    [House Hearing, 112 Congress]
    [From the U.S. Government Publishing Office]

        IS THIS ANY WAY TO TREAT OUR TROOPS? PART III: TRANSITION DELAYS

    =======================================================================

                                    HEARING

                                   before the

                       SUBCOMMITTEE ON NATIONAL SECURITY,
                    HOMELAND DEFENSE AND FOREIGN OPERATIONS

                                     of the

                             COMMITTEE ON OVERSIGHT
                             AND GOVERNMENT REFORM

                            HOUSE OF REPRESENTATIVES

                          ONE HUNDRED TWELFTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  MAY 4, 2011

                                   __________

                               Serial No. 112-28

                                   __________

    Printed for the use of the Committee on Oversight and Government Reform

             Available via the World Wide Web: http://www.fdsys.gov
                          http://www.house.gov/reform

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                  COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

                     DARRELL E. ISSA, California, Chairman
    DAN BURTON, Indiana                  ELIJAH E. CUMMINGS, Maryland,
    JOHN L. MICA, Florida                    Ranking Minority Member
    TODD RUSSELL PLATTS, Pennsylvania    EDOLPHUS TOWNS, New York
    MICHAEL R. TURNER, Ohio              CAROLYN B. MALONEY, New York
    PATRICK T. McHENRY, North Carolina   ELEANOR HOLMES NORTON, District of
    JIM JORDAN, Ohio                         Columbia
    JASON CHAFFETZ, Utah                 DENNIS J. KUCINICH, Ohio
    CONNIE MACK, Florida                 JOHN F. TIERNEY, Massachusetts
    TIM WALBERG, Michigan                WM. LACY CLAY, Missouri
    JAMES LANKFORD, Oklahoma             STEPHEN F. LYNCH, Massachusetts
    JUSTIN AMASH, Michigan               JIM COOPER, Tennessee
    ANN MARIE BUERKLE, New York          GERALD E. CONNOLLY, Virginia
    PAUL A. GOSAR, Arizona               MIKE QUIGLEY, Illinois
    RAUL R. LABRADOR, Idaho              DANNY K. DAVIS, Illinois
    PATRICK MEEHAN, Pennsylvania         BRUCE L. BRALEY, Iowa
    SCOTT DesJARLAIS, Tennessee          PETER WELCH, Vermont
    JOE WALSH, Illinois                  JOHN A. YARMUTH, Kentucky
    TREY GOWDY, South Carolina           CHRISTOPHER S. MURPHY, Connecticut
    DENNIS A. ROSS, Florida              JACKIE SPEIER, California
    FRANK C. GUINTA, New Hampshire
    BLAKE FARENTHOLD, Texas
    MIKE KELLY, Pennsylvania

                       Lawrence J. Brady, Staff Director
                    John D. Cuaderes, Deputy Staff Director
                         Robert Borden, General Counsel
                           Linda A. Good, Chief Clerk
                     David Rapallo, Minority Staff Director

        Subcommittee on National Security, Homeland Defense and Foreign
                                   Operations

                         JASON CHAFFETZ, Utah, Chairman
    RAUL R. LABRADOR, Idaho, Vice        JOHN F. TIERNEY, Massachusetts,
        Chairman                             Ranking Minority Member
    DAN BURTON, Indiana                  BRUCE L. BRALEY, Iowa
    JOHN L. MICA, Florida                PETER WELCH, Vermont
    TODD RUSSELL PLATTS, Pennsylvania    JOHN A. YARMUTH, Kentucky
    MICHAEL R. TURNER, Ohio              STEPHEN F. LYNCH, Massachusetts
    PAUL A. GOSAR, Arizona               MIKE QUIGLEY, Illinois
    BLAKE FARENTHOLD, Texas

                                C O N T E N T S

                                  ----------
                                                                       Page
    Hearing held on May 4, 2011......................................     1
    Statement of:
        Simpson, Lynn, Acting Principal Deputy Undersecretary of
          Defense for Personnel and Readiness, U.S. Department of
          Defense; John Medve, Executive Director, VA/DoD
          Collaboration Service, U.S. Department of Veterans Affairs;
          and Daniel Bertoni, Director, Education, Workforce and
          Income Security, U.S. Government Accountability Office,
          accompanied by Randall B. Williamson, Health Care Team
          Director, USGAO, and Mark Bird, IT Team Assistant Director,
          USGAO......................................................     5
            Bertoni, Daniel..........................................    41
            Medve, John..............................................    25
            Simpson, Lynn............................................     5
    Letters, statements, etc., submitted for the record by:
        Bertoni, Daniel, Director, Education, Workforce and Income
          Security, U.S. Government Accountability Office, prepared
          statement of...............................................    43
        Medve, John, Executive Director, VA/DoD Collaboration
          Service, U.S. Department of Veterans Affairs, prepared
          statement of...............................................    27
        Simpson, Lynn, Acting Principal Deputy Undersecretary of
          Defense for Personnel and Readiness, U.S. Department of
          Defense, prepared statement of.............................     9
        Tierney, Hon. John F., a Representative in Congress from the
          State of Massachusetts, prepared statement of..............    78

