[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
VA'S INDEPENDENT LIVING PROGRAM--A PROGRAM REVIEW
=======================================================================
HEARING
before the
SUBCOMMITTEE ON ECONOMIC OPPORTUNITY (EO)
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, NOVEMBER 13, 2013
__________
Serial No. 113-45
__________
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 Minority Member
DAVID P. ROE, Tennessee CORRINE BROWN, Florida
BILL FLORES, Texas MARK TAKANO, California
JEFF DENHAM, California JULIA BROWNLEY, California
JON RUNYAN, New Jersey DINA TITUS, Nevada
DAN BENISHEK, Michigan ANN KIRKPATRICK, Arizona
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MARK E. AMODEI, Nevada GLORIA NEGRETE MCLEOD, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
PAUL COOK, California TIMOTHY J. WALZ, Minnesota
JACKIE WALORSKI, Indiana
Jon Towers, Staff Director
______
SUBCOMMITTEE ON ECONOMIC OPPORTUNITY (EO)
BILL FLORES, Texas, Chairman
JON RUNYAN, New Jersey MARK TAKANO, California, Ranking
MIKE COFFMAN, Colorado Minority Member
PAUL COOK, California JULIA BROWNLEY, California
BRAD R. WENSTRUP, Ohio DINA TITUS, Nevada
ANN M. KIRKPATRICK, Arizona
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
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of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
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C O N T E N T S
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November 13, 2013
Page
VA's Independent Living Program--A Program Review................ 1
OPENING STATEMENTS
Hon. Bill Flores, Chairman, Subcommittee on Economic Opportunity
(EO)........................................................... 1
Prepared Statement of Hon. Bill Flores....................... 23
Hon. Mark Takano, Ranking Minority Member, Subcommittee on
Economic Opportunity (EO)...................................... 2
WITNESSES
Daniel Bertoni, Director, Education, Workforce, and Income
Security, U.S. Government Accountability Office................ 3
Prepared Statement of Mr. Bertoni............................ 24
Margarita Devlin, Acting Director, Vocational Rehabilitation and
Employment, Veterans Benefit Administration, U.S. Department of
Veterans Affairs............................................... 8
Prepared Statement of Ms. Devlin............................. 31
Richard C. Daley, Associate Legislation Director, Paralyzed
Veterans of America (PVA)...................................... 15
Paul R. Varela, Assistant National Legislative Director, Disabled
American Veterans (DAV)........................................ 17
Prepared Statement of Mr. Varela............................. 34
SUBMISSION FOR THE RECORD
U.S. Government Accountability Office............................ 37
VA'S INDEPENDENT LIVING PROGRAM--A PROGRAM REVIEW
Wednesday, November 13, 2013
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Economic Opportunity,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 2:32 p.m., in
Room 340, Cannon House Office Building, Hon. Bill Flores
[Chairman of the Subcommittee] presiding.
Present: Representatives Flores, Runyan, and Takano.
OPENING STATEMENT OF CHAIRMAN BILL FLORES
Mr. Flores. Good afternoon. The Subcommittee will come to
order. I want to begin by thanking my friend Mr. Takano for
participating in the two field hearings we held last week in
Riverside, California and in Waco, Texas. I know I found them
to be very informative, and I thank the Ranking Member for his
assistance in making them a great success, along with the
staffs for both sides that did a great job of putting this
together.
We are here today to conduct an oversight hearing on the
Vocational Rehabilitation and Employment Service's independent
living program. This program provides a wide array of services
to the most severely wounded and disabled veterans who have
disabilities that preclude them from working, but who can still
use VA services to help them achieve a higher level of
independent daily living. Our hearing today will focus on three
major objectives: the results of a Government Accountability
report on the independent living program that this Subcommittee
requested last Congress; second, VA's steps to implement the
recommendations of this report and other steps they are taking
to improve the performance of the independent living program;
and third, the view of this program at the local level from our
veterans service organization partners, and how they believe we
can better assist our most severely disabled veterans achieve
maximum daily living.
While I am encouraged that the recent GAO report found that
89 percent of the veterans in their study eventually completed
their independent living plans, they also found that there is
increased need for oversight in this program. For example, when
VA is unable to track simple performance metrics like counting
in realtime the number of veterans in the independent living
program, or provide an aggregate number of the types of
benefits being provided to veterans through the program,
something is not like it should be. I do not fault the VA's
central office for many of these problems. I believe most of
these issues stem from a lack of attention and resources that
are provided to the VR&E Service by the Veterans Benefit
Administration.
GAO found that VR&E's computer tracking system is in
serious need of an upgrade. But as GAO has mentioned in their
written statement, VR&E officials do not expect to receive the
funding needed for this upgrade for another three years. While
I know that VBA is transfixed on improvements to the Veterans
Benefit Management System, or VBMS, as we call it around here,
to bring down the disability backlog, they cannot continue to
drop the ball and lose sight of the fact that other important
programs that serve our veterans need assistance as well. We
saw this earlier this year when we had our hearing on the long
term solution for G.I. Bill benefits where a simple investment
could finish the job once and for all. The resources were
transferred to adjust the disability backlog.
Congress has never turned down VA's request for funding to
improve computer systems which will help veterans and
strengthen oversight. I hope to learn more about VA's plans to
update their systems during this hearing.
One other area that GAO has discussed in their report is
the need to review cost controls and approval authority for
large expenses within the independent living program. This
point was crystallized by the revelation that a VA central
office review was not needed for a VR&E office at the local
level to authorize about $17,000 to be spent on a fishing boat
motor and a trailer for a disabled veterans. I understand that
learning to fish can certainly improve a veteran's independence
and quality of life, but I think we can all find better ways to
do this than to buy a $17,000 boat.
I believe that this program has the ability to greatly
improve the lives of veterans, but more work needs to be done
to assure efficiency, improve performance, and to assure
transparency through oversight.
With that, I recognize the Ranking Member for his opening
remarks.
[The prepared statement of Hon. Bill Flores appears in the
Appendix]
OPENING STATEMENT OF HON. MARK TAKANO
Mr. Takano. Thank you, Mr. Chairman. And I too appreciate
the opportunity to work with you during the work session on our
field hearings. In particular, I did enjoy the testimony of
many of the witnesses in Waco on entrepreneurship. And I hope
we can work together to improve entrepreneurship for our
veterans.
We are here today to find out how well the independent
living services program at the VA is serving America's wounded
warriors as they recover from their injuries, set goals, and
work toward independent living. We will hear testimony from the
VA Vocational Rehabilitation and Employment Program, and from
two veterans service organizations whose primary mission is to
serve the needs of disabled and paralyzed veteran
servicemembers. We will also hear from the GAO, which has
reviewed the program in detail and has made some clear
recommendations.
Of particular interest to me, are the VR&E plans to
coordinate better with the Veterans Health Administration, so
independent living counselors can meet the individual needs of
each veteran. Because they are working with the most updated
and accurate medical information technology can provide on each
one.
So thank you, Mr. Chairman, for scheduling this hearing
today. And thank you to the witnesses and others for being
here. I look forward to your testimony and to your answers to
our questions.
Mr. Flores. I thank the Ranking Member. I now would like to
introduce the witness for our first panel. With us today is Mr.
Daniel Bertoni with the U.S. Government Accountability Office.
Mr. Bertoni, you are now recognized for five minutes.
STATEMENT OF MR. DANIEL BERTONI, DIRECTOR, EDUCATION,
WORKFORCE, AND INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY
OFFICE
Mr. Bertoni. Thank you. Chairman Flores, Ranking Member
Takano, Members of the Subcommittee, good afternoon. I am
pleased to discuss the Department of Veterans Affairs
Vocational Rehabilitation and Employment Programs independent
living track which provides support and services to help
veterans with disabilities live more independently when
employment is not feasible. Last year, almost 3,000 veterans
receive independent living assistance.
My testimony is based on our June, 2013 report, discusses
the characteristics of independent living track veterans and
benefits received, the extent to which their plans were
completed, and VR&E's management and oversight role.
In summary, of the 9,215 veterans enrolled in the
independent living track from fiscal years 2008 to 2011, 67
percent were male, including Vietnam-era veterans in their
fifties and sixties. Nearly 60 percent served in the Army. Less
than one percent served in the National Guard or Reserves. The
most prevalent disabilities among these veterans were PTSD and
tinnitus, and more than three-quarters had a disability rating
of at least 60 percent.
VA has broad discretion in determining the types of
independent living services it provides, and our work shows
that a wide range of goods and services were involved.
Counseling services and computers were most common. However,
other services include the installation of ramps to improve
home accessibility, and the purchase of gym memberships,
camping gear, kitchen appliances, lawn tractors, snow blowers,
and a motor boat and trailer.
We estimate that VA spent nearly $14 million in benefits
for those entering the IL track in fiscal year 2008. While the
average cost was about $6,000 per veteran, per person totals
ranged from $20 to over $33,000 for a veteran. About 89 percent
of veterans were deemed by VA to be successfully rehabilitated.
That is, to generally have completed their independent living
plans which outlined the veterans' goals. About five percent
were closed because plan goals were not met, and six percent
remained open.
Due to variations in case complexity, some plans were
fairly easy for VA to close as rehabilitated, for example, by
installing wider doors and bathtub rails, others were more
difficult because they required a wide range of supports and
services. Thus rehab rates varied across regional offices,
ranging from 49 percent to 100 percent, with offices with
larger case loads experiencing greater success.
While veterans' independent living plans were completed in
384 days on average, completion times also varied by region
from a low of 150 days to a high of 895 days.
We identified several areas where VR&E exercises limited
management oversight. First, regional counselors were not
consistently compliant with certain case management
requirements, such as coordinating with VHA staff in securing
health services for veterans. Thus some benefits were delayed,
or VR&E provided benefits that should have come from VHA. We
have recommended that VA explore options to improve
coordination between VR&E and VHA regional personnel.
We also found that VR&E's processes for reviewing and
approving independent living expenditures may not be sufficient
as regions were permitted to purchase a range of items without
central office approval, some of which were costly, including
$17,500 for a motor boat and trailer, and nearly $19,000 for a
riding mower. We have recommended that VA consider enhancing
its review and approval process for independent living
expenditures.
And finally, VR&E's case management system does not collect
information on independent living costs, type of benefits
purchased, and other data that could help ensure more
consistent oversight. The agency also lacks accurate data on
the number of veterans served. While current law allows VR&E to
serve up to 2,700 veterans annually, the data used to monitor
this cap are based on the number of plans developed, not on the
number of actual veterans enrolled. Thus veterans with more
than one plan are counted multiple times toward the cap, and
VR&E lacks accurate information on the number being served at
any given time. We have recommended that VA modify its systems
to address this deficiency.
In conclusion, the independent living track provides a
broad range of supports and services to veterans. However,
stronger central office oversight is needed to ensure program
requirements are met, cases are administered consistently,
expenditures for goods and services are appropriate, and
critical data is collected. This will be increasingly important
over the next several years, as more servicemembers transition
to civilian life and veteran status, as the current veteran
population ages, and as demand for services likely grows.
Mr. Chairman, this concludes my statement. I will be happy
to answer any questions that you or other Members of the
Subcommittee may have. Thank you.
[The prepared statement of Daniel Bertoni appears in the
Appendix]
Mr. Flores. Thank you, Mr. Bertoni. I will now recognize
myself for five minutes for questions. Can you give us a little
bit more information surrounding the case you reviewed where
the VR&E officer approved the $17,500 for the boat and the
trailer?
Mr. Bertoni. Yes. I anticipated I might get a question on
that, so yes.
Mr. Flores. Let me expand on it a little bit, too. I mean,
I am not trying to ask you to put yourself in the mind of the
VR&E officer. But can you tell me what their logic was for
approving an expenditure like this?
Mr. Bertoni. I believe the case was a primarily PTSD claim,
where the individual was suffering from some degree of social
isolation. And that person in prior times was a fisherman, you
know, so had a boat. But the current boat, to use their words,
rotted away and he no longer had one. So the request was put
in. At some point through the evaluation process, the VRC,
vocational rehabilitation counselor, determined that that was
one of the therapies or services the person would benefit from.
We are not questioning that. I mean, we are not
professionals in counseling, and we are not psychologists. Our
point is that it is a substantial expense. It piqued our
interest and some folks would say it potentially stretches the
bounds of what this program is set up to do, or the services
that should be provided. In our view, and from a basic internal
control standpoint, when you are talking about expenditures in
that amount, there should be another set of eyes on that and
some concurrence that that is an appropriate strategy.
Mr. Flores. Do you think they looked at alternatives, like
maybe transportation to take him to a fishing pier? Or anything
like that? Or did your study go that deep?
Mr. Bertoni. I cannot speak to that. I think it is a
possibility. They have to ask a range of questions. They have a
pretty extensive questionnaire where they walk through many
aspects of the person's life and how they might meet their
needs.
Mr. Flores. Okay. Thank you. Can you talk about, one of the
things you found in your study, there is a wide variability
from region to region in terms of the numbers, and how
effective this is. Can you tell us what your findings were in
terms of the findings about the variance in independent living
from one region to another?
Mr. Bertoni. Sure. Well we visited five regions, so we have
a direct boots on the ground perspective from the folks there
and what they are doing, and the level of effort and the
outreach going on in each of those locations. But like I said
from just a sheer numbers standpoint, we did see considerable
variation in the numbers of IL plans, IL participants across
the regions. We mentioned Montgomery, Alabama with over 900
cases, and the Boston, Massachusetts office with eight. And it
was somewhat perplexing in that they have similar
concentrations of veterans in that state and in that area.
