[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON PRE-DISCHARGE CLAIMS PROGRAMS:
ARE VA AND DOD EFFECTIVELY SERVING SEPARATING
MILITARY PERSONNEL
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, DECEMBER 13, 2017
__________
Serial No. 115-42
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://govinfo.gov
U.S. GOVERNMENT PUBLISHING OFFICE
31-616 WASHINGTON : 2019
COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BRAD R. WENSTRUP, Ohio JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida KILILI SABLAN, Northern Mariana
JODEY ARRINGTON, Texas Islands
JOHN RUTHERFORD, Florida ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MIKE BOST, Illinois, Chairman
MIKE COFFMAN, Colorado ELIZABETH ESTY, Connecticut,
AMATA RADEWAGEN, America Samoa Ranking Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
JIM BANKS, Indiana KILILI SABLAN, Northern Mariana
Islands
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
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C O N T E N T S
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Wednesday, December 13, 2017
Page
Legislative Hearing On Pre-Discharge Claims Programs: Are VA And
DOD Effectively Serving Separating Military Personnel.......... 1
OPENING STATEMENTS
Honorable Mike Bost, Chairman.................................... 1
Honorable Elizabeth Esty, Ranking Member......................... 2
WITNESSES
Terry A. Adirim, M.D., MPH, Deputy Assistant Secretary of Defense
for Health Services Policy and Oversight, U.S. Department of
Defense........................................................ 4
Prepared Statement........................................... 22
Willie C. Clark, Sr., Deputy Under Secretary for Field
Operations, Veterans Benefits Administration, U. S. Department
of Veterans Affairs............................................ 6
Prepared Statement........................................... 23
Accompanied by:
Beth Murphy, Director, Compensation Service, Veterans
Benefits Administration, U. S. Department of Veterans
Affairs
Patricia Murray, Chief Officer, Office of Disability and
Medical Assessment, Veterans Health Administration, U. S.
Department of Veterans Affairs
Gerardo Avila, Deputy Director, Medical Evaluation Board/
Physical Evaluation Board/Department of Defense Correction
Board, National Veterans Affairs and Rehabilitation Division,
The American Legion............................................ 7
Prepared Statement........................................... 25
Ryan M. Gallucci, Director, National Veterans Service, Veterans
of Foreign Wars................................................ 9
Prepared Statement........................................... 27
LEGISLATIVE HEARING ON PRE-DISCHARGE CLAIMS PROGRAMS: ARE VA AND DOD
EFFECTIVELY SERVING SEPARATING MILITARY PERSONNEL
----------
Wednesday, December 13, 2017
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Disability Assistance
and Memorial Affairs,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:00 a.m., in
Room 334, Cannon House Office Building, Hon. Mike Bost
[Chairman of the Subcommittee] presiding.
Present: Representatives Bost, Coffman, Banks, Esty, and
Brownley.
OPENING STATEMENT OF HONORABLE MIKE BOST, CHAIRMAN
Mr. Bost. Good morning, and welcome. The oversight hearing
of the Subcommittee on Disability Assistance and Memorial
Affairs will now come to order.
There are currently 1.3 million men and women serving in
the United States armed forces. It is our duty to ensure that
those who have defended our country receive their earned VA
benefits as soon as possible. Today's hearing will review
whether VA and DoD pre-discharge programs are effectively
assisting ervice members who are leaving the military while
coping with illness and injuries.
In a hearing on pre-discharge programs this Subcommittee
held in 2014, we heard from veteran service organizations who
were concerned about the quality of disability examinations,
the accuracy of the VA's ratings, and the lengthy decision
process. At this hearing we will look at what VA and DoD have
done to address those concerns since the hearing several years
ago.
Last week I had the privilege to meet with some of the
wounded warriors at Walter Reed, we were going through one of
the pre-discharge programs, the IDES program, more commonly,
well, Integrated Disability Evaluation Systems, or IDES as it
is commonly known. IDES is celebrating its tenth anniversary
this year, and is the joint VA-DoD program used to determine if
servicemembers dealing with injuries or illness are able to
continue to serve.
If the servicemember is found unfit for active duty, IDES
is designed to ensure that the transition from warrior to
veteran is seamless. Under IDES, servicemembers received one
medical exam from VA which will serve two purposes. First, DoD
will use the exam to assess if the servicemember is fit to
return to duty. And, if not, whether the member will be
medically retired.
Second, if DoD finds that the servicemember is not fit for
duty, the VA uses the exam results to issue a proposed
disability rating. This process saves the servicemember from
having to undergo two exams, one from DoD and another from the
VA.
I talked with the servicemembers about IDES last week, and
was pleased to hear that the people I talked to had no
complaints about their experience with the program at Walter
Reed, but that does not mean that the program can't be improved
on. We can always do better.
I want to discuss concrete proposals that will make this
process more effective to ensure that VA providers provides the
men and women of the armed forces who go to IDES the support
they need when they return to civilian life. We are also going
to focus on two other pre-discharge program benefits
deliveries.
The delivery at discharge--the Benefit Delivery at
Discharge, or the BDD, and Quick Start, which are also supposed
to help servicemembers with disabilities access VA benefits
soon after separating from the military. The BDD program
servicemembers who were within 60 to 180 days of discharge
could file a claim and receive a VA disability examination
before leaving the military.
The second program, Quick Start, allowed the servicemembers
who were going to be discharged within 60 days file a claim and
receive a disability exam from the VA as soon as they were
discharged. Both of these programs allowed separate
servicemembers to get a head start on their VA disability
claim. If the system worked as intended, individuals would
begin to receive disability benefits soon after leaving the
military.
However, VA has acknowledged that it had some challenges
with timeliness when administering the BDD and the Quick Start
programs. The VA recently told my staff that it was not meeting
timeliness goals for Quick Start because it can be difficult to
schedule a disability examination for servicemembers who are
within 90 days of discharge. To try to resolve this issue,
other VA and others, the VA eliminated the Quick Start program
on October 31st, 2017, and made some changes to the BDD
program.
I am looking forward to hearing feedback from both the
Department and VSO witnesses on three of these programs; IDES,
BDD, and Quick Start. I am particularly interested in whether
VA redesigning the BDD program is actually streamlining the
disability claim process for separating military personnel.
Lastly, I am hoping that we can find out ways that the VA and
DoD can make all of the pre-discharge processes more efficient
for our Nation's military members.
Again, I want to thank everyone for being here today. And I
would like to recognize, for opening comments, Ranking Member
Esty.
OPENING STATEMENT OF HONORABLE ELIZABETH ESTY, RANKING MEMBER
Ms. Esty. Thank you very much, Mr. Chairman. And thank all
of you for being with us here today. We are here today to look
at two programs that hold the promise of providing every
servicemember separating from military with his or her
veteran's benefits before discharge. That is our goal.
And we are not there yet, but the basis to achieve this
goal exists in the IDES and BDD programs. We now have ten years
of experience, and it is clear from what I have seen--and I
want to thank those of you who did a lengthy briefing with me
earlier this week in preparation for this--that the most
important element that we have seen in making improvement is,
in fact, better coordination between DoD and VA. And I want to
commend you for that. That is not easy to do, but it is
essential if we are going to continue to make progress.
A lot of progress has been made. If you look at the
timeliness numbers, for example. VA is showing a 102-day
improvement in terms of scheduling these. Now that is
extraordinary. So the time to completion has been cut almost in
half. The goal has been do these exams within 100 days, you are
now 19 days under that. That is to be commended. And I think it
is important to look at the progress that has been made.
But timeliness is one factor. Accuracy is another.
Connection is another, particularly for high-risk groups. And I
want to return to that. DoD tells us the result of the customer
satisfaction surveys of servicemembers are taken twice during
the IDES process. You are showing a satisfaction rate of 90
percent, and that is with 40-plus percent completion rate,
which is quite high for surveys. Again, we are pleased with
that. But it is over time, and it is with everyone that we are
looking for.
So in order to set a course towards even greater
improvement, today I want to do the following. Number one, I
want to make sure that errors are not slipping through as a
result of the recent changes in the way in which BDD claims are
being tracked. So, accuracy.
Two, I want to understand what steps are being taken to
ensure that Guard and Reserve troops have the same opportunity
to receive benefit determinations before they leave the Guard
and Reserves. BDD may not be the right program for them. But
due to the uniqueness of their service commitment, we need to
make sure they are not short-changed.
And I want to explore that a little bit more with the time
requirements and how those do not really line up very well with
the Guard, and we need to anticipate that and do this. I hear
about this from Guard and Reservists in Connecticut. And they
have frequent deployments, and this process is not really
serving them well.
Number three, I want to be assured that the military
service coordinators and the physical exam board service
officers are receiving the training that they need to help
injured or ill servicemembers and their families through the
process involved in IDES in a way that acknowledges and
respects the service to the Nation that they have given, and
particularly for terminally ill or those who have struggled
with mental health issues when leaving the military. I think
that respect factor and ensuring that it is not just about
timeliness and checking the boxes, it needs to be high touch
and respectful at all times.
Fourth, I want to hear that VA intends to update and
modernize how it is reaching out and communicating with troops
pre-separation about what benefits are available to them. I
also want to see a particular focus on that outreach to high-
risk groups that we know tend not to connect and suffer even
more when they do not. Especially looking at women and looking
at those who are most likely to suffer from PTSD, and all the
attendant issues of homelessness, chronic illness, and worse.
The other thing I want to do today is to ask our witnesses
to tell us what we in Congress can do to help support DoD and
VA to achieve greater success. We want an update on where you
are but, obviously, a charge from you and enlightenment about
what we need to do to do our jobs.
Let us know what resources you need, what authority you may
need to continue going forward to effectively, and
appropriately, and respectfully serve those who served this
great Nation. So, again, thank you for being here today, for
working with us as we exercise our responsibility to provide
oversight of these programs.
I look forward to your testimony and the opportunity to ask
questions. Thank you, and I yield back.
Mr. Bost. Thank you, Ms. Esty. I ask all Members waive
their opening remarks as per the Committee's custom. I want to
welcome the witnesses who are joining us here this morning, and
thank you for taking the time to be here.
Our first witness is Dr. Terry Adirim, the Deputy Assistant
Secretary of Defense of Health Services and Policy and
Oversight for DoD. Joining us from VA is Mr. Willie Clark, who
is the Department Under Secretary for the Field Operations of
VBA. He is accompanied by Ms. Beth Murphy, the Director of
Compensation Services for VBA, and by Ms. Patrick Murphy--
Murray, I am sorry, Patricia Murray, the Chief Officer of
Office of Disabilities and Medical Assistance for VHA.
Testifying on the behalf of the American Legion is Mr.
Gerardo Avila--I will get that correct, yeah--who is the Deputy
Director for the Medical Evaluation Board, Physical Evaluation
Board, and Department of Defense Correction Board for the
American Legion. Also joining us today is Mr. Ryan Gallucci,
the Department Director of the National Veterans Services for
VFW. We welcome to all of you.
I want to remind the witnesses that your complete written
statement will be entered into the hearing record.
