[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
DOD AND VA COLLABORATION TO ASSIST SERVICEMEMBERS RETURNING TO CIVILIAN
LIFE
=======================================================================
JOINT HEARING
with
HASC
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, JULY 10, 2013
__________
Serial No. 113-29
__________
Printed for the use of the Committee on Veterans' Affairs
______
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida CORRINE BROWN, Florida
DAVID P. ROE, Tennessee MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
JEFF DENHAM, California DINA TITUS, Nevada
JON RUNYAN, New Jersey ANN KIRKPATRICK, Arizona
DAN BENISHEK, Michigan RAUL RUIZ, California
TIM HUELSKAMP, Kansas GLORIA NEGRETE MCLEOD, California
MARK E. AMODEI, Nevada ANN M. KUSTER, New Hampshire
MIKE COFFMAN, Colorado BETO O'ROURKE, Texas
BRAD R. WENSTRUP, Ohio TIMOTHY J. WALZ, Minnesota
PAUL COOK, California
JACKIE WALORSKI, Indiana
Helen W. Tolar, Staff Director and Chief Counsel
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
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C O N T E N T S
__________
July 10, 2013
Page
DoD and VA Collaboration To Assist Servicemembers Returning To
Civilian Life.................................................. 1
OPENING STATEMENTS
Hon. Jeff Miller, Chairman,...................................... 1
Prepared Statement of Chairman Miller........................ 44
Hon. Adam McKeon, U.S. House of Representatives, (CA-25)......... 3
Hon. Michael Michaud, Ranking Minority Member.................... 4
Prepared Statement of Hon. Michaud........................... 45
Hon. Adam Smith, U.S. House of Representatives, (WA-09).......... 6
Hon. Corrine Brown, U.S. House of Representatives (FL-05),
Prepared Statement only........................................ 46
.............................................................
WITNESSES
Hon. Frank Kendall, Under Secretary of Defense for Acquisition,
Technology and Logistics, Department of Defense................ 7
Prepared Statement of Hon. Kendall........................... 46
Accompanied by:
Hon. Jonathan Woodson, M.D., Assistant Secretary of Defense
for Health Affairs and Director, TRICARE Management
Activity, Department of Defense
Hon. Jessica L. Wright, Acting Under Secretary of Defense
for Personnel and Readiness, Department of Defense
Stephen W. Warren, Acting Assistant Secretary for Information and
Technology, Department of Veterans Affairs..................... 10
Prepared Statement of Mr. Warren............................. 53
Accompanied by:
Hon. Robert A. Petzel, M.D., Under Secretary for Health,
Veterans Health Administration, Department of Veterans
Affairs
Mr. Danny Pummill, Deputy Under Secretary for Benefits,
Veterans Benefits Administration, Department of
Veterans Affairs
MATERIALS SUBMITTED FOR THE RECORD
Letter To: Hon. Dan Beniskek, From: Eric Shinseki, VA............ 58
QUESTIONS FOR THE RECORD
Post-Hearing Questions and Responses............................. 59
DOD AND VA COLLABORATION TO ASSIST SERVICEMEMBERS RETURNING TO CIVILIAN
LIFE
Wednesday, July 10, 2013
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, D.C.
The Committees met, pursuant to call, at 10:02 a.m., in
Room 2118, Rayburn House Office Building, Hon. Jeff Miller
[Chairman of the Veterans' Affairs Committee] presiding.
OPENING STATEMENT OF HON. JEFF MILLER
Chairman Miller. Thank you, everybody, for being here today
for this second joint hearing of the Veterans' Affairs
Committee and the House Armed Services Committee.
I welcome the Chairman, Buck McKeon, as well as the Ranking
Member of the HASC, Adam Smith, and of course, my good friend
from Maine, the Ranking Member of the Full VA Committee, Mike
Michaud.
And as I said, this is the second time now that we have
gotten these two Committees together. And I am proud to serve
on both of these particular Committees.
We are going to jointly review the collaborative efforts of
the DoD and VA, as it pertains to servicemembers and their
transition from active duty, to civilian life.
A year ago, we were privileged to have both Secretaries
Panetta and Shinseki at the witness table, and both of them
testified at great length regarding the progress VA and DoD
were making in several key areas.
And what I would like to do this morning first is to
revisit those areas in my opening statement. First, the
progress made in developing an integrated electronic health
record. Secondly, the progress that has been made in reducing
the wait times associated with VA disability claims, which
necessarily does involve cooperation from DoD in the transfer
of records.
So let's start, if we can, with the electronic health
record. In a response to a direct question last year, Secretary
Shinseki remarked that the two departments had finally, after
17 months of discussion, agreed on a way forward on a single,
joint, common-integrated electronic health record that would be
completed by 2017.
The Secretary told us that each of those words--single,
joint, and common--meant something and that finally we were
breaking through the cultural issues that existed between the
two departments and that really stifled in the past.
And we come here today, and I say what a difference a year
makes.
Contrary to the Secretary's testimony, two departments are
once again moving on their own tracks, with promises we have
heard before about making the two separate systems
interoperable.
Pardon my frustration, folks, but it seems the only thing
interoperable we get are the litany of excuses flying across
both departments every year as to why it has taken so long to
get this done.
In response to this latest course correction, the House
included an amendment in the national defense authorization
bill, an amendment that was developed in collaboration with the
leadership of HASC and VA and to direct the completion of an
integrated health record by October 1 of 2016. The message of
the amendment is simple--no more excuses, get it done.
I am anxious to hear from the witnesses today, to hear how
they will comply with the mandate of the amendment once it is
enacted into law.
The second issue I will briefly touch on is on the
disability claims backlog. It is interesting to note that the
progress made in reducing the pending inventory of claims the
last few months correlates with a heightened Congressional
oversight and media scrutiny.
None of us up here are going to take our foot off the gas
when it comes to ensuring progress is made on the backlog.
Every member in this room will agree with that statement. And
although progress has been made lately, VA is woefully short of
its own goals for this year.
So going forward, ending the backlog necessarily requires a
seamless record transfer from DoD. I look forward to hearing
the status of the efforts and what more can be done. The
problem of veterans waiting years for their disability claims
to be decided must remain at the forefront of our consciences,
especially as further troop draw-downs occur over the next 5
years.
It, too, is an example of where the excuses have to end and
real, sustained progress must occur.
To accommodate such a large contingent of members that are
with us this morning, I have agreed to last year's framework
that limited to 2 minutes each member's time to ask a question
of the witnesses. Therefore, I ask unanimous consent that each
member have not more than 2 minutes to question the panel of
witnesses, starting with my very own question.
Without objection, so ordered.
I ask unanimous consent to include all members' statements
in the hearing record today.
Without objection, so ordered.
And I recognize the Full Committee Chairman of the Armed
Services Committee, Buck McKeon, for his opening remarks,
followed by the Ranking Member Mike Michaud, and then the
Ranking Member Adam Smith, for their opening remarks.
Mr. Chairman?
[The prepared statement of Chairman Miller appears in the
Appendix]
OPENING STATEMENT OF HON. HOWARD P. ``BUCK'' MCKEON
Chairman McKeon. Good morning. I join Chairman Miller in
welcoming everyone here today to the second special joint
hearing with the Veteran Affairs Committee to continue our
oversight on the Department of Defense and Department of
Veterans Affairs collaboration to assist these members'
transition to civilian life.
After the successful joint hearing held last year, I want
to thank Chairman Miller and Ranking Member Michaud for their
leadership in continuing the shared efforts to provide our
servicemembers and veterans and their families the assistance
they need transitioning out of the military and the benefits
they deserve for having served this Nation.
At a time when we are rapidly drawing down our military,
which I strongly oppose, particularly while we are still
actively engaged in Afghanistan, the latest announcement of the
Army's plan to restructure the Army below 9/11 force levels is
another reminder of the impending military draw-down that will
force an additional 100,000 servicemembers and their families
on an already overburdened Veterans benefits system.
Today's hearing will look at the Department of Veteran
Affairs system for delivering benefits to veterans and the role
of the Department of Defense, specifically providing
information and documents necessary for adjudicating a claim
for benefits.
It is no secret that the VA has a backlog of well over
500,000 claims from veterans. A significant portion of these
claims are more than 125 days old, with some as old as 2 years.
These claims are not only from recently transitioned
veterans, but are from Vietnam veterans and veterans of the
wars since then. It is easy to talk about a claim as if it is
an impersonal object, but behind each of these claims is a
veteran.
You know, each of us, as we go home and talk to our
constituents, have people come up to us and tell us horror
stories of things that have happened to them. And we all--
nobody in this room wants to see that happen. It is just a very
difficult situation to resolve all of these issues with--we are
talking so many people.
A veteran who willingly served this country now is asking
only what was promised for that service. Alongside many of
these veterans are the families, families who stood by these
veterans while they served, enduring the hardships of military
life.
These are the people behind these claims who are waiting
for their benefits. We owe them an answer and we owe them our
commitment to continue to ask the hard questions until we are
satisfied with the accuracy and the timeliness of the benefits
system.
We find ourselves in a situation where it is tempting to
place blame and look for easy fixes, but that is not our
purpose here today.
I want to understand the reasons for the backlog and I want
to know what is being done by both departments to complete
these backlog claims and expeditiously provide veterans with
their benefits. Lastly, I want to know from the witnesses how
the integrated electronic health directorate will assist each
department to fulfill its responsibility for timely delivery of
transition assistance and benefits, and what role, if any, the
IEHR will play in reducing the VA backlog of claims.
Furthermore, I understand that DoD already passes a
significant amount of medical information to the VA and it will
be useful for all of us to better know how the IEHR will
improve that sharing of information. I have been encouraged by
the attention being paid the issue of electronic health records
by Secretary Hagel since he took office. The DoD acquisition
decision memorandum issued on June 21st certainly conveys the
sense of urgency we hope to instill with the amendment to the
fiscal year 2014 NDAA, that I sponsored with the Ranking
Member, Mr. Smith, and in collaboration with Chairman Miller,
Chairman Rogers, Chairman Young and Chairman Culberson.
Both press for aggressive deadlines for implementation and
increased oversight to ensure that DoD finally is able to field
a seamless, integrated electronic health record. What I hope
today is to see a similar commitment from the VA Department and
similar mechanisms to address the lack of measurable goals and
accountability by VA that the GAO pointed out in its previous
investigations in to the issue.
It is incumbent on this body to make sure that the
leadership for both departments see this as an important matter
deserving their personal attention and guidance. Our veterans
deserve nothing less for the sacrifices they have made for this
country.
With that, I thank you, Chairman Miller, for your
leadership in pulling this together and look forward to this
hearing.
Chairman Miller. Thank you, Mr. Chairman.
Mr. Michaud?
STATEMENT OF HON. MICHAEL H. MICHAUD
Mr. Michaud. Thank you very much, Mr. Chairman.
I, too, want to thank the two chairmen and Ranking Member
Smith for having this joint hearing today. Transition is a
critical issue that greatly affects our servicemembers and
veterans. This hearing is the second joint hearing our two
Committees have held concerning transitions. The purpose of
this hearing is to reiterate our joint oversight commitment and
to ensure that the Department of Veterans Administration and
the Department of Defense work together on behalf of the men
and women who are sent into harm's way.
At last year's joint hearing on this topic, the two
agencies' secretaries appeared before us sitting side by side.
I am disappointed to see that neither is here today. I take
this as a lack of personal engagement, as a sign that they care
less, that they are not as committed as they have been. My big
disappointment is solidified by receiving testimony in the 11th
hour. Clearly, this issue in this hearing is not a priority.
I would submit to you that the government has struggled to
fulfill the sacrifice, you know, trust to care for those who
have served and sacrificed in defense of our Nation. After 12
years of war, we know transition is the critical first step,
and it requires the cooperation of many agencies to accomplish
successfully.
I do not believe that we have made measurable progress in
getting the two agencies before us today to work more
effectively together. The Department of Defense has announced
it will put out a bid for a new system to manage its health
records. Such a decision appears to back an interoperable
approach over an integrated one--and integrated is integrated,
not interoperable. Electronic health records is something that
Congress has mandated years ago and we have spent hundreds of
millions of dollars delaying the delivery of an integrated
information-sharing system which runs directly against
congressional intent and ultimately hurts our veterans.
Also of particular importance to our Committees is the
claims backlog. Let me be clear. Both the VA and the DoD have a
responsibility to end the backlog by 2015. The claims backlog
is not a VA issue alone. The Department of Defense must do a
better job in transferring information needed for the VA to
approve or disapprove in a timely manner the claims. This
includes records of our National Guards and reservists. It also
includes late and loose records being sent to the VA.
Because benefits in health care affect so many
servicemembers and veterans, DoD and VA must put aside their
parochial differences and work more effectively together to
ensure an integrated process addressing transition issues.
Over the course of the last several months, we sent letters
to the secretaries and the President asking for their personal
commitment and support. We requested concrete decisions being
made in a timely manner. What we received in response is a no-
show to this hearing from the secretaries and the press
conference that kicks the decision down the road once again.
And it would appear that leadership is lacking not just at
this hearing. During the recent roundtable on the IEHR,
industry leaders told us progress is not due to lack of
availability--available technology solutions, but rather a lack
of leadership. That is right. Several of the roundtable
participants said there is a lack of leadership. When two
divisions in their companies can't or won't agree, the CEO
steps in and mandates a direction. Where are the DoD and VA
CEOs?
Just recently in a bipartisan effort and due to ongoing
congressional concerns with the backlog, with the lack of
unified vision between the VA and DoD electronic health records
programs, language was included in part of the National Defense
Authorization Act of 2014. This language creates a deliberate
approach in developing joint electronic health records. I am
told that strategies have been modified and collaborative
efforts are ongoing for both records transfer and IEHR.
However, months continue to go by with seemingly no real
progress.
I look forward to hearing from the panelists today just how
far you have come, and to learn about the path ahead on this
transition issue, and look forward to those questions that we
are going to be asking. This is a real important issue that we
have to deal with, and unfortunately there has been a lack of
leadership. And I don't only say that without two secretaries--
also the President of the United States who made it very clear
in this first term he wants both agencies to work together. And
that leadership has been lacking as well on this particular
issue.
So, I look forward to hearing your comments and to
answering the Committees' questions.
With that, Mr. Chairman, I yield back.
[The prepared statement of Hon. Michaud appears in the
Appendix]
Chairman Miller. Mr. Smith?
STATEMENT OF HON. ADAM SMITH
Mr. Smith. Thank you, Mr. Chairman.
I think my three colleagues have correctly raised the three
issues that we are most interested in today: How do we get
joint electronic medical records between the DoD and the VA;
the transfer issue when a veteran goes from being part of
active duty DoD over to the VA. How do the benefits transfer;
how seamless is that process--there are challenges there. And
then, of course, the backlog of claims that we are trying to
meet. And I share my colleagues' frustration with wanting to
get answers to that and wanting to make progress on all three
of those issues.
But I am also mindful of a couple of other facts. Over the
course of the last almost 12 years now, there has been a huge
increase in the number of injured veterans who have come
through, that DoD has had to process and that VA has had to
process. The initial determination of whether or not a given
servicemember can stay within the DoD or transfer is not an
easy process. It is a difficult one for the servicemember as
well as their family in making that determination. So that is a
significant challenge. And the sheer numbers are a significant
challenge.
And I would also like to point out that we have had--I have
lost track now over the course of the last 2-plus years--four,
five, six threatened government shutdowns which force both the
DoD and the VA into a position where they don't know how much
money they are going to have in a matter of weeks. So there are
things that Congress could do that would be helpful to you as
well.
Sequestration certainly doesn't help. I know there are
aspects of what you do that are exempt from that. There are
other aspects that are not exempt from that, and you have to
absorb those cuts while trying to deal with that increased
number of veterans and while trying to deal with the backlog.
And then lastly, we have failed to pass appropriations
bills in anything approaching a timely manner, and in some
cases, simply outright failed to pass them so that the VA and
DoD for an extended period of times are operating with a
continuing resolution which, again, places them at a huge
financial disadvantage.
So, I definitely want to see more leadership out of the VA
and out of the DoD, but I think Congress should also take a
look in the mirror and pass appropriations bills and fund what
we claim to be our top priority. If we really want to get these
systems integrated, if we really want to get the backlog
cleaned up, then we need to start passing appropriations bills.
We need to kill sequestration right now and actually fund what
it is that we claim is such a huge priority for us.
So I hope all parties involved will work together to
achieve what is clearly our common goal, and that is that our
servicemembers who have put their lives on the line to protect
our country and at our request at our order as policymakers are
taken care of: that they are not part of a backlog, they do not
slip through any crack in the system, they get the treatment
and care that they deserve.
But this is a collective responsibility between Congress
and the executive branch to get that done. I hope today we will
learn more about how we can work together to make that happen.
I yield back. Thank you, Mr. Chairman.
[The prepared statement of Hon. Adam Smith appears in the
Appendix]
Chairman Miller. Thank you very much, Mr. Smith.
Ladies and gentlemen, I want to welcome our first panel and
only panel to the hearing this morning. First of all, the
Honorable Frank Kendall, Under Secretary of Defense for
Acquisition, Technology and Logistics at the Department of
Defense.
The Under Secretary is accompanied by the Honorable
Jonathan Woodson, Assistant Secretary of Defense for Health
Affairs and Director, TRICARE Management Activity, Department
of Defense; and the Honorable Jessica Lynn Wright, Acting Under
Secretary of Defense for Personnel and Readiness at the
Department of Defense.
And also with us this morning is Mr. Stephen Warren, Acting
Assistant Secretary for Information and Technology at the
Department of Veterans Affairs. And Mr. Warren is accompanied
by the Honorable Dr. Robert Petzel, Under Secretary for Health
with the Department of Veterans Affairs; and Mr. Danny Pummill,
the Deputy Under Secretary for Benefits with the Department of
Veterans Affairs.
And I would say to Danny, congratulations on your new
position. And we look forward to working with you in the
future.
With that, Under Secretary Kendall, you are now recognized
for between 5 and 10 minutes. If you can hold it to 5 that
would be appreciated.
STATEMENT OF HON. FRANK KENDALL
Secretary Kendall. Thank you, Mr. Chairman. I will do my
best.
Chairman Miller and Chairman McKeon, Ranking Members Smith
and Michaud, Members of the Committees, thank you for the
opportunity to discuss the department's effort to improve and
modernize our existing electronic health care records and our
legacy health care management systems.
I am joined by Acting Under Secretary Wright and Assistant
Secretary Woodson. And we were recently informed that we would
be doing just one opening statement, so I will only cover the
information technology part of our testimony.
If there are questions, obviously, the people who accompany
me would be happy to answer them in terms of the backlog and
other elements of health care.
I would also like to ask, Mr. Chairmen, that our written
statement be admitted to the record.
Chairman Miller. Without objection, all statements will be
entered in the record.
Secretary Kendall. My personal involvement in our health
care management programs is relatively recent. In April, I was
tasked by Secretary Hagel to conduct a review of the
department's legacy health care management system modernization
options. The options under consideration were upgrades to DoD's
legacy ALTA system, an evolved and enhanced version of VA's
legacy VistA system, or conducting a competition that would
include modern commercially available heath care management
systems, as well as potentially systems based on existing
systems like VistA.
With Acting Secretary Wright, I formed a team of senior DoD
stakeholders and a working group of experts to evaluate DoD's
options and formulate their recommendation. The team worked for
approximately a month. It benefited greatly from prior
analyses, including a recent study that the department's cost
assessment and program evaluation direction had conducted, as
well as from consultations with VA on the basis of their
decision to adopt VistA as their future health care management
system core.
CAPE's analysis was based on extensive market research. The
conclusion the working group reached, which was endorsed by the
senior stakeholders and then forwarded to the secretary, was
that a competition to select a core set of capabilities out of
a best value basis was the right business decision for the
Department of Defense.
I have made the results of that review available to the
Committee staffs, and I would be happy to answer your questions
on the review, or to brief any of the members on the details.
Secretary Hagel made a decision to adopt the study
recommendations. After VA's decision a few months ago to stay
with VistA as the basis of its future health care management
system core software, DoD had a very different decision to make
than VA did. VA has a large installed VistA base, a large in-
house staff that maintains and programs software for VistA, and
a workforce that is experienced and trained with the current
vision of the VistA system.
There are sound logical business reasons for VA's decision
regarding VistA. But DoD is not in the same position.
The marketplace that provides health care management
systems has changed significantly in the last few years as we
have been going through the process that was alluded to in
earlier testimony. That marketplace provides a range of
products, modern products, that have advanced significantly
over the period of time that I mentioned. This is a vibrant
market, and we would like to be able to have the opportunity to
select a product that includes some of the offerings from that
market.
Our market research also showed that we would likely see
VistA-based offerings from multiple competitors. The review Ms.
Wright and I conducted compared cost, risk, performance and
growth potential and concluded that a sole-source selection of
either VistA or DoD's ALTA system was not the best business
decision for DoD.
A logical and sound business decision for the department
would be to conduct a competitive source selection on a best
value basis.
Let me assure you that nothing in this decision affects
DoD's commitment to the joint near-term fielding of fully
seamless integrated health records under the iEHR, our program,
being conducted by and managed by the interagency program
office today.
Health care records and health care management systems are
not the same thing. DoD and VA can share integrated records
without having the same software to manage those records or to
assist conditions as they provide care.
The secretary of defense has also asked me to take a more
direct role in the management of our health records and our
health care management systems. We will continue to work
closely with VA on all of these efforts.
At this point, I am still in the process of reviewing and
assessing the current programs for iEHR. But the DoD's
commitment to fielding data management accelerators with VA
this fiscal year and next year is firm.
Chairman McKeon, you mentioned my acquisition decision
mandate. That was one of the first steps that I took once the
secretary asked me to take responsibility. In addition, I have
appointed some key leaders. Mr. David Bowen is behind me, as
well as the program manager for our modernization system who
will be, I hope, executing some of the leadership that was
mentioned earlier. Compatibility with ongoing joint effort to
provide seamless, integrated electronic health care records
between DoD and VA will be a firm requirement as DoD works to
select a core for its health care management software system.
I am concerned, the language in the House fiscal year 2014
NDAA and the House fiscal year 2014 MILCON and Veterans
Appropriation Act may overly restrict both VA's and DoD's
options going forward, as well as impose significant oversight
burdens on the program.
I understand the members' frustrations--Mr. Chairman, you
mentioned that, with iEHR--and I have reviewed the history of
the last few years. But we would like to work with the Congress
on less restrictive language that would both address your
concern and allow for efficient program execution.
I commit to you that DoD will keep the Committees informed
of our progress and of any major developments in our health
care record and health care management acquisition programs,
and that DoD will work closely with VA to ensure that our
shared goals of a seamless, integrated record in the near term
and modernization of our health care management systems in the
mid-term are accomplished efficiently and effectively.
Our shared mission with the VA is to fundamentally and
positively impact the health outcomes of active duty military,
veterans and beneficiaries.
Every one on the panel before you with one exception is a
veteran. We understand the needs of these people and we support
them.
Health care record and management systems modernization is
a part of that process. And we believe the course we have
chosen is a prudent, cost-effective path to achieving our
mission.
I will be happy to take your questions.
I would like to make one comment on sequestration. It was
brought up by--in two of the opening remarks. I cannot sit
before this Committee today, 2 days after we started
furloughing our employees and not mention sequestration.
The effects of sequestration are real. They are distributed
all across the department. They are not dramatic in any
specific instance, but their cumulative impact is dramatic. And
they are having--and they will have over time, particularly if
allowed to continue in fiscal year 2014, a devastating impact
on the department.
I know I am not here to testify about that, but I can't
pass up the opportunity to mention that.
Mr. Chairman, with that I will conclude.
[The prepared statement of Secretary Kendall appears in the
Appendix]
Chairman Miller. Mr. Warren?
STATEMENT OF MR. STEPHEN W. WARREN
Mr. Warren. Chairman Miller, Chairman McKeon, Ranking
Member Smith, Ranking Member Michaud, and Members of the
Committees, we appreciate the opportunity to appear before you
today to discuss the collaboration taking place between the
Department of Veterans Affairs and the Department of Defense.
I am accompanied today, on my far left, by Under Secretary
Robert Petzel for Health, and to my immediate left, Mr. Danny
Pummill, the Principal Deputy Under Secretary for Benefits.
The efforts of our two departments reflect an unprecedented
level of collaboration on a number of important goals to ensure
seamless transition from servicemember to veteran. Through DoD
and VA channels such as the Joint Executive Committee, the
Health Executive Committee, the Benefits Executive Committee,
independent working groups and the day-to-day work of our
respective hard-working employees, our two departments are
removing barriers and challenges which impede seamless
transition.
Our collaboration efforts with DoD are also helping VA meet
its goals of increasing access to care, ending the benefits
claims backlog and ending veterans homelessness. We are making
progress together in several key areas.
Thanks to the VOW to Hire Heroes Act, we now enroll every
new servicemember in eBenefits. Enrollment has grown to 2.6
million since June 2011, an increase of over 648 percent. We
now have in place that single portal, whether you are a
servicemember or veteran, you can, to find out not only what
your benefits are, but also what the status of your claims are.
Through eBenefits, the two departments provide veterans and
servicemembers a central location to research, find, access and
manage a growing list of benefits. DoD and VA fully implemented
the Integrated Disability Evaluation System, known as IDES, in
October 2011.
IDES is an integrated DoD-VA program for servicemembers
being evaluated for medical separation from military service
that leads to faster processing time, increased transparency
for the servicemember, and a single set of medical exams for
single-source disability ratings and much more.
In April of 2009, President Obama directed the DoD and VA
to work together to define and build a seamless system of
integration for electronic health records. Today, DoD and VA
are already exchanging a significant amount of electronic
information and are taking aggressive action in 2013 to further
expand these efforts.
But most of the information today is not standardized. A
key priority for both departments is to standardize electronic
health record data and to make it immediately available for
clinicians so that they have the information they need to make
informed clinical decisions for our patients.
