Military and Veterans Disability System
Worldwide Deployment of Integrated System Warrants Careful Monitoring Gao ID: GAO-11-633T May 4, 2011This testimony discusses the efforts by the Departments of Defense (DOD) and Veterans Affairs (VA) to integrate their disability evaluation systems. Wounded warriors unable to continue their military service must navigate DOD's and VA's disability evaluation systems to be assessed for eligibility for disability compensation from the two agencies. GAO and others have found problems with these systems, including long delays, duplication in DOD and VA processes, confusion among servicemembers, and distrust of systems regarded as adversarial by servicemembers and veterans. To address these problems, DOD and VA have designed an integrated disability evaluation system (IDES), with the goal of expediting the delivery of VA benefits to servicemembers. After pilot testing the IDES at an increasing number of military treatment facilities (MTF)--from 3 to 27 sites--DOD and VA are in the process of deploying it worldwide. As of March 2011, the IDES has been deployed at 73 MTFs--representing about 66 percent of all military disability evaluation cases--and worldwide deployment is scheduled for completion in September 2011. This testimony summarizes and updates our December 2010 report on the IDES and addresses the following points: (1) the results of DOD and VA's evaluation of their pilot of the IDES, including updated data as of March 2011 from IDES monthly reports, where possible; (2) challenges in implementing the piloted system to date; and (3) DOD and VA's plans to expand the piloted system and whether those plans adequately address potential challenges.
In summary, DOD and VA concluded that, based on their evaluation of the pilot as of February 2010, the pilot had (1) improved servicemember satisfaction relative to the existing "legacy" system and (2) met their established goal of delivering VA benefits to active duty and reserve component servicemembers within 295 and 305 days, respectively, on average. However, 1 year after this evaluation, average case processing times have increased significantly, such that active component servicemembers' cases completed in March 2011 took an average of 394 days to complete--99 days more than the 295-day goal. In our prior work, we identified several implementation challenges that had already contributed to delays in the process. The most significant challenge was insufficient staffing by DOD and VA. Staffing shortages and process delays were particularly severe at two pilot sites we visited where the agencies did not anticipate caseload surges. The single exam posed other challenges that contributed to delays, such as disagreements between DOD and VA medical staff about diagnoses for servicemembers' medical conditions that often required further attention, adding time to the process. Pilot sites also experienced logistical challenges, such as incorporating VA staff at military facilities and housing and managing personnel going through the process. DOD and VA were taking or planning to take steps to address a number of these challenges. For example, to address staffing shortages, VA is developing a contract for additional medical examiners, and DOD and VA are requiring local staff to develop written contingency plans for handling caseload surges. Given increased processing times, the efficacy of these efforts at this time is unclear. We recommended additional steps the agencies could take to address known challenges--such as establishing a comprehensive monitoring plan for identifying problems as they occur in order to take remedial actions as early as possible--with which DOD and VA generally concurred.
GAO-11-633T, Military and Veterans Disability System: Worldwide Deployment of Integrated System Warrants Careful Monitoring
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United States Government Accountability Office:
GAO:
Testimony:
Before the Subcommittee on National Security, Homeland Defense, and
Foreign Operations, Committee on Oversight and Government Reform,
House of Representatives:
For Release on Delivery:
Expected at 9:30 a.m. EDT:
Wednesday, May 4, 2011:
Military and Veterans Disability System:
Worldwide Deployment of Integrated System Warrants Careful Monitoring:
Statement of Daniel Bertoni, Director:
Education, Workforce, and Income Security Issues:
GAO-11-633T:
Chairman Chaffetz, Ranking Member Tierney, and Members of the
Subcommittee:
I am pleased to be here today to comment on the efforts by the
Departments of Defense (DOD) and Veterans Affairs (VA) to integrate
their disability evaluation systems. Wounded warriors unable to
continue their military service must navigate DOD's and VA's
disability evaluation systems to be assessed for eligibility for
disability compensation from the two agencies. GAO and others have
found problems with these systems, including long delays, duplication
in DOD and VA processes, confusion among servicemembers, and distrust
of systems regarded as adversarial by servicemembers and veterans. To
address these problems, DOD and VA have designed an integrated
disability evaluation system (IDES), with the goal of expediting the
delivery of VA benefits to servicemembers. After pilot testing the
IDES at an increasing number of military treatment facilities (MTF)--
from 3 to 27 sites--DOD and VA are in the process of deploying it
worldwide. As of March 2011, the IDES has been deployed at 73 MTFs--
representing about 66 percent of all military disability evaluation
cases--and worldwide deployment is scheduled for completion in
September 2011.
