Font Size Down Font Size Up Reset Font Size

Sign Up for Committee Updates

 

Witness Testimony of Commander René A. Campos, USN (Ret.), Deputy Director, Government Relations, Military Officers Association of America

The Military Officers Association of America (MOAA) was extremely troubled by the findings in the Government Accountability Office’s (GAO) report, GAO-11-250, issued March 2011, titled, “DoD and VA Health Care; Federal Recovery Coordination Program Continues to Expand but Faces Significant Challenges,” and even more disappointed by the testimony presented to this Subcommittee at the May 13, 2011 hearing on the Federal Recovery Coordination Program (FRCP).

Further, MOAA found the September 12, 2011 letter signed by the Deputy Secretary of VA and DoD to the Subcommittee’s May 26 letter requesting their plan for implementing GAO’s recommendations and analysis of how the FRCP and DoD’s Recovery Coordination Program (RCP) could be integrated indicates to us more of a ‘business as usual’ approach rather than a roadmap of specifics that show the Departments’ sense of urgency in addressing these issues in the immediate future. 

MOAA’s assessment of the current state of the FRCP supports GAO’s findings and centers around three key areas. 

Many of the issues identified in the GAO report are similar to those in the Defense Department’s RCP.   We believe strongly the FRCP and RCP are victims of much larger systemic problems in wounded warrior care across the Departments of Defense (DoD) and Veterans Affairs (VA).  These systemic issues inhibit uniformity and consistency of operations to achieve a state of seamless transition, and include:

  • Lack of systematic compliance, accountability, and oversight;
  • Limitations on information sharing, accuracy of information, and communications; and,
  • Multiple segregated policies, programs, and services that are duplicative, inefficient, ineffective, and add to the already confusing bureaucratic morass.  

Recommendations:

MOAA fully concurs with the four recommendations outlined in the GAO’s report.

Additionally, we offer the following recommendations to improve the FRCP and address the larger systemic issues that exist in delivering care coordination between and within the DoD and VA:     

  • Revise and expand Sec. 1611 of Public Law 110-181 to mandate a single, joint VA-DoD program, establishing an office for managing, coordinating and assisting severely wounded, ill, and injured servicemembers, veterans and their families through recovery, rehabilitation, and reintegration.  Direct DoD to adopt and fully integrate VA’s FRCP policy and procedures outlined in VA Handbook 0802, March 23, 2011. 
  • Future hearings related to wounded warrior care coordination should be joint hearings before both the Veterans Affairs and Armed Services Committees.
  • An outside entity should be commissioned to evaluate the FRCP and RCP, assess how the programs function and operate within the context of the 10 major VA and DoD wounded warrior programs, and collect feedback from recovering warriors and family members on how to provide simpler ways for wounded warriors and their families to access care and services during transition.
  • Require VA and DoD medical and benefit systems to expand outreach and communication efforts to help increase awareness of all wounded warrior programs.
  • Conduct periodic needs assessment surveys to gather information from wounded warriors and their families on ways to improve programs and identify unmet needs.

MADAM CHAIRMAN AND DISTINGUISHED MEMBERS OF THE SUBCOMMITTEE, on behalf of the 370,000 members of the Military Officers Association of America (MOAA), I am grateful for the opportunity to present testimony on MOAA’s observations concerning the Federal Recovery Coordinator Program (FRCP).

MOAA does not receive any grants or contracts from the federal government.

MOAA thanks the Subcommittee for its commitment to enhancing the Department of Veterans Affairs (VA) care and support to our nation’s wounded, ill and injured and their families so they experience no loss of continuity in care, and their transition is as seamless as possible. 

Our Association also commends the Subcommittee for its leadership, persistent oversight and sense of urgency on the critical topic of care coordination for the heroes and the families these programs are intended to support.

FRCP and RCP Issues

While the focus of this hearing is on the FRCP, it is not possible to have a discussion on the program without including the DoD Recovery Coordination Program (RCP) since the two programs are interrelated and are seen as fulfilling the same roles and responsibilities in their respective agencies.