        IS THIS ANY WAY TO TREAT OUR TROOPS? PART III: TRANSITION DELAYS

                                  ----------

                             WEDNESDAY, MAY 4, 2011

                      House of Representatives,
    Subcommittee on National Security, Homeland Defense
                                and Foreign Operations,
                  Committee on Oversight and Government Reform,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 9:30 a.m. in
    room 2154, Rayburn House Office Building, Hon. Jason Chaffetz
    (chairman of the subcommittee) presiding.
        Present: Representatives Chaffetz, Labrador, Gosar,
    Farenthold, Tierney, Welch, Quigley.
        Also present: Representatives Issa, Cummings, Buerkle.
        Staff present: Thomas A. Alexander, senior counsel; Molly
    Boyl, parliamentarian; Kate Dunbar, staff assistant; Adam P.
    Fromm, director of Member liaison and floor operations; Erin
    Alexander, fellow; Jaron Bourke, minority director of
    administration; Kevin Corbin, minority staff assistant; Ashley
    Etienne, minority director of communications; Lucinda Lessley,
    minority policy director; Scott Lindsay, minority counsel;
    Zeita Merchant, minority LCDR, fellow; Dave Rapallo, minority
    staff director; and Donald Sherman and Carlos Uriarte, minority
    counsels.
        Mr. Chaffetz. Welcome. The committee will please come to
    order.
        I appreciate all of you being here on this important topic
    today, and I thank those participants in advance.
        We want to welcome you to this hearing, which is entitled
    Is This Any Way to Treat our Troops? Part III, Transition
    Delays.
        I would like to begin by thanking our military and
    intelligence community for their tireless efforts and heroism,
    as exemplified by the events of this past weekend. The fact
    that Osama bin Laden is no longer the leader of al Qaeda is a
    victory for the United States and those who stand against
    terrorism. A dark chapter in world history is now closed, but
    the fight is far from over.
        I hope we all take time to pause in our own way and
    recognize the victims that have been at the hands of this
    tyrant, but also to thank the men and women who have served so
    tirelessly in the intelligence community, the military, the
    families that have poured their efforts to fight the war on
    terrorism. Undoubtedly, that will continue. But we need to
    thank them in our own way, in our own hearts and in our own
    communities.
        As America redoubles its efforts to defeat global
    terrorism, let us never forget the brave men and women of our
    armed forces who have brought us this far. They have sacrificed
    everything for us, and have for generations. Since 2001, 6,014
    Americans have died in Operations Enduring Freedom, Iraqi
    Freedom, and New Dawn. Another 43,184 people have been injured
    during this time. In Afghanistan alone, these numbers have
    risen dramatically since our current President took office in
    2009. You will see some charts here on the walls.
        The total number of deaths has risen from 155 in 2008 to
    499 in 2010. The total number of injuries has more than
    doubled, from 2,144 in 2008 to 5,226 in the year 2010. There
    have been 81 deaths and 854 injuries this year alone. Some
    wounds are visible and some are not, but were all acquired in
    the defense of our Nation and serving our country.
        Just as our uniformed men and women took the oath to defend
    America, the Federal Government has a duty to provide care for
    them upon their return. Of the two, the Federal Government
    undeniably has the easier end of the equation. Yet we struggle
    to get it right. This is why we are here today.
        The subcommittee will examine issues associated with the
    transition of wounded service members from the Department of
    Defense to the Department of Veterans Affairs. In recent years,
    various oversight bodies have identified significant
    shortcomings in the care and treatment of our veterans. These
    entities include the Government Accountability Office, the
    Independent Review Group commissioned by Defense Secretary
    Gates, Inspectors General, as well as the Dole-Shalala
    Commission. Each has highlighted deficiencies in the
    administrative processing of wounded service members.
        A chief concern is the overly bureaucratic and lengthy
    disability evaluation system. The lack of seamless transition
    process is the source of great frustration for injured combat
    veterans and their families. Under the legacy Disability
    Evaluation System, often referred to as DES, service members
    wait an average, an average, of 540 days from the time they
    receive their medical evaluation from the Department of Defense
    to the time they receive a benefit check from the VA. Let me
    repeat that: 540 days. In some cases, this period is longer
    than the entire active duty enlistment.
        According to reports, there are a number of reasons for
    this delay. These include duplicative medical exams, poor IT
    infrastructure, lack of staffing and others.
        After much criticism, the Department agreed to revamp the
    DESs. In 2007, a pilot program called the Integrated Disability
    Evaluation system was introduced. This program aimed to
    consolidate programs and eliminate the gap in benefits. The
    goal is to reduce the 540 day process to 295 days. The average
    wait, according to a briefing by DOD and VA to committee staff
    is now 335 days. While 335 days is far more preferable than 540
    days, it is still too long. Some of the old problems have yet
    to be resolved. GAO will describe some of those challenges here
    today. We appreciate them being here with us.
        On March 17, 2011, Defense Secretary Gates and VA Secretary
    Shinseki agreed to examine ways to reduce the wait time to 75
    to 150 days. They also agreed to devise an interagency
    electronic health information record. I am trouble it took
    until 2011 for these agreements to be reached. However, I do
    look forward to hearing from our administration witnesses about
    how each department plans to achieve these goals.
        With each new administration, there seems to be a renewed
    enthusiasm to address veterans issues. There is no doubt that
    the Department of Defense, the VA and this President are well-
    intentioned and have veterans' best interests at heart. We must
    ensure that the Federal Government is working smartly at each
    step of the way. With the recent increases in the number of
    deaths and injuries in Afghanistan, we have to get this right.
        I look forward to hearing from our panel of witnesses about
    the successes and challenges they face. This subcommittee is
    ready to work with the Departments in whatever way possible to
    ensure the better care of our veterans.
        At this time, I would like to recognize the ranking member
    of the full committee, Mr. Cummings, for 5 minutes.
        Mr. Cummings. Thank you very much, Mr. Chairman. I want to
    thank also our ranking member, who is on his way, Mr. Tierney,
    for convening this hearing today.
        I too join you in saluting our troops, the CIA and all
    those people involved, and certainly too the President of the
    United States, Mr. Obama, for what was done over the last few
    days with regard to Osama bin Laden. I think it is quite
    appropriate, Mr. Chairman, that we sit here today addressing
    the issues confronting people like the Navy Seals, people like
    the young people who are right now at the U.S. Naval Academy in
    my State, and I serve on their board of visitors, who go out
    there, do their job, to protect our freedom, our rights, and
    protect our people. So I salute them and all those who are
    involved in that successful mission.
        Last month, I visited Walter Reed, along with you, Mr.
    Chairman, and the Naval Medical Center, to meet with our
    wounded warriors and their caregivers. We talked with an Army
    sergeant who lost his legs in Laghman Province in Afghanistan,
    an Army captain who lost both legs and several fingers in
    eastern Afghanistan, and a young private from the Midwest who
    lost a leg and was there with his mother.
        And these are very real costs of war. We owe our wounded
    warriors the very best health care when they return from the
    battlefield. For those of us sitting here, and those of you
    sitting at the witness table, it is our duty to make sure that
    the United States makes good on that promise. It is a very,
    very important promise.
        I have often said that this is not, this must not be about
    politics. It must be about purpose. It must be about
    commitments that we have made to our men and women in uniform.
    When the Washington Post published a series of articles in 2007
    detailing the appalling conditions at Walter Reed Army Medical
    center, I was angry and deeply embarrassed by the poor quality
    of care, the terrible conditions and the bureaucratic obstacles
    facing our service members and veterans.
        In the previous Congress, this committee has taken an
    active role in holding DOD and VA responsible for improving the
    care of our wounded warriors. Representative Tierney, to his
    credit, held the very first hearing on this issue in the 110th
    Congress. Back then, I wasn't even on this subcommittee, but I
    appeared with him at his first committee hearing on that,
    subcommittee hearing on that, at Walter Reed.
        And Chairman Chaffetz, by holding today's hearing, you are
    demonstrating your commitment to continuing our committee's
    bipartisan commitment to this cause. This is a situation where
    Republicans and Democrats must not move to common ground, we
    must move to higher ground.
        As a result of these vigorous oversight efforts, the Dole-
    Shalala Commission was created to assess longstanding health
    care and disability evaluation issues within DOD and VA. A
    joint DOD-VA senior oversight committee was also established to
    implement many of the recommendations made by the Dole-Shalala
    Commission. One of those recommendations, to improve the
    military's complicated and time-consuming disability evaluation
    system, is in the process of being fully implemented
    nationwide. I have one word for all of those at the witness
    table: we must move with all deliberate speed. Our veterans and
    our servicepeople cannot wait.
        I am encouraged that the new Integrated Disability
    Evaluation System has simplified the process for our wounded
    warriors and reduced the time it takes for veterans to get
    their full benefits. I am proud to say that when the IDES
    process is fully implemented, it will effectively eliminate the
    benefit gap faced by our newly minted veterans.
        But the process is still too time-consuming. We can do
    better. Our service members should not have to wait over a year
    to determine whether they are fit to continue their military
    service and the level of benefits they will receive if they are
    discharged. Even if DOD and VA were meeting their goal of
    completing the IDES process in 295 days, nearly 10 months is
    simply too long for our service members to wait while their
    future hangs in the balance. And by the way, their families are
    also affected greatly.
        DOD and VA must also do more to improve the exchange of
    medical records, given the complicated health conditions facing
    many of our service members when they leave Iraq or
    Afghanistan. It is vitally important therefore that the health
    care providers of these two departments communicate seamlessly.
    As I close, I know that DOD and VA are in the process of
    creating the interagency electronic medical records and I look
    forward to hearing more about the progress today.
        With that, again, Mr. Chairman, I thank you for calling
    this hearing and I yield back.
        Mr. Chaffetz. Thank you. The gentleman yields back.
        I now recognize the chairman of the full committee, Mr.
    Issa of California.
        Mr. Issa. Thank you, Mr. Chairman. It is a distinct honor
    to go after the ranking member, so that I can say I agree with
    everything the ranking member said. This is an issue that goes
    beyond partisanship. This is an issue in which the committee is
    completely united.
        I am honored to have Camp Pendleton in my district, and the
    Wounded Warrior facility that is there. There is no distance
    between Mr. Cummings and myself. I sometimes do see that there
    are reasons that we have 10 months or more in which a marine
    continues to try, or a corpsman, to return to full active duty
    and is working through that. But with the exception of those
    times in which you are clearly trying to help a soldier,
    sailor, marine or airman remain on active duty and that extends
    the determination, I do believe that the process is too slow
    and continues to be, we can do better but we haven't yet done
    it.
        So again, I thank the chairman for holding this hearing,
    and I thank Mr. Cummings for his appropriate remarks, and yield
    back.
        Mr. Chaffetz. The gentleman yields back.
        Members will have 7 days to submit further opening
    statements for the record.
        We will now recognize our panel. Ms. Lynn Simpson is the
    Acting Principal Deputy Undersecretary of Defense for Personnel
    and Readiness. Mr. John Medve is the Executive Director of the
    VA/DOD Collaboration Service. Mr. Dan Bertoni is the Education,
    Workforce and Income Security Team Director at the GAO. Mr.
    Randall Williamson is the Health Care Team Director at the GAO.
    And Mr. Mark Bird is the IT Team Assistant Director at the
    Government Accountability Office.
        We appreciate you all being here today. My understanding is
    that the GAO is going to submit one opening statement, but they
    will all participate in the discussion that we have moving
    forward.
        Pursuant to committee rules, all witnesses will be sworn in
    before they testify. If you would please rise and raise your
    right hands.
        [Witnesses sworn.]
        Mr. Chaffetz. Thank you. You may be seated.
        Let the record reflect that all the witnesses answered in
    the affirmative.
        In order to allow time for discussion, please try to limit
    your verbal testimony to 5 minutes. If there are additional
    materials or statements that you want to put into the record,
    your entire written statement will be made a part of the
    record.
        I again want to thank you for your time, effort, your
    expertise, your commitment to our country. I know your hearts
    are all in the right places. This is a frustrating issue for
    the time that it has taken. But we do want to hear from each of
    you.
        So with that, we will now recognize Ms. Simpson for 5
    minutes.

          STATEMENTS OF LYNN SIMPSON, ACTING PRINCIPAL DEPUTY
      UNDERSECRETARY OF DEFENSE FOR PERSONNEL AND READINESS, U.S.
     DEPARTMENT OF DEFENSE; JOHN MEDVE, EXECUTIVE DIRECTOR, VA/DOD
    COLLABORATION SERVICE, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND
       DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE AND INCOME
    SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE, ACCOMPANIED BY
     RANDALL B. WILLIAMSON, HEALTH CARE TEAM DIRECTOR, USGAO, AND
              MARK BIRD, IT TEAM ASSISTANT DIRECTOR, USGAO

                       STATEMENT OF LYNN SIMPSON

        Ms. Simpson. Thank you, Mr. Chairman.
        Representative Chaffetz, Representative Tierney, members of
    the subcommittee, thank you very much and good morning.
        Thank you for the opportunity and the privilege to testify
    today on our warriors in transition with my colleague from the
    VA, John Medve.
        Taking care of our wounded, ill and injured service members
    is one of the absolute highest priorities of the Department of
    Defense, the service Secretaries and the military chiefs. The
    Secretary of Defense has said that, other than directly
    supporting operations in theater, there is no higher priority
    for the Department of Defense.
        Reforming cumbersome and many times confusing bureaucratic
    processes is absolutely essential to ensuring our service
    members receive, in a timely manner, the care and benefits to
    which they are entitled. The Department's leaders continue to
    work to achieve the highest level of care and management and to
    standardize care among the military services and Federal
    agencies, while maintaining a laser focus on the wide range of
    needs of our wounded, ill and injured service members and their
    families.
        Working closely, carefully and collaboratively between our
    departments is also of the upmost priority. We have established
    governance at the highest levels of our respective departments
    on the wounded, ill and injured issues. The Secretaries of the
    Departments of Defense and Veterans Affairs have met three
    times in the last 90 days with an increased attention on the
    Disability Evaluation System and electronic health records and
    have committed also to meet quarterly to continue the dialog to
    resolve these critical areas of collaboration between our
    departments.
        The Secretary of Defense had directed the establishment of
    the Department of Defense, Department of Veterans Affairs,
    Senior Oversight Committee, referred to as the SOC, on May 3,
    2007. It was established to ensure that recommendations from
    the groups that many of you referenced were integrated,
    implemented and resourced. The Senior Oversight Committee's
    purpose is to ensure interagency oversight to streamline,
    deconflict and expedite efforts to improve the health care
    process, disability processing and the seamless transition of
    service member to veteran status. The Deputy Secretaries of
    both Departments serve as co-chairs.
        The overarching purpose of the Senior Oversight Committee
    is to establish a world class, seamless continuum of care that
    is efficient and effective. The SOC has had a lengthy record of
    accomplishments over its 4 years of existence in direct support
    of and caring for our wounded, ill and injured. I want to offer
    a few of the accomplishment highlights: reducing the gap in
    time service members receive veterans' benefits after
    separation; developing new approaches to address psychological
    health, to include traumatic brain injury and post-traumatic
    stress; expanding the implementation of the Integrated
    Disability Evaluation System; providing transitioning service
    members' health records to the VA prior to their separation
    from military service; and implementing the recovery care
    coordination program, highlighting the need to address
    caregiver issues to ensure that they receive support and
    information.
        The Disability Evaluation System was relatively unchanged
    from 1949 until 2007. As a result of Secretary-level attention,
    public concern and congressional interest, the Senior Oversight
    Committee chartered the DES pilot in November 2007. The SOC
    vision for this pilot was to create a service member-centric,
    seamless and transparent DES, administered jointly by the DOD
    and VA.
        The pilot transitioned to the Integrated Disability
    Evaluation System that integrates DOD and VA DES processes, so
    that the service member receives a single set of the physical
    disability evaluations and disability ratings, conducted and
    prepared by the Veterans Affairs office, with simultaneous
    processing by both departments to ensure the earliest possible
    delivery of disability benefits. Both departments use the VA
    protocols for disability examinations and the VA disability
    rating to make their respective determinations.
        The Department of Defense is partnering closely with the
    Department of Veterans Affairs as we aggressively move toward
    the full implementation of the IDES across all 139 continental
    United States and outside the continental United States by the
    end of this fiscal year. The IDES constitutes a major
    improvement over the legacy system and both DOD and VA are
    fully committed to the worldwide expansion of this program.
        The Department is, however, continuously exploring new ways
    to improve the current system. Because as long as one service
    member is in the system longer than perceived helpful, we are
    obligated and committed to do all we can to enhance the
    experience and make improvements. To that end, the Secretaries
    of Defense and Veterans Affairs have asked the teams to explore
    other options which could shorten the overall length of the
    disability evaluation process from its current goal of 295
    days.
        In addition, the Departments are also looking closely at
    the stages of the Disability Evaluation System that are outside
    the timeliness tolerances, and developing options to bring
    these stages within the goal. We are committed to do all we can
    within our areas of influence to enhance the experience and
    process and will be sure to keep the Congress informed of this
    progress along the way, and as new initiatives are identified
    that can further advance the efficiency and effectiveness of
    the disability evaluation process.
        Another highlight from the Senior Oversight Committee that
    drove to significant enhancement involves the attention to the
    caregiver.
        Mr. Chaffetz. Perhaps if we could submit the balance of
    that testimony, so that we have time to get to the full panel.
        Ms. Simpson. I will jump to the end of my last paragraph
    that summarizes what I have been trying to say to you this
    morning. Thank you.
        Mr. Chairman and subcommittee members, I cannot overstate
    how far DOD has come with our VA partners in the past 4 years,
    since the SOC and other governance processes were put in place.
    Our support for our wounded, ill and injured is night and day
    from the events that occurred at Walter Reed in 2007. Each of
    the services has stood up a very comprehensive and standalone
    warrior care program, as many of you are aware and have visited
    here and in your districts.
        Yet we still have much progress to make. As I close, I
    would like to be articulate, again, that one mistake,
    mistreatment, undue delay or any other aberration in the care
    or transition of our wounded, ill or injured service members is
    one too many. We will continue to work with our teammates at VA
    and throughout the interagency to do anything and everything we
    can to provide our service members with the absolute best care
    and treatment that they so rightfully deserve in return for
    their selfless service and sacrifice to our Nation.
        Thank you again for the opportunity.
        [The prepared statement of Ms. Simpson follows:]

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        Mr. Chaffetz. Thank you.
        Mr. Medve, we will now recognize you for 5 minutes.