Mr. Flores. And when you peeled back the layers of the
onion, did you find any reason for that? I mean, did you, I
mean, is there anything that came out in your study as to why
one region would have a lot higher----
Mr. Bertoni. A little bit. I mean, we could take this only
so far as we could take this and still get you a product in a
reasonable amount of time. But we think we placed a lot of good
data and observations on VA's doorstep to peel back the onion
even further. But I would say, you know, variation can be due
to a lot of things. They talked about specialized care in some
areas, so maybe veterans were going to other places in these
areas. We did speak to some folks on the ground and they talked
about sort of outreach and activism from the veterans service
representative community. So there are a range of factors. I
think that is something that we would ask VR&E to delve further
into. We just could not go very far in this review.
Mr. Flores. And can you elaborate on your recommendation
that the VR&E coordinate better with the VHA and other parts of
VBA to reduce overlap and improve performance?
Mr. Bertoni. Sure. In the course of our case file review,
we noticed instances where there seemed to be a coordination or
communication breakdown between VR&E and VHA staff. Where
referrals were being sent and not answered, VR&E staff, having
to, at some point move ahead, provide the service that appeared
to be a medical service that probably would be best provided by
VHA but ultimately VR&E provided that service. Also in our
visits to the region it was a fairly consistent theme that this
cooperation and coordination could be improved. Beyond that, we
felt there was enough evidence to ask central office to look at
how this can be improved, whether it be with training, or
additional instructions, fast letters, etcetera.
Mr. Flores. Okay. Thank you, Mr. Bertoni. I now recognize
the Ranking Member for five minutes.
Mr. Takano. Thank you, Mr. Chairman. Mr. Bertoni, in your
estimation, was VA ever at risk of exceeding the 2,700 cap?
Mr. Bertoni. At risk? Well the data shows that in the four
years that we looked at, they had not exceeded it. I do not
know, I mean, some have said that the agency has slowed or held
cases back towards the end of the year. We did not, that was
not part of our scope. We do know that they did not get close
to that cap in any given year since 2008. Our concern is that
the data that they are using to monitor the cap is inaccurate.
They are counting plans, not people. We found 408 veterans that
had more than one plan, some of them had three, some of them
had four plans. And they were counting these people, these
plans as people. So in excess of 500 veterans were included in
this caseload when this number of veterans really did not
exist, they were plans. So right now, they are severely
overcounting.
Mr. Takano. So my next question is----
Mr. Bertoni. I should not say severe, they are
overcounting.
Mr. Takano. Your answer may have just answered my next
question, which was, did veterans, any veterans, miss out on
getting independent living services because the VA counts plans
instead of veterans served?
Mr. Bertoni. Regardless of how you count, whether you are
counting plans or people, because they were under the cap, I
would say, any veteran who asked and was eligible for the
program likely did not. You know, they did not ever hit the cap
where they had to officially turn anybody away. Our concern, is
that should we get an influx of new veterans, we have about a
million veterans coming back over the next several years,
should you get that influx, you could have a lot more folks
vying for these services and you could approach that cap. And
you should at least have accurate data on how many veterans you
are serving.
Mr. Takano. Well related to that data, should the VA update
the CWINRS or develop a new IT program?
Mr. Bertoni. Absolutely, we have a recommendation. CWINRS,
which is a case management system that might not be the best
vehicle to do this with. But some systems enhancements need to
occur in terms of tracking the types of benefits being
provided, the costs of those benefits, and also they need to
build in better edit checks into the system. So information is
consistently entered, and they know exactly what they are
providing.
Mr. Takano. Can you help me--thank you for that. Can you
tell me what limits there are to the type of services or goods
that can be provided by the IL program?
Mr. Bertoni. Pardon?
Mr. Takano. What limit to the type of service or goods that
can be provided by the Independent living program?
Mr. Bertoni. Under the current law it is, I believe it says
something to the effect whatever the Secretary deems necessary
and appropriate. So it is a wide open----
Mr. Takano. So it is wide discretion?
Mr. Bertoni. Wide discretion, absolutely. And if you look
at our report, we looked at 182 cases. We listed every service
provided in our report, it is in the back. It is a broad range
of services that were provided some of which, like I said,
piqued our interest.
Mr. Takano. We went over the example of the trailer and the
boat. But have all goods and services provided to veterans been
beneficial to the veteran as far as you can tell?
Mr. Bertoni. That is difficult to say. I guess, you know, I
would have to look at the specific case to determine why a snow
blower would be beneficial; why a double oven would be
beneficial. It would have to be on a fact and circumstances
basis, going in and looking at the rationale as to why this
person received this service. I cannot say whether everyone
benefitted. It is somewhat subjective. And to make that link
between if I give this person a boat, a snow blower, or some
other lawn mower, how does that translate to greater
independent living? That is the sort of subjective area that
was difficult for us to sort of delve into.
Mr. Takano. Okay. Mr. Chairman, thank you. I yield back.
Mr. Bertoni. Thank you. Mr. Runyan, you are recognized for
five minutes.
Mr. Runyan. Thank you, Mr. Chairman. Mr. Bertoni, when you
conducted the study, did you get a sense of what the
participants' view of the program was? And do they believe that
the goals that the VA set truly led them to rehabilitation?
Mr. Bertoni. We did not directly speak with participants in
the programs. We did speak with VSOs. I think the VSOs believe
that this is a worthwhile program; that it provides a lot of
worthy services. Again, whether everything that is being done
translates to greater independence in terms of living in the
community, that linkage, that causal linkage is in my view
difficult to establish.
Mr. Runyan. Does the VA track that on the back end?
Mr. Bertoni. Well they have criteria. Basically, their
criteria for a successful rehabilitation is that the person met
all the goals in their plan. I will give you an example. The
New York office gives 90 percent of IL participants a computer
and computer lessons. If you purchase the computer, you take
the lessons, they check you off as being rehabbed and you are
down the road. Have you achieved greater independence? I do
not, you know, I cannot say. All I know is that this
constitutes success to VA. And they have a 93 percent success
rate.
Mr. Runyan. That kind of answered my next question,
discussing how hard it is to track the rates. And I know, I
think just by what you just said there, that it is another
subjective area. That, you know, your instance of using the
computer, does that do anything once they have completed that?
Mr. Bertoni. I will give you another example. I think the
Hartford, Connecticut office, the same thing. 90 percent of
individuals receive a computer and computer training. They have
a 99 percent success rate. It seems a fairly straightforward,
simple plan. We saw variation in the plan. Some very narrow,
some very complex. And you wonder at some point if, have these
counselors figured out, hey, if I go too complex it is going to
kill my performance goals. If I keep it narrow I am going to do
better in terms of the performance goals. So there is always
potential perverse incentives when you introduce performance
goals. But if you look at the St. Petersburg office and their
emphasis is on volunteer services. Getting people interacting
within the community, substantively, you know, participating.
And you would think that would be difficult, more difficult
than a computer, definitely more complex, and it probably is.
And their rehab rate is 78 percent. Is that bad? Are they doing
a bad job? You have to look at what they are offering, and, you
know, the substance of these plans. And we think that is
something that VA, VR&E, based on what we found, the next
generation of their analysis, that is where they should be
looking.
Mr. Runyan. Thank you. Chairman, I yield back.
Mr. Flores. Thank you, Mr. Runyan. If there are no other
questions, Mr. Bertoni you are excused. Thank you for your
appearance today and we appreciate the insight that you shared
with us.
With that, we will bring up the second panel.
Mr. Bertoni. Thank you.
Mr. Flores. On our second panel we have Ms. Margarita
Devlin, who is the Acting Director of Vocational Rehabilitation
and Employment Service of VA. Ms. Devlin, you are now
recognized for five minutes. Thank you for joining us today.
STATEMENT OF MS. MARGARITA DEVLIN, ACTING DIRECTOR, VOCATIONAL
REHABILITATION AND EMPLOYMENT, VETERANS BENEFIT ADMINISTRATION,
U.S. DEPARTMENT OF VETERANS AFFAIRS
Ms. Devlin. Mr. Chairman, Ranking Member, and Members of
the Subcommittee, thank you for inviting me to appear before
you today to discuss the independent living services provided
by the Department of Veterans Affairs Vocational Rehabilitation
and Employment Program, or VR&E. The primary mission of the
VR&E program is to assist servicemembers and veterans with
service-connected disabilities to prepare for, find, and keep
suitable jobs. For those with service-connected disabilities so
severe that they cannot immediately consider work, the VR&E
program offers independent living, or IL, services to improve
their ability to live as independently as possible.
Through an initial vocational assessment, a VBA Vocational
Rehabilitation counselor evaluates an individuals' interests,
aptitudes and abilities and determines entitlement to a program
of services. Many individuals with severe disabilities are able
to prepare for employment and independent living services may
be provided as part of their employment plans. My testimony
today, however, will focus on those individuals whose
disabilities are so severe that they cannot consider employment
and their total rehabilitation plan is focused on independent
living services.
To be eligible for a program of solely IL services, a
veteran or servicemember must have a minimum of 20 percent
service-connected disability rating; have a serious employment
handicap; and have a determination by a counselor that
employment is not feasible for them. If IL needs are identified
during the course of our preliminary IL assessment, the
counselor will conduct a more comprehensive IL assessment,
usually in the individual's home. Following these assessments,
the individual may be provided IL services if he or she has
limitations that impact daily living activities, can benefit
from independent living services, and can be expected to
maintain achieved gains in independence after services have
ended. The number of new IL cases is currently limited to 2,700
per fiscal year.
IL services are outlined in an individualized plan of
services which may include assistive technology, adaptive
equipment, IL skills training, improved access to the home and
community, assistance with finding appropriate volunteer
activities, services to decrease social isolation, and
assistance in accessing services from VA and non-VA service
providers. A counselor develops the plan of services and
provides assistance and support to enable the individual to
achieve his or her IL goals.
In June 2013, GAO completed a study of VR&E's IL services
and made three recommendations based on their findings. In
their first recommendation, GAO recommended that VBA work with
the Under Secretary for Health to enhance coordination to
ensure IL track veterans needs are met by VHA in a timely
manner. VA agrees with this recommendation. VBA and VHA have
been working on a project to automate medical and dental
referrals for VR&E participants through the CAPRI system. Using
an automated referral system rather than a paper based system
will expedite services and allow for better tracking of
referrals. The systems enhancements are complete and a pilot of
the new capability began in September of 2013. Upon completion
of the pilot, VBA and VHA intend to move towards national
implementation of the new automated process.
GAO's second recommendation focused on implementing an
oversight approach that enables VR&E to better ensure
consistent administration of the IL track across regions. VBA
is exploring whether or not we have capability, under our
current system, to generate ad hoc reports that will address
data needs in this area. VBA will also consider preparing
business requirements for enhancements to CWINRS, VR&E's case
management system, for implementation in future years.
GAO's third recommendation was to reassess and consider
enhancing the agency's policy concerning the required level of
approval for IL track expenditures. VBA finds merit in
reassessing the current policy to identify areas that can be
strengthened. Existing policy includes multiple levels of cost
threshold approvals, but there may be room to improve
consistency in determining the types of IL goods and services
veterans receive. With the assistance of contractor expertise,
VBA is conducting a detailed review of the IL program to
include benchmarking against other programs. An initial report
is scheduled to be completed in the first quarter of 2014, and
VBA will use the results of this study to determine the best
way to implement GAO's recommendation.
In conclusion, VR&E's IL services are designed to meet the
rehabilitation needs of veterans and servicemembers with severe
disabilities. Given this special target population, those men
and women who sacrificed so much for our country, VR&E is
dedicated to ensuring that our services prove very effective in
improving their independence and daily living. We have
developed advanced training, we have conducted significant
oversight, and constantly seek to improve the services we
provide.
Mr. Chairman, this concludes my statement. I would welcome
any questions you might have.
[The prepared statement of Margarita Devlin appears in the
Appendix]
Mr. Flores. Thank you, Ms. Devlin. It sounds like you have
been pretty proactive in dealing with the GAO report. The
Subcommittee appreciates that. To follow up on one of the areas
I did not hear you address, or maybe I missed it, as Mr.
Bertoni said there was wide variance in the implementation of
the IL program from one area to another. What sort of a
response do you have about that? I mean, what are the
underpinnings of that from your perspective?
Ms. Devlin. VA has actually been looking at that issue for
several years. Starting in 2011, we conducted a review of the
percentage of stations' workload that focused solely on
independent living cases. Typically, the percent of independent
living workload nationally is about two and a half percent. So
what we did was look at which stations fell well below the two
and a half percent mark. We also looked at stations that were
considerably higher than the national average, and we did
special reviews of their IL files. We also reviewed in those
stations with historically lower utilization, the applicants to
the program in general, because veterans do not apply to the
independent living program, they apply to the VR&E program and
then they receive a track of services based on their needs. So
we looked at cases where veterans had applied and not received
any services to see if any veterans might have been turned away
that could have benefitted from independent living services.
We found no instances where veterans had been turned away
who should have received independent living services in any of
those stations. If anything, we found procedural areas for
improvement, and we recommended training or other corrective
actions for those stations. But we did not find turning away of
veterans who should have been provided services.
So VA is embarking on an outreach plan in 2014 because we
do feel that there is some merit to a finding that stations
with increased outreach in independent living services receive
increased demand for those services. So we are embarking on
that in 2014, specifically targeting those offices where there
is low utilization to try to increase awareness of services.
Mr. Flores. Okay. It also sounds like there was wide
variability in terms of the services that are provided, or
services is not the right word, but the modalities that were
used from one area to another in terms of trying to deal with
veterans to help them achieve that maximum level. What does the
agency do to share best practices from one area to another? Or
do you have a program like that to share best practices?
Ms. Devlin. We do. In fact the study that we are conducting
currently with the help of a contractor is really looking at
every single station and conducting a survey of all staff
across all stations, and giving us feedback and recommendations
for possible improvements in consistency. I also want to just
point out the fact that the independent living program is very
tailored to a specific veteran's individual needs. And as you
look at the regions in which they live, whether it is primarily
a big city type of an environment versus a rural environment,
they might have very different needs. So that is another factor
to consider.