A critical mission of both departments is to fundamentally
and positively impact the health outcomes of active duty
military, veterans and eligible beneficiaries. As a result, we
have two distinct goals. Create a seamless health record
integrating VA, DoD and private provider data, and to modernize
the software supporting DoD and VA clinicians.
We are committing to doing both of these in the most
efficient and effective way possible. VA is still on track with
your support to deploy our core capability at two sites by 1
October 2014, and full operational capability by the end of
2017.
We are also working closely with our DoD colleagues to
address the benefits claims backlog. Today, many veterans wait
too long to receive benefits they have earned and deserve. This
has never been acceptable to the secretary or the dedicated
employees of the Veterans Benefit Administration, over half of
which are veterans themselves.
VA is implementing a robust plan to ensure we achieve our
goal of eliminating the claims backlog and improving decision
accuracy to 98 percent by 2015. We are making progress in
reducing the processing times for disability claims, and we are
on track to meet our agency priority goal of eliminating the
backlog of claims, those pending longer than 125 days, in 2015.
The total inventory of claims is now below 800,000, the
lowest since April 2011, and the backlog has been reduced by
more than 14 percent from its highest point just 4 months ago.
For the second month in a row, VA claims processors set
production records by completing more claims than in any
previous monthly period.
Collaboration efforts are ongoing with DoD to allow VA to
receive complete service records, and to receive them
electronically for faster and more efficient processing. On
December 6, 2012, VBA reached an agreement with our partners in
DoD requiring the military services to certify a
servicemember's service treatment record as complete as
possible at the point of transition to VA.
Effective January 1, 2013, all five military services began
implementation of service treatment record certification. By
the end of this year, each of the military services will be
sending all of the service treatment records electronically to
VA. This will contribute to reducing the time it takes to
process future disability claims.
VA and DoD are committed to our collaborations, and we
continue to look for ways to improve our decision-making,
achieve greater efficiencies, and accelerate the transition
process for servicemembers and veterans.
Thank you again for your support for our servicemembers,
veterans and their families, and your interest in the ongoing
collaboration and cooperation between the two departments. We
appreciate the opportunity to appear before you today, and we
are prepared to answer any questions you may have.
[The prepared statement of Stephen W. Warren appears in the
Appendix]
Chairman Miller. Mr. Kendall, first question is in regards
to the bidding process or the request for proposals that DoD
has done. Do you anticipate VistA being one of the software
solutions that will be allowed to be reviewed in the process?
Secretary Kendall. The answer is yes. Our market research
that was conducted by CAPE, as I mentioned, had a number of
responses. Fifteen of those responses were fully compliant with
the request.
And of those 15, three were VistA-based solutions. So we
know there are vendors out there. And one of the submissions
was from the VA itself, and the other two were from commercial
integrators. So we would fully expect that VistA will be
included in the things that we have to choose from.
Also, it won't be today's VistA. It will be a VistA that is
improved over the course of the time between now and when we
would actually make the award. So we will have an enhanced
version of VistA, if you will, at the time we do the source
selection.
Chairman Miller. Mr. Warren, I will say that in reviewing
your testimony talking about the backlog, you talked about
several reasons that there is a backlog out there. The under
secretary has talked about the surge of personnel that has been
used to reduce the backlog.
Nowhere do I see anything about what VA has done wrong,
i.e., mismanagement of personnel. And my fear is that we are
going to end up right back in the same place eventually. We may
draw the numbers down, but if we don't change the system and
how it is done, we are going to continue to see the backlog.
The Nehmer decision and all of the claims associated with
that decision, I mean, we knew that was coming. The secretary
knew it was coming. He actually said that by 2013, now, we
would be right back where we were prior to Nehmer. We are way
above where we are.
So, does VA have any culpability in regards to the backlog,
or is it just things outside their control?
Mr. Warren. Mr. Chairman, if I could hand that to my
colleague from the Benefits Administration to respond.
Mr. Pummill. Chairman Miller, one of the things that we
have done is the VBMS, the Veterans Benefits Management System.
We were in a paper system when we started doing the Nehmer
cases and worked through the Nehmer cases and got the
additional workload from the current conflict.
We now have a fully automated system rolled out to all 56
of our ROs. And by fully automated, I mean that its position at
the ROs and we are starting to do claims electronically instead
of paper. Today, about 20 percent of the total workload that we
have is electronic. Eighty percent is still paper.
Our goal is to, you know, not only knock out the backlog,
but to get all of that into electronic format. That will put us
in a position so that if a claim comes in from Ohio, it doesn't
have to be done in the state of Iowa by a claims person in
Ohio. When the claim comes in, the next available person
anywhere in the country can take that claim and work it because
all of the records will be electronic, eliminating the need to
mail records around the country and things like that.
We believe with the advent of the Veterans Benefits
Management System and the electronic service treatment records
that we are going to be receiving from the Department of
Defense, that that will go a long way to preventing future
backlogs and ending this backlog right now.
Chairman Miller. Mr. McKeon?
Chairman McKeon. Mr. Chairman. Secretary Kendall, Secretary
Warren, the process for gathering the necessary information to
complete a veterans claim for benefits requires participation
by the veteran, the DoD and the VA.
Some of the information is provided directly to the VA by
the servicemember. Other information is sent from DoD to the VA
either in electronic format or hard copy paper documents. I am
particularly interested in the health care and medical
information records that the DoD sends to the VA.
What medical information records are provided by the DoD to
the VA, and when and in what format are they sent, number one?
And two, who receives the information at the VA, and how is the
information then linked to a veteran's claim for benefits?
Secretary Kendall. Mr. Chairman, information is generally
sent electronically in digital form. And we have been doing
that for quite a few years now. We sent about--over a million
elements of data per day to the VA electronically.
The problem with those records is, A, that they are
incomplete. There are some paper files, often paper that is
produced by commercial providers of health care that our
servicemen have seen that need to be sent as well.
There are also problems at VA with how accessible and
readable some of that information is and how much it can be
manipulated. But we are sending electronic records, and we have
been doing that for quite some time. And it is the way the bulk
of the information goes.
I am going to turn it over to Ms. Wright and Dr. Woodson to
give you a more full answer.
Ms. Wright. Sir, if I can add to Mr. Kendall's statement,
we have an agreement now with VA that I think is working very
well. And that is to provide the service treatment records,
which includes personnel data, it includes administrative data,
it includes medical data and dental.
We also certify that at hubs within our services, within 45
days of the servicemember departing the military system and
moving into the veteran system. We send that electronically and
we send it paper-wise to the repository in VA.
By the 31st of December, we will be sending everything
electronically to VA, which will increase the speed of
processing a claim, should that individual choose to file a
disability claim.
Chairman McKeon. My time is expired. I don't know if there
is time for----
Chairman Miller. Mr. Woodson, would you like to add
anything?
Secretary Woodson. I would. Thank you very much for the
question and the invitation to be here today.
As Secretary Kendall indicated, we send a lot of health
record information electronically now. And for anyone who might
be interested, I will give you a Web site or a CD that shows
the functionality of the type of data we send that can be used
in direct patient care, as well as claim adjudication.
It is rather significant and it really has more information
and functionality than I would say most private offices in the
private sector and many of the great hospital systems in the
private sector.
By the end of the year, not only will we be able to
exchange that information so that it is read--it can be read by
whomever might need the information in the Veterans
Administration system, but it will be computable data.
Through the ongoing projects we have, through the inter-
agency program office focusing on this accelerator for this
data interoperability, which is really an important feature, it
will be computable data that will be real-time, that allows
providers as well as administrators to use that information for
the benefit of the transitioning servicemember.
And so, I think--I would be happy to make myself available
to any member or staff member to walk them through what the
capabilities are. I think if you have a chance to look at it,
you would be surprised at how much capability is there.
One last comment is that in trying to assist the Veterans
Administration in claims adjudication, particularly interfacing
with the VBA, we have a project, it is called the Health
Artifacts Information System, which will take care of
electronically transferring all of that loose and late paper
that is so--ties up the adjudication of these claims.
So we will be able to capture all of that information that
is coming from the private sector on care that was delivered to
servicemen and women. And remember, from the DoD's point of
view, about 60 percent of care comes from the private sector.
But we will be able to capture that and be able to transfer
that electronically and interface with their VBMS system, which
is part of their reengineering.
One more point, perhaps, is that as we have gone through
this process, we have also learned that it is about not only
the technology--it is not only about the technology solutions,
but it is also about the business process reengineering.
And I want to thank actually our VA colleagues, because we
have--through information-sharing summits and the like, have
illuminated areas where the business processing reengineering
needs to occur so that they can take advantage of the
technology solutions.
So thanks very much for the question.
Chairman Miller. Mr. Michaud?
Mr. Michaud. Thank you, Mr. Chairman. This question--I have
got two questions.
So the first one is for Mr. Warren and Mr. Kendall. When
will the two departments have the full capabilities of an
integrated, seamless health care records that can be used as
the President had envisioned? The first question.
The second question is for Mr. Kendall. And I would like to
read to you from the text of a March 28, 2013 memo from the
Office of the Secretary of Defense, regarding the pursuit of
the President's open standards for electronic health records.
And it reads, in part, and I quote--``Throughout the first
term, the Department's actions have been inconsistent with the
President's agenda. The Department's past and current desire is
to completely replace its health care information technology
package with an existing commercial health care advantage
package.''
It goes on to say that, and I quote--``The Department's
resistance to the President's open standard agenda appears to
be founded largely on an incorrect assumption.''
My question to those quotes is, do you believe that the
President's agenda was worth pursuing, or was there some mix-up
at the Department of Defense? And please help me understand
this because this has been going on for 4 years, long before
sequester. I hoped that you would be able to give us some idea.
So those are my two questions.
Chairman Miller. In 25 seconds or less.
Secretary Kendall. All of these terms have--like integrated
record, carry an awful lot of weight and are interpreted
differently by different people.
My view is that by 2014, we will have integrated records
that we share with VA. That is what the near-term projects are
doing. That is what the accelerators, which Dr. Woodson
mentioned, are doing.
And it is important for the Committees to distinguish
between integrated records and health care management software.
The health care management software doesn't just make a record.
It helps the physicians do their job. And that is a very
important reason for us to modernize our systems.
But as far as the records are concerned, we will have
records to common standards and they will be movable seamlessly
between DoD and VA, for use by both benefits adjudication
purposes and for health care purposes.
Your second question is about the comments that you made
about the President's agenda. We are fully supportive of the
President's agenda. So is VA. We are united in our effort to
develop common standards and to support the national standards
that the President articulated as a goal and that we are
working on with HHS.
So I don't know what the source of that quote was, but I
think it is entirely incorrect.
Mr. Michaud. Actually, the quote was from the Department of
Defense, the Secretary's office. And I will give you the memo
from DoD. They made it very clear it is inconsistent with what
the President directed them to do.
Secretary Kendall. I understand, but it is not correct.
Chairman Miller. Mr. Smith?
Mr. Smith. As following up on the computer records a little
bit, is it the case that you are going--and I think you
mentioned this, but I just want to clarify--is it the case that
you are going to have to develop a brand new system that both
departments can use, or do you think that there is a software
fix that can get your two systems to begin to better talk to
each other?
Secretary Kendall. We are currently talking to each other.
I think there is a misconception about this. We are sending
electronic records today.
So in that sense, we are talking to each other. VA can read
DoD's records when we send them, okay. We want to have an
improved system from that, where we are not just reading the
records, but actually using them and using the data that is
provided.
We also want to eliminate paper that is currently part of
the records that we are sending, for the reasons that I
mentioned that were discussed earlier. So we are moving very
quickly to accomplish those two things.
That is a separate thing from the software that manages
health care provision.
Mr. Smith. Right.
Secretary Kendall. And that is a distinction I want to
make.
Mr. Smith. And the software management system, you are
saying that you are going to come up with a new, relatively new
system beyond what you have now?
Secretary Kendall. Our choices are not between--we were on
the path at one time to develop an entirely new system.
Mr. Smith. Right.
Secretary Kendall. That was the history of this----
Mr. Smith. That is a tough path.
Secretary Kendall. It is a tough path, but we decided to
get off of it.
Mr. Smith. Yes.
Secretary Kendall. The costs for that were going to be
exorbitant. The last estimate that I saw was $28 billion of
lifecycle cost. So the decision was made a few months ago to
get off of that path.
Once we were off that path, VA made a decision that the
best path for VA was to continue with VistA and evolve and
enhance VistA to a modern project--a more modern product.
For DoD, as I mentioned in my opening comments, we have a
little different situation, we have a very different situation.
So we are not going to develop a new system. We are going to
look at a range of options that will include commercial, mature
products that are modern products that are being used
throughout the health care industry.
Mr. Smith. That is where the software improvement comes
from. We are working with a ton of companies and I think, gosh,
going back 20 years, we have had this history in a variety of
different government agencies where they try to come up with
some brand new system, where what has evolved is software
solutions to get old systems to better communicate with each
other. And that is--seems like the better approach.
Secretary Kendall. For DoD, it is better to have a choice
among a range of options that includes those types of systems.
Mr. Smith. Right.
Secretary Kendall. VA, as I said, is in a different
position, and I am not--they have VistA and they have in-house
programs to work with VistA, et cetera. So they have an
established base they can build on. It is not where we are.
There is an analogy that you will probably be familiar with
from your Armed Services Committee activities, with radios,
tactical radios that DoD acquires. Where we were doing a
program of records that took years and years and years, and
meanwhile the commercial industry was moving forward very
quickly. And we came to a conclusion to cancel some of those
programs and go out and do commercial like competitions in lieu
of doing our own development. We are in a little bit of that
situation here.
Mr. Smith. The tyranny of the program of record is a phrase
that occurs to me many times when I look at some of our
acquisition challenges. And I know you have done a lot of work
to try to get around that.
Mr. Smith. I yield back. Thanks.
Chairman Miller. Mr. Runyan?
Mr. Runyan. Thank you, Mr. Chairman.
I know we have been talking here a lot about moving
forward. I sit on both of these Committees, both HASC and VA,
and I chaired a subcommittee that deals with disability
assistance and memorial affairs. My question is really directed
both at the VA and the DoD. And this comes from a past VA
hearing.
In the hearing, it was discovered that VA initially--when
VA initially requests records from the DoD, and we are talking
about paper records--we are talking about dealing with the
current backlog--VA will wait 60 days before sending a follow-
up request. Following that request, VA will wait an additional
30 days to respond--for DoD to respond before making another
contact at DoD.
This is a very large work window. And as VA is trying to
adjudicate these claims in 125 days or less, that leaves 35
days before they can actually get their hands on the paperwork.
It was discovered through the hearing that this rule was
probably self-promulgated from the VA's adjudication manual.
Is this window necessarily that large? Does the VA need to
change their protocols on that? And why does it take the DoD so
long to get the--request of materials?
Mr. Warren. If I could hand that to Mr. Pummill to answer.
Mr. Pummill. Congressman, it is the timeframes that you
quoted are accurate timeframes. And those timeframes are based
on the requirement that we have in the Veterans Benefits
Administration to assist veterans--a duty to assist that says
that if we get a record and we believe that the record is not a
complete record, that we have certain timeframes that we have
to re-request the record again.
Now, we have actually fixed that in some work that we have
done with Ms. Wright's office in that the Department of Defense
has already started, as of January of this year, working to
give us from the five services certified service treatment
records. Basically, what they do now is they give us a service
treatment record with a document on top saying that the
Department of Defense certifies that this is a full and
complete record. That means that the record has all of the--we
have their personnel information, their dental information,
their medical information, and not just treatment from a
military treatment facility, but maybe if they went outside for
TRICARE or something, that eliminates the need for the VA to go
out and ask for any additional information--no more 60-day
letter, no more 30-day letter.
This will improve again when we get to December of this
year and we start receiving all of that information
electronically, because we will be able to shift it around to
different places to adjudicate it. But yes, that was a problem.
That still is a problem with veterans that are from previous
conflicts that are not coming directly from the Department of
Defense, because we still have to go out and request any place
they may have been for all their records, to ensure that we
have everything possible to give that veteran every benefit of
the doubt when we are adjudicating their claim.
Mr. Runyan. Thank you.
Mr. Chairman, I yield back.
Chairman Miller. Mr. Takano?
Mr. Takano. Thank you, Mr. Chairman.
I am pleased that DoD and VA, along with several other
agencies, have collaborated to improve and reinvent the
transition assistance program. However, I heard from the
California Department of Veterans Affairs that they are being
excluded from participation in transition GPS, the new program.
State governments provide key resources and services for
veterans, and I think it is important that they are included in
the transition program.
Can any of you address why the California Veterans Affairs
Department is being excluded? Or if that is a mistake, what
will you do to address the issue?
Ms. Wright. Sir, I would like to address that issue,
please.
Any individual that spends 180 days on active duty is--goes
through the transition assistance program that is now a very
active program at 206 installations throughout our system. It
is a collaborative effort between Department of Defense,
between VA and between Department of Labor.
The transition GPS will be up and running in the first of
October of 2013. In fact, we just all had a meeting about that
yesterday. But there are tracks to that, that those individuals
that come through the transition program still do. They do MOS
comparison to civilian. They do a transition plan. They do a
financial plan. And they do a career readiness solution.
What will be added onto the transition GPS are three
additional tracks that could potentially--that are volunteer,
the individual does not have to go through. So my concern is, I
don't know if you are talking about a reservist or guardsman
who is leaving the Guard and Reserve system, or if you are
talking about somebody who is leaving the active duty system.
So, what I have explained is for somebody that has been on
active duty. I would like to make an appointment with you and
follow up to see if it is clearly on the Reserve and Guard
side, and then I can answer your question.
Mr. Takano. I would appreciate that effort. Thank you.
Chairman McKeon. Mr. Forbes?
Mr. Forbes. Thank you, Mr. Chairman.
You have heard both Chairman Miller and Chairman McKeon
mention the collaborative effort we have with DoD and VA. One
of the concerns that I have is with these furloughs that the
secretary of defense has ordered. We know that the VA employees
are exempt from that, but not DoD employees.
So my concern is, what impact is that going to have on the
transfer of this information over from DoD. And if we have a 20
percent loss in the time that these employees have, are we
concerned about the messaging that we are sending to our
servicemembers that after a decade of war that they have served
their country, that the country is somehow content to give them
80 percent effort in this transitioning.
Ms. Wright. Sir, if I may, thank you for the question.
I would like to piggyback onto what Mr. Kendall said.
Sequestration is real in our department.
Mr. Forbes. I understand sequestration is real. Some of us
didn't support it, but the decision on the furloughs was the
secretary's.
Ms. Wright. Absolutely, sir. And furloughs are real and
they are catastrophic to the department and they are
catastrophic to the great civilian employees that work for the
department.
Saying that, we realize how important this is for those
individuals that have served our country admirably in the
military, to transfer their records to VA in a whole certified
manner, as Mr. Pummill brought up--the agreement that we have
between the two departments.
We are making that 45-day window. The reason we have a 45-
day window is to collect all that loose-flowing information
from TRICARE and other agencies where we can then certify that
they are correct and send them over to VBA to their repository.
So, should the individual choose to file a disability, his or
her records are there and correct.
So, yes, furloughs are real. Yes, they are damning. But we
have kind of locked this down as hugely important and we are
putting a full-court press on it, sir.
Mr. Forbes. In my 4 seconds, I don't think you have
answered the question. But if you could at some point in time
give us a metrics of a plan so that we can measure
independently that we are reaching our goals.
And with that, Mr. Chairman, I yield back.
Ms. Wright. Sir, we have the--if I may?
Mr. Forbes. Please.
Ms. Wright. We have a metric of 100 percent. The last
report from VA, and we get our numbers from VA, we were at 97
percent success rate of getting our records to VA on time. We
collaborate every day on this. I can provide you more metrics
if you choose.
Mr. Forbes. Thank you. I would love to. Thank you.
Ms. Wright. Thank you.
Chairman Miller. Mrs. Davis?
Mrs. Davis. Thank you, Mr. Chairman.
Just quickly, since we have little time. How is--how are VA
and the DoD working together on after-action reports regarding
suicides? I am familiar that the different services have their
own ways of doing that, but how are you integrating those
discussions? And what have we learned from it?
And secondly, what are we doing to reduce the stigma so
that people who are having difficulties actually report those
difficulties so that that goes on their medical reports when
they do apply for benefits later on? I understand that a number
of people actually do not, and so when the VA has to rate them
down the line, they have nothing on which to base it, even
though they have been serving for a number of years.
Secretary Petzel. Congresswoman Davis, let me begin, at
least, to answer that question.
The VA and DoD have a joint integrated mental health
strategy. One element of that strategy is suicide. We recently
jointly developed an integrated recordkeeping system for
suicide where we collect the data from each one of the states
as to the rate of suicide, et cetera, amongst veterans; collate
that data; and then use it to analyze our experiences in the
DoD on one hand, and in the VA on the other hand.
The second thing is that we have a number of joint efforts
going on right now to de-stigmatize suicide. The make-the-
connection campaign and the stand-by-them campaign are two
efforts to de-stigmatize mental health in general, but suicide
in particular, and to not glorify suicide.
The third element is the military-VA crisis hotline, where
people that are having a difficulty can call. We have received
almost 900,000 calls since it began almost 4-1/2 years ago;
26,000 saves from that. That is, people who were in danger of
harming themselves or someone else that were rescued from doing
that.
The suicide work group, the mental health work group of our
health executive council, that VA and DoD jointly chair,
regularly reviews the suicide experiences within each
organization and looks for, in further joint efforts----
Mrs. Davis. Excuse me, are those shared with the family as
well? Are those reports shared with the family?
Secretary Petzel. I can speak only for the VA in terms of
the family, that when we do a, what we call a psychological
autopsy on a patient or a review, yes, we would do what we call
institutional disclosure and discuss that with the family.
Mrs. Davis. Okay, thank you.
Chairman Miller. Dr. Benishek?
Mr. Benishek. Thank you, Mr. Chairman. My question is
actually for Dr. Petzel.
In 2008, the NDNA, a joint DoD-VA vision center of
excellence was established at Walter Reed. The purpose of this
center, along with two other joint centers of excellence, was
to improve clinical coordination and best practices between the
DoD and the VA.
The center was also tasked with developing a joint trauma
registry containing up-to-date info on the diagnosis, treatment
and the follow up for injuries received by our Nation's
military. The vision center alone was allocated $6.9 million
over 5 years.
Apparently, there are two current staff members from the VA
located at the vision center of excellence, and this is despite
repeated promises from the Secretary that there would be no
less than six. Why hasn't more staff been committed to the
vision center?
Secretary Petzel. Thank you, Dr. Benishek. My understanding
is that we have committed the staff that was initially agreed
to. I will go back, sir, and find out----
Mr. Benishek. See, I have also heard reports that the VA
plans to pull out of the centers of excellence. Is there any
truth to that?
Secretary Petzel. No, we do not plan on--we fully support
the concept of the centers of excellence.
Mr. Benishek. Well, I would like to be sure that there are
six staff members as the Secretary promised.
I have also heard reports that the VA has been refusing DoD
IT personnel with security clearance to access the VA health
records for purpose of building the trauma registry. Do you
have any knowledge of that?
Secretary Petzel. I do not, sir. I would ask Mr. Warren if
he has any knowledge of that.
Mr. Warren. I would like to take that for the record, but I
am not aware of that taking place, sir.
Mr. Benishek. Well, let's follow up with your staffs, so we
get these answers, because I have got some credible reports
that indicate that these questions are valid.
Mr. Warren. And can we reach out to your staff for further
information?
Mr. Benishek. Yup.
Mr. Warren. Thank you.
Mr. Benishek. Thank you. My time is up.
Chairman Miller. Mr. Wilson?
Mr. Wilson. Thank you, Mr. Chairman.
And thank you, Chairman Miller, Chairman McKeon, for your
leadership to promote DoD-VA collaboration on behalf of our
military servicemembers and military families and retirees.
Mr. Pummill, how many of the pending claims that VA is
waiting to process require information to be provided from the
DoD to be processed?
Mr. Pummill. About 4 percent. It is not very much.
Mr. Wilson. That is impressive. That is good.
Ms. Wright, how many pending claims does DoD need to
provide the VA information?
Ms. Wright. Sir, we are working on the 4 percent that we
are required to provide. We are also providing the current
service treatment records of those that are leaving. But those
that are within the backlog is about 4 percent.
Mr. Wilson. And this 4 percent has been a significant
reduction apparently, is that correct?
Ms. Wright. We are working together, sir. We have a team on
the ground, two teams on the ground at VA at their request and
they are working hand in glove with VA to bring down that
number.
Mr. Wilson. Well, I appreciate very much that information
and please keep us informed.
Mr. Pummill, do you believe that a joint DoD-VA integrated
electronic health care record would substantially aid the VA in
eliminating the current backlog?
Mr. Pummill. A joint electronic health record probably
won't do anything for the current backlog. It would be
wonderful for the future to have everybody in the government to
be able to look at one medical record and grab all their
information.
Right now, what we need is the electronic personnel dental
and medical records, which we have got a commitment from the
Department of Defense to get by the end of this calendar year.
And for claims purposes, that is what I need. The
electronic health record, if that ever works out for the
future, that would be great. That would help in the future. But
it would not help us in eliminating the current backlog.
Mr. Wilson. And finally, for the health and safety, I
certainly hope every effort is made to expedite the electronic
health care records. It is just got--for all of you, it is just
so important.
Thank you very much for your service.
Chairman Miller. Mr. O'Rourke?
Mr. O'Rourke. Thank you, Mr. Chairman.
And for Under Secretary Kendall, I wanted to draw your
attention to a Reuters investigative piece that was published
yesterday, entitled ``The Pentagon's Payroll Quagmire Traps
America's Soldiers.''
And one of the soldiers that they focus on is based at Fort
Bliss in El Paso, Texas, the community I have the honor of
representing. And after returning from two combat tours,
suffering from severe PTSD, traumatic brain injury, nerve
damage and chronic pain, his pay is mysteriously garnished, and
going from $3,300 a month to about $1,000 less, without
explanation.
After he complains about it, his pay goes down to a little
over $115 a month, forcing he and his family to go to food
pantries to be able to feed themselves. He has three children.
