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Witness Testimony of John Medve, Office of VA-DOD Collaboration, U.S. Department of Veterans Affairs

Good morning Chairman Runyan, Ranking Member McNerney, and Members of the Subcommittee.  My name is John Medve, Executive Director of the Department of Veterans Affairs (VA) Office of VA-DoD Collaboration within VA’s Office of Policy and Planning.  I am pleased to be joined by Mr. Jim Neighbors from the Department of Defense (DoD).  My testimony will focus on the status of the transition process from DoD to VA, with an emphasis on the Integrated Disability System (IDES), the Federal Recovery Coordination Program (FRCP), and Veterans Affairs Schedule for Ratings Disabilities (VASRD) modernization.  I will provide the Subcommittee with an overview of the status of the IDES, the process used to transition the wounded, ill, and injured who are unfit for continued military service.  I will also provide an overview of care coordination efforts designed to assist severely wounded, ill, and injured Servicemembers and Veterans through recovery, rehabilitation, and reintegration as it relates to the FRCP, and explain how VA and DoD are communicating about additions and revisions to the VASRD. 

Integrated Disability System (IDES)

VA and DoD’s joint efforts have resulted in improvements and created an integrated disability process for Servicemembers who are being medically retired or separated.

Much has been accomplished to improve the DoD disability process in the wake of the issues identified at the Walter Reed Army Medical Center in 2007. In early 2007, VA and DoD partnered to develop a modified, integrated Disability Evaluation System (DES) and a DES Pilot was launched in November 2007.  This new, joint process was designed to eliminate the duplicative, time consuming, and often confusing elements of the separate disability processes within VA and DoD.  The goals of the joint process were to:  (1) increase transparency of the process for the Servicemember;  (2) reduce the processing time;  (3) improve the consistency of ratings for those who are ultimately medically separated; and (4) reduce the benefits gap that existed between the point of separation or retirement and before receipt of VA disability compensation.  Authorization for the DES Pilot was included in the National Defense Authorization Act for Fiscal Year 2008. 

The DES Pilot was launched at three operational sites in the National Capital Region (NCR): Walter Reed Army Medical Center, National Naval Medical Center, and Malcolm Grow Medical Center on Andrews Air Force Base.  The DES Pilot was recognized as a significant improvement over the legacy DES process, and, as a result of the Senior Oversight Committee (SOC) findings and the desire to extend the benefits of the Pilot to more Servicemembers, VA and DoD expanded the Pilot.  By the end of March 2010, the DES Pilot had expanded to 27 sites and covered 47 percent of the DES population.  In July 2010, the co-chairs of the SOC agreed to expand the DES Pilot and rename it IDES.  Senior leadership of VA, the Services, and the Joint Chiefs of Staff strongly supported this plan and the need to expand the benefits of this improved process to all Servicemembers.  Expansion and full implementation of IDES was completed by September 30, 2011.  Currently, there are 139 IDES sites operational worldwide, including the original 27 DES Pilot sites.

In contrast to the DES legacy process, the IDES provides a single set of disability examinations and a single-source disability rating, used by both Departments in executing their respective responsibilities.  This results in more consistent evaluations, faster decisions, and timely benefits delivery for those medically retired or separated.  As a result, VA can deliver benefits in the shortest period allowed by law following discharge thus reducing the “benefit gap” that previously existed under the legacy process, i.e., the lag time between a Servicemember separating from DoD due to disability and receiving his or her first VA disability payment.  This also prevents the Servicemember from having to navigate the VA disability system on his or her own after separation.  The DoD/VA integrated approach has also eliminated many of the sequential and duplicative processes found in the legacy system.  Yet, there is more to be done.

To monitor our overall performance for the IDES process, VA and DoD track the performance of the core processes on a bi-monthly basis for the over 25,000 Service members in IDES.  In addition, VA’s Chief of Staff conducts bi-monthly internal Video Teleconferences (VTCs) with Central Office and Field Executive staff.  VA also has joint monthly VTCs with both Army and Navy/Marine Corps to discuss site performance and general collaboration opportunities.

VA is responsible for four core processes within IDES:  claims development, medical examination, proposed rating, and VA benefits.  VA average processing time for VA core processes has decreased from 186 days in February 2011 to 134 days as of February 2012.  The VA target for combined processes is 100 days of the 295 day combined VA-DoD target.  While VA is currently meeting the goals for claims development and medical examinations, it is still falling short of meeting the standards for developing the proposed rating and the delivery of VA benefits.  To address these shortcomings, VA assigned additional raters to Disability Rating Activity Sites (DRAS), increasing the number of Ratings Veterans Service Representative (RVSRs) to 167 among the three IDES rating sites in Seattle, Baltimore and Providence, which represents a 35 per cent increase in personnel.  To address the timeliness of benefit delivery, VA identified a process to receive Servicemember separation data electronically.  This functionality is scheduled to be deployed in May of this year. 