Dr. Adirim, you are now recognized for five minutes for the
Department of Defense's testimony on opening statement.
STATEMENT OF DR. TERRY ADIRIM
Dr. Adirim. Thank you. And I appreciate you pronouncing my
name perfectly.
Mr. Bost. I wish I did it for everybody.
Dr. Adirim. Yeah. No. I am very impressed. Thank you. Good
morning, everybody. Chairman Bost, Ranking Member Esty, and
distinguished Members of the Subcommittee, thank you for the
opportunity to testify today on the Integrated Disability
Evaluation System, and we all call it IDES, so thank you for
shortening that for us.
Since 2007, DoD and VA have jointly administered the IDES
to evaluate our Nation's wounded, ill, or injured
servicemembers, and to ensure they receive the benefits they so
rightly deserve. As a joint venture, DoD and VA implemented the
IDES to provide servicemembers with quality, efficient, and
transparent disability evaluations.
As you know, the IDES is a streamlined process in which
servicemembers receive a single examination, a single
disability rating, and simultaneous DoD and VA processing to
deliver benefits as early as possible following disability
separation or retirement from military service.
As a result, the IDES process accomplishes two primary DoD
objectives. The first, it ensures the medial readiness of the
U.S. armed forces. And, second, it provides potentially unfit
servicemembers with expedient transition to benefits and VA
care.
The IDES framework continues to exceed expectations. In
2007, prior to the IDES implementation, servicemembers waited
an average of 540 days from referral for disability evaluation
to receipt of VA benefits. Today, I am happy to report, active
component cases average 258 days for both DoD and VA to
complete their combined stages of the DES, a 52 percent
improvement from the previous DES process.
DoD is also outperforming our core, DoD-only process stage
goals as required by DoD policy. In October 2017, DoD core
stage performance for Active Component disability evaluation
was 104 days against 105-day goal, while Reserve Component
disability evaluation was 88 days against 125-day goal.
Nonetheless, DoD and VA continuously seek to improve the
timeliness and efficacy of the IDES.
Since DoD's last appearance before this Subcommittee to
discuss IDES, we have continued to improve processing across
all the military departments. We have made a concerted effort
to enhance case management, upgrade training standards, reduce
overall IDES timeliness, and expand our quality control
program.
Within IDES, servicemembers have a single point of contact
to help navigate the process known as a Physical Evaluation
Board Liaison Officer, or PEBLO. The PEBLO provides
servicemembers with all the critical information they need to
make informed decisions throughout the process that is our
direct touch.
Since 2014, DoD has taken concrete steps to improve the
IDES staff training. In collaboration with the military
departments, we issued new training standards and performance
objectives to ensure all IDES staff members are armed with the
necessary tools to assist wounded, ill, or injured
servicemembers.
Further, our quality assurance program enables us to
evaluate the performance, accuracy, and consistency of the
IDES. Our expansion of the quality assurance program gives DoD
the necessary information to monitor performance and correct
inefficiencies.
For fiscal year 2017, IDES scores reflect an accuracy rate
of 94 percent, a consistency rate of 77 percent, and a duty
performance rate of 80 percent, and we are still not satisfied.
Results of these combined efforts can be seen in our most
recent survey--as was already mentioned--of over 9,000
servicemembers who indicated an overall 93 percent satisfaction
rating with DoD and VA personnel implementing the IDES, and
their overall IDES experience.
So I am not surprised, Mr. Bost, that the Walter Reed
experience demonstrated this.
Again, I would like to thank you for the opportunity to
testify on these important issues, and I look forward to
answering your questions.
[The prepared statement of Dr. Terry Adirim appears in the
Appendix]
Mr. Bost. Thank you, Doctor, for your testimony. Mr. Clark,
you are recognized for five minutes.
STATEMENT OF WILLIE CLARK SR.
Mr. Clark. Good morning, Chairman Bost--
Mr. Bost. Good morning.
Mr. Clark [continued]. --Ranking Member Esty, and Members
of the Subcommittee. My name is Willie Clark, Deputy Under
Secretary for Field Operations and the Veterans Benefits
Administration. I am joined by Beth Murphy, Director of
Compensation Service, and Patricia Murray, Chief Officer,
Office of Disability and Medical Assessment with the VHA.
Today I will discuss VBA's pre-discharge programs for
servicemembers including IDES--sir, what you spoke to--and BDD.
I will also discuss improvements in both of these programs;
servicemembers satisfaction with IDES and training employees
involved in IDES and BDD.
On November 28, 2017, the Department of Veterans Affairs
and DoD celebrated the tenth anniversary of IDES. In 2007, VA
and DoD created an integrated disability evaluation process for
servicemembers who are being medically retired or separated
from service. This joint process was designed to provide a
seamless transition of benefits and health care for medically
separating servicemembers.
In fiscal year 2017, more than 22,000 servicemembers were
enrolled in IDES. As a result of our collaborative efforts, VBA
and DoD have met the goals established for IDES. VBA's average
processing time in September 2017 was 81 days, which is a 102-
day improvement from May of 2014; the last time we testified
here on the IDES program.
This 81 days is 10 days better than the VBA average of 100
days. And VBA awarded benefits within an average of 26 days of
discharge, exceeding the IDES timeliness goal of 30 days. As of
June 2017, the semi-annual customer satisfaction survey showed
that satisfaction was at 93 percent for IDES, and 89 percent
for our military service coordinators. VA continues to
collaborate with DoD on ways to improve the IDES execution
while remaining focused on timeliness and accuracy.
Since 1995, BDD and Quick Start programs have provided
transitional assistance to separating servicemembers by
engaging them in the claims process prior to discharge. VBA's
goal is to ensure that each servicemember transitioning from
service who wishes to file a claim for service-connected
disability benefits receives timely assistance.
In fiscal year 2017, VBA significantly improved BDD
production and timeliness, completing over 32,000 claims in an
average of 90 days compared to approximately 29,000 in 127 days
in fiscal year 2016. VBA also completed over 25,000 Quick Start
claims with an average of 109 days in fiscal year 2017. Pretty
good accomplishments, but as you mentioned, we have to do
better. We realize that, and we are embracing that.
VBA is dedicated to ensuring that veterans receive the
benefits they earned as quickly and accurately as possible. To
this end, VBA has redesigned the pre-discharge program to
enable servicemembers to receive disability benefit decisions,
in most cases the day after their discharge.
The redesigned program went into effect October the 1st of
2017. Pre-discharge claims are now distributed through the
National Work Queue, sending these claims to all the VA offices
rather than just a few. Modifications to the existing BDD
program include changing the filing deadline from 60 to 90
days, enabling VBA to complete all medical examinations prior
to the servicemembers' discharge from active duty.
So one of the reasons for redesigning the program was to
make sure that we had enough time to complete all of the exams
and get them completed along with the servicemembers active
duty and TDY requirements, and the like. So that is one of the
main reasons we changed the program.
As part of the redesign, VBA discontinued the Quick Start
program, instead utilizing the new decision ready claims
process, fully developed claim process, or traditional claims
as appropriate. We continue to work in concert with our VSO
partners who regularly collaborate with our MSCs on various
military basis in order to facilitate servicemembers' initial
claims submission.
VBA's pre-discharge program provide all transitioning
servicemembers the opportunity to initiate a claim for
disability compensation benefits. VBA provides substantial
training for all employees involved in the processing of
claims, including pre-discharge claims.
Ongoing technical training is required each year, and
training is regularly updated. VBA conducted training on the
redesigned BDD program in September of 2017, for MSCs in
October 2017 for claims processes. VBA plans to conduct a
comprehensive MSC training event in fiscal year 2018. VBA
remains committed to supporting our Nation's servicemembers
through improvements in the pre-discharge program.
Mr. Chairman, this concludes my statement. We would be
pleased to respond to questions you, Ranking Member Esty, or
other Members of the Subcommittee may have.
[The prepared statement of Mr. Willie Clark appears in the
Appendix]
Mr. Bost. Thank you, Mr. Clark. I guess I should have the
mike on. Thank you. Mr. Avila, you are recognized for five
minutes.
STATEMENT OF GERADO AVILA
Mr. Avila. Chairman Bost, Ranking Member Esty, and
distinguished Members of the Subcommittee on Disability
Assistance and Memorial Affairs, on behalf of the 2 million
members of the American Legion and National Commander Denise H.
Rohan, thank you for the opportunity to testify regarding the
American Legion's positions on the Integrated Disability
Evaluation System and VA's pre-discharge program for separating
servicemembers.
The goal of IDES since its inception ten years ago has been
to streamline the medical board process and create a seamless
transition for wounded, ill, and injured servicemembers from
DoD to VA. The American Legion has testified in the past
concerning issues with timeliness, lack of information for
those enrolled, and gaps in medical and compensation benefits
after separating.
Despite these concerns, we believe that the current IDES
system is an improvement over its predecessor. The issues
highlighted in our previous testimony have shown to improve.
Despite this, we have the following concerns.
DoD's practice of rating and, in many instances,
recommending a reduction of disability rating decisions for
individuals placed on the Temporary Disability Retirement List,
also referred to as TDRL. A servicemember found unfit with a
condition deemed not stable to assign the permanent disability
rating will end up on TDRL.
Once an individual transitions out of military service,
they will be required to undergo periodic examinations by DoD
to determine if the condition has stabilized and able to assign
a permanent disability rating. In many instances these
examinations are done at a DoD medical facility or by a DoD
contractor. For instance, I have recently been contacted by a
Navy veteran in this predicament.
In 2013 the individual was given a rating for 60 percent
for and unfit condition and placed on TDRL. After this latest
reexamination in October of this year, the Navy considered the
condition stable and is proposing a new rating of 20 percent.
If nothing changes, this individual will be separated with
severance despite still being rated at 60 percent for the same
condition by VA.
One of the goals of IDES was to have a single rating
decision used by both VA and DoD. In an effort to keep the
integrity and spirit of the IDES process, the American Legion
believes that DoD should communicate with VA when recommending
new ratings for individuals placed on TDRL. We recommend that
if VA has a current rating for the condition, DoD should apply
that same rating.
American Legion service officers continue to encounter lack
of resources for members of the National Guard and Reserves,
specifically with Line of Duty, or LOD, investigations. An LOD
is crucial to establish that a disability was caused due to
military service. Without needed documentation, many
servicemembers face a possibility of being separated with no
benefits.
With the hectic nature of military duty, it is not always
possible to capture the facts when an injury occurs. The
failure to capture and record crucial details has shown to be
harmful for members of the National Guard and Reserve when
undergoing the IDES process.
With regards to the pre-discharge program for transitioning
servicemembers, the American Legion continues to maintain
service officers at the regional office in Winston-Salem, North
Carolina, and Salt Lake City, Utah. A service officer assists
transitioning servicemembers with 500 pre-discharge claims
quarterly.
Recently, the Veterans Benefit Administration introduced
the new changes with the launch of the pre-discharge redesigned
program. Major changes include the elimination of the Quick
Start program and adjusting the filing day for pre-discharge
claims between 180 and 90 days before separation.
