[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
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
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55-231
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
______
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JOHN J. HALL, New York, Chairman
DEBORAH L. HALVORSON, Illinois DOUG LAMBORN, Colorado, Ranking
JOE DONNELLY, Indiana JEFF MILLER, Florida
CIRO D. RODRIGUEZ, Texas BRIAN P. BILBRAY, California
ANN KIRKPATRICK, Arizona
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.
C O N T E N T S
__________
February 24, 2010
Page
Examination of the U.S. Department of Veterans Affairs Benefits
Delivery at Discharge and Quick Start Programs................. 1
OPENING STATEMENTS
Chairman John J. Hall............................................ 2
Prepared statement of Chairman Hall.......................... 27
Hon. Doug Lamborn, Ranking Republican Member..................... 1
Prepared statement of Congressman Lamborn.................... 28
WITNESSES
U.S. Government Accountability Office, Daniel Bertoni, Director,
Education, Workforce, and Income Security Issues............... 4
Prepared statement of Mr. Bertoni............................ 28
U.S. Department of Defense, Hon. Noel C. Koch, Deputy Under
Secretary of Defense (Wounded Warrior Care and Transition
Policy)........................................................ 10
Prepared statement of Mr. Koch............................... 36
U.S. Department of Veterans Affairs, Diana Rubens, Associate
Deputy Under Secretary for Field Operations, Veterans Benefits
Administration................................................. 23
Prepared statement of Ms. Rubens............................. 47
______
American Veterans (AMVETS), Raymond C. Kelley, National
Legislative Director........................................... 19
Prepared statement of Mr. Kelley............................. 42
Disabled American Veterans, John L. Wilson, Assistant National
Legislative Director........................................... 20
Prepared statement of Mr. Wilson............................. 43
Iraq and Afghanistan Veterans of America, Thomas Tarantino,
Legislative Associate.......................................... 15
Prepared statement of Mr. Tarantino.......................... 38
Veterans of Foreign Wars of the United States, Gerald T. Manar,
Deputy Director, National Veterans Service..................... 17
Prepared statement of Mr. Manar.............................. 40
SUBMISSION FOR THE RECORD
American Federation of Government Employees, AFL-CIO, and AFGE
National Veterans Affairs Counsel, statement................... 49
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to Daniel Bertoni, Director, Education, Workforce,
and Income Security Issues, U.S. Government Accountability
Office, letter dated March 25, 2010, and response letter
and attachment, dated April 16, 2010....................... 52
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to Hon. Noel Koch, Deputy Under Secretary of
Defense, Office of Wounded Warrior Care and Transition
Policy, U.S. Department of Defense, letter dated March 25,
2010, and DoD responses.................................... 55
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to Thomas Tarantino, Legislative Associate, Iraq
and Afghanistan Veterans of America, letter dated March 25,
2010, and IAVA responses................................... 58
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to Gerald T. Manar, Deputy Director, National
Veterans Service, Veterans of Foreign Wars of the United
States, letter dated March 25, 2010, and VFW responses..... 60
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to Raymond C. Kelley, National Legislative
Director, AMVETS, letter dated March 25, 2010, and AMVETS
responses.................................................. 64
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to John L. Wilson, Assistant National Legislative
Director, Disabled American Veterans, letter dated March
25, 2010, and DAV responses................................ 65
Hon. John J. Hall, Chairman, Subcommittee on Disability
Assistance and Memorial Affairs, Committee on Veterans'
Affairs, to Diana Rubens, Associate Deputy Under Secretary
for Field Operations, Veterans Benefits Administration,
U.S. Department of Veterans Affairs, letter dated March 25,
2010, and VA responses..................................... 68
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,
Committee on Veterans' Affairs,
Subcommittee on Disability Assistance and
Memorial 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 on
p. 28.]
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 on p. 27.]
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 on p. 28.]
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 still 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.
One 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 on p. 36.]
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 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 foolproof 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, 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
STATEMENT OF THOMAS TARANTINO
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 process if it is ever to be actually
effective. And informational Web sites, VA.gov and within the
DoD are great, but today's veteran expects services through
their Web sites in addition to information.
Mr. Hall. Mr. Tarantino if you would summarize with these
bullet points and----
Mr. Tarantino. I mean basically----
Mr. Hall. I appreciate it. Thank you.
Mr. Tarantino. Basically, IAVA, along with the other
veterans organizations, are pushing to reform the disability
process as a whole. We want to change the work culture at the
VA to emphasize quality over quantity, we want a modern
information technology (IT) system, and we want a more
transparent application process where that emphasizes customer
service and removes unnecessary steps.
Thank you very much for the opportunity.
[The prepared statement of Mr. Tarantino appears on p. 38.]
Mr. Hall. Thank you, Mr. Tarantino. I am sorry to interrupt
you, but we have votes coming up and I am hoping to get all of
our panelists' testimony before that happens.
Mr. Manar, you are now recognized.
STATEMENT OF GERALD T. MANAR
Mr. Manar. Mr. Chairman, thank you for this opportunity to
speak before the Subcommittee. On behalf of the 2.1 million men
and women of the Veterans of Foreign Wars of the United States
and our auxiliaries, we appreciate the opportunity to present
our views and concerns regarding the VA Benefits Delivery at
Discharge and Quick Start Programs.
In the past 20 years, DoD and VA have made significant
strides to ensure that our newest veterans are better prepared
for life after discharge than any generation of veterans that
preceded them. Unfortunately, we believe that VA fails to reach
tens of thousands of those leaving active duty and most members
of the Reserve and National Guard. Further, the quality of the
ratings given those warriors is often poor.
The VFW began placing National Service Officers on select
military installations in 2001. Today, we have nine Pre-
Discharge Claims Representatives serving servicemembers at 16
military installations. We also have National Service Officers
in San Juan and Las Vegas who work at nearby military bases and
help servicemembers who qualify for the BDD and Quick Start
Programs. Last year our service officers briefed over 14,400
servicemembers and helped over 8,400 file disability claims.
They received over $9 million in benefits shortly after
discharge.
VA reports that it received 51,000 claims from the BDD and
Quick Start programs in 2008, up from 47,000 the year before.
Further, it reports that nearly 60 percent of those it briefed
filed claims.
If 51,000 claimants represent 60 percent of those briefed,
then VA is briefing only about 85,000 servicemembers. However,
with over a hundred thousand personnel leaving active duty and
another hundred thousand released from the Reserves and
National Guard each year, it is clear that a large number of
those who serve our Nation are not receiving critical
information through VA's outreach effort.
The most interesting observation to be made from this data
is that it appears VA is a victim of its own success. While
51,000 claims submitted under the BDD and Quick Start program
may constitute only a small part of VA's annual claims receipt,
VA devotes a significant portion of its workforce to educating
servicemembers, as well as developing and rating those claims,
thereby reducing its ability to deal with the rest of the
workload.
We do not suggest that VA or DoD lessen their efforts in
helping servicemembers prepare for life after the military. It
is absolutely the right thing to do. However, it is important
to recognize that doing so comes at a cost. We applaud Congress
for encouraging these programs, and we support VA and DoD in
their efforts to ensure that every servicemember has an
opportunity to adequately prepare for their lives after
discharge.
As we see it, VA has several challenges to resolve if it
hopes to increase the number of servicemembers it reaches and
the quality of the service it provides them.
There are too many servicemembers who are not adequately
briefed about their benefits prior to discharge. Further, VA
has been slow to expand the BDD program to additional
installations. Since 2004, VA has expanded its presence at
military bases from 139 to only 153 bases. VA must move more
quickly to expand to other military installations.
Veteran service organizations are critical partners in the
BDD program. VA personnel often do little more than help
servicemembers fill out a claim form. VFW service officers
usually spend an hour with each servicemember, they go through
the service treatment records page by page, identifying chronic
problems which may be granted service connection and ensure
that those conditions are documented on the application.
Finally, they provide answers about what to expect in dealing
with VA.
As helpful as veteran service officers are, you would think
that DoD would welcome us with open arms. Gaining the
permission of DoD to work on base requires careful and extended
negotiations with both base commanders and the VA. That's
because VA does not anticipate that service organizations may
be able to provide service officers to help. As a consequence,
space, always at a premium, is often difficult to find.
As VA and DoD expand the BDD program to other
installations, we urge them to reach out to veteran service
organizations to determine whether we're able to provide
service officers to help them help servicemembers.
Finally, in our experience, quality of disability ratings
is no better in BDD and Quick Start cases than it is for other
veterans. In November 2009, Winston-Salem, San Diego, and Salt
Lake City, the offices where these claims are processed, had
substantive error rates ranging from 17 to 22 percent. By VA's
own admission, and we view these numbers with a great deal of
suspicion based on our own experience, one out of every five
decisions it makes are wrong.
There are 29 Members in the House Veterans' Affairs
Committee. If you all submitted claims for benefits from the
VA, nearly six of you would have ratings which were in error.
We encourage Secretary Shinseki and his management team to
focus this year on changing the culture in the Veterans
Benefits Administration (VBA) so that quality is the rule not
the exception.
I thank you for this opportunity to testify on these
important programs, and I look forward to answering any
questions you may have.
[The prepared statement of Mr. Manar appears on p. 40.]
Mr. Hall. Thank you, Mr. Manar.
Mr. Kelley, you are now recognized.
STATEMENT OF RAYMOND C. KELLEY
Mr. Kelley. Thank you, Mr. Chairman. Due to time
constraints, I'm going to limit my discussion to the BDD
program only.
Despite the fact that tens of thousands of servicemembers
have used the BDD program at more than 150 locations, there are
issues that must be addressed to improve the program, not only
for the veterans who utilize it, but also for DoD and VA. If
there continues to be impediments and inconsistencies in the
departments that facilitate the program, it's value will be
lost.
The concept of a single separation physical seems simple
enough; however, physicals can be facilitated by either DoD,
VA, a contractor, or a combination of the three. The national
agreement between VA and DoD sets guidelines for local MOUs
that will determine who will be responsible for the physical.
However, there have been some challenges at the local level in
communicating and following the content of the local MOU.
A 2008 GAO report found that more than half of all BDD
intake sites visited had challenges in administering a single
comprehensive exam. Often it was the lack of communication that
failed to reach DoD personnel at the lowest level, therefore,
duplicate exams continued to take place. Often local leadership
and commands did not understand the program, and, therefore,
ignored the MOU and continued to administer two exams.
Resources were also identified as a challenge for local BDD
facilities. In some locations, DoD physicians were not
qualified to conduct exams that would meet both DoD and VA
requirements. In other locations when DoD is required by the
local MOU to conduct the exam, no provisions were put in place
to accommodate the increase in time and resources it would take
to conduct the exam.
These and other issues make it difficult for bases offering
BDD to meet time frames set by the program. These MOUs must be
disseminated and understood by all personnel who are effected
by the MOU to insure proper implementation. Also, if there are
implementation issues, the MOU must be revised to better meet
the needs of the BDD sites.
Because VA does not control or enforce the local BDD sites,
AMVETS believes VA cannot expect--cannot be expected to account
BDD development time in their timeliness of claims process.
However, AMVETS believes it is important to track the BDD
process from intake so efficiencies can be identified and best
practices can be developed. A plan should be put in place that
will allow VA to track the development process of BDD claims
and conduct periodic reviews so efficiencies can be determined.
Enforcing--informing servicemembers of this program
continues to be difficult. Again, local commands' understanding
and support for the program greatly affect participation. If
the military command does not see the value in the program,
they will not be as likely to disseminate the information to
the troops. VA and DoD must make a concerted effort to educate
base command structures so there will be a buy-in to the
program.
The Transition Assistance Program should be an excellent
way to communicate the BDD program to transitioning
servicemembers, as well. However, only the Marine Corps
mandates that TAP participates--participants attend the VA
presentation. Since this portion isn't mandatory,
servicemembers have the perception it isn't important, leading
to low participation. The VA benefits portion of TAP should be
mandatory.
AMVETS also believes each regional office should have the
authority to rate BDD claims. We understand that as a pilot
program, it was practical to have only two offices rate these
claims. But now with more than 150 intake locations, allowing
ROs to rate claims should increase the timeliness of
adjudication.
AMVETS is also concerned that BDD enrollees must fill out
different forms--BDD enrollees must fill out a different form
than veterans who file a traditional claim. These are stark
differences in the two forms--there are stark differences in
the two forms, most notably the length of the form and the
depth of the questions asked. The BDD form is shorter and lacks
instructions. Also the respondent's burden of time for filling
out the BDD form is half of that of the traditional form. This
is due, in part, to the degree of explanation that is required.
For example, each form asks the veteran to state what
disabilities they are claiming. The BDD form provides a small
block with only four notebook-style lines for the veteran to
state their claim. But in the traditional form, the veteran is
provided with an entire page asking for specific details. A
study must be conducted to determine if providing
servicemembers with a reduced form has any adverse effects on
the development and the final rating of these claims.