My testimony summarizes and updates our December 2010 report on the
IDES[Footnote 1] and addresses the following points: (1) the results
of DOD and VA's evaluation of their pilot of the IDES, including
updated data as of March 2011 from IDES monthly reports, where
possible; (2) challenges in implementing the piloted system to date;
and (3) DOD and VA's plans to expand the piloted system and whether
those plans adequately address potential challenges. A detailed
explanation of our methodology supporting our prior work (conducted
between November 2009 and December 2010) can be found in our December
2010 report. We updated this performance audit from April to May 2011,
in accordance with generally accepted government auditing standards.
In summary, DOD and VA concluded that, based on their evaluation of
the pilot as of February 2010, the pilot had (1) improved
servicemember satisfaction relative to the existing "legacy" system
and (2) met their established goal of delivering VA benefits to active
duty and reserve component servicemembers within 295 and 305 days,
respectively, on average. However, 1 year after this evaluation,
average case processing times have increased significantly, such that
active component servicemembers' cases completed in March 2011 took an
average of 394 days to complete--99 days more than the 295-day goal.
In our prior work, we identified several implementation challenges
that had already contributed to delays in the process. The most
significant challenge was insufficient staffing by DOD and VA.
Staffing shortages and process delays were particularly severe at two
pilot sites we visited where the agencies did not anticipate caseload
surges. The single exam posed other challenges that contributed to
delays, such as disagreements between DOD and VA medical staff about
diagnoses for servicemembers' medical conditions that often required
further attention, adding time to the process. Pilot sites also
experienced logistical challenges, such as incorporating VA staff at
military facilities and housing and managing personnel going through
the process. DOD and VA were taking or planning to take steps to
address a number of these challenges. For example, to address staffing
shortages, VA is developing a contract for additional medical
examiners, and DOD and VA are requiring local staff to develop written
contingency plans for handling caseload surges. Given increased
processing times, the efficacy of these efforts at this time is
unclear. We recommended additional steps the agencies could take to
address known challenges--such as establishing a comprehensive
monitoring plan for identifying problems as they occur in order to
take remedial actions as early as possible--with which DOD and VA
generally concurred.
Background:
Under the existing, or "legacy" system, the military's disability
evaluation process begins at a military treatment facility when a
physician identifies a condition that may interfere with a
servicemember's ability to perform his or her duties. On the basis of
medical examinations and the servicemember's medical records, a
medical evaluation board (MEB) identifies and documents any conditions
that may limit a servicemember's ability to serve in the military. The
servicemember's case is then evaluated by a physical evaluation board
(PEB) to make a determination of fitness or unfitness for duty. If the
servicemember is found to be unfit due to medical conditions incurred
in the line of duty, the PEB assigns the servicemember a combined
percentage rating for those unfit conditions, and the servicemember is
discharged. Depending on the overall disability rating and number of
years of active duty or equivalent service, the servicemember found
unfit with compensable conditions is entitled to either monthly
disability retirement benefits or lump sum disability severance pay.
In addition to receiving disability benefits from DOD, veterans with
service-connected disabilities may receive compensation from VA for
lost earnings capacity. VA's disability compensation claims process
starts when a veteran submits a claim listing the medical conditions
that he or she believes are service-connected. In contrast to DOD's
disability evaluation system, which evaluates only medical conditions
affecting servicemembers' fitness for duty, VA evaluates all medical
conditions claimed by the veteran, whether or not they were previously
evaluated in DOD's disability evaluation process. For each claimed
condition, VA must determine if there is credible evidence to support
the veteran's contention of a service connection. Such evidence may
include the veteran's military service records and treatment records
from VA medical facilities and private medical service providers.