To better understand the two programs, it is helpful to look back at the timelines and purposes for establishing them. 

  • The Senior Oversight Committee (SOC) implemented the FRCP through two Memorandums of Understanding (MOU) between the VA and DoD.
  • The first MOU was signed by the Secretary of Veterans Affairs and the Secretary of Defense on August 31, 2007, requiring the establishment of the FRCP.
  • On October 31, 2007, the VA released a statement announcing the agency and DoD had signed an agreement (October 30), establishing the FRCP to help “ensure medical services and other benefits are provided to seriously wounded, injured and ill active duty servicemembers and veterans.” 

The program supported one of the recommendations of the President’s Commission on Care for America’s Returning Wounded Warriors, better known as the Dole-Shalala Commission. 

The MOU further “defined the FRCP, designated the Federal Recovery Coordinators (FRCs) as the ‘ultimate resource’ for monitoring the implementation of services for wounded, ill and injured servicemembers and veterans enrolled in the FRCP.  VA would provide the coordinators in collaboration with DoD, to coordinate services at military treatment facilities, services between the two Departments, private-sector facilities.”

  • On January 28, 2008, the President signed into law the National Defense Authorization Act for Fiscal Year 2008 (P.L. 110-181), directing VA and DoD to jointly develop and implement a comprehensive policy on improvements to care, management, and transition of recovering service members not later than July 1, 2008

As part of this joint policy, recovery care coordinators were to be assigned to recovering servicemembers.  Their duties were to include “overseeing and assisting the service member’s course through the entire spectrum of care, management, transition, and rehabilitation services available from the Federal Government, including assistance and services provided by the DoD, VA, Department of Labor, and the Social Security Administration.”

  • On December 1, 2009, DoD Instruction 1300.24 established the RCP.   The instruction assigns Commanders of Military Departments’ Wounded Warrior Programs overall responsibility for the management of their individual RCPs.  Further, the instruction requires recovering servicemembers to be referred to the appropriate RCP, either the DoD RCP or the FRC.
  • On March 23, 2010, VA Handbook 0802 established procedures for the FRCP—a combined initiative of VA and DoD to assist severely wounded, ill and injured post-9/11 servicemembers, veterans and their families through recovery, rehabilitation, and reintegration into their home community.

In the handbook, VA defines the RCC as “an individual assigned by the military services to recovering servicemembers whose period of recovery is anticipated to exceed 180 days, but who are likely to return to active duty.  RCCs’ duties include assisting servicemembers as they process through the DoD system of benefits and care.”

The fact that the FRCP was the first care coordination program jointly created and implemented by the two agencies and was to be the ‘ultimate resource for wounded warriors and their families with questions or concerns about VA, DoD or other federal benefits’ would lead one to believe that the program would be institutionalized and should serve as a model for other VA-DoD collaboration.  

While both VA and DoD care coordination programs boast of being joint, the reality is both are managed and operated in the opposite manner, separate and distinct from each other as was clearly stated by VA and DoD FRC and RCP officials at the May 13 hearing.  During the hearing:

  • The VA official concurred with the GAO recommendations, mentioning that many in DoD/Service wounded warrior programs refer to the FRCP as a VA program and think the FRCP should only care for wounded warriors when they become or are about to become veterans. 
  • The DoD official talked about the RCP being directed by Congress and that FRCs and RCCs serve similar purposes, but cover different categories of wounded warriors—RCCs are assigned, day one.  The official pointed to the RCP instruction that indentifies when the FRCs come into the DoD process to provide more comprehensive care.  While DoD told the Subcommittee they were willing to bring the FRCs earlier into the process, the Department was quite clear that they “wanted control over their people,” and so did the Military Services.

The latter statement sums up the problem quite succinctly.  Rather than fulfill the objective of jointness and seamlessness, the various bureaucracies too often end up putting their organizational interests ahead of those of wounded members and families.