Having to go through Operation Santa Claus to get Christmas
gifts for his children.
And the Reuters reporter was able to find that this is not
an isolated incident. It is widespread throughout the
Department of Defense. There was also a GAO report in 2012 that
cited some of these same problems. The response from the
Department of Defense was to call the GAO report overblown.
One of the other findings in the article shows that the
Department of Defense's system is a jury-rigged network of
incompatible computer systems for payroll and accounting that
are obsolete and unable to speak with each other or communicate
with each other within the DoD.
And so, I knew we had a problem communicating DoD to VA, I
didn't know we had a problem communicating DoD to DoD.
Considering the GAO report, the Reuters report, this case
of medic Aiken, what is your response to this? How are you
going to fix this and when will you fix this?
Secretary Kendall. Congressman, I have to pass that
question over to Ms. Wright.
Ms. Wright. I apologize for the microphone.
First thing I will tell you that I have not seen the
article, but I will absolutely read it today. It is very
important. It is catastrophic if this is happening to our
servicemembers, if it is happening to one or if it is happening
to a multitude. So I would like to do that.
I am the personnel and readiness person, so I am not
responsible for DFAS, but I am responsible for the health and
welfare of our soldiers and our military members.
So, sir, I don't have an answer for you. I would like to
take it for the record, but more importantly, I would like to
follow up on the one particular person and fix that right away,
see what we have for the system issues, involve the
comptroller, and get back to you, if that is okay?
Mr. O'Rourke. I look forward to following up with you,
thank you.
Ms. Wright. Thank you.
Chairman Miller. Mr. Loebsack?
Mr. Loebsack. I thank the Chairman. I want to thank the two
Chairs and the Ranking Members for this hearing. I had seven
veterans' forums last week at the beginning of the week, and
what Congressman O'Rourke mentioned is something I hear often.
I could just spend all of my 2 minutes sort of recounting
all the stories that I have heard over the 7 years that I have
been in office, so I won't do that. I just want to broaden out
the discussion of mental health a little bit, if I may.
Good to see you again, Dr. Woodson. I hope you will chime
in on this, as well. And Dr. Petzel, it is really important
what Congresswoman Davis brought up, the suicide issue, but I
would like to go a little bit further than that, talk about
transitioning from DoD to VA, in particular from active duty to
the VA, and with respect to the mental health care system that
is in existence now with DoD and then going to the VA.
Can both of you speak to that issue, please?
Secretary Woodson. Yes, I would be happy to start and thank
you again for this question, which is a really important topic.
As we know, mental health issues have become one of the
signature health issues out of the decade-plus of war. As Dr.
Petzel said several moments ago, he and I have worked very,
very closely together to harmonize and advance the care
relative to mental health.
It begins with a group that has been working on an
integrated mental health strategy, so that we are enhancing the
practice guidelines even as we hand off servicemembers who are
transitioning to veteran status.
We have a robust, collaborative effort on research to
advance our understanding of treatment strategies that are
important. We have a significant collaborative effort to insure
transition is smooth in transition programs. Making sure that
there is follow up at VA. We have developed a series of
initiatives that are looking at what kind of care is being
delivered and its effectiveness. And we discuss this every
month in terms of how to move this ball forward.
The development of applications that can be used by
individuals who might have PTSD to enhance resolution of their
symptoms. What has been interesting and this goes to a question
that was asked earlier about suicide, is that we have learned
something from the studies that have been done in the
Department of Defense and in the Department of Veteran's
Affairs. That in fact we have slightly different issues
relative to the cohorts that we need to focus on and how we
need to tailor some of our suicide prevention programs and
campaigns.
So within the Department of Defense, the biggest profile at
risk are the young individual, first-time enlisted who has
financial problems, relation problems, maybe previous family
problems prior to coming into the service. Whereas in the
Veteran's Affairs, it is the vet in their 50s or 60s with
additional qualifiers. And so it has been very important to
understand that bimodal set of events so that we can
individually address what might be the factors for the people
in our society and the people that we are responsible for that
are most at risk.
But the bottom line message I want to leave you with is
that Dr. Petzel and I, as the people principally responsible
for this, work enormously closely together to try and enhance
our understanding, treatment strategies, prevention. And I
would just say that you know, we are doctors, so we don't just
concentrate on medical issues, we are talking about how to
develop comprehensive programs writ large to get communities
involved, crisis line. Try and educate families about risk
factors and profiles of people at risk. So we co-sponsor
suicide prevention conferences to bring our people together to
look at what we should be doing and what advances should be
made. So difficult problem, but we are 110% after this
together.
Secretary Petzel. Thank you. Mr. Chairman could I add just
30 seconds to what Dr. Woodson said?
Chairman Miller. Yes sir.
Secretary Petzel. Thank you. Two things. Number one is that
we have a series of case managers that we share that transit
the seriously ill and injured people from the DoD into the VA
Health Care System. And this includes people with serious
mental illness. We are hoping that the Transition Assistance
Program, the new TAP, is going to have in it an even better way
of making a hot transfer for people that are ill, not
necessarily in the seriously ill or injured group, but do need
that kind of transition.
And the last thing I would comment on, just to reiterate
what Dr. Woodson said, I have been in the VA for a long time
and worked with DoD for a long time. The level of collaboration
and cooperation in the clinical sphere in medicine right now is
unprecedented. I mean absolutely. We share so much and do so
many things now jointly that we wouldn't have even dreamed of 5
or 6 years ago.
Mr. Loebsack. Thank you. And thank you, Mr. Chair, for
indulging for such a lengthy period.
Chairman Miller. Mr. Coffman.
Mr. Coffman. Thank you, Mr. Chairman. Secretary Wright,
there has been a three-point series by the Colorado Springs
Gazette that an investigative report, reporting, that talked
about soldiers receiving less than honorable discharges due to
minor infractions. And a lot of those soldiers are combat
veterans from Iraq and from Afghanistan who also it was
reported that had TBI and post-traumatic stress disorder in
some of those instances.
These, the nature of this discharges, disallowed these
combat veterans from receiving any care under the VA. And so I
am wondering if you, I am very concerned about this, and I
wonder if you can comment on this?
Ms. Wright. Sir I can comment on the transition portion and
then I am going to turn it over to Dr. Woodson to comment on
the medical diagnosis portion. So the minor infraction that you
talked about could be a multitude of things. These individuals,
whether they receive an honorable discharge or whether they
receive a less than honorable, would still go through the
transition program that all servicemembers leaving the program
must go through. During that period of time, they receive not
only counseling from the Department of Defense and Department
of Labor, they also receive 6 hours of counseling classes from
the VA.
So what the Secretary of VA is concerned about is even when
people leave with a dishonorable discharge, people going into
kind of the homeless category, and so he wants that warm
handoff through the VA system and we are working together.
Now your question involved those that may have PTSD or
another type of diagnosis that could have related to the
dishonorable discharge----
Mr. Coffman. Less than honorable. There is a difference--
less than honorable discharge versus dishonorable. There is a
pretty significant difference.
Ms. Wright. Yes sir, less than honorable versus
dishonorable. So I am going to turn that over to Dr. Woodson
because we are doing something to review those cases.
Secretary Woodson. Again, thank you for the question and
again, just to restate. I think at the heart of your question
is whether or not some individuals are being discharged with
less than honorable discharge, being denied benefits, and in
fact have an injury of war. And so we have enhanced our
screening and require screening that if someone is being
discharged for what is considered bad conduct, bad conduct
discharge, that they have to go through certain screening for
PTSD and TBI to insure that that is not a contributing factor.
So you know, heretofore, there were examples of individuals
because, you know, line leadership just was not clinically
oriented and someone did a bad thing. But the question was what
was the root cause of that change in behavior? Was it a brain
injury or was it PTSD? We now have screening mechanisms to look
at those issues.
Ms. Wright. Sir if I can follow up on one more thing. At
the beginning of a war, we may have diagnosed them as having an
adjustment disorder, which is different than PTSD or TBI of
course.
Mr. Coffman. Right.
Ms. Wright. So we have rescreened those cases within the
services. That doesn't mean we can reverse the discharge
because it may not have been, you know, I don't know what the
particular issue was that created that particular discharge.
But we are working through each individual case to see if we,
if the missed diagnosis was there, which could have resulted in
the, in an unfavorable discharge.
Mr. Coffman. Thank you Mr. Chairman I yield back. I would
just like to see treatment available to these soldiers,
marines, airmen and sailors who have served this country in
combat and are being discharged for minor, were discharged for
minor infractions.
Chairman Miller. Mr. Conaway.
Mr. Conaway. Thank you, Mr. Chairman. I was struck by the
sincerity of each one of your answers, particularly when
confronted with what appears to be a fail, like Mr. O'Rourke
was mentioning earlier and wanted to get at. But I would like
Mr. Kendall and Mr. Warren to think about the word
accountability.
Each of you have talked about deadlines and progress to be
made in the future and those kind of things. If those things
aren't met, what is, is anybody's performance evaluation
effected? Are there consequences to anybody in the system for
failure to meet the deadlines which are being set?
Secretary Kendall. Absolutely. One of the things I have
asked for the IPO to do and we will be doing this together with
Mr. Warren is to lay out a set of commitments, a list of
deliverables with schedules that we expect them to deliver.
Those will be shared commitments between ourselves and DoD and
VA And the IPO will be held responsible. It is similar to what
we do with all of our Program Managers and Program Executive
Officers. We are going to be managing this program----
Mr. Conaway. So a year from now, we would be able to look
at an evaluation report from somebody who had a standard to be
met, didn't meet it. There would be a consequence on their
personnel evaluation and they would either be fired or demoted
or held accountable some way?
Secretary Kendall. Yes.
Mr. Conaway. Okay. Mr. Warren how about your side?
Mr. Warren. The same sir.
Mr. Conaway. Say again?
Mr. Warren. Yes, the accountability and the responsibility
to perform to the standards and the commitments we have made is
in the performance plans and individuals are held accountable
for those sir.
Mr. Conaway. Okay. You just used the word ``past tense''
are or currently. So we could look at your system----
Mr. Warren. Are and will be, sir.
Mr. Conaway. But we could look at your system and actually
see where somebody was disciplined or demoted or fired or
something because they didn't meet some important deadline?
Mr. Warren. Or their performance rating was less than
outstanding. So again, remember the way the performance program
works is you lay out----
Mr. Conaway. How many get outstanding?
Mr. Warren. I will get you back that number for the record,
sir.
Mr. Conaway. My issue is if everybody gets an outstanding,
then that doesn't mean anything. So if----
Mr. Warren. I will assure you, sir, that in the senior
executive cadre at the VA, the number of outstandings has
steadily decreased over the last couple of years as a result of
the system of accountability that Secretary Shinseki has
brought to the department, and not just for the senior execs
but in other areas. And we are glad to get that to you for the
record, sir.
Mr. Conaway. I appreciate that.
I yield back. Thank you.
Chairman Miller. Which means there are a lot of bonuses
being given out.
Ms. Brownley?
Ms. Brownley. Thank you, Mr. Chair. And I also wanted to
sort of follow up on this accountability issue and benchmarks,
et cetera.
So you are saying that you have provided them, and I want
to know how you are going to report back to us and your process
by which you are meeting those benchmarks, how--what is your
recommendation and the best ways for us to hold--to monitor
what you are doing over the course of the next 18 months, I
think you said.
I wasn't here for part of the testimony, but my
understanding was that you would have this complete by 2014,
the integrated system--health system.
Secretary Kendall. We have a set of near-term goals that we
share that the IPO is executing. I haven't reviewed them in
detail yet, but I will be doing that very shortly. And we will
have commitments on what we will deliver and when. I don't
think it will change substantially from the current plan.
I am concerned about some of the schedule risk in some of
the things we are doing. We will be in close contact with the
Committees and their staffs as we go throughout this process.
We know there is a lot of interest in these programs and in
their success for very good reasons. And we also know that the
history has been a source of some frustration.
So we are going to keep in close contact. We will have
specific benchmarks that we have to met, and we will inform you
of how we are doing against them.
Ms. Brownley. And you will have those complete by?
Secretary Kendall. I should have some of those in place
within the next few months from my perspective, although I
think some already exist from the perspective of the VA that
they are more confident of than I am right now.
Mr. Warren. The VA has commitments in place. In fact, the
near-term accelerators that we have been speaking about today,
there are sites where we are deploying the integrated viewer.
It is taking place during the month of July. At the end of the
month of July, we will have it all--the polytrauma units. So we
will complete that.
By the end of December, we will have built that viewer.
Where today you are seeing the information separate, but as a
result of the work on data translation, you will be able to see
a blended view. That will be by the end of December. So that is
on the joint side. We are still finalizing the deployment
schedule of that joint viewer at different facilities and
capabilities in 2014. That is the piece Secretary Kendall was
referring to.
On the VA side, we have a commitment to ensure that we are
deploying the core capability, which is about 15 percent of the
IHR that the VA made the decision on back in September, by 1
October next year at two locations, Hampton Roads and San
Antonio.
So there is a set of near-term that we are making great
process on, and there are some out-year commitments that we
have made in terms of deploying systems and making the
necessary enhancements.
Ms. Brownley. Thank you. I yield back.
Chairman Miller. Ms. Tsongas?
Ms. Tsongas. Thank you, Mr. Chairman. And thank you all for
being here today. I am glad that this joint Armed Services-
Veterans Affairs hearing is becoming an annual exercise. This
is our second, and I hope we continue to have it in the coming
years.
There are a wide number of continuum of care issues which
we have been discussing here today. So I think it just shows us
how obvious it is and how little sense it makes to treat DoD
and the VA as two separate stovepipes, when it comes to
addressing some of the most critical health challenges our
veterans are facing. And I appreciate all the work that you are
putting into it.
Certainly, survivors of military sexual assault are among
the most vulnerable members of this population, and I greatly
appreciate the efforts over the last several years by both DoD
and the VA to improve the treatment of the victims of this
crime within the Armed Services.
I was heartened to learn yesterday in a meeting with senior
representatives from the VA, including Assistant Secretary
Mooney, that the documentary film ``The Invisible War'' is now
mandatory viewing for senior VA managers. This is a movie that
has really helped to draw very important attention to the great
challenge of this issue.
Among its many ways in which it did do so, it also
painfully highlighted the multiple bureaucratic hurdles that a
survivor of such assault has to endure to prove that their
physical and mental health symptoms are connected to an
incident of military sexual trauma within the VA, and shows
that too often, victims are unsuccessful in pursuing their
claims for assistance.
So to address one aspect of this problem, the fiscal year
2012 defense authorization included language that required the
secretary of defense, in consultation with the secretary of the
VA, to develop a comprehensive policy for the Department of
Defense on going about the retention of and access to evidence
and records relating to sexual assault involving members of the
Armed Services, because that was one of the issues that we have
come to understand.
So my office continues to closely monitor implementation of
this and other vital measures. I want to honor the 2-minute
time limit. I will submit some questions for the record. But
just to let you know that this is an issue that this Committee
takes very seriously.
And I look forward to--I heard some feedback yesterday as
to the work you all are doing, and we will continue to monitor
it closely. Thank you, and I yield back.
Chairman Miller. I thank the gentlelady for yielding. Dr.
Heck?
Dr. Heck. Thank you, Mr. Chairman. Thank you all for taking
the time to be here. My question has to do with the Integrated
Disability Evaluation System, which attempts to take what was
an almost 540 day process and get it down to about 295 days
from profile initiation to either unit reintegration or
separation.
Can you give me an update on the progress of IDES and the
cooperation between both DoD and the VA, specifically phase
one, the MEB process, and phase two, the PEB/PDA process?
Secondarily, do you believe that when an integrated
electronic health record is finally achieved that that will
help expedite the process even further? And what more, if
anything, can Congress do to help the IDES process along?
Secretary Woodson. Thank you, Congressman, for that
question. Obviously, the Integrated Disability Evaluation
System has been troublesome, particularly over the early parts
of the war. Since we have brought a collaborative effort to
looking at the process from beginning to end, I think a lot of
improvement has been made.
So that if you look particularly in the Navy and the Air
Force, they are meeting standards relative to the MEB and the
PEB process. The Army still has some outlier sites. And the
reason of course is they have got the bulk of the wounded
warriors and the folks in the IDES system. There still are
about 36,000 folks in the IDES system.
But we have made a commitment to improving the process of
that information. So the single disability rating and the
information flowing back from the VA to inform the final
narrative summaries has improved tremendously.
And so most of the medical boards are now meeting
standards, and most of the PEB boards are now meeting
standards. We have increased of course the number of personnel
assigned, and we continue to refine the information management.
So to the last part of your question about electronic
transfer of information, it is not only about transfer of the
health information, which most of the current-era servicemen
and women have electronic records, but it is about getting that
loose paper that we have talked about. And we have got a
solution for that which will be in place in the near term
basically.
So my expectation is that we will be able to drive down
even more the number of days relative to that particular
process. There are some things that contribute to the total
number on the periphery which are probably not as important,
such as the number of leave days that are accrued and those
kinds of things.
But I don't know that that impacts sort of the quality of
the experience and the fairness of the process. But there have
been a significant improvement in the overall system.
Chairman Miller. Dr. Wenstrup?
Dr. Wenstrup. Thank you, Mr. Chairman.
Dr. Wenstrup. A couple questions on the health electronic
medical records, if you will. And I am just curious how much
provider input is being given as to how this system is set up.
Is there an ease for them? And is there anything being done to
reduce some of the administrative load to the providers so that
they can see more patients?
And then lastly, I just want to clarify. Hopefully, we are
headed towards a goal of not just sharing two systems and
having access to two systems, but actually having one DoD-VA
record.
And I will address that to both doctors. Thank you.
Secretary Woodson. So, thank you so much for that question,
because I want to point out a couple of things that in the
proposed legislation, I was struck by the fact that as the
Congress was requiring us to set up this advisory committee,
there was no requirement for clinical input on that advisory
board. And so I am taking you have some experience with
electronic health records from the provider point of view.
Let me assure you that Dr. Petzel and I represent the
functional community and we have extensive integrated clinical
informatics boards made up of clinicians that help develop the
requirements. So it is functional community-driven, even as we
know that the system has got to support other administrative
processes.
But it is not the pyramid turned upside-down where the
administrative process, which is probably the mistake we made
earlier in the Department of Defense, where the administrative
process drives the development of the record so that it becomes
difficult to use by the provider.
So, I wholeheartedly accept your challenge in your
question, and I think Dr. Petzel and I are meeting that in
terms of how we are developing the requirements.
Secretary Petzel. Thank you. I would echo what Dr. Woodson
has said. And I would also point out that the VA record was
really developed by a group of clinicians as a clinical
management platform. It had nothing to do with the
administrative functions.
And the tradition within our organization is that the
clinicians set the requirements and really drive the process of
developing the record. And the IPO, with its clinical advisory
board, has really adopted that principle. The two groups of
clinicians from DoD and VA have worked very well together
developing the requirements for the various packets of
applications that are going to eventually hang on this record.
And I would also point out that it is my sincere desire
that we have a single record between these two organizations,
as well as eventually across the Federal government.
Dr. Wenstrup. Thank you.
Secretary Woodson. Sir, if I might just add one particular
point. I would be very happy to work with any clinicians or
members of Congress who want to look at the functionality of
what we are rolling out this year, to make sure that you
understand what we are really delivering on in terms of that
integrated interoperability piece. It is usable. That is the
key thing. It is usable. So we would be happy to demonstrate it
to you.
Dr. Wenstrup. Thank you. And I would like to get that Web
site you mentioned earlier.
Chairman Miller. Mr. Walz?
Mr. Walz. Thank you, Mr. Chairman.
As a veteran and a citizen, thank you all for what you do.
I appreciate the Chairman for holding this, again getting us
together, and echo my colleagues' statement this is important.
Mr. Pummill, two questions to you. I will ask them both
together and get my response. You have the authority to issue
interim, partial or temporary disability benefits. That
obviously speeds the process along. It gets important things
like voc-rehab to our folks right away before these become
chronic problems.
I have to tell you it doesn't appear to be happening in
southern Minnesota, and when I check around the country. My
question to you is: Are VA opposed to interim ratings and
compensation that has been determined there is going to be at
least 30 percent? Because I don't see it happening.
My other question deals with private medical evidence. You
use them for--DBQs, but we are having a problem getting that in
to get some of the ratings done. I have a piece of legislation,
along with Mr. Denham, to try and use that. Let's maximize our
resources. Let's have a force-multiplier and use this medical
evidence. Get them in. You already use them for DBQs, why not
further them along?
Those are my two questions.
Mr. Pummill. The first question, are we opposed to the
interim ratings? No, we are not. And I will have to check and
find out what is going on.
On the second one, we do have a problem getting private
medical evidence. A lot of the raters that are out there that
are actually doing the rating of the servicemembers, when I go
around and talk to them, tell me that, you know, sometimes you
have to query a doctor's office three, four times trying to get
the private medical evidence. So, anything that we can get that
would help us speed up getting that private medical evidence.
We are hoping that the DBQs will be a big step in that, where
the servicemember can walk in and say, ``Doctor, could you
please fill out this DBQ?'' It is pretty self-explanatory; easy
to fill in the blanks. And they can do it electronically or by
hand, and get that from the doctor. And that would forego the
need for those private medical records. But in the cases where
we need them, it is tough.
Mr. Walz. We have got folks that wander off. Anecdotally,
there seems to be that the thought is that there is a bias
against using that outside information, which always sticks in
the craw of my folks because it is Mayo Clinic in some of
those. I hope that is not the case.
Mr. Pummill. No, it is not the case. From VBA, not only are
we not opposed to the private medical records, we actively seek
those private records and we are required by law to contact
those doctors and attempt to get those records.
Mr. Walz. I am glad to hear it. Thank you.
I yield back.
Chairman Miller. Mr. Barber?
Mr. Barber. Thank you, Mr. Chairman. Thank you for
convening this important hearing.
I join with my colleagues in wishing that we were listening
also to the secretaries of defense and veterans affairs, but I
am pleased, of course, that the witnesses are here.
I represent a district where there are about 90,000
veterans, one of the largest in the country. I also represent
the men and women of two military installations, Fort Huachuca
and Davis-Monthan Air Force Base.
The veterans' caseload is the highest of any in our office.
I think that is probably true of all of my colleagues. And the
frustration that they feel, the veterans that come to us, and
my staff feel, in getting progress is never-ending.
And while I understand and appreciate your efforts to
develop systems that will take care of this backlog, I think
one of the ways that you might understand our frustration is to
spend an hour in one of our offices taking calls from veterans
and listening to their frustration and their concerns. It is
very enlightening and obviously a very emotional experience.
So, my question to you is this. What are leaders of DoD and
the Veterans Administration doing to set measurable progress
metrics and holding people accountable? Leadership is about
setting goals, holding people accountable, measuring progress.
And I would like to know concretely from both of the
departments what concrete measurements are you putting in place
and how are you holding your staff accountable for meeting
those measurements.
That is the only way we are going to get this job done, and
I would appreciate your answers. Thank you.
Mr. Pummill. Congressman, from the benefits side, the
compensation side and the backlog, we now, at the behest of
Under Secretary Hickey, have some very strong and stringent
metrics in place for not only the individual raters, but their
coaches, their supervisors, the regional office directors, all
the way up through the leadership.
We know it is--you can look at the math. You can see what
we have to do to knock out the number of claims that are coming
in and the backlog. And we have set standards that people have
to do that.
We in VBA didn't meet what we were supposed to meet last
year. We were--the backlog grew for a lot of reasons. We pushed
our automation program, VBMS. We now have it out there. As a
result of our performance last year, no senior executives in
VBA received a performance award at the end of the year because
we felt that it was an overall goal of our administration, of
VBA, to make positive progress on the backlog. We didn't get
there, so no performance awards were paid out.
This year, we will look at the standards. We do see that
some of the regional offices have really turned the corner. The
ones that have got--some are really embracing VBMS and starting
to churn out the claims. Thus, 2 months in a row of breaking an
all-time record, but it is still not enough. We are still not
where we need to be. We have a higher standard that we need to
reach and we will hold people to that standard.
Mr. Barber. Thank you.
And from Defense?
Ms. Wright. Thank you, sir, for the question.
As we talked about before, we are the providers of
information so VA can process the claims. We are not the claims
processor. So it is our responsibility to provide that
information.
So, working with VA, there was about 4 percent that we owe.
We have--and those are for the backlog--so we have two teams on
the ground that are hands-on going through these records,
calling back, and getting--seeing if this information is in DoD
and providing that to the disability claims adjusters so they
can adjust the claim.
We also, according to VA, they said the single most
important thing that we can do to assist them was to provide
them with the certified service treatment records. So to hold
people accountable, both myself as the Acting Under Secretary
and the Vice Chairman of the Joint Chiefs of Staff, receive
reports weekly to make sure that we are working towards the
metric of 100 percent. We are at the 97 percentile now and we
are working towards the metric of 100 percent within a 45-day
window of when the servicemember departs DoD.
Mr. Barber. Thank you.
Mr. Chairman, I yield back.
Chairman Miller. Mr. Scott?
Then Dr. Roe?
Mr. Scott. Thank you, Mr. Chairman.
And ladies and gentlemen, thank you for being here.
And I do believe you are sincere in trying to cure this
backlog. And my questions will be more for Dr. Petzel and Mr.
Warren, if you will.
And we all know, as I just said, that the veterans are
waiting too long to have their benefits processed and receive
the benefits. And in the private sector, beneficiaries would
actually be receiving an interest payment for the time between
when the claim should have been adjudicated and when it
actually was, and that is something that we may need to look at
from our side.
I am glad to hear about the VBMS software, the continued
progress there that is going in. And my concern comes from the
reports and the delays--and I know you have addressed this--
just the months that may take place before the veteran's
records are processed into that VBMS system.
And I know many of them have to be manually scanned and
many of them probably have to be transcribed, and that
contributes to the delay. But some of the things that I think
also contributes to the confusion, the delays, veterans,
because they are unable to track their records, resubmit their
records, which means there is more paper coming into the system
and more files.