Also, if necessary for reaching a decision on a claim, VA arranges for
the veteran to receive a medical examination. Medical examiners are
clinicians (including physicians, nurse practitioners, or physician
assistants) certified to perform the exams under VA's Compensation and
Pension program. Once a claim has all of the necessary evidence, a VA
rating specialist determines whether the claimant is eligible for
benefits. If so, the rating specialist assigns a percentage rating. If
VA finds that a veteran has one or more service-connected disabilities
with a combined rating of at least 10 percent, the agency will pay
monthly compensation.
In November 2007, DOD and VA began piloting the IDES. The IDES merges
DOD and VA processes, so that servicemembers begin their VA disability
claim while they undergo their DOD disability evaluation, rather than
sequentially, making it possible for them to receive VA disability
benefits shortly after leaving military service. Specifically, the
IDES:
* Merges DOD and VA's separate exam processes into a single exam
process conducted to VA standards. This single exam (which may involve
more than one medical examination, for example, by different
specialists), in conjunction with the servicemembers' medical records,
is used by military service PEBs to make a determination of
servicemembers' fitness for continued military service, and by VA as
evidence of service-connected disabilities. The exam may be performed
by medical staff working for VA, DOD, or a private provider contracted
with either agency.
* Consolidates DOD and VA's separate rating phases into one VA rating
phase. If the PEB has determined that a servicemember is unfit for
duty, VA rating specialists prepare two ratings--one for the
conditions that DOD determined made a servicemember unfit for duty,
which DOD uses to provide military disability benefits, and the other
for all service-connected disabilities, which VA uses to determine VA
disability benefits.
* Provides VA case managers to perform outreach and nonclinical case
management and explain VA results and processes to servicemembers.
Pilot Evaluation Results Were Promising, but Degree of Improvement was
Unknown, and Timeliness Has Since Worsened:
In August 2010, DOD and VA officials issued an interim report to
Congress summarizing the results of their evaluation of the IDES pilot
as of early 2010 and indicating overall positive results. In that
report, the agencies concluded that, as of February 2010,
servicemembers who went through the IDES pilot were more satisfied
than those who went through the legacy system, and that the IDES
process met the agencies' goals of delivering VA benefits to active
duty servicemembers within 295 days and to reserve component
servicemembers within 305 days. Furthermore, they concluded that the
IDES pilot has achieved a faster processing time than the legacy
system, which they estimated to be 540 days.
Although DOD and VA's evaluation results indicated promise for the
IDES, the extent to which they represented an improvement over the
legacy system could not be known because of limitations in the legacy
data. DOD and VA's estimate of 540 days for the legacy system was
based on a small, nonrepresentative sample of cases. Officials planned
to use a broader sample of legacy cases to compare against pilot cases
with respect to processing times and appeal rates; however
inconsistencies in how military services tracked information and
missing VA information (i.e., on the date VA benefits were delivered)
for legacy cases, precluded such comparisons.
While our review of DOD and VA's data and reports generally confirmed
DOD and VA's findings as of early 2010, we found that not all of the
service branches were achieving the same results, case processing
times increased between February and August 2010, and other agency
goals are not being met. Since our December report, processing times
have worsened further and the agencies have adjusted some goals
downward.
* Servicemember satisfaction: Our reviews of the survey data as of
early 2010[Footnote 2] indicated that, on average, servicemembers in
the IDES pilot had higher satisfaction levels than those who went
through the legacy process. However, Air Force members--who
represented a small proportion (7 percent) of pilot cases--were less
satisfied. Currently, DOD and VA have an 80-percent IDES satisfaction
goal, which has not been met. For example, 67 percent of
servicemembers surveyed in March 2011 were satisfied with the IDES.