Despite the overall reduction in combined processing time achieved to date, challenges remain and there is room for significant improvement in IDES execution.

VA and DoD are committed to supporting our Nation’s wounded, ill, and injured Warriors and Veterans through an improved IDES.  As such, VA believes that its continued partnership with DoD is critical and is nothing less than our Servicemembers and Veterans deserve.

Federal Recovery Coordination Program (FRCP)

The FRCP was created in October 2007 in direct response to the Dole-Shalala Commission’s recommendation for improved care coordination for seriously wounded, ill and injured.  The FRCP is designed to work and interact with existing military and VA health care teams, case managers, benefit coordinators, other federal agencies and the private sector.  FRCP provides seamless support from the Servicemember’s arrival at the initial Military Treatment Facility (MTF) in the United States through the duration of his or her recovery, rehabilitation, and reintegration.  The FRCP staff at the policy level coordinates with their DoD counterparts under the umbrella of the Joint Executive Council.  The FRCP is an integral part of VA and DoD efforts to address issues raised about the coordination of care and transitions between the two Departments for recovering Service members.  Federal Recovery Coordinators (FRCs) are located in 12 facilities across the country including four MTFs, two VA Medical Centers, three VA Polytrauma Centers, and three Wounded Warrior Program offices. 

FRCs assist severely wounded, ill, and injured Servicemembers, Veterans and their families through each client’s recovery, rehabilitation, and reintegration.  They are Masters-prepared nurses or clinical social workers who provide high-level care coordination for their clients.  The FRC creates a Federal Individual Recovery Plan (FIRP) for each client based on the goals expressed by the client, with input from his or her family and/or caregiver and health care team.  To show greater transparency with Servicemembers and Veterans, the FIRP is available through the eBenefits portal 24 hours a day, seven days a week.  eBenefits is a web-based toll that is now available all Service members and Veterans and currently has over 1.2 million subscribers.  FRCs provide client-centric assistance by coordinating all clinical and non-clinical care, benefits, and services, that are aligned with their clients’ FIRP goals, regardless of medical diagnosis, geographic location of injury or illness or place of medical treatment.  Clients remain enrolled in the program as long as there is a perceived need and benefit to the client.  FRCP is unique to other programs in that once a FRC is assigned to a client, the FRC is the constant point of contact for that client throughout all transitions.

Veterans Affairs Schedule for Ratings Disabilities (VASRD)

The VA Schedule for Rating Disabilities (VASRD) is the regulatory framework through which VA provides Veterans with compensation for diseases and injuries they incur while serving our nation.  It is this rating schedule that guides the disability rating personnel of VA and DoD in making the correct determination of the compensation benefit level applicable for a Veteran’s service-connected condition(s).  The VASRD contains disability percentages ranging from 0 to 100% that translate into monthly compensation for Veterans based, by statute, on “the average impairments of earning capacity.”  (38, U.S.C., section 1155)  VA is proactively updating and comprehensively revising the entire VASRD, which currently includes 15 body systems. This effort is the result of an October 2009 Secretarial directive to revise and update all parts of the VASRD, using current medical science and econometric earnings loss data.  The update process is statutorily required under Section 1155 of Title 38, which states that “[t]he Secretary shall from time to time readjust this schedule of ratings in accordance with experience.”  VA has partnered with DoD and the academic community to collaborate on revisions to the rating schedule.  The collaboration involves public forums in which medical experts, members of the Advisory Committee on Disability Compensation, DoD officials, Veterans Service Organizations, and other stakeholders provide input and subsequently form working groups to substantively revise the rating schedule. 

While the public forums and working groups gather input from these important entities, under title 38 U.S.C., section 1155, VA has ultimate responsibility for adjustments to the VASRD.  The Veterans Benefits Administration (VBA) has implemented a project management plan detailing the organizational, developmental, and supporting processes to modernize the rating schedule by 2016.  The plan calls for eight medical officers and six attorneys to work with the subject-matter experts and cross-agency working groups as described above.  The public forum and working group system is based on a methodology consistent with the Institute of Medicine’s method of involving medical subject matter experts across disciplines, agencies, and private sectors.  During this ongoing update process, VBA is engaged in a seamless partnership with VHA.

The VA remains fully committed to meeting the needs of our Nation’s heroes and their families.  VA and DoD are partners and will continue to work together diligently to resolve transition issues while aggressively implementing improvements and expanding existing programs.  These efforts continue to enhance the effectiveness of support for Wounded Warriors and their families.  While we are pleased with the quality of effort and progress made to date with our joint collaboration, we fully understand our two Departments have a responsibility to continue to improve these efforts.

Thank you again for your support to our wounded, ill, and injured Servicemembers, Veterans, and their families. This concludes my testimony and I will be happy to respond to any questions.