And so what is being done to speed up that or at the least
track the records? And I think if there was a tracking system
so that the veterans could go online and see that all of the
paperwork had been received and that their claim was in process
and where it was in line in being processed that may resolve
some of that. And if you would speak to that I would appreciate
it.
Mr. Pummill. Yes, Congressman, I will answer that question.
You hit the nail right on the head. Our big problem in VBA
is always going to be--for the next few years, we are gonna
receive a million claims a year. Most of those claims are gonna
come from outside the Department of Defense. The Department of
Defense claims that we are gonna get from servicemembers that
are leaving active Guard and Reserve will have the electronic
personnel, dental and medical records, so we will be able to do
exactly what you say.
For all the other veterans that send us in the paper and
multiple copies of the paper, we are still going to have to
take those records, ingest them through some scanning system
that we have in place and put them into VBMS.
Right now, as I stated before, we are only at 20 percent
done with that right now. We still have 80 percent to go, and
it is probably gonna take us about a year to get the ones that
we have in. Meantime, a million new ones are gonna come in, in
the same status. So it is a never ending problem that is always
gonna be there.
One of the future things that we have in VBMS is if you go
into my eBenefits right now and you file a claim, you can see
when your claim is filed. But what you can't see is, have we
received your records, what is the status of your claim. Future
upgrades of VBMS--I think it is December, 6.0, will allow the
veteran to see when the claim arrived, what the status of their
claim is, and the VBMS software has built into it right now for
the scanning--if you--scan a document and a medical record and
then 6 months later you send us the same medical record, the
system will identify it that there is a duplicate of that
record, because it is a semi-intelligent system, and will
prevent that new record from going in.
What it doesn't prevent is when it arrives, the clerk that
gets it doesn't know that it is already in there, so somebody
has to take that record and get it to the scanning operation,
re-scan it, and then once it is there we realize we already
have it.
It will prevent having extra records, but we don't know how
to prevent the work in the first place other than to notify the
veterans, please go online, my eBenefits, register, look. You
will see that we did get your file. You will be able to
actually go online and look at your file.
Right now I can go into my eBenefits--I went in there last
week--and I was missing one of my personal files from my time
in the Army. And through my eBenefits, I linked into my Army
electronic record, was able to get the personal file downloaded
and ship it over to the VA.
It is still a little complicated, but we are getting better
and better at it, Congressman.
Chairman Miller. Dr. Roe?
And then Mrs. Kirkpatrick.
Dr. Roe. Thank the Chairman.
And thank you all for being here. It is good to see you all
again.
And just a couple or three quick things. One of the--as Mr.
Scott and Barbara both mentioned, the most common thing that a
Congressman, probably everybody up here has, are a backlog of
VA claims--why can't they get adjudicated quicker?
And I know these 800,000 claims are likely a hodge podge of
World War II, Korea, Vietnam, Desert Storm and so forth. So I
think that is correct.
How many of those are in an electronic format where you
could actually look at them, that you have scanned them in?
Where are they? That is one.
And then the second question that I still want to get an
answer to that I am still not sure I do. I know that the DoD
has an orphaned electronic health system, and they are going to
have to replace either the software or do new hardware
upgrades.
I think what everybody has asked but is still not clear to
me is that when a young soldier, an 18-year-old soldier takes
the oath and goes into the military, will that system that the
DoD has, is an electronic record, be able to transfer directly
to the VA and speak seamlessly to the VA when we have spent
billions of dollars--we just spent a billion and we couldn't do
that. It just didn't happen.
So is that gonna happen? Because it is not clear to me--I
have heard yes or no on that yet. So those are two questions I
have.
Secretary Woodson. So maybe I can respond to the last
question first and then my VA colleagues can respond to your
questions to them.
The answer is yes. And that is why we have got to
concentrate on the data interoperability.
Dr. Roe. Yes. And then when?
Secretary Woodson. So, again, by the end of 2013 and
rolling out in 2014. And, again, I will show you the
functionality if you would like, as to what that means.
So the answer is yes.
It is important to understand that we will always be
evolving system, and we have to communicate, again, with the
private sector. Many times this morning we have talked about
the loose paper and issues relative to what we need to capture
from the private sector. So it has got to be about data
standards so that we can transfer information rather than what
systems and when it is on, because we will never get the entire
Nation to be on the same system.
Dr. Roe. Correct.
Secretary Woodson. But we do need to capture that data.
Dr. Roe. One last thing, Mr. Chairman, just--and I will
yield my time back--is one of the things the VA is doing I
think is very good is the video conferencing for VA--for
veterans who want to appeal. We did our first one in the
district the other day. So that a disabled veteran doesn't have
to go to Nashville and then drive to Washington, D.C. You can
video conference that.
And that will save tons of money, make it much easier. So I
want to commend you on doing that and encourage you to continue
to do that.
I yield back.
Chairman Miller. Ms. Kirkpatrick--then Mr. Kilmer.
Ms. Kirkpatrick. Thank you, Mr. Chairman.
My question to the panel has to do with immediate mental
health treatment. Twenty-two veterans commit suicide every day.
Every time a new patient goes to the VA they have to go through
the enrollment and eligibility process, which includes a
physical exam. Oftentimes, this physical exam takes 2 months or
more to set up, and this includes patients who need immediate
mental health treatment.
My VA caseworker is contacting hospitals directly to
schedule these emergency physicals for these veterans who need
immediate treatment.
I know the Department of Defense does a quick evaluation
before discharge, but there is no direct handoff of that
evaluation to the VA. So my question is, how can the VA and the
Department of Defense work together? What kind of system has to
be put in place as soon as possible to make sure that these
veterans get their immediate mental health treatment?
Secretary Petzel. Congresswoman Kirkpatrick, let me just
address the emergency part of this. If someone has an urgent or
emergent medical--mental health condition, they will be seen
immediately. They don't have to have a physical, they don't
have to have anything else. They will be seen and evaluated for
that mental health condition.
And if it should transpire that they need to be admitted,
et cetera, they can be admitted. The rest of the work in terms
of determining eligibility, et cetera, will occur.
I would like to talk personally with you about the specific
cases. If they are something less than urgent or emergent,
then, yes, there is a step process that one goes through, but
it can be done in a pretty expeditious way.
Ms. Kirkpatrick. Let's follow up, because evidently it is
not happening. And it may be the criteria that is used for what
is an emergency. So----
Secretary Petzel. I would be delighted to talk with you
about it.
Ms. Kirkpatrick. The response from the Department of
Defense, please?
Secretary Woodson. Yes, I think previously in testimony,
both Dr. Petzel and I talked about integrated mental health
strategy, warm hand-off, case managers that handle
servicemembers with identified mental health problems that need
immediate and follow-up care.
So I think over the last couple of years, we have really
enhanced greatly identifying individuals who have particular
mental health problems that need to be seen right away, and
making sure that they get to those----
Ms. Kirkpatrick. Doctor, let me ask, with that evaluation
that is done right before discharge is there any way to make a
quick hand-off of to the VA of that information and the results
of that?
Secretary Woodson. Absolutely. We do that. We transfer----
Ms. Kirkpatrick. That is being done?
Secretary Woodson. Yes. We transfer those----
Ms. Kirkpatrick. It--okay.
Secretary Woodson. --records.
Ms. Kirkpatrick. I yield back. Thank you for the courtesy,
Mr. Chairman.
Chairman Miller. Mr. Kilmer and then Mr. Nugent.
Mr. Kilmer. Thank you, Mr. Chairman.
My question is for Dr. Petzel and Mr. Pummill. Obviously,
admirably, many employers have shown leadership in hiring those
who served.
But I want to raise a concern that I have heard over the
years from servicemembers reintegrating into civilian life who
have reported that their military or veteran status has
occasionally been used against them in the pursuit of
employment or in the pursuit of housing, with employers or
landlords raising concerns--raising from fears that someone
would potentially get redeployed or--and in some cases, folks
raising concerns about things like post-traumatic stress.
In my state, I work with a coalition of veterans' groups
and a bipartisan group to try to address this and expand
nondiscrimination protections in our state.
I was hoping if you could briefly tell us if you are aware
of this type of discrimination against veterans and returning
servicemembers?
Mr. Pummill. Congressman, I have heard that kind of stuff
anecdotally, but I can't relate a specific incident. I do know
that there was a bill being pushed forward about
antidiscrimination against veterans.
And from a VA perspective, we are advocates of veterans. We
are very supportive of any efforts in that area. We haven't had
a chance to study the bill yet.
I haven't actually seen it, but because of the subject
matter discretion--discrimination, it would probably be an
Office of Personnel Management and Department of Justice would
have to be giving the opinions on that. But from a VA
perspective, we support it.
Mr. Kilmer. Thank you.
Secretary Petzel. I would, Congressman, just make a
comment. The VA has developed an educational package for
employers that we use often at the employee forums that we have
around hiring veterans that tend to debunk, if you will, the
myths about veteran employees around mental health issues, as
well as the rest of the issues that might arise, as you say,
because of someone's veteran status.
We are trying, working very hard to have employers
understand that these are excellent employees. They are very
well trained. They are disciplined. They are used to working
hard and they are bright and they can contribute tremendously
to a workplace.
Mr. Kilmer. Thank you. I certainly agree with you and I am
hopeful we can have more comprehensive protections. We will be
getting a copy of that bill to you. Senator Blumenthal and I
are working on a bill together and we will get that to you.
Thank you.
Chairman Miller. Mr. Nugent and Ms. Duckworth.
Mr. Nugent. Thank you, Mr. Chairman, and I want to thank
this panel for your service to our country and what you do for
our veterans. And being a father of three veterans currently
serving, I do appreciate it.
But one of the things I hear, and I have about 100,000
veterans in my district, is that the vernacular between doctors
and claim processors sometimes does not match up, which causes
them issues when it goes to VBA, because they are looking for
certain key words as they are scanning through it, because
there is so much there.
And I understand that. So my question to you is what are we
doing to try to marry up or delineate the vernacular so it
doesn't cause our veterans the problem? Because we know what
the doctor's intent is. They go to the VA, but they haven't
filled out the form with the proper wording and then it gets
kicked.
What, if anything, are we doing to address that?
Secretary Petzel. Thank you, Congressman Nugent. And you
have articulated an issue which, in the most part, is in the
past.
The development of the disability questionnaires, we call
them DBQs, that are to be filled out by the VA doctor or the
private doctor, basically answer all the questions. So there is
no ambiguity in terms of the language. And a rater can take
that DBQ and can do the rating basically from the DBQ, because
it forces the clinician to answer the questions in a fashion
that will be understood by the rater. I would ask Mr. Pummill
if he has any other comment about that?
Mr. Pummill. I would agree with Dr. Petzel.
Mr. Nugent. Let me ask you this question I have. I don't
mean to interrupt, we have a short time. Is that currently
being done, particularly with docs at the VA, believe it or
not, that is part of the problem. We are hearing that
specifically today, still.
Secretary Petzel. Yes, it is. And the other thing that I
wanted to add is that we have, in the main, a separate group of
physicians that do--and providers that do pension and
compensation exams that are trained in the vocabulary, if you
will, of claims and adjudication.
I can't say that there isn't an occasional issue or
problem, but in the main, these two systems I think work very
well together.
If you have a specific instance, I would love to talk to
you about it and see if we can find out what happened.
Mr. Nugent. Thank you, sir, very much. I yield back.
Chairman Miller. Ms. Duckworth? Then Mr. Gibson.
Ms. Duckworth. Thank you, Mr. Chairman. Well, I first want
to just note that it is very clear that this panel is very much
dedicated to our military men and women and to our veterans.
Many of you have your own military service, decades of military
service, as well as your decades in civilian service.
I just have to note that we have in our midst General
Wright, who is the first female helicopter pilot in the
National Guard. And women in aviation stand on your shoulders.
So thank you for that.
Mr. Warren, I think it is widely known that VA's chief
information office has had many successes in terms of the
delivery of PMAS and other cost-saving measures and new
systems.
I want to make sure that we, as members of Congress, are
doing the right thing in terms of how we work with you, both
Mr. Warren and Mr. Kendall, in developing the electronic--
integrated electronic records system.
I would like Mr. Warren to answer first and then, if we
have time, Mr. Kendall. What can we do to help with this
process as members of Congress? Are there--you mentioned,
specifically Mr. Warren, there are a lot of reports that you
have to do that take up a lot of time.
But are there other things--restrictions on decisions you
are making, budget authority? Are there different colors of
money, developmental money versus acquisition money? What is
there that Congress can do to help you move forward with this
effort?
Mr. Warren. Thank you for that question and the offer. I
would say that holding--continuing to hold us accountable for
progress is key. And I think a lot of the effort and a lot of
the overcoming of institutional barriers has been a result of
the interest and the desire to make sure we do not only what is
right for our servicemembers and for our veterans. So thank you
for that and I believe that is important.
The challenge we are facing today is that there is language
that constrains where we can execute dollars. It is pretty
acute on the VA side. We have made a commitment to make
deliveries by the end of December and by 1 October next year.
Those are at risk because of some of the constraints on us with
respect to execution.
There is an ask for plans. Those are in process to be
delivered up to the appropriate Committee staff for their
review. And any help that we could get on making sure those get
cleared so we can continue to make that critical progress would
be greatly appreciated, ma'am.
Ms. Duckworth. Could you provide that information to my
office in writing at a later time?
Mr. Warren. I would be glad to, ma'am.
Ms. Duckworth. Thank you.
Mr. Kendall, just----
Secretary Kendall. If I may, Mr. Chairman, what I would ask
from you is that you not over-constrain us. So I am very
concerned, as I mentioned in my opening statement, about some
of the language in various bills right now.
But essentially we have to take some steps to get this
program on track, these programs on track, that if we are
overly constrained it will be very, very difficult for us. I
need a little bit of time to sort a few things out. I have just
recently been asked to take over this by the Secretary.
For example, tying us to a strategic plan that was written
last fall, which is very much overcome by events now, is not
particularly helpful, I am afraid. It was only submitted to
Congress relatively recently, but that plan does not really
reflect some very fundamental changes that have been made since
it was initially written.
So there are things like that that would--that kind of tie
our hands. There are also a lot of reporting requirements. We
have no problem with keeping the Committees informed. We are
happy to do that.
The withholds that are in some of the language, I think,
also, are becoming increasingly problematic for us. And
particularly, right now for VA, that is a concern we have that
is somewhat imminent.
So I am--we are very happy to work with the Committees,
very happy to work with the members and their staffs, and to be
very transparent about what we are doing, but we ask that, in
return, you be--relieve some of the constraints that you have
in mind right now and allow us to take the best path forward
and give us the opportunity to explain that to you.
Ms. Duckworth. Thank you. I yield back, Mr. Chairman.
Chairman Miller. Mr. Kendall, I appreciate your comments
and the fact that you just came on board, but there were people
before you, there is time before you, and there were billions
of dollars spent before you.
Mr. Gibson? Then Mr. Johnson.
Mr. Gibson. Thank you, Mr. Chairman. I appreciate very much
your leadership and I found this hearing very helpful this
morning. Thank you to the panelists for your leadership and
your commitment.
The single integrated health care record, something that we
are all endeavoring towards. I am the author of a bipartisan,
bicameral bill to hold us towards that end, towards Mr.
Warren's comment just moments ago.
And my question may have been answered, but I want to just
offer it again to see if there might be further clarification.
It has to do with Mr. Kendall's opening remarks where he
alluded to onerous language. And I just heard a listing.
And I also heard Mr. Woodson, earlier he mentioned that it
would have been helpful if the language included clinical
input. I appreciate those remarks. And so, I guess I will ask
Mr. Kendall, is there anything else that you want to highlight
when you were talking about onerous language?
Because we are trying to strike a balance here between, you
know, not getting in the way of somebody trying to get to where
we all think we need to go, and at the same time what Mr.
Warren said, that we have got to hold everyone accountable
because the American people expect it, and of course they
should. So Mr. Kendall?
Secretary Kendall. Thank you, Congressman. It is a good
question. I would like to take it for the record in order to
give you a more detailed answer. We have been reviewing the
language. I am a lawyer. I respect lawyers more than most
people perhaps. I would like to have our lawyers have a chance
to take a look at it because there is some language in there
that isn't quite clear to us what the intent is or what it
really does to us.
I would like to give you a response for the record that
just kind of lays out specifically what it is that we might
have a problem with, if that is all right with you.
Mr. Gibson. I do appreciate it, and of course that would be
fine. I just want you to understand that part of the reason why
we are concerned is because we think we are all moving towards
that same objective, and then we get these comments that, well,
we are--it appeared to us like we are taking a step back. Now
we have gotten some further context about that. But what we
really want to do is just make sure we all get up on the
objective because we know we need to get there. So thank you. I
look forward to receiving that for the record. And with that, I
yield back, Mr. Chairman.
Chairman Miller. Mr. Johnson, then Mr. Wittman.
Mr. Johnson. Thank you, Mr. Chairman. And thank you all for
your service to the Nation. Mr. Petzel and Pummill, I would
like to ask, are you aware of the situation in Atlanta where
three mental health patients were--ended up dead and poor
recordkeeping and poor management has been cited as one of the
reasons for that?
Secretary Petzel. Yes, sir. I am aware.
Mr. Johnson. And are you aware of the allegation--and it
may be a fact--that a former top administrator at the Atlanta
VA medical center received performance bonuses over a 4-year
span as internal audits revealed lengthy wait times for mental
health care and mismanagement that led to the deaths?
Secretary Petzel. I am not specifically aware of the track
record or the award record for senior managers there, but I
certainly can find out.
Mr. Johnson. How about you, Mr. Pummill?
Mr. Pummill. No, Congressman. I wouldn't be involved in the
Veterans Health Administration. I work over at the Veterans
Benefit Administration.
Mr. Johnson. Okay. Well, Dr. Petzel, do top administrators
at the VA still receive bonuses?
Secretary Petzel. Congressman Johnson, yes. Some of the top
administrators in the VHA, which is what I can speak for, do
receive bonuses. They have been dramatically reduced. We call
them awards, not bonuses. They have been dramatically reduced
by almost I believe 50 percent over the last 3 years. But yes,
there are some people who do receive awards.
Mr. Johnson. And those awards would be based on what?
Secretary Petzel. On their performance. They have--all
senior executives have a performance contract and the awards
have to be based upon the performance in relationship to their
performance contract.
Mr. Johnson. And who or what entity determines who gets the
awards?
Secretary Petzel. Well, the recommendation for an award,
sir, is made by the supervisor of the individual. And that then
works its way up through the administration. It would pass in
the case of the Veterans Health Administration through me up to
the department level. And eventually, all the awards are signed
off on at the department level.
Mr. Johnson. I see. And so approximately how many awards
have been granted for the 2013 fiscal year?
Secretary Petzel. I would have to take that for the record,
Congressman. But the awards I think that we are talking about
would be administered after the end of the fiscal year. They
are based upon the performance during this fiscal year, which
would be 2013. So technically there would be no awards that
have been administered yet.
Mr. Johnson. I see. What about 2012?
Secretary Petzel. I would have to take that back for the
record, sir. I do not have that on my mind.
Mr. Johnson. All right. And I yield back. Thank you.
Chairman Miller. Mr. Wittman?
Mr. Wittman. Thank you, Mr. Chairman. Panelists, thank you
so much for joining us today. I want to ask, if you would, to
just limit your responses to yes or no so I can get through
these questions.
I will begin with Secretary Pummill. With appropriate
privacy release consent, are you willing to work with pro bono
law schools like the College of William and Mary's Veterans Law
Clinic and let them inside the benefit claims process?
Mr. Pummill. Yes.
Mr. Wittman. Secretary Warren, is a recently discharged,
combat-wounded soldier flagged in a system in a way that their
claim is streamlined electronically for immediate review and
processing?
Mr. Warren. Sir, I can't answer that question. But I will
get it for the record, sir.
Mr. Wittman. Okay. Thank you. Secretary Warren, again, you
know, you heard from Mr. Runyan, with today's technology, we
can pull records faster than we can in the past. The VA's
internal procedure is to wait 60 days after requesting a
record, and then an additional 30 days to follow up. Ninety
days of waiting. This is your procedure. Yes or no. Can you
change it and reduce the time?
Mr. Warren. I believe testimony will show that for
individuals on active duty that are going through the
transition, we have changed that. But because of the duty-to-
assist requirements--and Mr. Pummill can answer that better
than I can in terms of what legal and legislative requirements
are with respect to that. But glad to get you a more detailed
answer for the record.
Mr. Wittman. Okay. I would like just a straightforward yes
or no. Seems to be pretty significant. Can you or can you not
reduce the time?
Mr. Pummill. Yes.
Mr. Wittman. Okay. Thank you. Secretary Woodson, you are
discharging servicemembers who you know have serious injuries.
Amputees, suicidal PTSD patients. Yes or no. Do you communicate
with the VA to prioritize these veterans and ensure they have
the proper paperwork transitioning to the VA?
Secretary Woodson. Yes.
Mr. Wittman. Also, can a veteran with no recorded--and I
will ask this of the VA panel members--can a veteran with no
recorded medical history documenting a service-connected
disability claim something as service-connected in a VA claim
years, even decades after the fact, for an injury that very
well could be connected with aging?
Mr. Pummill. Congressman, I can't answer that with a yes or
no. Sorry. You could have something in our personnel record or
your dental record or a buddy statement, or in the case of
military sexual trauma, change in performance that would allow
you to make a claim later on in your life.
But for most cases, unless you have something in your
medical record that is--substantiates a disease, injury or
illness that occurred during active duty or a period of active
duty for the Guard or Reserve, you would not be able to file a
claim.
Mr. Wittman. Okay. Very good. Thank you, Mr. Chairman. I
yield back.
Chairman Miller. Mr. Langevin?
Mr. Langevin. Thank you, Mr. Chairman. I want to thank our
witnesses for their testimony today, and especially appreciate
the update on the move to complete the project of transitioning
over to electronic medical records and hopefully once and for
all significantly reducing or eliminating the backlog that our
veterans are facing.
It is one of the number-one complaints and problems that I
hear from among veterans in my district. So I do thank you for
your work on that, and I hope that the project is completed as
expeditiously as possible. The--obviously, the issues that are
under discussion today are of course of critical importance and
interest to all of us, and we certainly appreciate our
witnesses sharing their expertise with us today. I want to
focus on the path through the DoD and VA system for veterans
suffering from neurological traumas such as TBI and spinal cord
injury.
And I wanted to ask if you can describe for us how their
treatment and benefit trajectory varies from the baseline and
what supplemental assistance is available other than normal
benefits for those no longer able to move around comfortably in
their homes.
And let me say that in response to unmet needs that
veterans organizations throughout--that are brought to my
attention, I have introduced what is called the Veterans Home
Buyer Accessibility Act last Congress to aid our injured
servicemembers, modify their homes to ensure that they are
accessible. And I certainly plan to introduce it again in this
Congress. Has there been an examination of benefits shortfalls
specific to neurological traumas, particularly with regard to
adaptive modifications to homes? So if you could take both of
those questions.
Secretary Petzel. Congressman, I can begin. The VA does
have an adaptive home modification program. Substantial--
thousands, I think even tens of thousands of dollars can be
spent on modifying a veteran's home for mobility with, you
know, within that home. I am not aware of the fact that there
are restrictions or shortfalls in the benefit. And I would
certainly like to work with you directly to find out exactly
what those shortfalls are. We are not aware of them.
And I would ask Mr. Pummill if he has any other comments,
because VBA does administer some of those programs.
Mr. Pummill. No, Congressman, I am not aware either. But
what I will do is I will get with our veterans service
organizations, our partners out there. They are our eyes and
ears in America, provide us good information on veterans, and
see what they have to say and what they can provide back to us.
And I would just like to add, too, that, you know, as we
are making progress on the backlog because of the assist we are
getting from DoD, it is tri-fold. It is VA. It is DoD. And it
is the veterans service organizations helping us get DBQs,
fully developed claims, talking to veterans, doing the things
that we need to do. So, they help us a lot and I will see what
they can provide me.
Mr. Langevin. That would be very helpful. I appreciate
that. Thank you.
I yield back.
Chairman Miller. Thank you very much, Mr. Langevin.
Thank you to the witnesses for being with us for a little
over 2 hours. We certainly appreciate that.
I thank all the members that were here today to ask some
very pertinent questions. I would ask unanimous consent that
all members would have 5 legislative days with which to revise
and extend their remarks and add any extraneous material,
subject to the hearing topic today.
And without objection, so ordered.
And with that, this hearing is adjourned.
[Whereupon, at 12:11 p.m., the Committees were adjourned.]
A P P E N D I X
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Prepared Statement of Hon. Jeff Miller, Chairman
Good morning. Welcome to this joint hearing of the Committees on
Veterans' Affairs and Armed Services. I also welcome Chairman Buck
McKeon and Ranking Member Adam Smith and, of course, my friend from
Maine the Ranking Member of the Veterans' Affairs Committee, Mike
Michaud.
This is the second time in two years that these two Committees on
which I am proud to serve have met jointly to review the collaborative
efforts of the Departments of Defense and Veterans Affairs in assisting
servicemembers with their transition from active duty to civilian life.
A year ago we were privileged to have Secretaries Panetta and
Shinseki at the witness table. Both of them testified at length
regarding the progress VA and DoD were making in several key areas. I'd
like to revisit two of those areas in my opening statement. First, the
progress made in developing an integrated electronic health record.
Second, the progress made in reducing the wait times associated with
veterans' disability claims, which necessarily involves cooperation
from DoD in the transfer of records.
I'll start with the electronic health record. In response to my
direct question at last year's hearing Secretary Shinseki remarked that
the two departments had finally, after 17 months of discussion, agreed
on a way forward on a ``single, joint, common Integrated Electronic
Health Record'' that would be completed by 2017. The Secretary told us
that each of those words - single, joint, and common--meant something,
and that finally we were breaking through the cultural issues between
the two departments that had stifled progress in the past.
What a difference a year makes. Contrary to the Secretaries'
testimony, the two departments are, once again, moving on their own
tracks, with promises we've heard before about making two separate
systems ``interoperable.'' Pardon my frustration, but it seems the only
thing interoperable we get are the litany of excuses flying across both
departments every year as to why it's taking so long to get this done.