Mr. Chairman, this concludes my testimony. And I will be
happy to answer any questions that you have.
[The prepared statement of Mr. Kelley appears on p. 42.]
Mr. Hall. Thank you, Mr. Kelley.
Mr. Wilson, you are recognized for 5 minutes.
STATEMENT OF JOHN L. WILSON
Mr. Wilson. Thank you, sir. Mr. Chairman and Members of the
Committee, I am glad to be here today on behalf of the Disabled
American Veterans to address the Department of Veterans Affairs
Benefits Delivery Discharge and Quick Start programs.
VA and DoD collaboration to establish single separation
exam programs has generally been successful. According to a GAO
report entitled, ``Better Accountability and Access Would
Improve the Benefits Delivery at Discharge Program,'' of
September 2008, and the February 2010 GAO report on the same
subject, veterans may begin receiving benefits within 2 to 3
months instead of the typical 6 or 7 months if they had applied
after discharge under the traditional disability claims
process.
While the programs can generally be viewed as successful,
there are concerns with performance measures and program
management. For example, VA's FY 2009 Performance and
Accountability Report, or PAR, has only one supporting measure
for BDD and Quick Start. It does not separate BDD and Quick
Start data despite their specific eligibility differences and
population focus. VA also does not include BDD claim
development time, as a rule, as was discussed earlier.
While the timeliness of receipt of benefits after discharge
is useful, excluding the time spent on development of claims
makes it difficult to correct negative trends and adopt
positive ones. This most recent GAO report draws the same
conclusion as Disabled American Veterans.
An important next step for a seamless transition of all
military personnel would be implementation of a mandatory
single comprehensive medical examination in order to complete
military separation. It seems logical.
The DoD and VA have made positive strides in transitioning
our Nation's military to civilian lives and jobs at their work
with the Department of Labor's Transition Assistance Program
and Disabled Transition Assistance Program. These TAP and DTAP
programs have improved but challenges remain. The prospect of a
servicemember after multiple deployments returning stateside to
be placed on medical or administrative hold has dissuaded some
from going to these briefings and from filing disability
claims. Also, while receiving information has improved, quick
processing time may allow some individuals to fall through the
cracks. This is of particular concern for DTAP participants
where those with severe disabilities may already be getting
health care from a VA spinal cord injury center despite still
being on active duty. Since they are no longer located near a
military installation, they are often forgotten in the
transition systems process. DTAP has not had the same level of
success as TAP, and closer coordination from the DoD, VA, and
VETS is critical to improving this disparity.
In conclusion, the BDD and Quick Start programs are a
generally effective tool. Their effectiveness could be even
greater should the DoD and VA incorporate our suggestions.
It has been a pleasure to appear before you this afternoon.
I will be happy to answer any questions you may have.
[The prepared statement of Mr. Wilson appears on p. 43.]
Mr. Hall. Thank you very much, Mr. Wilson. And I will ask
each of you to answer this, if you would. Both BDD and Quick
Start are generally considered to be successful programs and
good ideas. That being said, if there was one thing you would
change in these programs, what would it be? Mr. Tarantino.
Mr. Tarantino. Mr. Chairman, I think you are correct. They
are excellent programs, and they are great ideas. The fact that
it took 12 years just to get to the not-quite full
implementation is a little bit insane.
I think if I would change that, I would roll it out
completely, and I would make sure that every single
servicemember knows that these programs exist and are able to
easily apply for them, that it is command supported, and it's
part of transition assistance, not just 60 or 90 days out, but
6 months to a year out when they are actually looking at that
decision, thinking about their retention options.
Mr. Hall. Thank you. Mr. Manar.
Mr. Manar. Well, I could say, ``Ditto,'' but let me expand
on a couple of other things, and that is quality. As I spoke
earlier, quality is really poor in the VA rating program. And I
think if we could change one thing, it would be that the
quality of rating decisions be improved substantially.
No one in this room would even think about buying a car,
for instance, where 20 percent of its parts were defective or
where you had a chance that one out of every five cars would
stop working as soon as you left the dealership.
So I think the VA--the one thing we need here is vastly
improved quality of rating decisions.
Mr. Hall. Mr. Kelley.
Mr. Kelley. I think that, to continue to add, having MOUs
at the local level that work and insuring that those MOUs work.
So if the DoD is tasked with providing these physicals, that,
okay, that's what the MOU says, but do they have all the
resources that they need on that base to facilitate that in a
timely manner and with the resources that they need? And I
think that's the biggest thing, and perhaps educating DoD
leadership on the importance of this BDD program.
Mr. Hall. Mr. Wilson.
Mr. Wilson. Building on that, I would say mandatory
physical exams. For active duty personnel, it's not a problem.
For the Guard and Reserve, demobilization makes this difficult.
But nonetheless, the resources should be made available to keep
every Guardsman or Reservist on active duty--on active duty
orders until they are able to get their separation physicals.
At that time, and only then, should their paperwork be
certified and they are eligible to then separate from the
service.
Mr. Hall. Okay. Thank you so much for your testimony. You
have been most helpful. We will submit more questions to you in
writing, if you don't mind. And I think we can move on with the
information you have given us, and go to our final witness
before these votes are called.
So Mr. Tarantino, Mr. Manar, Mr. Kelley, and Mr. Wilson,
you are all excused. Thank you, again, very much, for your
service to our veterans.
Our third panel now consists of Diana Rubens, Associate
Deputy Under Secretary for Field Operations, Veterans Benefits
Administration, U.S. Department of Veterans Affairs,
accompanied by Mr. Bradley Mayes, Director of Compensation and
Pension Service at the VBA, U.S. Department of Veterans
Affairs. Thank you both for your patience and thank you to all
of our previous witnesses for their concise testimony.
Ms. Rubens, welcome and you are now recognized.
STATEMENT OF DIANA RUBENS, ASSOCIATE DEPUTY UNDER SECRETARY FOR
FIELD OPERATIONS, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY BRADLEY G.
MAYES, DIRECTOR, COMPENSATION AND PENSION SERVICE, VETERANS
BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Rubens. Thank you, Mr. Chairman. Thank you for your
support on the issues for veterans benefits.
It is my pleasure today to discuss our ongoing nationwide
Benefits Delivery at Discharge and Quick Start pre-discharge
programs. As you mentioned, Mr. Mayes has joined me here today.
These two programs are really just elements of our strategy
to provide that transition assistance to separating or retiring
servicemembers and to engage those servicemembers in the claims
process prior to discharge. A pre-discharge claim is any claim
received from a servicemember prior to release from active
duty.
VBA's goal is to ensure that each and every servicemember
separating or retiring from active duty who wishes to file a
claim with VA for a service-connected disability benefit will
receive assistance in doing just that.
We have talked a lot about the fact that the BDD program is
open to servicemembers who are within 60 to 180 days of being
released, as well as the Quick Start being available to those
servicemembers with 59 days or less prior to separation.
One of the things that I think is interesting is that
during the fiscal year 2009, our BDD and Quick Start claims may
have represented just 20 percent of all our original
compensation claims received nationwide. But during the same
period, approximately 65 percent of separating servicemembers
who filed their claims within 1 year of separation came through
the BDD and Quick Start programs. So we think that our profile
using these programs has been high. We know that we'd like to
improve it, but we think we're doing pretty well at this point.
The timeliness for our processing for both BDD and Quick
Start claims is much better than our general workload, and we
believe that that is because we are getting that head start on
the claim before that servicemember gets out of the Service.
As mentioned previously, one of the things that we have
worked to do is streamline the process by incorporating an
imaging technology for the paperless processing of the BDD
claims. Our BDD paperless processing began initially as a pilot
in the Winston-Salem Rating Activity Site in March of 2006, and
was expanded to the Salt Lake Rating Activity Site in March of
2007. The goal was to paperlessly process our BDD claims
through the entire life cycle from initial submission through
adjudication and, if applicable, through the appeals
resolution. The advantage to processing BDD claims in a
paperless environment included reduction of time and cost
associated with shipment of folders. In August of 2008, we
began ensuring that all BDD claims were being sent to our
scanning vendor so that they could be incorporated into the
paperless environment.
Talking about the environment that we are using today, what
we recognize is that our existing Virtual VA architecture and
configuration are not scalable for all C&P processing.
Currently we are developing the Veterans Benefits Management
System as an initiative to establish our large-scale effort so
that we have an IT solution that will allow us to do all
processing within that paperless environment.
We have talked quite a bit about the outreach efforts and
the things that we are doing jointly with DoD to ensure that
servicemembers prior to release are getting information. In
addition to having those brochures, the Web sites, and the
folks out at the TAP and the DTAP sessions, I want to touch on
the fact that we are continuing to expand the number of
servicemembers we are reaching. In fiscal year 2008, there were
roughly 300,000 servicemembers that, through the myriad or
programs we have, received information on benefits prior to
discharge. In fiscal year 2009, that number exceeded 360,000.
So we are looking to continue to increase that exposure to
ensure all servicemembers released from active duty are aware
of the benefits that they have so richly earned.
I am going to conclude with renewing our commitment to
providing efficient and timely service to our Nation's
veterans. We continue to evaluate the BDD and Quick Start
programs to look for those improvements that we can accomplish
with current technology, as well as new technology to further
enhance benefits delivery under these important programs and to
improve the veteran's experience.
This concludes my testimony. I would be pleased to answer
any questions you might have.
[The prepared statement of Ms. Rubens appears on p. 47.]
Mr. Hall. Thank you, Ms. Rubens. You are onto something,
you and Mr. Mayes. And I think we are all impressed with the
potential and also with what has been realized already with
these programs.
Your testimony points out that 65 percent of separating
servicemembers who filed their claims within 1 year did so
through BDD and Quick Start. My first question is would there
be a benefit to keeping statistics of BDD and Quick Start
utilization separately?
Mr. Mayes.. Mr. Chairman, we are tracking the utilization,
in other words, service personnel that are separating and
filing their claims through the BDD program or the Quick Start
program as a ratio of all of those servicemembers that are
filing claims within a year. That is one of the things that we
have worked with the Department of Defense to come up with a
utilization rate measure. So we are doing that.
And we have seen it increase through the years, as Ms.
Ruben pointed out in her testimony, which we believe is a
measure of the success. To me that says that we are getting the
word out. The commands are making the servicemembers available.
As you mentioned, and I think Under Secretary Koch mentioned,
for the Marine Corps it is mandatory. We are continuing to push
that through our collaboration with DoD through the Benefits
Executive Council and the Joint Executive Council.
So those are the kinds of things that we are doing, as you
mentioned, in improving utilization.
Mr. Hall. Right. Excuse me. There's 12 minutes left on the
vote, and I just want to ask you a couple more questions, and
then we will submit further questions in writing. But what do
you think accounts for the other 35 percent who do not
participate in the program?
Mr. Rubens. I would tell you that I think that there are
some servicemembers who, as they get out, feel as though they
are healthy, that their period of service hasn't brought them
to the point where they need to submit a claim.
Mr. Hall. Okay. And thank you. Sounds like a reasonable
assumption for many of them. We understand that there are 142
BDD sites. Are there qualified physicians available to do BDD
exams at all those sites?
Mr. Mayes. There are actually 131 sites that are covered by
a formal Memorandum of Understanding, 95 total MOA. We are
doing the single separation exam at 153 sites. So there is
capacity to do those single separation exams at all of those
sites. As we mentioned, and I think you mentioned in your
opening statement, servicemembers can still file claims through
the Quick Start program even if they can't get the single
separation exam at that site.
Mr. Hall. What help can we in Congress give you to expand
BDD and Quick Start?
Mr. Mayes. Mr. Chairman, I think that Congress help us get
the word out. We delivered pamphlets. You clearly have a good
grasp of the program. I think that is helpful. When your staff
and your local offices understand this program, they have an
opportunity to interact with veterans, Guard, and Reserve
units, helping us to continue to do that.
And as Under Secretary Koch said, us presenting here before
you and answering these questions forces us to take a look at
what we are doing. We are going to continue to collaborate with
the Department of Defense to push so that we have access to
active duty and Guard and Reserve members service personnel
before they get out. We would love to see mandatory TAP so that
we have that opportunity to educate people that are leaving the
service.
Mr. Hall. Thank you, Mr. Mayes. And I have one last
question is regarding the GAO report, which noted a failure to
effectively track the accuracy of claims that are processed
through these specific programs. Does the VA view this as a
significant concern and are there any potential complications
involved in tracking these programs separately?
Mr. Mayes. We do look at a valid sample of decisions
requiring a rating determination for each regional office
around the country. It is a valid sample, 256 cases per
regional office per year. That would include the Rating
Activity Sites at Winston-Salem, Salt Lake, and the site in San
Diego.