Mr. Flores. Okay. With that I, let us see, I think I do
have one more question. Tell us a little bit more about the
training modules that VR&E has created for the independent
living program, and in particular, do these modules have
testing requirements at the end of the training? And what
repercussions will there be if a VR&E counselor does not
complete these modules by the end of fiscal year 2014?
Ms. Devlin. We have multiple trainings around the
independent living program. For new voc rehab counselors that
come into VA there is a two-hour, self-paced course. It is a
new counselor training performance support system that includes
two hours of independent living training. In September of 2013,
we also conducted a one-hour extra training session on
independent living. The TPSS, the Training Performance Support
Systems, do include testing during the course of the module and
the tests have to be passed. If the test is not passed, the
counselor must go back and relearn or retake the module until
they can pass the test. Also in September of 2013, we deployed
a 15-hour advanced independent living training performance
support system module and that will be for all counselors who
have completed the precursor, which would be the new counselor
training. All counselors will be required to take this 15 hour
advanced independent living training, which also includes tests
throughout the modules.
Mr. Flores. Okay. My next question will take a little bit
longer. I think what we will do is, we will just have a second
round. And with that, I would recognize the Ranking Member for
five minutes.
Mr. Takano. Thank you, Mr. Chairman. Ms. Devlin, has the VA
ever slowed applications to the independent living program with
the intent of not exceeding the cap?
Ms. Devlin. We have not even come close to the cap in many
years. I do know that there was one year where we came close
and we did ask all regional offices to send their requests for
independent living programs up to VA central office for review
and approval in the event that we did hit the cap and would
need to prioritize the more severely disabled individuals
first. And so those, while we did not slow it down, we did turn
the approval process over to VACO to ensure that we could
monitor it more closely.
Mr. Takano. Is it true that each plan made by the VA for
veterans counts toward, well I think you have answered this
question, it is true that a plan by the VA for veterans counts
toward the mandatory cap even though a veteran may have more
than one plan? Is that right?
Ms. Devlin. That is correct, although it is rare that a
veteran would have more than one plan in the same fiscal year.
Mr. Takano. Do you think that there would be more
participation in the program if the cap were removed? You say
you have not come close to it. But is there any sense that that
cap inhibits participation?
Ms. Devlin. I think that it is something that we carefully
monitor, and the counselors in the field are very well aware
that we monitor it. We do inform the field if we are getting
close to the cap. If that does happen, it is usually not until
the end of the fiscal year. However, I would say as we conduct
our outreach efforts in 2014, I would anticipate a higher
demand for independent living and we would have to reassess it
as we go through the year to see if we get close to the cap.
Mr. Takano. Some of the veterans service organizations have
complained that it takes VA a long time to provide home
modifications to terminally ill veterans. Is this a policy that
is under review? And does it take the VA a long time to approve
such modifications?
Ms. Devlin. I am not aware of such delays. However, anytime
a veteran has significant circumstances that would require
expeditious service, and if the counselor is made aware of
that, for example terminally ill veterans, we would certainly
expedite to the greatest extent of our capability. Construction
can take time by the mere fact that it is construction, and to
be done right, it would take some time. But the approval
process should not be delayed and in fact can be expedited. We
have expedited cases in the past for such reasons.
Mr. Takano. Okay. As I asked Mr. Bertoni, the issue of the
IT needs, and he cited the inadequacy of data. In your view, is
CWINRS meeting all of the IT needs for the independent living
program?
Ms. Devlin. There is always room for improvement with any
IT system. We are looking at possible modifications to the
system to enable us to put tighter controls and more careful
monitoring on IL expenditures. And we are looking at that for
future years.
Mr. Takano. So you do not have any more specifics about the
plan now to share with the Committee?
Ms. Devlin. We do not have all of those requirements
identified yet. However, what we have done is look at whether
there are fields within the current system that can be used to
more carefully monitor those expenditures through ad hoc
reports. So what we are looking at now in terms of expediting a
possible implementation, is what can we do with the current
system as it stands today, while we develop our requirements
for the future.
Mr. Takano. Mr. Chairman, thank you and I yield back. And I
am going to have to depart early.
Mr. Flores. Okay. Thank you, Mr. Takano. Mr. Runyan, you
are recognized for five minutes.
Mr. Runyan. Thank you, Mr. Chairman. Ms. Devlin, just kind
of going back into oversight. In the report, it says with 57
regional offices, VR&E is doing about 12 site visits a year.
That means that each RO is only being visited about once every
five years. Do you believe that that is an effective way to
track performance? And should you be conducting more site
visits?
Ms. Devlin. The site visits that VR&E conducts are just one
part of our oversight for independent living and for the other
tracks of our program. We also conduct specialized quality
assurance reviews of CER files, which is the veteran's
Counseling Evaluation and Rehabilitation file. We conduct
special reviews specifically for independent living cases above
and beyond our standard quality assurance, which is done as a
random sample of all cases in all tracks. So in addition to the
12 site visits, we conduct regular quality assurance reviews
and specialized independent living reviews throughout the year.
We also do targeted reviews, as I mentioned earlier, where we
look at stations that have historically low or high utilization
of IL by doing targeted pulls at those stations to ensure that
they are following proper procedures.
Mr. Runyan. Now you touched on this, I think when answering
one of the Chairman's questions. But there is a, in different
ROs, there is a huge variation in days to complete their goal.
Is that because of what the actual task or the modality is? Or
is it something internally within that structure and that
region and who is running that program?
Ms. Devlin. There could be a variety of reasons for the
length of time that a veteran takes to complete his or her
program. It could be in part because of the services provided,
some of those services might require lengthier periods of
service delivery. It could also be in part because of the
veteran's own circumstances and needing to take time off from
participating in the plan due to family or medical issues. But
the primary reason, I would say, would be because of the type
of services provided.
Mr. Runyan. And kind of in the oversight kind of realm,
understanding that it can be difficult to meet with each IL
participant every month, has the VA utilized other technologies
such as Skype or video conferencing as an alternative to face-
to-face communication?
Ms. Devlin. We are actually working on that now. We have
conducted a pilot to test secure video technology to allow the
counselors to conduct some of their sessions with veterans by
video counseling. That pilot has gone really well. Veterans
have reacted very well to it as well as our counselors. We are
now in the process of determining how we would deploy that
nationally beyond a pilot.
Mr. Runyan. Thank you, Chairman. I yield back.
Mr. Flores. Thank you, Mr. Runyan. I would like to have a
round of follow up questions, if I could. The GAO report
stated, and as you acknowledged, the CWINRS IT system has some
shortcomings. In particular, its tracking performance of the
VR&E participants is flawed and, you know, because it is
counting plans instead of participants. Are there any other
limitations that you became aware of as a result of the GAO's
report? I mean, you talked about the expense tracking. Anything
else that we need to know about?
Ms. Devlin. We are always looking for opportunities to
improve the system. So anytime an audit, whether external or
internal is conducted, we are always looking for opportunities
to improve the system. More recently, one of the changes that
we made just in the last quarter of 2013, is to change how our
case status system progresses. A veteran who is in the
independent living program, for example, and because of changes
in circumstances, disability conditions, or anything else that
might change that veteran's life during the course of
participating in the program, they might need to redevelop
their plan. And so in order to redevelop that plan, in the
past, we had to move the case to a different status and then
reroute it back into independent living status. And so it would
look like there were two plans, when in effect, it was one
veteran really just getting their plan adjusted for their new
services.
The change that we made, which just went into CWINRS, is to
make it more of a linear process. So that once the veteran
enters independent living program status, they stay in that
status, even if their services change.
Mr. Flores. Okay. In terms of making improvements to VBMS,
the changes that we talked about that would improve these
systems, you were non-specific as to timing. I mean, I would
like to press on you a little bit. What is the timing of trying
to make these changes?
Ms. Devlin. We hope to actually capitalize on the VBMS
system because it is paperless, and VR&E is currently a very
paper intensive organization. We have paper files and very
little of the veteran's progress is recorded in the IT system.
So one of the things we want to do is be strategic about our
progression and actually capitalize on the VBMS system. We need
to build requirements that will not create a separate system
that does not communicate with VBMS. We are very reliant on
Compensation service-connected disability decisions. Therefore,
it would behoove us to make sure that we capitalize on the VBMS
system and build a system that would work with it, as opposed
to separate from it.
Mr. Flores. So what is the best prediction you could give
me today as far as timing? I know you do not want to answer
that, so----
Ms. Devlin. Well the budget cycle works in two-year cycles.
So we would hope that in the next two to three years, we would
be able to implement these changes.
Mr. Flores. Okay. If we were to help VA make this a
priority, how quickly could you get this done if we, you know,
Congress said, hey, we think you need to make this a priority.
What is the fastest track that you could see this happening?
Ms. Devlin. Well with any IT development, we would need to
acquire the services of a qualified contractor to----
Mr. Flores. Not CGI, though.
Ms. Devlin. Sorry?
Mr. Flores. Not CGI.
Ms. Devlin. I would have to take that for the record and
see how long it would take us to implement those changes.
Mr. Flores. Okay. If you could respond supplementally, that
would be great. And then my last minute and 27 seconds, the
question that you have been anxiously awaiting for, can you
walk us through what you think was going on in the mind of the
VR&E counselor that approved the boat and the one that approved
the lawn mower?
Ms. Devlin. So not having the details of those cases before
me, I can only speak to the general principles that I would see
as appropriate behind those cases. If a veteran, because of
disability conditions, can no longer conduct the basic care of
their home, for example taking care of their lawn, it is
conceivable that we would want to help that veteran to not have
to rely on family members or on other people to help them
accomplish those tasks. And if they did not have the equipment
to perform those tasks, we might want to help them attain that
equipment.
Similarly, with the boat, I can only say that if the
veteran previously used to have an activity of fishing that was
enjoyable and actually helped them with their symptoms of PTSD
by lessening those symptoms, and now they can no longer perform
those activities, I would imagine the counselor was trying to
return that veteran to sort of a pre-disability condition; a
pre-disability condition status of being able to have
meaningful activity in their life and reduce their symptoms.
Those cases were actually from 2008. Since 2008, we have
actually implemented a multitude of different procedures that
would change the way those cases were handled today.
Mr. Flores. Okay. Mr. Runyan, would you have any questions?
Okay. Thank you, Ms. Devlin for your testimony. I appreciate
you coming up with, being proactive and responding to the GAO
report. You are now excused.
We are going to invite our third panel to the witness table
at this point. On this final panel, we will have Mr. Richard
Daley with Paralyzed Veterans of America and Mr. Paul Varela
with Disabled American Veterans. Mr. Daley, when you are ready
we would like to recognize you for five minutes.
STATEMENTS OF MR. RICHARD C. DALEY, ASSOCIATE LEGISLATION
DIRECTOR, PARALYZED VETERANS OF AMERICAN (PVA); AND MR. PAUL R.
VARELA, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED
AMERICAN VETERANS (DAV)
STATEMENT OF RICHARD C. DALEY
Mr. Daley. Chairman Flores, Members of the Subcommittee,
Paralyzed Veterans of American thanks you for the opportunity
to present our views on the VA's Vocational Rehabilitation and
Employment Programs independent living service. PVA appreciates
that you are reviewing the program intended to help veterans
that sustain serious disabilities that may inhibit their
progress as they begin or continue their rehabilitation. We
support the Committee's concern and effort as it recommends and
approves that the men and women who have honorably served their
Nation are making an effort to transition back to the civilian
world.
Information from the recent GAO report highlights some
issues that will require attention and continued oversight of
this important VA program. The independent living program was
established by Congress in 1980 as part of Vocational
Rehabilitation and Employment. Although employment for the
veteran should be a goal for VR&E, those veterans with serious
disabilities requiring extensive rehabilitation before
considering employment, or who may never be employable, will
qualify and benefit from the independent living program.
The original independent living program was a pilot program
authorized by Congress 33 years ago with a limit or a cap of
500 veterans admitted each year. That cap has been increased
several times to the current total of 2,700 veterans per year.
Military service, including overseas combat, does not place a
limit or a cap on serious injuries that take place while
serving the Nation. For this reason, the authors and supporters
of the independent budget have asked Congress to consider
removing the cap.
The flexibility of the IL program allows a VR&E counselor
and the veteran to decide what is needed at the time to best
accommodate their rehabilitation or improve their quality of
living. Using IL programs common practice eight to ten years
ago for terminally ill veterans that were diagnosed with ALS
and MS to make small modifications to their homes. Since the VA
has existing programs to make modifications on a home to
practice of using IL funds was discontinued. Unfortunately,
these veterans with service-connected conditions may have only
months to live. To assist the veteran in their final months,
the IL plan would arrange and provide for funding for
modifications to the home so the veteran could spend their
remaining days with their family. The majority of the
situations required a small modification such as widening of a
bathroom door or a ramp. The problem with the existing programs
for home modifications, completing the work often takes 12 to
24 months. The veteran may not have 24 months to live.
After realizing the time required for the VA to make the
modifications, often the veteran takes out a loan to have the
work completed. The veteran spends their last months at home
regardless of the VA's policy. PVA believes that the use of the
IL funds for terminally ill veterans was within the mission of
helping achieve maximum independence.
During a quarterly meeting of VSOs recently, the VA
discussed a program of expediting the modifications for homes,
realizing that their existing programs were not working. The
current process contains inspections, approvals, reinspections,
reapprovals, construction delays. The VA must figure out a way
to streamline this process for terminally ill veterans because
the current system is not working.
PVA service officers and employment rehabilitation
counselors regularly work with veterans who participate in the
IL program. In my written testimony, I have included some
examples of the creative use of this program. One of them was,
I have heard reference to the oven and it may the case that I
listed here, in Atlanta, Georgia that was a few years ago.