The Salt Lake City regional office was selected as the
pilot site for the program. The early feedback from a
representative there has been positive. A representative states
that he has seen more pre-discharge claims being completed
prior to the date of separation. This was not the case under
the previous program. This new expedited method is beneficial
to the veterans as they will receive their compensation
immediately upon separating.
The American Legion has concerns with the elimination of
the Quick Start program due to the loss of the in-service
diagnosis. Without this diagnosis, servicemembers are at
greater risk at being denied, or at least delayed, in being
considered service-connected.
The American Legion continues their commitment to
transitioning the servicemembers by maintaining a dedicated
staff to assist during this crucial phase. We feel that these
challenges can be improved with the integration of stakeholders
at all levels and improve channels of communication, we owe it
to the men and women who have volunteered for service to the
Nation.
Thank you, again, Chairman Bost, Ranking Member Esty, and
distinguished Members of the Subcommittee. We appreciate the
opportunity to present the American Legion's views, and look
forward to answering any question that you and/or the
Subcommittee may have.
[The prepared statement of Mr. Gerardo Avila appears in the
Appendix]
Mr. Bost. Thank you, Mr. Avila. And, Mr. Gallucci, you are
recognized for five minutes.
STATEMENT OF RYAN M. GALLUCCI
Mr. Gallucci. Thank you. Chairman Bost, Ranking Member
Esty, and Members of the Subcommittee, on behalf of the VFW,
thank you for the opportunity to testify on VA and DoD's pre-
discharge claims programs.
To the VFW, there is no more critical point than when a
servicemember leaves the military and seeks to access their
benefits. Filing an initial claim is just the beginning of what
the VFW considers a lifetime of advocacy that resulted in
nearly $7.7 billion in benefits delivered to all VFW-
represented veterans in 2017.
We serve 24 military installations through our pre-
discharge program, and I want to thank both VA and DoD for
allowing our highly-trained and professional advocates to
assist in this transition. By working together, we ensure
timely delivery of benefits for veterans at a pivotal point,
and we set up veterans for positive interactions with VA moving
forward.
As transition programs evolve, we seek to make changes to
improve the experience. Many times they yield positive results
such as the military life cycle model, IDES, or the acceptance
of pre-discharge claims, but sometimes changes have unintended
consequences. This is where it is the VFW's responsibility to
inform the agencies and this Committee of our concerns.
Recently, VA made two significant changes that concern the
VFW. First, VA shifted its timelines for BDD, only allowing
servicemembers to submit claims from 180 to 90 days prior to
discharge. Second, VA eliminated Quick Start, meaning
servicemembers with 89 days or fewer left on active duty no
longer have an option tailored to their needs.
On its own, the shift to 90 days makes sense. VA can
complete exams and propose decisions in time for separation.
However, coupled with DoD's VOW Act requirements to deliver
transition training and the elimination of Quick Start, the VFW
believes this only makes it more difficult for transitioning
servicemembers to access their benefits at separation, and more
difficult to evaluate whether VA is effectively serving this
population.
GAO recently reported that DoD still struggles to meet the
90-day requirement to commence transition. This is problematic
for lower-ranking servicemembers who do not control their
schedules and for those who must remain operational as long as
possible.
VFW data shows that nearly half of our clients were Quick
Start prior to October 1. This is not a knock on DoD. We know
military mission requirements come first and believe the VOW
Act standard is reasonable. This is where VA needs to be
flexible and cutting off BDD at 90 days does not help. If
servicemembers have not been briefed yet on how to access their
benefits, how can we expect them to file their claims?
In the past, the Quick Start EP code allowed both the VFW
and VA to track pre-discharge work and ensure the best possible
outcome for the veteran. VA argues that eliminating the code is
not a big deal, and that BDD excluded claims can be worked in
regular order once the servicemember is discharged. However,
this unique population deserves unique attention.
It troubles us that VA is telling servicemembers they will
no longer work up to 50 percent of pre-discharge claims until
they officially leave the military. Additionally, by losing the
EP code, we lose optics on this population at a critical point.
Pre-discharge claims are treated differently when we review
them, and we can find errors in up to 20 percent of them. If we
cannot identify problems early, we are not setting the
servicemember up for post-military success.
To make matters worse, when VA receives a claim with fewer
than 90 days, the servicemember now receives a letter that
implies that they did something wrong and that VA did not
accept their claim. Since this change went into effect, all of
our pre-discharge reps on military installations have heard
from clients who received this letter and believe that
something went wrong.
Many have confidence that we can resolve the issues, but
for those who believe that the VFW did something wrong, we have
lost our ability to advocate. At best, these letters are
unnecessary. At worst, they are tone deaf and viewed as
irresponsible.
The solutions are simple. First, stop the disqualification
letters. Second, reinstate an EP code for pre-discharge claims
filed with fewer than 90 days. And, third, address the
ambiguity and code regarding VA's authority to accept these
claims. In Title 10 and Title 38, nothing explicitly directs VA
to accept them. Instead, the authority is inferred through the
statutes of authorizing TAP and VA compensation generally. We
should clarify this.
Finally, the VFW worries that these changes are the latest
in a series of changes that obfuscate VA's pending workload ,
but not all pending work is bad for the veteran. While VA does
not get a pass on drawing out certain processes, some pending
work is legitimate.
If we set reasonable expectations and explain the process,
veterans will have positive experiences. But this also means we
can't seek out headlines every time VA reports that something
took more than 125 days. It is time to have a reasonable
discussion about workload and what it really means to the
veteran's experience.
The military to civilian transition can be unknown and
unpredictable. All of us in the room have dedicated substantial
time and resources to make sure we get it right. The VFW values
the role that we play alongside VA and DoD, and we are always
looking for ways to improve. Our goal is to work together to
ensure that our transitioning servicemembers have access to the
benefits they have earned.
Mr. Chairman, this concludes my testimony, and I am happy
to answer any questions you or the Subcommittee may have. Thank
you.
[The prepared statement of Ryan M. Gallucci appears in the
Appendix]
Mr. Bost. Thank you, Mr. Gallucci. Thank you. We are going
to go on now with questioning. I will recognize myself for five
minutes.
Mr. Avila, you stated that the agreement and the spirit of
IDES is so DoD stays out of the rating business and leaves part
of the process--that part of the process to the VA. Can you
explain why the American Legion recommends that the VA rather
than DoD conduct the needed periodic exams, and assigns any--
just a minute, let me get this right--and then assign any
revised rating for veterans who have already been placed on
TDRL?
Mr. Avila. The American Legion--sorry. The American Legion
does not feel that DoD is doing this on purpose or is doing it
to low-ball the military member when giving them a rating. And
we understand that ratings can change. Maybe they were given 60
percent, in the sample that I used, and it's now maybe a lower,
or maybe even a higher rating if the condition has gotten
worse.
But I think if we are trying to get it--if the goal is to
get an accurate reading of what the current condition is today,
I think the conversation needs to happen between DoD and VA.
Specifically, if the member is now receiving the health care
through the VA, I think VA can paint a complete picture to DoD
by saying this is the current condition, this is his latest
appointment, this is the current medication, or what has been
the action plan.
And I think once the VA has that--I mean, once DoD has a
complete picture, then they can make perhaps a better decision
than just bringing the member in and doing a one-time
compensation and pension examination, for lack of a better
word, and then basing a rating off that one decision. Going
forward, like I mentioned in my testimony, let's use one
rating.
If we start changing ratings and we have different ratings
between DoD, then we are going back to the old system, and that
was kind of the change of IDES that we would have one rating
decision and the only rating decision would be used by both DoD
and VA. I do not think we want to head back down that road.
Mr. Bost. Mr. Clark, why doesn't the VA conduct the follow
up exams and ratings when a veteran is placed on TDRL?
Mr. Clark. Chairman Bost, we would have to work with DoD to
change the process. But as it currently stands, then that is a
DoD responsibility for the temporary, and even permanent due to
retirement list. But I am in agreement, and certainly we would
have to work with our DoD partners that VA can take that
responsibility on and provide this one rating.
But as Mr. Avila just mentioned, as it presently stands,
that is a DoD responsibility. But we are certainly open to
making that happen, and I feel that we can make that happen.
But we will have to speak to that. And Dr. Adirim--
Mr. Bost. Dr. Adirim, does DoD agree with that?
Dr. Adirim. Whenever there is a--in general, when there is
a VA rating, and we have access to that, and we have found
about, at least Army, about 70 percent of the time has access
to that rating, we do use that exam. But we are happy to work
with our VA colleagues to see where we can make improvements.
Mr. Bost. Thank you. Ms. Murphy, I am going to ask some
real quick things here. Quick Start was eliminated, and then
BDD was changed around and tried to revamp. What were the
reasons for the changes--
Ms. Murphy. Certainly.
Mr. Bost [continued]. --and getting rid of quick Start?
Ms. Murphy. Good morning. Thank you. So we are always
looking to improve, and streamline, and modernize in our
processes with DoD, within VA, to best help our transitioning
servicemembers and our veterans. I heard some of the comments,
and certainly your concerns are our concerns as well for our
servicemembers and our veterans about giving them the head
start on their disability claim before they leave service for
tailoring the process to them. And I think we have maintained
that in our new redesign of the pre-discharge program.
In BDD, now instead of 60 days prior to dis-charge, we have
moved that back 90 to 120 days. I think we are doing a better
job through our TAP program to get the word out to
transitioning servicemembers about what is available to them
through VA. And we are getting them educated, if you will.
So giving us a little bit more time prior to discharge to
get all the records together, to get the exams done, it is--we
see it as better service to them in that time. We did not want
to leave a gap, in fact, for some time we considered just
completely eliminating Quick Start and not replacing it with
anything, and just saying we will meet you on the other side of
discharge and we will work with your claim there.
We had some feedback from our VSO partners. They were very
adamant about working with the servicemember while they were
still on active duty. So we went back to the table, we thought
about it, and we decided we would go ahead and open up some of
our other options--traditional claim process, fully developed
claim process, and our brand new decision ready claim process--
that transitioning members can have that available now tailored
to them, and they get to be in the driver's seat.
They decide when it is best for them to get the exam, they
work with a service officer if that is helpful to them. Quick
Start was not quick, and with decision ready claims, we are
seeing an early result of about eight days after--
Mr. Bost. Okay. I have one quick question, my time is about
out, too. But this is for Ms. Murray. Was VA having difficult--
why was VA having difficulty scheduling and completing the
medical exams before? What are some reasons that were in there?
Ms. Murray. Can you repeat the question, please?
Mr. Bost. Yeah. Why were we having trouble scheduling these
exams? You know, there was a problem with scheduling, correct?
What were some of the reasons that the scheduling problems were
occurring?
Ms. Murray. I think in terms of scheduling in VHA, we
initially had a contract that we were using for surge capacity.
And so we had examiners that we could tap into under contract.
But then the contract was removed from VHA, and so we are now
limited to our internal capacity. And so we did have a
challenge with being able to surge outside of VA, and so we are
limited to our in-house capacity. And so now we are sharing
that overflow of capacity with the VBA contract. So we had to
shift to a different way of scheduling.
Mr. Bost. Okay. Thank you. Ms. Esty, you are recognized for
five minutes.