In response to this latest course correction, the House included an
amendment to the National Defense Authorization bill, an amendment
developed in collaboration with the leadership of the Armed Services,
Veterans' Affairs, and Appropriations Committees, to direct the
completion of an integrated health record by October 1, 2016. The
message of the amendment is simple: No more excuses, get this done. I'm
anxious to hear from our witnesses how they'll comply with the mandate
of the amendment once it is enacted into law.
The second issue I'll briefly touch on is the disability claims
backlog. It's interesting to note that the progress made in reducing
the pending inventory of claims the last few months correlates with the
heightened Congressional oversight and media scrutiny. Well, none of us
up here are going to take our foot off the gas when it comes to
ensuring progress on the backlog. And although progress has been made
lately, VA is woefully short of its own goals for the year.
Going forward, ending the backlog necessarily requires a seamless
records transfer from DoD. I look forward to hearing the status of
those efforts and what more can be done. This problem of veterans
waiting years for their disability claims to be decided must remain at
the forefront of our consciences, especially as further troop draw
downs occur over the next five years. It, too, is an issue where the
excuses must end, and real, sustained progress must occur.
Very quickly, just a bit of housekeeping before we proceed. To
accommodate such a large contingent of members we have agreed to last
year's framework that limited to 2 minutes each member's time to ask
questions of the witnesses. Therefore, I ask unanimous consent that
each member have not more than 2 minutes to question the panel of
witnesses, starting with my own questions. Without objection, so
ordered.
Further, I ask unanimous consent to include all Member statements
in today's hearing record. Without objection, so ordered.
I now recognize Chairman Buck McKeon for his opening remarks to be
followed by Ranking Member Mike Michaud, and then Ranking Adam Smith
for their opening remarks.
Prepared Statement of Hon. Michael H. Michaud
I want to thank the Chairs of the House Committee on Veterans'
Affairs and Armed Services for holding this joint hearing today.
Transition is a critical issue that greatly affects our servicemembers
and veterans.
This hearing is the second joint hearing our two Committees have
held concerning transition. The purpose of this hearing is to reiterate
our joint oversight commitment, and ensure that VA and DoD work
together on behalf of the men and women who are sent into harm's way.
At last year's joint hearing on this topic, the two Agency
Secretaries appeared before us, sitting side by side. I am disappointed
to see that neither is here today. I take this lack of personal
engagement as a sign that they care less, that they are not as
committed, that they have delegated - abdicated - ownership of this
issue. My disappointment is solidified by receiving testimony in the
eleventh hour. Clearly, this issue, and this hearing, is not a
priority.
I would submit to you that the government has struggled to fulfill
the ``sacred trust'' to care for those who have served and sacrificed
in defense of our Nation. After twelve years of war, we know transition
is the critical first step, and it requires the cooperation of many
agencies to accomplish successfully. I do not believe we have made any
measurable progress in getting the two agencies before us today to work
more effectively together.
The Department of Defense has announced it will put out to bid for
a new system to manage its health records. Such a decision appears to
back an interoperable approach over an integrated one. An integrated -
integrated, not interoperable - electronic health record is something
that Congress mandated years ago. We have spent hundreds of millions of
dollars. Delaying the delivery of an integrated - that is integrated,
not interoperable - information sharing system runs directly against
Congressional intent, and ultimately hurts our veterans.
Also, of particular importance to our Committees is the claims
backlog. Let me be clear, both VA and DoD have a responsibility to end
the backlog by 2015. The claims backlog is not a ``VA issue''. DoD must
do a better job of transferring veteran and servicemember's records to
VA in a timely and complete manner.
This includes the records of our National Guard and Reservists. It
also includes late and loose records being sent to VA.
Because benefits and health care affect so many servicemembers and
veterans, DoD and VA must put aside their parochial differences and
work more effectively together to ensure an integrated - that's
integrated, not interoperable - process addressing transition issues.
Over the course of the last several months we sent letters to the
Secretaries, and the President, asking for their personal commitment
and support. We requested concrete decisions be made in a timely
manner. What we received in response is a no-show to this hearing, and
a press conference that kicks the decisions down the road . . . again.
And, it would appear that leadership is lacking not just at this
hearing. During a recent Roundtable on the iEHR, industry leaders told
us progress is not due to a lack of available technology solutions, but
rather a lack of leadership. When two divisions in their companies
can't - or won't - agree, the CEO steps in and mandates a direction.
Where is DoD and VA's ``CEO''?
Just recently, in a bi-partisan effort and due to ongoing
congressional concerns with the lack of a unified vision between VA and
DoD electronic health record programs, language was included as part of
the National Defense Authorization Act for 2014. This language created
a deliberate approach in developing a joint electronic health record.
I am told that strategies have been modified and collaborative
efforts are ongoing for both records transfer and iEHR. However, months
continue to go by with seemingly no real progress.
I look forward to hearing from our panelists today just how far
they have come, and to learn about the path ahead on the transition
issues that are the focus of this hearing today.
Thank you and I yield back.
Prepared Statement of Hon. Corrine Brown
Thank you, Messrs. Chairmen and Messrs. Ranking Members, for
calling this hearing today.
I believe it is our duty as Americans to provide proper care for
our veterans and servicemen who have unselfishly put their lives on the
line for our wellbeing. This starts with health care. Time has shown
that we, as Members of Congress, and Senior Leadership of the
Department of Defense, and Department of Veterans Affairs' have not
been able to provide timely compensation for the work our servicemen
and women did to defend this Nation from all enemies. While the VA has
made incredible progress with its initiative to resolve all claims
older than two years and now one year, there are still too many claims
not being resolved in a timely manner.
Secretary Hagel has stated that with the majority of claims being
made for those veterans who served previous to Iraq and Afghanistan
both the DoD and VA need to:
Certify service treatment records so that claims
processors know not to hold up processing to request additional
records.
Hold data-sharing summits every six weeks to look for
ways to improve DoD and VA practices.
Conduct separation health assessments to establish
baseline medical conditions, which will speed future disability
benefits claims.
Improve the format of DoD service treatment records so
that they are portable and can be quickly scanned by other users.
I am concerned that while talking about pursuing these goals, the
DoD is not fully behind the plan. Earlier this year, the DoD pulled out
of joint program with the VA to develop one computer system that would
be able to be used by both departments.
Just the other day, there was an article in the Washington Post
regarding a company that created a back-end computer program to have 6
separate accounting programs be able to talk to each other. It cannot
be that difficult to do what you each propose.
Both the DoD and VA have a full understanding of what needs to be
done to fix this issue with the integrated electronic health record
program (iEHR), but, efforts to progressively move this program forward
have proven diligently slow. You must put forth a greater effort to
ensure that these veterans are awarded their benefits in a timely
manner and their health care is seamless. I am resolute in my
commitment to ensure the DoD and VA work toward their shared goal of
achieving full interoperability of health care records. It is
imperative that the DoD and VA make progressive moves together to
ensure an effective system is ran between both agencies that will
produce consistent service for our current servicemen and veterans.
Prepared Statement of Hon. Frank Kendall
Chairman McKeon, Chairman Miller, Ranking Member Smith, Ranking
Member Michaud, and distinguished members of the Committees, thank you
for extending the invitation to discuss the recent actions that the
Department of Defense (DoD) has taken to assist the Department of
Veterans Affairs (VA) to eliminate the disability benefits claims
backlog and our collaboration on the integrated Electronic Health
Record (iEHR) program. Although DoD is currently operating under
significant resource constraints as a result of sequestration,
including civilian furloughs, DoD will continue to work in conjunction
with VA to provide exceptional care and services for America's service
members and veterans. Thank you for your attention to this issue and
for your continued support of our active and reserve component military
members, and their families who serve with distinction every day and
who deserve the best medical care and treatment as both service members
and as veterans.
BACKGROUND - VETERANS' DISABILITY BENEFIT CLAIM BACKLOG
Veterans' benefits are a vital extension of a holistic benefits
package to sustain an all-volunteer force. DoD and VA are committed to
working together to provide continuous, accessible, and quality health
care for America's active duty military and veterans. When a service
member completes his or her service obligation and separates from the
military, DoD is responsible for ensuring that they are seamlessly,
efficiently, and quickly transitioned to the care of Veterans Affairs -
with all of their records.
DoD currently provides VA with electronic access to approximately
98 percent of the required personnel and administrative data for claims
adjudication, including electronic ``read-only'' health records, and we
meet together on a regular basis to close the gap on the remainder. We
provide VA access to scanned images of all personnel records (including
available DD Form 214) through a DoD data system web portal, and we are
taking action to provide Veterans Benefits Administration employees
with enhanced access to our electronic medical record data. DoD has
electronically provided VA with the health data of more than 5.9
million servicemembers who have separated since 1989. The ability to
access and view this data has existed between all DoD and VA medical
facilities on 4.7 million shared patients since 2007. Building upon
past successes in real-time data exchange, the Departments have sought
to go beyond point-to-point interfaces between their systems and to
establish full data interoperability. Achieving interoperability will
mean the Departments will use a common taxonomy that provides access to
human and machine-interpretable data by doctors and patients anywhere,
anytime. Health care record transfer from DoD is not a major factor in
VA's current backlog.
Over the last few months, both Secretary Hagel and Acting Under
Secretary Wright have met with and listened carefully to the concerns
and input from DoD's health care providers, leaders from the VA, and
Veterans Service Organizations and Military Support Organizations.
Their input has been vital to ensuring that our service members and
veterans receive quality care, and their input has been very helpful in
defining a path forward.
On May 22, 2013, the Secretary of Defense and the Secretary of
Veterans Affairs met with Senator Mikulski and the Senate
Appropriations Committee on Defense in a roundtable discussion
regarding the disability benefits backlog and we provided an overview
of our actions to support VA.
Most recently, on July 2, 2013, the Secretary of Defense, Under
Secretary Kendall and Acting Under Secretary Wright met with Secretary
Shinseki, Dr. Robert Petzel, the Director of the Veterans Health
Administration and Ms. Maureen Coyle, the VA Deputy Chief Information
Officer, to ensure that the efforts of both of our Departments are
aligned and that appropriate progress is being made to address the
backlog issue. Our meeting agenda specifically focused on our mutual
efforts to help VA reduce the veteran disability benefit claim backlog,
veteran homelessness, and our electronic health record systems.
DOD EFFORTS TO ASSIST VA WITH THE BACKLOG
The most important thing DoD does to help VA process claims is to
provide VA with the information that it needs. DoD provides information
to VA in both electronic and paper form. With the exception of some
records from visits to private health care providers since 2004,
medical records have been transferred as electronic records. DoD
provides Service Treatment Records (STRs), personnel and administrative
data within 45 days from when a Service member separates from the
military.
The Department of Defense is working closely with VA to provide any
information VA needs to enable them to complete the processing of
disability claims. In collaboration with VA, we are also refining our
processes by which we provide information to ensure future disability
benefit claims can be processed by in a shorter time.
For example:
DoD has agreed to provide VA with certifications that
STRs are complete with all known information at the time they are sent
to VA. VA claims processors, following established VBA claims
processing protocols, will not have to delay processing to request
additional medical records when the service members' claim is not
substantiated in the record VA has received from DoD. This will reduce
one source of additional claims from adding to the current backlog and
reduce future processing time. Certification began in earnest in April
2013, and, with input from the Director of the Veterans Benefits
Administration, we continue to refine this process.
DoD provided a team of subject matter experts to the
Veterans Benefits Administration in January 2013 to review the
disability claims backlog to analyze cases where DoD has information
that can assist VA in processing claims. The team has been assisting VA
with the most difficult cases. The team has recently shifted to assist
with the oldest claims, those that have been in process for over one
year.
Enhancing direct access to DoD electronic medical record
data is extremely useful to VA in preparing claims for decisions.
Enhanced access can increase VA production rates for any claims which
are awaiting STR information - not just claims in the backlog, but at
any stage in the process. We are fielding the Janus Joint Legacy
Viewer, which will allow both DoD and VA to be able to access and read
the other Department's electronic health records. The Joint Legacy
Viewer is in operation now and will be fully deployed by December 2013.
On July 1, 2013, a DoD Liaison cell comprised of senior military
personnel with medical, administrative and personnel expertise was
placed at VA to assist in the reduction and elimination of the backlog.
This cell was requested by the Secretary of Veterans Affairs and agreed
to by the Secretary of Defense to operate for six months.
DoD has provided VA with approximately 5,000 accounts
giving direct access to the Defense Personnel Record Information
System, which allows disability claims adjudicators access to Official
Military Personnel Files. Additionally, VA also has been provided with
access to 300 accounts giving direct access to the Defense Finance
Accounting Service to validate pay and retirement information. This
same pay and retirement information is also provided daily to the VA
Data Information Repository system.
DoD also provided 15 Service members to the VA Seattle,
WA, Disability Rating Activity Site, in support of an Integrated
Disability Evaluation System (IDES) backlog in May 2013. These service
members provide administrative assistance, which frees up disability
benefits claims processors to speed up the overall IDES process.
DoD and VA convene an Information Sharing Summit (usually
80+ participants from all Services, Coast Guard, DoD and VA) every 6 to
8 weeks to further the electronic exchange of personnel, medical and
administrative information between the two Departments. This summit has
met 5 times since January 1, 2013, to monitor process improvement
events and major system developments to ensure alignment of all efforts
in support of reducing the disability claims backlog and evolving this
interchange to a truly paperless environment.
The Department of Defense has also initiated the following actions
to streamline processes for exchanging information, but these actions
will assist with reducing the processing time for future claims, not
claims in the current backlog:
In January 2013, DoD initiated the establishment of a
Separation Health Assessment (SHA) for all service members who do not
request a disability claim upon their separation from the military.
This assessment will provide VA with the ability to better assess the
basis for a service connection on future disability benefits claims. VA
will continue to conduct the assessment for those service members who
do make a disability benefits claim at the time of separation. DoD will
make the required policy changes associated with this action by the end
of fiscal year (FY) 2013. We have begun to implement the SHA at some
locations and we plan to complete implementation by the end of FY 2014.
In January 2013, DoD committed to accelerate the
deployment of the Health Artifact and Image Management Solution (HAIMS)
in support of a move to a digital environment. Deployment is planned to
be complete by December 2013. HAIMS will consolidate military and
private sector treatment and medical images and artifacts and make them
available for use by VA medical clinicians and VA disability claims
processors, who will be provided with direct access. Once deployed,
this will allow for electronic processing of information; lower
storage, mailing requirements, and manual processing and facilities
costs; and accelerate future claims processing.
DoD and VA will conduct a pilot, beginning in September
2013, whereby a version of the STR will be sent to VA in an electronic
document format at the time a service member attends mandatory
Transition Assistance Program in addition to the certified copy which
is sent within 45 days from when the Service member separates from the
military. This will give VA an archived version of the STR, which VA
believes may reduce the time required to process a future disability
claim by as much as 50 days.
SERVICE MEMBER TRANSITION ASSISTANCE PROGRAM
In compliance with the Veterans Opportunity to Work (VOW) to Hire
Heroes Act of 2011 (Public Law 112-526), and in accordance with the
recommendations of the Veterans Employment Initiative Task Force, the
Department of Defense, Military Departments and our interagency
partners are successfully implementing the redesigned Transition
Assistance Program (TAP). The redesigned TAP, including a new
curriculum called Transition GPS (Goals, Plans, Success), is aligned
with the VOW Act, as codified in in Chapter 58, title 10 United States
Code, which requires all eligible Service members discharged or
released from active duty after serving their first 180 continuous days
or more (including National Guard and Reserves) to participate in Pre-
separation Counseling, Department of Veterans Affairs (VA) Benefits
Briefings and the Department of Labor (DOL) Employment Workshop. While
some Service members may be exempted from attending the DOL Employment
Workshop, as allowed by Congress, every Service member will attend Pre-
separation Counseling and the revised VA Benefits Briefings.
Additional components of the redesigned TAP include specialized
tracks developed for Service members to tailor their transition program
to correspond with their expressed interest in achieving their future
employment goals through Higher Education, Career Technical Training,
or Entrepreneurship. These specialized tracks are being piloted this
summer and will be implemented across the Department of Defense by 1
October 2013. The cornerstone of the redesigned TAP is the concept of
Career Readiness Standards. These standards correspond to deliverables
that all Service members are to meet prior to separation. The value of
the Career Readiness Standards is ensuring we equip our service members
with the tools they need to become valued, productive and employed
members of our labor workforce cannot be overstated. We are, and have
been, fully engaged in implementing the redesigned program.
BACKGROUND - INTEGRATED ELECTRONIC HEALTHCARE RECORDS (iEHR)
In March 2009, President Obama directed the Department of Defense
and the Department of Veterans Affairs to ``work together to define and
build a seamless system of integration with a simple goal: When a
member of the Armed Forces separates from the military, he or she will
no longer have to walk paperwork from a DoD duty station to a local VA
health center; their electronic records will transition along with them
and remain with them forever.'' This directive built on the
Congressional requirement established in the National Defense
Authorization Act for Fiscal Year 2008 for the two Departments to
``jointly develop and implement electronic health record systems or
capabilities that allow for full interoperability of personal health
care information between the Department of Defense and the Department
of Veterans Affairs.'' Our Service members, Veterans, retirees, and
eligible family members deserve nothing less than the best possible
care and service our two Departments can provide. Successfully
achieving the goals articulated by Congress and the President is
fundamental to delivering on our promise to them and we are fully
committed to doing so.
In March 2011, DoD and VA agreed on a joint approach to develop a
single longitudinal health record to be used by both Departments: the
``integrated electronic health record'' or ``iEHR.'' This approach was
intended to meld the Departments' ongoing efforts to improve their
health information technology: firstly, by achieving interoperability
of health data, as sought by the President and the Congress; secondly,
by modernizing their respective healthcare management systems, which
were each in need of replacement or upgrade (i.e., replacing the DoD's
Armed Forces Health Longitudinal Technology Application (AHLTA) and
replacing or upgrading the VA's Veterans Health Information Systems and
Technology Architecture (VistA)). Acting on this decision, the
Departments re-chartered the DoD-VA Interagency Program Office (IPO) -
established by Congress in the FY2008 NDAA to oversee joint data
interoperability efforts - to accomplish this expanded mission.
Together, the two Departments have made important steps toward
achieving health data interoperability between DoD and VA and procuring
the foundations of an underlying joint IT infrastructure. Specifically,
we have:
Made the DoD Health Data Dictionary (HDD), the common
data model used by all DoD medical treatment facilities, openly
available to the nation and initiated VA data mapping to ensure
integrated, common data for all patient information across DoD and VA;
Established the Development Test Center to provide a
testing configuration that emulates the operational healthcare
environment and infrastructure;
Selected a joint DoD-VA Single Sign On / Context
Management (SSO / CM) solution. ``Single Sign-On'' enables a user to
access multiple applications after logging in only once. ``Context
Management'' allows clinicians to choose a patient once during an
encounter and ensure all required applications are able to present
information on the patient being treated. This capability was
successfully deployed to the Development Test Center and is now being
deployed at San Antonio;
Implemented a joint Graphical User Interface (GUI) pilot
at North Chicago, Tripler, and San Antonio that displays information
from both DoD and VA systems;
Completed business process mapping for initial clinical
capabilities;
Developed integrated Program Level Requirements (iPLR),
which detail the functional requirements for the program, e.g.,
laboratory, pharmacy, etc.;
Developed and published the iEHR architecture and
Technical Specifications Package that provide high-level technical and
business requirements to enable a standardized and interoperable
solution.; and
Begun work on a number of data interoperability
``accelerators.''
A SHIFT IN STRATEGY FOR iEHR
In December of last year, Secretaries Panetta and Shinseki directed
a joint review of the iEHR program to simplify and accelerate the
achievement of data interoperability while reducing the cost and
technical risk of what had proven to be a complex and expensive joint
IT development program. This February, they agreed to specific actions
for each Department; these agreements have since been reinforced by
Secretary Hagel. While some may have interpreted this shift in strategy
as backing away from our commitment to achieve an integrated electronic
health record, that is not the case.
For the remainder of this calendar year, the two Departments are
focused on achieving full interoperability of health data through a
series of near-term ``Accelerator'' efforts. These efforts will result
in each Service member and Veteran having a single, seamless, shared,
integrated healthcare record. All patients, and the clinicians serving
them, will be able to access all of their health data, whether the
patient is currently a military member or Veteran and treated at a DoD
or VA hospital. This interoperability will be achieved without
replacing the healthcare management software system for either
Department.
In 2012, DoD made its Health Data Dictionary data model openly
available for use by VA and other interested parties including non-
government healthcare providers. VA will map their data to this
standard, thereby contributing to the establishment of an authoritative
health data source for both Departments by January 2014. This will
fully realize the health element of the President's vision for a
Virtual Lifetime Electronic Record, incorporating all clinical care for
Service members and Veterans into a common, computable and
interoperable health record, accessible wherever care is provided.
For the DoD, achieving data interoperability is also the path
forward to exchanging health information with private healthcare
providers. Today, 65 percent of all Service members', dependents' and
beneficiaries' healthcare is provided outside the military health
network through private providers. Capturing this health information
can only be accomplished through interoperability standards championed
by the Department of Health and Human Services and being adopted by
commercial health care providers. The use of open national standards to
express the content and format of the information, not a single
healthcare management software system, is the cornerstone of seamless
exchange of health information.
Secretaries Panetta and Shinseki also announced that the two
Departments were revising their strategy for modernizing their legacy
healthcare management software systems to use existing EHR technologies
rather than bearing the cost and risk of designing, building and
implementing an entirely new system. The two Departments agreed instead
to use a ``core'' set of applications from existing EHR technology.
Based on this core concept, VA determined that its best course of
action would be to evolve its legacy system, VistA, to serve their
modernization purposes. This decision left DoD with the need to
determine whether modernization based on VA's existing VistA system,
DoD's legacy AHLTA system, or one of the several commercially available
modern healthcare management systems was the best course of action for
DoD.
DoD'S DECISION MAKING ON iEHR
In testimony before the House Appropriations Committee and the
Senate Armed Services Committee on April 16-17, 2013, Secretary Hagel
committed to provide Congress his decision on the Department's
modernization strategy within thirty days. Under Secretary Kendall and
Acting Under Secretary Wright commissioned a team of senior
stakeholders and technical experts to review and assess the options and
to recommend a course of action for modernization. After confirming
that further evolving AHLTA, DoD's legacy healthcare IT system, was not
a viable alternative, the group focused on two alternative courses of
actions: (1) pursue an evolution of VistA as the DoD ``core''
capability or (2) compete a modernization solution from a broader field
of options. This team reviewed existing artifacts, studies and analyses
and received briefings from the IPO and from VA/VHA leadership.
The team concluded and recommended that the DoD and VA continue
their ongoing near-term efforts to develop data federation,
presentation and interoperability, particular through the completion of
ongoing ``accelerator'' efforts. The team recommended that DoD select a
core healthcare management system on a ``best value'' basis.
The DoD assessment characterized the alternatives based on
estimates of life cycle cost, schedule, performance, risk and capacity
for further modernization and growth. The assessment leveraged data
from a formal Request for Information conducted by the OSD Cost
Assessment and Program Evaluation (CAPE) organization. This market
research identified a broad field of existing EHR capability providers,
with exiting commercial products that spanned a range of maturity,
capability, cost and implementation risk. The responses to the RFI
included commercial offerings as well as vendors offering an evolved
VISTA solution, as well as a VA proposal for an evolved VistA offering.
The assessment concluded that a competition provided the best
opportunity for the Department to identify the best value solution -
one that offered advanced clinical capabilities, low adoption risk, the
potential to evolve further as new innovation enters the EHR
marketplace and the potential for significant cost savings.
The Department recognizes that adopting and evolving VA's current
VistA software was a reasonable and sound business decision for VA. The
Department of Veterans Affairs already employs a substantial workforce
and infrastructure supporting the VistA system; VA caregivers are
already trained on the system and its processes reflect the VA's
organization and business practices. Adopting VistA would require the
Department to duplicate these ``sunk cost'' investments by the VA.
While evolving and enhancing VistA was a logical business decision for
VA, DoD faces a very different situation.
The DoD study confirmed that the Department requires a healthcare
software management solution that can operate in its unique medical
environment, interfacing with VA and private sector providers using
open national standards and providing operational medicine capabilities
in a variety of environments, often with limited or no connectivity.
The Department will also require the capability to easily add
specialized modules to address DoD needs, such as battlefield casualty
care, in a timely manner. Given the options available to DoD, the best
course of action for DoD is to conduct a ``best value'' competition
acquisition of a core healthcare management software system.
THE DoD WAY AHEAD ON iEHR
The study team reported its findings and recommendations to
Secretary Hagel in May. This was formalized on May 21, 2013, with a
memo to the Department outlining the way ahead for integrated
Electronic Health Records, and reinforcing DoD's commitment to
providing high-quality healthcare for current Service members, their
dependents and our nation's Veterans. The Department informed the
Congress of the Secretary's decision on May 22, 2013. In his memo, the
Secretary directed the USD(AT&L) to assume direct responsibility for
DoD healthcare records related acquisition programs and to conduct a
full and open competition for the core set of capabilities for DoD
Healthcare Management System Modernization. USD(AT&L) was tasked to
lead DoD coordination with VA on the technical and acquisition aspects
of healthcare records and healthcare management systems.
USD(AT&L)'s first step was to restructure the Department's health
care IT efforts. The former iEHR program is being refocused on two
separate but related healthcare information technology efforts: the DoD
Healthcare Management System Modernization (DHMSM) program, and the
joint DoD/VA iEHR program. Both efforts will be conducted as highly
tailored Major Automated Information System (MAIS) programs. USD(AT&L)
will serve as the DoD Milestone Decision Authority (MDA) for both
programs.
The revised iEHR program will remain focused on the near term goal
of delivering the tools and supporting data infrastructure to ensure
integrated health data can move seamlessly between VA, DoD, and
commercial healthcare providers with initial fielding targeted for
early CY 2014. The IPO is taking the following steps to deliver
seamless, shared integrated health information on an accelerated basis:
Developing and deploying a data management service to
give DoD and VA clinicians access to integrated patient health record
information by the beginning of CY 2014.