Where the veteran did a lot of baking from his wheelchair. He
rolled up to the oven, he put the door down, and he constantly
burnt his legs, going to the VA clinic for burned legs. So they
said, for a small fee, they had an oven with a fold out,
sideway open door so that the veteran could continue baking.
There are other creative uses of the IL program that help the
veteran. You know, they do not solve all the problems, but they
help them from the initial stages to continuing to, you know,
decide whether they should decide on a work program, or take an
educational program, or they give them that little bit of
assistance that they need. So we strongly support the program.
That concludes my testimony. I am happy to answer any
questions you may have.
Mr. Flores. Thank you, Mr. Daley. Mr. Varela, you are
recognized for five minutes.
STATEMENT OF PAUL R. VARELA
Mr. Varela. Chairman Flores, Congressman Runyan, thank you
for inviting DAV to testify at today's hearing on VA's
independent living program, one of five tracks offered through
Vocational Rehabilitation and Employment Services. As the
newest member of DAV's legislative staff, I look forward to
working with this Subcommittee to help fulfill our promises to
the men and women who served.
Before accepting my assignment, I worked for a decade as a
DAV national service officer in New York and Los Angeles. Like
all DAV NSOs, I myself participated in and completed a VR&E
rehabilitation plan. I have repeatedly been trained on all VR&E
programs, including the independent living program, and I
regularly refer veterans to voc rehab programs whenever
appropriate.
As you can imagine, Mr. Chairman, DAV is a staunch
proponent of the program, as we are for all voc rehab programs
because they embody DAV's central purpose of empowering
veterans to lead high quality lives with respect and dignity.
This program in particular, is uniquely designed to provide
disabled veterans with serious employment handicaps who are
currently unlikely to benefit from one of the four employment-
related tracks, the opportunity lead more fulfilling and
independent lives. Whether they have lost limbs, sustained
severe burns, or suffer from debilitating mental disorders such
as Post-Traumatic Stress Disorder, this program was created to
help these men and women become more independent in their daily
lives, to interact with families and in communities, and find
greater purpose and meaning in their lives. Considering all
they have sacrificed for us, it is the least that a grateful
Nation can offer them.
To improve the independent living program, Congress must
remove the cap. VR&E must increase outreach and awareness
efforts both internally and externally. VBA must incorporate
VR&E into VBMS as soon as possible, and the Department of
Veterans Affairs must improve cooperation with VR&E from VA
offices and programs.
First, when the IL program was initially created as a pilot
in 1980, it had a hard cap of 500 participants. But over the
years that number has risen to 2,700 participants. While we
appreciate the fiscal constraints and budgetary concerns that
Congress must address, we believe that a cap is an arbitrary
limit. There is little or no data available to determine how
many veterans would or could benefit from the program. Some
VR&E officials we have talked with believe that the cap
discourages some ROs from promoting the program. DAV believes
that if the independent living program is the right track for a
seriously disabled veteran, it should be available without any
arbitrary limit. The cap must be removed.
Second, in order to maximize the benefits of the program,
VR&E must significantly enhance its internal and external
awareness and outreach efforts. We understand VR&E is preparing
to distribute literature throughout VA facilities and is
creating a new web-based training element. That is a great step
in the right direction, but to be effective, this training must
be repeated at regular intervals. And we would recommend that
it should be part of the skill certification process. We also
recommend that VBA include information about entitlement to
vocational rehabilitation services in all appropriate
correspondence with eligible veterans.
Third, DAV recommends that VR&E's IT needs be addressed
through the new Veterans Benefits Management System, commonly
known as VBMS. We agree with GAO that VR&E's current IT system
does not meet its current needs and limits its oversight
abilities. It fails to capture some of the most basic data and
information, including the number of program participants, how
much money is spent on individual independent living services,
or even the aggregate totals each year. VA must request and
Congress must approve sufficient funding for IT development and
deployment of VBMS to include vocational rehabilitation as soon
as technically feasible.
Fourth, VR&E must develop and receive greater cooperation
from other VA offices, including the Veterans Healthcare
Administration, Prosthetic and Sensory Aid Service, Specially
Adapted Housing, and Home Improvement and Structural Alteration
Programs. Despite the fact that these are all VA programs and
offices, GAO and others have reported that coordination and
cooperation can often be difficult. All of these offices work
for the same department and should be serving the interests of
veterans. If they are unable or unwilling to work together
effectively, the Secretary and Congress must take appropriate
actions to make them do so.
Finally Mr. Chairman, despite the management and oversight
challenges discussed in our testimony, and the GAO report, we
continue to believe the independent living program is an
essential, appropriate, and empowering benefit that has and
should continue to make a tremendous difference in the lives of
thousands of veterans every year. We strongly encourage you to
continue examining ways to improve this program. DAV stands
ready to work with this Subcommittee in any way we can to offer
our expertise, assistance, and support.
This concludes my testimony, and I would be happy to answer
any questions you may have.
[The prepared statement of Paul R. Varela appears in the
Appendix]
Mr. Flores. Thank you, Mr. Varela. I now recognize myself
for five minutes for questions. The first question is for each
of you and it is a matter of prioritization. Each of you had
several things that you recommended that the VA do. And so, I
would ask you this, we will start with you, Mr. Daley, what is
the one thing that Congress would do today that would help
improve the IL program?
Mr. Daley. Well as you said, there are several things. They
probably, lifting the cap is one thing that the veterans
organizations all support. Now will that immediately improve?
No, it will not. But at least it will open the program up to
more people. I, when we say cap I like to think of it as cliff.
You know, as they approach that, they are never going to get,
they are never going to go off that. There would be terrible
consequences from the national office if they ever go over
2,700. So anywhere when they get to 2,000, they start slowing
down. So removing the cap would be one positive thing for the
overall program and for veterans in the future.
Mr. Flores. Mr. Varela, what is the one thing that Congress
would do that would help the VA improve the IL program?
Mr. Varela. We would agree with PVA in that the cap should
be removed.
Mr. Flores. Okay. What is the second thing that we could
do? Let us start with, Mr. Varela you have got the microphone,
so keep going. So we will come back to you, Mr. Daley.
Mr. Varela. Thank you, Chairman Flores. Increase outreach
and awareness about the program, informing veterans of the
potential for that benefit through vocational rehabilitation,
and making sure when they go online to visit the VA, that
information is there, how to apply. Making people aware of the
program to include, to include those VR&E counselors by
providing them with the training to administer the program
properly.
Mr. Flores. Mr. Daley, what is the second thing that
Congress could do?
Mr. Daley. Well let me quote my colleague there exactly.
Outreach. You have got to have more people aware of it, and
more people will apply for it and ask for it. And the
counselors, they need more training. They need to be aggressive
in using the program. Probably some counselors do not
understand it totally, so they do not use it, and other
counselors, you know, for years I have always heard that well,
the St. Petersburg office uses the program all the time.
Atlanta, Georgia used it all the time. Some other offices do
not use it.
Mr. Flores. Right.
Mr. Daley. I do not know why. They are still getting
disabled veterans at the other offices. But apparently people
who, at those offices that use it a lot, they understand the
program, they like the program, they are comfortable, and they
use it for the veteran's benefit.
Mr. Flores. I would like to get a couple more questions in
a limited amount of time. What types of services do each of
your organizations offer to veterans over and above what the IL
program includes? Mr. Daley, we will start with you and try to
keep your answer short if you could. Do you all, does your
organization offer any----
Mr. Daley. Yes. We have an employment program that we run
in seven of the VA hospitals, and we have a vocational
rehabilitation person right there in the hospital that works
with the veteran, the recently injured veteran. Because, as I
said in my testimony, it is important to kind of get their mind
set that life can continue on. They can get a job someday, go
back to school.
Mr. Flores. Okay. Mr. Varela?
Mr. Varela. DAV provides direct access to information in
the regional offices, out on the road with our mobile service
vehicles, inside hospitals as well. Also, that is an ingrained
part of our training program. So when veterans come to us, that
is something that our counselors are familiar with and can
refer them appropriately to VR&E.
Mr. Flores. Okay. Mr. Daley, this question is for you. In
your written statement, you discuss the lack of coordination
between VHA and VBA, and how it can adversely affect disabled
veterans, especially those who only have a few months to live.
Can you expand on what you put in that written statement?
Mr. Daley. Well often, if they are looking for, to look
some type of recommendation, they have to get advice from VA,
the medical people and the attending doctor as far as the
condition of the veteran to decide whether their recommendation
will actually benefit or not. And often, there is no response
at all, which is hard to understand why. But that did not apply
to modifications, but that is just adaptations or appliances or
equipment that they may benefit from.
Mr. Flores. Okay. I have a couple of more questions, but we
will wait and do a second round. Mr. Runyan, you are recognized
for five minutes if you have any questions.
Mr. Runyan. Thank you, Mr. Chairman. Mr. Daley, kind of
what the Chairman was talking about, and you were talking about
adaptation of housing or whatever. Is there a significant
amount of time that the local municipality may have in changing
someone's home on top of what you said with the VBA and getting
the doctors the approval. We know that process takes, can you
expand on that a little bit?
Mr. Daley. As far as the local municipality, you mean as
far as getting codes----
Mr. Runyan. Building codes, and----
Mr. Daley. Well, some of the modifications probably would
not take building codes. If the person just wants their
bathroom door made eight or 12 inches wider so they can get in
there with their wheelchair, I think, I do not know whether you
would have to----
Mr. Runyan. So you are suggesting most of this is internal
in the VA?
Mr. Daley. Internal, yes, sir. Yes. It is not external. It
is the VA process. Which works, if you have time to wait. And I
understand them wanting to account for the money out of the
right pool of money, out of Home Modifications. But these
veterans are dying. You know?
Mr. Runyan. And Mr. Varela, just talking a little bit, you
know, I know we are talking about the cap and all this. But I
asked a question to both the GAO and the VA, talking about what
constitutes true rehab? And in your experience with your
members, do they come to you and say this works, this does not
work? Because it does not seem like there is a follow up metric
from the VA side to really say, this time, we just completed
the program, but there is nothing to say that maybe there needs
to be, you know, more things done down the road. Do you have a
sense of that within your membership?
Mr. Varela. Congressman, in my experience, when we have
referred individuals to vocational rehabilitation, we did not
send them down there to examine independent living services
specifically. We sent them down there to see what benefits
could be provided through VR&E. And we had a lot of good
feedback in Los Angeles from the VR&E program. So on the
surface, it appeared that they were receiving the services that
could be provided. We did not get a lot of push back from our
clients that VR&E was not giving them what they were seeking.
So that was based on my experience in Los Angeles.
Mr. Runyan. Just the whole discussion raises the question,
in my head, from a clinical aspect, is what they were trying to
accomplish, did it get accomplished? I do not think a lot of
those answers have been, are even available. But I just throw
that out there and I yield back, Mr. Chairman.
Mr. Flores. Okay. Thank you, Mr. Runyan. One final question
for Mr. Varela. You had some suggestions on what the VA could
do to their IT system that tracks the IL participants and the
services that VR&E provides. Could you go into a little more
detail on the improvements you would like to see?
Mr. Varela. First, we just want to be clear that we do not
want any money wasted. We want to make sure that every dollar
is spent appropriately. Unfortunately, the current system that
they have, does not give them that oversight ability. So what
that system ultimately looks like, that is still up for
discussion. But we would gladly offer our input if it is
sought. We would be more than happy to work with the
Subcommittee.
It needs to be integrated with VBMS at some point in time
because that is the future. Unfortunately as it stands, now a
veteran can go online, file for disability compensation and
other benefits, but you cannot do that with vocational
rehabilitation. So there is a disconnect there. And I do not
know that we can wait two or three years to do that.
Mr. Flores. Okay. If you would not mind, if you could send
us, supplementally, the recommendations you would have for the
IT system that has to do with voc rehab, that would be helpful
to us.
Okay, I would like to thank the third panel for their
testimony today, and thank you for the services that you
provide to our Nation's veterans. I am assuming that no other
Member has additional questions. In closing, I urge the VA in
the strongest possible terms to prioritize the funding and the
improvements for CWINRS, and to address the issues raised by
the GAO. It sounds like they are off to a good start. But in
particular, it sounds like the IT programs need to be
prioritized.
As I mentioned in our hearing earlier this year on the long
term solution for G.I. Bill claims that we have got the same
issue there, that system needs to be made a priority in terms
of the IT funding allocations within the VA. So the VA needs to
make sure that they are taking steps to not ignore the needs of
other vital VA programs while they continue to tackle the
disability backlog.
Finally, I ask unanimous consent that all Members have five
legislative days to revise and extend their remarks and include
any extraneous material in the record of today's hearing.
Hearing no objection, so ordered.
If there is nothing further, this hearing is adjourned.
Thank you.
[Whereupon, at 3:38 p.m., the Subcommittee was adjourned.]
A P P E N D I X
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Prepared Statement of Hon. Bill Flores
Good morning and the Subcommittee will come to order. I want to
begin by thanking my good friend Mr. Takano for participating in the
two field hearings we held last week in Riverside, CA, and Waco, TX. I
know I found them to be very informative and I thank the Ranking Member
for his assistance in making them a great success.
We are here today to conduct oversight over the Vocational
Rehabilitation and Employment (VR&E) service's independent living
program. This program provides a wide array of services to the most
severely wounded and disabled veterans who have disabilities that
preclude them from working, but can still use VA's services to help
them achieve a higher level of independent daily living.
Our hearing today will focus on three major objectives:
The results of a Government Accountability Office (GAO)
report on the Independent Living Program that this Subcommittee
requested last Congress;
VA's steps to implement the recommendations of this
report and other steps they are taking to improve the performance of
the I.L. program; and
The view of this program at the local level from our
veteran service organization partners, and how they believe we can
better assist our most severely disabled veterans achieve maximum daily
living.