So within that sampling are cases that are worked through
the BDD program. All of the sites where there is consolidated
processing actually had higher quality on average than the
nationwide average. So we felt that through that National
Quality Assurance Program that we were capturing how well they
make an entitlement determination. In the end, the entitlement
determination for a BDD or a Quick Start claim is grounded in
the same requirements, the same regulations, the same rules as
any other claim. So we felt we were properly evaluating the
quality for those sites.
Mr. Hall. Well, thank you, Ms. Rubens and Mr. Mayes, for
your work for our veterans and servicemembers and for your
testimony today. The Subcommittee may have further questions
that we will submit in writing to you. Those Members who were
unable to be here today may have questions, but I want to note
that there are 5 legislative days for other Members to make
remarks or submit questions for the record. And thank you to
all of our witnesses today.
This hearing is now adjourned.
[Whereupon, at 3:27 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. John J. Hall, Chairman,
Subcommittee on Disability Assistance and Memorial Affairs
Good afternoon.
Would everyone please rise for the Pledge of Allegiance? Flags are
located at the front and back of the room.
Ladies and gentlemen, we are here today to examine the Benefits
Delivery at Discharge (BDD) and Quick Start programs, two components of
the pre-discharge program established by the Departments of Defense
(DoD) and Veterans Affairs (VA) to streamline servicemembers'
transition from active duty to veterans' status.
By way of background, any member of the Armed Forces who has seen
active duty--including those in the National Guard or Reserves--is
eligible to apply for VA disability benefits prior to leaving military
service through the BDD program or Quick Start pre-discharge program.
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 the health exam required by the DoD upon exiting the
military and the VA disabilities assessment exam into a single exam.
Once a BDD or Quick Start claim is approved, veterans may begin
receiving benefits within 2 to 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. In 1998, VA and DoD fully rolled
out the BDD program.
Last Congress, my friend Rep. Peter Welch (D-VT) 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 (P.L. 110-181). This statute ensures that
Guardsmen as well as Reservists can participate in the VA/DoD pre-
discharge program.
In the past 15 years, over 170,000 servicemembers have availed
themselves to BDD and QuickStart processing. 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
processed in 2009, were processed in a paperless environment, with an
average processing time of 95.5 days. It is VA's stated goal to be
processing all compensation and pension claims in a ``paperless''
environment. The Subcommittee is committed to helping VA achieve this
goal.
I, along with Congressman Rodriquez, and other Members of this
Committee and Congress, requested that GAO prepare a report to assess
the effectiveness of the BDD and Quick Start initiatives. I look
forward to hearing from the GAO about its report, how its
recommendations have been implemented, and what, if any impact they
have had on the pre-discharge program.
We also look forward to feedback from veteran service organizations
as well as from VA and DoD on what if any resources are needed to fully
realize the potential of these two tools.
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 P.L. 110-389.
P.L. 110-389 paved the way for a number of initiatives also targeting
the VA claims backlog issue. It is my hope that the BDD and Quick Start
programs we examine today, coupled with the electronic claims system
and other business reformation efforts in P.L. 110-389 currently
underway at VA will together help significantly transform today's VA
claims processing system so that we may soon play ``Taps'' for the VA
comp & pen backlog.
I now recognize Ranking Member Lamborn for his opening statement.
Prepared Statement of Hon. Doug Lamborn, Ranking Republican
Member, Subcommittee on Disability Assistance
Thank you Mr. Chairman,
And welcome everyone, to this hearing on the Benefits Delivery at
Discharge and Quick Start programs.
These programs are modeled 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'm 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 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 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 assessment of the BDD program.
GAO's findings confirmed that allowing claims to befiled 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, I
yield back.
Prepared Statement of Daniel Bertoni, Director, Education, Workforce,
and
Income Security Issues, U.S. Government Accountability Office
VETERANS' DISABILITY BENEFITS
Opportunities Remain for Improving Accountability for and Access to
Benefits Delivery at Discharge Program
GAO Highlights
Why GAO Did This Study
Through the Benefits Delivery at Discharge (BDD) program, the
Department of Veterans Affairs (VA) collaborates with the Department of
Defense (DoD) to streamline access to veterans' disability benefits by
allowing some servicemembers to file a claim and undergo a single
collaborative exam process prior to discharge. BDD is designed for
servicemembers with conditions that, while disabling, do not generally
prevent them from performing their military duties. This program can
shorten the time it takes for veterans to receive benefits by several
months.
GAO was asked to discuss issues surrounding VA's and DoD's BDD
program and related Quick Start program, and identify ways VA and DoD
could improve these programs for transitioning servicemembers. This
statement is based on GAO's September 2008 report (GAO-08-901) that
examined (1) VA efforts to manage the BDD program and (2) how VA and
DoD are addressing challenges servicemembers face in accessing the BDD
program. GAO updated some information to reflect the current status of
claims processing and improvement initiatives in the BDD program.
What GAO Found
Although VA awards disability benefits more quickly under BDD than
through its traditional disability claims process, gaps in program
management and accountability remain. For example, VA does not
separately measure the total time its personnel spend developing BDD
claims. As a result, VA has limited information on potential problems
and improvement opportunities regarding BDD claims. GAO continues to
believe that VA should measure BDD development time; however, VA told
GAO it has no plans to capture this information. GAO also found that VA
implemented two initiatives to improve the BDD program--i.e.,
consolidating BDD processing in two offices and instituting paperless
processing of BDD claims to increase efficiencies and improve security
of information--but did not evaluate whether or the extent to which
desired improvements resulted. Finally, GAO found that VA was not
completely or consistently monitoring BDD operations at all locations.
VA has since taken steps to review BDD operations at more sites and has
revised its protocols to ensure more consistent reviews of BDD
operations.
VA and DoD have taken steps to improve servicemembers' access to
the BDD program; however, opportunities remain for further improvement.
For servicemembers such as National Guard and Reservists who are
generally unable to complete the BDD claims process within the required
time frame, VA established an alternative predischarge program called
Quick Start. Under this program, servicemembers may still initiate a
disability application prior to discharge, but can complete the claims
process, including medical exams, at another location after discharge.
In response to GAO's recommendation, VA has taken steps to collect
additional data to determine the extent to which the Quick Start
program is helping those with limited or no access to the BDD program.
However, as with BDD claims, VA told GAO it has no plans to measure
time spent developing these particular claims, and GAO continues to
believe it should. VA and DoD have coordinated to increase BDD program
awareness through VA benefits briefings for servicemembers, and DoD
established a goal that 85 percent of servicemembers attend these non-
mandatory briefings. GAO continues to believe that DoD should establish
a plan with a specific time frame for meeting this goal, but DoD has
not developed such a plan. Finally, GAO found that some bases faced
difficulties maintaining local agreements intended to prevent
redundancy and inconvenience for servicemembers in obtaining required
medical exams. In response to GAO's recommendation, DoD reported that
it is working with VA to identify best practices to address local
challenges to implementing their cooperative exam process.
__________
Mr. Chairman and Members of the Subcommittee:
I am pleased to have the opportunity to comment on the Benefits
Delivery at Discharge (BDD) program and related Quick Start program,
which are administered by the Department of Veterans Affairs (VA) in
collaboration with the Department of Defense (DoD). Both programs are
intended to help servicemembers transition from military service to
life as civilians and veterans by allowing them to initiate their VA
disability benefits applications while they are still in the military.
The BDD program further allows servicemembers to go through one
collaborative examination process that satisfies DoD's requirement to
determine their general health and VA's requirement to assess any
claimed disabilities, instead of separate exam processes for both DoD
and VA. Under BDD and Quick Start, veterans should begin receiving
benefits sooner than the 6 to 7 months it would typically take if they
had applied after discharge under the traditional disability claims
process. Both programs are designed for servicemembers with conditions
that, while disabling, do not generally prevent them from performing
their military duties.\1\
---------------------------------------------------------------------------
\1\ The military has a separate disability evaluation process for
servicemembers who are being discharged because they can no longer
perform their duties because of a disabling condition.
---------------------------------------------------------------------------
You asked us to discuss issues surrounding VA's and DoD's BDD
program and related Quick Start program, and identify ways VA and DoD
could improve these programs for transitioning servicemembers. My
statement draws on our prior work, which examined (1) VA efforts to
manage the BDD program and (2) how VA and DoD are addressing challenges
that servicemembers face accessing the BDD program,\2\ and was
conducted in accordance with generally accepted government auditing
standards. We have updated some information to reflect the current
status of VA claims processing and improvement initiatives in the BDD
program.
---------------------------------------------------------------------------
\2\ GAO, Veterans' Disability Benefits: Better Accountability and
Access Would Improve the Benefits Delivery at Discharge Program, GAO-
08-901. (Washington, D.C.: Sept. 9, 2008).
---------------------------------------------------------------------------
In summary, we found that although VA awards compensation more
quickly under BDD than through its traditional disability claims
process, there are gaps in program management, accountability, and
access. For example, VA does not track time spent developing a BDD
claim prior to the servicemember's discharge and therefore lacks
information on how efficiently its personnel are developing BDD claims.
In addition, although VA and DoD have made efforts to improve all
servicemembers' access to the BDD program, we identified additional
opportunities to help improve access. For example, VA established the
Quick Start program whereby servicemembers unable to complete exams
within BDD's required time frames--such as National Guard and
Reserves--may at least initiate a disability application prior to
discharge.\3\ However, VA lacked sufficient data to determine whether
the Quick Start program was helping those with no or limited access to
the BDD program. In response to our recommendation, VA has updated its
data system to track participation by National Guard/Reserves. We also
found that efforts to raise awareness about the BDD program may not
reach all those who are eligible. DoD has set a goal that 85 percent of
servicemembers attend Transition Assistance Program (TAP) sessions, but
it has not implemented our recommendation to establish a plan with a
specific time frame to meet this goal, and we continue to believe that
it should.
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\3\ At the time of our review, VA referred to this program as its
new, alternative predischarge program. Today, this program is referred
to as the Quick Start program.
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Background
Through its disability compensation program, VA pays monthly
benefits to veterans with service-connected disabilities.\4\ Under VA's
BDD program, any member of the armed forces who has seen active duty--
including those in the National Guard or Reserves--may apply for VA
disability benefits prior to discharge. The program allows veterans to
file for and potentially receive benefits earlier and faster than under
the traditional claim process because medical records are more readily
accessible and key forms needed to process the claim can be signed
immediately. Establishing that the claim is related to the member's
military service may also be easier under the BDD program because the
member is still on active duty status. In 2008, VA and DoD offered the
program at 142 bases,\5\ providing access to over 70 percent of
servicemembers who were discharged in fiscal year 2007.\6\ In July
2008, VA issued policy guidance allowing servicemembers being
discharged from any military base to initiate BDD claims at other
locations where VA personnel were located, such as at all of its 57
regional offices. VA also established an alternative predischarge
program, now called Quick Start, to provide members who cannot
participate in the BDD program an opportunity to initiate claims before
discharge. Last year, over 51,000 claims were filed through the BDD and
Quick Start programs.
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\4\ The amount of disability compensation depends largely on the
severity of the disability, which VA measures in 10 percent increments
on a scale of 0 percent to 100 percent. In 2010, basic monthly payments
for veterans with no dependents have ranged from $123 for 10 percent
disability to $2,673 for 100 percent disability.
\5\ BDD is also present at an additional 11 Coast Guard bases,
which are administered by the Department of Homeland Security.
\6\ This percentage does not include members of the National Guard
or Reserve forces.
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To participate in the BDD program, servicemembers generally must
meet six requirements: (1) be in the process of being honorably
discharged from military service, (2) initiate their application for VA
disability benefits between 60 and 180 days prior to their discharge
date, (3) sign a Veterans Claims Assistance Act (VCAA) form,\7\ (4)
obtain and provide copies of their service medical records to local VA
personnel, (5) complete a VA medical exam, and (6) remain near the base
until the exam process is done. The 60- to 180-day time frame is
intended to provide sufficient time prior to discharge for local VA
personnel at BDD intake sites to assist members with their disability
applications, including scheduling exams.
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\7\ The Veterans Claims Assistance Act of 2000 (VCAA) (Pub. L. No.
106-475) assigns VA the duty to assist veterans in obtaining any
records relevant to their claims, provided the veterans adequately
identify such records so that VA is able to request them.
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While VA has examination requirements for those applying for
disability compensation, DoD also has examination requirements for
those leaving military service. For all servicemembers leaving the
military, the military services generally require health assessments
that consist of a questionnaire about the member's general health and
medical history, among other topics. In some cases, members who are
separating from the military may receive a physical exam to obtain
evidence for a particular medical problem or problems that might exist.