Ms. Esty. Thank you very much. Dr. Adirim, I wanted to
ask--drill down a little bit more on the Guard and Reservists,
because we are getting feedback about difficulty with records.
So, for example, they are often in a rush to try to get their
records updated. Now this is done much better with active duty.
As soon as the Reservists come back, everybody, everybody
disperses. Those records do not get updated, and that then
poses huge problems.
That is the kind of thing we get calls in our office all
the time. I can't find my records, nobody updated them. I will
tell you here is where I was, this happened, and there is no
records available to us. As part of this process, I think we
need to make sure that that is being dealt with. So I would
like you to start, and anyone else who has--it is not directly
on this, but this is literally we do not get the medical
records updated, and that causes enormous problems down the
line because you can't get accurate evaluation if the records
are not present at the time that they are transitioning back.
Dr. Adirim. All right. Well, thank you for bringing up this
issue. It is a struggle because when you are in active duty the
records are there, it is a central, you know, health record and
so it is easy to access. With the Guard and Reserves, their
care could be, you know, outside of the military system which
makes it a struggle. And as a physician, I know this struggle
in getting records for my patients.
So I think this is something that we would like to take
back, and we would like to look at, and determine what we can
do to help our Guard and Reserve access their records quicker.
Whatever that we need to do to help them with that. And we can
get back to you on that.
Ms. Esty. Thank you, because I think that is important as
part of this process, and, again, as we are relying so much on
Guard and Reserve. This is not occasional, these are our
seasoned fighters at this point, and they deserve to have those
records updated. And, again, I hope we can schedule to have a
hearing in a few months' time so that we can put our heads
together and find out what needs to happen to get this fixed.
And--
Dr. Adirim. I agree. And thank you for bringing up the
issue.
Ms. Esty. Thank you. We had discussed earlier some of the
challenges, earlier in my office, some of the challenges we are
looking at. Can you talk about what is being done with outreach
for populations who do not seem to be connected, who we know,
based on other surveys and other data, are more at risk for not
getting employment? Suffering from PTSD, becoming homeless.
What are you doing to use technology and to use every resource
available to improve outreach at that transition point?
Mr. Clark. I will start, and then Ms. Murphy, or Ms.
Murray, and even Dr. Adirim may join. As we discussed, that is
an opportunity for improvement. We have a TAP program that I am
working with DoD. We are attempting to get that word out sooner
and to more people. We have a division in VBA benefits services
led by Margarita Devlin that is in charge of TAP, to get that
information out.
And as our MSCs and our other members of the regional
offices go on and engage with the military members before they
get out, we provide information on VA benefits. But we need to
do a better job because one servicemember that does not get the
word is one servicemember too many.
So we have ways that we get out using TAP, but we have to
do a better job, and then we have to reinforce it because a one
and done won't get it. Often times you have members that they
are at a point in their lives that they are transitioning, they
are thinking about a lot of things, and even when they get the
briefing, it may not be a point in time that they are ready to
receive that.
So we need to do a better job of going back and telling
them again, and yet again, until they get that. And that is an
opportunity for improvement that we need to do, and we have
taken that and embraced that.
Ms. Esty. Well, I hope you will come back to us maybe when
we reconvene in a couple months' time with specific things. Are
there resources you need to do that? I think ensuring that we
get Internet, you know, appropriate email that is good for
every single departing servicemember is one key thing. And then
you can actually code them and do outreach, at least online
outreach, at two months out, six months out when people might
be more ready, more aware of the challenges they are facing,
and we can target that a lot better.
So I think we have to be using technology, we have to be
capturing all pieces of information as we can when they are
making that transition so it does not get lost, and they do not
get lost. And that is, again, I know all of you are committed
to that, but we have to do better, and I do think we need to
use technology as well to capture who these folks are so that
we have a way systematically when they move around the country
to be able to reach back out and make sure they are connected.
I am over time. Thank you, and I yield back.
Mr. Bost. Thank you. Mr. Banks, you are recognized for five
minutes.
Mr. Banks. Thank you, Mr. Chairman. Mr. Avila, to Ms.
Esty's point, the Ranking Member's point. As a Navy Reserve
Officer myself, I have seen first-hand the difficulties that
Reservists and Guardsmen sometimes have in comparison with
their active duty counterparts. In your testimony, you
mentioned the American Legion's concerns regarding the lack of
resources for members of the National Guard and Reserves who
are undergoing the IDES process in their home station.
I know we have heard some others on the panel about their
perspective, but could you elaborate on the American Legion's
perspective on that point?
Mr. Avila. As Chairman Bost mentioned going out to Walter
Reed earlier, and I think if you go there you see the resources
that are available in-house to everybody. You have JAG, social
work, your medical appointments are there. There is a benefit
to National Guard Reservists doing the medical process at their
home station.
They are home, they are with the family, they are not
separated. But I think the fear there is that they do not have
the resources that their active duty counterparts have. So it
is a double-edged sword. Do we send them somewhere as a TDY to
make sure they do their IDES process at a consolidated location
where the resources are there. So I think that is the biggest
gap that we see.
I receive emails from Guard members or Reservists going
through the IDES process at their home station, and they are
telling me, I just got my proposed ratings and my 199 back from
DoD, and I need to make some elections. And my JAG lawyer is,
you know, at the state capital, or something like that. So they
do not have somebody readily available to go there.
And I think that is where we see the biggest difference.
And then whenever you talk about available resources that are
there on hand to assist the member make the crucial decisions,
they are always going to be crucial as they separate, and what
are the benefits they are going to receive.
Mr. Banks. Thank you. Ms. Murphy, in place of Quick Start,
the VA is allowing servicemembers who are within 90 days of
discharge to begin preparing but not submit a fully developed
claim, decision ready claim, or a traditional claim. If the
servicemember has a character of discharge determination and
has completed all requirements to develop their claim, why must
this servicemember wait until after separation to file their
claim with the VA?
Ms. Murphy. We can begin working on this and we track these
things, but until you are a veteran, we can't start paying you,
until you are out of service. We do have some in-house tracking
of end products and tracking those claims, but we are just
working with you ahead of time.
As far as the decision ready claim, your formal claim is
what really starts our clock. So a servicemember works with a
veteran service officer, collects records, goes gets the exam.
And then when it is time, submits that to us. And as I said
earlier, we have been turning those around in about eight days.
And I do want to clarify that that new program is not just
available to transitioning servicemembers that is available to
any veteran who wants to work with a VSO. Right now we are
limited to claims for increase, but we have recently expanded
just this week to additional new issues on claims that we have
already seen. So if you want to add an issue, a secondary
issue, maybe your back is hurting because of your knee, also
presumptive claims. So we have expanded about 500 percent the
eligible pool there.
But to your point, we are working with them ahead of time,
it is just that we are not processing the claim and paying the
benefits until they are on the discharged side.
Mr. Banks. Okay. Thank you.
Mr. Gallucci. Mr. Banks, I would like to comment on that,
if I could, for just a couple of minutes because this is--
Mr. Banks. No, I do not have a couple of minutes.
Mr. Gallucci. Okay. Well--
Mr. Banks. Let me move onto my next--
Mr. Gallucci. About just--
Mr. Banks. Excuse me. Mr. Avila, and Mr. Gallucci, to get
to you on another point. Do you think that the fully developed
claim program and decision ready claim program will meet the
needs of separating servicemembers who are unable to file a BDD
claim, to that point?
Mr. Gallucci. I am glad you asked that, because that is
what I was about to talk about.
Mr. Banks. All right.
Mr. Gallucci. So, no. Unequivocally, no. From the VFW's
perspective, we have not had positive experiences with the
decision ready claims process. I would say about 60/30
negative--or 70/30 negative to positive experiences. What we
are talking about here is that control over the exam, the
official submission date. There is no product on the VA side.
We are requesting exams, a veteran may conduct an exam--
Mr. Banks. I have five seconds. Mr. Avila, do you agree
with that?
Mr. Avila. I think from part of my testimony, we have seen
some positive experience. We are seeing the claims completed
prior to the discharge date. Obviously, it is early on, and we
got to keep an eye on it.
Mr. Banks. Okay. Thanks. My time is expired.
Mr. Bost. Ms. Brownley.
Ms. Brownley. Thank you, Mr. Chairman. I have two quick
questions. One to the VA. If you could speak to the issue that
VFW raised with regards to letters that the servicemembers are
receiving saying that veterans are disqualified from BDD. I
think what is happening is they are receiving those letters and
thinking, well, I am not eligible for any kind of benefit. But
you are saying that they are not eligible right now but they
will be later. But that is--the letter, they way it is written,
is I think creates a lot of misunderstanding.
Mr. Clark. Well, we will have to take that back, and
certainly in working in concert with the VSOs to make sure that
we are clear when we send that letter what that is about. So,
obviously, we have to work closer with them to make sure that
between the two of us, you know, we have got military service
coordinators out there, we have got outreach specialists in the
field that go out to military bases to let folks know that,
hey, we have got these programs. The combined program just
started on 1 October, so we have not gone the full 90 days.
But as the testimony was shown by American Legion, we are
finding that it is successful, and we need to do better. And,
obviously, we need to get more information out there and let
folks know. But we think it is a good program.
Ms. Brownley. So does VFW, would you like to respond?
Mr. Gallucci. Thank you, Ms. Brownley, absolutely. Based on
the volume that we see, we anticipate significant challenges,
especially in tracking how we serve that population who does
not meet that 90-day deadline. I respectfully have to disagree
with the Legion's perspective on this.
The VFW processed more than 15,000 pre-discharge claims
last year, and in reviewing our pending workload, it has gone
down. I was out at the San Diego VA Regional Office, where we
have a rating review team, just last week, and they have all
but processed all of their Quick Start claims.
Whether they are processed as DRC, FDC, or a traditional
claim, we do not know that it is a transitioning servicemember
anymore. To us that is problematic from a quality control
standpoint to evaluate the efficacy of these programs as we
have discussed in detail today.
Ms. Brownley. Thank you. And, hopefully, we can follow up
on this and improve upon that process. So the other question I
wanted to ask is, you know, I want to commend everybody for
improvement of timeliness. This is good, we seem to be moving
in the right direction. I am sort of interested in the spirit
of, I guess, transparency and really pealing the onion to have
a good look at everything that is going on.
What about, you know, are there cases where they are sort
of outliers to the averages of the data? And so I would
appreciate candidness with an answer. And, you know, if there
is, you know, what are we doing to identify those issues and
barriers, and how to improve upon the process for where there
are, indeed, outliers?
Mr. Clark. You know, with the IDES process, and I can let
the Doctor speak to that. But overall, you know, we have said
that there is an average processing time, well less than 100
days for all claims in VA. Certainly IDES and BDD processes it
shorter still, but that is an average. So we do have scenarios
where it will take a little longer.
Sometimes there are issues that are added later in the
process, there are attempts if they are Guard and Reserve
trying to get the records. But we have identified those and we
continue to work and collaborate on ways to make sure that we
get all of the records, and that we just be mindful that we
have got the need from DoD to transition as quickly as possible
while also trying to understand that we are dealing with
members that are unsure about their future and where they are
going, and we need to be compassionate in our approach and
worry about them whether than our processes.