While I am encouraged that the recent GAO found that 89% of the
veterans in their study eventually completed their independent living
plans, they also found that there is a need for increased oversight
over this program.
For example, when VA is unable to track simple performance metrics
like counting, in realtime, the number of veterans in the independent
living program or provide an aggregate number of the types of benefits
being provided to veterans through the program . . . something is
wrong.
I don't fault VA Central Office staff for many of these problems. I
believe many of these issues stem from the lack of attention and
resources that are provided to the VR&E service by the Veterans Benefit
Administration (VBA).
GAO found that VR&E's computer tracking system is in serious need
of an upgrade, but as GAO has mentioned in their written statement,
VR&E officials don't expect to receive the funding needed for this
upgrade for another 3 years.
While I know that VBA is transfixed on improvements to the Veterans
Benefits Management System (VBMS) to bring down the disability backlog,
they can't continue to drop the ball and lose sight of the fact that
other important programs that serve our veterans need assistance as
well.
We saw this earlier this year with our hearing on the Long Term
Solution for G.I. Bill benefits, where a simple investment could finish
the job once and for all, but resources were transferred to disability
backlog.
Congress has never turned down VA's request for funding to improve
computer systems, which will help veterans and strengthen oversight. I
hope to learn more about VA's plans to update their systems today.
One other area that GAO discussed in their report is the need to
review cost controls and approval authority for large expenses within
the independent living program.
This point was crystallized by the revelation that VA Central
office review was not needed for a VR&E officer at the local level to
authorize $17,500 for the purchase of a glass-pro fishing boat, motor,
and trailer for a disabled veteran.
I understand that learning to fish can certainly improve a
veteran's independence and quality of life, but I think we can all
think of better ways to teach veterans this skill than purchasing a
$17,500 boat.
I believe that this program has the ability to greatly improve the
lives of veterans, but more work needs to be done to ensure efficiency
and improve performance.
With that, I recognize the Ranking Member for his opening remarks.
Prepared Statement of Daniel Bertoni
Chairman Flores, Ranking Member Takano, and Members of the
Subcommittee:
I am pleased to discuss our recent work on the Department of
Veterans Affairs' (VA) Vocational Rehabilitation and Employment
Program's (VR&E) Independent Living (IL) ``track.'' \1\ The IL track is
one of five tracks administered by VR&E and provides non-employment
related benefits--such as counseling and assistive devices--to help
veterans with service-connected disabilities live more independently
when employment is not a feasible goal. \2\ In fiscal year 2011, almost
3,000 veterans nationwide were served through VR&E's IL track.
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\1\ The VR&E program refers to each of the five possible courses of
action it provides to veterans as a ``track.''
\2\ The other four tracks administered by VR&E are intended to help
veterans prepare for, find, and maintain suitable employment. These
tracks include (1) Reemployment, (2) Rapid Access to Employment, (3)
Self-Employment, and (4) Employment Through Long-Term Services.
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Currently, there are 56 VA regional offices with responsibility for
administering the IL track. Each office has a VR&E Officer who is
responsible for ensuring compliance with national policies and
performance standards, and for supervising Vocational Rehabilitation
Counselors (VRCs) who work directly with veterans to assess their IL
needs and provide benefits. The law allows VR&E broad discretion in
determining the types of services that can be provided to address
veterans' IL needs. \3\ When assessing each veteran, VR&E focuses not
only on assisting veterans with activities of daily living, \4\ but
also on their emotional needs and avocational and leisure interests,
among other areas. \5\ An individualized IL plan, which is developed
for each veteran admitted into the IL track, identifies the veteran's
IL goals, the goods and services VR&E will provide to help the veteran
meet his or her goals, and estimated time frames for providing the
goods and services, among other areas. In general, timeframes for IL
plans may not exceed 24 months, except under certain circumstances. \6\
Under VA regulations, VR&E may declare a veteran successfully
``rehabilitated'' when all goals in their IL plan have been achieved,
or if they meet other conditions. \7\ Therefore, ``rehabilitation''
does not necessarily mean that the veteran's disabilities have
improved, but rather that the goals developed in their IL plan to
facilitate independence have been met. When veterans are not
successfully rehabilitated, their case may be closed as
``discontinued.'' VR&E can also temporarily ``interrupt'' a veteran's
case when circumstances arise that affect the provision of the goods
and services. Because there is no statutory limit on the number of IL
plans a veteran can have, officials told us that veterans can reapply
to the VR&E program at any time and start another IL plan. \8\ However,
unlike VR&E's four employment-related tracks, the number of veterans
who can be admitted into the IL track annually is limited by the law.
While this number has increased over the years, the cap was set at
2,600 veterans in fiscal year 2011, and 2,700 in fiscal year 2012. \9\
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\3\ Under 38 U.S.C. Sec. 3120(d), a veteran's IL program ``shall
consist of such services . . . as the Secretary determines necessary to
enable such veteran to achieve maximum independence in daily living.''
\4\ Activities of daily living are basic activities that
individuals perform on a daily basis, such as bathing, feeding, and
dressing themselves.
\5\ According to VA officials, IL services that support emotional
needs and/or avocational and leisure interests may be included in IL
plans only when gains in independence are an anticipated result.
\6\ 38 U.S.C. Sec. 3105(d), 38 C.F.R. Sec. 21.76(b). An
additional period of 6 months is allowed if it would enable veterans to
substantially increase their level of independence in daily living. In
addition, VR&E may extend the duration up to 36 months for veterans
with severe disabilities who served on active duty after September 11,
2001. 38 U.S.C. Sec. 3105(d)(2)(A)(ii) and Department of Veterans
Affairs, Veterans Benefits Administration, Extension of Independent
Living Services related to the Veterans Benefits Improvement Act of
2008 (Public Law 110-389), VR&E Letter 28-09-10 (January 30, 2009).
\7\ VR&E may declare a veteran successfully ``rehabilitated'' when
all goals in their IL plan have been achieved, or if not all achieved,
when the following three conditions have been met: (1) the veteran has
attained a substantial increase in the level of independence; (2) the
veteran has maintained the increased level of independence for at least
60 days; and (3) further assistance is unlikely to significantly
increase the veteran's level of independence. 38 C.F.R. Sec.
21.283(e).
\8\ Specific criteria must be met before approving new plans for IL
services. These criteria include meeting requirements for participation
in a program of IL services, and the worsening of the veteran's
condition or other changes in the veteran's circumstances resulting in
a substantial loss of independence. 38 C.F.R. Sec. 21.284(b).
\9\ The Veterans' Benefits Act of 2010 increased the cap to 2,700
effective ``with respect to fiscal years beginning after the date of
enactment of this Act.'' Pub. L. No. 111-275, Sec. 801, 124 Stat.
2864, 2888. Because the enactment date of the Act was October 13, 2010,
which is in fiscal year 2011, the cap of 2,700 veterans would have
become effective starting in fiscal year 2012.
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My remarks today are based on our report, which was released on
June 7, 2013, and describes (1) the characteristics of veterans in the
IL track, and the types and costs of benefits they were provided; (2)
the extent to which their IL plans were completed, and the time it took
to complete them; and (3) the extent to which the IL track has been
administered appropriately and consistently across regional offices.
\10\ To obtain this information, we reviewed relevant federal laws and
regulations; standards for internal controls and managerial cost
accounting; as well as VR&E policies, procedures, and other relevant
studies and documentation. We also interviewed VA officials and veteran
service organizations, and visited VA regional offices in San Diego,
California; Atlanta, Georgia; Detroit, Michigan; Philadelphia,
Pennsylvania; and the District of Columbia. In addition, we analyzed VA
administrative data and used statistical models to determine any
differences in rehabilitation times. Moreover, we reviewed the case
files of a random, generalizable sample of 182 veterans who were
assigned to the IL track at some point during fiscal year 2008. We
conducted this work in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform
the audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives. A
more detailed explanation of our methodology is available in our
report.
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\10\ GAO, VA Vocational Rehabilitation and Employment Program:
Improved Oversight of Independent Living Services and Supports Is
Needed, GAO-13-474 (Washington, D.C.: June 7, 2013).
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The IL Track Mainly Serves Older Veterans and Provides a Wide Variety
of Benefits
From fiscal years 2008 through 2011, the typical participant in the
IL track was a male Vietnam-era veteran. Of the 9,215 veterans who
entered the IL track in these years, most (67 percent) were male and 50
years old or older. Most women in the IL track were in their 40s or
50s. Most of the 9,215 IL track veterans served in the Vietnam War;
relatively few served in the Global War on Terrorism as part of
Operation Enduring Freedom or Operation Iraqi Freedom. \11\ In
addition, most (60 percent) IL track veterans served in the U.S. Army,
and less than 1 percent served in the National Guard or Reserves. More
than three-quarters of IL track veterans had a combined service-
connected disability rating of at least 60 percent, and 34 percent had
a disability rating of 100 percent. Regardless of disability rating
level, the most prevalent disabilities among this group were post-
traumatic stress disorder (PTSD), tinnitus (``ringing in the ears''),
and hearing loss.
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\11\ In fiscal year 2011, 46 percent of the 9,215 IL track veterans
served in the Vietnam War, whereas 16 percent served in the Global War
on Terrorism.
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Furthermore, our review of the case files of 182 randomly selected
IL track veterans in fiscal year 2008 shows that they were provided a
wide range of goods and services, from individual counseling and the
installation of ramps to a boat, camping gear, and computers. The most
common type of goods or services were related to counseling, education
and training, and computer and camera equipment. \12\ For all veterans
who entered the IL track in fiscal year 2008, we estimated that VR&E
purchased a total of almost $14 million in goods and services. The
average spent per IL track case that year was nearly $6,000.
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\12\ For a detailed list of goods and services provided to IL track
veterans, see GAO-13-474.
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Most Veterans Were ``Rehabilitated'' but within Varying Time Frames
We found that most (about 89 percent) of IL track veterans who
began only one plan during fiscal year 2008 were classified by VR&E as
``rehabilitated''--i.e., successfully reaching and maintaining the
goals identified in their IL plan--by the end of fiscal year 2011. At
the same time, about 11 percent of cases were either ``discontinued''--
i.e., closed by VR&E because the rehabilitation goals in the veteran's
IL plan were not completed--or were still active cases. Of the IL cases
that had been discontinued, the reasons included the veteran declining
benefits, not responding to VA's attempts to contact them, worsening
medical conditions, and death. We also found that some IL plans were
easier to close as rehabilitated than others, due to the varied nature
and complexity of IL plans, which are based on veterans' individual
disabilities and needs. For example, one IL plan we reviewed for a
veteran with rheumatoid arthritis only called for the purchase and
installation of eight door levers and a grab rail for the bathtub to
facilitate his independence. However, another IL plan we reviewed
called for providing a veteran who used a wheel-chair with medical,
dental, and vision care as needed, and about $24,000 in modifications
to the veteran's home, including modifying the veteran's bathroom,
widening doors and modifying thresholds, and installing an emergency
exit ramp in a bedroom.
While the overall IL rehabilitation rate nationwide was 89 percent
for veterans who started an IL plan in fiscal year 2008, the rate
varied by regional office, from 49 to 100 percent. \13\ About two-
thirds of regional offices rehabilitated 80 percent or more of their
2008 IL track veterans by the end of fiscal year 2011. In addition,
VR&E's IL rehabilitation rate was higher in regional offices with
larger IL caseloads. Among veterans who entered the IL track in fiscal
year 2008, an average of 90 percent were rehabilitated at offices with
more than 25 IL entrants, compared to an average of 79 percent at
offices with 25 or fewer IL entrants. \14\
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\13\ We excluded the Washington D.C. Regional Office--now referred
to as the National Capital Region Benefits Office--because only two
veterans entered the IL track during fiscal year 2008. One IL case was
discontinued, and the other was open at the end of fiscal year 2011.
\14\ Twenty-six regional offices had more than 25 veterans enter
the IL track during fiscal year 2008, while 30 offices had 25 or fewer
veterans enter the IL track during the same time period. Two offices
had no IL track entrants that year.
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Furthermore, in fiscal year 2008 IL veterans nationwide completed
their IL plans in an average of 384 days (about 13 months); however, we
found that the length of time to rehabilitate these veterans varied by
regional office from a low of 150 days at the St. Paul Regional Office
to a high of 895 days at the Roanoke Regional Office. \15\ At most
regional offices (49 of 53), however, the average number of days to
complete veterans' IL plans ranged from 226 to 621 days (8 to 21
months). \16\ To control for various factors that could influence
rehabilitation time frames, we used a statistical model to estimate the
amount of time it would take certain groups of IL track veterans to
complete their IL plans. \17\ The results of our model show differences
across regional offices in the amount of time it takes for veterans to
become rehabilitated based on caseload. More specifically, the chance
of rehabilitation within 2 years was less than 50 percent at 4 offices,
between 50 and 90 percent at 18 offices, and 90 percent or higher at 16
offices. Veterans served by regional offices with large IL caseloads
generally had a higher probability of completing an IL plan more
quickly than a veteran served by an office with a small IL caseload
(see fig 1).
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\15\ The St. Paul Regional Office had nine veterans enter the IL
track during fiscal year 2008, while the Roanoke Regional Office had
two veterans enter that year.
\16\ We reported the average time to complete IL plans for 53 of
VA's 56 regional offices because two offices did not have veterans
begin the IL track in fiscal year 2008. Another office had two IL track
veterans begin during this period, but these veterans were not
``rehabilitated.''
\17\ Our model controlled for type and severity of disability and
other demographic characteristics, among other factors. For additional
information on the methodology we used for our statistical analysis,
see our report (GAO-13-474).