                        STATEMENT OF JOHN MEDVE

        Mr. Medve. Thank you, Mr. Chairman.
        Mr. Chairman, Ranking Member Cummings and members of the
    subcommittee, good morning and thank you for the opportunity to
    testify before you today.
        My name is John Medve, Executive Director of the Department
    of Veterans Affairs/Department of Defense Collaboration Service
    for VA's Office of Policy and Planning. I am pleased to be
    joined by the chief of staff from the Undersecretary of Defense
    Office of Personnel and Readiness, Lynn Simpson.
        I would like to provide the subcommittee with an overview
    of collaboration between the VA and DOD to ensure a seamless
    transition of our wounded, ill and injured service members from
    active duty to veteran status. I ask that my complete statement
    be included in the record.
        Much has been accomplished in the wake of the problems
    identified at the Walter Reed Army Medical Center in 2007 to
    improve the DOD disability process and the resulting transition
    to veteran status. The focus of my testimony is VA and DOD's
    joint efforts to make the improvements and to create an
    integrated disability process for service members who are being
    medically separated.
        Currently we are in the process of implementing the
    Integrated Disability Evaluation System, the process used to
    transition the wounded, ill and injured who are unfit for
    continued service from service member to veteran. In early
    2007, VA partnered with DOD to make changes to the DOD's
    existing DES. A modified process called VA/DOD DES pilot was
    launched in November 2007. The DES pilot was intended to
    simplify the disability process, increase the transparency,
    reduce the processing time and improve the consistency of the
    disability ratings among the services and between the services
    and VA. Authorization for the pilot was included in the
    National Defense Authorization Act of 2008, and further
    energized our efforts for improving DOD's DES process.
        The DES pilot model was launched originally at three
    operational sites in the National Capital region and recognized
    a significant improvement over the legacy process. The pilot
    model was subsequently expended in 2008 and 2009, ultimately
    covering 27 sites and 47 percent of the DES population when
    ended in March 2010.
        In July 2010, the co-chairs of the Senior Oversight
    Committee agreed to expand the pilot and rename it IDES. Senior
    leadership of VA, the services and the Joint Chiefs of Staff
    strongly supported this plan and the need to expand the
    benefits of this improved DES pilot model to all service
    members.
        VA and DOD are now working together to launch IDES
    enterprise-wide. As a result, in October 2010, we started the
    transition from the existing legacy process to IDES using the
    pilot model process. Currently, there are 77 IDES sites
    operational nationwide, which includes the original 27,
    covering 72 percent of the DES population. When fully
    implemented in October 2011, there will be a total of 139
    sites.
        Through the implementation of IDES, the departments hope to
    create a more transparent, consistent and expedient disability
    evaluation process. We believe that through the implementation
    of the DES pilot, we have largely achieved that goal. To
    explain, 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 responsibility.
        This results in more consistent evaluations, faster
    decisions and timely benefit delivery for those medically
    retired or separated. As a result, VA benefits can be delivered
    in the shortest period allowed by law following discharge, thus
    eliminating the pay gap that previously existed under the
    legacy process.
        The DOD/VA integrated approach has also eliminated much of
    the sequential and duplicative processes found in the legacy
    system. Overall processing time for the delivery of DOD
    disability benefits will be reduced from an average of 540 days
    to a goal of 295 days while simultaneously shortening the
    period until the delivery of VA disability benefits after
    separation from an average of 166 days to approximately 30
    days.
        Through the challenges and lessons learned, DOD recognized
    that we expanded outside the NCR, we did not have a robust
    business processes in place to certify each site's preparedness
    before it became operational. Through analysis of lessons
    learned and by working with Congress, we have developed initial
    operating capability readiness criteria that stress quality
    over expedience to ensure that future sites are operationally
    ready for IDES.
        Mr. Chairman, I will cut short the rest of my statement in
    the interest of time and thank you again for your support of
    our wounded, ill and injured service members, veterans and
    their families, and the opportunity to appear before you today.
        [The prepared statement of Mr. Medve follows:]

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        Mr. Chaffetz. Thank you.
        It is my understanding that Mr. Bertoni is going to make
    the opening statement for the GAO. You are recognized for 5
    minutes.

                      STATEMENT OF DANIEL BERTONI

        Mr. Bertoni. Mr. Chairman, Ranking Member Cummings, members
    of the subcommittee, good morning.
        I am pleased to discuss the Departments of Defense and
    Veterans Affairs' efforts to integrate their disability
    evaluation systems. I am joined today by Randy Williamson of
    our health care team, who can address any questions you may
    have regarding VA's Federal recovery coordination program, and
    Mark Bird, of our information technology team, who can field
    any questions on systems integration and data sharing between
    the departments.
        Mr. Chairman, thousands of service members have been
    wounded or injured in Iraq and Afghanistan, and many who can't
    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, duplicative processes and confusion among
    service members.
        In 2007, DOD and VA piloted an Integrated Disability
    Evaluation System [IDES], to streamline and expedite the
    delivery of VA benefits to service members. My statement today
    summarizes and updates key findings of our December 2010
    report, which examined the agencies' evaluation of pilot
    results, key implementation challenges and efforts to mitigate
    those challenges in advance of a planned worldwide roll-out.
        In summary, in their evaluation the departments noted that
    the pilot had improved service member satisfaction relative to
    the legacy system. It met their goal for delivering VA benefits
    to active duty and reserve members within 295 and 305 days,
    respectively. Despite meeting the overall timeliness goal, not
    all service branches achieved the same results. Only the Army,
    with about 60 percent of all cases, met the established goals,
    while average processing times for the other services were
    substantially higher.
        Moreover, as caseloads have increased, processing times
    have also steadily worsened. And as of March 2010, active duty
    cases took an average of 394 days to complete.
        The departments have also had difficulty meeting their goal
    for their percentage of cases processed on time, and have since
    adjusted that goal downward from 80 percent to 50 percent. Over
    the past 6 months, the data shows that this new, lower goal has
    never been met for active duty cases, and only rarely for
    reserve and National Guard cases.
        DOD and VA encountered several implementation challenges
    with the pilot that contributed to delays. 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 sites that had large caseload surges
    related to deployments. At one location, it took over 140 days
    to complete a single medical exam, well in excess of the 45 day
    goal.
        We identified other issues and delays associated with this
    single exam, such as problems with 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 service members awaiting a
    decision.
        As DOD and VA proceed with rapid expansion worldwide, they
    are taking steps to address several challenges. This includes
    increasing exam and case management personnel, VA additional
    hiring, staff relocations and contracting, requiring more
    thorough assessments of site readiness and contingency plans
    for addressing caseload surges, and making changes to improve
    the quality of exam summaries.
        While these initiatives are promising, we have recommended
    that DOD and VA take steps to ensure sites have enough military
    physicians to handle projected workloads, as well as available
    housing and operational capacity to absorb service members. It
    is also critical that the departments proactively assess and
    mitigate delays associated with diagnostic differences and
    insufficient exam summaries, and going forward, develop a
    robust data collection and monitoring mechanism to identify and
    address local level challenges, such as sudden staffing
    shortages.
        In conclusion, the IDES shows promise for expediting the
    delivery of VA benefits to service members. However, we have
    identified significant challenges that require our careful
    attention. Although steps taken to date may mitigate these
    challenges, the current deployment schedule remains ambitious,
    in light of substantial unresolved issues and evidence of
    steadily worsening processing times. Thus it is unclear whether
    actions taken will sufficiently and timely support worldwide
    implementation.
        Time frames aside, the ultimate success or failure of IDES
    will depend on DOD's and VA's ability to quickly and
    effectively address resource needs, make adjustments and
    resolve challenges as they arise, not only at initiation, but
    on an ongoing basis.
        Mr. Chairman, this concludes my statement. I am happy to
    answer any questions that you or other members of the
    subcommittee may have. Thank you.
        [The prepared statement of Mr. Bertoni follows:]