Accessing data through a single integrated view to nine
high priority sites by the beginning of CY 2014.
Making standardized, integrated clinical record data
broadly available to clinicians across the DoD and VA later in CY 2014.
Enhancing ``Blue Button'' functionality, which will give
patients the ability to download and share their own electronic medical
record information, enabling them take greater control of their own
healthcare.
The DoD Healthcare Management System Modernization program will
focus on competitively acquiring a core set of capabilities to replace
the DoD legacy Military Health System (MHS) clinical software systems,
including the Armed Forces Health Longitudinal Technology Application
(AHLTA), Essentris, Composite Health Care System (CHCS), and Theater
Medical Data Store (TMDS) systems. The objective is to field a
modernized replacement for legacy systems by 2017.
The USD(AT&L) has designated a Program Executive Officer (PEO) to
oversee both iEHR, which will continue to be executed by the Integrated
Program Office (IPO), and DHMSM. A Program Manager (PM) has also been
designated for the DHMSM program. The PEO will ensure that DHMSM works
in close collaboration with iEHR to ensure compatibility and
interoperability with the standardized healthcare data framework,
infrastructure, and exchange standards being made available via the
iEHR program.
The PM for DHMSM is initiating internal planning activities for
release of a Request for Proposals (RFP) that supports an objective to
achieve full fielding of core DHMSM capabilities. It is crucial to note
that a seamlessly integrated and interoperable electronic health
records with full data exchange and read/write capability can be
achieved without DoD and VA operating a single healthcare management
software system. Just as someone can send and receive the same e-mails
from a range of different e-mail software clients, health record
information can be made available to patients and physicians without
every hospital in the nation moving to a single healthcare management
software system. In fact, private sector experience shows using the
same software does not guarantee information can be shared. By
competitively selecting a core to replace its Legacy Systems, DoD will
have an opportunity to evaluate a range of modern commercial
alternatives in order to determine a best value approach.
FY14 LEGISLATIVE IMPACTS FOR iEHR
Current legislation passed by the House of Representatives
addressing iEHR include Sections 713 and 726 of the National Defense
Authorization Act (NDAA). The Department interprets Section 713 as
requiring a report describing the Secretary's basis for selecting the
preferred alternative. With this interpretation, the Department has no
objection to Section 713 since it allows the flexibility to implement
the Secretary's direction as outlined in his May 21, 2013, memo.
Section 726, however, imposes extensive governance, design, schedule
and reporting requirements and funding withholds that will impede the
Department's ability to compete a full range of commercial solutions
and significantly increase schedule risk and cost. In particular, the
requirement to execute a joint iEHR development program per the Joint
Strategic Plan is counter to the Department's competitive approach.
Setting a deadline for deploying an integrated electronic health record
could preclude a best-value solution. Overly restrictive criteria for
meeting open architecture standards could also disqualify some
effective, commercially developed solutions. The Department has similar
concerns with the Military Construction, Veterans Affairs, and Related
Agencies Appropriations Act which constrains VA funding for electronic
health records. The proposed language, as written, constrains the VA
funding to agreements established prior to the Secretaries new
direction. The Department seeks to work with the Congress to streamline
the multiple reporting mechanisms, conditions and oversight and
advisory functions directed in Sections 713, 726, and the MILCON/VA
Appropriations Act.
CONCLUSION
Chairman McKeon, Ranking Member Smith, Chairman Miller, Ranking
Member Michaud, and members of these distinguished Committees, again,
thank you for the opportunity to testify today. The Secretary of
Defense has taken very seriously the needs and responsibilities of the
Department of Defense to provide first-class healthcare to our Service
members and their dependents, and to enable the seamless sharing of
integrated healthcare records between the Departments of Defense and
Veterans Affairs. The Department is committed to ensure that our
Service members receive the best service we can provide while in
uniform. As importantly, we also have the responsibility to ensure that
this same quality of health care and service is carried through to the
end of a Service members' career when their status changes to civilian
status as a Veteran.
The Secretary remains committed to fully cooperating with the
Department of Veterans Affairs to continue ongoing efforts to create a
seamless electronic health record integrating VA and DoD data in the
near-term. In addition, the Secretary believes a competitive
acquisition to acquire a healthcare software modernization solution
will achieve the best value for the Department's Service members by
evaluating all potential solutions and considering the costs and risks
of the options that will be offered to the Department.
The Secretary and the Department greatly appreciate the Congress'
continued interest and efforts to help us deliver the healthcare that
our nation's Veterans, Service members, and their dependents deserve.
Whether it is on the battlefield, at home with their families, or after
they have faithfully concluded their military service, the Department
of Defense and our colleagues at the Department of Veterans Affairs
will continue to work closely together, in partnership with Congress,
to deliver benefits and services to those who sacrifice so willingly
for our Nation.
We look forward to your questions.
Prepared Statement of Stephen W. Warren
Chairman McKeon, Chairman Miller, Ranking Member Smith, Ranking
Member Michaud, and Members of the Committees, we appreciate the
opportunity to appear before you today to discuss the Department of
Veterans Affairs' efforts to reduce the backlog of disability
compensation claims and to develop an Electronic Health Record (EHR)
with the Department of Defense (DoD).
Disability Compensation Claims Backlog
Today, many Veterans wait too long to receive benefits they have
earned and deserve. That has never been acceptable to the Secretary, or
the dedicated employees of the Veterans Benefits Administration (VBA);
over half are Veterans themselves. VA is implementing a robust plan to
ensure we achieve our goal of eliminating the claims backlog and
improving decision accuracy to 98 percent in 2015.
Over the last 3 years, the claims backlog has grown from 180,000 at
the end of fiscal year (FY) 2009, to approximately 530,000 claims as of
June 19, 2013. To meet the goal of eliminating the backlog by 2015, we
have set to transform VBA into a 21st century organization. VBA's
transformation is demanded by a new era, emerging technologies, and the
latest demographic realities
As background, it is important to note that over 60 percent of the
pending claims are ``supplemental'' claims from Veterans seeking to
address worsening conditions or file for new conditions (``issues'').
Seventy-seven percent of these Veterans are already receiving
disability compensation and are eligible for VA health care.
Additionally, as VA does not limit claims submissions, Veterans can
continue to apply for additional service-connected disabilities while
their claims are pending.
There are several factors that have impacted on the volume of
incoming claims. In 2009, based on all available scientific evidence
and the Institute of Medicine's Veterans and Agent Orange: Update 2008,
VA made the decision to add three presumptive conditions (Parkinson's
disease, ischemic heart disease, and B-cell leukemias) for Veterans who
served in the Republic of Vietnam or were otherwise exposed to the
herbicide Agent Orange.
Due to this policy change, the number of compensation and pension
claims received increased from 1 million in 2009 to 1.3 million in 2011
(a 30 percent increase). In addition, beginning in October 2010, VBA
identified these claims for special handling to ensure compliance with
the provisions in the Nehmer court decision that requires VA to re-
adjudicate claims for these three conditions that were previously
denied. VBA dedicated over 2,300 claims staff to re-adjudicating these
complex claims, which required time-consuming and detailed review.
Nehmer claims for all live Veterans were completed as of April 2012 and
Nehmer survivor claims were completed in October 2012. The claims staff
previously focused on these Agent Orange claims are now working on
reducing the backlog. As of June 19, 2013, VA has processed
approximately 280,000 claims and awarded over $4.5 billion in
retroactive benefits for the three new Agent Orange presumptive
conditions to more than 166,000 Veterans and survivors. Our focus on
processing these complex claims contributed to a larger claims backlog,
but it remains the right thing to do for our Vietnam Veterans, many of
whom waited a long time for these benefits. In 2010, VA also made an
important decision to simplify the process to file disability claims
for combat Post-traumatic Stress Disorder. These decisions expanded
access to benefits for hundreds of thousands of Veterans and brought
significantly more claims into the system.
There are several other factors that have resulted in the
submission of more disability claims and contributed to the backlog.
These include VA initiatives to increase access and externally driven
demand to address unmet disability compensation needs such as:
increased use of technology and social media by Veterans, families, and
survivors to self-inform about available benefits and resources;
improved access to benefits through the joint VA and DoD Pre-Discharge
programs; and increased outreach programs to inform more Veterans of
their earned benefits, which can include compensation claims. The
demand for disability compensation has also been impacted by: ten years
of war with increased survival rates for our wounded; an aging
population of previous era Veterans such as Vietnam and Korea, whose
conditions are worsening; a difficult economy, and the growth in the
complexity of claims decisions as of result of the increase in the
average number of medical conditions for which each claimant files.
The current composition of the inventory and backlog also includes
claims from Veterans of all eras - from Veterans of the current
conflicts to World War II Veterans who are just now filing a claim for
the first time. The largest cohort of claims comes from our Vietnam-era
Veterans who filed 448,000 claims in FY 2012, and made up 36 percent of
the inventory and 37 percent of the backlog as of May 31, 2013. Gulf
War Era Veterans make up 23 percent of the total inventory and 22
percent of the backlog. Veterans of Iraq and Afghanistan conflicts make
up 20 percent of the total inventory and 22 percent of the backlog.
Veterans of the Korean War, World War II and all other eras make up
less than 10 percent of both total inventory and backlog. The remainder
of the inventory and backlog is from peacetime era Veterans.
To meet the goal of eliminating the backlog, VBA is aggressively
implementing its Transformation Plan, a series of tightly integrated
people, process, and technology initiatives designed to achieve our
goal of processing all claims within 125 days with 98 percent accuracy
in 2015. VBA is retraining, reorganizing, streamlining business
processes, and building and implementing technology solutions based on
the newly redesigned processes in order to improve benefits delivery.
VBA is deploying technology solutions that improve access, drive
automation, reduce variance, and enable faster and more efficient
operations. VBA's digital, paperless environment also enables greater
exchange of information and increased transparency to Veterans, the
workforce, and stakeholders. Our technology initiatives are designed to
transform claims processing from the time the Servicemember first
enrolls in the joint VA and DoD eBenefits system and submits an online
application, to the issuance of the claims decision and receipt of
compensation payments.
VBA's major technology initiative to reduce the backlog is the
Veterans Benefit Management System (VBMS). VBMS is a powerful
paperless, Web-based, and electronic claims processing solution
complemented by improved business processes. It is assisting in
eliminating the existing claims backlog and serves as the technology
platform for quicker, more accurate claims processing.
National deployment of VBMS began in 2012, with 18 regional offices
(RO) operational by the end of calendar year (CY) 2012. As of June 10,
2013, all 56 ROs and our Appeals Management Center have fielded the
first generation of VBMS paperless processing capabilities. All new
incoming claims are being established and processed using the new
system, which will gradually eliminate paper processing of claims. We
estimate that with the development of additional automated
functionality in the future generations of VBMS, it will help improve
VBA's production by at least 20 percent (in each of FYs 2014 and 2015)
and accuracy by at least 8 percent.
There are over 12,400 users of VBMS to include Veterans Health
Administration (VHA) staff and VSO representatives. VBMS has also
successfully converted 133 million documents to images, which is the
main mechanism for transitioning from paper-based claim folders to the
new electronic environment. Veterans enrolled in the VA/DoD portal,
eBenefits, receive electronic notification of changes in status of
their disability claims, including notification of the claims decision
and any benefit payments due.
In addition, through the Veterans Relationship Management (VRM)
process VBA engages, empowers, and serves Veterans and other claimants
with seamless, secure, and on-demand access to benefits and military
service information. Veterans have access to benefits information
through multiple VA sources or channels - on the phone, online, or
through eBenefits. VRM provides multiple self-service options for
Veterans and other stakeholders.
Also, as part of VBA's technology initiatives, the Veterans On-Line
Application (VONAPP) Direct Connect (VDC) incorporates a complete
redesign of the legacy Veterans On-line Application (VONAPP) system,
leveraging the eBenefits portal. Claims filed through eBenefits use VDC
to load information and data directly into the new VBMS application for
paperless processing. Veterans can now file both original and
supplemental compensation claims through VDC.
Support from our partners and stakeholders is critical to better
serving our Veterans, Servicemembers, and their families. VA's claims
transformation changes our interactions with employees, other Federal
agencies, Veterans Service Organizations (VSO), and state and county
service officers.
Fully Developed Claims (FDC) are critical to achieving VBA's goals
and provide a method for our VSOs, DoD, and State and county partners
to assist in gathering the necessary evidence to decide a claim. An FDC
is a claim submitted to VA with all the material required for VA to
make a decision, along with the Veteran's certification that nothing
further will be provided. An FDC is critical to reducing ``wait time''
and ``rework.'' VBA currently receives 9.5 percent of claims in fully
developed form. When a qualified FDC is received, VBA is able to
discharge its evidence-gathering responsibilities under the Veterans
Claims Assistance Act much more efficiently than in traditional claims.
VA currently completes FDCs in about average time to complete all other
claims. VBA's target for FY 2013 is to receive 20 percent of claims in
the fully developed format with the help of our DoD and VSO partners.
In addition, collaborative efforts are ongoing with DoD to allow VA
to receive complete service treatment records (STR) - and to receive
them electronically for faster and more efficient claims processing. In
December 2012, VBA reached agreement with DoD to require the military
services to certify a Servicemember's STRs as complete at the point of
transfer to VA. The final medical treatment facility at each military
service, including the National Guard and Reserve component, will
certify the completeness of all STRs at the point of separation from
military service. This will further increase the number of FDCs. This
action has potential to cut as much as 60-90 days from the ``awaiting
evidence'' portion of claims processing, and reduce the time needed to
make a claim ``ready for decision'' from 133 days currently to 73 days
for departing Servicemembers.
We are working with DoD to be able to view DoD electronic health
records information, which will enable VBA to review any DoD records
that VBA does not already possess in order to complete claims. We are
also working with DoD on a capability to provide information in the
Armed Forces Health Longitudinal Technology Application system (AHLTA)
as a print-to-portable document format (PDF). A pilot of this
capability will begin in September 2013 to provide VA electronic data
(PDF) of information contained in AHLTA at the time a Service member
separates from the military. DoD will deploy the Healthcare Artifact
and Image Management Solution (HAIMS) to provide a mechanism for
scanning and uploading paper documents to make them readily available
to VA. Additionally, the technology could also be used to scan and
upload paper medical record items received from private-sector
providers. DoD has initiated an accelerated deployment schedule for
HAIMS with a goal of stopping the flow of paper STRs to VA by December
2013.
On April 19, 2013, VA announced a new initiative to expedite
compensation claims decisions for Veterans who have waited 1 year or
longer. VA claims raters are making provisional decisions on the oldest
claims in inventory, which allows Veterans to begin collecting
compensation benefits more quickly, if eligible. Veterans are able to
submit additional evidence for consideration a full year after the
provisional rating, before VA issues a final decision. Provisional
decisions are based on all evidence provided to date by the Veteran or
obtained on their behalf by VA. If a VA medical examination is needed
to decide the claim, it is ordered and expedited.
As a result of this initiative, more than 65,000 claims - or 97
percent of all claims over two years old in the inventory - have been
eliminated from the backlog. VBA staff are now focusing their efforts
on completing all disability claims of Veterans who have been waiting
over one year for a decision.
It is important to understand that as a result of this initiative,
metrics used to track the timeliness of benefit claim decisions will
fluctuate. The focus on processing the oldest claims will cause the
overall measure of the average length of time to complete a claim to
rise in the near term because of the number of old claims that are
being completed. VA's average time to complete claims will improve as
the backlog of oldest claims is cleared and more of the incoming claims
are processed electronically through VA's new paperless processing
system. In addition, the average days pending metric - or the average
age of a claim in the inventory - will decrease, since the oldest
claims will no longer be part of the inventory.
The Department already prioritizes processing of some claims,
including the claims of seriously injured and Servicemembers separating
through IDES as well as those of Medal of Honor recipients, former
prisoners of war, the homeless, terminally ill, and those experiencing
extreme financial hardship. The Department also prioritizes FDCs.
VA has made huge strides in its journey to improve technology and
provide all generations of Veterans the best possible health care and
benefits that they earned through their selfless service. VA is
committed to continue that journey, especially as the numbers of
Veterans using VA services increase in the coming years.
Electronic Health Records
In April of 2009, President Obama directed the DoD and VA to,
``work together to define and build a seamless system of integration
with a simple goal: When a member of the Armed Forces separates from
the military, he or she will no longer have to walk paperwork from a
DoD duty station to a local VA health center; their electronic records
will transition along with them and remain with them forever.''
The mission of both Departments is to fundamentally and positively
impact the health outcomes of active duty military, Veterans, and
eligible beneficiaries. As a result, VA and DoD are committed to
creating a seamless health record integrating VA and DoD data, while
modernizing the software supporting VA and DoD clinicians in the most
efficient and effective way possible.
Today, DoD and VA are already exchanging a significant amount of
electronic information and are taking aggressive actions in 2013 to
further expand these efforts. But, most of the information shared today
is not standardized to support use in electronic clinical decisions. As
an example, different names for ``blood glucose'' in the DoD and VA
systems make it impossible to integrate and track blood sugar levels
for diabetics across the two systems. Once this data is mapped to
standard codes it will be possible to chart and track blood sugar
levels across DoD and VA records. A key priority for both Departments
is to standardize electronic health record data and make it immediately
available for clinicians so they have the information they need to make
informed medical decisions for our patients.
In December of 2012, when presented with the revised cost and
schedule information, the Secretaries directed that the Interagency
Program Office (IPO) Advisory Board Co-Chairs and the Health Executive
Committee (HEC) Co-Chairs prepare and provide ``quick win''
recommendations to accelerate interoperability and recommend changes to
the governance structure and budget impacts. As a result, the IPO
Advisory Board Co-Chairs and HEC Co-Chairs provided a plan which the
Secretaries approved that included:
Program Strategy: Adjusted the March 2011 iEHR acquisition business
rules from ``buy'' commercially available solutions for joint use,
``adopt'' a Department-developed application if a modular commercial
solution is not available and one Department has a solution, ``create''
a joint application on a case by case basis if neither a modular
commercial or Department-developed solution are available, to ``adopt,
buy, create'' to leverage existing capabilities for joint use. The
Departments will also define a ``core'' set of iEHR capabilities that
would allow us to evaluate the selection of existing EHR products to
reduce program risks and costs while accelerating implementation.
Quick Wins: On February 5, 2013 VA and DoD agreed to four
accelerators. First, VA and DoD clinical health data will be made
interoperable and available in near real-time using translation
mechanisms such as the Health Data Dictionary and DoD's adoption of
Blue Button. This data interoperability work will be completed by
January 2014. Second, we approved deployment of the presentation
software called JANUS Graphical User Interface to five VA polytrauma
rehabilitation centers and two associated Military Treatment
Facilities. JANUS is the tool clinicians use to view VA and DoD health
data simultaneously. Third, the Departments will create a VA-DoD
Medical Community of Interest network and security infrastructure to
enable the creation of a logical ``single medical enclave'' that meets
both Departments' security requirements, provides equal access to iEHR
services by both Departments, leverages existing DoD and VA existing
infrastructure, and provides connectivity between DoD and VA medical
networks. Fourth, the Departments will rapidly adopt an identity
management solution to establish consistent methods for identifying
patients across the two organizations.
Under this plan, VA has committed to deploying an iEHR ``core''
based on VistA while DoD committed to evaluating available alternatives
in order to make a ``core'' technology selection that will best fit its
needs. In order to achieve the desired data interoperability between
both Departments, both ``cores'' will conform to an agreed-upon set of
standards that enable the secure and interoperable exchange of
information.
While the immediate focus is on accelerating data interoperability
between the two Departments, the end goal remains the same - to make
certain that VA and DoD are creating a seamless health record
integrating VA and DoD data and modernizing the software supporting DoD
and VA clinicians. As a result of a DoD review directed by Secretary
Hagel to determine the best way forward for improvements in
interoperability and EHR modernization, DoD has decided that they will
use a competitive process in choosing their ``core.'' This will allow
DoD to consider commercial alternatives that may offer them reduced
cost, reduced schedule, and technical risk and access to increased
current capability and future growth in capability by leveraging
ongoing advances in the commercial marketplace.
In today's world that means that VA and DoD don't have to utilize
the same EHR software. Health record data integration and exchange is
possible regardless of the software systems. In fact, as private sector
experience has shown, using the same system does not guarantee that
information can be shared. The important thing is that both systems use
national standards and a common language to express the content and
format of the information they share.
To achieve the goal, the Departments are taking the following steps
that will deliver seamless, integrated health information on an
accelerated basis: We are creating a Data Management Service that will
give DoD and VA clinicians access to integrated patient health record
information. The service will retrieve data from across DoD and VA for
a given patient in seven critical clinical areas-- medications,
problems, allergies, lab results, vitals, immunizations, and note
titles--representing the vast majority of patients' clinical
information. The data will be mapped to open national standards--the
same as those being adopted by the private sector--making the data
computable and supporting health information sharing not only across
DoD and the VA, but also with private sector providers. The data will
be available in near real-time, so clinicians can rely on it for urgent
clinical decisions. The standardized, integrated data will fuel a
variety of apps, tools and views supporting clinicians.
The Data Management Service will be developed and deployed by the
beginning of CY 2014. Nine high priority sites will have access to
these data through a single integrated view. DoD and VA intend to make
standardized, integrated clinical record data broadly available to
clinicians across DoD and VA later in CY 2014. We are also enhancing
``Blue Button'' functionality, giving patients the ability to download
and share their own electronic medical record information (in
structured and coded format), helping them take control of their own
health.
Efforts to deliver the Data Management Service are currently funded
through FY13 and are in the President's FY14 budget submission. This
work leverages previous health data interoperability efforts funded
through the Joint DoD/VA Interagency Program Office (IPO). The IPO's
efforts to date to standardize data and provide the infrastructure to
integrate and view electronic health information across the Departments
are the foundation for the efforts to create a seamless health record
by 2014.
In the mid-term, both VA and DoD have identified the need to update
their respective healthcare management systems, replacing or enhancing
existing legacy systems to give clinicians and patients the best
healthcare software support, including state-of-the-art clinical
decision support and analytics, to provide our Servicemembers, their
dependents and our Veterans with the best healthcare possible. VA with
its large installed base, trained workforce and in-house development
and support capacity has chosen to enhance its healthcare management
system core capability based on an evolved VistA. This is a logical
choice and a sound business decision for VA. But, the Departments will
ensure that the acquisition of their respective healthcare management
systems will deliver the capabilities needed to meet each Department's
clinical requirements, while delivering the best value to the American
taxpayer.
The Departments intend to jointly determine and then leverage open
standards, open architecture, and open published application
programming interfaces (API), while still ensuring accessibility for
users with disabilities, that will provide a strong shared foundation
for both healthcare management systems. The Departments will also use
mature solution approaches and will apply acquisition best practices
(to include maximum use of competition) to efficiently address clinical
needs. Where appropriate, VA and DoD will jointly acquire capabilities.
To meet its need for modernized software to support clinicians and
Veterans VA chose the ``core'' technology of VistA to reduce the costs
and risks associated with the selection and implementation of a
different technology. Most importantly, while we are engaged in
continuously improving VistA, it is still one of the best electronic
health record systems available worldwide. Because the source code to
VistA is available via Open Source, we know that we will be able to
achieve competitive pricing for any changes we need to make. The basis
of the decision to utilize an evolved VistA as the iEHR core include:
VistA satisfactorily meets the majority of the core criteria; VistA has
an enormous investment of clinical and business knowledge imbedded into
the system; VistA is able to be progressively modernize the system
module by module with less risk; and a thriving and growing Open Source
community exists to engage in evolving VistA to meet future needs.
Through the President's leadership and the strong support of
Congress, VA has made huge strides in providing all generations of
Veterans the best possible health care and benefits through improved
technology. VA in concert with its DoD partners is committed to
creating a seamless record and to modernizing its health record
software, in order to realize the President's vision of healthcare
records that can be used across the range of national healthcare
providers, including Defense, Veterans Affairs and commercial
providers. This course of action will also ensure that we meet our
commitment to providing our active duty military, Veterans, and
beneficiaries with the healthcare they deserve now and in the future.
VA and DoD are committed to our collaborations, and we continue to
look for ways to improve our decision-making, achieve greater
efficiencies, and accelerate the transition process for Servicemembers
and Veterans. Thank you again for your support to our Servicemembers,
Veterans, and their families and your interest in the ongoing
collaboration and cooperation between our Departments. We appreciate
the opportunity to appear before you today, and we are prepared to
respond to any questions you may have.
Materials Submitted For The Record
Letter To: Hon. Dan Beniskek, From: Eric Shinseki, (VA)
THE SECRETARY OF VETERANS AFFAIRS
WASHINGTON
January 4, 2014
The Honorable Dan Benishek
U.S. House of Representatives
Washington, DC 20515
Dear Congressman Benishek:
Thank you for your cosigned letter regarding the Department of
Defense (DoD) Centers of Excellence (CoE) for Vision and Hearing, and
the Department of Veterans Affairs (VA)/DoD Extremity Trauma and
Amputation Center of Excellence.
Congressionally-directed CoEs work collaboratively to address the
needs of Servicemembers and Veterans. The three CoEs you write about
each receive guidance and direction through a joi nt DoDNA CoE
Oversight Board. The Board consists of members from each of the
military services, DoD Health Affairs, VA, the Joint Staff, and the
Uniformed Services University of Health Services. This Board helps to
ensure that the missions and goals of the CoEs are well-defined and
create value by achieving improvement in outcomes through clinical,
educational, and research activities.
For fiscal year (FY) 201O through 2014, VA allocated $6.9 million
to the Vision CoE. For FY 2012 through 2014, VA allocated $1.65 million
to the Extremity Trauma and Amputati on CoE, and $1.74 million to the
Hearing CoE. VA funding requirements for FY 2015 through FY 2018 are
currently under review and planning.