[GRAPHIC] [TIFF OMITTED] T5870.001
VR&E Exercises Limited Oversight of the IL Track
We identified four key areas where VR&E's oversight of the IL track
was limited: (1) ensuring compliance with case management requirements,
(2) monitoring regional variation in IL track caseload and benefits
provided, (3) adequacy of policies and procedures for approving
expenditures on goods and services for IL track veterans, and (4)
availability of critical program management information.
Regional Offices May Not Be Complying with VR&E Case Management
Requirements
Certain VR&E case management requirements were not being met by
some regional offices. For example, based on our review of VR&E's site
visit monitoring reports, we found that some Vocational Rehabilitation
Counselors (VRCs) were not fulfilling VR&E's requirement to meet in-
person each month with IL track veterans to monitor progress in
completing their IL plans. \18\ VRCs told us that this requirement is a
challenge due to the size of their caseloads and the distances that
they may have to travel to meet with veterans. Furthermore, while VR&E
and the Veterans Health Administration (VHA) both have policies that
require them to coordinate on the provision of goods and services for
IL track veterans, we found that some VRCs experience challenges in
doing so. \19\ Several VRCs in the regions we interviewed indicated
that when they refer IL track cases to VHA physicians, the physicians
do not respond or they respond too late. As a result, services for IL
track veterans are delayed or purchased by VR&E instead of VHA. In our
review of 182 IL track case records, we found some instances where VR&E
purchased goods and services that appear to be medically related, such
as ramps and grab bars, which could have been provided by VHA. In
response, we recommended VA explore options for enhancing coordination
to ensure IL track veterans' needs are met by VHA, when appropriate, in
a timely manner. VA concurred and stated that it was piloting an
automated referral system that would allow VR&E staff to make referrals
to VHA providers and check on their status electronically.
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\18\ VR&E's policy manual states that contact via telephone, email,
or mail can be used as alternatives when necessary. Department of
Veterans Affairs, Vocational Rehabilitation and Employment, Chapter 9:
Guidelines for the Administration of An Independent Living Plan, VR&E
manual, Part IV, Section C, Chapter 9.
\19\ Specifically, VA regulations governing VR&E's IL track require
that if a veteran needs special equipment and is eligible for such
equipment under another VA program, the items will be provided under
that program. See 38 C.F.R Sec. 21.216(b). In addition, VHA's policy
directive for coordinating with VR&E is intended to ensure that all
VR&E participants, including those in the IL track, receive timely
access to VHA health care services. See Department of Veterans Affairs,
Veterans Health Administration, VHA Directive 2010-022, Vocational
Rehabilitation: Chapter 31 Benefits, Timely Access to Health Care
Services (May 14, 2010).
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VR&E Does Not Systematically Monitor Variation in IL Caseload and
Benefits Provided
VR&E does not systematically monitor variation in IL track caseload
size and benefits across its regional offices. We found that the total
IL track caseload for fiscal years 2008 through 2011 ranged from over
900 cases in the Montgomery, Alabama Regional Office to 4 cases in the
Wilmington, Delaware Regional Office. In addition, we found that some
regions developed IL plans that addressed a broad range of needs while
others elected to develop more focused plans that provided fewer
benefits to achieve VR&E's rehabilitation goal. VR&E has relied on the
information provided through its general quality assurance (QA)
activities \20\ and a series of periodic ad hoc studies to oversee the
administration of the IL track. Because these activities are limited in
scope, frequency, and how the information is used, we noted that they
may not ensure consistent administration of the IL track across
regions. In response, VR&E officials commented that QA results are
analyzed to determine trends, and make decisions about training content
and frequency.
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\20\ A team of VR&E QA staff at the national level perform periodic
site visits to each VA regional office at least every 3 years, although
officials told us they have not been able to meet this goal in recent
years because of budgetary constraints. This team also periodically
reviews a sample of veterans' records from VR&E's IL and employment
tracks in selected regions, and produces a report for the particular
region under review.
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VR&E's Policy for Approving IL Track Expenditures May Not Be Adequate
VR&E's current policy for approving IL track expenditures may not
be adequate, considering the broad discretion VR&E provides to regions
in determining and purchasing goods and services. While officials told
us that VRCs are required to include all cost estimates when they
submit veterans' IL plans to be reviewed and approved by the region's
VR&E Officer, VR&E's written policy and guidance do not explicitly
require this for all IL expenditures. Thus, regional offices have the
ability to purchase a broad range of items without any Central Office
approval, resulting in some offices purchasing goods and services that
may be questionable or costly. (See table 1 for the level of approval
required for IL expenditures.) In one case we reviewed, VR&E Central
Office approval was not required for the purchase of a boat, motor,
trailer, and the boat's shipping cost, among other items, totaling
about $17,500. In another case we reviewed, VR&E Central Office was not
required to approve total expenditures of $18,829 for a riding lawn
mower--which VR&E's current policy prohibits \21\--and other IL goods
and services including a bed, bed frame, desktop computer, and
woodworking equipment. Without appropriate approval levels, VR&E's IL
track may be vulnerable to potential fraud, waste, and abuse. \22\ In
our report, we recommended that VA reassess and consider enhancing its
current policy concerning the required level of approval for IL track
expenditures. VA concurred with our recommendation and said it will use
the results of an internal study to determine if changes are needed to
its existing cost-review policies or procedures. VA stated that any
necessary changes should be implemented by March 2014.
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\21\ While officials told us that the provision of riding lawn
mowers was not specifically prohibited by VR&E's policy in 2008, its
current policy states that tractors or mowers should not be approved as
a mobility aid. See Department of Veterans Affairs, Veterans Benefits
Administration, Purchase of Vehicles for Vocational Rehabilitation &
Employment (VR&E) Participants under 38 U.S.C. Chapter 31 is
prohibited, VR&E Letter 28-13-08 (November 6, 2012).
\22\ To guard against fraud, waste, abuse, and mismanagement,
standards for internal control in the federal government emphasize the
need for agencies to have appropriate levels of supervision and
controls in place to prevent one individual from having responsibility
for all key aspects of a transaction or event. GAO, Internal Control
Management and Evaluation Tool, GAO-01-1008G (Washington, D.C.: August
2001).
[GRAPHIC] [TIFF OMITTED] T5870.002
VR&E Lacks Critical IL Track Information for Oversight
VR&E's case management system--commonly referred to as ``CWINRS''
\23\--does not collect or report critical program management
information that would help the agency in its oversight
responsibilities. More specifically, this system does not collect and
maintain information on:
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\23\ VR&E has used the CWINRS system since 2001 to track veteran
cases through its process and to manage program costs. The ``WINRS''
part of the acronym represents the first 5 regional offices that tested
the original system. These offices include Waco, Texas; Indianapolis,
Indiana; Newark, New Jersey; Roanoke, Virginia; and Seattle,
Washington.
Costs of IL goods and service purchased: The system does
not collect information on the total amount of funds VR&E expends on IL
benefits. VR&E aggregates costs across all its tracks, despite VA's
managerial cost accounting policies that require the costs of products
and services to be captured for management purposes. \24\ Federal
financial accounting standards also recommend that costs of programs be
measured and reported. \25\ According to VA officials, cost information
is not collected on the IL track alone because they view the five
tracks within VR&E as a single program with the same overarching goal--
to help veterans achieve their employment goals. We previously reported
on this issue in 2009. At that time, we found that VR&E's five tracks
do not share the same overarching goal. Therefore, we concluded that
VR&E should not combine track information. \26\
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\24\ VA's policy states that managerial cost accounting should be
performed to measure and report the costs incurred by the agency.
Specifically, each administration and its units should identify the
cost of products and services provided. The goal of this effort is to
identify the product or service at the level in which it is rendered to
an external customer, such as a veteran receiving benefits from a VA
program. Department of Veterans Affairs Managerial Cost Accounting: VA
Financial Policies and Procedures, volume III, chapter 3 (July 2010).
\25\ Managerial cost accounting is a fundamental part of an
agency's financial management system, and each agency and its units
should report the costs of their activities on a regular basis. This
cost information can be used by Congress and federal executives in
making decisions about allocating federal resources, authorizing and
modifying programs, and evaluating performance. The cost information
can also be used by program managers in making managerial decisions to
improve operating economy and efficiency. Statement of Federal
Financial Accounting Standards 4: Managerial Cost Accounting Standards
and Concepts.
\26\ GAO, VA Vocational Rehabilitation and Employment: Better
Incentives, Workforce Planning, and Performance Reporting Could Improve
Program, GAO-09-34 (Washington, D.C.: January 26, 2009).
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Types of IL benefits provided: The system does not
collect information on the types of IL benefits provided to veterans in
a standardized manner that can be easily aggregated and analyzed for
oversight purposes. In several of the IL track cases we reviewed, the
goods and services purchased were grouped together under a general
description, such as ``IL equipment'' or ``IL supplies,'' without any
further details. In addition, we found that controls for data entry
were not adequate to ensure that all important data were recorded. \27\
For example, we estimated that the service provider field was either
missing or unclear for one or more services in about 15 percent of all
IL cases that began in fiscal year 2008.
---------------------------------------------------------------------------
\27\ Standards for internal control emphasize the need to have
controls over computerized information systems to ensure the data
entered is complete and accurate (GAO-01-1008G). In addition, GAO's
federal information system controls audit manual states that agencies
should establish procedures to provide reasonable assurance that all
inputs into the application have been authorized, accepted for
processing, and accounted for; and any missing or unaccounted for
source documents or input files have been identified and investigated.
GAO, Federal Information System Controls Audit Manual (FISCAM), GAO-09-
232G (Washington, D.C.: February 2009).
---------------------------------------------------------------------------
Number of IL veterans served: The system does not provide
VR&E with the information it needs to monitor its statutory entrant cap
and program operations. The law allows VR&E to initiate ``programs'' of
independent living services and assistance for no more than a specified
number of veterans each year, which, as of 2012, was set at 2,700. \28\
In analyzing VR&E's administrative data, we found that VR&E counts the
number of IL plans developed annually rather than the number of
individual veterans admitted to the track. Because multiple IL plans
can be developed for an individual veteran during the same fiscal year,
veterans with multiple plans may be counted more than once toward the
statutory cap. As a result, VR&E lacks complete information on the
number of veterans it is serving through the IL track at any given
time--information it could use to better manage staff, workloads, and
program resources, and ensure that it can effectively manage its cap.
---------------------------------------------------------------------------
\28\ 38 U.S.C. Sec. 3120(e). According to agency officials, ``IL
plans'' are the same as ``programs'' of independent living services and
assistance.
Similar to our report's findings, VR&E's 2012 evaluation of CWINRS
has shown that the system limits VR&E's oversight abilities and does
not capture all important data elements to support the agency's
``evolving business needs.'' \29\ Officials told us that they plan to
modify CWINRS, and that the new system modifications will enable them
to individually track veterans served through the IL track. However, we
found that the CWINRS redesign will not enable VR&E to obtain data on
IL track expenditures or the types of goods and services provided. At
the time of our review, no specific time frames were provided for the
CWINRS redesign, but officials noted it could take up to 3 years to
obtain funding for this effort. In our report, we recommended that VA
implement an oversight approach that enables VR&E to better ensure
consistent administration of the IL track across regions. This approach
would include ensuring that CWINRS (1) tracks the types of goods and
services provided and their costs, (2) accounts for the number of IL
track veterans being served, and (3) contains stronger data entry
controls. VA concurred with our recommendation and stated that
discussions of system enhancements and the development of ad hoc
reports are ongoing. The agency also will be considering a new
oversight approach as part of an internal study.
---------------------------------------------------------------------------
\29\ Department of Veterans Affairs, Vocational Rehabilitation and
Employment (VR&E) Case Management Portal Project, Version 1.0, Case
Management Portal, Business Requirements Document (September 26, 2012).
---------------------------------------------------------------------------
In conclusion, strengthening oversight of VR&E's IL track is
imperative given the wide range of goods and services that can be
provided under the law to help veterans with service-connected
disabilities improve their ability to live independently when
employment is not feasible. More attention at the national level can
help ensure that IL track case management requirements are met, the
track is administered consistently across regions, expenditures for
goods and services are appropriate, and critical information is
collected and used to ensure veterans' IL needs are sufficiently
addressed.
Chairman Flores, Ranking Member Takano, and Members of the
Subcommittee, this concludes my prepared remarks. I would be happy to
answer any questions that you or other members of the subcommittee may
have.
Contacts and Staff Acknowledgments
For further information regarding this testimony, please contact
Daniel Bertoni at (202) 512-7215, or at [email protected]. Contact
points for our Office of Congressional Relations and Public Affairs may
be found on the last page of this statement. Individuals who made key
contributions to this testimony include Clarita Mrena (Assistant
Director), James Bennett, David Chrisinger, David Forgosh, Mitch
Karpman, Sheila McCoy, James Rebbe, Martin Scire, Ryan Siegel, Almeta
Spencer, Jeff Tessin, Jack Warner, and Ashanta Williams.
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Prepared Statement of Margarita Devlin
Mr. Chairman and members of the Subcommittee, thank you for
inviting me to appear before you today to discuss the independent
living (IL) services provided by VA's Vocational Rehabilitation and
Employment (VR&E) program. My testimony will provide an overview,
performance summary, discussion of VR&E's technology system, and an
update on implementation of the Government Accountability Office's
(GAO) recommendations for the IL program.
VR&E Mission and Eligibility
The Veterans Benefits Administration's (VBA) VR&E program assists
Servicemembers and Veterans with service-connected disabilities to
prepare for, find, and keep suitable jobs. For Veterans with service-
connected disabilities so severe that they cannot immediately consider
work, the IL program offers services to improve their ability to live
as independently as possible.
Veterans are eligible for a comprehensive vocational assessment if
they have a 10 percent or greater service-connected disability rating
or a 20 percent or greater memorandum rating. Servicemembers are
eligible for a comprehensive vocational assessment if they have a 20
percent or greater memorandum rating, an Integrated Disability
Evaluation System (IDES) rating, or are eligible under the Wounded
Warrior Act, Public Law (P.L.) 110-181, Title XVI, as extended by the
Veterans Opportunity to Work (VOW) to Hire Heroes Act of 2011, P.L.