Ms. Brownley. So you said two things. You said, all claims
are under a hundred and some days. And then you said, but we
are dealing with averages. So those are two very different
things. An average is an average, and, you know, there are
highs and lows, and all means all. So, anyway, Doctor, do you
have any comments?
Dr. Adirim. No, I would just add, thank you for that
question. And, certainly, with any process there are going to
be outliers, and those are cases that are more complicated. And
we do monitor those cases, and we look into what the issues are
to see where we can address those issues. But I would caution
you that we want to make sure that every servicemember, you
know, gets all due consideration. So if there are problems
where we can expedite those cases, we do do that. But then
there are cases where, you know, time is helpful to that
servicemember. So thank you for brining that up.
Ms. Brownley. Well, and I appreciate that answer. I, you
know, in those more complicated cases I think, you know, the
expectation is that we are hanging in there with the veteran,
and communicating and standing by them shoulder to shoulder
because, you know, both the veteran and their family,
obviously, are going to be very, very concerned in those more
complicated processes.
Dr. Adirim. Right. Good point. Thank you.
Ms. Brownley. Yes. Thank you. I yield back.
Mr. Bost. Mr. Coffman.
Mr. Coffman. Thank you, Mr. Chairman. Dr. Adirim, what
conditions does the Department of Defense require somebody who
has an injury to be on a medical hold status subject to
treatment? If somebody says that I have a physical injury, I
have some type of stress related condition, is there ever a
situation where that individual is put on medical hold, and
that is subject to treatment, and that discharge is delayed?
Dr. Adirim. I am not certain I quite understand the
question. Do you mean that the servicemember is put on TDRL,
or?
Mr. Coffman. I do not know what TDRL is. A medical hold
being that their discharge is suspended pending some sort of
treatment, medical treatment.
Dr. Adirim. I think what you are talking about is the TDRL.
That when a servicemember has a condition under which they, you
know, may have a condition where they will--where it is
anticipated that they will eventually need to be put through
the disability evaluation system. However, they will undergo
treatment, and then a determination is made subsequently
whether or not they can return to service versus being put
through the disability evaluation system. That is what you are
talking about, right?
Mr. Coffman. Yes.
Dr. Adirim. Okay. Good. And so your question is, what
conditions?
Mr. Coffman. Well, how often does that occur, and under
what conditions?
Dr. Adirim. We have--I believe we have--I can get back to
you on that because I know the number but it is not coming to
me right now, of servicemembers who are on that particular
list. And the conditions would include any condition for which
they are currently undergoing treatment which it is anticipated
that they may improve but, you know, and they are reassessed at
18 months. So I am not sure if I answered the question.
Mr. Coffman. Well, if they are going through the disability
process, and they are claiming something that the Department of
Defense, the health system, could rehabilitate, you know,
through surgery, through treatment, or through any process.
What is the connection between our DoD health care system and
that claims process relative to that issue?
Dr. Adirim. Sure. Well, there are multiple different steps,
and I just want to make sure I understand clearly what you are
asking. If there is--a servicemember has a condition or an
injury to which they need treatment, they would be put on a
profile or limited duty, that would be the first step. If it is
determined that it is likely that they will not be able to
serve but they are still undergoing treatment, they would be
put on the Temporary, TDRL--
Mr. Gallucci. Temporary Disability.
Dr. Adirim [continued]. --Disability, right. They may be
put on that particular status, and they would undergo their
treatment, and then at 18 months they would have another exam
to determine whether or not they would need to be separated
versus--undergo the disability system and separated versus
going back to service.
Mr. Coffman. Okay. So we have 20 veterans committing
suicide on a daily basis in the United States. I would suspect
a fair amount are going through the process, let's say it is
post-traumatic stress--
Dr. Adirim. Sure.
Mr. Coffman [continued]. --or depression, or whatever. So
my concern is what type of treatment are they then receiving
before the discharge, and what connection do they have with the
VA for an automatic hand-off to continue that treatment?
Dr. Adirim. Thank you for that question. Now I understand
what you are asking. Suicide and mental health conditions is a
top priority of both DoD and the VA. We have a program in DoD
called In Transition, which provides a warm hand-off for a
servicemember to their care when they are out of the service.
So a coach calls any servicemember that has had any mental
health visits within that past year, or has been diagnosed with
a mental health condition over that past year, and the
servicemember's able to opt in. So all are called who have a
mental health condition.
And those that opt in get coaching and are provided with
information about care that they may receive, and there is a
warm hand-off, for example, to the VA. So we do have a program
to do that for people who have mental health conditions.
Mr. Coffman. Okay. And I think that in Congress--and I
can't remember if it is this Committee or armed services--I
think passed a provision in the last couple years that provided
a physical for Guard and Reserve prior to their retirement. Am
I correct in that?
Dr. Adirim. I believe that is true, yes.
Mr. Coffman. Okay. I yield back.
Mr. Bost. All right. With that, I would like to recognize
the Ranking Member for any closing remarks you might have.
Ms. Esty. Thank you very much, I really appreciate your
joining us here today. And there are a couple of issues that
sort of came up in the course of our discussion today that I
wanted to flag for you and have you think about.
One is to facilitate transition, and this, frankly, has to
do with other hearings we have had here. It seems to me that
getting accurate email address is unbelievably important to
stay in touch with our veterans, particularly in this
transition time.
They are much more likely to keep their email address and
be findable that way than when we know from past experience,
they are moving around, they are not sure where they are going
to be living. That leads to a whole host of problems. We are
not able to find them, we have had all those issues about
service of process and receiving notice. It seems to me vital
that we figure out a way to capture, as best we can, their
email addresses.
And I understand there has been some question about whether
that can or should be asked as part of the DD-214. But I would
like you to consider what we can do to ensure that we have our
best possible, not only physical presence mail address which we
ask for, but that is a legacy. The reality is right now a cell
phone number and--that you could send text to, which we know
to, in fact, be very effective.
In a lot of the mental health issues, being able to text is
actually vitally important. So I would ask you to consider the
utility of having email addresses and cell phone numbers to
facilitate interacting with and not, frankly, losing our
veterans. So that is one, and where can we do that?
And the other is, in my discussion with folks on my team,
is to ask you, too, what kind of outreach is being done by the
VA at that transition time to advise people of what state
benefits might be available? Some of the states have very
extensive programs, some do not. And it would seem to me, as
part of our one-stop shopping, that we should be looking at
that issue of what we can do.
And there, again, having email addresses then allows us, as
people are moving around, to say, say in a check-in, two months
out, six months out, to say where are you currently living,
and, if so, you should be aware, here are at least links to
your state programs that you should explore. And we could, I
think--again, using technology, we could do a much better job.
So I would like, when we next convene, to look at both of
those pieces as to how we do a better job. And it is just,
frankly, leveraging the resources. States who have very good
programs and are devoted, we should be utilizing and making
those available to our veterans and not waiting for them to try
to find them, or requiring our VSOs to try to find the veterans
we have lost track of.
So this is, again, in part of a spirit in doing a better
job, connecting better with our veterans, faster, and better,
and not losing one single one of them. So, again, thank you all
very much. Thank you, Mr. Chairman.
Mr. Bost. Thank you. And the only thing I would add is,
obviously, from the conversation that we had today, you will be
working with the VSOs on trying to--notification letter, try to
correct that. So thank you. I want to thank all the witnesses
for being here.
And as I said at the beginning of the hearing, the complete
written statements of today's witnesses will be entered into
the hearing record.
Hearing no objection, so ordered.
I also ask unanimous consent that all Members have 5
legislative days to revise and extend their remarks, and
include extraneous material.
Hearing no objection, so ordered.
This hearing is now adjourned.
[Whereupon, at 11:04 a.m., the Subcommittee was adjourned.]
A P P E N D I X
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Prepared Statement of Dr. Terry A. Adirim
REGARDING
THE INTEGRATED DISABILITY EVALUATION SYSTEM
Opening Remarks
Chairman Bost, Ranking Member Esty, distinguished Members of the
Subcommittee, thank you for the opportunity to appear before you today
to discuss the Integrated Disability Evaluation System, also known as
the IDES.
The IDES is a joint Department of Defense (DoD) and Department of
Veterans Affairs (VA) program that achieves two primary DoD objectives:
(1) ensuring the readiness of our military forces, and (2) providing
timely, quality disability evaluation of wounded, ill, or injured
Service members so we can assess their fitness-for-duty and, if unfit,
the appropriate disability disposition and compensation.
Improved IDES Performance
The IDES is a success story that reflects the two Departments'
shared commitment to collaboratively improve the evaluation of Service
members transitioning to Veteran status due to disability. Since DoD's
last appearance before this Subcommittee to discuss the IDES, the
Department has continued to improve the efficiency and quality of the
disability evaluation process.
Since 2014, improved processing of nearly 22,000 physically unfit
Service members per year has allowed the Military Departments to
significantly reduce the amount of time Service members spend in a
permanent non-deployable status and direct their resources towards
accessing, training, and equipping ***physically ready forces.
The IDES also provides improved case management and transparency
for Service members undergoing evaluation due to disability. Within the
IDES, there is a single point of contact for providing information to
the Service member or their representative, as applicable, about the
DES process. The IDES also provides a more transparent disability
evaluation process by allowing Service members to receive their
proposed VA disability ratings and compensation at the same time they
receive their DoD physically unfit determination. This allows the
member to make an informed decision about the best course of action,
which is a great help to Service members who have their military career
unexpectedly ended by a disabling condition.
Today, Active Component (AC) IDES cases average 258 days from the
date of referral to notification of VA disability benefits, well within
the 295-day goal. This represents a 23 percent improvement since Fiscal
Year (FY) 2014 and an overall 52 percent improvement over the 540 days
Service members averaged to complete the Departments' separate
disability processes prior to the worldwide implementation of the IDES.
Similarly, Reserve Component (RC) IDES cases achieved a 22 percent
timeliness improvement since FY 2014.
DoD is responsible for four core IDES process steps: Referral,
Medical Evaluation Board, Physical Evaluation Board, and Transition. We
are outperforming the DoD core process stage goals required by DoD
policy. For example, in October 2017, DoD Core Stage performance for AC
disability evaluation was 104 days against a 105-day goal, while RC
disability evaluation was 88 days against a 125-day goal.
Although exceeding IDES performance goals, DoD is analyzing
opportunities to reduce these goals to improve the readiness of our
military forces and allow Service members to more quickly transition to
veteran status.
Improved IDES Efficiency
In 2014, DoD consolidated and revised its disability evaluation
issuances to provide clear policy guidance on Military Department
operation of their respective DES processes. To accomplish this goal,
DoD combined thirteen previous disability evaluation issuances and
directive-type memoranda. A revised DoD Instruction, supported by
specific topics presented in three DoD Manuals, addresses each aspect
of the disability evaluation system and set requirements for each
Military Department's execution of disability evaluation activities.