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        Mr. Chaffetz. Thank you. I appreciate that.
        I am going to recognize myself for 5 minutes. Ms. Simpson,
    Mr. Medve, I appreciate the task that you have before you. When
    I hear, see and read what the GAO has to say and I listen to
    your statements and presentations, it seems like you are on a
    different planet. That is the concern.
        Let me ask specifically, because I hope at the conclusion
    of this we have at least some sense of the timing, the
    realistic timing, the cost of this, I haven't heard much
    mention of what this is all costing, and some explanation of
    why it is taking so long. Because we talked about May 3, 2007,
    virtually about 4 years almost to the date, and yet we feel
    like we are still sliding backward as opposed to forward.
        Can veterans now download their electronic medical records
    with the click of a mouse? Yes or no, Ms. Simpson?
        Ms. Simpson. Yes, they can, both with the VA and from
    TriCare Health Agency.
        Mr. Chaffetz. Mr. Medve, can they do that?
        Mr. Medve. They can do it through the Blue Button system,
    Mr. Chairman. They can download information from the medical
    records into Blue Button.
        Mr. Chaffetz. Can we get the assessment from the GAO? Is
    that something that they can do, click on the mouse and
    download their records?
        Mr. Bird. Yes, they can, but the information that is
    available to them may be limited.
        Mr. Chaffetz. Explain that to me.
        Mr. Bird. Well, there are, not all medical records are
    necessarily in electronic form.
        Mr. Chaffetz. So my understanding is that what is in
    electronic form is what they self-import, right? What they
    themselves put into the system? Or is it broader than that?
        Mr. Bird. No, it is broader.
        Mr. Chaffetz. But is it complete?
        Mr. Bird. It may not be complete.
        Mr. Chaffetz. How do they figure out if it is complete or
    not? That is one of the issues, right? The President made this
    quote during the State of the Union: ``Veterans can now
    download their electronic medical records with the click of a
    mouse.'' But then right after that, we had the Iraq and
    Afghanistan Veterans of America president comment that was not
    true. And he said, ``The President's comments are misleading to
    service members, veterans and the American public who now think
    that this system is in place and functional, while it is
    clearly not.''
        Is he right or is he not right? Mr. Bird.
        Mr. Bird. As I said, there is information that is readily
    available at the click of a button. But the information for all
    veterans in all cases may not be complete.
        Mr. Chaffetz. Do you have any sense of how do we get to
    that finish line? How much of it is in there? What percentage
    of this is actually done? And how do we get to that finish
    line? It is a huge, mammoth task, no doubt about it.
        Mr. Bird. Yes. The Departments frankly have been working on
    this, the exchange, the electronic exchange of health records,
    for over 10 years. They have slowly been increasing the extent
    to which they can exchange records, starting back in 1998, to
    the present time.
        There are in some cases limitations in the systems within
    the Departments that preclude the full exchange of medical
    records for any individual.
        Mr. Chaffetz. How close are they to completing this? Is it
    next month? Is it next year? If there is a spectrum, and we are
    trying to get to the finish line, and I recognize it is an
    ongoing process, but information technology is supposed to make
    life simpler, easier, swifter, more effective, more efficient,
    not more burdensome. Where are we on that spectrum?
        Mr. Bird. Well, it is difficult to say, because the extent
    of the problem hasn't necessarily been defined yet by the
    Departments. The desired end state is frequently moving as
    technology improves, and as certain capabilities are delivered,
    people want more.
        Mr. Chaffetz. Would anybody else from the GAO care to
    comment on that?
        Mr. Bertoni. I could talk more on that from a logistics and
    operational standpoint with the IDES. The larger macro issue of
    data sharing between DOD and VA affects not only, primarily
    folks who have left the services and are in the world and need
    to get their records and it is very difficult. In terms of the
    IDES, that is pretty much a self-contained unit. You have VA
    staff, you have DOD staff in these medical treatment
    facilities. And the problem they have is their individual
    systems haven't been integrated sufficiently onsite.
        So we have work-arounds, we have manual processes, we have
    multiple computers on individuals' desks to sort of access
    multiple sites. But in the case of this project, would it
    expedite if they had a seamless access to each others' records?
    Yes. Would it facilitate quicker processing? Absolutely. Is it
    the Achilles heel for this system? No. I think there are bigger
    issues.
        Mr. Chaffetz. And what are those bigger issues?
        Mr. Bertoni. Initially I think not staffing these sites
    appropriately, not maintaining the ratios of staff to
    workloads, to cases. Just not having the appropriate knowledge,
    skills and ability on the ground when these sites were stood
    up. Primary.
        Mr. Chaffetz. There is lots more to discuss, but I am
    coming to the conclusion of my time with respect to the 5-
    minutes. We will now recognize Mr. Welch from Vermont for 5
    minutes.
        Mr. Welch. Thank you, Mr. Chairman. I appreciate your
    calling this hearing.
        Mr. Williamson, I want to thank you for conducting the GAO
    study, which I and others had requested after that Washington
    Post series of articles. I missed your opening statement, so I
    apologize if you have to re-cover answers that you have already
    given. But can you please share how the findings of that study
    can help this committee on how we can move forward in making
    the transition from DOD to the VA more streamlined for our
    soldiers?
        Mr. Williamson. The study we completed on March 23rd was on
    the Federal Recovery Coordination Program. And as you may know,
    that is a program for the most severely catastrophically
    injured, ill and wounded service members. In the process of
    that, we have obviously looked at a variety of other programs.
        As you know, each of the services has their own wounded
    warrior program. And in addition to the Federal Recovery
    Coordination program, which is administered by VA, there is a
    recovery coordination program administered by DOD as well. So
    there are a lot of organizations that are involved in terms of
    care coordination and case management.
        Some of the IT issues in terms of coordination, just to
    kind of follow on what the chairman was talking about, it is
    very important, because of the overlap that occurs between all
    the programs, the wounded warrior programs that are now
    ongoing, very important that these programs coordinate with one
    another. Right now, the recovery coordination program has a
    comprehensive transition plan and the FRP also has that.
        So it is important that if they are not talking to one
    another, or can't communicate with one another, they have
    problems. We had a situation where----
        Mr. Welch. I am not going to have a lot of time. What I
    think would be helpful is, on the basis of your study, what are
    the one, two, three types of recommendations that you might
    have?
        Mr. Williamson. The recommendations deal with proper
    identification of potential enrollees. Right now they need to
    do a better job of identifying the people who are severely
    wounded. And that is an issue because there is no good data
    base of severely wounded people.
        No. 2, determining a number of staff and the workload
    ratio, so that we don't overload. And three, where to place the
    people.
        Mr. Welch. All right, thank you.
        Let me ask Ms. Simpson and Mr. Medve a question. When the
    Vermont Guard returned, we had our largest Guard deployment
    since the Second World War, over 200 were kept on medical hold
    with the DOD and not able to return home to their family to
    begin that reintegration process. The question is, how can
    members of the National Guard and Reserve have access to the
    high quality care that is provided by the Department of Defense
    without losing the opportunity to get the benefits of receiving
    that care closer to home? That is particularly a challenge for
    our members of the Guard who are, many of them, living in very
    rural and remote areas. I will start with you, Ms. Simpson.
        Ms. Simpson. Thank you, Mr. Welch. I think the issues that
    you highlighted for the Guard are of upmost priority to both
    Departments. Because of the unique nature of the Guard being
    part of a community, it is more difficult to get services to
    them.
        However, that being said, there has been an increased
    emphasis to ensure that they not only have the benefits and
    care from these transition units, but also making an outreach
    to the community. The Army in particular has done a good job
    trying to reach back to the communities on behalf of the Guard
    and Reserve community.
        There is more to be done, obviously, because that Guard and
    Reserve community is one of our highest priorities, as some of
    their statistics are not as good as some of the others. So we
    are working on that exact issue.
        Mr. Welch. Thank you. Mr. Medve.
        Mr. Medve. Congressman, thank you for the question. As Ms.
    Simpson said, we are looking at the specific issues surrounding
    Guard and Reserve. When they return from a deployment, DOD has
    been, as we look at somebody that may be unfit, we are working
    through those specific issues of getting them through the IDES
    program and looking for ways that we can do this treatment much
    closer to the home base to ensure that we have the requisite
    staff that can handle that influx.
        Mr. Welch. Thank you. I yield back.
        Mr. Chaffetz. The gentleman yields back. Thank you.
        We will now recognize the vice chairman, Mr. Labrador from
    Idaho, for 5 minutes.
        Mr. Labrador. Thank you, Mr. Chairman.
        Mr. Bird, I just want to followup on a question that the
    chairman asked you. I am not sure I understood your answer. In
    the State of the Union, President Obama stated that veterans
    can now download their electronic medical records with the
    click of a mouse. And you said that is somewhat true.
        But you were not specific enough, letting us know exactly
    what they can download. I am just going to quote the president
    of the Iraq and Afghanistan Veterans of America. He said that
    ``The comments are misleading to service members, veterans and
    members of the American public who now think that the system is
    in place and functional. This is clearly not.'' Then he says
    specifically that from the VA system what you can download are
    pharmaceutical records and personal health information that he
    or she has self-entered.
        Is that an accurate statement?
        Mr. Bird. I believe that is an accurate statement.
        Mr. Labrador. So that is all you can download right now, is
    pharmaceutical records and then self-input information?
        Mr. Bird. That is my understanding.
        Mr. Labrador. So what do you think the President meant when
    he said that veterans can now download all this information?
        Mr. Bird. I wouldn't want to speculate.
        Mr. Labrador. Anybody else want to take a crack at that?
        OK. Ms. Simpson, could you please comment on that?
        Ms. Simpson. I was just going to say that I think the Blue
    Button, as Mr. Medve mentioned, is a reference to trying to get
    to that goal that you are talking about, the full electronic
    health record, and that has made significant progress. I am not
    technically detailed in the exact information that the member
    can get, though. But the Blue Button, as Mr. Medve said, is the
    way that they get the information.
        Mr. Labrador. So we are trying to achieve this compliance,
    where they can actually download. But it sounds like we are not
    really there yet.
        Now, we have a system, the IDES system, and we also have
    the legacy DES system. Ms. Simpson, can you tell me what was
    the projected cost of the legacy DES program?
        Ms. Simpson. I don't have that figure for the cost, but we
    can get that for you.
        Mr. Labrador. OK. I want to know what the projected cost
    was, and I want to know what the actual cost was. Do you, Mr.
    Medve, have that information?
        Mr. Medve. Sir, DES is a DOD program, so I wouldn't have
    that information on IDES in terms of our projections for health
    care with VHA and VA. Those are embedded in their overall
    budget, because frankly, service members who transition through
    IDES would be our customers anyway. So we project for that
    population.
        Mr. Labrador. Can you provide that information for the
    record?
        Mr. Bertoni. Sir, I actually have, as of November I have
    some numbers.
        Mr. Labrador. That would be great.
        Mr. Bertoni. DOD estimates $63 million annually for the
    IDES, with VBA's portion about $33 million and VHA at $17
    million. And additional benefits paid out would be $960
    million.
        Mr. Labrador. What was the projected cost?
        Mr. Bertoni. I do not know the projected, just what their
    estimates were at that time.
        Mr. Labrador. Thank you.
        According to your testimony, Mr. Medve, you said that
    through the implementation of IDES, the Departments hope to
    create a more transparent, consistent, expeditious program. And
    you believe that it will largely achieve the goal of creating a
    more transparent, consistent program. Why do you think that is,
    just largely? Do you think that it is going to achieve these
    goals, or do you think that it is not going to achieve the
    goals?