A recent letter signed by the Deputy of Secretary of VA and DoD on September 12, corroborates our view that the two agencies continue to operate as separate programs, struggling to implement the joint program they committed to over four years ago when the agency’s leadership signed the first MOU establishing the FRCP program in October of 2007.  Comments such as:

  • “In order to ensure the capabilities are in place to address these (GAO) recommendations, we are in the process of evaluating the care coordination resources and capabilities of VA and DoD so that the necessary personnel are available with the appropriate skill levels to support the wounded, ill and injured population.
  • The Departments recognize that the FRCP and RCP are complementary, not redundant programs.
  • While we concur in principle that the establishment of a single recovery coordination program may be the preferred course of action to provide fully integrated care and coordination services for the wounded, ill and injured servicemembers, veterans and their families, we are still in the process of working out the details for the Senior Oversight Committee.”

Clearly, the two Departments have not been able to fix these policy and programmatic gaps on their own these last four years—and, unlikely to do so in the immediate future without some sort of immediate outside intervention and oversight.  Wounded warriors and their families are struggling and need help now—the last thing they want to hear policymakers say is that ‘we are working on the problem and we will have a plan in place soon.’

So today, wounded, ill and injured servicemembers, disabled veterans and their families are once again faced with trying to understand the complexities, nuances, and navigate two more separate programs in the VA and DoD systems, including unique and fragmented service care coordination programs in each of the Military Departments.  Simply put, the programs that were built to be joint and help them navigate the complicated processes have themselves become parochial and part of the navigation problem.

The current FRCP and RCP policies are opaque, confusing and incongruent with the intent of Congress.  The VA and DoD were supposed to jointly develop and implement a comprehensive policy on improvements to care, management, and transition of recovering service members, but have in fact developed separate and independent programs. 

While the FRCP was operational January 2008, program procedures weren’t published until this year, March 2011.  Additionally, DoD did not publish its RCP policy until December 2008, well past the July 1, 2008 congressional deadline.

The Department of Defense Recovering Warrior Task Force, 2010-2011 Annual Report, published September 2, 2011, highlights a significant number of program deficiencies, recommending the need to “standardize and clearly define the roles and responsibilities of the RCC, FRC, non-medical care manager, VA Liaison for Healthcare, and VA Polytrauma Case Managers serving a recovering warrior and his or her family.  Standardize the criteria for who is eligible to be assigned to a RCC (or Army Wounded Warrior (AW2) Advocate) and FRC.”

While both the FRCP and RCP programs have deficiencies, MOAA hears far less complaints and far more compliments for the FRCP.  VA’s policy and procedures also tend to be more comprehensive and easier to understand than DoD’s RCP regulations.

MOAA urges the Subcommittee to revise and expand Sec. 1611 of Public Law 110-181 to mandate a single, joint VA-DoD program and establish an office for managing, coordinating and assisting severely wounded, ill, and injured servicemembers, veterans and their families through recovery, rehabilitation, and reintegration.  DoD should be directed to adopt and fully integrate VA’s FRCP policy and procedures outlined in VA Handbook 0802, March 23, 2011.

Systemic Issues

Many of the broad departmental issues plaguing both VA and DoD systems are also impacting and limiting the FRCP, the RCP and likely the 10 other major wounded warrior programs cited by GAO at the May hearing.  The persistent problems with information sharing, and the long-standing issues of inadequate collaboration between the agencies are well documented and alive and well today.  These issues continue to impede progress and prevent VA and DoD from effectively and efficiently serving our most vulnerable servicemembers and disabled veterans who critically need these support services.

MOAA believes strongly that the key systemic issues which inhibit uniformity and consistency of operations to achieve a state of seamless transition include:

  • Lack of systematic compliance, accountability, and oversight;
  • Limitations on information sharing, accuracy of information, and communications; and,
  • Multiple segregated policies, programs, and services that are duplicative, inefficient, ineffective, and add to the already confusing bureaucratic morass. 