The purpose of the exam is to obtain information on the individual's
medical history, and includes diagnostic and clinical tests, depending
on the types of disabilities being claimed. VA's exam for disability
compensation is more comprehensive and detailed than the military
services' separation exams, which are intended to document continued
fitness for duty, whereas the purpose of the VA exam is to document
disability or loss of function.\8\
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\8\ See GAO, VA and DoD Health Care: Efforts to Coordinate a Single
Physical Exam Process for Servicemembers Leaving the Military, GAO-05-
64 (Washington, D.C.: Nov. 12, 2004).
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Under the BDD program, DoD and VA coordinate efforts to perform
exams for servicemembers being discharged that satisfy requirements of
both the military and VA. Because of variation in the availability of
local resources, such as physicians trained to use VA's exam protocols,
DoD and VA agreed that local military bases should have flexibility to
determine whether VA or military physicians or some combination of both
will conduct the exam. In 2004, the agencies signed a memorandum of
agreement (MOA) delineating their roles and responsibilities. The
national agreement delegates authority to VA regional offices and
individual military bases to create memorandums of understanding (MOU)
that detail how the exam process will be implemented at the local
level.
VA's Veterans Benefits Administration (VBA) is responsible for
administering and monitoring the BDD program.\9\ VBA personnel assemble
claims-related information and send the claims to be processed at one
of two regional offices.\10\ VBA is also responsible for the paperless
BDD claims process, an initiative intended to improve efficiency by
converting claims-related information stored in paper folders into
electronic format, as part of VA's effort to have all claims processed
electronically by the end of 2012.
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\9\ While VA administers the BDD program, VA and DoD's Joint
Executive Council (JEC) oversees joint efforts to eliminate barriers
that servicemembers may face as they leave the military. Under the JEC,
the Benefits Executive Council is focused on improving information
sharing between the agencies and the transition process for
servicemembers.
\10\ In 2006 VA completed its consolidation of BDD processing
activities into two regional offices--Salt Lake City, Utah, and
Winston-Salem, North Carolina--to increase the consistency of BDD
claims.
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VA has established a performance goal to increase the percentage of
first-time disability claims filed through the BDD program.
Servicemembers generally learn of the BDD program through VA-sponsored
benefits briefings conducted at military bases as part of TAP sessions.
Led primarily by the Department of Labor, TAP consists of about 3 to 4
days of briefings on a variety of topics related to benefits and
services available to servicemembers as they are discharged and begin
life as veterans. Generally, servicemembers are required to attend a
short introductory briefing, while all other sessions--including the VA
benefits segment in which members learn about BDD--are optional.
In addition to its participation goal for the BDD program, VA has
three general goals for the timeliness and accuracy of all disability
claims: average days pending (i.e., waiting for a final decision),
average days to complete all work to reach a final decision, and
average accuracy rate (percentage of claims with no processing
errors).\11\ In 2009, VA reached its performance goal for one measure,
i.e., average days to complete claims was 161 days compared with a goal
of 168 days. However VA fell short of two goals last year: Average days
pending was 117 days compared with a goal of 116 days, and national
accuracy rates were 83 percent compared with a goal of 90 percent.\12\
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\11\ VA has several other measures for claims overall, including
measures of satisfaction and how well VA keeps veterans informed of
benefits.
\12\ National accuracy rate data are through July 2009.
VA's Management of the BDD Program Provides Limited Accountability for
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Results, although Recent Improvements Have Been Made
VA Has a Performance Measure for BDD Participation, but Lacks Adequate
Measures for Timeliness of BDD Claims
VA has established one performance measure for the BDD program that
tracks participation in the program. Since fiscal year 2005, VA has
tracked the percentage of all disability claims filed through the BDD
program within 1 year of discharge. VA's most recent data for fiscal
year 2008 indicate that 59 percent of claims filed within 1 year of
discharge were filed through the BDD program--9 percentage points
higher than its fiscal year 2008 goal of 50 percent. VA recently
revised this measure so that it accounts only for claims filed by
members who are discharging from bases covered by the BDD program.\13\
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\13\ Previously, VA had included in the denominator claims from
members who were discharged from non-BDD locations. Using those data,
in fiscal year 2007, only 43 percent of first-year claims were filed
through BDD, significantly short of VA's goal. VA will come closer to
its goal by excluding servicemembers who, being from non-BDD locations,
will generally be unable to meet BDD program requirements.
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Although VA fine-tuned its measure for BDD program participation,
VA does not adequately measure timeliness of BDD claims. VA tracks the
days it takes to process traditional claims starting with the date a
veteran first files a claim, whereas it tracks days to process BDD
claims starting with the date a servicemember is discharged.\14\ This
approach highlights a key advantage of the BDD program--that it takes
less time for the veteran to receive benefits after discharge. However,
the time VA spends developing a claim before a servicemember's
discharge--at least 60 days according to VA--is not included in its
measures of timeliness for processing BDD claims, even though claims
development is included in VA's timeliness measures for traditional
disability claims.\15\
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\14\ While VA lacks a separate performance measure on BDD
timeliness, VA officials reported the agency does track the average
days BDD claims are pending a decision and the average days it takes VA
to complete work on BDD claims separately from traditional claims.
However, VA includes only the time after servicemember discharge when
tracking BDD timeliness.
\15\ By not including the time it takes to develop BDD claims, VA
underestimates its overall processing time. However the impact is not
large because predischarge (BDD and Quick Start) claims represent a
small portion of all claims processed--about 5 percent in 2009.
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VA officials told us the agency does not measure the timeliness of
BDD claims development for three reasons: (1) VA lacks legal authority
to provide compensation until a servicemember is discharged and becomes
a veteran; (2) VA officials perceive most development activities, such
as obtaining the separation exam and medical records, to be outside of
their control; and (3) VA officials said that a primary objective of
the program was to shorten the time from which the member was entitled
to benefits--by definition, after discharge--to the time he or she
actually received them.
While it is useful to know how soon after discharge servicemembers
begin receiving benefits, excluding the time VA personnel spend on
developing BDD claims limits VA's information on challenges in this
stage of the process and may inhibit VA from taking action to address
them. Personnel in 12 of the 14 BDD intake bases we reviewed indicated
significant challenges with claims development activities, such as
scheduling and completing sometimes multiple exams for servicemembers
who leave an area. Challenges such as these may delay the development
of servicemembers' claims, putting them at risk of having to drop out
of the BDD program. The fact that the servicemember is not yet a
veteran does not absolve VA from tracking the time and resources spent
developing BDD claims, which could ultimately help VA identify and
mitigate program challenges. As for lack of control over the claims
development process, VA also faces similar limitations with traditional
disability claims, because VA must rely on veterans to submit their
applications and on other agencies or medical providers for records
associated with the claim. Nevertheless, VA tracks time spent
developing these claims and could also do this for BDD claims.
VA Has Not Fully Evaluated Initiatives to Improve the BDD Program
VA implemented two initiatives to improve the BDD program but did
not fully evaluate either. In 2006, VA finished consolidating claims
processing activities for BDD into two regional offices--Salt Lake
City, Utah, and Winston-Salem, North Carolina--to improve the
consistency and timeliness of BDD ratings.\16\ In fiscal year 2007,
each office completed about 11,000 BDD claims. Although VA reported to
us that it monitors claims workloads between these offices and, in one
case, sent claims from one office to the other so that claims could be
processed more quickly, VA had not conducted an evaluation to determine
whether consistency improved compared with prior practices.
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\16\ These two regional offices complete development, rating, award
actions, and notification actions for BDD claims.
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VA also has not evaluated a second BDD initiative, known as the
paperless claims processing initiative, which is intended to increase
the timeliness of claims processing and security of BDD claims
information. Since our report, VA told us that all BDD claims have been
processed in the paperless environment since August 2008, and that it
continues to monitor the BDD paperless initiative by hosting monthly
teleconference calls with all 57 regional offices, intake sites, and
area offices to provide ongoing guidance and training, as well as
address any issues or problems the field may be experiencing. However,
VA has not evaluated the extent to which this initiative improved
overall timeliness or security.
VA's Review of BDD Operations Has Been Inconsistent, although VA Has
Recently Taken Steps to Improve Monitoring
We identified gaps related to VA's monitoring of the BDD program,
but VA has since taken some steps to address those gaps. For example,
we found that between September 2002 and May 2008, VA conducted reviews
of BDD operations in only 16 of the 40 offices it visited. Further, in
10 of the offices that were reviewed, VA personnel did not document the
extent to which BDD claims were fully developed before being passed on
to the processing office, pursuant to VA policy.\17\ We also found that
the review protocol did not prompt reviewers to verify the extent to
which claims were being fully developed before being sent to the
processing office. In addition, for 14 offices, reviewers did not
address whether agreements related to processing BDD claims existed
between the processing office and relevant regional office, even though
VA's BDD operations review protocol specifically prompts reviewers to
check for such agreements. In response to our recommendations, VA
officials reported that they have increased the number of BDD oversight
visits, including visits to sites that had not been reviewed in several
years, such as Honolulu, Hawaii, and Louisville, Kentucky. Furthermore,
VA revised its protocol to require a review of BDD operations as part
of its site visits to monitor regional offices.
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\17\ VA policy directs the processing offices to have agreements
with all of the regional offices in their jurisdiction to define roles
and responsibilities for processing BDD claims.
VA and DoD Took Steps to Increase Access to the BDD Program, but Some
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Servicemembers May Still Face Barriers to Participation
Some Servicemembers Have Limited Access to the BDD Program, but May
Participate in the Alternative Quick Start Program
Although the BDD program is designed to provide most servicemembers
with access, some members may be unable to initiate a claim 60 to 180
days prior to discharge or remain within the vicinity of the base long
enough to complete their exams. According to VA officials, this is a
challenge particularly for demobilizing servicemembers of the National
Guard and Reserves, who typically remain at a base for only 2 to 5 days
before returning home, and are generally unable in this brief time to
complete requisite exams or obtain required copies of their service
medical records. Servicemembers located in remote locations until just
a few days prior to discharge may also be unable to participate.
Finally, we were told that servicemembers going through the DoD Medical
Board process are ineligible for the BDD program because they typically
are not given a firm discharge date in advance of the 60- to 180-day
discharge window, and a firm date is required to avoid servicemembers
returning to active duty after completing the claims process.\18\
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\18\ DoD and VA are piloting a program whereby the assessment used
to determine a wounded soldier's fitness for duty can be used to
determine VA disability benefits for those ultimately deemed unfit.
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In April 2007, VA established an alternative predischarge program,
now known as Quick Start, to provide members who cannot participate in
the BDD program an opportunity to initiate disability claims before
they are discharged. Under this program, local VA personnel typically
develop servicemembers' claims as much as possible prior to discharge
and then send the claims to the San Diego or Winston-Salem regional
offices, which were designated as consolidated processing sites for
Quick Start claims in August 2009.\19\ In addition, in 2009, VA also
created a predischarge Web site, which allows servicemembers to
initiate either a BDD or Quick Start claim electronically, although
exams must still be completed in person.
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\19\ These designated processing sites complete development,
rating, award actions, and notification actions for Quick Start claims.
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We found VA lacked data to assess the extent to which
servicemembers benefit from the alternative predischarge program.
Specifically, we found that VA was unable to assess participation in
the Quick Start program by National Guard and Reserve servicemembers
because they could not be distinguished from other servicemembers.\20\
In response to our recommendation, the agency reported that it has
updated its data system to distinguish between National Guard/Reserves
and full-time active duty servicemembers who file such claims.
---------------------------------------------------------------------------
\20\ At the time of our review, VA also expressed concern that
early Quick Start program data might not be accurate because of to the
newness of the program.
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We also found that, like BDD claims, timeliness measures for Quick
Start claims do not include days spent developing the claim prior to
discharge. According to VA officials, the timeliness of Quick Start
claims may vary substantially from both BDD and traditional claims. For
example, servicemembers who are on base only a few days prior to
discharge, such as members of the National Guard and Reserves, may have
enough time only to fill out the application before returning home and
may need to schedule the VA exam necessary to fully develop their claim
after discharge. Overall, this will most likely result in less timely
receipt of VA disability compensation than through the BDD program, but
more timely than traditional claims. On the other hand, servicemembers
with more time before discharge may be able to complete more or all of
the claim development process, including the VA exam. Because VA does
not adequately track timeliness of Quick Start, it may be unable to
identify trends and potential challenges associated with developing and
processing these claims. However, as with BDD claims, VA told us it has
no plans to measure time spent developing these particular claims, and
we continue to believe it should.