        Mr. Medve. I believe it will achieve the goals. In many
    cases, we have, with service members.
        Mr. Labrador. Does GAO agree with this assessment, Mr.
    Bertoni?
        Mr. Bertoni. I think the concept of transparency is built
    into it. We have a system unlike the legacy system, where we
    have case management, clinical, non-clinical case management
    from referral through payment of VA benefits. So to the extent
    that these folks are able to do their job, they have sufficient
    workloads and ratios where they can actually speak with the
    service member and explain to them why things are happening the
    way they are, why the decisions are playing out the way they
    are. I think you do have a much more transparent system.
        Mr. Labrador. Mr. Chairman, I have no more questions, just
    one last comment. It seems to me that we have had this problem
    for 4 years, trying to figure out how the system works. This is
    a lot of the same stuff we are going to be doing with the
    health care system, if it goes national. So I have some
    concerns about the projected costs in the future for a health
    care system.
        Mr. Chaffetz. Thank you. The gentleman yields back.
        I now recognize the ranking member of the committee, Mr.
    Tierney from Massachusetts, for 5 minutes.
        Mr. Tierney. I thank the chairman. I thank the chairman for
    having this hearing, as well, as the folks on the dais for
    testifying.
        Mr. Bertoni or Mr. Williamson, Mr. Bird, let me ask you
    folks one thing. Is it your impression that the Veterans
    Administration and the Department of Defense completed all the
    recommendations that you made with respect to their pilot
    program?
        Mr. Bertoni. We have made recommendations dating back to
    2007. To the extent that we have asked them to institute more
    robust assessment practices while they were going through the
    pilot, we think they have been fairly responsive. I would say
    responsive. I think the design of the pilot was better, the
    metrics they were capturing were better because they were
    responsive to our recommendations.
        Down the road, we just issued a report in December where we
    have several recommendations in which they have agreed. To the
    extent that they complete them, I think they will have a
    positive impact.
        Mr. Tierney. Do you have an estimate of how long it should
    take them to complete the recommendations from December?
        Mr. Bertoni. There are some estimates. We had asked them to
    look at the extent to which there are disagreements and
    diagnoses between DOD and VA, which we believe could be
    substantial. I have been doing this quite a while, and usually
    Federal disability programs, cases tend to get mired in the mud
    when you can't complete the medical record or you have
    disagreements about the medical record. They sit on desks, they
    have to be looked at again. Medical exams expire and we see the
    service member on the disability evaluation hamster wheel.
        So we think they really need to look at this issue. I
    believe they intend to study it and make a determination of
    whether adjustments need to be made by July 2011. And there are
    other areas where they are actively right now making
    adjustments.
        Mr. Tierney. To what extent, if any, do you think that this
    disagreement, or maybe substantial disagreements on disability,
    would be a case of hoping that the other department or agency
    incurs the cost?
        Mr. Bertoni. I don't think that is the issue. I think it
    just, it is the way their criteria is laid out in terms of how
    they assess disability. Terminology, nomenclature, guidance, I
    think there are just fundamental differences across the two
    entities. And things get lost in the translation.
        Right now, there is guidance being developed. We haven't
    seen it, and we really don't know how it is going to address
    this problem. What we are really concerned about is, we went to
    10 sites. We heard this at enough sites to raise it to the
    attention of the agencies, that you really need to get your
    hand around extent, nature and the impact on delays. That is
    good information to make some adjustments.
        Mr. Tierney. Mr. Medve and Ms. Simpson, is there any talk
    in the Veterans Administration or Department of Defense about
    kicking this up to the White House level to get a referee?
    Somebody has to be able to make a decision, as opposed to
    letting it keep being arbitrated and negotiated back and forth.
    At some point, somebody has to have some leadership, a sense of
    direction, make a decision and force movement.
        Mr. Medve. Mr. Ranking Member, as Mr. Bertoni said, one of
    the recommendations was for us to look at those discrepancies.
    As he said, we are undergoing a study right now which will be
    coming out in July. We are also looking at a number of variety
    of ways, because as he points out, most of the cases that there
    is a discrepancy, it resolves around the mental health issues.
    Those are tough calls to make in terms of service members. So
    while the DOD doctors will have had a service member for a
    while and have an opinion, and then when we do the exam, we may
    come to a different conclusion.
        So we are working out a way that we can leverage the
    ongoing treatment, get that in a form where our raters can look
    at that, and then use that as the basis for making the
    determination which should help eliminate any discrepancies.
        Mr. Tierney. Had nobody identified that issue between the
    time that you were working on the pilot and the time you
    decided to start trying to scale this program up? It sounds to
    me like there was no plan on how the scaling up was going to
    happen.
        Mr. Medve. I can't answer that question. I wasn't there
    during the pilot phase of it. I know a number of these issues,
    we are dealing with individual cases. So as you are dealing
    with individual service members----
        Mr. Tierney. I don't want to interrupt you, but my time is
    short. I know we are dealing with individual cases, and I am
    aware of all the difficulties that presents. But when we had a
    pilot program, presumably we identified some of the issues
    there. Before we went to moving to scaling it up, I would have
    thought there would have been a plan, and the plan would have
    involved resolving some of these issues.
        Mr. Bertoni, are you aware of any plan where they said,
    these are the issues, we are going to get these resolve and
    this is how we are going to deal with it as we scale it up?
        Mr. Bertoni. Certainly the pilot identified challenges that
    the DOD and VA have undertaken efforts to address. I think one
    of the issues was at the time they issued that report in August
    2010 that there were only 1,300 completed cases. They were
    working off of data that was 6 months old at the time they
    began analyzing it.
        So I think some of the emerging issues just hadn't worked
    their way through the system yet. By the time we started to
    look, a year later, at some of the data, some of these trends
    were starting to play themselves out more fully. So making
    decisions on the basis of 1,300 cases on the goodness of the
    pilot, they were able to do that in some respects. But I don't
    think they knew everything that was going to be coming down the
    road.
        Mr. Tierney. Thank you.
        Mr. Chaffetz. Thank you. We will now recognize Mr. Gosar of
    Arizona for 5 minutes.
        Mr. Gosar. Mr. Williamson, let me make sure I've got this
    right. You made a comment just a minute ago, because of lack of
    documentation of the injured. Are you kidding me? Is that true?
        Mr. Williamson. Well, again, the Federal Recovery
    Coordination program covers the severely injured. And there is
    no data base in DOD or VA that actually defines what severely
    wounded is, or keeps track of it. So it makes it difficult for
    the program to identify potential enrollees.
        Mr. Gosar. Well, this seems just backward to me. I am a
    dentist, and health records are everything to a patient for
    continuity of care. And I see this over and over in my
    district. We collect claims from White Mountains to Native
    Americans to Flagstaff to Prescott to Phoenix all about this.
    And this is the simplest of tasks. And it comes back to the
    lack of an interagency discipline to have something that both
    agencies can agree upon. Would you not agree on that, Ms.
    Simpson and Mr. Medve?
        Ms. Simpson. I think absolutely it requires both
    departments working together, throughout the entire department
    at the senior levels of leadership to address those specific
    issues. I believe that the teams are working to address those.
        Mr. Gosar. Wasn't there a meeting on May 2nd? What was the
    followup on that? Can you give us some details?
        Ms. Simpson. I was not present at the meeting. We are in
    the process of documenting the next steps for both the issues
    of the electronic health record and the disability evaluation
    system and the way forward. Both departments will be connecting
    on that to get specifics in addressing those issues.
        Mr. Gosar. I find a real disconnect, I am sorry, but these
    are people's lives. Having gone over to Walter Reed to see the
    severely injured, to see even some of the folks who are looking
    at problems with post-traumatic syndrome type aspects, folks,
    it is that easy.
        It seems like we are just studying this over and over and
    over again, going nowhere. It is a common theme throughout our
    whole, my district, which is laden with veterans and our
    military supporters. This is unacceptable. Just absolutely
    unacceptable. Because the whole system is now in place and it
    is a problem, it is interfering with the treatment of our
    soldiers. Would you not agree?
        Ms. Simpson. Access to data and information absolutely is
    critical to being able to address issues, I agree.
        Mr. Gosar. Then why aren't we prioritizing that record?
    This is no different. I am not going to give you any solace.
    Because in the private sector, we are not given that leeway.
    And I don't see we should be giving you any more leeway because
    of what is impounding here. And not to have documentation on
    severely wounded people that are coming back here, that is the
    minimum standard, folks. That is a minimum standard. What you
    are giving us is unacceptable results, absolutely unacceptable
    results.
        Not knowing what came about on May 2nd, Ms. Simpson, where
    would you go with this? You are in a position of making a
    comment and putting your weight behind an idea. Where would you
    like to see this go?
        Ms. Simpson. I believe we would like to see it go to
    exactly what you are talking about, commitment and service to
    getting our service members and our wounded warriors into
    veteran status seamlessly. It has to be the upmost priority.
    And the technical aspects of the systems, I am not detailed in
    that type of information, but there are very dedicated people
    in both departments that are working tirelessly to make sure
    that the technical, systematic architecture and the details
    about the infrastructure that is required to support the record
    you are referring to is going to be a reality.
        Mr. Gosar. I would hope somebody in leadership would
    actually stand up and be counted. Because too many times our
    men and women who put their lives on the line are being the
    victims here. That is inappropriate.
        We have heard this over and over again, throughout my
    district, like I said. I would like to say, in a few short
    weeks, we are going to celebrate Memorial Day. I hope,
    especially, it is very important during this time, that we
    remember our obligations. It is not about saving our jobs, it
    is not about not speaking up. It is about speaking up on behalf
    of what is right. I don't see a lot of that happening.
        Thank you, Mr. Chairman.
        Mr. Chaffetz. Thank you. The gentleman yields back.
        We will now recognize Mr. Quigley from Illinois for 5
    minutes.
        Mr. Quigley. Thank you, Mr. Chairman.
        Ms. Simpson, I will ask you but if anyone else wants to
    chime in, I would appreciate it. Isn't it true that the
    problems at Fort Carson is really a staffing problem? Are you
    concerned that this is not just Fort Carson, but these systemic
    shortages could lead to these same delays across the entire
    system?
        Ms. Simpson. I think an element of the issues at Fort
    Carson was the staffing issue. One of the actual lessons
    learned from the pilot, the first pilot, was in fact having
    accountability and a thorough assessment of making sure that
    all aspects of the requirements to integrate the systems was in
    place before going live. So the teams now are going around to
    the different sites and looking at best practices. Not every
    site has the severity of the issues as identified in Fort
    Carson.
        But to address that, we are looking at the other sites to
    incorporate the lessons learned there, and getting more
    specific in the metrics, they are consistent across all the
    sites.
        Mr. Quigley. Then how much of it is the staffing issue
    there, and what is the danger of it spreading? How do you break
    it down? Is it the analysis you are doing now to try to answer
    that question?
        Mr. Medve. If you don't mind, Congressman, one of the
    things that we learned in terms of as we move forward with IDES
    is we had not instituted a process that brought together the
    teams before they stood up in their respective sites and
    applied a rigorous methodology of making sure they understood
    what they were getting into as they were going to implement.
        We started that back in September with the first iteration
    where we brought them all together. We sat them as groups. We
    had them do a site assessment and then from that site
    assessment it went through a murder board where people looked
    at their analysis and after that analysis, they developed their
    draft implementation plan.