Satisfaction by service ranged from 54 percent for the Marine Corps to
72 percent for the Army.[Footnote 3]
* Average case processing times: Although the agencies were generally
meeting their 295-day and 305-day timeliness goals through February
2010, the average case processing time for active duty servicemembers
increased from 274 to 296 days between February and August
2010.[Footnote 4] Among the military service branches, only the Army
was meeting the agencies' timeliness goals as of August, while average
processing times for each of the other services exceeded 330 days.
Since August 2010, timeliness has worsened significantly. For example,
active component cases completed in March 2011 took an average of 394
days--99 days over the 295-day target. By service, averages ranged
from 367 days for the Army to 455 days for the Marine Corps.
Meanwhile, Reserve cases took an average of 383 days, 78 days more
than the 305-day target, while Guard cases took an average of 354
days, 49 days more than the target.[Footnote 5]
* Goals to process 80 percent of cases in targeted time frames: DOD
and VA had indicated in their planning documents that they had goals
to deliver VA benefits to 80 percent of servicemembers within the 295-
day (active component) and 305-day (reserve component) targets. For
both active and reserve component cases at the time of our review,
about 60 percent were meeting the targeted time frames. DOD and VA
have since lowered their goals for cases completed on time, from 80
percent to 50 percent. Based on monthly data for 6 months through
March 2011, the new, lower goal was not met during any month for
active component cases. For completed Reserve cases, the lower goal
was met during one of the 6 months and for Guard cases, it was met in
2 months. The strongest performance was in October 2010 when 63
percent of Reserve cases were processed within the 305-day target.
Pilot Sites Experienced Several Challenges:
Based on our prior work, we found that--as DOD and VA tested the IDES
at different facilities and added cases to the pilot--they encountered
several challenges that led to delays in certain phases of the process.
* Staffing: Most significantly, most of the sites we visited reported
experiencing staffing shortages and related delays to some extent, in
part due to workloads exceeding the agencies' initial estimates. The
IDES involves several different types of staff across several
different DOD and VA offices, some of which have specific caseload
ratios set by the agencies, and we learned about insufficient staff in
many key positions.[Footnote 6] With regard to VA positions, officials
cited shortages in examiners for the single exam, rating staff, and
case managers. With regard to DOD positions, officials cited shortages
of physicians who serve on the MEBs, PEB adjudicators, and DOD case
managers. In addition to shortages cited at pilot sites, DOD data
indicated that 19 of the 27 pilot sites did not meet DOD's caseload
target of 30 cases per manager.[Footnote 7] Local DOD and VA officials
attributed staffing shortages to higher than anticipated caseloads and
difficulty finding qualified staff, particularly physicians, in rural
areas. These staffing shortages contributed to delays in the IDES
process.
Two of the sites we visited--Fort Carson and Fort Stewart--were
particularly challenged to provide staff in response to surges in
caseload that occurred when Army units were preparing to deploy to
combat zones. Through the Army's predeployment medical assessment
process, large numbers of servicemembers were determined to be unable
to deploy due to a medical condition and were referred to the IDES
within a short period of time, overwhelming the staff. These two sites
were unable to quickly increase staffing levels, particularly of
examiners. As a result, at Fort Carson, it took 140 days on average to
complete the single exam for active duty servicemembers, as of August
2010--much longer than the agencies' goal to complete the exams in 45
days. More recently, Fort Carson was still struggling to meet goals,
as of March 2011. For example, about half of Fort Carson's active
component cases (558 of 1033 cases) were in the MEB phase, and the
average number of days spent in the MEB phase by active component
cases completed in March 2011 was 197 days, compared to a goal of 35
days.
* Exam summaries: Issues related to the completeness and clarity of
single exam summaries were an additional cause of delays in the VA
rating phase of the IDES process. Officials from VA rating offices
said that some exam summaries did not contain information necessary to
determine a rating. As a result, VA rating office staff must ask the
examiner to clarify these summaries and, in some cases, redo the exam.
VA officials attributed the problems with exam summaries to several
factors, including the complexity of IDES pilot cases, the volume of
exams, and examiners not receiving records of servicemembers' medical
history in time. The extent to which insufficient exam summaries
caused delays in the IDES process is unknown because DOD and VA's case
tracking system for the IDES does not track whether an exam summary
has to be returned to the examiner or whether it has been resolved.