VA and DoD Have Coordinated to Provide Briefings with Information about
BDD, but Military Duties and Other Factors May Hinder
Attendance
VA and DoD have coordinated to provide servicemembers with
information about the BDD program through VA benefits briefings and
other initiatives, but attending these briefings is optional for most
servicemembers. According to DoD and VA personnel, most servicemembers
learn about the program through VA benefits briefings conducted as part
of TAP sessions, although some may also learn about BDD through base
television spots, papers, and word of mouth.\21\ However, the Marine
Corps is the only service branch to require servicemembers to attend VA
benefits briefings. For the other service branches, participation
requirements may vary by base and command.
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\21\ In addition, the Benefits Executive Council's BDD Working
Group has also developed a BDD and Quick Start pamphlet to be
distributed at all VA intake sites, and VA's recently developed
predischarge Web site also includes links to the TAP Web site and
information.
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We found that commanders' and supervisors' support for transition
services, such as VA-sponsored benefits briefings, can vary by
base.\22\ Even though DoD policy requires commanders to allow
servicemembers to attend TAP sessions upon the member's request, we
were told at one base that servicemembers have on occasion not been
released from their duties to attend the briefings, resulting in VA
personnel going up the chain of command to obtain permission for the
members to attend. At two bases, VA officials considered outreach to be
difficult--because of conflicting missions between VA and DoD and lack
of support from some base commanders--resulting often in servicemembers
being called away from the briefings.
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\22\ GAO, Military and Veterans' Benefits: Enhanced Services Could
Improve Transition Assistance for Reserves and National Guard, GAO-05-
544 (Washington, D.C.: May 20, 2005).
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Although some military officials recommended that servicemembers be
required to attend TAP sessions, rather than mandate attendance, DoD
decided in August 2007 to establish a goal that 85 percent of
separating servicemembers and demobilizing National Guard and Reserve
members participate in TAP sessions, including VA benefits briefings.
We recommended that DoD establish a plan with a specific time frame for
meeting this goal, but DoD has not developed such a plan. We continue
to believe that DoD should establish a plan for meeting its goal. In
the course of our review, we also learned that TAP participation data
may be inaccurate or overstated because unique identifiers were not
used to document servicemembers' attendance and servicemembers who
attend more than one briefing could be double-counted. Currently, the
Department of Labor (DOL), VA, and DoD track participation in their
respective TAP sessions separately. We recommended that DoD establish
an accurate measure of servicemembers' participation in TAP, including
VA benefits briefings. DoD recently reported it is working in
collaboration with DOL and VA to determine what improvements can be
made in measuring servicemembers' participation in all components of
TAP.
Most BDD Sites Have Local Memorandums of Understanding to Provide a
Cooperative Exam Process, but Maintaining Them Has Been a
Challenge for Some Bases
Most BDD sites employ local MOUs to establish a cooperative exam
process, and implementation of the exam process varies
significantly.\23\ According to data provided by VA during our review,
more than 60 percent of bases offering the BDD program had local MOUs
that called for the exclusive use of VA physicians, 30 percent used VA
contractors to conduct exams, and 7 percent used a sequential process
involving resources and exams from both VA and DoD.\24\ At bases
offering the BDD program overseas, VA exams were conducted by
physicians under contract with DoD because VA does not have physicians
at these bases.
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\23\ At the time of our review, 130 of the 142 DoD bases that
offered the BDD program had a local MOU in place; the remaining 12
bases were newer and had not yet established local MOUs. VA noted that
its policy guidance (Fast Letter 08-20), signed July 2, 2008,
eliminated the requirement for a local MOU to be in place in order for
VA to accept a BDD claim. In this guidance, VA expanded the definition
of a BDD claim, removing the criterion that BDD claims may be accepted
only at military bases where local MOUs are in place.
\24\ For example, at 2 bases, DoD officials started the exam
process by conducting diagnostic testing, such as hearing and vision
tests; a VA physician or contractor conducted the remainder of the
exam, which was then incorporated to meet both VA and DoD separation
requirements.
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At several bases we visited, we identified resource constraints and
communication challenges that have affected servicemembers' access to
the program. Resource challenges we identified at five bases included
no designated VA exam provider for more than 7 months, difficulties
hiring physicians, and displaced staff because of construction. At
seven bases, we identified communication challenges or a lack of
awareness of the local cooperative exam MOU caused by uncertainties
generally resulting from deployment of a key DoD local official or
changes in command leadership. In one case, communication between DoD
and VA personnel was conducted on an inconsistent basis, if at all.
Such constraints and challenges have caused delays in servicemembers'
exams or otherwise made it difficult to meet time frames required by
the BDD program.
At the time of our review, DoD and VA had provided some guidance on
implementing and maintaining local MOUs; however, personnel in some
sites we visited were interested in learning about promising practices
at other bases. We recommended that VA and DoD identify and disseminate
information on promising practices that address challenges local
officials commonly face in ensuring servicemembers have full access to
a cooperative exam. DoD officials recently reported collaborating with
VA on a September 2009 conference focusing on seamless transition. DoD
officials planned to work with conference sponsors to identify best
practices for dealing with the cooperative exam process as it relates
to the challenges local personnel commonly face.
Conclusion
The BDD program appears to be an effective means for thousands of
separating servicemembers to receive their disability benefits faster
than if they had filed a claim under VA's traditional process. Despite
BDD's inherent advantages, VA has not followed through on opportunities
to ensure accountability and to optimize results. Similarly, although
DoD and VA have made significant progress in increasing servicemembers'
access to the BDD and Quick Start programs, opportunities to further
ensure or improve access remain. At a time when so many servicemembers
are being discharged with injuries, it is more important than ever to
process benefits as efficiently and effectively as possible. BDD and
Quick Start programs have great potential to achieve these goals, as
long as VA maintains a sharp focus on accountability, and both DoD and
VA follow through on recommended actions.
Mr. Chairman, this concludes my prepared statement. I would be
pleased to answer any questions that you or other Members of the
Subcommittee may have.
Related Products
Veterans' Disability Benefits: Further Evaluation of Ongoing
Initiatives Could Help Identify Effective Approaches for Improving
Claims Processing. GAO-10-213. Washington, D.C.: January 29, 2010.
Veterans' Disability Benefits: Preliminary Findings on Claims
Processing Trends and Improvement Efforts. GAO-09-910T. Washington,
D.C.: July 29, 2009.
Military Disability System: Increased Supports for Servicemembers
and Better Pilot Planning Could Improve the Disability Evaluation
Process. GAO-08-1137. Washington, D.C.: September 24, 2008.
Veterans' Benefits: Increased Focus on Evaluation and
Accountability Would Enhance Training and Performance Management for
Claims Processors. GAO-08-561. Washington, D.C.: May 27, 2008.
Federal Disability Programs: More Strategic Coordination Could Help
Overcome Challenges to Needed Transformation. GAO-08-635. Washington,
D.C.: May 20, 2008.
VA and DoD Health Care: Progress Made on Implementation of 2003
President's Task Force Recommendations on Collaboration and
Coordination, but More Remains to Be Done. GAO-08-495R. Washington,
D.C.: April 30, 2008.
VA Health Care: Additional Efforts to Better Assess Joint Ventures
Needed. GAO-08-399. Washington, D.C.: March 28, 2008.
DoD and VA: Preliminary Observations on Efforts to Improve Care
Management and Disability Evaluations for Servicemembers. GAO-08-514T.
Washington, D.C.: February 27, 2008.
Information Technology: VA and DoD Continue to Expand Sharing of
Medical Information, but Still Lack Comprehensive Electronic Medical
Records. GAO-08-207T. Washington, D.C.: October 24, 2007.
DoD and VA: Preliminary Observations on Efforts to Improve Health
Care and Disability Evaluations for Returning Servicemembers. GAO-07-
1256T. Washington, D.C.: September 26, 2007.
GAO Findings and Recommendations Regarding DoD and VA Disability
Systems. GAO-07-906R. Washington, D.C.: May 25, 2007.
Information Technology: VA and DoD Are Making Progress in Sharing
Medical Information, but Are Far from Comprehensive Electronic Medical
Records. GAO-07-852T. Washington, D.C.: May 8, 2007.
Veterans' Disability Benefits: Processing of Claims Continues to
Present Challenges. GAO-07-562T. Washington, D.C.: March 13, 2007.
Veterans' Disability Benefits: Long-Standing Claims Processing
Challenges Persist. GAO-07-512T. Washington, D.C.: March 7, 2007.
High Risk Series: An Update. GAO-07-310. Washington, D.C.: January
31, 2007.
Veterans' Disability Benefits: VA Can Improve Its Procedures for
Obtaining Military Service Records. GAO-07-98. Washington, D.C.:
December 12, 2006.
Military Disability Evaluation: Ensuring Consistent and Timely
Outcomes for Reserve and Active Duty Service Members. GAO-06-561T.
Washington, D.C.: April 6, 2006.
Military Disability System: Improved Oversight Needed to Ensure
Consistent and Timely Outcomes for Reserve and Active Duty Service
Members. GAO-06-362. Washington, D.C.: March 31, 2006.
VA and DoD Health Care: Opportunities to Maximize Resource Sharing
Remain. GAO-06-315. Washington, D.C.: March 20, 2006.
Veterans' Benefits: Further Changes in VBA's Field Office Structure
Could Help Improve Disability Claims Processing. GAO-06-149.
Washington, D.C.: December 9, 2005.
Veterans' Disability Benefits: Claims Processing Challenges and
Opportunities for Improvements. GAO-06-283T. Washington, D.C.: December
7, 2005.
Veterans' Disability Benefits: Claims Processing Problems Persist
and Major Performance Improvements May Be Difficult. GAO-05-749T.
Washington, D.C.: May 26, 2005.
Military and Veterans' Benefits: Enhanced Services Could Improve
Transition Assistance for Reserves and National Guard. GAO-05-544.
Washington, D.C.: May 20, 2005.
VA and DoD Health Care: Efforts to Coordinate a Single Physical
Exam Process for Servicemembers Leaving the Military. GAO-05-64.
Washington, D.C.: November 12, 2004.
Veterans' Benefits: Improvements Needed in the Reporting and Use of
Data on the Accuracy of Disability Claims Decisions. GAO-03-1045.
Washington, D.C.: September 30, 2003.
Prepared Statement of Hon. Noel C. Koch, Deputy Under
Secretary of Defense (Wounded Warrior Care and Transition
Policy), U.S. Department Secretary of Defense
Mr. Chairman, thank you for inviting me to join you today to
discuss how the Department of Defense (DoD) in collaboration with the
Department of Veterans Affairs (VA) is working to increase
transitioning servicemember's participation in the Benefits Delivery at
Discharge (BDD) and Quick Start Programs. The Departments continue to
work together to address these issues through the auspices of the DoD/
VA Benefits Executive Council and the Joint Executive Council.
The Office of Wounded Warrior Care and Transition Policy's (WWCTP)
mission is to ensure Wounded, Ill, Injured & transitioning Warriors
receive the highest quality care and seamless transition support. Some
of our Wounded, Ill or Injured servicemembers may be able to return to
active duty following their recovery, and may choose to do so, while
others may leave military service. But while in the care of DoD, it is
my office's job to develop policy and provide oversight of several
parts of a servicemember's care, recovery and transition.
As you are aware, one of the most important efforts we made was in
response to the recommendations sent forth by the President's
Commission on Care for America's Returning Wounded Warriors and
required by the National Defense Authorization Act for Fiscal Year 2008
(NDAA 2008) to provide a single point of contact for recovering
servicemembers and their families. In response to the NDAA requirement,
we launched the Department of Defense Recovery Coordination Program
(RCP).
The RCP places Recovery Care Coordinators (RCC) in each Military
Department's Wounded Warrior Program. The RCCs support eligible
Wounded, Ill and Injured servicemembers, including members of the
Reserve Component, and their families, by ensuring their non-medical
needs are met along the road to recovery.
My office also has oversight for training the Recovery Care
Coordinators. To improve outreach to those supported by an RCC, I had
my staff expand the training curriculum for the DoD Transition
Assistance Program (TAP) and its TurboTAP Web site. RCCs are told how
to connect wounded, ill and injured servicemembers with the BDD and
Quick Start Programs through their supporting TAP office. BDD or Quick
Start can now be added to the members' comprehensive plan, if
applicable.
Servicemembers leaving the military are informed about BDD and
Quick Start during the Pre-separation Counseling phase of the
transition process. There are five components of TAP, namely:
Pre-separation Counseling--sponsored by DoD and the
Military Services
VA Benefits Briefings--sponsored by VA
Disabled Transition Assistance Program (DTAP)--
sponsored by VA
Department of Labor (DOL) TAP Employment Workshops--
sponsored by DOL
One-on-one coaching which occurs following the
previously mentioned four components.
Information on BDD and Quick Start is first provided during the
pre-separation portion of the transition process. These programs are
addressed again, in greater depth, by VA during the VA sponsored VA
Benefits Briefing, and a third time during the VA sponsored DTAP.