        So they got a good sense of where they were from a
    requirements standpoint, in terms of what they needed for
    staffing. And then developed their plan and had to be certified
    by two senior executives, one from DOD, one from VA, for each
    local site. That again I think is building on the
    recommendations that the GAO made.
        As part of that they also had to develop contingency plans,
    should there be an influx of how they would handle additional
    cases coming into the system. So I think what happened at Fort
    Carson, we did learn that lesson, we have embedded it and
    institutionalized it in our going-forward plan for rolling it
    out for the rest of the fiscal year.
        Mr. Quigley. I can't help, Mr. Chairman, my frustration
    here is I am flashing back to my academic days in public
    policy. I feel like I am getting an answer that would be
    suitable for a public administration class. In layman's terms,
    the essence of the problem, how much of it is staffing, how
    much of it is we just screwed up and didn't know how to do this
    the right way?
        Mr. Medve. Sir, I think at the beginning we didn't have as
    good a plan as we needed. We did not apply the leadership from
    the local level up. And we have now turned that around to where
    the Chief of Staff of the Department of Veterans Affairs and
    the Vice Chief of Staff of the Army have quarterly VTCs with
    the Army IDES sites to hold each site and both Department
    personnel accountable for that. We are examining the staffing
    as part of that process. And if there is a requirement to add
    more staff, we are doing it.
        Mr. Quigley. I respect how difficult this is. I really do.
    I guess I don't understand how it can crop up. It sounds like
    the first day on the job. Doing this for a long time, what
    changed to make it all of a sudden a problem that you had to
    uncover?
        Mr. Bertoni. Sir, I could take a crack at that from a GAO
    standpoint. I think, as Mr. Medve stated, the up-front work in
    terms of doing a look-back on the history of Carson would have
    been very helpful, a more granular look, a month by month look
    at what the deployment schedules looked like, what did the
    impairments look like, numbers, types of impairments,
    illnesses, injuries. Then you can build your knowledge, skills
    and abilities around that.
        In the case of Carson, there was a large shortage in
    specialty medical exams. Many of these folks are coming back
    from multiple deployments. The science says when you go through
    multiple deployments, more likely to have PTSD and other mental
    impairments to deal with.
        So if you know the history of the site, you can build your
    staffing model around that and be ready for surges. That was
    not done. We think it is being done better now.
        Mr. Quigley. Is it possible to continue? Thank you, Mr.
    Chairman. Then it gets to the question, if this is new, is it
    because we are in uncharted territory about how many
    deployments we are sending our young men and women to? Anybody?
        Ms. Simpson. The deployments piece is not new. I think the
    new----
        Mr. Quigley. The deployment what?
        Ms. Simpson. The deployment assessments is not new.
        Mr. Quigley. But what is new is how many deployments we are
    asking our people to go on, to go through.
        Ms. Simpson. I think what we are trying to say, or at least
    Mr. Medve and I are trying to say, is the issues that were not
    addressed in the first look at the pilot were categorized into
    a plan. And now they have constant interaction and talking with
    one another through these various forums that Mr. Medve
    mentioned. And the constant attention to making sure that all
    of the staffing, the facilities, all of the things that are
    required to make sure that the site is able to function at the
    upmost quality is there.
        Mr. Quigley. Mr. Chairman, I want to thank our
    participants. With the greatest respect, I am not any smarter--
    maybe that is an attack on me--after this discussion than I was
    coming in and reading this and being prepared. But I do
    appreciate what you have done to put this together.
        Mr. Chaffetz. Thank you. The gentleman yields back.
        We will now recognize the gentleman from Texas, Mr.
    Farenthold, for 5 minutes.
        Mr. Farenthold. Thank you very much.
        I never cease to be amazed at the inability of the Federal
    Government to create what seems to me to be a relatively simple
    computer system that works. I am stunned by it.
        I want to take a step back and just kind of look at what is
    actually involved in doing this. We had a comment, I think it
    was Mr. Medve, that we had some staffing issues. Are the
    staffing issues doctors? Are the staffing issues data input
    clerks? Where is the staffing problem? That is my first
    question.
        Mr. Medve. In terms of IDES, what we needed to understand
    was what the requirement was at each site, based on their
    specific requirements. So it was a combination of ensuring that
    we had the amount of medical professionals who could do the
    examinations, that we had the requisite number of VA military
    service coordinators to handle the cases. And then
    correspondingly, the DOD had the number of physical evaluation
    board liaison officers.
        Mr. Farenthold. OK. Well, here is my concern on this. I
    actually have a little bit of experience in this. I had a
    computer company before I came to Congress. We were approached
    by a chain of five minor emergency centers that wanted to do an
    electronic medical records system, online and Web-based. We did
    that with five people in 4 months.
        Now, I realize you have a whole lot bigger scale. But it
    doesn't seem like it is a whole lot different project, with
    maybe the addition of some workflows. You have a doctor in the
    military that sees them. They dictate the report, or they enter
    it into the computer themselves.
        Then they move on, get discharged, they move on to the
    Veterans Administration. They get evaluated by another doctor,
    who dictates or enters that report. It gets reviewed by
    somebody that says yes or no, and the checks start coming.
        I realize that is a gross oversimplification. But it seems
    to me that is a pretty simple data base application with some
    workflow. I would bet if you put it just in simple terms and
    gave it to a student at Harvard, he could probably get it done
    in the evening. We got Facebook up in no time, a kid in his
    spare time.
        Am I missing something here? Can anybody tell me how it is
    that much more complicated than that?
        Mr. Bertoni. In the case of the IDES, what we found was it
    was a people issue. At each stage of the process, there is a
    workload. And let's just talk about ratings. To the extent that
    there aren't enough raters in play, that workload is going to
    back up. Medical exams, to the extent that there aren't enough
    medical examiners to handle the workload, and if we get a surge
    from a deployment on top of that, that work is going to back
    up. Yes, computers and automation can help leverage limited
    resources. But it has to be hand in hand with appropriate
    workload ratios.
        Mr. Farenthold. I understand that. But it seems like these
    are men and women that have put their lives on the line for our
    country. There is no way they are going to get discharged from
    the military before they see a doctor. That doctor ought to be
    able to make an initial assessment, and you all ought to trust
    your brother agency that is a good initial assessment, so they
    can get the money that they deserve to take care of their
    family as soon as they get out. Then you all can take as long
    as you want to do the second evaluation and say no. We have
    created too many steps and too much red tape to get that done.
        Would you guys just do me a favor? When you finish, just
    stand out in the hall and work out the 10 steps that it takes
    to get this done and see how we can implement it. Forget the
    red tape, forget the standard, just do a block diagram on the
    back of a napkin and then hand it to some kid at Harvard and
    let him write it. It is simple, basic, undergrad computer
    science to get the technology to work. And I think you need to
    give your brother and sister agencies the benefit of the doubt.
        I apologize for preaching more than I asked questions, but
    I am just appalled at the amount of time and the disservice we
    are doing to the men and women who have sacrificed life and
    limb for this country.
        Thank you very much. I yield back.
        Mr. Chaffetz. Thank you. The gentleman yields back.
        We will now recognize the ranking member of the full
    committee, Mr. Cummings of Maryland for 5 minutes.
        Mr. Cummings. Thank you very much, Mr. Chairman.
        Let me go back to what I said in my opening statement. Mr.
    Tierney, I complimented you for back in 2007 grabbing hold of
    this issue. I was telling them about how we were at Walter Reed
    and what we saw back then. We have seen some improvement.
        But one of the things I am most concerned about is I think
    that we may be accepting a normal that is simply inappropriate.
    And I don't know that we are dealing with what the President
    talks about on other issues, and that is the urgency of now.
    According to DOD and VA, under the original pilot program, the
    departments were able to meet their goals of reducing the
    average disability evaluation processing time for an active
    duty military below 295 days and reducing the average
    processing time for reservists to under 305 days. However,
    according to GAO, the average case processing time has steadily
    increased.
        Let me say that this is simply unacceptable. I am very
    concerned about the rapid increase in the average processing
    time to complete the IDES system. They are now well above the
    initial goals of 295 and 305 days. It appears as if DOD and VA
    are unable to replicate the success of the pilot program as the
    IDES program has expanded to additional sites.
        Mr. Medve, can you explain why this is the case?
        Mr. Medve. Congressman, we have noticed an increase. That
    is why, as Secretary Shinseki looks at this, he feels very
    strongly that this is a leadership issue from the lowest level
    up to the top. That is why we have instituted reviews at all
    levels to understand what each site is facing in terms of
    challenges, what resources they might need, how we can get
    those resources to them. If there are people that need to be
    added or if there is equipment that needs to be sent there, as
    I stated before, we have now instituted very senior leader
    sessions between the VA and the Army to examine each one of
    these sites in detail.
        Mr. Cummings. When can we expect an answer with regard to
    the results of what you are talking about? We went out to
    Walter Reed, and I cannot get this man off of my mind. We went
    and we saw a gentleman, and I feel emotional just talking about
    it, where he had both of his legs blown off. And one of them,
    it was cut so high, up to about the waist, they basically had
    nothing to strap it onto.
        And when I see people like that, and we talk about how much
    we love our veterans, how much we love our service members, we
    applaud what was just done by our Navy Seals and those brave
    men and women who resolved the issue of the last few days. And
    then it seems like suddenly we are talking about, we are going
    to meet, we are going to meet, we are going to meet. At some
    point, somebody has to say, wait a minute, these people are
    suffering now. Not yesterday, now. They have done their job.
        So this constant thing of let's talk, let's talk, let's
    talk, that is fine. But when I see numbers increasing, that is
    a problem. It seems like alarm bells should go off everywhere.
    I think that is why Mr. Chaffetz, Mr. Tierney, are so
    concerned, and all of us are concerned about these issues. I am
    just wondering if we are all getting it.
        So to constantly say, we are looking at it at the highest
    levels, this is the question: can you tell us when the chairman
    can bring you back before us with some answers to the questions
    that you just raised? In other words, why is this happening,
    how is it happening, how do we deal with it, so that we can get
    on with it. You know what I fear? I fear in 6 months we will be
    seeing the same stuff, and more people will have suffered.
        So can you give us a date, Mr. Chairman, this is just
    something I think we need to do, to have you all come back and
    give us some real answers and show us some progress? Can you do
    that for us?
        Mr. Medve. Mr. Chairman, I don't know if I can give you an
    exact date. I know that as we move out to----
        Mr. Cummings. Six months? How about 6 months? How about
    three?
        Mr. Medve. Mr. Chairman, we will come back any time we are
    invited to----
        Mr. Cummings. No, no, you are not listening to me. What I
    am asking you to do is give us, I don't want us to have a
    hearing and then we come back and hear the same stuff. So if
    you tell me 3 months, I would suggest to the chairman, and he
    will do what he chooses, I understand, Mr. Chairman, I will
    give you 3\1/2\ if you say 3; if you say 2, I will say 2\1/2\.
    But we have to have answers, and we have to act on this with
    the urgency of now.
        So how long will it take to get those questions answered
    that you just asked?
        Mr. Medve. All I can tell you, Mr. Chairman, is that we are
    holding people accountable now to meet those standards and we
    are working toward getting to each of those sites to meet the
    standards.
        Mr. Cummings. Mr. Chairman, I thank you for your
    indulgence. I just think, Mr. Chairman, if you don't mind, and
    Mr. Ranking Member, I really think we have to set some
    deadlines. Because other than that, we will be hearing this
    over and over and over again. I just hope that we can do that