* Medical diagnoses: While the single exam in the IDES eliminates
duplicative exams performed by DOD and VA in the legacy system, it
raises the potential for there to be disagreements about diagnoses of
servicemembers' conditions. For example, officials at Army pilot sites
informed us about cases in which a DOD physician had treated members
for mental disorders, such as major depression. However, when the
members went to see the VA examiners for their single exam, the
examiners diagnosed them with posttraumatic stress disorder (PTSD).
Officials told us that attempting to resolve such differences added
time to the process and sometimes led to disagreements between DOD's
PEBs and VA's rating offices about what the rating should be for
purposes of determining DOD disability benefits. Although the Army
developed guidance to help resolve diagnostic differences, other
services have not.[Footnote 8]
Moreover, PEB officials we spoke with noted that there is no guidance
on how disagreements about servicemembers' ratings between DOD and VA
should be resolved beyond the PEBs informally requesting that the VA
rating office reconsider the case. While DOD and VA officials cited
several potential causes for diagnostic disagreements, the number of
cases with disagreements about diagnoses and the extent to which they
have increased processing time are unknown because the agencies' case
tracking system does not track when a case has had such disagreements.
[Footnote 9]
* Logistical challenges integrating VA staff at military treatment
facilities: DOD and VA officials at some pilot sites we visited said
that they experienced logistical challenges integrating VA staff at
the military facilities. At a few sites, it took time for VA staff to
receive common access cards needed to access the military facilities
and to use the facilities' computer systems, and for VA physicians to
be credentialed. DOD and VA staff also noted several difficulties
using the agencies' multiple information technology (IT) systems to
process cases, including redundant data entry and a lack of
integration between systems.
* Housing and other challenges posed by extended time in the military
disability evaluation process: Although many DOD and VA officials we
interviewed at central offices and pilot sites felt that the IDES
process expedited the delivery of VA benefits to servicemembers,
several also indicated that it may increase the amount of time
servicemembers are in the military's disability evaluation process.
Therefore, some DOD officials noted that servicemembers must be cared
for, managed, and housed for a longer period. The military services
may move some servicemembers to temporary medical units or to special
medical units such as Warrior Transition Units in the Army or Wounded
Warrior Regiments in the Marine Corps, but at a few pilot sites we
visited, these units were either full or members in the IDES did not
meet their admission criteria. In addition, officials at two sites
said that members who are not gainfully employed by their units and
left idle are more likely to be discharged due to misconduct and
forfeit their disability benefits. However, DOD officials also noted
that servicemembers benefit from continuing to receive their salaries
and benefits while their case undergoes scrutiny by two agencies,
though some also acknowledged that these additional salaries and
benefits create costs for DOD.
Deployment Plans Address Many, but not All, Challenges:
DOD and VA are deploying the IDES to military facilities worldwide on
an ambitious timetable--expecting deployment to be completed at a
total of about 140 sites by the end of fiscal year 2011. As of March
2011, the IDES was operating at 73 sites, covering about 66 percent of
all military disability evaluation cases.
In preparing for IDES expansion militarywide, DOD and VA had many
efforts under way to address challenges experienced at the 27 pilot
sites. For example, the agencies completed a significant revision of
their site assessment matrix--a checklist used by local DOD and VA
officials to ascertain their readiness to begin the pilot--to address
areas where prior IDES sites had experienced challenges. In addition,
local senior-level DOD and VA officials will be expected to sign the
site assessment matrix to certify that a site is ready for IDES
implementation. This differs from the pilot phase where, according to
DOD and VA officials, some sites implemented the IDES without having
been fully prepared.
Through the new site assessment matrix and other initiatives, DOD and
VA planned to address several of the challenges identified in the
pilot phase.
