Apr112013
Hearing Transcript on Examination of the U.S. Department of Veterans Affairs Benefits Delivery at Discharge and Quick Start Programs.
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EXAMINATION OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS BENEFITS DELIVERY AT DISCHARGE AND QUICK START PROGRAMS
HEARING BEFORE THE SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION FEBRUARY 24, 2010 SERIAL No. 111-63 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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COMMITTEE ON VETERANS' AFFAIRS |
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
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 official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
February 24, 2010
Examination of the U.S. Department of Veterans Affairs Benefits Delivery at Discharge and Quick Start Programs
OPENING STATEMENTS
Chairman John J. Hall
Prepared statement of Chairman Hall
Hon. Doug Lamborn, Ranking Republican Member
Prepared statement of Congressman Lamborn
WITNESSES
U.S. Government Accountability Office, Daniel Bertoni, Director, Education, Workforce, and Income Security Issues
Prepared statement of Mr. Bertoni
U.S. Department of Defense, Hon. Noel C. Koch, Deputy Under Secretary of Defense (Wounded Warrior Care and Transition Policy)
Prepared statement of Mr. Koch
U.S. Department of Veterans Affairs, Diana Rubens, Associate Deputy Under Secretary for Field Operations, Veterans Benefits Administration
Prepared statement of Ms. Rubens
American Veterans (AMVETS), Raymond C. Kelley, National Legislative Director
Prepared statement of Mr. Kelley
Disabled American Veterans, John L. Wilson, Assistant National Legislative Director
Prepared statement of Mr. Wilson
Iraq and Afghanistan Veterans of America, Thomas Tarantino, Legislative Associate
Prepared statement of Mr. Tarantino
Veterans of Foreign Wars of the United States, Gerald T. Manar, Deputy Director, National Veterans Service
Prepared statement of Mr. Manar
SUBMISSION FOR THE RECORD
American Federation of Government Employees, AFL-CIO, and AFGE National Veterans Affairs Counsel, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
EXAMINATION OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS BENEFITS DELIVERY AT DISCHARGE AND QUICK START PROGRAMS
Thursday, February 24, 2010
U. S. House of Representatives,
Subcommittee on Disability Assistance and Memorial Affairs,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:03 p.m., in Room 334, Cannon House Office Building, Hon. John J. Hall [Chairman of the Subcommittee] presiding.
Present: Representatives Hall, Rodriguez, and Lamborn.
Mr. HALL. Welcome to the Subcommittee on Disability Assistance and Memorial Affairs Subcommittee hearing on Examination of the U.S. Department of Veterans Affairs (VA) Benefits Delivery at Discharge (BDD) and Quick Start Programs.
Could I ask everyone, please, to rise for the Pledge of Allegiance?
[Pledge of Allegiance.]
Mr. HALL. Thank you, all. Ladies and gentlemen, we are here today to examine the Benefits Delivery at Discharge or BDD and Quick Start programs, two components of the pre-discharge program, which were established by the U.S. Departments of Defense (DoD) and Veterans Affairs to streamline servicemembers’ transition from active duty to veteran status.
And because of the scheduling problems that we have here in the House with multiple Committee meetings, I am going to recognize Ranking Member Lamborn for his opening statement, first.
Mr. Lamborn?
OPENING STATEMENT OF HON. DOUG LAMBORN
Mr. LAMBORN. Well, thank you, Mr. Chairman. I appreciate your flexibility in doing this. Normally, I am very happy to go second here. But I do have to be at another Subcommittee where I am also the Ranking Member, so it is one of those times when I wish I could be in two places at once.
I also welcome everyone today to this hearing on the Benefits Delivery at Discharge and Quick Start Programs. These programs are focused on the concept of providing a seamless transition from military service to civilian life.
I, along with Chairman Hall, my fellow Subcommittee Members, and many of you here are long-time advocates for creating a seamless transition. Therefore, I am sure we can all recognize the inherent value of beginning the VA claims process while service medical records are readily available and proof of service-connection is easily established.
Allowing veterans to file VA compensation claims prior to separation from active duty is simply a logical approach. BDD is more efficient than the traditional VA claims process and it eliminates many problems that are created by the time gap that often exists between discharge and application for benefits.
Among the requirements to establish eligibility for VA compensation, veterans must be able to show that a condition was incurred during service and that there is a continuity of treatment between that incurrence and the current condition for which they are filing.
Obviously with BDD there is no time gap, so it alleviates the need to show continuity of treatment. This saves both the veteran and the VA a lot of time and effort obtaining private treatment records. One can imagine that such efforts can become quite extensive for claims filed several years subsequent to service.
In 2008, full Committee Ranking Member Steve Buyer requested a U.S. Government Accountability Office (GAO) assessment of the BDD program. GAO’s findings confirmed that allowing claims to be filed prior to discharge is more efficient than the traditional VA claims process.
While I am optimistic about the overall assessment of the program, I encourage VA to make every effort to improve the program and increase access to BDD sites. I believe that processing as many claims as possible in this manner will have a positive impact throughout the entire system.