Servicemembers meeting the eligibility criteria are given a minimum of
three opportunities to learn about these vital programs.
Other actions the Department has taken in conjunction with our
partners at VA to educate and inform servicemembers about the BDD and
Quick Start Programs include:
Launched the VA Pre-Discharge Web site in June 2009
and linked it to our DoD TurboTAP Web site.
Developed a BDD and Quick Start pamphlet.
Promoted BDD and Quick Start on servicemember's Leave
and Earnings Statements (September 2009).
Convened the Joint Interagency Strategic Working
Group for the Transition Assistance Program to assess and
update the program.
One outcome was a recommendation that DoD
update its DoD Instruction on Pre-separation Counseling
by requiring counselors to cover the BDD and Quick
Start Programs. This policy modification will help us
close any gaps that may exist.
Another outcome was to update the Pre-
separation Counseling Checklist for Active Component
and Transitioning Counseling Checklist for
Demobilizing/Deactivating Reserve Component Services
members by adding BDD and Quick Start. Although our
emphasis is on counseling and coaching servicemembers,
it is equally important that we document that
counseling was conducted. The forms are the tools which
allow us to do that.
Within two weeks following the Joint
Interagency Strategic Working Group meeting, DoD TAP
joined the social network community by launching the
DoD TAP Facebook. We are taking advantage of the
popularity of social media as another communications
resource to promote transition services and benefits to
military personnel and families. One of the first links
and resources on our Facebook homepage is to the Pre-
Discharge Web site.
So where are we today? What other steps are we taking that will
continue to foster our commitment and support to our deserving
warriors?
The Department will soon issue a Memorandum to the Military
Departments asking senior leaders and commanders at all levels to
strengthen their emphasis on the importance of BDD and Quick Start. We
view this Memorandum as a ``call to action'' to our commanders to
become more engaged with ensuring eligible servicemembers submit their
claim for disability compensation through BDD or Quick Start before
separating from the military.
As the Co-Chairs of the Benefits Executive Council (BEC), my
distinguished colleague, the former Under Secretary for Benefits, and I
wanted to institutionalize and strengthen responsibilities of our Pre-
Discharge Working Group, which falls under our purview. To accomplish
this we directed this group to develop a ``Pre-Discharge Working Group
Charter'' for our approval. I am delighted to report, Mr. Chairman that
I recently signed the Charter as the DoD BEC co-chair and sent it to my
VA Co-chair counter-part, the Acting Under Secretary for Benefits for
his signature.
But these programs and actions notwithstanding, much remains to be
done. Both DoD and VA are aware that we can improve how we care for our
servicemembers and Veterans, be it through further research, continuing
to ease access to benefits for those who earned them, and finding more
efficient and effective service-delivery systems that will provide
better support for our warriors and their families.
Mr. Chairman, we are reminded daily of our obligation to our
servicemembers and their families, and particularly to the Wounded, Ill
and Injured, and those who bear the greatest burden of caring for them.
We are committed to providing the support they need to help ensure a
successful transition through recovery and rehabilitation and back to
active duty or reintegration into their communities.
We appreciate the opportunity to come before you today to discuss a
subject which the Secretary of Defense has said repeatedly is a
Departmental priority second only to the wars in which we are engaged.
I will be happy to answer your questions.
Thank you.
Prepared Statement of Thomas Tarantino, Legislative
Associate, Iraq and Afghanistan Veterans of America
Mister Chairman, Ranking Member, and Members of the Subcommittee,
on behalf of Iraq and Afghanistan Veterans of America's (IAVA) 180,000
members and supporters, I would like to thank you for the opportunity
to speak before you today to express the concerns of our membership on
some very important issues facing veterans of Iraq and Afghanistan and
their families.
As an OIF veteran with 10 years of service in the Army, I have seen
firsthand the difficulties that many face when transitioning from being
a servicemember to being a veteran. For the wounded warrior, torn from
service due to their extraordinary sacrifice, and the young veteran,
who spent most of their formative years in uniform, the transition can
be difficult. All too often, we leave behind structured and accessible
care and benefits of the military when seeking care and benefits at the
Department of Veterans Affairs (VA), where we're left to our own
devices.
In response to the need for a more seamless transition from
servicemember to veteran, the VA and Department of Defense (DoD) 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 no idea of the scope and
availability of the benefits I was entitled to as a veteran. In fact,
it never occurred to me to seek benefits and health care from the VA
for the general wear and tear of a decade of military service. If it
weren't for the advice of a Sergeant Major attending the Army Civilian
Alumni Program with me I would never have applied.
But 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 will fall through the
cracks. The Marine Corps mandates TAPS programs within 90 days of
separation, while the Army conducts their Civilian Alumni Program
within 30 days. Both of these programs are useful, but begin far too
late to effectively utilize the Benefits Delivery at Discharge Program.
Additionally, neither program has comprehensive and mandatory briefings
about the availability of VA services.
The VA must begin to see itself as a military alumni program. Many
of us remember the guy from our college's alumni society who greeted us
freshman year and continued to pester us throughout college and for
years afterward. It may have been annoying at times, but the message
was communicated clearly and consistently. The VA needs to be
communicating at least that effectively with our veterans. There should
be no excuse for a veteran not knowing what services are available to
them when they separate. Only when the VA integrates its outreach and
education efforts with the DoD will benefits programs reach their full
potential.
Early outreach also requires VA boots on the ground. To effectively
utilize quick start services the VA must have a presence at all
military installations in order to provide access and information to
the benefits and services that the servicemembers have earned.
Additionally, the VA should offer training to AGR members of the
National Guard and reserve in order to educate servicemembers who do
not have the same interaction with the military services as their
active duty counterparts.
Just as the VA must rethink the way it conducts outreach, the DoD
must understand that it has a responsibility to its servicemembers to
set them up for success whether they retire from service or choose to
leave. The military is a lifestyle, not a job. Those that 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 a
comprehensive and structured Transitional Assistance Program that
integrates VA benefits and services.
In addition to integrating outreach and training we 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 DoD medical
facility. Many of the processing issues that plague the standard system
still exist. They are mitigated by the fact that the servicemember is
still in uniform and has full access to DoD care and services, while
waiting for their rating, thus reducing the time it takes to develop a
claim.
Receiving a disability rating at the VA can be a long and confusing
process for a veteran. Often, a veteran 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 born. This has lead to a situation
where hundreds of thousands of veterans must navigate an antiquated
system that focuses on the quantity over quality of the processed
claims. Consequently, 17 percent of cases do not accurately compensate
veterans for their earned benefits. And as we all know, that leads to
months, if not years, of delayed payments.
IAVA applauds some of the innovative initiatives that the VA has
undertaken to mitigate this problem. Two such programs are the pilot
that integrates the Virtual VA into the Benefits Delivery at Discharge
process, establishing online information for quick start programs, and
the Six Sigma pilot at the Little Rock Regional Office. Now it is time
to take it to the next level. The Virtual VA is a step in the right
direction, but it must integrate with VHA records if it is to be
effective. Informational Web sites are good, but today's veterans
expect a Web site to offer services as well as information.
This year IAVA, along with many of our fellow Veterans Service
Organizations, have selected reform of the disability benefits approval
process as our number one legislative issue. We believe that our
veterans and survivors deserve a top quality disability claims system
and we commit to supporting and passing disability claims reform
legislation that:
Develops a work culture at VA that emphasizes quality
at all steps by creating a management culture that measures and
rewards quality of results, not just quantity, and provides
sufficient training of VA's management and workforce in order
to achieve this outcome.
Modernizes the IT infrastructure and optimizes
business processes by creating a secure and accessible
paperless IT system which rapidly moves and organizes the
information necessary for VA to approve claims for benefits,
while optimizing workflow and business processes.
Develops a simpler and more transparent application
and approval process by creating a universal and simple
application process that provides veterans with regular updates
on the progress of their claims and allows them to access their
records and the status of their claims.
Thank you again for the chance to communicate our analysis and
suggestions on this most important issues facing veterans of Iraq and
Afghanistan. We look forward to continuing to work with the committee
and I appreciate your time and attention.
Prepared Statement of Gerald T. Manar, Deputy Director, National
Veterans Service, Veterans of Foreign Wars of the United States
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE: On behalf of the 2.1
million men and women of the Veterans of Foreign Wars of the U.S. (VFW)
and our Auxiliaries, we appreciate the opportunity to present our views
and concerns regarding the VA Benefits Delivery at Discharge (BDD) and
Quick Start Programs.
In 1973, I spent the last two weeks of active duty in the Navy at
Treasure Island in San Francisco Bay. During that entire period I did
not hear a single word about VA disability compensation, VA health care
or the GI Bill. My experience was, I believe, not at all out of the
ordinary. Other than education benefits, I knew virtually nothing about
the services VA provided to veterans until I was hired by VA in 1974 as
a benefits counselor to work on college campuses in the Detroit area.
The world has changed tremendously in the decades since my
discharge from the Navy. DoD and VA have made significant strides to
ensure that our newest veterans are better prepared for life after
discharge than any generation of veterans that preceded them.
Unfortunately, VA fails to reach tens of thousands of those leaving
active duty and most Reserve and National Guard members. Further, the
quality of the ratings given these warriors is, in a word, awful.
Background
The Transition Assistance Program (TAP) and the Disability
Transition Assistance Program (DTAP) was created in the 1980's to
better inform servicemembers about benefits and opportunities following
service. Those programs have expanded significantly so that today,
classes and briefings start months before release from active duty. The
TAP and DTAP don't just cover VA benefits. Information on resume
writing, employment counseling, small business information, personal
finance, and much more is provided to soon to be released servicemen
and women.
From 2005-2007, VA briefed over 1 million servicemen and women and
interviewed over 318,000.
The BDD initiative is an outgrowth of the TAP and DTAP programs. It
began in 1995 as a joint project by VA and DoD at only three Army
bases. It has expanded to over 150 installations covering all branches
of service. This program allows servicemembers within 60 to 180 days of
discharge to file a claim for compensation benefits, receive necessary
medical examinations, and obtain a rating soon after release from
active duty.
Veterans of Foreign Wars
Veteran service organizations have worked hand in hand with the VA
and DoD to ensure that our nation's newest veterans receive every
benefit to which they are entitled under the law.
The VFW began placing national service officers on select military
installations in 2001. Today, we have 9 Pre-Discharge Claims
Representatives serving troops at 16 military installations. We also
have national service officers in San Juan and Las Vegas who perform
TAP briefings several times a month at nearby military bases and help
servicemembers who qualify for the BDD and Quick Start programs. Last
year our service officers briefed over 14,400 servicemembers and helped
over 8,400 soldiers, sailors, airmen and marines file disability claims
with VA.
The VFW also has two full time specialists reviewing BDD ratings at
the VA regional offices in Winston-Salem and Salt Lake City Rating
Activity Sites RAS. All told in 2009, our small cadre of national
service officers helped BDD and Quick Start participants receive over
$9 million in benefits at or shortly after discharge.
Challenges
VA reports that it received 51,000 claims from the BDD and Quick
Start claims programs in 2008, up from 47,000 the year before. Further,
it reports that nearly 60 percent of those it briefed filed claims.
These numbers are fascinating for several reasons. First, that at
least 60 percent believe they were disabled to some degree during their
military service is significant. While I do not have the exact numbers,
our experience is that nearly all will receive service connection for
at least one disability and most will receive compensation at some
level.
Second, if 51,000 claimants represent 60 percent of those briefed,
then VA is briefing only about 85,000 servicemembers. However, it is
our understanding that each year over 100,000 personnel leave active
duty and another 100,000 are released from the Reserves and National
Guard. While some Reserve and National Guard personnel use the BDD and
Quick Start programs as they depart active duty it is clear that a
large portion of those serving on active duty and in the reserves are
not receiving critical information through VA's outreach efforts.
The most interesting observation is that VA is a victim of its own
success. It may be merely a coincidence but in the mid-1990s at about
the time VA expanded its TAP and DTAP programs, VA's workload began to
increase. While 51,000 claims submitted under the BDD and Quick Start
programs may constitute only 5 percent of VA's annual claim receipts,
VA devotes a significant portion of its workforce to educating
servicemembers and encouraging them to file claims. Further, many
highly skilled personnel at the Winston-Salem, Salt Lake City and San
Diego Regional Offices have been tasked to work BDD and Quick Start
claims exclusively.
We do not suggest that VA or DoD lessen their efforts in helping
servicemembers prepare for life after the military. It is absolutely
the right thing; it may not always be the easiest or cheapest thing. We
applaud Congress for encouraging these programs and we support VA and
DoD in their efforts to ensure that every servicemember has an
opportunity to adequately prepare for their post-discharge life.