* Ensuring sufficient staff: With regard to VA staff, VA planned to
increase the number of examiners by awarding a new contract through
which sites can acquire additional examiners. To increase rating
staff, VA filled vacant rating specialist positions and anticipates
hiring a small number of additional staff. With regard to DOD staff,
Air Force and Navy officials told us they added adjudicators for their
PEBs or planned to do so. Both DOD and VA indicated they plan to
increase their numbers of case managers. Meanwhile, sites are being
asked in the assessment matrix to provide longer and more detailed
histories of their caseloads, as opposed to the 1-year history that
DOD and VA had based their staffing decisions on during the pilot
phase. The matrix also asks sites to anticipate any surges in
caseloads and to provide a written contingency plan for dealing with
them.
* Ensuring the sufficiency of single exams: VA has been revising its
exam templates to better ensure that examiners include the information
needed for a VA disability rating decision and to enable them to
complete their exam reports in less time. VA is also examining whether
it can add capabilities to the IDES case tracking system that would
enable staff to identify where problems with exams have occurred and
track the progress of their resolution.
* Ensuring adequate logistics at IDES sites: The site assessment
matrix asks sites whether they have the logistical arrangements needed
to implement the IDES. In terms of information technology, DOD and VA
were developing a general memorandum of agreement intended to enable
DOD and VA staff access to each other's IT systems. DOD officials also
said that they are developing two new IT solutions--one intended to
help military treatment facilities better manage their cases, another
intended to reduce multiple data entry.
However, in some areas, DOD and VA's efforts to prepare for IDES
expansion did not fully address some challenges or are not yet
complete. For these areas, we recommended additional action that the
agencies could take, with which the agencies generally concurred.
* Ensuring sufficient DOD MEB physician staffing: DOD does not yet
have strategies or plans to address potential shortages of physicians
to serve on MEBs. For example, the site assessment matrix does not
include a question about the sufficiency of military providers to
handle expected numbers of MEB cases at the site, or ask sites to
identify strategies for ensuring sufficient MEB physicians if there is
a caseload surge or staff turnover. We recommended that, prior to
implementing IDES at MTFs, DOD direct military services to conduct
thorough assessments of the adequacy of military physician staffing
for completing MEB determinations and develop contingency plans to
address potential shortfalls, e.g. due to staff turnover or caseload
surges.
* Ensuring sufficient housing and organizational oversight for IDES
participants: Although the site assessment matrix asks sites whether
they will have sufficient temporary housing available for
servicemembers going through the IDES, the matrix requires only a yes
or no response and does not ensure that sites will have conducted a
thorough review of their housing capacity. In addition, the site
assessment matrix does not address plans for ensuring that IDES
participants are gainfully employed or sufficiently supported by their
organizational units. We recommended that prior to implementing the
IDES at MTFs, DOD ensure thorough assessments are conducted on the
availability of housing for servicemembers and on the capacity of
organizational units to absorb servicemembers undergoing the
disability evaluation; alternative housing options are identified when
sites lack adequate capacity; and plans are in place for ensuring that
servicemembers are appropriately and constructively engaged.
* Addressing differences in diagnoses: According to agency officials,
DOD is currently developing guidance on how staff should address
differences in diagnoses. However, since the new guidance and
procedures are still being developed, we cannot determine whether they
will aid in resolving discrepancies or disagreements. Significantly,
DOD and VA do not have a mechanism for tracking when and where
disagreements about diagnoses and ratings occur and, consequently, may
not be able to determine whether the guidance sufficiently addresses
the discrepancies. Therefore, we recommended that DOD and VA conduct a
study to assess the prevalence and causes of such disagreements and
establish a mechanism to continuously monitor diagnostic
disagreements. VA has since indicated it plans to conduct such a study
and make a determination by July 2011 regarding what, if any,
mechanisms are needed.
Further, despite regular reporting of data on caseloads, processing
times, and servicemember satisfaction, and preparation of an annual
report on challenges in the IDES, we determined that DOD and VA did
not have a systemwide monitoring mechanism to help ensure that steps
they took to address challenges are sufficient and to identify
problems in a more timely basis. For example, they did not collect
data centrally on staffing levels at each site relative to caseload.
