Witness Testimony of Philip A. Burdette, Principal Director, Wounded Warrior Care and Transition Policy, Office of the Under Secretary of Defense for Personnel and Readiness, U.S. Department of Defense
Madam Chairwoman and Members of the Subcommittee:
Thank you for the opportunity to discuss the Department of Defense’s (DoD ) role in the Federal Recovery Coordination Program (FRCP). While the FRCP was jointly developed by DoD and Department of Veterans Affairs (VA) leaders on the Senior Oversight Committee (SOC) in August 2007, the program is administered by VA.
Overview of DoD Recovery Coordination Program
The DoD Recovery Coordination Program (RCP) was established later by Section 1611 of the FY2008 National Defense Authorization Act. This mandate called for a comprehensive policy on the non-medical care and management of recovering Service members, including the development of a comprehensive recovery plan, and the assignment of a Recovery Care Coordinator for each recovering Service member. In January 2009, a Directive-Type Memorandum followed in December 2009 with a Department of Defense Instruction (DoDI 1300.24), set policy standardizing non-medical care provided to wounded, ill and injured Service members across the military departments. A summary of the roles and responsibilities captured in the DoDI are as follows:
- Recovery Care Coordinator (RCC): The RCC supports eligible Service members by ensuring their non-medical needs are met along the road to recovery.
- Comprehensive Recovery Plan (CRP): The RCC has primary responsibility for making sure the CRP is complete, including establishing actions and points of contact to meet the Service member’s and family’s goals. The RCC works with the Commander to oversee and coordinate services and resources identified in the CRP.
- Recovery Team: The Recovery Team (RT) includes the recovering Service member’s Commander, the RCC, Medical Care Case Manager, Non-Medical Care Manager, and, when appropriate, the Federal Recovery Coordinator (FRC) for catastrophically wounded, ill or injured Service members,. The RT jointly develops the CRP, evaluating its effectiveness and adjusting it as transitions occur.
There are currently 162 RCCs in 67 locations placed within the Army, Navy, Marines, Air Force, United States Special Operations Command (USSOCOM) and Army Reserves. Care Coordinators are hired and jointly trained by DoD and the Services’ Wounded Warrior Programs. Once placed, they are assigned and supervised by Wounded Warrior Programs but have reach back support as needed for resources within the Office of Wounded Warrior Care and Transition Policy. DoD RCCs work closely with VA FRCs as members of a Service member’s recovery team.
The DoDI 1300.24 establishes the standardized processes for referral for care coordination of seriously, severely and catastrophic injured and ill Service members for RCCs and FRCs. The RCC’s focus is on Service members who will be classified as Category 2 and 3. A Category 2 Service member has a serious injury/illness and is unlikely to return to duty within a time specified by his or her Military department and may be medically separated. A Category 3 Service member has a severe or catastrophic injury/illness and is unlikely to return to duty and is likely to be medically separated. The FRC’s focus is on those Service members referred by Service Wounded Warrior programs.
While defined in the DoDI, Categories 1, 2 and 3 are all administrative in nature and have proven difficult to operationalize. The intent of the DoDI is to ensure that wounded, ill, and injured Service members receive the right level of non-medical care and coordination. DoD is continuing to work with the FRCP to ensure that Service members who need the level of medical and nonmedical care coordination provided by a FRC are appropriately referred.
Government Accountability Office (GAO) Report on Federal Recovery Coordination Program
The Departments recognize that the FRCP and RCP are complementary, not redundant programs. There is a “hand-off” from DoD RCCs to the VA FRCs. This occurs when it is clear that the catastrophically wounded, ill, or injured Service member will not return back to duty, which is a highly individualized determination based on multiple factors, including the Service members’ condition, and their desire to stay on active duty. 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 coordination services, the two Departments are still in the process of working out the details.
As a full partner with the VA, the Department of Defense will assist with implementing the GAO recommendations. Specifically, in accordance with DoD Policy, all Category 3 (severe or catastrophic injury or illness) and other recovering Service members who would most benefit from the services of a Federal Recovery Coordinator (FRC) will be referred. In order to ensure the capabilities are in place to address these 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.
Following are DoD’s responses to the GAO report.
Duplication of case management efforts between VA and DoD
The report outlines the confusion and inefficiency that arises as a result of a Service member who may have multiple case managers. The GAO report shows a matrix with the various DoD and VA care/case management programs in place. As many as 84% of Service members in the FRCP are also enrolled in a Military Service Wounded Warrior Program. While the programs vary in the populations they serve and services they provide, there is a necessary overlap in functions.
The GAO outlined one instance where a recovering Service member was receiving support and guidance from both a DoD RCC and a VA FRC. The two coordinators were effectively providing opposite advice and the Service member was in receipt of conflicting recovery plans. The Service member had multiple amputations and was advised by his FRC to separate from the military in order to receive needed services from VA, whereas with his RCC he set a goal of remaining on active duty. We recognize that better coordination in the future will avoid these situations.
The SOC directed RCP and FRCP leadership to establish a joint DoD-VA Recovery Care Coordination Executive Committee to identify ways to better coordinate the efforts of FRCs and RCCs and resolve issues of duplicative or overlapping case management. The Committee conducted its first meeting in March and its final two-day meeting in May. The results of the Committee’s efforts were briefed to the SOC and DoD supports the recommendations to better integrate the FRCP into the RCP while considering options to improve transitions for Recovering Service members In March 2011, DoD also conducted an intense two and a half day Wounded Warrior Care Coordination Summit that included focused working groups attended by subject matter experts who discussed and recommended enhancements to various strategic wounded warrior issues. One chartered working group focused entirely on collaboration between VA and DoD care coordination programs. Actionable recommendations were reviewed, presented to the Overarching Integrated Product Team and will continue to be worked until the recommendations and policies are implemented. The joint DoD-VA committee also considered the work produced by the working group at this summit in coming up with its recommendations on how to best collaborate, coordinate, or integrate these two programs.
Lack of access to equipment at installations
FRCs reported to the GAO that “logistical problems” impacted their ability to conduct day-to-day work. Specific areas causing this include: a) provision of equipment, b) technology support and c) private work space. There are existing Memoranda of Agreement (MOA) between DoD and VA at facilities where FRCs work, however immediate compliance with these MOAs in an environment of reduced or limited resources is always a challenge.
DoD’s Office of Wounded Warrior Care and Transition Policy (WWCTP) stands ready to assist in securing the resources required at DoD facilities for FRCs and will work with the Services and VA to ensure that daily duties are not interrupted by equipment, technology or space constraints.
The Committee requested an analysis of, and potential options for, integrating the FRCP and RCP under a single umbrella, to reduce redundancy and better fulfill the goal of establishing a seamless transition for wounded warriors and their families. 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 coordination services for the wounded, ill, or injured Service members, Veterans, and their families, the two Departments are still in the process of working out the details for the SOC.
DoD is committed to working closely with the VA Federal Recovery Coordination Program leadership to ensure a collaborative relationship exists between the DoD RCP and the VA FRCP. The Military Department Wounded Warrior Programs will also continue to work closely with FRCs in support of recovering Service members and their families.
Madam Chairwoman, this concludes my statement. On behalf of the men and women in the military today and their families, I thank you and the members of this Subcommittee for your steadfast support.