
current timeline for rolling out the program worldwide is a bit
aggressive given the challenges that have already been
identified. What would you say to these critics who question
that?
Mr. Medve. Senator, first, what I would say is, yes, we
have a timeline and a way forward. But that is bounded by our
criteria-based assessment. So even though we have a quarterly
rollout goal, I think both Mr. Campbell and I have said before,
we are making it clear to the sites that they do not go forward
until everything in that site assessment certification meets
the standard.
Chairman Akaka. Your comment, Mr. Campbell?
Mr. Campbell. Basically the same thing, Senator--that it is
criterion-based and it is not timeline sensitive in that
regard.
Chairman Akaka. In closing, I again thank all of our
witnesses for participating today. My hope is that we can move
forward from today's hearing with a better understanding of how
the current process is working and what improvements need to be
made as DOD and VA expand IDES. We are looking forward to that
and thank you again for your responses. It has been helpful to
us.
This hearing is adjourned.
[Whereupon, at 11:27 a.m., the Committee was adjourned.]