As a result, DOD and VA may be delayed in taking corrective action
since it takes time to assess what types of staff are needed at a site
and to hire or reassign staff. DOD and VA also lacked mechanisms or
forums for systematically sharing information on challenges, as well
as best practices between and among sites. For example, DOD and VA
have not established a process for local sites to systematically
report challenges to DOD and VA management and for lessons learned to
be systematically shared systemwide. During the pilot phase, VA
surveyed pilot sites on a monthly basis about challenges they faced in
completing single exams. Such a practice has the potential to provide
useful feedback if extended to other IDES challenges.
To identify challenges as they arise in all DOD and VA facilities and
offices involved in the IDES and thereby enable early remedial action,
we recommended that DOD and VA develop a systemwide monitoring
mechanism. This system could include continuous collection and
analysis of data on DOD and VA staffing levels, sufficiency of exam
summaries, and diagnostic disagreements; monitoring of available data
on caseloads and case processing time by individual VA rating office
and PEB; and a formal mechanism for agency officials at local DOD and
VA facilities to communicate challenges and best practices to DOD and
VA headquarters. VA noted several steps it plans to take to improve
its monitoring of IDES workloads, site performance and challenges--
some targeted to be implemented by July 2011--which we have not
reviewed.
Concluding Observations:
By merging two duplicative disability evaluation systems, the IDES has
shown promise for expediting the delivery of VA benefits to
servicemembers leaving the military due to a disability. However, we
identified significant challenges at pilot sites that require careful
management attention and oversight. We noted a number of steps that
DOD and VA were undertaking or planned to undertake that may mitigate
these challenges. However, the agencies' deployment schedule is
ambitious in light of substantial management challenges and additional
evidence of deteriorating case processing times. As such, it is
unclear whether these steps will be sufficiently timely or effective
to support militarywide deployment. Deployment time frame
notwithstanding, we continue to believe that the success or failure of
the IDES will depend on DOD and VA's ability to quickly and
effectively address resource needs and resolve challenges as they
arise, not only at the initiation of the transition to IDES, but also
on an ongoing, long-term basis. We continue to believe that DOD and VA
cannot achieve this without a robust mechanism for routinely
monitoring staffing and other risk factors.
Chairman Chaffetz and Ranking Member Tierney, this concludes my
prepared statement. I would be pleased to respond to any questions
that you or other Members of the Subcommittee may have at this time.
GAO Contact and Staff Acknowledgment:
For further information about this testimony, please contact Daniel
Bertoni at (202) 512-7215 or bertonid@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this testimony. In addition to the individual named
above, key contributors to this testimony include Michele Grgich, Greg
Whitney, and Daniel Concepcion. Key advisors included Bonnie Anderson,
Mark Bird, Sheila McCoy, Patricia Owens, Roger Thomas, Walter Vance,
and Randall Williamson.
[End of section]
Related GAO Products:
Military and Veterans Disability System: Pilot Has Achieved Some
Goals, but Further Planning and Monitoring Needed. [hyperlink,
http://www.gao.gov/products/GAO-11-69]. Washington, D.C.: December 6,
2010.
Military and Veterans Disability System: Preliminary Observations on
Evaluation and Planned Expansion of DOD/VA Pilot. [hyperlink,
http://www.gao.gov/products/GAO-11-191T]. Washington, D.C.: November
18, 2010.
Veterans' Disability Benefits: Further Evaluation of Ongoing
Initiatives Could Help Identify Effective Approaches for Improving
Claims Processing. [hyperlink,
http://www.gao.gov/products/GAO-10-213]. Washington, D.C.: January 29,
2010.
Recovering Servicemembers: DOD and VA Have Jointly Developed the
Majority of Required Policies but Challenges Remain. [hyperlink,
http://www.gao.gov/products/GAO-09-728]. Washington, D.C.: July 8,
2009.
Recovering Servicemembers: DOD and VA Have Made Progress to Jointly
Develop Required Policies but Additional Challenges Remain.
[hyperlink, http://www.gao.gov/products/GAO-09-540T]. Washington,
D.C.: April 29, 2009.
Military Disability System: Increased Supports for Servicemembers and
Better Pilot Planning Could Improve the Disability Evaluation Process.