    in a bipartisan way where we can get to the bottom of this.
        Mr. Tierney. If the gentleman would yield, and if the
    chairman would allow me to make a statement on that? Thank you.
        Look, I think we are maybe yelling at the wrong people on
    that. When we had the hearing out at Walter Reed, when this
    thing first broke, we wanted to hold people at the top
    accountable, not necessarily the people who are out there
    slugging away every trying to get these things done and taking
    the heat on that.
        We had the hearing in March 2007. The Army Surgeon General,
    who was the top Army officer responsible for the failures out
    there, resigned. That was followed by the commander of Walter
    Reed, the Army Secretary, they resigned. And in July 2007, the
    Secretary of Veterans Affairs.
        I suggest, Mr. Chairman, at the next hearing, we don't keep
    pestering this group of people who are out there working,
    trying to take orders. We kick it up a notch and we have some
    accountability for the people who are supposed to do this. We
    found out the Army Surgeon General lived across from Walter
    Reed, so he was a surgeon, he was a member of the services, and
    he was a neighbor, and hadn't visited. These things are just
    unacceptable.
        And to keep forcing these folks, the good folks that come
    in front of us and explain what is going wrong, they can only
    do so much unless somebody at the top takes responsibility for
    working out these things. If a large part of it is personnel,
    then these folks aren't necessarily going to be able to make
    that decision. Somebody has to call to Congress' attention that
    we need X amount of dollars for the following personnel, they
    are to be assigned to the following locations and move it on.
        So my respectful recommendation is that we consider
    bringing in folks at the top level decisionmaking thing and
    holding them responsible. I think the American people would
    have the same response, they will require some accountability
    on this.
        Mr. Chaffetz. I would concur with both the ranking member
    and Mr. Cummings as well. While I appreciate the two people who
    have been here testifying today, it is an embarrassment to the
    Veterans Affairs, it is an embarrassment to the Department of
    Defense, to not send the most senior-most people to this
    committee. They owe these responses to the American people. I
    would hope we could work in a bipartisan way. If we have to
    issue subpoenas to get them here, we will issue subpoenas.
        To have people come here who aren't even in the meeting on
    May 2nd, with all due respect, is an embarrassment to those two
    agencies. We need answers. This has gone on for years and years
    and years. And no longer will this committee put up with the
    tolerance of just saying, well, we are putting together and we
    are having meetings. It is not acceptable. It is absolutely not
    acceptable.
        We will work together in a bipartisan way to make that
    happen. I totally concur with the comments that were just made
    here.
        I would now like to recognize a member of our full
    committee, Ms. Buerkle from New York. She is also the chairman
    of the Veterans Affairs Subcommittee on Health. We will
    recognize her for a very lenient 5 minutes.
        Ms. Buerkle. Thank you very much, Mr. Chairman, and thank
    you for allowing me to participate in this hearing this
    morning.
        I come here as the chairman of the Subcommittee on Health
    for Veterans Affairs, and I sit here this morning appalled at
    what I am hearing. As was echoed by my colleagues, we can't
    hold you accountable, but we can hold the Veterans
    Administration and DOD. This is shameful. This is absolutely
    shameful. Our men and women provide and protect us, and the
    very least we can do is, when they come home, we can provide
    them with the services and the health care that they need.
        So I am trying to understand what happened here. In 2007,
    we identified problems. And then were there parallel systems?
    And now as of March there will be an integrated system? Am I
    understanding that correctly?
        Mr. Medve. I think we had, what we termed a legacy
    Disability Evaluation System, which the DOD used to put the
    service member through who was going to be determined unfit.
    And then they were separated from the service. At that point
    then, they filed a claim with the VA. So they had a medical
    examination under DOD, they were separated, they came to the
    VA, and they went through another medical examination in order
    to get a rating.
        What we have done since we have started both the pilot and
    now the full implementation is integrate both of those
    processes. So as a service member is identified as potentially
    being unfit for service, when they get into this process, they
    are then given one, we call it one medical exam, but it is
    composed of a number of them, because they may have a number of
    things, on the issues that make them unfit for continued
    service. At the same time, we also catalog all those things of
    which is service-connected for them. So we are doing all those
    examinations at one time.
        Once those are done, then the record is sent to the VA for
    a disability rating for us, and at the same time sent to the
    DOD for an evaluation on the unfitting conditions. So that is
    happening now. But we still have a mixture of both legacy and
    the new system in place.
        Ms. Buerkle. So earlier, Mr. Bird, you testified that when
    a veteran downloads their medical record, they will at least
    get the pharmaceutical portion and then any other information
    that they may have entered into the system. Is that correct?
        Mr. Bird. That is correct.
        Ms. Buerkle. So we are then asking someone, their
    laboratory results aren't in there? Physical examination? Any
    examinations conducted by a physician? If they downloaded their
    medical records, all they are getting are those two components?
        Mr. Bird. Yes, that is correct.
        Ms. Buerkle. Does anybody realize how ineffective and
    inefficient that is? How that just doesn't work? We just had a
    vet here sitting in this committee download her medical
    records, Healthy Vet. And all she got when she downloaded her
    medical records was her name and address and anything she
    entered into that record. She didn't choose to enter her blood
    type in, so that didn't show up.
        So it sounds to me like we haven't made a whole lot of
    progress. And what I hear from the veterans over and over and
    over again is they can't get processed out. They are in such a
    hurry, because this process takes so long, they are in such a
    hurry that they just, they wash their hands of it and they just
    move on because they want to go spend time with their family
    and process out.
        This isn't some theoretical problem we have here. This is
    very real. And I echo my trip to Walter Reed and to Bethesda
    and the suffering that these veterans are going through. The
    very least this Nation can do, the very least, is to get this
    process up and running and help them facilitate their discharge
    from their service to this country.
        I was an attorney and represented a large teaching
    hospital. We integrated electronic medical records, the whole
    world is doing it. The Department of Defense and Veterans
    Affairs and Veterans Administration should be able to do it. We
    have the resources, you have bipartisan support that you don't
    get anywhere else. When it comes to our veterans and our
    military, there is bipartisan support.
        There is no reason why we shouldn't be able to do this. I
    agree with my colleague, we need to set a timeframe, we need to
    get a time line. And I will echo what was said, we need to hold
    leadership responsible. I realize you folks are here just
    testifying. But we need to hold leadership responsible, because
    this is not theoretical, these are very real people, real
    veterans, and they are really suffering.
        I yield back. Thank you, Mr. Chairman.
        Mr. Chaffetz. Thank you. I appreciate that.
        Let me make sure I have these numbers right. Processing was
    taking about 540 days. But I believe, Mr. Bertoni, you say that
    is now back up to 394? The goal was, I believe the number I
    wrote down during part of the testimony was 394 days is the
    average time.
        Mr. Bertoni. Yes. Under the legacy system, they calculated
    a 540 day total processing time from referral to VA benefits.
    Right now, or as of March 31st, they are at 394 for active. If
    you are a marine, you are at 455 days. So these numbers are
    quickly closing in on the 540.
        Mr. Chaffetz. How do you explain this? You have a family
    whose loved one has been serving overseas. It takes over a year
    to get them through the process and get them a check? What
    would you say to those veterans and their families? Ms.
    Simpson, go ahead.
        Ms. Simpson. I don't think there is anything we could say
    that would make their situation better. I was not, I regret
    that I was not aware that the average time had gotten that
    high.
        Mr. Chaffetz. How is that? That scares me unto itself. I
    appreciate your candor. I think you are right, I don't think
    there is an excuse any more. These reports that came out in
    2004, then in 2007, then we are going to have a meeting. And I
    realize you are in the hot seat and it is much bigger and
    broader than just you. But you can understand why we are so
    infuriated. We are going backward at this point.
        Mr. Medve.
        Mr. Medve. Mr. Chairman, all I can tell you is, it is my
    responsibility, because I am part of the team to ensure that we
    are----
        Mr. Chaffetz. Were you at the meeting on May 2nd?
        Mr. Medve. I was.
        Mr. Chaffetz. What was said? What were the conclusions?
        Mr. Medve. The two topics they covered were IDES and
    electronic health records. And there is commitment by both
    Secretaries to improve IDES and to work toward a----
        Mr. Chaffetz. So they sat down and said, we are committed
    to this, just like they had said before. There had to be some
    more detail or goals or particulars that came out of that
    meeting.
        Mr. Medve. We have been charged with getting the system
    more efficient and effective and get----
        Mr. Chaffetz. But that was the goal before, was it not?
    Come on, there had to be something new that came out of this.
    When is this thing going to work, fully work, like when can you
    say, this thing works?
        Mr. Medve. Mr. Chairman, I can't give you a specific date.
        Mr. Chaffetz. You are in a meeting with the Secretaries, we
    expect to hear an understanding of what the conclusion of that
    was. You have no specifics to share with us as to what was
    said?
        Mr. Medve. Mr. Chairman----
        Mr. Chaffetz. How long did the meeting last?
        Mr. Medve. An hour.
        Mr. Chaffetz. What specifics came out of that meeting? I
    have to believe that two Secretaries, in the midst of tackling
    Osama bin Laden, came up with some sort of conclusions and
    didn't just waste their time in this meeting.
        Mr. Medve. Mr. Chairman, we are working toward getting this
    system for IDES as good as we can get it. That is the
    commitment.
        Mr. Chaffetz. Now, one of the goals that the Secretaries
    put out is that they wanted to reducing the waiting time to 75
    to 150 days. How in the world did they come up with that? We
    are still over a year and the number is sliding backward. How
    did they come to that conclusion?
        Mr. Medve. Sir, that is an aspiration. We are looking
    closely at what we can actually achieve in terms of time.
    Embedded in this total time we do have appellate rights for the
    service members, we have transition----
        Mr. Chaffetz. I didn't come up with the goal. They did.
    When would we expect, when can service men and women expect
    that we would meet the goal laid out by Secretaries Gates and
    Shinseki?
        Mr. Medve. I can't give you a specific date, Mr. Chairman.
        Mr. Chaffetz. Can you give me a year?
        Mr. Medve. We are committed to come up with a
    recommendation----
        Mr. Chaffetz. The answer is no, isn't it? The answer is no.
    And that's the frustration. You can't even tell me what year
    you think we are going to accomplish this. And as was pointed
    out here earlier--I am beyond words to understand why this is
    taking so long. We were chatting, and maybe one of the things
    we should do is, what if we went back and just photocopied the
    records and put them on 3 x 5 cards? Would that speed up the
    process at this point?
        Mr. Medve. Mr. Chairman, if there is an impression that
    there aren't records, we----
        Mr. Chaffetz. No, there are records. They just can't seem
    to talk to each other. We can't get them to go from the DOD to
    the VA.
        Mr. Medve. We do have, when a service member transitions
    out to veteran standard, their electronic versions of what they
    have in their medical records are sent to a data warehouse that
    the VA can access, if you apply for----
        Mr. Chaffetz. We will get through the minutiae. It scares
    me that you cannot even tell me what year you think we are
    going to get to these ``aspirational'' days. I think the
    servicemen and women are being misled in this understanding
    that this is accelerating, when the reality is, the numbers are
    getting worse. The wait times are getting worse. And we can't
    even, we have meetings with the Cabinet Secretaries that last
    for an hour, and they have aspirational goals, oh, it is going
    to get better.
        Well, it is not getting better. And that is why we need
    more definitive answers.
        I am over my time and will yield to the gentleman from
    Massachusetts, Mr. Tierney.
        Mr. Tierney. Thank you. Before I forget, Mr. Chairman, may
    I ask unanimous consent that my opening statement be submitted
    into the record?
        Mr. Chaffetz. Absolutely.
        [The prepared statement of Hon. John F. Tierney follows:]