As We See It
VA has several challenges to resolve if it hopes to improve the
number of servicemembers it reaches and the quality of the service it
provides them:
There are too many servicemembers who are not adequately
briefed about their benefits prior to discharge. While DoD may
require pre-discharge education far too many servicemembers are
either not provided, or find some way to avoid these programs.
Further, VA has been slow to expand the BDD program to
additional installations. In 2004, VA was at 139 military
bases; in 2008 the number stood at only 150. VA must move more
quickly to expand to other military installations.
Veteran Service Organizations are a critical partner in the
BDD program. VA personnel have neither the time nor, often, the
expertise to help servicemembers fill out more than a claim.
VFW service officers usually spend an hour with each
servicemember, talking with them about their problems and
concerns; they go through the service treatment records page by
page, identifying chronic problems which originate or are
aggravated by military service and ensure that those conditions
are both listed and documented on the application. They
accomplish Veterans Claims Assistance Act (VCAA) notification
which helps shorten the development process. Finally, they
provide answers about what to expect in dealing with VA.
As helpful as veteran service officers are you would think
that DoD would welcome us with open arms. Gaining the
permission of DoD to work on base requires careful and extended
negotiations with both DoD and VA. That's because VA does not
anticipate that service organizations may be able to provide
service officers to help. As a consequence, space, always at a
premium, is often difficult to find.
As VA and DoD expand the BDD program to other installations, we
urge them reach out to Veteran Service Organizations to determine
whether we are able to provide service officers to help them help
servicemembers.
Finally, in our experience quality of disability ratings is no
better in BDD and Quick Start cases than it is for other veterans. The
VA STAR report for November, 2009, shows that 17 percent of all ratings
nationally contained at least one substantive error. Winston-Salem met
the national error rate, while San Diego, where Quick Start claims are
rated had a 19 percent error rate. Salt Lake City trailed with a 22
percent error rate. Essentially, one out of every 5 decisions made by
VA are wrong.
There are 29 members on the House Veterans Affairs Committee. If
you all submitted claims for benefits from the VA nearly 6 of you would
have ratings which were wrong.
We encourage Secretary Shinseki and his management team to focus
this year on changing the culture in VBA so that quality is the rule,
not the exception.
Aristotle once said: ``We are what we repeatedly do. Excellence
then is not an act, but a habit.''
VA needs to create a culture where excellence is a habit.
Prepared Statement of Raymond C. Kelley, National
Legislative Director, American Veterans (AMVETS)
Chairman Hall, Ranking Member Lamborn, and members of the
subcommittee, thank you for the opportunity to appear before you today
to provide AMVETS' views regarding the Benefits Delivery at Discharge
and Quick Start Programs.
The Benefits Delivery at Discharge (BDD) program was established to
allow servicemembers to begin their disability claims process prior to
discharge. Another benefit to this program is the servicemembers will
receive a single physical that will satisfy both the requirements for
DoD separation as well as VA disability claims assessment. By doing
this, servicemembers who are less than 180 days but more than 60 days
away from separating from active military service can initiate a VA
disability claim. This will allow for a more seamless transition for
the servicemember who may begin receiving disability compensation
within one to three months after discharge as apposed to six to seven
months if they file their claim in the tradition manner.
Despite the fact that tens of thousands of servicemembers have used
the BDD program at more than 150 locations, there are issues that must
be addressed to improve the program not only for the veterans who
utilize it, but also for DoD and VA. If there continue to be
impediments and inconsistencies for the departments that facilitate the
program, the real value of the program will be lost.
The concept of a single separation physical seems simple enough.
However, the physicals can be facilitated by either DoD, VA, a
contractor, or a combination of the three. The national agreement
between VA and DoD set guidelines for local Memorandums of
Understanding (MOU) that will determine who will be responsible for the
physical. However, there have been some challenges at the local level
in communicating and following the content of the local MOU. The
``Veterans' Disability Benefits'' GAO report (GAO-08-901) found that
more than half of all BDD intake sites visited had challenges in
administering a single, comprehensive exam. Often it was a lack of
communication that failed to reach DoD personnel at the lowest level,
therefore, duplicate exams continued to take place. Often, local
leadership of commands did not understand the program and therefore
they ignored the MOU and continued to administer two physicals.
Resource changes were also identified as a challenge for local BDD
facilities. In some locations DoD is responsible for conducting the
exam, but current physicians were not qualified to conduct exams that
would meet both DoD and VA requirements. At other locations, when DoD
is required by the local MOU to conduct the exam, no provisions were
put in place to accommodate the increase in time and resources it would
take to conduct the exams. These and other issues make it difficult for
bases offering BDD to meet time frames set by the program. These MOUs
must be disseminated to and understood by all personnel who are
affected by the MOU to ensure proper implementation. Also, if there are
implementation issues the MOU must be revised to better meet the needs
of BDD sites
Because VA does not control or enforce the local BDD sites, AMVETS
believes VA cannot be expected to account BDD development time in their
timeliness of claims processing. However, AMVETS believes it is
important to track the BDD process from intake so efficiencies can be
indentified and best practices can be developed. A plan should be put
into place that will allow VA to track the development process of BDD
claims and conduct periodic reviews so efficiency can be determined.
Informing servicemembers of this program continues to be difficult.
Again, local commands' understanding and support for the program
greatly affects participation. If the military command does not see the
value in the program, they will not be as likely to disseminate the
information to the troops. VA and DoD must make a concerted effort to
educate base command structures so there will be buy-in of the program.
This is the first step to delivering the information to troops.
The Transition Assistance Program (TAP) should be an excellent way
to communicate the BDD program to transitioning servicemembers as well.
However, only the Marine Corps mandates that TAP participants attend
the VA presentation. Since this portion is mandatory, servicemembers
have the perception that it is unimportant, leading to low
participation. The VA benefits portion of TAP should be mandatory.
AMVETS also believes each Regional Office (RO) should have the
authority to rate BDD claims. We understand that as a pilot program, it
was practical to have only two offices rate these claims, but now with
more than 150 intake locations allowing the ROs to rate claims should
increase the timeliness of adjudication.
AMVETS is also concerned that BDD enrollees must fill out VA Form
21-526c, the Pre-Discharge Compensation Claim, while veterans who file
a traditional claim must fill out VA Form 21-526. There are stark
differences in the two forms. The two most notable differences are the
length of the form and the depth of the questions asked. The BDD forms
are four pages shorter and lack the instructions that are present in
the traditional VA compensation and pension form. Also, the
respondent's burden of time for filling out the BDD forms is half that
of the traditional form. This is due in part to the degree of
explanation that is required. For example, each form asks the veteran
to state what disabilities they are claiming. The BBD form provides a
small block with four ``notebook'' style lines for the veteran to state
their claim, but in the traditional form the veteran is provided with
an entire page asking for specific details pertaining to each of the
veterans' claims. A study must be conducted to determine if providing
servicemembers with a reduced form has any adverse affects on the
development and the final rating of these claims.
Mr. Chairman, thank you again for providing AMVETS the opportunity
to present our views on BDD and Quick Start. This concludes my
testimony and I will be happy to answer any questions you may have.
Prepared Statement of John L. Wilson, Assistant
National Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to have this opportunity to appear before you on
behalf of the Disabled American Veterans (DAV) to address the
Department of Veteran Affairs (VA) Benefits Delivery at Discharge and
Quick Start Programs.
The Benefits Delivery at Discharge (BDD) and Quick Start programs
provide servicemembers the opportunity to apply for disability
compensation benefits from the VA prior to retirement or separation
from military service. Servicemembers who leave the military and file
disability claims with the VA may be subject to duplicative physical
exams in order to meet requirements of both the Department of Defense's
(DoD's) military services and VA. To streamline the process, the
military services and VA moved to coordinate their physical exam
requirements by developing a single separation exam program. This
program found its beginnings in 1995 when VA began accepting disability
compensation claims from servicemembers in the BDD program at three VA
regional offices and three Army installations. However, differences in
the availability of physicians trained to use VA's exam protocols,
resulted in DoD and VA agreeing that local military bases be given
flexibility in implementing the exams by allowing either VA or military
physicians to conduct the exam.
In 1998, VA and DoD signed a memorandum of understanding (MOU)
instructing local units to establish single separation exam programs.
In 2002, the agencies created a Joint Executive Council to oversee
joint efforts to eliminate barriers servicemembers face as they leave
the military. The Joint Executive Council's Benefits Executive Council,
is focused on improving information sharing between the agencies and
improving the transition process for servicemembers. The agencies
signed another memorandum of agreement in 2004, laying out roles and
responsibilities for each agency in establishing a cooperative
separation exam process. The signing of the National Defense
Authorization Act for Fiscal Year 2008 mandated BDD services were to
also be provided to National Guard and Reserve personnel at non-
traditional BDD sites such as armories, military family support center
to the maximum extent possible.
Participation in the BDD program is offered to servicemembers who
are within 60 to 180 days of release from active duty and who remain in
the area in order to complete the medical examinations. To participate
in BDD, servicemembers generally must meet six requirements: (1) be in
the process of being honorably discharged, (2) initiate their VA
disability benefits application between 60 and 180 days prior to
discharge, (3) sign a Veterans Claims Assistance Act (VCAA) form, (4)
provide the VA copies of service medical records, (5) complete a VA
medical exam, and (6) remain near the base until all exams are
completed. The BDD claims are then processed at VA Regional Offices at
Salt lake City, Utah or Winston-Salem, North Carolina.
Quick Start is offered to all servicemembers with less than 60 days
remaining on active duty or demobilization. It is well suited for
National Guard and Reserve members as they can file a claim while
attending demobilization briefings and continue the claims process
after returning home. This may make it possible for them to receive VA
compensation benefits faster after separation or retirement.
Servicemembers with 1-59 days remaining on active duty or full-time
Reserve or National Guard (Title 10 or Title 32) or servicemembers who
do not meet the BDD criteria requiring availability for all
examinations prior to discharge may apply through Quick Start. There
are three ways to apply for Quick Start: (1) Download VA Form 21-526,
Veteran's Application for Compensation and/or Pension, from the VA Web
site and submit it to the nearest VA Regional Office or any location
where VA accepts claims; (2) Submit an online application at www.va.gov
using ``Apply Online'', then click ``Compensation & Pension'' on the
drop-down menu; (3) Request a claim form be mailed by calling the VA
toll-free number. The servicemember must submit a paper copy of their
service treatment records with each of the three options.
Current BDD program participants include 40 regional offices and
153 military installations (142 DoD sites and 11 Homeland Security
Coast Guard sites). This number includes 5 locations overseas (3 in
Korea and 2 in Germany). VA also issued policy guidance that allows
servicemembers being discharged from any base to file BDD claims at all
57 VA Regional Offices and other locations where VA personnel are
located.
The Veterans Benefits Administration (VBA) has also established a
Web site of http://www.vba.va.gov/predischarge/index.htm to provide
information on the four components of the Pre-Discharge Program:
BDD
Quick Start
Disability Evaluation System (Pilot program)
Seriously Injured/Very Seriously Injured (SI/VSI)
The collaboration between the VA and the military services to
establish single separation exam programs has generally been a
successful endeavor. According to a Government Accountability Office
(GAO) Report titled ``Better Accountability and Access Would Improve
the Benefits Delivery at Discharge Program,'' GAO-08-901, September 9,
2008, once a BDD application is approved, veterans may begin receiving
benefits within 2 to 3 months, instead of the 6 to 7 months it
typically takes if they had applied after discharge under the
traditional disability claims process. In the past 5 years, about
140,000 servicemembers have used the BDD program. More than 70 percent
of servicemembers leaving the military in fiscal year (FY) 2007 were
discharged at military bases offering the BDD program.
A primary advantage of this program is that service treatment
records are more readily accessible to the servicemember and the VA so
filing a VA disability claim through the BDD program can be faster than
filing a claim as a veteran under the traditional claim process.
Establishing service connection for a claimed condition may be easier,
since the member is still on active duty status. Key forms needed to
process the claim can also be signed immediately.
While the programs can generally be viewed as successful, there are
concerns with performance measures and program management. For example,
VA's FY 2009 Performance and Accountability Report (PAR) has only one
supporting measure for BDD and Quick Start. The PAR supporting measure
is ``out of all original claims filed within the first year of release
from active duty, the percentage filed at a BDD site prior to a
servicemember's discharge.'' The strategic goal is 65 percent. Results
for each of the fiscal years is as follows: FY 2006 result of 46
percent with a target of 53 percent; FY 2007 result of 53 percent with
a target of 48 percent; FY 2008 result of 59 percent with a target of
50 percent; FY 2009 result is unknown with a target of 60 percent.
While increasing participation seems evident, the measure references
BDD and Quick Start together, despite their very specific differences.