112-56, Title II, if they have a severe injury or illness.
Independent Living - Overview
The VR&E program provides eligible Veterans with IL services to
enable them to function independently within their homes and in their
communities. IL services can be provided in conjunction with other
services in a rehabilitation plan leading to an employment goal. Many
of our men and women returning from service with severe injuries are
preparing to return to the workforce, but also need IL services that
can be provided concurrently with their training and employment
services. Rehabilitation programs may also consist exclusively of IL
goals, when employment is not feasible for the Servicemember or
Veteran. These independent living programs will be the focus of my
testimony.
Once basic eligibility for an evaluation is established, a VBA
vocational rehabilitation counselor will conduct a comprehensive
assessment of the individual's interests, aptitudes, and abilities. If
the counselor determines that an employment goal is not feasible for
the individual, the counselor will evaluate the individual's
eligibility for an IL rehabilitation plan. Servicemembers eligible
under P.L. 110-181, as extended by the VOW to Hire Heroes Act of 2011
P.L. 112-56, who require IL services to transition to civilian life,
and Veterans with a 20 percent service-connected disability rating and
a serious employment handicap may be eligible to participate in an IL
rehabilitation program when a counselor has determined that a
vocational goal is not feasible. The counselor will conduct a
preliminary assessment of the individual's IL needs. If preliminary
needs are identified, the counselor will conduct a comprehensive
assessment to fully evaluate the individual's IL needs and identify
potential services to meet those needs. The comprehensive assessment
usually takes place in the individual's home. Following these
assessments, the individual may be provided a program of IL if he or
she has limitations in activities of daily living that impact
independence, can benefit from independent living services, and can be
expected to maintain achieved gains in independence after services have
ended.
Programs of IL may be approved for up to 24 months, and the VR&E
Officer can approve a 6-month extension. Veterans who served on or
after September 11, 2001 are eligible for additional extensions as
provided for in section 331 of P.L. 110-389.
Some of the IL services VR&E can provide include assistive
technology, adaptive equipment, IL skills training, improved access in
the home, improved access to the community, assistance with identifying
and initiating volunteer or supported employment, services to decrease
social isolation, and assistance in coordinating services from VA and
non-VA service providers. The VBA counselor provides ongoing support
and assistance to enable a participant to achieve his or her IL goals,
and whenever possible, the counselor will reassess the feasibility of
employment.
VR&E collaborates with the Specially Adapted Housing Grant program
administered by VBA's Loan Guaranty Service when a participant is in
need of home adaptations. VR&E also collaborates with Veterans Health
Administration (VHA) programs, including Home Improvements and
Structural Alterations, Automobile Adaptive Equipment, and the Visually
Impaired Services Team, for specialized services to support the
participant's IL goals. IL plans include a coordination element with
one or more of these programs when appropriate.
The Independent Living Cap
IL services started as a pilot program in 1980 with the passage of
P.L. 96-466, the Veterans' Rehabilitation and Education Amendments of
1980. Under this pilot program, the number of new IL cases was limited
to no more than 500 per fiscal year (FY). The program was made
permanent with the passage of P.L. 101-237, Title IV, the Veterans
Education and Employment Amendments of 1989. The cap was raised in 2001
from 500 to 2,500 new cases per FY. The most recent increase in the cap
was included in P.L. 111-275, the Veterans' Benefits Act of 2010, which
raised the cap to 2,700 cases as of FY 2011. Currently, only 2,700 new
IL programs may be initiated during a FY. In FY 2013, the VR&E program
initiated 2,152 new cases.
Program Data
In FY 2013, 2,152 new IL programs were approved and initiated. A
total of 1,708 Veterans were declared rehabilitated upon completion of
their IL programs during FY 2013. Many of these Veterans began
receiving services prior to the start of the FY. As of September 30, a
total of 2,887 Veterans were actively participating in their IL
programs. This includes Veterans who started their programs during the
FY as well as Veterans who started their programs in prior years. IL
program participants comprise about 2.3 percent of VR&E program
workload.
The VR&E Longitudinal Study Annual Report issued in 2013 provides
information on two cohorts of Veterans participating in the VR&E
program. Data for 2010-cohort participants who enrolled in an IL
program reflects that, as of September 30, 2012, 70 percent had
successfully rehabilitated, 24 percent were still actively
participating in their programs, and 6 percent had discontinued
participation as of the end of FY 2012. Data for 2012-cohort
participants in an IL program reflects that, as of September 30, 2012,
12 percent had successfully rehabilitated, 87 percent were still
actively participating in their programs, and 1 percent had
discontinued participation as of the end of FY 2012 \1\. The second
year of longitudinal data for the 2010-cohort is encouraging given the
strong rehabilitation rate and the rate of participants continuing to
pursue their programs. If the 2010-cohort continues on this positive
trajectory, their program outcomes will be consistent with the 94
percent IL target rehabilitation rate \2\ reported in the FY 2012
President's Budget as part of the VR&E performance plan.
---------------------------------------------------------------------------
\1\ VR&E Longitudinal Study, Annual Report 2013 for FY2012
\2\ FY 2013 President's Budget submission
---------------------------------------------------------------------------
Program Oversight
Oversight of IL programs begins with the development of the
Individualized Independent Living Plan (IILP). The plan outlines
individual IL rehabilitation needs and details the services that will
be provided to meet those needs. At VBA regional offices, VR&E
counselors must obtain approval from their VR&E Officer for all
proposed plans of independent living prior to implementation to ensure
that program procedures and policies have been properly followed.
Depending on the total cost of the case, additional approvals may also
be required prior to implementation. Cost thresholds for cases
including construction services are as follows: $2,000 or less requires
VR&E Officer approval; $2,001 to $25,000 requires the Regional Office
Director's approval; and over $25,000 requires the VR&E Service
Director's approval. Cost thresholds for cases without construction
services are as follows: $25,000 or less requires the VR&E Officer's
approval; $25,001 to $100,000 requires the Regional Office Director's
approval; and over $100,000 requires the VR&E Service Director's
approval.
Nationally, VR&E Service monitors IL services through several
mechanisms, including reviews conducted during ongoing quality
assurance audits, site visits, and cost approval requests. VR&E
conducted 12 site visits in FY 2013, conducted 120 targeted reviews of
IL cases, and 26 reviews of IL construction cost-approval requests for
services exceeding $25,000. Additionally, VR&E monitors the number of
new IL program plans each month to ensure the cap is not exceeded.
VR&E Service developed and deployed an IL Training Performance
Support System in FY 2013 to provide important training to vocational
rehabilitation counselors on independent living eligibility,
assessments, plan development, and case management requirements.
Vocational rehabilitation counselors will be required to complete all
modules of this training course during FY 2014.
Information Technology
Corporate WINRS (CWINRS) is the VR&E case-management application
(named after the stations that collaborated to develop the original
version:
Winston-Salem, Indianapolis, Newark, Roanoke, and Seattle) used to
record adjudication of VR&E claims, rehabilitation planning, provision
of services, and disposition of cases. CWINRS tracks a Veteran's
progress through the VR&E program. This includes establishing
entitlement to benefits, establishing appointments, and sending
transactions to the financial management systems for vendor payments.
CWINRS utilizes VBA's corporate database to maintain participant
information and interfaces with VBA's Benefits Delivery Network (BDN)
and other financial systems to process payment and accounting
transactions. Veteran cases for all five tracks, including the IL
track, are managed through the CWINRS application.
CWINRS enhancements are currently focused on developing a
Subsistence Allowance Module which will eliminate VR&E's reliance on
the legacy BDN system and move towards payment through the corporate
Financial Accounting System. The new corporate payment module is being
beta tested in eight regional offices, and is currently successfully
making subsistence payments to more than 200 participants in the VR&E
program. VR&E is finalizing development of this module to enable future
national deployment. VR&E is also building requirements for a future
case-management system that will build on functionality in the Veterans
Benefits Management System.
Update on implementation of GAO recommendations
GAO made three recommendations in their report titled ``VA
Vocational Rehabilitation and Employment Program: Improved Oversight of
Independent Living Services and Support is Needed.'' GAO recommended
that VBA ``work with the Undersecretary for Health to explore options
on ways to enhance coordination to ensure IL track veterans' needs are
met by VHA, when appropriate, in a timely manner.'' VBA worked with VHA
to automate medical and dental referrals in the Compensation and
Pension Records Interchange system, which will expedite services and
better coordinate and track services to ensure Veterans' needs are
timely met. The system enhancements are complete, and a 60-day pilot of
the new capability began in September 2013. Upon completion of the
pilot, VBA and VHA intend to implement the new process to automate
medical and dental referrals nationally.
GAO's second recommendation was to ``implement an oversight
approach that enables VR&E to better ensure consistent administration
of the IL track across regions.'' VBA is exploring whether ad hoc
reports, which provide data on total case costs and types of benefits
provided, can be developed to meet this requirement. VBA will also
consider preparing business requirements to allow for additional IL
data collection for implementation in future years. GAO's third
recommendation was to ``reassess and consider enhancing the agency's
current policy concerning the required level of approval for IL track
expenditures, given the broad discretion individual regional offices
have in determining the types of goods and services IL track veterans
receive.'' VBA finds merit in reassessing the current policy to
identify areas that can be strengthened. While the existing policy
includes a great deal of cost-threshold approvals, there may be room to
improve consistency in determining the types of IL goods and services
Veterans receive. VBA contracted for a detailed review of the IL
program, including benchmarking against other programs. The initial
report from this study is due to be completed in first quarter of FY
2014. VBA will consider the results and recommendations from this
assessment in determining the best way to implement GAO's
recommendation.
Concluding Remarks
VR&E continues to assess the IL program to ensure we are providing
effective services to our Nation's men and women who sacrificed so much
and deserve to live their lives without dependence on others to the
maximum extent possible. We have developed detailed training, conducted
significant oversight, and continue our efforts to enhance the services
we provide.
Mr. Chairman, this concludes my statement. I would be pleased to
answer questions from you or any of the other members of the
Subcommittee.
Prepared Statement of Paul R. Varela
Chairman Flores, Ranking Member Takano and Members of the
Subcommittee:
Thank you for inviting DAV (Disabled American Veterans) to testify
at today's hearing of the Subcommittee on Economic Opportunity
reviewing the Department of Veterans Affairs' (VA's) Independent Living
(IL) program within the Vocational Rehabilitation and Employment (VR&E)
service.
As you know, DAV is a non-profit veterans service organization
comprised of 1.2 million wartime wounded, injured and ill veterans and
dedicated to a single purpose: empowering veterans to lead high-quality
lives with respect and dignity. To fulfill our mandate of service to
America's disabled veterans, DAV employs a corps of close to 270
National Service Officers (NSOs), all of whom are wartime service-
connected disabled veterans, in order to provide benefits counseling at
no charge to any veteran, their dependents, or their survivors. Before
accepting my current assignment on DAV's National Legislative staff, I
worked for a decade as a DAV NSO in New York and Los Angeles, serving
as the Supervisor of DAV's LA office for my final five years in the
field.
Every one of DAV's NSOs brings with them military experience, as
well as personal experience navigating the VA health care and claims
processing systems. We have all participated and completed a VR&E
``rehabilitation'' plan as part of our DAV training. Due to our
backgrounds and training, DAV's NSOs not only possess a significant
knowledge base, but also a passion for helping our fellow veterans
through the labyrinth of the VA system.
DAV NSOs are situated in all 56 VA regional offices (RO) as well as
in other VA facilities throughout the nation. Last year, DAV NSOs
interviewed over 187,000 veterans and their families; reviewed more
than 326,000 VA claims files; filed over 234,500 new claims for
benefits; and obtained more than $5.1 billion in new and retroactive
benefits for the wounded, injured, and ill veterans we represented
before the VA. Our NSOs also participated in more than 287,000 VA
Rating Board actions. In addition to assisting them file claims for
disability compensation, our NSOs regularly advise veterans of the
opportunities and benefits offered by VA's vocational rehabilitation
programs, particularly for those with severe disabilities making work
difficult or impossible. As part of our lifelong continuing education
program, DAV's NSOs are trained on all VR&E programs, including the IL
program, and we regularly refer and encourage our clients to consider
VR&E programs whenever appropriate.
Mr. Chairman, DAV is a staunch proponent of the IL program and all
VR&E programs, because they embody DAV's central purpose of empowering
veterans to lead high-quality lives with respect and dignity. To be
eligible and entitled to receive VR&E services, a veteran generally
must have a service-connected disability rated at least 20% or greater
and have an employment handicap. Veterans with a 10% rating may be
entitled to VR&E services if it is determined that they have a serious
employment handicap. When evaluating barriers to employment, the
Vocational Rehabilitation Counselor (VRC) takes into consideration the
veteran's level of disability, rehabilitation potential, and future
employment goals. Once entitlement is established, a VRC works with the
veteran to develop a rehabilitation plan along one of five tracks:
reemployment (with a prior employer); new employment; self-employment;
employment through long-term services (through on-the-job training,
college, and other training programs); and independent living.
The IL program is uniquely designed to provide seriously disabled
who are currently unlikely to benefit from one of the four employment-
related tracks, the opportunity to lead more fulfilling and independent
lives within the constraints and limitations of their service-connected
disabilities. Together with the veteran, the VRC will develop an
Independent Living plan detailing the specific goods and services
needed to achieve the goals of the plan. Until a recent change was made
to the M-28 Procedures Manual, the VRC was guided by nine fundamental
principles, considered the ``Philosophical Framework'' of the IL
program:
1. To enhance the disabled veteran's participation in activities of
daily living (ADL);
2. To assist the veteran in participating to the maximum extent
possible and desirable in family and community life;
3. To provide the most effective services and assistive technology
based on sound research evidence;
4. To provide required holistic evaluation and services for all
veterans who qualify;
5. To develop rehabilitation plans that provide services to address
all identified independent living needs;
6. To consider the veteran's expressed interests and desires but
provide services based on objectively identified needs;
7. To establish goals and measure/verify outcomes;
8. To provide services that produce a sustaining influence that
continues after rehabilitation services are completed; and
9. To explore the possibility of paid or volunteer employment, when
feasible.
We believe that these principles should continue to guide the work
of VRCs and would recommend that VR&E consider whether it would be
beneficial to restore the language into the preamble of the Manual or
in any other appropriate way.
A VRC has wide latitude in developing an IL plan, which generally
includes five types of services: assistive technology; specialized
medical, health and/or rehabilitation services; services to address any
personal or family adjustment issues; independent living skills
training; and connection with community-based support services. When
possible, services and goods required by a plan should be provided
through other existing VA programs, such as the Specially Adapted
Housing (SAH), the Prosthetic and Sensory Aids Service (PSAS) and Home
Improvements and Structural Alterations (HISA) programs.
VR&E will also directly purchase needed goods and services to
fulfill the IL plan. VR&E Officers are authorized to approve IL plan
expenditures of up to $75,000; expenditures of $75,000 to $100,000
require the approval of the RO director; and expenses exceeding
$100,000 require the approval of the VR&E Service Director. There also
exist additional approval requirements for construction costs up to
$2,000, costs between $2,000 and $25,000 and costs exceeding $25,000,
which require the approval of the VR&E Service Director.
It is important to remember, Mr. Chairman, this program serves men
and women who have suffered significant injuries and illnesses from
their service, who are not able to find employment, and who are not
likely to benefit from any employment-related services. Whether they
have lost limbs, sustained severe burns, or suffer from debilitating
mental disorder, such as PTSD, the IL program was created to help these
men and women become more independent in their daily lives, to interact
with families and in communities, and to find greater purpose and
meaning in their lives. Considering all that they have sacrificed for
us, it is the least that a grateful nation can offer them.
Remove the Cap on Independent Living Participants
The IL program was initially created as a pilot program by Congress
in October 1980 as part of Public Law 96-466, and was limited to no
more than 500 participants. In 1986, Congress enacted legislation,
Public Law 99-576, that made the program permanent and the cap on
participants has increased over the years since, most recently
increasing to 2,700 in 2010 with enactment of Public Law 111-275. While
we appreciate the fiscal constraints and budgetary scoring concerns
that Congress must address, we believe that placing a cap of 2,700 IL
participants establishes an arbitrary limit on a valuable program that
serves some of our most deserving and needy veterans.
Moreover, there is little or no data available to determine how
many veterans could benefit from participation in the IL program in the
absence of the arbitrary cap. As the Government Accountability Office
(GAO) has pointed out in their recent report on the IL program (GAO-13-
474), VR&E does not systematically track variances in caseloads among
its ROs. Based on GAO's analysis, during fiscal years 2008 thru 2011,
the number of IL participants ranged from a high of 908 at the
Montgomery, Alabama RO to a low of four at the Wilmington, Delaware RO.
The GAO report makes clear that every RO approaches the IL program
differently, with some aggressively steering eligible veterans in that
direction, and others apparently having little understanding or
interest in pursuing the IL track. Anecdotally, we have heard VR&E
officials indicate that the cap on participation discourages VRCs from
promoting the IL program, and that conversely, if the cap were removed
it could create greater interest among VRCs to promote this option to
appropriate veterans.
It is also worth noting that a veteran can have more than one IL
plan within the same year, and that each of this veteran's plans counts
towards that cap, further limiting the number of veterans who can
benefit. This requirement also creates some confusion in the reporting
and accounting elements of the program that must be clarified.
There is now legislation pending that would remove this cap and
require VR&E to improve the education of its employees in regards to
the IL program. H.R. 3330, the Veterans' Independent Living Enhancement
Act, was introduced by Congresswoman Michelle Lujan Grisham in October
and currently has 16 cosponsors. We would urge this Subcommittee to
consider and report this legislation.
Improve Awareness and Outreach for the Independent Living Program
In order to maximize the benefits of the IL program, VR&E must
significantly enhance its internal and external awareness and outreach
efforts. We have been informed that VR&E is preparing to distribute
literature within VA facilities notifying veterans about the IL program
and we applaud that effort. We have also been made aware that VR&E is
creating a web-based training element on the IL program that will be
mandatory for all VRCs. However, although participation in the web-
based training will reach all current and newly hired VRCs once, it is
imperative that this training be repeated at appropriate intervals to
ensure the VRCs maintain current knowledge about the IL program and the
opportunities it presents for appropriate veterans. VR&E should also
review whether its VRC skills certification process is sufficient to
ensure continued national understanding of the IL program.
The GAO report also found that one of the key reasons for
differences in caseloads among ROs was due to the, `` . . . office's
focus on IL cases and community outreach efforts, including the
involvement of veterans service organizations.'' DAV would welcome
opportunities to collaborate with other VSOs and VR&E to make veterans
more aware of these services. As I mentioned earlier, DAV NSOs
regularly counsel eligible veterans about the benefits of participation
in VR&E programs including the IL program. Furthermore, as part of
their continued employment with DAV, our NSOs will review the VR&E
program, including the IL program, as part of our Structured and
Continued Training Program, which must be completed and repeated
throughout our careers. In addition, we are currently planning to host
a web-based training initiative to highlight components of the IL
program as part for our ongoing training administered to NSOs.
Another way to increase awareness programs would be to require that
VBA include information about entitlement to vocational rehabilitation
services in all appropriate correspondence with eligible veterans.
Currently, disability compensation claims decisions and notification
letters awarding or increasing a service-connected rating of 10 percent
or greater are required to include information about VR&E eligibility,
however other rating actions, such as denials for increases or other
benefits, do not. VBA should reexamine its procedures and consider
other ways to educate and encourage veterans to consider VR&E services.
IT Modernization Needed for Better Program Management and Oversight
In its recent report, GAO concluded that VR&E's case management
information technology (IT) system, commonly referred to as CWINRS, ``
. . . does not meet VR&E's current needs and limits its oversight
abilities . . . '' The CWINRS system does not properly capture some of
the most basic data and information, including the number of IL
participants. Instead it tracks the number of IL plans, making it
ineffective at monitoring the statutory cap on participation. In
addition, CWINRS also does not maintain information on how much money
is spent on individual IL services, nor even the aggregate totals for
such services each year. The tracking system is woefully inadequate to
allow sufficient management or oversight VR&E programs in general.
VR&E recently began a one-year test to improve its tracking of IL
expenditures and outcomes related to home modifications and
construction. (VR&E Letter 28-13-43). However, this and other attempts
to improve the transparency, management and oversight of the IL program
will continue to be hampered as long as they are relying on an
outdated, inadequate IT system, such as CWINRS.
Rather than spend time and resources on trying to patch and upgrade
the CWINRS system, DAV recommends that the VR&E IT needs be addressed
through the new Veterans Benefits Management System (VBMS), which was
primarily developed by VBA for managing the disability compensation
system. Although VBMS is eventually intended to serve all of VBA's
business lines, there remains much work on that core system, limited
resources and no current plans to make it ready for use by VR&E. Given
the importance of vocational rehabilitation programs, including the IL
program, and the inadequate CWINRS system currently in place, VA must
request, and Congress should approve sufficient additional funding for
IT development and deployment of VBMS as soon as technically feasible.
Better Coordination and Cooperation within VA
As mentioned above, the IL program provides veterans with many
services and goods from other VA programs, including health care from
the Veterans Health Administration (VHA), equipment from the PSAS and
adaptive equipment and services from the SAH and HISA programs. Despite
the fact that these are all VA programs and offices, GAO and others
have reported that coordination and cooperation can often be difficult.
VR&E rehabilitation plans, including IL plans, often require
concurrence from a VHA physician, such as in relation to mobility
devices, and there may be occasions when the physician believes that
allowing a veteran to rely on a mobility device may be contrary to the
clinical need to encourage greater physical activity for their
rehabilitation in responding to VR&E requests.
However, just as VBA has encountered problems in trying to get VHA
doctors to complete disability benefit questionnaires for veterans with
claims for disability compensation, VR&E has problems getting VHA
physicians to approve IL plans in a timely fashion. VR&E and VHA must
work together to provide better education and training to VHA staff to
encourage greater cooperation.
VRCs have also encountered similar difficulty getting responses
from SAH, PSAS and HISA program offices. In some instances, this may
result in the purchase of goods and services from an outside contractor
that could and should have been provided by internal VA programs. As
with the difficulties related to VHA, VR&E must work with these program
officials to remove unnecessary delays and other bureaucratic red tape
that hinders the timely provision of services to IL participants. All
of these offices work for the same Department and should be serving the
interests of veterans. If they are unable or unwilling to work together
effectively, the Secretary and Congress must take appropriate actions
to make them do so.
Mr. Chairman, despite the management and oversight challenges
discussed in our testimony and the GAO report, we continue to believe
that VR&E's Independent Living program is an essential, appropriate and
empowering benefit that has and should continue to make a tremendous
difference in the lives of thousands of veterans every year. We
strongly encourage you to continue examining ways to improve this
program and we stand ready to work with the Subcommittee in any way we
can to offer our assistance and support.
This concludes my testimony and I would be happy to answer any
questions you may have.
Submission For The Record
U.S. GOVERNMENT ACCOUNTABILITY OFFICE
View GAO-14-149T. For more information, contact Dan Bertoni at
(202) 512-7215 or [email protected].
Highlights of GAO-14-149T, a testimony before the Subcommittee on
Economic Opportunity, Committee on Veterans' Affairs, U.S. House of
Representatives
November 13, 2013
VA VOCATIONAL REHABILITATION AND EMPLOYMENT PROGRAM
Independent Living Services and Supports Require Stronger Oversight
Why GAO Did This Study
The IL track--one of five tracks within VA's VR&E program--provides
a range of non-employment related benefits to help veterans with
service-connected disabilities live more independently when employment
is not considered feasible at the time they enter the VR&E program.
These benefits can include counseling, assistive devices, and other
services or equipment. This testimony is based on GAO's report issued
in June 2013, and describes (1) the characteristics of veterans in the
IL track, and the types and costs of benefits provided; (2) the extent
to which their IL plans were completed, and the time it took to
complete them; and (3) the extent to which the IL track has been
administered appropriately and consistently across regional offices.
GAO analyzed VA administrative data from fiscal years 2008 to 2011,
and reviewed a random, generalizable sample of 182 veterans who entered
the IL track in fiscal year 2008. In addition, GAO visited five VA
regional offices; interviewed agency officials and staff; and reviewed
relevant federal laws, regulations, and agency policies, procedures,
studies, and other documentation.
What GAO Recommends
In its June 2013 report, GAO recommended that VR&E explore options
to enhance coordination with VHA, strengthen its oversight of the IL
track, and reassess its policy for approving benefits. VA agreed with
these recommendations.
What GAO Found
Of the 9,215 veterans who entered the Department of Veterans
Affairs' (VA) Independent Living (IL) track within the Vocational
Rehabilitation and Employment (VR&E) program from fiscal years 2008 to
2011, most were male Vietnam era veterans in their 50s or 60s. The most
prevalent disabilities among these veterans were post-traumatic stress
disorder and tinnitus (``ringing in the ears''). GAO's review of 182 IL
cases from fiscal year 2008 shows that VR&E provided a range of IL
benefits to veterans; the most common benefits being counseling
services and computers. Less common benefits included gym memberships,
camping equipment, and a boat. GAO estimates that VR&E spent nearly $14
million on benefits for veterans entering the IL track in fiscal year
2008--an average of almost $6,000 per IL veteran.
About 89 percent of fiscal year 2008 IL veterans were considered by
VR&E to be ``rehabilitated'' by the end of fiscal year 2011; that is,
generally, to have completed their IL plans. These plans identify each
veteran's independent living goals and the benefits VR&E will provide.
The remaining 11 percent of cases were either closed for various
reasons, such as the veteran declined benefits, or were still active.
Rehabilitation rates across regions varied from 49 to 100 percent, and
regions with larger IL caseloads generally rehabilitated a greater
percentage of IL veterans. On average, IL plans nationwide were
completed in 384 days; however, completion times varied by region, from
150 to 895 days.
GAO identified four key areas where VR&E's oversight was limited.
First, some regions may not be complying with certain case management
requirements. For instance, while VR&E is required to coordinate with
the Veterans Health Administration (VHA) on IL benefits, VR&E
counselors have difficulty obtaining timely responses from VHA. This
has resulted in delayed benefits or VR&E providing the benefits instead
of VHA. Second, VR&E does not systematically monitor regional variation
in IL caseloads and benefits provided. Instead, it has relied on its
quality assurance reviews and ad hoc studies, but these are limited in
scope. Third, VR&E's policies for approving IL expenditures may not be
appropriate as regions were permitted to purchase a range of items
without Central Office approval, some of which were costly or
questionable. In one case GAO reviewed, Central Office review was not
required for expenditures of $17,500 for a boat, motor, trailer, and
the boat's shipping, among other items. Finally, VR&E's case management
system does not collect information on IL costs and the types of
benefits purchased. VR&E also lacks accurate data on the number of IL
veterans served. While the law currently allows up to 2,700 veterans to
enter the IL track annually, data used to monitor the cap are based on
the number of IL plans developed, not on the number of individual
veterans admitted. Since veterans can have more than one IL plan in a
fiscal year, one veteran could be counted multiple times towards the
cap. VA plans to make modifications to its case management system to
address this, but officials noted that it could take up to 3 years to
obtain funding for this project.