        [GRAPHIC] [TIFF OMITTED] T8045.048

        [GRAPHIC] [TIFF OMITTED] T8045.049

        Mr. Tierney. Thank you.
        I would like to move on to how we are going to resolve
    this, if we can. Have we, and anybody that feels qualified can
    answer this, have we identified all of the technical problems
    that exist in this system, and have we identified all the
    personnel problems and whatever other problems are there? Do we
    know where the problems lie?
        Mr. Medve. We have identified those areas resource-wise,
    facility-wise, and all, that we examine prior to any site going
    into the new process. We have actually held up sites because
    they either didn't have the right number of personnel or the
    right number of facilities. Because they weren't ready. So yes,
    I think we have----
        Mr. Tierney. You think we know what the challenges are, and
    if we solve those challenges we will be doing better?
        Mr. Medve. We know what the challenges are, and as we are
    moving forward with implementation, we are holding people to
    those standards, and we are not moving into it until they are
    read.
        Mr. Tierney. So is there a plan for each of those areas,
    and how are you going to go bout solving the technology
    problems? How are you going to go about solving the personnel
    problems, whatever? Is there a large plan on that, an overlying
    plan?
        Mr. Medve. Each site develops their own assessment. They
    develop their own concept plan of how to----
        Mr. Tierney. But I would hope there is somebody a step up
    from that making sure that each site does that.
        Mr. Medve. There are, absolutely.
        Mr. Tierney. Who is responsible for that? Who is the
    ultimate go-to person that anybody would go to for an answer or
    to report the progress on each of these sites?
        Mr. Medve. Each of these sites are briefed to both deputy
    secretaries in the Senior Oversight Council.
        Mr. Tierney. And do those deputy secretaries have the final
    say in what software is used, what hardware is used, the
    numbers of personnel that are hired and where they are
    situated?
        Mr. Medve. They don't get to that level of detail. Because
    each of the services in the VA has their responsibility.
        Mr. Tierney. So you think the decisionmaking and all that
    steps a level lower than that?
        Mr. Medve. Yes, in terms of the recommendations for that,
    what gets briefed to the deputy secretaries are, are you on
    target, do you have the number of resources----
        Mr. Tierney. So it stops at the deputy secretaries, they
    know what the targets are and it is their responsibility to
    hold----
        Mr. Medve. But I thought you were asking number of
    computers and that sort of thing.
        Mr. Tierney. No, no, but I want the level of the person who
    says, have you solved this problem in hardware, have you solved
    this problem in software, have you got the right personnel in
    place, are we deciding whether it is cheaper to fly these
    people to a central location to get all the myriad physical and
    mental exams, or is it better to try to have that kind of
    personnel available at the site, those types of things, it is
    the deputy secretary level?
        Mr. Medve. There is a brief during the SOC.
        Mr. Tierney. And we think we have identified what the
    challenges are, that now just somebody has to monitor it for
    implementation and resolution?
        Mr. Medve. Yes, sir, and that is where I think we are at
    now.
        Mr. Tierney. And we know which services, which service
    branches, aren't doing as well as others, for instance, Air
    Force is not doing as well as Army?
        Mr. Medve. Correct.
        Mr. Tierney. One of the things that disturbed me in reading
    this was that when we didn't meet the goals, instead of
    deciding how we were going to meet them, we lowered the goal. I
    don't think that is the preferred path here, and I hope it is
    going to be reversed on that.
        So if we really wanted an answer, instead of pounding at
    you and Ms. Simpson, it would be better to go to the deputy
    secretaries and find out just how much they are riding this. It
    seems to me if you really want to prioritize something, and you
    think this is the important thing, then a deputy secretary
    would be having a meeting every week, not every quarter or half
    year, but every week, asking the responsible people that report
    to them, just where are we on this and why aren't we further
    along. Does that sound reasonable, if we were to question those
    folks?
        Mr. Medve. You can be assured that we are having those
    accountability meetings at a variety of levels currently.
        Mr. Tierney. Do you have access to whatever kind of
    technical expertise you think you might need, in other words,
    outside computer analysts, computer specialists, computer
    entrepreneurs, whatever, are you able to resource those people
    and get them in to discuss with you some of the larger, more
    technical problems that you might be having challenges with?
        Mr. Medve. I can't speak for our IT people, but we have set
    up workgroups to look at the technical challenges for the
    existing IT systems we have supporting this, to see where we
    can improve it.
        Mr. Tierney. And those support groups go outside of just
    what we have in the Department of Defense and VA? We use other
    people as well?
        Mr. Medve. I would assume so.
        Mr. Tierney. What recommendations would you have for this
    committee in terms of, how can we best drill down on this and
    get ourselves an answer as to when we could expect this thing
    to be moving smoothly?
        Mr. Medve. All I can tell you, Mr. Ranking Member, is that
    we are committed to implementing this through the rest of the
    fiscal year. As you know, each case takes a number of times. So
    in terms of getting more data, the sites we are bringing online
    now are at least, even if we hit our goal, 295 days down the
    line until we have any data in order to see if they are on
    target or off target with terms of the whole process. We can
    start to get glimpses in terms of how long it is taking to do
    the exams and those incremental pieces. But it does take a
    while.
        Mr. Tierney. I understand the implications of each case and
    how sensitive that is. But Mr. Bertoni, do you get the feel
    that there is some sort of systematic approach to this, that
    somebody has an overarching plan to get this resolve on the
    level of systems and plans as opposed to the individual cases?
        Mr. Bertoni. I testified in December that I had not seen
    what I call a service delivery plan that puts all these pieces
    together.
        Mr. Tierney. Exactly.
        Mr. Bertoni. Would that be great for us to get our hands on
    and to assess? Absolutely.
        Mr. Tierney. Who do you think would be responsible for
    doing that from your vantage point, when you look at what is
    being done and who is responsible for whatever over there, who
    would you look to for that?
        Mr. Bertoni. I think there are some very talented people at
    VA and DOD that we have been working with that know this
    program, know the data. And those folks would be the people to
    do that.
        Mr. Tierney. And who do they answer to?
        Mr. Bertoni. Mr. Medve, for one. [Laughter.]
        Mr. Tierney. OK, Mr. Medve. And who do you answer to?
        Mr. Medve. Sir, I answer to the Assistant Secretary for
    Planning and Policy.
        Mr. Tierney. The Assistant Secretary.
        Mr. Medve. Yes, Assistant Secretary.
        Mr. Tierney. And that person reports to the Deputy?
        Mr. Medve. Yes, sir.
        Mr. Tierney. Thank you all very much. I appreciate your
    testimony.
        Mr. Chaffetz. Thank you. I would like to maybe just go down
    the row here, and just one last thing. I want to be very
    crystal clear, just the succinct, simple biggest problems and
    challenges that you see, and the recommendation or suggestion
    of what we need to have happen.
        What I would like to do is start with Ms. Simpson and Mr.
    Medve, then go to Mr. Williamson, Mr. Bird and end on Mr.
    Bertoni, if we could, please.
        Ms. Simpson. Thank you, Mr. Chairman.
        My understanding is that the access to data, making sure
    that information is accurate, valid and succinct and that the
    metrics are held to, that is one thing. Second thing, to take a
    look at each of the sites, at each step in the process, and
    find out what specifically is going on to account for the
    length of time. I knew it was higher than 295, but I wasn't
    aware it was that high, that was just mentioned earlier.
        And then the followup that is required to actually get to
    the place of the electronic health record, that we have very
    senior IT specialists who have reach-back capability to outside
    experts, outside the Federal Government, to be able to provide
    that foundation to use those records.
        Mr. Chaffetz. Thank you.
        Mr. Medve. Mr. Chairman, I would echo what Ms. Simpson
    said, in terms of the process. We are taking a hard look at
    ensuring that we have the requisite amount of medical personnel
    and outsourced personnel to do that. We are also monitoring
    that very closely to ensure that we have the required number. I
    am happy to come back again as we move through this
    implementation to show you how things are going and to brief
    the staff.
        Mr. Chaffetz. Thank you.
        Mr. Williamson.
        Mr. Williamson. I would say from my standpoint, there are
    IT issues associated with the wounded warrior programs that
    would allow them to communicate and talk with one another.
    Without that, you are going to get confusion and consternation
    and conflicting kinds of recovery plans for our veterans and
    service members.
        Mr. Chaffetz. How bad is the problem and how close are we
    to solving it?
        Mr. Williamson. We are a ways away. There are some things
    that are going on right now in terms of the Federal Recovery
    Coordination program, that is a VA program, that requires DOD
    cooperation. It is the same thing you have been talking about
    throughout here.
        Mr. Chaffetz. Thank you.
        Mr. Bird.
        Mr. Bird. Developing large scale IT solutions is
    challenging enough for anybody. The Department of Defense has
    capabilities and VA has capabilities. They need to establish
    joint capabilities to tackle some of these large scale
    problems.
        Mr. Chaffetz. Have they started that process?
        Mr. Bird. As I mentioned earlier, they started over 10
    years ago. And they have frankly slowly been increasing their
    capabilities as well as increasing their capabilities to work
    together to tackle some of the challenges.
        Mr. Chaffetz. But we are nowhere close to getting to the
    finish line?
        Mr. Bird. It is difficult to say, because the finish line
    has not yet been defined.
        Mr. Chaffetz. Who should define that? Who should define the
    finish line?
        Mr. Bird. The department should define the finish line.
        Mr. Chaffetz. The Secretaries, is what we need. That is
    encouraging.
        Mr. Bertoni.
        Mr. Bertoni. I think over the last several years, we have
    identified specific challenges I think that have impacted this
    program negatively. To DOD and VA's credit, I think they have
    tried to get in front of many of those. In particular, the
    issue of standing up sites, readiness, lookbacks, making sure
    that down the road, they are going to have appropriate staff in
    play.
        Beyond that, I think there needs to be additional data
    collection at a more granular level. You need to know at
    particular site level locations, what are your ratios looking
    like? What are the problems with the diagnoses, problems with
    the exam summaries? Those are the things you need to know that
    are bogging the system down. Right now, that capability is not
    there.
        So that is something that we definitely would see them do
    more granular data analysis and collection and monitoring, so
    they can make the adjustments. And this way, you could get in
    front of problems. You don't have to wait until you are 295
    days down the road to say, we have a problem with ratings, we
    have a problem with exam summaries. But if you start to see
    this emerging, you can make the adjustments, you can apply the
    training and you can apply the technology to get in front of
    those problems.
        Mr. Chaffetz. Thank you. I want to thank you all for your
    participation. I know your heart is in the right spot in all
    these things.
        It is terribly frustrating, it is terribly frustrating.
    These men and women, our American military does amazing things.
    We just saw that play out. But when it comes time, when they
    come home to take care of, we are failing. And it is about time
    that we at the Secretary level, at the Presidential level, that
    we get somebody who is irate who can actually move the ball
    forward and do some things to actually make this thing happen.
        I know that members on this committee, I know Mr. Tierney
    has worked tirelessly on this. I will continue to pour my
    efforts into it. But we have to demand that we actually achieve
    these goals. That is going to take some serious leadership. I
    think that leadership is lacking within the highest levels with
    the Department of Defense and within the Veterans
    Administration.
        I thank you all again for your information. You are pouring
    your hearts, like I said, in the right direction. We look
    forward, unfortunately, we will be having another one of these
    hearings again. But hopefully the news will be better and we
    will be making more progress.
        Thank you again for your expertise and your testimony
    today. The committee stands adjourned.
        [Whereupon, at 11:17 a.m., the committee was adjourned.]