This effort was the first attempt to establish a DoD-wide group of
consolidated disability evaluation policy and procedure issuances since
the 1996 publication of a legacy DES directive and instruction. As a
result, the Military Departments now operate with a much-improved,
well-defined set of policy and process documents.
As directed by Congress in the FY2013 National Defense
Authorization Act, the Department implemented the DES Quality Assurance
Program (QAP) in 2014. The DES QAP enables DoD to evaluate the accuracy
and consistency of Military Department disability determinations, the
degree to which Military Departments comply with DoD policy in their
disability determinations, and the duty performance of Medical and
Physical Evaluation Boards and Physical Evaluation Board Liaison
Officers. DoD requires a minimum 80 percent score for quality assurance
measures, and uses case reviews to help assess and monitor Military
Departments' DES performance in those areas. DES QAP scores for FY 2017
reflect an accuracy rate of 94 percent, a consistency rate of 77
percent, and 80 percent for duty performance. Consistency scores fell
under the 80% goal in FY 2017 due to a purposeful effort to increase
the complexity of test case themes used to evaluate Military
Departments' consistent application of DoD policy. DoD increased the
number of conditions for each test case, as well as the complexity of
conditions presented. This added rigor in DoD's evaluation methodology
identifies deficient areas so that the Military Departments ensure
equitable and consistent application of DoD policy.
Training remains vital to the continued success of the IDES. DoD
issued, in collaboration with the Military Departments, training
standards and performance objectives (TSPOs) to ensure all IDES staff
are prepared to provide Service members with the critical assistance on
which they depend. Collectively, these efforts ensure that disability
evaluation personnel are prepared to provide final adjudicative
decisions accurately and in compliance with law and DoD policy.
Service Member Satisfaction
DoD remains committed to continuously evaluating the IDES to
enhance the experience of wounded, ill, and injured Service members as
they undergo this process. Constant oversight is critical to identify
needed IDES improvements, monitor implementation, and measure Military
Department performance. As such, DoD surveys Service members at the end
of both the Medical Evaluation Board and Physical Evaluation Board
phases of the IDES process, assessing their satisfaction with DoD and
VA personnel and their overall IDES experience. Survey results taken
from over 9,000 Service members from April to September 2017 indicate
93 percent of Service members were satisfied with their IDES
experience. DoD will continue to utilize survey information and data to
identify improvements.
Conclusion
DoD is committed to the IDES process and identifying potential
improvements to the program. Moving forward, we will maintain our close
collaboration with the VA to meet our shared goals of providing quality
and timely integrated disability evaluations of America's wounded, ill,
and injured Service members.
Mr. Chairman, Ranking Member Esty, and distinguished members of the
subcommittee, I thank you for your unwavering support of the brave men
and women that serve our nation, and your dedication to ensuring we
have the most efficient systems in place to meet their evaluation and
transition needs.
Prepared Statement of Willie C. Clark, Sr.
Good morning Chairman Bost, Ranking Member Esty, and Members of the
Subcommittee. My name is Willie Clark, Deputy Under Secretary for Field
Operations, in the Veterans Benefits Administration (VBA). I am joined
by Beth Murphy, Director of VBA's Compensation Service, and Patricia
Murray, Chief Officer, Office of Disability and Medical Assessment,
Veterans Health Administration (VHA). I appreciate the opportunity to
discuss several of VBA's pre-discharge programs for Servicemembers,
including the Integrated Disability Evaluation System (IDES) and
Benefits Delivery at Discharge (BDD). My testimony will also cover
improvements to the IDES and BDD programs; Servicemember satisfaction
with IDES; and training for employees involved in IDES and BDD claims.
Integrated Disability Evaluation System (IDES)
On November 28, 2017, the Department of Veterans Affairs (VA) and
the Department of Defense (DoD) will celebrate the 10th Anniversary of
IDES. In 2007, VA and DoD created an integrated disability evaluation
process for Servicemembers who are being medically retired or separated
from service. This joint process was designed to eliminate the
duplicative, time-consuming, and often confusing elements of the
separate and consecutive disability processes within VA and DoD. In
fiscal year (FY) 2017, more than 22,000 Servicemembers were enrolled in
the IDES program.
IDES provides a single set of disability examinations and a single-
source disability rating that are used by both departments in executing
their respective responsibilities - eliminating the duplicate medical
examination and rating determinations within DoD and within VA
processes. The joint VA and DoD partnership through IDES has resulted
in more consistent disability ratings, faster decisions, and more
timely delivery of benefits for those personnel being medically retired
or separated. Following discharge, VA can deliver disability
compensation benefits in the shortest period allowed by law, thus
reducing the ``benefit gap'' that previously existed under the legacy
process. The integration of VBA's Military Service Coordinators (MSCs),
disability examinations, and proposed disability ratings into the IDES
process prior to separation ensures Servicemembers no longer have to
navigate the VA disability compensation system on their own to apply
for VA benefits.
As a result of our collaborative efforts, VA and DoD have met the
six goals established for IDES. These goals are (1) develop a single
set of medical exams used by VA and DoD for disability rating; (2)
eliminate the benefits delivery gap from separation to receipt of VA
benefits; (3) increase transparency and consistency of the disability
evaluations for Servicemembers; (4) reduce the combined processing
time; (5) develop a less complex and non-adversarial process; and (6)
provide a seamless transition of benefits and health care for
separating Servicemembers through IDES.
VA is responsible for four core IDES process steps: claim
development, medical examination, proposed rating, and benefit
notification. For the combined four core steps, VA's average processing
time in September 2017 was 81 days, a 102-day improvement from the last
time we testified on the IDES program in May 2014, and 19 days better
than the VA target of 100 days. In addition, VBA awarded benefits
within an average of 26 days of discharge, under our IDES timeliness
goal of 30 days.
DoD provides Servicemembers with IDES customer service satisfaction
surveys when they separate. DoD publishes the results on a semi-annual
basis, which includes VBA MSC customer satisfaction. At the end of June
2017, customer satisfaction with the overall IDES program was 93
percent and with MSCs was 89 percent.
VA continues to collaborate with DoD on ways to improve IDES
execution, while remaining focused on meeting timeliness standards. Our
continued partnership with DoD is critical. VA and DoD are committed to
supporting our Nation's wounded, ill, and injured Servicemembers
through the IDES process.
Benefits Delivery at Discharge (BDD)
Since 1995 when the BDD pilot started, the BDD and Quick Start
programs have provided transitional assistance to separating or
retiring Servicemembers and engaged Servicemembers in the claims
process prior to discharge. VBA's goal is to ensure that each
Servicemember separating from active duty and who wishes to file a
claim with VA for service-connected disability benefits receives the
upfront and timely assistance in doing so. Just as IDES provides
Servicemembers, who are facing medical discharge, with the opportunity
to initiate a claim for disability compensation benefits, the program
has also provided this opportunity to Servicemembers who are
transitioning via traditional or ``non-medical'' separation.
In FY 2017, VBA significantly improved BDD production and
timeliness, completing over 32,000 claims in an average of 90 days,
compared to approximately 29,000 claims in 127 days in FY 2016. VBA
also completed over 25,000 Quick Start claims in an average of 109 days
in FY 2017.
VA is dedicated to ensuring that Veterans get the benefits they
have earned and deserve as quickly and accurately as possible. As a
result, VA has redesigned its pre-discharge program to enable
Servicemembers to receive disability benefit decisions, in most cases,
the day after their discharge. The redesigned program went into effect
October 1, 2017. Since then, pre-discharge claims are distributed
through the National Work Queue to all VBA regional offices. Prior to
this change the claims were distributed only to the rating activity
sites that were processing these types of claims. The new modifications
to the existing BDD program include changing the filing deadline to 90
days, rather than 60 days, in order to enable VBA to schedule and
complete all of the medical examinations that are necessary to prepare
the disability compensation claim decision prior to the Servicemember's
discharge from military service. As part of the redesign, VBA
discontinued the Quick Start program and instead will fill the gap by
utilizing the new Decision Ready Claim program in addition to the Fully
Developed Claim or traditional claim processes as appropriate after
separation. We continue to work in concert with our Veterans Service
Organization (VSO) partners on the pre-discharge program. VSOs
regularly collaborate with our MSCs on various military bases, in order
to facilitate Servicemembers' initial claims submission.
Training
VBA provides substantial training for all employees involved in the
processing of claims, including pre-discharge claims. VBA's Challenge
Training program provides the basic technical skills to process claims
in a blended learning format that includes both classroom and practical
application. Ongoing technical training is also required each year.
In September 2017, BDD redesign training was provided to MSCs, and
VBA plans to conduct a comprehensive MSC training event in FY 2018. In
October 2017, VBA conducted focused training on the new redesigned BDD
program for claims processors.
Conclusion
VA remains committed to supporting our Nation's Servicemembers
through improvements in pre-discharge programs. VA believes its
continued enhancements are critical to program success in delivering
the benefits and services our Servicemembers and future Veterans
deserve.
Mr. Chairman, this concludes my statement. We would be pleased to
respond to questions you or other Members may have.
Prepared Statement of Gerardo Avila
ON
``THE INTEGRATED DISABILITY EVALUATION SYSTEM (IDES) AND VA'S PRE-
DISCHARGE PROGRAMS FOR SEPARATING SERVICEMEMBERS''
December 13, 2017
Chairman Bost, Ranking Member Esty and distinguished members of the
Subcommittee on Disability Assistance and Memorial Affairs (DAMA); on
behalf of the 2 million members of The American Legion and National
Commander Denise H. Rohan; The American Legion, the largest patriotic
service organization for veterans serving every man and woman who has
worn the uniform for this country, thank you for the opportunity to
testify regarding The American Legion's position on the ``Integrated
Disability Evaluation System and VA's pre-discharge programs for
separating servicemembers''.
The goal of the Integrated Disability Evaluation System (IDES)
since its inception in 2007 has been to streamline the medical
separation process and create a seamless transition for wounded, ill,
and injured servicemembers from the Department of Defense (DoD) to the
Department of Veterans Affairs (VA). This seamless process would create
a one-stop shop and encourage better coordination between DoD and VA.
Key components would include reducing the overall time it takes a
servicemember to complete the IDES process, a medical evaluation for
receipt of VA benefits, utilizing a single examination process that
meets the needs of both VA and DoD, and increasing transparency of both
the DoD disability evaluation system and the VA claims process.
Prior to the IDES program, the transfer of wounded, ill and injured
servicemembers from DoD to VA was fragmented. This led to large gaps in
medical care and VA disability compensation. These large gaps in
coverage placed further stress on those servicemembers most at risk and
at the crucial point of transitioning out of active duty service. It
also hindered their ability to plan for their financial future due to
their VA claims not being adjudicated for months and in some cases,
years after their separation. In many instances it seemed that DoD and
VA were using different sets of criteria to rate disabilities, all too
often unfit conditions received a different set of ratings from DoD
compared to VA. Servicemembers were confused by this new system, and
many were unaware of their rights and how the process worked.