VA has contributed 6.6 full-time equivalent employees (FTEE) for
the Vision CoE; 2.6 FTEE are currently filled, and four FTEE are in the
hiring process. VA provides four FTEE for the Extremity Trauma and
Amputation CoE, for which two positions are presently filled and
individuals have been selected for the other two positions. VA staffing
for the Hearing CoE is four FTEE for which one position is currently
filled, and three FTEE are in the hiring process.
The current governance agreements are Memorandums of Agreement
(MOA) signed by the Acting Assistant Secretary of Defense (Health
Affairs) and the VA Under Secretary for Health for the Vision CoE
(signed October 2009), and for the Extremity Trauma and Amputation CoE
(signed August 2010).
There are 17,375 Servicemember records entered in the Defense and
Veterans Eye Injury and Vision Registry as of August 28, 2013 .
.Development of the joint military Hearing Loss and Auditory System
Injury Registry by DoD is underway and should be completed in FY 2015.
VA will provide data, in accordance with existing data sharing
agreements between VA and DoD, to help populate this registry once it
is completed by DoD. Although the Extremity Trauma and Amputation CoE
does not have a requirement for a patient registry, this Center has
used an online database to track all DoD amputee patients from
Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New
Dawn (OEF/OIF/OND) since 2003. There have been a reported total of
1,626 amputee patients from the OEF/OIF/OND cohort treated in all
military treatment facilities. As of April 2013, a total of 1,265 OEF/
OIF/OND amputees have been provided some level of prosthetic services
and health care by VA. Not all injuries to these patients were
necessarily combat related; some are due to motor vehicle accidents,
training accidents, and other causes.
VA remains committed to partnering with DoD to provide
comprehensive high-quality care and services to Servicemembers, and to
our Nation's Veterans. If you have additional questions, please have a
member of your staff contact Mr. Omara Boulware, Congressional
Relations Officer, at (202) 461-6468 or by e-mail at
[email protected]. A similar letter has been sent to the other
cosigners of your letter.
Thank you for your continued support of our mission.
Sincerely,
Eric K. Shinseki
Questions For The Record
QFR submitted by Thornberry, Mac
House Committee on Armed Services
Question for: Honorable Frank Kendall
1) Please describe the process that led to SECDEF's electronic
health record (EHR) procurement decision. What steps is DOD taking,
both internally and jointly with VA, to improve oversight and
management to support the effective implementation for this decision?
The Secretary of Defense convened an internal Department of Defense
(DoD) review following his April 2013 budget hearings to examine the
current state of the iEHR program and identify a way ahead for future
EHR development and deployment. Based on the results of this internal
review, which included inputs from previous analyses performed by the
Director, Cost Analysis and Program Evaluation, as well as an
assessment of the current Department of Veterans Affairs (VA) internal
information technology, the Secretary of Defense issued a memorandum on
May 21, 2013, reinforcing DoD's commitment to working with VA to
establish healthcare data interoperability and directing the Under
Secretary of Defense for Acquisition, Technology, and Logistics
(USD(AT&L)) to oversee a competitive acquisition to modernize DoD
healthcare management systems.
Following the issuance of the memorandum, USD(AT&L) restructured
DoD's health care information technology (IT) efforts to focus on both
the DoD Healthcare Management System Modernization program and the
joint DoD/VA iEHR program. By pursuing these efforts separately, the
Interagency Program Office is able to focus near-term efforts to
establish standards-based healthcare data interoperability between DoD
and VA. Concurrently, DoD can pursue a competitive acquisition,
consistent with sound acquisition business practices, to obtain the
most capable clinical support system for our Service Members at the
best value to American taxpayers.
QFR submitted by Thornberry, Mac
House Committee on Armed Services
Question for: Mr. Stephen Warren
2) Please describe the decision-making process the VA used to
determine that maintaining the existing Veterans Health Information
Systems and Technology Architecture, or VistA, was the best approach
for your organization.
See attachment
QFR submitted by Langevin, James R.
House Committee on Armed Services
Question for: Honorable Robert Petzel
3) I want to focus on the path through the DoD and VA system for
our veterans suffering from neurological traumas, such as TBI and
spinal cord injury. Can you describe for us how their treatment and
benefit trajectory varies from the baseline, and what supplemental
assistance is available other than normal benefits for those no longer
able to move around comfortably in their homes?
Outcomes data collected in the VA Spinal Cord Injury/Disorders
(SCI/D) and Polytrauma/Traumatic Brain Injury (TBI) Systems of Care
show that Veterans with SCI/D and TBI that receive rehabilitation in VA
medical centers meet or exceed external non-Veteran benchmarks in
functioning, community participation, and satisfaction with life. These
outcomes reflect the outstanding rehabilitative care, prosthetic
services, benefits, and adaptive modifications to the home and
automobile that help Veterans with these severe disabilities to
overcome common obstacles to achieve personal independence, positive
life adjustment, and opportunities in meaningful areas of life. VA
provides a wide variety of mobility aids for eligible Veterans with
functional limitations due to neurological traumas and other health
conditions. Mobility aids, like all other prosthetic devices and
sensory aids, are made available based on a treatment plan developed by
health care providers to address the specific needs of the Veteran to
optimize independent mobility and home and community accessibility, and
assist with other activities of daily living. Mobility aids provided by
VA range from simple items, such as transfer boards and canes, to
complex devices and installations, such as wheeled mobility and
overhead lift systems that can help maneuver Veterans with severe
mobility limitations around the home. Mobility aids are often augmented
by devices that support activities of daily living such as
environmental controls for activating home mechanisms and appliances,
adaptive bathroom equipment to support self-care, and alternative
communication devices and adaptive computer access for persons with
communication challenges. Supplemental adaptations and specialized
devices are provided for Veterans with cognitive difficulties such as
memory lapses due to TBI. The Veteran and caregivers receive
comprehensive education and training from VA clinical providers to
ensure the provided equipment is used effectively and safely.
Additionally, VA has a robust Housing Adaptation program that serves to
modify certain Veterans or Servicemembers residences to accommodate
their disabilities. Such adaptations afford individuals with functional
limitations the capability to live at home in a barrier-free
environment.
Disability compensation claims for neurological conditions such as
TBI and spinal cord injury receive expedited processing for seriously
injured and very seriously injured Veterans. A large portion of these
claims are handled through the joint VA/DoD Integrated Disability
Evaluation System, resulting in disability compensation awards for
separating Servicemembers at the time of discharge from military
service. In addition to compensation, Servicemembers with a traumatic
brain or spinal cord injury who meet certain criteria may be eligible
for additional assistance for home adaptations and modifications,
automobile allowances and adaptations, and statutorily-authorized
special monthly compensation.
QFR submitted by Langevin, James R.
House Committee on Armed Services
Question for: Mr. Danny Pummill
4) I want to focus on the path through the DoD and VA system for
our veterans suffering from neurological traumas, such as TBI and
spinal cord injury. Can you describe for us how their treatment and
benefit trajectory varies from the baseline, and what supplemental
assistance is available other than normal benefits for those no longer
able to move around comfortably in their homes?
Outcomes data collected in the VA Spinal Cord Injury/Disorders
(SCI/D) and Polytrauma/Traumatic Brain Injury (TBI) Systems of Care
show that Veterans with SCI/D and TBI that receive rehabilitation in VA
medical centers meet or exceed external non-Veteran benchmarks in
functioning, community participation, and satisfaction with life. These
outcomes reflect the outstanding rehabilitative care, prosthetic
services, benefits, and adaptive modifications to the home and
automobile that help Veterans with these severe disabilities to
overcome common obstacles to achieve personal independence, positive
life adjustment, and opportunities in meaningful areas of life. VA
provides a wide variety of mobility aids for eligible Veterans with
functional limitations due to neurological traumas and other health
conditions. Mobility aids, like all other prosthetic devices and
sensory aids, are made available based on a treatment plan developed by
health care providers to address the specific needs of the Veteran to
optimize independent mobility and home and community accessibility, and
assist with other activities of daily living. Mobility aids provided by
VA range from simple items, such as transfer boards and canes, to
complex devices and installations, such as wheeled mobility and
overhead lift systems that can help maneuver Veterans with severe
mobility limitations around the home. Mobility aids are often augmented
by devices that support activities of daily living such as
environmental controls for activating home mechanisms and appliances,
adaptive bathroom equipment to support self-care, and alternative
communication devices and adaptive computer access for persons with
communication challenges. Supplemental adaptations and specialized
devices are provided for Veterans with cognitive difficulties such as
memory lapses due to TBI. The Veteran and caregivers receive
comprehensive education and training from VA clinical providers to
ensure the provided equipment is used effectively and safely.
Additionally, VA has a robust Housing Adaptation program that serves to
modify certain Veterans or Servicemembers residences to accommodate
their disabilities. Such adaptations afford individuals with functional
limitations the capability to live at home in a barrier-free
environment.
Claims for neurological conditions such as TBI and spinal cord
injury receive expedited processing for seriously injured and very
seriously injured Veterans. A large portion of these claims are handled
through the joint VA/DoD Integrated Disability Evaluation System,
resulting in disability compensation awards for separating
Servicemembers at the time of discharge from military service. In
addition to compensation, Servicemembers with a traumatic brain or
spinal cord injury who meet certain criteria may be eligible for
additional assistance for home adaptations and modifications,
automobile allowances and adaptations, and statutorily-authorized
special monthly compensation.
The Veterans Benefits Administration (VBA) and Veterans Health
Administration are also working together to revise the sections of the
VA rating schedule for disabilities pertaining to neurological
conditions. As part of the upcoming revisions to the schedule, VBA is
considering how best to address the issue of neurological traumas.
QFR submitted by Langevin, James R.
House Committee on Armed Services
Question for: Honorable Robert Petzel
5) In response to unmet needs that veterans organizations brought
to my attention, I introduced the Veterans Homebuyer Accessibility Act
last Congress to aid our injured servicemembers modify their homes to
ensure they are accessible, and I plan to introduce it again this
Congress. Has there been an examination of benefit shortfalls specific
to neurological traumas, particularly with regard to adaptive
modifications to homes?
The Veterans Health Administration (VHA) has a number of housing
adaptation programs that serve to adapt and/or modify a Veteran's/
Servicemember's residence to accommodate their disability or
disabilities. These programs are managed under the Home Improvements
and Structural Alterations grant; or the Veterans Benefits
Administration (VBA) under the Specially Adapted Housing (SAH), Special
Housing Adaptation, Temporary Residence Adaptation; or Vocational
Rehabilitation & Employment Independent Living program.
Adaptations and/or modifications are individually determined based
on the medical feasibility for the Veteran/Servicemember to reside in
their home, continuation with medical treatment and rehabilitation, and
capability to live independently in a barrier-free environment. VBA's
SAH program may assist with the purchase of a home to accommodate a
Veteran's/Servicemember's disability or disabilities. VBA routinely
reviews the program to ensure the program is meeting the needs of
eligible Veterans. VBA also works closely with Veterans Service
Organizations to incorporate their feedback.
Veterans with neurological traumas such as traumatic brain injuries
or spinal cord injuries may be eligible for SAH grants if they meet the
statutorily defined medical eligibility criteria. Specifically, the SAH
grant is available to Veterans and Servicemembers who are entitled to
disability compensation for a service-connected, permanent and total
disability due to: Loss or loss of use of both lower
extremities, such as to preclude locomotion without the aid of braces,
crutches, canes, or a wheelchair; Blindness in both eyes, plus
loss or loss of use of one lower extremity; Loss or loss of
use of one lower extremity together with: 1) residuals of organic
disease or injury, or 2) the loss or loss of use of one upper
extremity, affecting balance and propulsion as to preclude locomotion
without the aid of braces, crutches, cases, or a wheelchair;
Loss or loss of use of both upper extremities at or above the elbows;
or A severe burn injury.
Additionally, Public Law 112-154 authorized a temporary expansion
of eligibility for a Veteran or Servicemember who served after
September 11, 2001, and is entitled to compensation for permanent
service-connected disability that was incurred on or after September
11, 2001, and that is due to the loss or loss of use of one or more
lower extremities which so affects the functions of balance or
propulsion as to preclude ambulating without the aid of braces,
crutches, canes, or a wheelchair. This expansion is set to expire on
September 30, 2014, and VA may not approve more than 30 applications
for assistance in fiscal year 2014.
QFR submitted by Langevin, James R.
House Committee on Armed Services
Question for: Mr. Danny Pummill
6) In response to unmet needs that veterans organizations brought
to my attention, I introduced the Veterans Homebuyer Accessibility Act
last Congress to aid our injured servicemembers modify their homes to
ensure they are accessible, and I plan to introduce it again this
Congress. Has there been an examination of benefit shortfalls specific
to neurological traumas, particularly with regard to adaptive
modifications to homes?
The Veterans Benefits Administration's Specially Adapted Housing
(SAH) staff routinely review the program to ensure the program is
meeting the needs of eligible Veterans. SAH staff also work closely
with Veterans Service Organizations to incorporate their feedback.
Veterans and Servicemembers with neurological traumas such as
traumatic brain injuries or spinal cord injuries may be eligible for
SAH grants if they meet the statutorily defined medical eligibility
criteria. Specifically, the SAH grant is available to Veterans and
Servicemembers who are entitled to disability compensation for a
service-connected, permanent and total disability due to: Loss
or loss of use of both lower extremities, such as to preclude
locomotion without the aid of braces, crutches, canes, or a wheelchair;
Blindness in both eyes, plus loss or loss of use of one lower
extremity; Loss or loss of use of one lower extremity together
with: 1) residuals of organic disease or injury, or 2) the loss or loss
of use of one upper extremity, affecting balance or propulsion as to
preclude locomotion without the aid of braces, crutches, cases, or a
wheelchair; Loss or loss of use of both upper extremities at
or above the elbows; or A severe burn injury.
Additionally, Public Law 112-154 authorized a temporary expansion
of eligibility for a Veteran or Servicemember who served after
September 11, 2001, and is entitled to compensation for a permanent
service-connected disability that was incurred on or after September
11, 2001, and that is due to the loss or loss of use of one or more
lower extremities which so affects the functions of balance or
propulsion as to preclude ambulating without the aid of braces,
crutches, canes, or a wheelchair. This expansion is set to expire on
September 30, 2014, and VA may not approve more than 30 applications
for assistance in fiscal year 2014.
QFR submitted by Coffman, Mike
House Committee on Armed Services
Question for: Mr. Stephen Warren
7) What are VA unique requirements for the electronic health record
that you don't feel a commercial solution addresses and requires
continued investment in a VA-specific solution?
VA's rich history and success with its internally-developed
electronic health record (EHR) can be attributed to the outstanding
collaboration that has, and continues to, exist between our clinical
users and the software developers. VA clinicians play a pivotal role in
defining and prioritizing the EHR enhancements that most directly
impact delivery of care to the Veterans we are proud to serve. Our VA
system intentionally and necessarily contains software specific to the
eligibility of our unique patient population. For example, VA providers
document in the EHR whether care is related to a Veteran's service-
connected condition and this information then determines whether the
Veteran pays a co-pay for the visit and whether we send a bill to a
third party insurance company. The EHR contains VA-specific
determinations related to exposures such as ionizing radiation or Agent
Orange and is currently being expanded to capture care for health
conditions that may be related to time on the Camp Lejeune Base. VA's
EHR has also been modified over time to capture and continually improve
treatment for military sexual trauma, posttraumatic stress disorder,
traumatic brain injury, amputations, and an evolving list of conditions
that our Veteran population faces based on their military service. By
having an internally-developed core, we are able to rapidly implement
additional VA-specific changes when needed to meet internal or external
demands and we are able to rapidly share treatment best practices in
new and evolving areas in order to improve care for our Veterans. Such
modifications would not be made quickly, if at all, by a commercial
vendor. VA's EHR is published in the open source and is used by many
non-VA health facilities. Those non-VA facilities, in turn, enhance the
software to meet industry-wide evolving health management needs and
contribute those changes back to the open source community. By using an
open Source EHR, VA is able to integrate enhancements made by others
immediately without the significant planning and financial investments
that would have to be made to have such enhancements made by a
commercial vendor.
Having core EHR functionality built and maintained by VA enables us
to continue to rapidly expand our health data exchanges with private
health care providers to expand the amount of health care data used in
clinical decision-making. In an environment of rapidly evolving health
IT solutions, having a VA-specific EHR core allows VA to integrate with
best-of-breed components rather than purchasing a single, commercial
EHR solution which may excel in some capabilities, but fall far short
in others. VA feels strongly that a continued investment in a VA-
specific EHR core with integration of appropriate open source and
commercial products provides the best solution for our patients, our
providers, and the taxpayers. VA is committed to developing an EHR
record that can exploit the value of a service-based architecture
(SOA). SOA will enable us to modify clinical decision support in near-
real time, improve care coordination, and facilitate the integration of
new software applications into our health information technology stack.
QFR submitted by Maffei, Daniel B.
House Committee on Armed Services
Question for: Honorable Frank Kendall
8) The DoD and VA are now working to implement a Service-Oriented
Architectures (SoA) suite to achieve interoperability. Can you speak to
the progress of this effort and why a SoA suite is the best solution
for interoperability? What issues stand in the way for
interoperability?
An SOA can facilitate the delivery and use of healthcare data
services by the Department of Defense (DoD) and the Department of
Veterans Affairs (VA) by ``transporting'' messages between any DoD and
VA electronic health record systems implemented in the future and the
numerous information management systems used by private providers.
Because of the complexities of medical record exchanges, such as
mediating terminologies, simply transmitting messages is insufficient
to provide interoperability between applications or even within the
same application. To overcome these challenges, an SOA is envisioned to
provide messaging services that ensure access for applications via
standard protocols and support interoperability and data sharing.
The SOA suite efforts completed to date include design, testing,
engineering demonstration (proof of concept), security certification,
and accreditation. Key milestones achieved include:
Award of an SOA suite acquisition contract in March 2012;
Establishment of commercial and Government development test
environments to allow DoD and VA product developers and other approved
users an opportunity to develop trial integrations with the SOA suite
(the Government test site is in the Pacific-Joint Information
Technology Center; the commercial test site is located in a contractor
facility in Melbourne, Florida); and, Implementation of the
SOA suite at DoD sites in Hampton Roads and San Antonio.
There are two challenges associated with achieving this level of
interoperability. First, there is a technical challenge to ensure all
Government and commercial capabilities adhere to the same data exchange
standards required for interoperability. Second, the business process
engineering efforts required of both parties must ensure the successful
integration of standardized data.
QFR submitted by Maffei, Daniel B.
House Committee on Armed Services
Question for: Honorable Frank Kendall
9) As DoD and VA continue to address health records
interoperability, it would seem that a modular approach that allows the
departments to choose and integrate the best of each electronic health
records provider would be ideal - delivering the best product at the
best price. Have your offices studied this approach?
Yes, the Interagency Program Office has considered modular
development, as highlighted in the February 2013 Request for
Information. The Department of Defense will continue to consider the
appropriate degree of system modularity and its inherent trade-offs in
the forthcoming competitive source selection process. It is important
to note that there are significant benefits to acquiring a more tightly
coupled group of key capabilities that will have been developed and
tested to be both secure and fully integrated. Conversely, increased
modularity brings with it increased development and integration risks
which may introduce patient safety risks in addition to measured costs
that would be borne by the Government.
QFR submitted by Scott, Austin
House Committee on Armed Services
Question for: Honorable Jonathan Woodson
10) A recent GAO report sites that acceptance of TRICARE by
civilian physicians has declined to an estimated 70% between 2008 and
2011. In some areas of the nation, TRICARE acceptance is under 50% for
doctors accepting new TRICARE patients.
There is also a disparity between Medicare and TRICARE
reimbursement rates, and fourteen percent of civilian physicians in the
GAO study said they do not take TRICARE because of the low
reimbursement rates.
What factors do you attribute to the declining acceptance of
TRICARE?
What factors account for the disparity between TRICARE and Medicare
reimbursement rates?
The number of TRICARE participating providers has actually risen
slightly. In Fiscal Year 2012, the number of participating providers
increased to a total of 415,500 providers. This followed a similar
increase in Fiscal Year 2011, when there were 399,200 participating
providers. The total number of participating providers increased by 15%
in areas near military bases and by 2% in areas not near military
bases.
About 90% of the 9.6 million Uniformed Services beneficiaries enjoy
access to a contracted provider network near where they work or live.
However, we remain concerned with access for our beneficiaries and have
submitted a legislative proposal to require providers who participate
with Medicare to also participate with TRICARE. By law, TRICARE is
required to follow Medicare's reimbursement fee schedule. Although we
have not experienced any significant issues with contracting for
sufficient numbers of providers to meet the health care needs of
beneficiaries that live or work near our contracted networks (military
bases or base closure sites), the intent of the legislative proposal is
to improve access for our TRICARE Standard beneficiaries who live
outside of the network areas.
Our surveys indicate that, on average, only three to seven percent
of a provider's practice in the United States, particularly those
practices not located near military installations, is dedicated to
treating TRICARE beneficiaries. We believe survey results indicating
that seven of ten physicians are accepting TRICARE patients, if they
are accepting new patients at all, is actually a good news story
considering the small percentage of TRICARE patients seen in any
typical provider practice. Beneficiaries may easily find providers who
have accepted TRICARE patients in the recent past by using the online
TRICARE Provider Search Tool, maintained by TRICARE contractors, that
lists non-network providers who have submitted one or more TRICARE
claims during the previous 14 months.
QFR submitted by Barber, Ron
House Committee on Armed Services
Question for: Honorable Jonathan Woodson
11) Secretary Woodson, I wanted to ask a question about TRICARE and
our beneficiaries in the Philippines. For years, the Department of
Defense has said there has been a problem of fraud by providers to
TRICARE Management Activity in that country. TMA has implemented a
number of policies that has had the result of reducing access to care,
yet failing to combat fraud. At this time, TMA is six months into a new
demonstration project, and a constituent of mine has kept me well
informed on how it is proceeding. Mr. Secretary, I must say I am
dismayed to report that the demonstration program has seen many flaws
and I am quite concerned that beneficiaries are being limited to a
number of providers, for example, one authorized hospital in a city
larger than New York City. Many have seen their fees doubled or have
had to pay up front for office visits. What is the Department's
response to this situation? Can you please provide me a detailed report
on the implementation of TMA's demonstration program since January
2013, how much fraud DoD has found in TMA's work with Philippine
providers, and how this new demonstration program is combating this
fraud? Thank you for your timely consideration to these questions.
(1) Providers have a choice to participate as approved providers,
which may result in an insufficient mix of primary and specialty
providers. The TRICARE Management Activity has approved specialty
waivers in designated demonstration areas for beneficiaries to receive
inpatient services at hospitals that are approved providers for
outpatient services only. As of July 2013, there are 8 institutional
providers and 151 professional providers delivering health care in
designated demonstration areas for Phase I. Beneficiaries can still
seek care from certified providers, professional and institutional,
outside designated demonstration areas.
TRICARE reimburses health care costs based on the lesser of billed
charges or the Philippine fee schedule located online at http://
www.tricare.mil/CMAC/ProcedurePricing/SearchResults.aspx. To
participate in the TRICARE Department of Defense Philippine
Demonstration Project, providers have agreed to bill at the lesser of
the billed charges or the Philippine Foreign Fee Schedule. Approved
providers have agreed to collect only the appropriate deductible and
cost-shares from TRICARE Standard under the Demonstration Project.
According to TRICARE policy, beneficiaries who use TRICARE Standard,
whether they reside overseas or in the United States may be required to
pay their deductible and cost-shares up front when receiving medical
services.
(2) In response to your request for a detailed report on the
implementation of TMA's demonstration program, we have enclosed a
document outlining the Philippine Demonstration Project.
(3) In 2008, the Department's aggressive action resulted in
seventeen individuals convicted of defrauding the TRICARE program of
more than $100 million. The Department's health care antifraud
initiatives have resulted in a cost avoidance of approximately $255
million from 2006 through the end of Fiscal Year 2011.
(4) To combat fraud under the Demonstration Project, the
establishment of an approved provider network allows the TOP contractor
to screen out providers under prepayment review because of the
providers' historical fraudulent claims activity before they become
approved demonstration providers for TRICARE. Approved providers must
comply with the on-site verification, certification, and credentialing
requirements. The TOP contractor provides one-to-one education to
approved providers to ensure the approved providers understand how to
submit accurate claims. To date, there have been no identified
fraudulent billing activities under the Demonstration Project.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Honorable Robert Petzel
12) How many disability claims is the VA processing annually which
were filed by sexual assault victims? Of those, what percentage is
submitted by male victims?
VA tracks ``sexual assault'' claims as posttraumatic stress
disorder (PTSD) disability claims based on military sexual trauma
(MST). The number of PTSD/MST claims processed varies. However, from
August 2012 through July 2013, VA processed approximately 5,060 PTSD/
MST claims. Male Veterans filed approximately 1,480 (29 percent) of
these claims.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Mr. Danny Pummill
13) How many disability claims is the VA processing annually which
were filed by sexual assault victims? Of those, what percentage is
submitted by male victims?
VA tracks ``sexual assault'' claims as posttraumatic stress
disorder (PTSD) disability claims based on military sexual trauma
(MST). The number of PTSD/MST claims processed varies. However, from
August 2012 through July 2013, VA processed approximately 5,060 PTSD/
MST claims. Male Veterans filed approximately 1,480 (29 percent) of
these claims.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Honorable Frank Kendall
14) We are hearing a lot about musculoskeletal injuries that come
as a result of long term wear of body armor and/or other equipment. How
many disability claims are you processing annually that involve
musculoskeletal injuries incurred as a result of the wear of heavy body
armor and/or equipment? What are some of the most common ailments cited
by veterans?
The Department of Defense (DoD) continues to look for ways to
reduce the load weight carried by its troops. More specifically, the
Army is leveraging new material construction and design approaches to
reduce the weight of the Improved Outer Tactical Vest (IOTV) and
Soldier Plate Carrier System (SPCS). The current Generation III IOTV,
which weighs 31 pounds (lbs) (with plates) for a size medium, is four
percent lighter than the previous IOTV variant. These same approaches
are applied to the SPCS, which weighs 23 lbs (with plates) for a size
medium, to reduce the weight by three percent. As newer weight saving
technologies become available, DoD will incorporate them to lessen the
burden on the troops. DoD defers to the Department of Veterans Affairs
for specifics regarding disability claims processing and common
ailments cited by veterans.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Honorable Robert Petzel
15) We are hearing a lot about musculoskeletal injuries that come
as a result of long term wear of body armor and/or other equipment. How
many disability claims are you processing annually that involve
musculoskeletal injuries incurred as a result of the wear of heavy body
armor and/or equipment? What are some of the most common ailments cited
by veterans?