[hyperlink, http://www.gao.gov/products/GAO-08-1137]. Washington,
D.C.: September 24, 2008.
DOD and VA: Preliminary Observations on Efforts to Improve Care
Management and Disability Evaluations for Servicemembers. [hyperlink,
http://www.gao.gov/products/GAO-08-514T]. Washington, D.C.: February
27, 2008.
DOD and VA: Preliminary Observations on Efforts to Improve Health Care
and Disability Evaluations for Returning Servicemembers. [hyperlink,
http://www.gao.gov/products/GAO-07-1256T] Washington, D.C.: September
26, 2007.
Military Disability System: Improved Oversight Needed to Ensure
Consistent and Timely Outcomes for Reserve and Active Duty Service
Members. [hyperlink, http://www.gao.gov/products/GAO-06-362].
Washington, D.C.: March 31, 2006.
[End of section]
Footnotes:
[1] GAO, Military and Veterans Disability System: Pilot Has Achieved
Some Goals, but Further Planning and Monitoring Needed, [hyperlink,
http://www.gao.gov/products/GAO-11-69] (Washington, D.C.: Dec. 6,
2010). See also GAO, Military and Veterans Disability System:
Preliminary Observations on Evaluation and Planned Expansion of DOD/VA
Pilot, [hyperlink, http://www.gao.gov/products/GAO-11-191T]
(Washington, D.C.: Nov. 18, 2010).
[2] We reviewed the agencies' survey methodology and generally found
their survey design and conclusions to be sound.
[3] IDES monthly reports present participant satisfaction percentages
as averages of three surveys during the IDES --MEB phase, PEB phase,
and Transition phase (completion of PEB phase through discharge from
service). Previous reports, which were weekly, provided separate data
for each phase. Thus, we were unable to determine the extent to which
satisfaction has improved or declined.
[4] We reviewed the reliability of the case data upon which the
agencies based their analyses and generally found these data to be
sufficiently reliable for purposes of these analyses. Our data
reliability assessment included interviews regarding internal
controls, electronic testing, and a trace-to-file process, where we
matched a small number of randomly sampled case file dates against the
dates that had been entered into the Veterans Tracking Application,
the case tracking system for the IDES. For the trace-to-file process,
the overall accuracy rate was 84 percent, and all but one date was 70
percent accurate or better and deemed sufficiently reliable for
reporting purposes.
[5] The IDES monthly report now separates "Guard" (Army and Air Force
Guard) cases from other reserve component cases for the purpose of
reporting case processing times and do not provide an overall reserve
component average processing time.
[6] For the IDES pilot, the agencies have set targets for both DOD and
VA case managers to handle no more than 30 cases at a time. However,
DOD's guidance for the general disability evaluation system sets the
target at a maximum of 20 cases per case manager, and agency documents
related to planning for IDES expansion indicate that DOD is striving
for a 1:20 caseload target for DOD case managers in the IDES. The Army
has established a caseload target for MEB physicians of 120
servicemembers per physician. The Navy and Air Force have not
established caseload targets for their physicians; their MEB
determinations are prepared by physicians who perform other
responsibilities, such as clinical treatment or supervision.
[7] Data were not available nationally to determine the extent to
which sites are meeting the Army's target of 120 servicemembers per
MEB physician or VA's target of 30 cases per VA case manager.
[8] To address such processing delays, the Army issued guidance in
February 2010 stating that MEB physicians should review all of the
medical records (including the results of the single exam) and
determine whether to revise their diagnoses. If after doing so, the
MEB physician maintains that his or her original diagnosis is
accurate, he or she should write a memorandum summarizing the basis of
the decision, and the PEB should accept the MEB's diagnosis.
[9] DOD and VA officials attributed disagreements about diagnoses to
several factors, including the agencies identifying conditions for
different purposes in the disability evaluation system, servicemembers
being more willing to disclose all of their medical conditions to VA
than to DOD since VA can compensate for all of the conditions, and VA
examiners not receiving or not reviewing the servicemembers' medical
records prior to the exam, making them unaware of the conditions for
which the members had been previously diagnosed and treated.
[End of section]
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