Thank you and I yield back. And once again, thank you, Mr. Chairman.
[The prepared statement of Congressman Lamborn appears in the Appendix.]
OPENING STATEMENT OF CHAIRMAN HALL
Mr. HALL. Thank you, Mr. Lamborn.
By way of background, any member of the Armed Forces who has seen active duty, including those in the Guard and Reserve, are eligible to apply for VA disability benefits prior to leaving military service through the BDD or Quick Start pre-discharge programs. During the application process, servicemembers can get help in completing forms and preparing other required documentation from VA personnel located at their bases.
Additionally, this pre-discharge program combines, both, the health exam required by DoD upon exiting the military and the VA disabilities assessment exam into one single exam. Once a BDD or Quick Start claim is approved, veterans may begin receiving benefits within 2 or 3 months, instead of the 6 to 7 months it would typically take if they had applied after discharge under the traditional disability claims process.
Participation in the BDD program is open to servicemembers who are within 60 to 180 days of being released from active duty and who are able to complete their scheduled VA medical examinations prior to leaving their points of separation. The Quick Start program is available to servicemembers within 1 to 59 days of separation from service or servicemembers who do not meet the BDD criteria requiring availability for all examinations prior to discharge.
The BDD program started as a pilot program in 1995 at three Army bases and three VA regional offices (ROs). In 1998, VA and DoD fully rolled out the BDD program.
Last Congress, my friend Congressman Peter Welch of Vermont introduced H.R. 2259, legislation to expand the BDD program to members of the National Guard and Reserves, which was incorporated in the National Defense Authorization Act for 2008, Public Law 110-181. This statute ensures that Guardsmen as well as Reservists can participate in the VA/DoD pre-discharge program.
In the last 15 years, over 170,000 servicemembers have availed themselves of the BDD and Quick Start process. The programs have expanded from 3 military bases to more than 153 locations in the United States, Germany, and South Korea.
According to VA, the majority of pre-discharge claims, 46,856 claims to be exact, were processed in 2009 in a paperless environment, with an average processing time of 95.5 days. It is VA’s stated goal to process all compensation and pension claims in a paperless environment eventually, and the Subcommittee is committed to helping VA achieve this.
I, along with Congressman Rodriquez, and other Members of this Committee and Congress, requested that GAO prepare a report to assess the effectiveness of these programs, Quick Start and BDD, and I look forward to hearing from the GAO about its report, about its recommendations, how they have been implemented, and what, if any, impact they have had upon the pre-discharge program.
We also look forward to feedback from veteran service organizations as well as the VA and DoD on what, if any, resources are needed that we in Congress can provide to fully realize the full potential of these two programs.
The examination of VA and DoD’s pre-discharge program follows up our last hearing concerning the implementation of the Veterans’ Benefits Improvement Act of 2008, which was codified in Public Law 110-389. That law paved the way for a number of initiatives also targeting the VA claims backlog, which is an issue that concerns us all. It is my hope that the BDD and Quick Start programs that we are considering today, coupled with the electronic claims system and other business process transformation efforts in Public Law 110-389, which are currently underway at VA, will together significantly transform the VA claims processing system so that someday, someday soon we may play Taps for the VA compensation and pension (C&P) backlog.
I would like to remind our panelists that the complete written statements you have submitted are being made a part of the hearing record. Please limit your remarks to 5 minutes so that we can have sufficient time for questions and avoid the dreaded buzzer for the votes that will be called at some unknown time.
Our first panel consists of David Bertoni, Director of Education, Workforce, and Income Security Issues with the Government Accountability Office.
Mr. Bertoni, welcome. You are now recognized for 5 minutes.
[The prepared statement of Chairman Hall appears in the Appendix.]
STATEMENT OF DANIEL BERTONI, DIRECTOR, EDUCATION WORKFORCE, AND INCOME SECURITY ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE
Mr. BERTONI. Thank you very much. Good afternoon, Mr. Chairman. I am pleased to be here to discuss the Benefits, Delivery at Discharge and Quick Start programs which represent a collaborative effort by the Departments of Veterans Affairs and Defense to expedite the disability claims process for servicemembers. These programs streamline access to VA disability benefits by allowing many servicemembers to file and initiate claims development prior to discharge, thus shortening the time it takes to receive benefits. Last year over 51,000 claims were filed through both programs.
My statement today draws on our prior work and focuses on two areas, an assessment of VA’s overall management of the BDD program and steps VA and DoD have taken to expand access to both BDD and Quick Start.
In summary, although VA awards benefits more quickly under BDD than through the traditional claims process, gaps in program management and accountability remain. We found that VA’s BDD timeliness measure excludes time spent and claims development prior to a servicemember’s discharge. Thus, VA has limited information on a frequently problematic phase of the process.
Conversely, claims development activities are included in VA’s timeliness measure for traditional claims. Personnel, 12 of the 14 intake sites we reviewed, noted significant claims development challenges, including difficulty in scheduling and completing exams and gathering additional medical evidence. We continue to believe that tracking the time and resources spent on claims development could help VA mitigate any barriers to program efficiency and servicemember participation.
We also found that VA implemented two key initiatives, consolidation of BDD claims processing activities in two locations and paperless claims processing, without fully evaluating their effectiveness over prior practices.
While we support VA’s efforts to achieve greater efficiencies, we continue to believe ongoing evaluation is necessary to optimize results for these initiatives. And finally, we identified gaps of VA’s monitoring activities for this program. At the time of our review, VA reviewed BDD operations in only 16 of 40 Regional Offices and reviewers rarely examined these cases to ensure they were properly developed and they lacked protocols to do so. Per our recommendation, VA has since taken steps to increase the scope and quality of site visits.
In regard to improving servicemember access to expedited services, VA and DoD have taken a number of actions, most notably establishing the Quick Start Program for servicemembers, such as National Guard and Reservists who are generally unable to complete the BDD application and medical exams prior to discharge.
We have recommended and VA has begun to collect additional data to assess whether Quick Start is meeting servicemember needs. However, as with BDD, VA has no plans to track the time spent developing these claims.
VA and DoD have also coordinated to increase program awareness of BDD and Quick Start through VA benefit briefings and DoD has established an 85 percent participation goal for those briefings. However, our work shows that DoD needs better metrics for capturing servicemember participation, as well as a service delivery plan for meeting its targeted goal.
Despite these efforts, during our site visits, we identified numerous implementation challenges associated with local DoD and VA agreements intended to prevent redundancies and servicemember inconvenience in obtaining required medical exams. These challenges were often due to turnover on base command, communication breakdowns and resource constraints, sometimes resulting in multiple unnecessary medical exams and delayed claims development.
However, in response to our findings and recommendation, VA and DoD have begun to explore local office best practices to address challenges to the cooperative exam process.
And in closing, I want to strongly emphasize that at a time when so many servicemembers are being discharged with injuries and the current conflicts in Iraq and Afghanistan, opportunities exist to improve, both, the BDD and Quick Start programs as long as both VA and DoD maintain a sharp focus on accountability and follow through on recommended actions.
Mr. Chairman, this concludes my remarks. I am happy to answer any questions you may have. I am within my time.
[The prepared statement of Mr. Bertoni appears in the Appendix.]
Mr. HALL. Good job setting an example for all witnesses to come.
Mr. BERTONI. I've set a high bar.
Mr. HALL. And maybe for the Chairman himself.
Thank you, Mr. Bertoni. You point out that VA has established only one performance measure for BDD and Quick Start programs, which is tracking participation in the programs. VA does not track for these claims, as it does for general compensation claims, how much time a veteran has to wait for a final decision, the average days that it takes to complete all work to reach a final decision or the percentage of claims with no processing errors.
How do you think additional performance measurements, such as those mentioned, could assist VA in fully implementing these programs?
Mr. BERTONI. I think the rationale is that they had the STAR-review process, which is a systematic technical accuracy review where they sample a number of cases. Our concern is that this review is not capturing enough of these type of specialized cases to give them a good enough reading on what is going on.
So in general, you need good management information data to improve your program. You need to know how accurate your cases are, how consistent you are rating cases, how much time they are being taken to be processed, how long they sit in a particular phase.
Right now, there are three entry points for getting VA benefits, the traditional method, the DES—the DoD VA Disability Evaluation System pilot, which down the road might go worldwide, and there is BDD and Quick Start. For the other two programs, I can look at the metrics and I can track from time of entry, from time of application to the time those benefits are delivered and get a good sense of what is going on at all phases. That is not the case with BDD and Quick Start.
Mr. HALL. Your testimony also notes that VA tracks days it takes to process traditional claims starting with the date that a veteran first files a claim. Whereas, it tracks days to process BDD claims starting with the date of discharge of that servicemember. This approach does not count the time that VA spends developing the claim while the servicemember is sill in active duty or still under the DoD’s purview.
The VA claims it does not measure the full claim processing time because it lacks legal authority to provide compensation until a servicemember is discharged and becomes a veteran. Do you have any suggestions that might allow VA to track the time to process the entire disability claim, including that time before discharge and how might this improve the BDD and Quick Start programs?
Mr. BERTONI. Absolutely. I agree they don’t have the legal authority to pay the claim but they have the legal authority to develop the case, and if a person applies for benefits while a servicemember, the clock ticks, the VA representatives develop that case, it gets to a point where it is rating ready and you stop the clock. So if that is 1, 2 or 3 months, that is the development phase.
Six months down the road, once that person discharges, the clock starts again. That is the rating phase, whatever that takes, the 76 days. We put those two pieces together. That is development. That is the entire time for the case to be developed. So it is not a matter of not having legal authority to pay. They can develop a case before they are able to pay. It is a matter of doing it.
And again, it is happening with the DES pilot right now between DoD and VA. They are tracking from date of referral to date of payment and it is possible and we believe it is reasonable for them to be doing, to make this process more transparent, and it is certainly to give them the metrics and the data that they can make adjustments down the road.
Once thing they have not been able to do is to reach their 60-day optimal goal at the back end. Perhaps that is due to problems at the front end with development, but they are not tracking it, they are not looking at it. If they were, they might be able to make the adjustments to reach that 60-day goal at the front end.
Mr. HALL. Right. Well, thank you, sir. We have a few examples that have come before the Committee and the Subcommittee where VA and DoD have maybe not been as cooperative or may not have allowed the overlap of work to happen that would enable a seamless transition in several different areas, and since we have representatives from both DoD and VA here, maybe we will get a chance to talk about that.
But you note in your testimony that most VA and DoD Memorandums of Understanding (MOUs) require a VA physician to administer the joint physical exam required by BDD and Quick Start. You also mentioned that only 7 percent of those MOUs surveyed permit disability exams to be administered by either a VA or DoD physician. Do you suggest that MOUs need to be expanded to permit DoD physicians or contracted physicians to conduct these exams as well as VA docs? How does the effectiveness of this program suffer as a result of this limitation.
Mr. BERTONI. I think, again, I will just hearken back to the pilot, the DES pilot, though that is right now basically, it is primarily the exams are coming from VA staff. Even in this program, I think 90 percent of the exams are being conducted by either VA staff or contracted with VA. I think the thinking is they have the broader expertise to assist in making the fit/unfit decision for the military, but also to assess and compile all the other potential injuries that that person might claim down the road for VA benefits.
At the same time, there is leeway in those agreements for DoD physicians, DoD contractors or some type of hybrid approach between VA and DoD to do, sort of, share those duties.
I think that what it comes down to in a lot of respects is resources. And right now VA has stepped up and I am not sure if they have asked or what the dialogue is between VA and DoD as to expanding the role on DoD’s end.
Mr. HALL. Well, the dialogue between Secretary Shinseki and Secretary Gates has certainly been, I think, at a deeper level and a more cooperative level than what I have noticed in previous cases of Secretaries of both Departments. Hopefully that cooperative relationship will translate down through both Departments.
You also noted in your testimony that VA has implemented two initiatives to improve BDD and Quick Start, but that they did not fully evaluate either. These include VA’s consolidating claims, processing activities into two regional offices and creating a paperless claims processing system. Do you know why VA has not evaluated these measures and what the implications might be of not doing that?
Mr. BERTONI. I think the position was that they—I think in one of the meetings, as far as the electronic processing goes, it was a proof of concept. It appeared to work. We decided to rule it out. And now that is ruled out, it didn’t make any sense to go back, cease and desist and evaluate it. We gave them that. At the end of the day we said that is fine, but we still think that you need to go back in and develop an evaluation plan for both of these efforts: What level of performance are you shooting for; what metrics are you going to measure against in terms of how you are trending; and, ultimately, how are you evaluating this?
This is basic principles of pilot planning, basic principles of business reengineering processes. We didn’t see it. We would hope that they agree to look at this and monitor it. I don’t know what they are doing right now, but I believe they have gone back and are looking at some of the aspects of both of those programs. Our recommendations are open. Down the road we will look further into it and see if we can close them out.
Mr. HALL. Thank you.
Mr. Rodriguez, would you like to ask a question?
Mr. RODRIGUEZ. Yes. Thank you. Let me first apologize for being late.
Let me ask you—I know you have addressed this issue many times in the past from the GAO perspective and made recommendations and we have had a lot of difficulty in the transition between DoD and VA. We have pumped in a lot of money trying to get the DoD and the VA to come together and I think somebody explained that DoD has another great system; however, and the VA has a great system, they just don’t talk to each other. I was wondering if you had any thoughts about what we need to do next after my 12 years on the Committee, this dialogue occurred even before I arrived here. What do we need to do to or what kind of studies do we need to do to get us to the next level?
At one point we had talked about getting a private entity to come in from the outside and try to do the same first and now, as you have done, the GAO reports indicate a number of areas where a variety of programs could be tracing data more effectively. What other GAO studies could be utilized that would give us a better handle as to how to do this? From your perspective, what other GAO studies or reports could be helpful for us coming to grips with this and now moving forward with the VA and trying to get it to the next level?
Mr. BERTONI. Okay. Let me just say, we have been at the ground floor at both the DES the pilot, as well as looking at the BDD program for quite some time. So I would say, in terms of two large bureaucracies coming together and trying to merge or meld two processes that, I think, both think they do very well, I think there are just external forces—Walter Reed, the current wars, oversight on your part, GAO—basically involved here are sort of, I don’t want to say forcing, but helping them to work together. And I could say in, both, the BDD program as well as the DES pilot, there is a lot of cooperation between the two entities, not always consistent in terms of how they view every aspect, but I would say, very productive in terms of their cooperation.
In terms of information, we have received and the cooperation we have received in both those efforts, it has been exceptional, so I just want you to know that.
I think, as far as further improvement, these two programs, the BDD and the DES pilot, they are very close, so I am sorry—I know it is BDD, but I want to bring that in also.
They just need to keep working to sort of, to refine the machine, and I think this report that we issued, we essentially said BDD and Quick Start is a good program. It has many positive attributes. It just needs to be refined and tweaked. And if you do some of these things, it will be a better program in terms of service delivery.
In terms of other reports, we have a body of work. I would much rather think about that and perhaps submit something to you at a later time.
Mr. RODRIGUEZ. I would like to see those ideas because a lot of times you react to what we come out with but you might have a better feel as to what might be helpful to improve services as we provide more resources. And at some point we felt, and we should have for good reason that we weren’t providing them with the necessary resources.
But as we move forward with resources, we expect them to be held accountable. Can you provide me or the Chairman, with some ideas as to how we can go about additional studies that could be done to allow for more recommendations and how best to do this?
Because as elected officials, our biggest problem is not only the bureaucracy out there, but I am sure that this is the same case for the Secretary.
Mr. BERTONI. Sure and, just, I am in the process now of drafting a report for this Committee, looking at training for VSRs and RVSRs. That is going to be very important in terms of the fact that they have hired 4,200 staff over the last several years. These folks are the folks that are being placed in these rating centers, in these processing centers. They are the ones that are going to have to move this work, are crucial to accuracy, consistency and timeliness of the work.
So I think that is an important piece we are doing it. We will be out shortly. We also have some work. We just issued and under way, looking at how they can expedite the backlog problem, so I will have my staff get in contact with you.
Mr. RODRIGUEZ. With the understanding that, we have only dealt with about 8 million veterans from 23 million in the country, we have to continue to push forth on the outreach to our veterans. Okay. Thank you.
Mr. BERTONI. And the BDD program is a good tool for the outreach and education to sort of bring that service into play earlier in the servicemember’s life.
Mr. HALL. Thank you, Mr. Rodriguez. I would just say that I think we all are in agreement that these are good programs that are positive steps for our veterans and we are trying to figure out how to make them better.
As part of that quest, and noting that VA has created a pre-discharge Web site so that servicemembers can initiate Quick Start or BDD claim electronically, I wanted to ask you in closing whether you think this paperless system should be expanded to permit all claims to be processed or initiated electronically. How much effect do you think that would have upon the stubborn claims backlog?
Mr. BERTONI. In terms of having accessibility via the Web site, I think that is—all modern business is heading in that direction. You know, commerce and transactions, that is how it is happening today. We have servicemembers coming back, these young individuals who have, you know, they are very familiar with that kind of public service delivery. So any time you can do that, open up another portal for quick service, we would support that.
We have not got in and looked at the actual functioning of that system, so the jury’s out there.
What was the other part of your question?
Mr. HALL. That was it. Thank you.
Thank you, Mr. Bertoni. I appreciate very much your testimony and look forward to your next progress report, and you are now excused with our gratitude.
Mr. BERTONI. We will follow up on recommendations and keep you apprised.
Mr. HALL. We will absolutely try to do our best.
Because of scheduling and travel plans, we are going to ask the Honorable Noel Koch, Deputy Under Secretary of Defense, from the third panel, to come up and be our next panel all by himself. He is the Under Secretary for Wounded Warrior Care and Transition Policy at the U.S. Department of Defense, and we will just take you, Mr. Under Secretary, out of order so you can make your plane.
As usual, your statement is a part of the written record of this hearing, so feel free to improvise as you wish for 5 minutes.
You are now recognized, sir.
STATEMENT OF HON. NOEL C. KOCH, DEPUTY UNDER SECRETARY OF DEFENSE (WOUNDED WARRIOR CARE AND TRANSITION POLICY), U.S. DEPARTMENT OF DEFENSE
Mr. KOCH. Thank you, Mr. Chairman, and thank you very much for your consideration and realigning the witnesses. It is a great pleasure, as always, to be before this Committee, and as you already have my testimony, this is, of course, this is an area in which we are, we are a junior partner and, in fact, with the Veterans Administration and happy to be.
So our job and our responsibility is, for the most part, to make sure that our veterans—or not veterans but pre-veterans, people who are prior to separation, who will be separating, are fully informed on the programs and the benefits that are available to them.
And so as Mr. Bertoni has indicated, this is very much a work in progress. The programs, themselves, are unexceptionable, I think. There is always room for improvement, but I think that the programs themselves are excellent. The question is, are we—how is it working on the execution side?
So in the interest of improvement, one of the things that we did, as you know, I think, Mr. Chairman and Members, our responsibility is to focus on wounded warriors and their care and their transition either back to active duty or to veteran status. And of course, many of them do go back on active duty.
And so that, it would appear that our charter is somewhat limited to those people and, of course, the programs that we are talking about are much broader and encompass all the servicemembers that we have.
So, but, from the perspective, from the place that we stand in this process, we do touch, I think, morally wounded warriors, but everybody across the board.
As you are familiar with the Transition Assistance Program (TAP), this was started during the Gulf War. It is 20 years old, or more than 20 years old now. And it was very much outdated and so last November we went away for a week, took this thing apart completely, along with our colleagues in this endeavor, and put it back together and updated it so that it accommodates people who are not very much, very well accommodated previously, our National Guardsmen and our Reservists who are very much engaged in the fight today.
And so in other areas of communication, again, this seems to be the entire issue is how do we make our people aware of what is available to them. And I have now visited many, many hospitals and warrior transition units and met with hundreds and hundreds, literally of, just our clients and people we are responsible for, constituents, and it is a constant source of partly amazement and partly disappointment at how little aware they are. And so before we get to the challenging questions, I think we can stipulate that we are not doing as well in this communications effort. The numbers don’t show it and the anecdotal revenues doesn’t show it, and so we are working very hard to correct that and to find a way to communicate.
And, Mr. Chairman and Members, you will appreciate this. This is partly a generational issue. They don’t communicate the way people my age communicate. They don’t refer to these thick manuals that we put out, that they are just chock full of information, which nobody reads.
Even Web sites are becoming somewhat antiquated in the eyes of some of our younger servicemembers and so we have, and I have indicated in my testimony, we are moving into social media, such as Facebook.
It is very successful. We have two Marines on the space station who are friends of ours on Facebook, and we have other people like this, and we are working with Twitter, and we are finding some success here.
Now, how successful are we? These programs are too embryonic at this point for us to make a judgment to say, okay, we know this is working, the baseline still remains to be established and I am about to run out of 5 minutes, and so I will be happy to take your questions. Thank you.
[The prepared statement of Mr. Koch appears in the Appendix.]
Mr. HALL. Thank you, sir. I appreciate your work and your testimony and your brevity and also your written submission, during which, you point out that servicemembers learn of BDD and Quick Start programs during the TAP briefings.
However, GAO states that only the Marines have made these briefings mandatory. We have learned that while DoD policy requires commanders to allow servicemembers to attend TAP sessions upon the Member’s request, in some cases servicemembers have not been released from their other duties in order to attend TAP briefings.
So given this, why are the TAP briefings not made mandatory for all of the service branches? And further, why not make BDD and Quick Start available for all servicemembers as a part of the normal discharge process?
Mr. KOCH. Let me answer the first part of your question, Mr. Chairman, first. This—you have touched on a very sore point here, and it is a sore one with me particularly because we would like to make just about everything that constitutes a benefit or a prospective benefit for the servicemembers mandatory, for them to be aware of these things.
And in some cases we have been successful in making that happen. In other cases we have not. There are contravening priorities here. In some cases, you know, we have limited manpower and where some of these things can be done in theater, they are also fighting a war in theater, and so it becomes difficult to persuade the higher authorities to make certain programs mandatory because the commanders object to that, and so to some extent it becomes almost a local option.
We want it to be mandatory for the servicemember to have, to be able to be told about it, and then if they want to avail themselves of the additional information to be briefed or counseled, whatever arrangements are provided for them, then their commanders, it should be mandatory for the commanders to release them so that they can avail themselves of this benefit. We have not, in every case, been able to do that, and I think we will just continually chip away at it.
I am sorry. The second question, I believe, was why are the benefits delivery in Quick Start not available to all of them. Quick Start, as you know, essentially focused more on the benefit accrues to the Reservists and that National Guardsmen, more usefully than to our active components. And the reason for it is, of course, they don’t know. There is a shorter fuse on this, a shorter timeline for them to get into the system and the reason is because they don’t necessarily know when they are going to be up for rotation.
As far as the BDD is concerned, this is available to everybody. It is just that not everybody needs to have these benefits. They are not necessarily all hurt in any way that would give them access, and in other cases they just don’t want to bother with it. And the third case, as I indicated in my oral testimony, in some cases I am sure there are people that simply don’t know about it because we have failed to reach them.
Mr. HALL. Well, I appreciate that. I think we all share the goal that you just stated of having the knowledge of these programs made available and passed on to every servicemember, be they active duty, Guard or Reserve.
I am still curious as to why the Marines have made the Transition Assistance Program briefings mandatory and the other services have not. I don’t know. Maybe we need to get that answer from somebody else. But it is two schools of thought obviously.
The Quick Start program was created to ensure that our soldiers serving in active duty who come from Guard and Reserve units can also take advantage of the benefits of the pre-discharge program. Are we offering Quick Start at Guard bases? In particular, I am curious whether my own constituents serving, for instance, in the National Guard at Camp Smith and New York and the Hudson Valley, can get a Quick Start exam when they return and demobilize there?
Mr. KOCH. Mr. Chairman, I think I am going to have to get back to you on that question because I think it is a split issue. In some places it is available and other places it is not available.
[The DoD subsequently provided the following information:]
The Department of Veterans Affairs provides information on the Quick Start program at military installations where demobilization/deactivation of National Guard and Reserves takes place and there is a VA presence. National Guard and Reservists can file their Quick Start claim while still on Active Duty; however, the examination to meet the requirements of Quick Start cannot be accomplished in the limited time during demobilization/deactivation.
Once the servicemember has completed and submitted the Quick Start application a VA representative can schedule the member for the Quick Start examination prior to their release from Active Duty. The actual examination occurs after the servicemember has returned to home station.
Mr. HALL. Maybe when you get back to us because other Members, I am sure, would like to know for their districts, how that decision is made and what, you know, what percentage of bases and where they are and, you know, how is it decided that, you know, which base will have a Quick Start examination available.