As a response to fill the void, The American Legion works to assist
servicemembers across the United States. Until recently, The American
Legion assisted with the Medical Evaluation & Physical Evaluation Board
(MEB/PEB) process at the Servicemember & Family Assistance Center
(SFAC) at Joint Base Lewis-McChord, WA. Additionally, the National
staff offices in Washington D.C. supports surrounding region by
assisting transitioning servicemembers at the Warrior Transition Units
located at Walter Reed National Military Medical Center (WRNMMC), and
Fort Belvoir, VA. The American Legion helps in reviewing the findings
of the board, writing rebuttals, and answering questions on the IDES
process. Also, The American Legion maintains service officer staff at
the VA's Benefits Delivery at Discharge (BDD) sites in Winston-Salem,
NC and Salt Lake City, UT and have assisted veterans with over 500 BDD
and Quick Start (QS) claims quarterly. The service officers also review
exam results, as well as represent servicemembers in hearings when
warranted.
The American Legion continues to focus on the many challenges
facing today's transitioning servicemembers. The IDES program, while
not perfect, has been helpful in reducing the number of days it takes
to complete the medical board process, which has drastically reduced
the gap from separation date to receipt of benefits. The American
Legion supports the idea of having one compensation & pension (C&P)
exam and rating decision with the results being accepted by both VA and
DoD.
While the above improvements have been made, The American Legion
still has the following concerns:
DoD Rating individuals placed on the Temporary Disability
Retirement List (TDRL):
Servicemembers found unfit to continue service for a condition that
is not stable enough to assign a permanent rating will end up on TDRL.
If the individual is retired and is transitioned out of service, they
will be required to undergo periodic examinations by DoD to see if the
condition has improved, worsened, or become stable enough to assign a
permanent rating. The agreement and spirit of IDES is that DoD would
stay out of the rating business and leave the decision to VA. The
American Legion believes that DoD is violating the principles of IDES
and should not be conducting ratings. The American Legion suggests that
DoD communicate with VA and inquire if the individuals ratings have
changed. By doing so, the one rating decision will be maintained.
Additionally, the ability to add new conditions once a servicemember is
enrolled in IDES can cause issues. Medical appointments and treatment
do not stop once an individual is enrolled in IDES and the probability
of receiving a new diagnosis is likely. The American Legion has
represented individuals who were unable to add new conditions and told
to file a claim with VA once they were separated. While the advice is
true, the goal of IDES was to correctly rate an individual by both DoD
and VA concurrently and prior to seperation. By allowing new conditions
to be added, the servicemember will have a complete picture of their
financial outlook and can concentrate on transitioning and not have to
think about another VA claim.
A lack of available resources by members of the National Guard and
Reserves undergoing the IDES process at their home station:
In the past, The American Legion has expressed concern about Line
of Duty (LOD) investigations, lack of resources, and the accurate
dissemination of information on the IDES process for this group of
servicemembers. Unlike their active duty counterparts, LOD
investigations are crucial to proving that the disability was incurred
due to their service, without it, they will be separated with no
retirement or severance. Attempting to undergo this endeavor at home is
much more difficult compared to their active duty counterparts who are
located at a military instillation where medical, legal services, and
transition assistance are co-located. If feasible, members of the
Reserves and National Guard should be recommended for assignment to a
Warrior Transition Unit while enrolled in IDES.
The American Legion would also like to see improvements in other
areas as well, specifically, the pre-discharge program previously
referred to as Benefits Delivery at Discharge (BDD) and Quick Start
(QS) program. Under BDD, transitioning servicemembers could file their
VA disability claim between 60-180 days from their separation dates and
those under 60 days could file under the QS program. The goal of the
program was to initiate the claim while the servicemember was still on
active duty, with the goal of shortening the gap from separation to the
benefits receipt date. BDD intended to have the claims completed within
60 days of discharge. According to our two BDD field service officers,
this goal was never reached. Almost all BDD claims were taking an
average of 6-12 months after discharge to be completed, with QS claims
taking even longer earning the nickname ``quick start, slow finish.''
These statements are supported by the last audit conducted by the
VA Office of the Inspector General (VAOIG) which conducted a review of
the Quick Start program. VAOIG found delays remained and accuracy
figures well below VA target numbers. While VA was able to reduce the
Average Days to Complete a Claim (ADTC) from 291 days in 2011 to 249
days in 2013 the accuracy of those claims remains below 70 percent. \1\
The OIG found the lengthy ADTC rates were due to insufficient program
controls in VA and recommended recurring program evaluations and
increased training on processing QS claims.
---------------------------------------------------------------------------
\1\ VAOIG Report 12-00177-138 ``Audit of VA's Quick Start Program''
May 20, 2014
---------------------------------------------------------------------------
In 2017, the Veterans Benefits Administration (VBA) introduced new
changes to the BDD program with the launch of the pre-discharge
redesign. The major changes include doing away with the QS program and
combining it with BDD. Timelines have also changed. Now servicemembers
must file their claim between 90-180 days of their separation. VA will
hold claims filed under the 90 day window and begin to work as a
traditional or fully developed claims once the separation date is
reached. The Salt Lake City Regional Office was selected as the pilot
site for the program, and our representative has indicated that the
recent changes have been positive thus far. They base their opinions on
seeing more pre-discharge claims completed prior to discharge,
previously BDD claims were rated after discharge. For example, a claim
was completed on October 31st for someone with a discharge date of
November 30th and another completed on October 17th with a discharge
date of October 31st. Our representatives stated that this was not the
case under the previous program and mentioned that the new program is
good for veterans because they will receive their compensation right
after discharge.
The elimination of the QS program creates a serious concern for The
American Legion in cases where VA is quicker to grant service-
connection for conditions that are diagnosed while still in service, as
opposed to being diagnosed even one day after. Servicemembers are at a
greater risk of being delayed service-connection for medical conditions
unless it's a condition subject to presumptive service-connection under
Code of Federal Regulations (CFR) paragraph 3.309.
If this is the case, a veteran will have to gather supporting
documentation to establish the nexus between the disability and their
time in service to be granted service-connection for the condition.
This could result in additional obstacles the veteran must overcome to
receive their benefits. Another concern is the inability to add new
conditions once under the 90-day window. New conditions claimed will
not be accepted and written notification will be sent reminding the
servicemember the need to file a new claim after separating.
The American Legion has lent its voice and taken direct actions to
ensure today's transitioning servicemembers are fully supported and
have all the information available to make sound decisions. We also
support a more robust presence of veteran service organizations and
other private stakeholders on the DoD side to ensure transitioning
veterans have the support required. The American Legion has asked for
better dissemination of information by both DoD and VA, as well as
requesting to make the IDES system robust enough to assist veterans
with Vocational Rehabilitation and Employment \2\programs \3\. Better
support is needed for National Guard and Reserve members to ensure they
do not fall behind their active duty counterparts.
---------------------------------------------------------------------------
\2\ Resolution No. 42: ``Compensation Benefits Information
Disseminated at all Transition and Access Points''
\3\ Resolution No. 32: ``Enhancements to Integrated Disability
Evaluation System Process''
---------------------------------------------------------------------------
All of these challenges can be improved with better integration of
stakeholders at all levels of the process. We cannot allow this severe
disparity in access of medical support between the military and veteran
communities. These men and women who deserve these earned services must
not continue to struggle unnecessarily.
As always, The American Legion thanks this subcommittee for the
opportunity to elucidate the position of the 2 million veteran members
of this organization. For additional information regarding this
testimony, please contact Mr. Derek Fronabarger, Deputy Director of The
American Legion's Legislative Division at (202) 861-2700 or
[email protected].
Prepared Statement of Ryan M. Gallucci
WITH RESPECT TO
``To Discuss the Integrated Disability Evaluation System (IDES) and
VA's Pre-Discharge Programs for Separating Service Members''
Chairman Bost, Ranking Member Esty and members of the Subcommittee,
on behalf of the men and women of the Veterans of Foreign Wars of the
United States (VFW) and its Auxiliary, I would like to thank you for
the opportunity to testify on the Integrated Disability Evaluation
System (IDES) and the Department of Veterans Affairs' (VA) pre-
discharge programs for separating servicemembers.
As the nation's oldest major veterans service organizations (VSO),
the VFW serves 24 military installations to help veterans navigate and
understand their earned VA benefits. Given the structure of the IDES
program, we only have minimal interaction with servicemembers as they
navigate this process. Therefore, most of this testimony will focus on
VA's pre-discharge claims programs.
To the VFW, filing claims prior to separation from the military is
one of the most important processes that a servicemember can complete
during the transition process. Not only does this ensure timely
delivery of benefits after discharge, but it also increases the
likelihood of granting benefits, setting veterans up for future
success.
The reason that the VFW has invested significant resources to
support transitioning servicemembers is to foster a lifetime of
advocacy on their behalf. As you know, the VFW and organizations like
us provide this service free of charge. This is not just a courtesy
that we provide. This highly-regulated professional service is a
cornerstone of the VFW's mission to advocate for our nation's veterans.
When we say a lifetime of advocacy, we mean that the advocacy we
provide does not stop after the initial appointment with a
transitioning servicemember to file an initial VA claim. Instead, from
that point forward, we hold limited power of attorney to advocate on
behalf of the veteran and his or her dependents in any claim actions
before VA. What this means is that after service, if a condition
worsens, if the veteran marries or has children, the VFW's global
network of more than 1,900 highly-trained, professional, and VA-
accredited advocates is there to help navigate the process. Even when
the veteran passes away, VFW advocates are there to support the
surviving family members in understanding and accessing any benefits to
which they are entitled.
According to VA, this lifetime of advocacy yielded nearly $7.7
billion in earned benefits for nearly 500,000 VFW-represented claimants
in fiscal year (FY) 2017--an increase of more than $200 million over FY
2016. The VFW believes in this lifetime of advocacy, and the most
critical point in establishing this relationship is the time when a
servicemember chooses to leave the military. For this, I want to thank
both VA and the Department of Defense (DoD), whom we heard from today,
for allowing the VFW to play a critical role in this transition.
I just had the opportunity to visit with our work sites on Camp
Pendleton, Naval Base San Diego, and in the San Diego VA Regional
Benefits Office, so I have seen firsthand the importance of
collaboration among DoD, VA, and the VSOs to best serve our
transitioning servicemembers.
A positive experience for a transitioning servicemember in
navigating their VA benefits sets everyone up for success. The veteran
receives timely, accurate benefits, setting them on a course to
financial stability during a difficult transition. VA can more easily
process benefits for veterans whose health conditions clearly manifest
during their time on active duty, making VA an approachable and non-
adversarial steward of these critical benefits. DoD fosters a smooth
transition into civilian life, solidifying its rapport with veterans
and ensuring the sustainment of the all-volunteer force. Finally, it
postures the VFW to provide the best possible service to our clients no
matter where they choose to go after they leave the military.
As transition programs evolve, Congress, DoD, and VA all seek to
make changes to better suit the transition experience. Many times,
these changes result in improved service for the transitioning
servicemember, such as the Transition Assistance Program (TAP) mandate
included in the VOW to Hire Heroes Act; DoD's deployment of the
military lifecycle model for transition; VA's establishment of the pre-
discharge claims program; or the joint DoD/VA commitment to develop a
single medical record for servicemembers and veterans.
Unfortunately, sometimes changes have unintended consequences that
may result in a degraded transition experience for the servicemember.
This is where the VFW takes its responsibility as a veterans' advocate
to inform the agencies of jurisdiction and this committee of our
concerns.
Recently, VA made two significant changes to its pre-discharge
claims programs that make the VFW concerned about the future of this
critical interaction and the professional services we provide to our
transitioning military members. First, VA shifted its timelines for the
Benefits Delivery at Discharge (BDD) program, only allowing
servicemembers to submit BDD claims from 180 - 90 days prior to
discharge. Second, VA eliminated the Quick Start (QS) claims program
entirely, meaning veterans with 89 days or fewer left on active duty no
longer have an option tailored to their unique circumstances to easily
access their earned benefits.
The VFW understands why VA wanted to shift the timeline for BDD to
90 days. We understand that this allows VA to complete exams and
propose rating decisions to deliver benefits as close to a
servicemember's date of discharge as possible. In a vacuum, this is a
positive step. However, coupled with the elimination of QS and the
military's cumbersome transition timelines, the VFW believes this
change would disqualify most servicemembers the VFW serves from easily
accessing their benefits on their way out of the military.
According to VA, the VFW's claimants on military installations who
filed QS claims fluctuated between 33 and 50 percent over the past
year. In visiting with our pre-discharge claims sites, we hear that
most clients visit our offices with far fewer than 90 days left on
active duty, meaning most of our past BDD clients would no longer be
qualified for the program. Yes, VA still accepts these claims, but they
are no longer processed expediently while the veteran still serves on
active duty, and they are no longer tracked with a unique end product
(EP) code specific to QS claims, formerly EP code 337.
In the past, this EP code allowed the VFW to track pre-discharge
claims work to perform rating reviews and ensure the best possible
outcome for our transitioning servicemembers. Now, with the elimination
of the QS EP code, claims we submit on behalf of transitioning
servicemembers are assigned as any other claim in VA's National Work
Queue. VA will argue that this is not a big deal and that VFW-
accredited representatives anywhere can conduct these rating reviews.
While this is technically true, we lose optics on these claims and can
no longer properly track and report how well VA is serving the
transitioning servicemember population. If we cannot identify problems
this early in the process, we are not setting up the servicemember for
post-military success.
This is why the VFW commits substantial resources at the national
level to not only initial claims intake but also quality controls on
adjudication of the original claim. As of this hearing, the VFW has six
personnel stationed at the VA regional offices (VARO) responsible for
pre-discharge claims adjudication whose sole responsibility is to
review rating decisions and correct any possible errors. Our most
recent data indicates that our rating review specialists catch VA
adjudication errors in up to 20 percent of pre-discharge claims and are
able to resolve such errors prior to promulgation of the award. This
quality control allows us to establish the aforementioned lifetime of
advocacy that we consider so vital to a veteran's future, posturing our
local advocates for success once a recently-transitioned veteran
settles down.
Several years ago, recognizing the unique needs of transitioning
servicemembers, VA committed not to broker work from the consolidated
pre-discharge claims worksites at the VAROs in Winston-Salem, Salt Lake
City, and San Diego. VA reneged on this promise last year with its
across-the-board implementation of the National Work Queue, as we have
testified in the past, and we do not expect VA will go back to its old
workflows, since this has seemed to increase productivity and
efficiency for VA. However, through unique EP codes and Station of
Origination filtering in Veterans Benefits Management System (VBMS),
our pre-discharge quality control team was able to track and review
work regardless of the VARO of jurisdiction for adjudication. This was
a satisfactory middle ground to meet both the needs of VA to broker its
work and the VFW's need to maintain optics on specific claims for
quality control purposes. However, with the elimination of the QS EP
code, we lose optics on this work and can no longer fulfill our
commitment to transitioning servicemembers to perform the proper
quality controls on their claims.
We have not seen the full effects of this yet, but our rating
review specialist at the San Diego VA Regional Benefits Office already
reports that QS claims for review are declining, and in meeting with
the VARO Director, we learned that the total pending QS workload is all
but adjudicated. So what happens now?
This becomes especially problematic for servicemembers who are
lower in rank--the servicemembers who need our services the most.
Through surveying the VFW's clients, we have learned that many of our
junior enlisted clients do not receive their TAP training in time to
file a BDD claim. We also know that the military branches are just
narrowly able to satisfy the VOW to Hire Heroes Act requirement for
servicemembers to start their transition training with no fewer than 90
days remaining on active duty. If servicemembers have not been briefed
yet on how to access their earned benefits, how can VA expect them to
file their claim actions?
This is especially problematic on installations, like Camp
Pendleton, that serve large numbers of junior enlisted transitioning
servicemembers. On my recent site visit, I saw that most of the clients
visiting our representative are much closer to their discharge date
than 90 days. Based on our internal numbers, most of our clients on
Camp Pendleton were QS claimants prior to October 1.
Moreover, VA exacerbated an already tenuous situation by notifying
transitioning servicemembers with fewer than 90 days on active duty
that they were ``disqualified'' from filing BDD claims. This is a
situation where language is critical. When the VFW was first presented
with this letter, we vehemently disagreed with VA's decision to send it
as worded. This concern was ignored. Since the change went into effect
October 1, we have heard from all of our pre-discharge claims sites and
several of our VARO worksites that veterans have called or visited the
office, concerned that something went wrong with their claim. We even
have one report from our office at Walter Reed National Military
Medical Center that a retiree received a BDD disqualification letter 92
days prior to separation.
Thankfully, many of these clients have confidence in our
representatives to explain the situation or resolve any discrepancies.
However, what concerns us are the servicemembers that we do not hear
from who thinks that the VFW did something wrong. For these veterans,
we have lost our ability to advocate, and they already have a negative
perception of how both VFW and VA will handle their benefits.
The VFW calls on VA to put veterans, not appearances, first. It
must accept claims prior to separation instead of punishing
transitioning servicemembers whose chain of command does not permit
them the opportunity to begin their transition process 90 days before
they separate from military service. At the very least, VA must
reestablish an EP code for transitioning servicemembers who file a
claim within 90 days of separation to ensure the VFW and other veterans
organizations are able to assist veterans in successfully transitioning
from military service back to civilian life, regardless of where they
choose to call home.
VA must also rework the disqualification letters to simply notify
the veterans that their claims have been received, but it cannot be
worked until they separate from service and submit their DD-214
paperwork. It is unconscionable that transitioning servicemembers be
led to believe they are not eligible for VA benefits simply because VA
refuses to change the wording on its letters. These simple steps will
once again ensure that the VFW and similarly-structured organizations
can continue to provide the advocacy our clients expect, and
transitioning servicemembers will once again have peace of mind that VA
is responsibly handling their pending benefits claims.
Unfortunately, the VFW worries there is a larger objective with the
recent changes to VA's pre-discharge claims programs. While VA asserts
that moving the window to 90 days results in better claims service, the
elimination of the QS EP code and the rapid deployment of programs like
the Decision-Ready Claims (DRC) process indicate to the VFW that VA's
primary objective is to obfuscate the total pending workload.
Based on the VFW's estimates, we would lose optics on up to 50
percent of our pre-discharge workload simply by VA shuffling the BDD
timelines and eliminating the QS EP code. The problem is not only that
we lose optics on the claims, but VA will not formally establish the
BDD-excluded claims until veterans formally submits their DD-214 after
they separate from service. This means that any time from 89 days to
the time of the veteran's submission does not count as pending work as
it formerly counted when the claim was established under a QS EP code.
On December 11, 2017, VA deployed new functionality in DRC,
encouraging VSOs to work DRC claims for transitioning servicemembers.
While it may seem advantageous for VSOs to be able to request VA exams
for separating servicemembers who are not BDD eligible, the process
completely falls apart with the requirement for the separating
servicemembers to formally submit the claim once they leave military
service. Per VA guidance, if we were to work with a separating
servicemember to prepare a DRC claim, the VSO would never actually
submit the claim. Instead, the servicemember would be responsible for
not only formally submitting their DD-214 after they leave active duty,
but for also completing and submitting the formal paperwork to
establish their claim. This is a non-starter for the VFW and our
clients because we lose all control of our client's claim. Veterans
come to us so that they do not have to worry about these processes and
wonder whether or not they are doing something right. Moreover, after
our pre-discharge claims representatives work with a separating
servicemember who leaves the military, we have lost the ability to help
them without their proactive effort. Our preferred method of doing
business is to take care of all the required claims processes while the
servicemember is still on active duty--especially establishing a claim.
To the VFW, the only benefit to shifting the onus to file onto the
veteran is that, once again, there is no formal work product pending
with VA, implying that claims processing times have improved. To the
VFW, we cannot compromise quality customer service so that VA can
report more favorable adjudication numbers.
Please do not read this as VFW accusing VA of having nefarious
motives in clearing its pending workload. After all, the VA pending
workload has been the subject of heavy scrutiny from VSOs, the public,
and this committee for years. But maybe it is time to have an honest
discussion about this. VA is notorious for unnecessarily drawing out
certain business processes, but not all pending work is because of VA
inaction, such as development for QS claims, and not all pending work
is bad for the veteran, such as the 48-hour review period. As veterans'
advocates, it is our job to properly explain these nuances in the VA
claims process to veterans before the barracks lawyers get a hold of
them and tells them VA is out to get them. We can help do this. In
fact, I did it just this week on a site visit to our pre-discharge
claims site in San Diego. During a Transition Goals, Plans, Success
(TGPS) Capstone briefing, I had the opportunity to speak with a sailor
who was going through the IDES process at Naval Base San Diego. He had
been notified of his VA rating, but still has a few weeks left on
active duty. His question was simple: When do my benefits start? After
a brief explanation of the next steps, he understood why he would not
receive his VA benefits while on active duty, and he understood the
timelines he would experience once he received his discharge paperwork.
After the conversation, he seemed more confident and understanding of
what was happening. To this sailor, the timelines did not matter nearly
as much as the clarity. If we all set reasonable expectations, and
explain the processes behind the timelines, veterans will have a
positive experience. This is what we do as advocates.
Unfortunately, confusion and constant changes only perpetuate
negative perceptions of VA and the programs VA administers. I say this
in our regular meetings with VA: Help us help you. After all, we are
the veterans' community. Many of us have been through this transition.
We understand what our clients are going through. Our personal
experiences, coupled with the training VA requires of us to understand
this highly-regulated process means that we can explain things in a
context that separating servicemembers will understand. We can carry
the water if the focus is veteran-centric.
To the VFW, the time when servicemembers transition off of active
duty is one of the most significant changes they will experience in
their lives. This Congress and the VSO community have dedicated
substantial resources to make sure that we get this right. The VFW
values the role that we are allowed to play in the process through both
VA and DoD, and we are always looking for ways to improve. Our goal is
that we can move forward together to ensure that our transitioning
servicemembers have access to the programs, information, and services
they need for a successful transition out of military life.
Mr. Chairman, this concludes my testimony. I will be happy to
answer any questions you or the Committee members may have.
[all]