The DoD Recovering Warrior Task Force highlighted similar themes in its report (Department of Defense Recovering Warrior Task Force, 2010-2011 Annual Report)

“Disparities exist across recovering warrior (RWs) programs and policies in the Headquarters or Department vision and in the way in which those programs and policies are implemented in the field and experienced by RWs and their families.  Clear, consistent, and accurate information does not reliably reach RWs about the programs and policies intended to support them.  Also, parity of care across the Services has not been achieved.  From language used to services offered, eligibility criteria, and staffing requirements, the Services implement policies and programs differently.  There also are significant differences in the experiences of Active Component (AC) RWs, Reserve Component (RC) RWs healing at Active Duty installations, and RC RWs receiving community-based care.”

While much has improved in the last two years as the FRCP expanded to meet workload and improve seamless transition between the two programs, MOAA is very concerned that VA and DoD systems still struggle with basic terminology, policy, management, and technological system differences after more than a decade of war. 

The impact of these system failures can have a profound impact on the medical outcomes and the quality of life our wounded warriors and their families will experience.  The impact and experiences of these individuals today continue to be all over the map, regardless of the time frame of the injuries.

  • One caregiver whose loved one was injured early in 2010 told the Senate Veterans Affairs Committee of the difficulties in transitioning out of the military at a hearing this past July,  “…Coordination of care for her wounded warrior has also been a problem.  There seem to be so many coordinators that they are actually not all on the same page and sometimes doing things opposite of each other.  Though she was trying to help, I rarely got to see our FRC, who seemed to have too many people she was responsible for.  The lack of communication also extended to benefits and programs…,” she said.
  • To another caregiver, the mother of her severely disabled son, “Our FRC is affectionately called our ‘Wonderful FRC!’ It is as simple as that, yet, what she has done, and continues to do for our family is nothing short of miraculous and a Godsend. She has taken care of every aspect of my son's care back to 2008 when he was critically injured. Not only has the FRC provided excellent care and has been my son's number one advocate, she has been supportive and an inspiration to me as my son's primary caregiver—and I know she must be the same to the dozen or more wounded warriors families she also cares for each and every day.”
  • Another wounded warrior couple whose servicemember was injured in 2009 and was first introduced to their RCC at the time of their medical board, was provided no information about the FRCP.  This spouse told us, “We completely trust our RCC, though things were a little rocky at first—now he has our full trust!  Financially, the transition has been difficult.  Her wounded warrior is on the Temporary Duty Retirement List (TDRL)…The military has taken months to reevaluate her husband’s condition, and the family no longer has the financial resources while on active duty.  The TDRL process and navigating the medical and benefits systems has been a battle from the beginning of his injury—no one has been there to explain the process.”

Wounded, ill and injured servicemembers, disabled veterans and families deserve the very best care and support from systems that are simple, transparent and accessible.  They don’t want more policies or programs to further bog down the progress—they just want the systems to do their job—and to fulfill the obligations, promises and commitments made to them.

MOAA urges Congress to provide the necessary leadership in: 

  • Ensuring that future hearings related to wounded warrior care coordination are joint hearings that include both the Veterans Affairs and Armed Services Committees.
  • Commissioning an outside entity to evaluate the FRCP and RCP, to include how the programs operate within the context of the 10 major VA and DoD wounded warrior programs and collection of feedback from recovering warriors and family members on how  to develop simpler ways for wounded warriors and their families to access services and support during transition.
  • Requiring VA and DoD medical and benefit systems to expand outreach and communication efforts to help increase awareness of all wounded warrior programs.
  • Conducting periodic needs assessment surveys to gather information from wounded warriors and their families to improve programs and identify unmet needs.

Conclusion

MOAA is grateful to the Subcommittee for your leadership in supporting our wounded, ill and injured servicemembers, disabled veterans and their families who have “borne the battle” in defense of the Nation.