And lastly, I want to ask you, the Subcommittee has taken a particular interest in servicemembers suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI) and military sexual trauma (MST) to make sure that they receive the benefits to which they are entitled. The full VA Committee on the House side has examined how some servicemembers suffering from these disabilities take their own lives before they get help, or in spite of getting help, or tragically, we have a record number of veterans and soldiers who are still in uniform committing suicide or attempting suicide.
With this in mind, could you offer some thoughts about the steps we are taking during the pre-discharge process to screen for PTSD, TBI, MST and possible depression or other psychological states that might lead to suicidal tendencies?
Mr. KOCH. Yes, sir. Let me try to provide a blanket answer to that if I may. We try to screen for these disabilities before the servicemember moves on to—for example, when they come back from theater, they are tested to see if they are exhibiting symptoms of post-traumatic stress or other psychological and mental health issues that might be debilitating. And we just don’t have our arms around it. I am sorry. Again, I could probably give you a very eloquent long answer that wouldn’t make a whole lot of sense and by the time you distilled it, it would come down to the fact that we are still just not very good at this.
One of the problems is, I can tell you in my generation coming back from Vietnam, there are a lot of things that people look for in terms of symptoms, maybe symptoms of post-traumatic stress, but they also may be symptoms of the fact that you are just coming home hot, you don’t want to be here in many cases. You know, you want to be back down range, you want to be with your unit, you want to be with your friends, you don’t want to face the complexity of the life that you are going back to.
There are a lot of reasons why people come home in ways and upset and exhibit symptoms that may be construed as post-traumatic stress or other—you know, TBI is the result of, you know, that is different. We know what that is. But diagnosing post-traumatic stress is a very—is a problem of a different magnitude and while the symptoms that you are looking at really are not symptoms, but are being misread, that does not preclude that individual from suffering from post-traumatic stress 15 or 20 years later and you are not going to catch it at the front end.
And so where we have gotten very good as it—dealing with traumatic amputations, providing the necessary prosthesis, the counseling and everything that helps people get back on their feet after they have lost their legs. We can do that. And even traumatic brain injury is something that we know we can work with this to some degree of feeling like we are making progress. In the area of post-traumatic stress, I don’t know that anybody is going to come up there and say, they are pretty happy, I think we have finally got our arms around it. If they tell you that, you know, you ought to have them under oath.
Mr. HALL. I appreciate your candor and honesty, sir. And it is nice to hear anybody from government or business or anywhere say, honestly, we don’t have our arms around it. This is something that we all are trying to improve as much as possible, but nobody at this point, I don’t think, expects that we will have a full proof way of identifying those people in that kind of trouble.
But before you leave, I just wanted to ask if you have any suggestions or approaches that you are trying or that you suggest that we might, on the Congressional side, be able to do to help make that identification?
Mr. KOCH. Well, your funding is—at least we are happy with our fundings. That may be something, if you are people tell you, that we are satisfied with what we have got, we are satisfied with your support, we are grateful for your questions and for your—because it stimulates our thinking.
There is one thing that, I guess, you and all of our colleagues could help us with and, you may notice when you hear Admiral Mullen or other senior military leadership talk about the problem that we just finished discussing, they don’t refer to disorder and I would like to see if we could, first, if we could get this out of the Diagnostic and Statistical Manual of Mental Disorders manual.
When we talk about post-traumatic stress disorder, we are automatically creating a problem for that individual, because it is a term that connotes dysfunctionality, it connotes something that is weird, if you like, in that person, and that is a great disservice to the individual because when you begin with the notion that it is a disorder, which I think it should not be called that, then you get quickly to this issue of stigma, which is just a kinder word for prejudice and it is a short jump from prejudice to discrimination in a job market and these people shouldn’t—
Mr. HALL. Thank you, sir. You are echoing the statement of a father of a young veteran who took his own life who testified before this Subcommittee and suggested that it be called post-traumatic stress injury or post-traumatic stress syndrome which it use to be. Anything but disorder because of the fact that it attaches a stigma to it.
Mr. KOCH. Thank you.
Mr. HALL. To what is actually a human response to an inhuman experience or living through conditions and events that most human beings don’t have to deal with.
So I appreciate your testimony and your suggestions and I hope you have a safe travel, sir. Thank you very much for your testimony.
Mr. KOCH. Thank you, Mr. Chairman.
Mr. HALL. Mr. Under Secretary, you are now excused.
Mr. KOCH. Thank you, Counsel.
Mr. HALL. I will go back to our scheduled program and ask Panel 2 to join us now, please, including Thomas Tarantino, Legislative Associate, Iraq and Afghanistan Veterans of America (IAVA); Gerald T. Manar, Deputy Director of the National Veterans Service, Veterans of Foreign Wars of the United States (VFW); Raymond C. Kelley, the National Legislative Director of AMVETS; and Mr. John L. Wilson, Assistant National Legislative Director for Disabled American Veterans (DAV).