VA does not track musculoskeletal injuries that are caused
specifically by the wearing of heavy body armor and/or equipment, only
these injuries generally. For all Veterans, the most common ailments
are: 1. Tinnitus, recurring; 2. Hearing loss; 3. Post-traumatic stress
disorder; 4. Scars, other; 5. Diabetes mellitus; 6. Lumbosacral or
cervical strain; 7. Hypertensive vascular disease; 8. Limitation of the
flexion of the leg; 9. Degenerative arthritis of the spine; and 10.
Limited motion of the ankle.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Mr. Danny Pummill
16) We are hearing a lot about musculoskeletal injuries that come
as a result of long term wear of body armor and/or other equipment. How
many disability claims are you processing annually that involve
musculoskeletal injuries incurred as a result of the wear of heavy body
armor and/or equipment? What are some of the most common ailments cited
by veterans?
VA does not track musculoskeletal injuries that are caused
specifically by the wearing of heavy body armor and/or equipment, only
these injuries generally. For all Veterans, the most common ailments
are: 1. Tinnitus, recurring; 2. Hearing loss; 3. Post-traumatic stress
disorder; 4. Scars, other; 5. Diabetes mellitus; 6. Lumbosacral or
cervical strain; 7. Hypertensive vascular disease; 8. Limitation of the
flexion of the leg; 9. Degenerative arthritis of the spine; and 10.
Limited motion of the ankle.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Honorable Robert Petzel
17) Information technology is critical to helping tackle the
backlog of disability claims. What percentage of veterans are currently
able to retrieve their Official Military Personnel File through the
eBenefits online portal? What is the timeline and strategy to make this
an option for all veterans (going back to Vietnam, Korea, World War
II)?
The Official Military Personnel File (OMPF) records are maintained
in each of the military service's records management systems. Active
duty Servicemembers and Veterans (including Reserve and National Guard
members) who separated or retired from their respective branch of
service on or after the dates specified below may access their OMPFs
through the eBenefits online portal: Army - Since October
1994, 4.2 million OMPF records have been uploaded in its Interactive
Personnel Electronic Records Management System. Air Force -
Since October 2004, 1.6 million OMPF records have been uploaded in its
Automated Records Management System. Navy - Since January
1995, 1.6 million OMPF records have been uploaded in its Electronic
Military Personnel Record System. Marine Corps - Since January
1999, nearly 900 thousand OMPF records have been uploaded in its
Optical Digital Imaging-Records Management System. Coast Guard
- The Personnel Data Record (PDR), the Coast Guard's equivalent to
DoD's OMPF, is unavailable electronically. The PDR is still maintained
in paper format and is sent to National Personnel Records Center upon
separation or retirement.
As of July 22, 2013, 8.3 million OMPF records were available
through the eBenefits online portal. VA does not have any information
as to whether the Department of Defense plans on making this option
available to all Veterans. If a Veteran's OMPF is not available
electronically through eBenefits due to his or her military service
ending prior to the date when his or her service branch digitalized its
OMPF records, the records are maintained in paper form at the National
Archives and Records Administration's National Personnel Records Center
(NPRC) in St. Louis, Missouri. In these instances, eBenefits provides
the Veteran with links to the request form (SF 180) and to the NPRC Web
site.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Mr. Danny Pummill
18) Information technology is critical to helping tackle the
backlog of disability claims. What percentage of veterans are currently
able to retrieve their Official Military Personnel File through the
eBenefits online portal? What is the timeline and strategy to make this
an option for all veterans (going back to Vietnam, Korea, World War
II)?
The Official Military Personnel File (OMPF) records are maintained
in each of the military service's records management systems. Active
duty Servicemembers and Veterans (including Reserve and National
Guardsmen) who separated or retired from their respective branch of
service on or after the dates specified below may access their OMPFs
through the eBenefits online portal: Army - Since October
1994, 4.2 million OMPF records have been uploaded in its Interactive
Personnel Electronic Records Management System. Air Force -
Since October 2004, 1.6 million OMPF records have been uploaded in its
Automated Records Management System. Navy - Since January
1995, 1.6 million OMPF records have been uploaded in its Electronic
Military Personnel Record System. Marine Corps - Since January
1999, nearly 900 thousand OMPF records have been uploaded in its
Optical Digital Imaging-Records Management System. Coast Guard
- The Personnel Data Record (PDR) is unavailable electronically. The
PDR (Coast Guard's equivalent to DoD's OMPF) is still maintained in
paper format which is sent to National Personnel Records Center upon
separation or retirement.
As of July 22, 2013, 8.3 million OMPF records were available
through the eBenefits online portal. VA does not have any information
as to whether the Department of Defense plans on making this option
available to all Veterans. If a Veteran's OMPF is not available
electronically through eBenefits due to his or her military service
ending prior to the date when his or her service branch digitalized its
OMPF records, the records are maintained in paper form at the National
Archives and Records Administration's National Personnel Records Center
(NPRC) in St. Louis, Missouri. In these instances, eBenefits provides
the Veteran with links to the request form (SF 180) and to the NPRC Web
site.
QFR submitted by Tsongas, Niki
House Committee on Armed Services
Question for: Mr. Stephen Warren
19) Information technology is critical to helping tackle the
backlog of disability claims. What percentage of veterans are currently
able to retrieve their Official Military Personnel File through the
eBenefits online portal? What is the timeline and strategy to make this
an option for all veterans (going back to Vietnam, Korea, World War
II)?
The Official Military Personnel File (OMPF) records are maintained
in each of the military service's records management systems. Active
duty Servicemembers and Veterans (including Reserve and National
Guardsmen) who separated or retired from their respective branch of
service on or after the dates specified below may access their OMPFs
through the eBenefits online portal: Army - Since October
1994, 4.2 million OMPF records have been uploaded in its Interactive
Personnel Electronic Records Management System. Air Force -
Since October 2004, 1.6 million OMPF records have been uploaded in its
Automated Records Management System. Navy - Since January
1995, 1.6 million OMPF records have been uploaded in its Electronic
Military Personnel Record System. Marine Corps - Since January
1999, nearly 900 thousand OMPF records have been uploaded in its
Optical Digital Imaging-Records Management System. Coast Guard
- The Personnel Data Record (PDR) is unavailable electronically. The
PDR (Coast Guard's equivalent to DoD's OMPF) is still maintained in
paper format which is sent to National Personnel Records Center upon
separation or retirement.
As of July 22, 2013, 8.3 million OMPF records were available
through the eBenefits online portal. VA does not have any information
as to whether the Department of Defense plans on making this option
available to all Veterans. If a Veteran's OMPF is not available
electronically through eBenefits due to his or her military service
ending prior to the date when his or her service branch digitalized its
OMPF records, the records are maintained in paper form at the National
Archives and Records Administration's National Personnel Records Center
(NPRC) in St. Louis, Missouri. In these instances, eBenefits provides
the Veteran with links to the request form (SF 180) and to the NPRC Web
site.
QFR submitted by Kilmer, Derek
House Committee on Armed Services
Question for: Mr. Danny Pummill
20) Please outline the difficulties in replacing staff in field
offices. I have been told it takes as many as nine months.
Specifically: a. How long does it take to replace a staff member? Are
there any particular obstacles that make it more difficult to staff
field offices? b. During that length of time, what happens to the
caseload and the referrals that the vacant field staff position would
normally work on?
A) According to the Office of Personnel Management, a position
should be filled within 80 days of being announced. The Veterans
Benefits Administration is in-line with this guidance and typically
fills positions at regional offices within 2-3 months of being
announced. A number of factors may impact the time required to fill
these positions. For example, bargaining unit positions must be posted
for a specific length of time. Also, labor markets greatly vary from
one geographic location to the next. Regional offices in large cities
may face challenges recruiting and retaining qualified employees based
on a higher cost of living. Regional offices in rural areas may be an
employer of choice but have fewer applicants with necessary skill sets.
B) During periods of time when field positions are vacant, the
caseloads are redistributed to other employees who continue to work on
them until new staff are hired and fully trained. Management takes
necessary steps to adjust workload and help staff keep up with
increased demands.
QFR submitted by Kilmer, Derek
House Committee on Armed Services
Question for: Mr. Danny Pummill
21) I have heard from a number of stakeholders concern over how
HUD-VASH vouchers are allocated and the data that both HUD and the VA
use to make these determinations. In order to help promote better
understanding of how decisions are made, please explain: a. how the VA
uses state point-in-time data to determine number of homeless veterans
who need vouchers, b. the method used by the VA to allocate this data
to regions, and c. how the regions are ranked within the VA to
determine need.
The Department of Housing and Urban Development - Veterans Affairs
Supportive Housing (HUD-VASH) program is an interagency effort to end
Veteran homelessness, where HUD provides Section 8 Housing Choice
Vouchers and VA provides wrap around case management and supportive
services to promote Veteran participants' sustainment in permanent
housing. Although the HUD-VASH program has been a notable success in
the Administration's efforts to end Veteran homelessness, HUD-VASH
vouchers are a finite resource that must be allocated in areas where
the most need is identified, and these vouchers must be targeted to the
most vulnerable and chronically homeless Veterans. VA and HUD work
collaboratively to fairly and objectively determine the location of
HUD-VASH vouchers based on the best data presently available to HUD and
VA.
A) It is clear that in order to end Veteran homelessness, the
finite and limited number of HUD-VASH vouchers must be targeted towards
those Veterans who are chronically homeless and/or especially
vulnerable. Thus, to determine the location of fiscal year (FY) 2013
HUD-VASH vouchers, HUD and VA formulated data methodology to target
these valuable HUD-VASH resources towards the chronically homeless and/
or especially vulnerable homeless Veteran population. HUD uses a
formula to assess relative need for HUD-VASH vouchers throughout the
United States. HUD runs the point-in-time (PIT) data, VA data related
to contacts with homeless Veterans, and PHA and VAMC performance data
through the formula to determine the proportional allocation of
relative need for each HUD continuum of care (CoC). Because HUD
distributes HUD-VASH vouchers through local Public Housing Authorities
(PHA), it is critical that the proportionate allocation of relative
need is determined for each CoC. To better target chronically homeless
and vulnerable homeless Veterans, the FY 2013 allocation of the HUD-
VASH vouchers had greater weight applied to the local PIT number of
unsheltered homeless Veterans and the percent of chronically homeless
Veterans served in the VA medical centers (VAMC).
B)HUD and VA use applicable data resources to determine the
proportional allocation of relative need by each CoC. The CoCs are then
matched with VAMC and Community-Based Outpatient Clinics (CBOC) that
serve Veterans in the CoCs' geographic area. It is through this
matching process that HUD determines that a CoC within a particular
VAMC or CBOC catchment area should be allocated HUD-VASH vouchers. Once
the CoC allocations are determined, HUD begins the process of
identifying PHAs that cover each CoC location to be invited to
participate in the HUD-VASH program by administering the voucher
allocations
C)During the collaborative allocation process, VA and HUD do not
rank regions to determine need. VA and HUD process data to determine
the locations with the highest relative need. Vouchers are allocated
proportionally through the data formula that HUD and VA use. This
allows locations with the highest relative need to get a proportionally
higher number of HUD-VASH vouchers than a location with fewer
chronically homeless Veterans and less relative need.
QFR submitted by Wittman, Robert J.
House Committee on Armed Services
Question for: Mr. Danny Pummill
22) Is a recently discharged, combat wounded, amputee prioritized
or triaged in a way that his/her claim is reviewed and processed
before, for example, a 45 year old vet discharged 20 years ago claiming
a service connected disability for knee pain?
Servicemembers who are separated due to wounds, injuries, or
illness are evaluated in the Integrated Disability Evaluation System
(IDES). This system started in 2007 when DoD and VA collaborated to
design a more seamless transition for Servicemembers who could no
longer continue their military careers for medical reasons. Claims for
VA benefits from Servicemembers enrolled in IDES are adjudicated by
staff solely dedicated to this mission. For Servicemembers enrolled in
IDES and identified as seriously injured or very seriously injured, VA
prioritizes their claims at all stages of processing to ensure benefits
decisions are issued as quickly as possible.
QFR submitted by Wittman, Robert J.
House Committee on Armed Services
Question for: Honorable Robert Petzel
23) Is there an administrative triage process in place to service
our combat wounded or members seriously injured in training accident
claims first?
Servicemembers who are separated due to wounds, injuries, or
illness are evaluated in the Integrated Disability Evaluation System
(IDES). This system started in 2007 when DoD and VA collaborated to
design a more seamless transition for Servicemembers who could no
longer continue their military careers for medical reasons. Claims for
VA benefits from Servicemembers enrolled in IDES are adjudicated by
staff solely dedicated to this mission. For Servicemembers enrolled in
IDES and identified as seriously injured or very seriously injured, VA
prioritizes their claims at all stages of processing to ensure benefits
decisions are issued as quickly as possible.
QFR submitted by Wittman, Robert J.
House Committee on Armed Services
Question for: Mr. Danny Pummill
24) Are you looking at sleep apnea as a disability, which may be
treated with a CPAP machine and yet still rates a 50% disability?
: The rating criteria for sleep apnea were published in the Federal
Register as a Final Rule on September 5, 1996, and have remained
unchanged since that time. However, significant medical advances
regarding the diagnosis, classification, and management of this
disability have occurred since the initial introduction of the
diagnostic code. VA has established a Respiratory Workgroup for the
purpose of evaluating all diagnostic codes and rating criteria in the
Respiratory System under the Schedule for Rating Disabilities (38 Code
of Federal Regulations, Part 4), to include sleep apnea. The references
relied upon by the Respiratory Workgroup for proposed revisions to the
rating schedule criteria comprise a reflection of the current medical
standards for the diagnosis, measurement of severity, and response to
treatment of sleep apnea.
QFR submitted by Wittman, Robert J.
House Committee on Armed Services
Question for: Mr. Danny Pummill
25) Would you please expand on what a ``buddy statement'' is and
the process for validating this type of statement?
A ``buddy statement'' is lay testimony from any person who knows
facts relevant to a claimant's claim. They most often relate to a
sickness, disease, injury, or event in service which may support a
Veteran's claim for service-connected disability compensation benefits.
A ``buddy statement'' can serve as a secondary or alternative source of
evidence to corroborate certain elements of a Veteran's claim when
considered in light of all available evidence, such as corroborating an
in-service stressor, establishing proof of service in the Republic of
Vietnam, supporting involvement in combat, or establishing that service
treatment records (STR) have been destroyed. Most often they are
submitted by, but not restricted to, fellow Servicemembers who can
corroborate the Veteran's claim. Under VA regulations, a lay person is
competent to testify to issues that do not require specialized
education, training, or experience, so long as the person providing the
testimony has knowledge of the facts or circumstances of the matter at
hand and the matter can be observed and described by a lay person.
While each statement is evaluated on a case-by-case basis in accordance
with individual facts, ``buddy statements'' in general are accepted if
the statement is consistent with the times, places, and circumstances
of the service of both the Veteran and the ``buddy.'' If the evidence
available calls into question the qualifications of the ``buddy'' to
make such a statement, the ``buddy'' is asked to submit his or her DD
Form 214, or other evidence of service with the claimant.
QFR submitted by Wittman, Robert J.
House Committee on Armed Services
Question for: Mr. Danny Pummill
26) You indicated your willingness to work with pro-bono law
clinics such as the Lewis B. Puller, Jr. Veterans Benefit Clinic at
William and Mary's Law School. At this point pro-bono law clinics are
able to help veterans compile their claims and could significantly
assist the VA's efforts to process claims. Are you willing, with
appropriate privacy release forms, to have regional offices interact
with pro-bono law clinics regarding specific cases both for initial
claims and for appeal claims to help work through specific details on
claims as they are being processed through the system? What are your
thoughts on developing a pilot program to work on a Fully Developed
Claims type program for appeal cases? Have you considered working to
establish Centers of Excellence to disseminate information and training
on how pro-bono clinics might best work with the VA to support out
nation's veterans?
VA appreciates the assistance of organizations like William and
Mary's Puller Veterans Benefits Law Clinic in helping Veterans complete
their claims. This assistance also helps reduce the claims backlog.
Although our primary focus is currently on eliminating the backlog, we
are also actively seeking ways to expedite the appeals process. We are
evaluating several proposals submitted by the Puller Clinic, which
include establishing a Center of Excellence as well as developing an
integrated training program that could be used as a model for improving
collaboration between VA and law school clinics. Although VA shares
your interest in having law schools serve Veterans nationwide, we are
also mindful of constraints to entering a formal partnership with a
private entity. As such, we are carefully considering the various
options available. In the meantime, we have established a Community of
Practice, which is a partnership between VA and organizations that
commit to submitting claims as Fully Developed Claims (FDC). On August
22, 2013, the Puller Clinic was welcomed to the FDC Community of
Practice. The Puller Clinic joins The American Legion and Disabled
American Veterans, both Veterans Service Organizations who are charter
members of the community.
IFR submitted by Forbes, J. Randy
House Committee on Armed Services
Question for: Ms. Jessica Wright
1) Page 47 Line 1116
The Department of Defense and the Department (DoD) of Veterans
Affairs (VA) agreed on 22 February 2013 to certify that Service
Treatment Records (STR) are complete with all known medical record
information at the time they are transferred to VA, within 45 days of
Service member's separation from the military. VA previously measured
DoD compliance based on the percentage of Complete STRs--those
containing both medical and dental components--that also contained a
Certification Letter. Between April and June 2013, DoD improved from
26% the first week the metric was tracked, to over 99%.
The VA introduced a new metric on 24 June 2013. DoD and VA agreed
to use a more stringent metric for certifying STRs and have developed
the new DD Form 2963 to attach to all STRs sent to VA from DoD. This
will verify that the STR is complete, and will ensure that VA has all
proper documents to process STRs. This new metric is effective as of 1
August 2013 and it is our intent to be 100% by 1 Nov 2013.
IFR submitted by Conaway, K. Michael
House Committee on Armed Services
Question for: Mr. Stephen Warren
2) page 64 line 1522
VA Performance Rating FY2012 Total On Board at VA GS Employees
Rated Outstanding 89,456 204,142 SES Employees Rated Outstanding 111
459
IFR submitted by Conaway, K. Michael
House Committee on Armed Services
Question for: Mr. Stephen Warren
3) Page 64 Line 1531
VA Performance Rating FY2012 Total On Board at VA GS Employees
Rated Outstanding 89,456 204,142 SES Employees Rated Outstanding 111
459
IFR submitted by Wenstrup, Brad R.
House Committee on Armed Services
Question for: Honorable Jonathan Woodson
4) Page 73 Line 1754
A narrated, close captioned online demonstration of the Joint
Legacy Viewer (JLV) can be viewed at the following link: http://
www.pacifichui.org/hui/ext/JLV--Demo/JLV--demo.html JLV provides an
integrated, read-only view of health data from DoD and VA sources in a
common viewer.
An important stepping stone toward modernizing our VA and DoD
health information systems, JLV supports care of our Wounded Warriors
and Veterans by improving access to electronic patient records and
reducing the need to transfer information by fax, mail or CD.
The JLV will be accessible to DoD and VA clinicians at nine sites
using their DoD or VA credentials by the end of this month.
IFR submitted by Duckworth, Tammy
House Committee on Armed Services
Question for: Mr. Stephen Warren
5) Page 93 Line 2246
As Mr. Frank Kendall stated in testimony, VA and DoD seek help on
this issue in the following ways: ``If I may, Mr. Chairman, what I
would ask from you is that you not over-constrain us. So I am very
concerned, as I mentioned in my opening statement, about some of the
language in various bills right now... For example, tying us to a
strategic plan that was written last fall, which is very much overcome
by events now, is not particularly helpful ... It was only submitted to
Congress relatively recently, but that plan does not really reflect
some very fundamental changes that have been made since it was
initially written. So there are things like that ... tie our hands.
There are also a lot of reporting requirements. We have no problem with
keeping the committees informed. We are happy to do that. The withholds
that are in some of the language ... are becoming increasingly
problematic for us. And particularly, right now for VA, that is a
concern we have that is somewhat imminent. So [we are] very happy to
work with the committees, very happy to work with the members and their
staffs, and to be very transparent about what we are doing, but we ask
that, in return, you relieve some of the constraints that you have in
mind right now and allow us to take the best path forward and give us
the opportunity to explain that to you.''
IFR submitted by Gibson, Christopher P.
House Committee on Armed Services
Question for: Honorable Frank Kendall
6) Page 96 Line 2318
No Answer
IFR submitted by Johnson, Henry C. ``Hank''
House Committee on Armed Services
Question for: Honorable Robert Petzel
7) Page 98 Line 2373
Please see attached list of SES and SES-Equivalent FY 2012
Performance Awards for the Department of Veterans Affairs. (Attachment
B).
IFR submitted by Johnson, Henry C. ``Hank''
House Committee on Armed Services
Question for: Honorable Robert Petzel
8) Page 98 Line 2381
Please see attached list of SES and SES-Equivalent FY 2012
Performance Awards for the Department of Veterans Affairs. (Attachment
B).
IFR submitted by Wittman, Robert J.
House Committee on Armed Services
Question for: Mr. Stephen Warren
10) Page 99 Line 2413
The timeline outlined in the hearing transcript only applies to
service treatment record (STR) requests for Veterans currently serving
in the National Guard and Reserves. National Guard and Reserve STRs are
maintained at the unit level, and the 60/30-day timeframe was
established to allow unit record custodians adequate time to gather
records and appropriately reply to requests. VA's duty to assist
claimants, an obligation created by 38 U.S.C. Sec. 5103A, requires VA
to undertake certain efforts to obtain Federal records as outlined in
paragraph (c)(2):
Whenever the Secretary attempts to obtain records from a Federal
department or agency under this subsection, the efforts to obtain those
records shall continue until the records are obtained unless it is
reasonably certain that such records do not exist or that further
efforts to obtain those records would be futile.
To obtain National Guard and Reserve STRs VA takes the following
steps: 1. The VA regional office mails a letter to the Veteran's
assigned National Guard State Adjutant General's Office or Reserve Unit
requesting the military records necessary to process the claim. An
internal 60-day suspense is set in VA claim processing records. 2. If
no response is received after 60 days, VA phones the National Guard or
Reserve Unit to request the records again, and the call is documented
in VA systems. An internal 30-day suspense is set in VA claim
processing records. 3. If no response is received, or if the response
is not legally adequate, VA phones the Veteran and asks him/her to
contact the National Guard or Reserve Unit to request that the unit
send the records to VA for processing. An internal 30-day suspense is
set in VA claim processing records. 4. To satisfy VA's duty-to-assist
obligations, VA must continue to request records from all Federal
agencies until the records or a negative response from the Federal
record custodian is received. VA conducts follow-up requests to the
National Guard, Reserve Unit, and Veteran every 30 days until the duty-
to-assist obligation is satisfied.
As service department records are being digitized, VA can build and
update systems and revise its procedures to take advantage of digital-
to-digital transfer capabilities. While VA continues to rely on paper
service records (the only records available in many cases), current
procedures must be continued.
IFR submitted by Langevin, James R.
House Committee on Armed Services
Question for: Honorable Robert Petzel
11) Page 102 Line 2483
Outcomes data collected in the VA Spinal Cord Injury/Disorders
(SCI/D) and Polytrauma/Traumatic Brain Injury (TBI) Systems of Care
show that Veterans with SCI/D and TBI that receive rehabilitation in VA
medical centers meet or exceed external non-Veteran benchmarks in
functioning, community participation, and satisfaction with life. These
outcomes reflect the outstanding rehabilitative care, prosthetic
services, benefits, and adaptive modifications to the home and
automobile that help Veterans with these severe disabilities to
overcome common obstacles to achieve personal independence, positive
life adjustment, and opportunities in meaningful areas of life. VA
provides a wide variety of mobility aids for Veterans with functional
limitations due to neurological traumas and other health conditions.
Mobility aids, like all other prosthetic devices and sensory aids, are
made available based on a treatment plan developed by health care
providers to address the specific needs of the Veteran to optimize
independent mobility and home and community accessibility, and assist
with other activities of daily living. Mobility aids provided by VA
range from simple items, such as transfer boards and canes, to complex
devices and installations, such as wheeled mobility and overhead lift
systems that can help maneuver Veterans with severe mobility
limitations around the home. Mobility aids are often augmented by
devices that support activities of daily living such as environmental
controls for activating home mechanisms and appliances, adaptive
bathroom equipment to support self-care, and alternative communication
devices and adaptive computer access for persons with communication
challenges. Supplemental adaptations and specialized devices are
provided for Veterans with cognitive difficulties such as memory lapses
due to TBI. The Veteran and caregivers receive comprehensive education
and training from VA clinical providers to ensure the provided
equipment is used effectively and safely.
Additionally, VA has a robust Housing Adaptation program that
serves to modify a Veteran's or Servicemember's residence to
accommodate their disability. Such adaptations afford individuals with
functional limitations the capability to live at home in a barrier-free
environment.
IFR submitted by Langevin, James R.
House Committee on Armed Services
Question for: Mr. Danny Pummill
12) Page 103 Line 2498
The Veterans Benefits Administration's Specially Adapted Housing
(SAH) staff routinely review the program to ensure the program is
meeting the needs of eligible Veterans. SAH staff also work closely
with Veterans Service Organizations to incorporate their feedback.
Veterans and Servicemembers with neurological traumas such as
traumatic brain injuries or spinal cord injuries may be eligible for
SAH grants if they meet the statutorily defined medical eligibility
criteria. Specifically, the SAH grant is available to Veterans and
Servicemembers who are entitled to disability compensation for a
service-connected, permanent and total disability due to: