Joint Hearing of the Committee on Homeland Security and Governmental Affairs of the U.S. Senate and the Committee on Veterans’ Affairs of the U.S. House of Representatives at 1:00 p.m. CDT.
Submission For The Record of Paralyzed Veterans of America
Chairwoman Buerkle, Ranking Member Michaud, and Members of the Subcommittee, Paralyzed Veterans of America (PVA) would like to thank you for the opportunity to submit a statement for the record regarding the progress and development of the Federal Recovery Coordinator Program (FRCP).
For more than 65 years it has been PVA’s mission to help catastrophically disabled veterans and their families obtain health care and benefits services from the Department of Veterans Affairs (VA), and provide support during the rehabilitative process to ensure that all disabled veterans have the opportunity to build bright, productive futures. It is for this reason that PVA strongly supports the FRCP, and appreciates the Subcommittee’s continued work on improving the transition from active duty to veteran status for severely injured, ill, or wounded veterans and service members.
The FRCP was created as a joint program between VA and the Department of Defense (DoD) to provide severely injured, ill, or wounded service members and veterans with individualized assistance obtaining health care and benefits, and managing rehabilitation and reintegration into civilian life. Through the program, veterans and service members are assigned a Federal Recovery Coordinator (FRC) and create a Federal Individual Recovery Plan that consists of long-term goals for the veteran and his or her family members. Such a plan motivates veterans to fight through the initial difficulties of adjusting to life after a catastrophic injury.
The purpose of today’s hearing is to assess the progress and challenges of the FRCP and identify potential ways in which the program can be improved in order to fulfill its mission. In the past year, the FRCP has made changes to enhance service delivery and expand its outreach; however, more work must be done in order to adequately meet the needs of veterans. Specifically, PVA believes that VA, DoD, and Congress must work together to address challenges in the areas of continuity of care, care coordination, and program awareness in order to make a difference in the lives of those that have made the ultimate sacrifice for our country.
Continuity of Care
A primary component of the FRCP is continuity of care. As it relates to the FRCP, we believe that continuity of care means providing veterans and service members with individualized care that is facilitated by an assigned primary Federal Recovery Coordinator (FRC) who maintains a working relationship with the veteran and his or her family to help manage a successful transition into civilian life after an illness or injury.
PVA believes that one way in which continuity of care can be improved within the FRCP is to ensure that FRCs remain in contact with veterans not only during the initial phases of enrollment and administration of the Federal Individual Recovery Plan, but also after the veteran has become reintegrated in his or her community setting and home. PVA believes it of extreme importance that FRCs keep in touch with veterans and their families at this point to ensure that they are adjusting to life after a disability, and providing information when necessary to make certain that the veteran is aware of VA and DoD benefits and services that may be beneficial to him or her as utilization of the FRCP lessens.
In support of continuity of care, VA and DoD must also work to create a system that monitors and manages the level of complexity and size of FRC caseloads. As it is a goal of the FRCP to meet the individualized needs of veterans and service members, each case will be unique and require different levels of attention. These factors must be taken into consideration if FRCs are expected to provide timely quality assistance that is truly helpful to veterans and their families.
In conjunction with FRC caseloads, the staffing of FRCs is another area of concern that must be assessed to determine if current staffing levels are adequate to meet veterans’ needs. In a recent study conducted by the Government Accountability Office (GAO) it was reported that “the FRCP faces challenges in determining staffing needs and has not clearly defined or documented its process for managing FRC caseloads…” With a limited number of FRCs, issues involving transportation and distance have the potential to hinder access to care and resources for many veterans in rural areas, and thus, become threats to continuity of care. PVA encourages VA to develop an outreach strategy for veterans living in rural areas to make certain that they are aware of the FRCP and have access to a FRC if necessary. We also strongly recommend that VA develop a system to monitor and measure the complexity and size of FRC caseloads. We ask that as the program expands, VA, DoD, and Congress consider placing FRCs in locations where veterans with disabilities are already seeking services such as VA spinal cord injury centers or amputation centers of care.
It is important to remember that veterans participating in the FRCP are also utilizing a multiplicity of other services from both VA and DoD. Care coordination of all the services and programs that a veteran chooses to utilize is extremely important for the success of the FRCP. In The Independent Budget for FY 2012—co-authored by PVA, AMVETS, Disabled American Veterans, and Veterans of Foreign Wars—it was reported that “…veterans transitioning from the DoD to VA who are not assisted by the FRCP may be forced to interact with as many as five VA representatives…” Interaction with so many different points of contact can be burdensome and overwhelming for veterans and their families and lead to disengagement of not only the FRCP, but other programs and services as well.
On the contrary, when a veteran participates in the FRCP, the FRC is familiar with these various services and programs and can help the veteran better manage the multiple areas of care. Therefore, it is vital for FRCs to be fully aware of the different programs and services available to FRCP participants to avoid a duplication of efforts and conflicting information that can lead to “information overload” and confusion for veterans and service members.
With regard to VA health care, the Veterans Health Administration is currently undergoing a change in the way it delivers health care to veterans by utilizing patient aligned care teams (PACT). PACT is designed to provide patient-centered care through a team-based approach that emphasizes care coordination across disciplines. PVA encourages the FRCP leadership to work closely with the VA Office of Patient Centered Care and Cultural Transformation since FRCs serve as an information resource during the medical recovery process and the PACTs will be making FRCP referrals.
Additionally, in support of care coordination, PVA hopes that FRCs will reach out to the service officers and advocates who represent various veteran service organizations and work with veterans in a similar capacity on a daily basis. PVA has a network of National Service Offices within VA that provide services to paralyzed veterans, their families, and disabled veterans. These services range from bedside visits to guidance in the VA claims process to legal representation for appealing denied claims.
In fact, we recently received multiple reports describing close working relationships between PVA’s Senior Benefits Advocates and FRCs. Our Senior Benefit Advocates and the FRCs work together on a daily basis to assist veterans and their families. National Service Officers can be a great resource to the FRC for referrals, information on VA benefits and programs, and getting the word out about the FRCP within the veteran community.
Program Awareness Among Veterans
Making sure that veterans and service members, as well as their families and caregivers, are aware of the FRCP has proven to be a continuous challenge. While participation numbers are growing, FRCP leadership must work to keep information about the program circulating throughout the veteran and military communities. This can best be accomplished as a joint effort that incorporates the different offices and departments across both the VA and DoD.
Information posters and pamphlets should be made available to veterans and service members when they visit other VA and DoD offices to promote the FRCP. Such educational literature would be useful not only for the veteran or service member, but for their families and caregivers as well. As previously mentioned, veterans participate in many VA programs, but it is often a loved one or caregiver who is helping manage and coordinate the various services of care and who could significantly benefit from the help of an FRC.
Collaboration between FRCP staff and specialized services teams is another way to reach the targeted population that can benefit from FRCP services. The referral criteria for the FRCP includes veterans and service members who have sustained a spinal cord injury, amputation, blindness or vision limitations, traumatic brain injury, post traumatic stress disorder, burns, and those considered at risk for psychosocial complications—all areas included in VA’s system of specialized services. Therefore, it is only logical for the FRCP to work with these specialty teams to promote the FRCP, and educate veterans entering VA specialized systems of care on the FRCP services and benefits.
In conclusion, PVA urges continued Congressional oversight of this extremely important program and recommends that FRCP leadership periodically survey veterans and service members, and their families, to identify areas for improvement. As the FRCP is a new program, there are numerous lessons to be learned and an abundance of opportunities for development.
PVA appreciates the emphasis this Subcommittee has placed on reviewing the care being provided to the most severely disabled veterans and service members. Navigating through America’s two largest bureaucracies is a daunting task, but it can be particularly overwhelming when doing so after incurring a catastrophic injury such as a spinal cord injury, amputation, or as a polytrauma patient. Providing veterans with professional guidance and stability during this process gives them the resources to make informed decisions involving their health care and benefits and focus on their recovery and future endeavors.
PVA would like to once again thank this Subcommittee for the opportunity to submit a statement for the record. We look forward to working with you to continue to improve the Federal Recovery Coordination Program. Thank you.
 United States Government Accountability Office, Report to Congressional Requestors: “DOD and VA Health Care: Federal Recovery Coordination Program Continues to Expand but Faces Significant Challenges.” March 2011; GAO-11-250.
 The Independent Budget, “The Continuing Challenge of Caring for War Veterans and Aiding Them in Their Transition to Civilian Life,” pp. 91; 2011.