Gentlemen, thank you for your patience. Your written statements are in the record, and Mr. Tarantino, you are now recognized for 5 minutes.
STATEMENTS OF THOMAS TARANTINO, LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA; GERALD T. MANAR, DEPUTY DIRECTOR, NATIONAL VETERANS SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; RAYMOND C. KELLEY, NATIONAL LEGISLATIVE DIRECTOR, AMERICAN VETERANS (AMVETS); AND JOHN L. WILSON, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS
Mr. TARANTINO. Mr. Chairman, thank you very much and on behalf of Iraq and Afghanistan Veterans of America’s 180,000 members and supporters, I would personally like to thank you for the opportunity to speak before you today and express our views of our membership on some very important issues.
As an Operation Iraqi Freedom veteran with 10 years of service in the Army, I have seen firsthand the difficulties many face when transitioning from being a servicemember to a veteran. For the wounded warrior torn from service due to their extraordinary sacrifice, or the young veteran who spent most of their formative years in uniform, the transition can be very difficult. And all too often, we leave behind the structured, accessible care and benefits of the military when seeking benefits to the Department of Veterans Affairs, where we are left largely on our own devices.
In response to the need for a more seamless transition from servicemember to veteran, the VA and the Department of Defense have embarked on several initiatives that allow servicemembers to walk off post with their benefits in hand. However, the potential of these programs has yet to be fully realized. And their full impact will not be felt until the VA begins aggressive outreach to servicemembers and the DoD makes transition programs uniform and mandatory.
When I left the Army in 2007, I had absolutely no idea of the scope and availability of the benefits that I was entitled to as a veteran. In fact, it never even occurred to me to seek benefits and health care from the Department of Veterans Affairs just for the general wear and tear of a decade of military service. If it weren’t for an old Sergeant Major that was attending the Army Civilian Alumni Program with me, I would have never even applied.
And we cannot rely on word of mouth to spread this information. The DoD and the VA must integrate their outreach and ensure a smooth transition of services before a servicemember is ready to leave the uniform behind. Otherwise, more men and women are going to fall through the cracks.
Now, as you mentioned, the Marine Corps mandates TAPS programs, I believe, within 90 days of separation, and the Army conducts their Civilian Alumni Program within 30 days of separation. Both of these programs are useful for what they are, but they really begin far too late to utilize the Benefits Delivery at Discharge Program. And neither program has comprehensive or mandatory briefings about the availability of VA services.
The VA must begin to see itself as a military alumni program. Many of us remember that guy in the cheap suit from our college alumni society who greets us on freshman year and continues to pester us throughout college and for years afterward. It may have been kind of annoying, but the message was communicated clearly and it was consistent. The VA needs to be communicating at least that effectively with our veterans. There should be absolutely no excuse for any veteran not knowing what services are available to them when they separate. And only when the VA integrates its outreach and education efforts with the DoD will benefits programs reach their full potential.
Now, early outreach also requires VA boots on the ground. To effectively utilize Quick Start services the VA must have a presence, physically, at all military installations in order to provide access and information to the benefits and services that servicemembers have earned. Additionally, the VA should offer training to AGR members of the National Guard and Reserve so that there can be benefits counselors and educate servicemembers who do not have the same interaction with the military services as do their active duty counterparts.
Just as the VA must rethink the way it conducts outreach, the DoD must understand that it has an inherent responsibility to its servicemembers to set them up for success whether they retire from service or they choose to leave before retirement. The military is a lifestyle. It is not a job. And those who choose this life must be afforded every opportunity to excel both while in uniform and when they put the uniform away. The DoD must mandate comprehensive and structured Transitional Assistance Programs that integrates the VA benefits and services.
Now, in addition to integrating outreach and training, we also need to address the expedience and accuracy of the benefits process. The Benefits Delivery at Discharge Program generally provides more accurate and timely benefits to separating servicemembers than the standard benefits approval process. However, this is largely due to the co-location of the servicemember with their respective records and the DoD medical facility.
Many of the processing issues that plague the standard system still do exist, but they are mitigated by the fact that the servicemember is still in uniform, has full access to DoD care and services while waiting for their rating, thus reducing the time it takes to develop their claim during these programs.
I think we all know that receiving a disability rating at the VA can be a long and confusing process for a veteran. And often, veterans must wait for a rating that does not accurately reflect what they are entitled to. The VA currently uses a disability evaluation process that was outdated long before many Iraq and Afghanistan veterans were even born. And this has lead to a situation where hundreds of thousands of veterans must navigate an antiquated system that focuses on quantity over quality of processed claims. And consequently, 17 percent of cases do not accurately compensate veterans for their earned benefits. And as we all know, this leads to months, if not years, of delayed payments.
And IAVA applauds some of the innovative initiatives that the VA and the DoD have undertaken to solve this problem, such as the pilot that integrates the Virtual VA into the Benefits Delivery at Discharge process and the Six Sigma pilot at the Little Rock Regional Office for the traditional claims process.
But now it is time to take it to the next level. You know, the Virtual VA is a step in the right direction, but it has to integrate with the Veterans Health Administration as well as the Board of Appeals proce
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