Since both programs are measured in a combined fashion, it is difficult
to determine the utilization rates of the two programs. Also, there is
no breakout by Service component making it difficult to determine the
number of National Guard and Reservists who are using these programs.
While program participation is measured, VA does not adequately
measure timeliness and accuracy rates separately from claims that go
through the traditional process. The current bookkeeping rules
stipulate that BDD claims be tracked from the date of discharge whereas
traditional claims are tracked beginning from the date a veteran files
a claim. So, while VA and DoD state a key advantage of the BDD program
is that it takes less time for the veteran to receive benefits after
discharge, the accuracy of such a statement remains unclear. While a
case can be made that the clock should not start ticking until the
servicemember transitions from the service and attains veteran status
with the necessary DD-214 form in hand, the actual work done by VA
employees to complete the rating decision and place the disability
compensation benefit in the new veterans account is not accurately
measured. At least 60 days is spent by VA staff developing a claim
before a servicemember's discharge but this is not included in its
measures of timeliness for processing BDD claims, even though claims
development is included in VA's timeliness measures for traditional
disability claims. According to the aforementioned GAO Report, VA data
shows that it is not processing claims (including BDD claims) as
quickly as expected. By the end of FY 2007, it was taking an average of
76 days to complete BDD claims, even though VA has an informal goal of
completing work on BDD claims no later than 60 days after discharge. In
contrast, VA was taking an average of 183 days to complete all claims,
compared to a goal of 125 days.
While information detailing the timeliness of receipt of benefits
after discharge is useful, excluding the time spent on development of
claims makes it difficult to identify and understand any challenges in
this stage of the process. This, in turn, impacts VA's ability to
identify problems in a timely fashion and develop viable solutions to
address them. The GAO Report GAO-08-901 noted,
Personnel in 12 of the 14 BDD intake bases we reviewed
indicated significant challenges with various claims
development activities. For example, personnel on several bases
told us they had a hard time scheduling exams, because
servicemembers were leaving the area so they could complete
their service at home, among other reasons. Also,
servicemembers at several bases may have to obtain more than
one exam and therefore take more time to complete their BDD
claim. Challenges such as these may delay the development of
servicemembers' claims, putting them at risk of having to drop
out of the BDD program. Unless VA tracks performance related to
claims development prior to discharge, it cannot easily
identify problems and compare performance across BDD locations.
The report also noted, ``VA calculates a national accuracy rate,
based on the percentage of claims that were processed without any
errors. However, VA's accuracy reviews to date have focused on claims
overall, and have not targeted specific types of claims, such as BDD.
VA officials stated that the current sample approach and size are
sufficient for estimating a national accuracy rate, but are not
sufficient for obtaining precise results for specific types of claims.
Consequently, VA is unaware of the extent to which BDD claims are more
or less accurately processed relative to other claims and has
incomplete information to help identify problems or challenges that BDD
locations may face related to accurately developing claims.''
As mentioned earlier, the servicemember applying for VA benefits
through BDD or Quick Start must provide either the original or a copy
of their paper service treatment records. This burden will be overcome
for them and every other servicemember applying under other programs
once the Veterans Lifetime Electronic Record is established.
Another important step would be the implementation of a single
comprehensive medical examination as a prerequisite to completing the
military separation process. If and when a single separation physical
becomes the standard, VA should have this responsibility because it has
the expertise to conduct a comprehensive examination as part of its
compensation and pension process.
The problem with separation physicals identified for active duty
servicemembers is compounded when mobilized Reserve and Guard forces
enter the mix. A mandatory separation physical is not required for
demobilizing Reserve and Guard members. Unfortunately, there have been
some cases when they were not made aware of this option, which later
negatively impacted their ability to obtain a favorable service
connection. While separation physical examinations of demobilizing
personnel have greatly improved, there are still a number of
servicemembers who ``opt out'' of the physicals, even when encouraged
by medical personnel to have them. While the expense and manpower
needed to facilitate these physical exams might be significant, the
separation physical is critical to the future care of demobilizing
servicemembers. Mandatory separation physical examinations would also
enhance collaboration by the DoD and VA to identify, collect, and
maintain the specific data needed by each to recognize, treat, and
prevent illnesses and injuries resulting from military service.
The DoD and VA have made positive strides in transitioning our
nation's military to civilian lives and jobs. The Department of Labor's
(DOL) Transition Assistance Program (TAP) and Disabled Transition
Assistance Program (DTAP), which are handled by the Veterans Employment
and Training Service (VETS) are typically the first point of contact
with the VA and DOL for a separating servicemember. Thanks to the
insistence of the DoD, local commanders are allowing more of their
soldiers, sailors, airmen, marines, and coastguardsmen to attend these
courses well enough in advance to take advantage of the information
they receive.
The TAP and DTAP programs have continued to improve, but challenges
remain at some local military installations, overseas locations and
with services and information for those with injuries. The prospect of
a servicemember after having been on multiple deployments to return
stateside and then be placed on medical or administrative hold has
persuaded some from filing a claim for VA compensation or other
ancillary benefits. Also, though individuals are receiving the
information, the haphazard nature and quick processing time may allow
some individuals to fall through the cracks. This is of particular
concern in the DTAP program where those with severe disabilities may
already be getting health care and rehabilitation from a VA spinal cord
injury center despite still being on active duty. Because these
individuals are no longer located on or near a military installation,
they are often forgotten in the transition assistance process. DTAP has
not had the same level of success as TAP, and it is critical that
coordination be closer between the DoD, VA, and VETS to improve this
disparity.
Many veterans with significant disabilities are turning to state
vocational rehabilitation and workforce development systems because of
these and other impediments to accessing VA's vocational rehabilitation
and employment benefits. Almost all state vocational rehabilitation
agencies have entered into memoranda of understanding with VA to serve
veterans. Disabled Veterans Outreach Program and Local Veterans'
Employment Representative Program personnel are often housed in state
One-Stop Career Centers and these positions are often praised as a
model that should be emulated by the broader workforce system. However,
all of these vocational programs are under considerable resource
distress and their ability to serve veterans who are unserved by the
Vocational Rehabilitation and Employment Service is hindered by their
own personnel and budgetary limitations.
Although the achievements of the DoD and VA have been good with
departing active duty servicemembers, there is a much greater concern
with the large numbers of Reserve and National Guard servicemembers
moving through the discharge system. Both the DoD and VA seem ill-
prepared to handle the large numbers and prolonged activation of
reserve forces for the global war on terrorism. The greatest challenge
with these servicemembers is their rapid transition from active duty to
civilian life. If servicemembers are uninjured, they may clear the
demobilization station in a few days, and little of this time is
dedicated to informing them about veterans benefits and services.
Additionally, DoD personnel at these sites are most focused on
processing soldiers through the site. Lack of space and facilities
often restricts contact between demobilizing soldiers and VA
representatives.
The DoD and VA have made progress in the transition process.
Unfortunately, limited funding and a focus on current military
operations interfere with providing for servicemembers who have chosen
to leave military service. If we are to ensure that the mistakes of the
first Gulf War are not repeated during this extended global war on
terrorism, it is imperative that a truly seamless transition be
created. With this, it is imperative that proper funding levels be
provided to VA and the other agencies providing services for the vast
increase in new veterans from the National Guard and Reserves.
Servicemembers exiting military service should be afforded easy access
to health care and other benefits that they have earned. This can only
be accomplished by ensuring that the DoD and VA improve their
coordination and information sharing to provide a seamless transition.
A review of the VA/DoD Joint Executive Council's Strategic Plan for
FY 2009 to 2011 addresses the issue of seamless transition in Goal 3,
Seamless Coordination of Benefits. Their goal is to ``enhance
collaboration efforts to streamline benefits application processes,
eliminate duplicative requirements, and correct other business
practices that complicate the transition from active duty to veterans
status.'' Their objective is ``to improve participation in the BDD
program nationwide and ensure servicemembers are afforded the single
cooperative examinations where available.'' To achieve this goal, the
Benefits Executive Council's Benefits Delivery at Discharge Working
Group is to align BDD with concurrent efforts dedicated to streamlining
delivery of VA benefits for eligible personnel; calculate and analyze
BDD participation rates at MOU sites; and instill ownership of BDD with
operational commanders. While strategic goals and objectives are
important, they achieve the best results when there are measureable
outcomes with clear due dates. A review of this objective finds
neither. So, this successful program may lack the clarity of data from
the DoD as well, which may delay even greater utilization of this
important and effective program.
It is the recommendation of the DAV that:
1. DoD and VA ensure that servicemembers have a seamless
transition from military to civilian life.
2. DoD and VA continue to develop electronic medical records
that are interoperable and bidirectional, allowing for a two-
way electronic exchange of health information and occupational
and environmental exposure data. These electronic medical
records should also include an easily transferable electronic
DD-214.
3. In accordance with the recommendation of the FY 2008
National Defense Authorization Act and the recommendation of
the President's Commission, the DoD and VA implement a single
comprehensive medical examination as a prerequisite of promptly
completing the military separation process. VA should be
responsible for handling this duty.
4. DoD and VA encourage active duty servicemembers to seek
veterans service organization representation during
outprocessing and discharge examinations.
5. Congress and the Administration provide adequate funding
to support TAP and DTAP which are managed by the DOL Veterans
Employment and Training Service to ensure that active duty, as
well as National Guard and Reserve, servicemembers do not fall
through the cracks while transitioning.
6. VA track and account for the time needed for claims
development activities that occur prior to discharge in the
agency's timeliness calculation for BDD and pre-discharge
claims;
7. VA separately estimate the accuracy of BDD and
predischarge claims;
8. VA collect data for all claims filed by Service component
and analyze the extent to which different components are filing
claims and receiving timely benefits under BDD, Quick Start,
predischarge and traditional claims processes;
9. VA include program reviews of BDD operations as part of
oversight visits to regional offices with BDD operations and
ensure such reviews are consistently conducted and reported;
10. DoD establish an accurate measure of servicemembers'
participation in TAP including VA benefit briefings; and
11. DoD establish a plan with specific time frames for meeting
its goal of 85 percent participation rate in TAP.
Mr. Chairman, this concludes my testimony. I will be pleased to
answer any questions you or the Committee may have.
Prepared Statement of Diana Rubens, Associate Deputy Under Secretary
for Field Operations, Veterans Benefits Administration, U.S.
Department
of Veterans Affairs
Mr. Chairman and Members of the Subcommittee, it is my pleasure to
be here today to discuss our ongoing nationwide Benefits Delivery at
Discharge (BDD) and Quick Start pre-discharge programs. Joining me
today is Bradley Mayes, Director of the Department of Veterans Affairs
(VA) Compensation & Pension (C&P) Service.
The BDD and Quick Start programs are two elements of the Veterans
Benefits Administration's (VBA) strategy to provide transitional
assistance to separating or retiring servicemembers and engage
servicemembers in the claims process prior to discharge. A pre-
discharge claim is any claim received from a servicemember prior to
release from active duty. VBA's goal is to ensure that each and every
servicemember separating or retiring from active duty who wishes to
file a claim with VA for service-connected disability benefits will
receive assistance in doing so.
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 report for a VA examination prior to discharge. However, for
those servicemembers with 59 days or less before separation, VA
introduced the ``Quick Start'' pre-discharge claims process in July
2008. This provides servicemembers within 59 days of separation, or
servicemembers within 60-180 days of separation who are unable to
complete all required examinations prior to leaving the point of
separation, to be assisted in filing their disability claim.
The BDD and Quick Start pre-discharge programs offer advantages to
Veterans. Minimal development is required because service records are
readily available and examinations are requested prior to discharge.
Once service treatment records are obtained, the servicemember
acknowledges that notification required by the Veterans Claims
Assistance Act of 2000 has been provided and is offered the opportunity
to acknowledge that no additional medical evidence needs to be
submitted. After the VA examination is conducted, the claim can be
rated in a timely manner. This process has generated a very high
participation rate among servicemembers because disability benefits are
received shortly after separation from service. During fiscal year (FY)
2009, BDD and Quick Start claims represented just over 20 percent of
all original compensation claims received nationwide. However, during
this same period, approximately 65 percent of separating servicemembers
who filed their claims within one year of their discharge did so
through the BDD and Quick Start programs.
The average processing time, or average days to complete (ADC), for
BDD and Quick Start claims continues to show gradual improvement. At
the end of FY 2009, ADC for BDD claims was 70.8 days. At the end of FY
2009, ADC for Quick Start claims was 105.9. ADC for both programs
remains significantly lower than the nationwide ADC (160.7 days at the
end of FY 2009) for all disability rating claims received.
Background
VBA established the BDD program at three VA regional offices and
three Army installations in 1995, and nationwide expansion began in
1998. Expansion promoted the development of claims and the conduct of
physical examinations sufficient for VA rating purposes prior to
separation with a disability rating to be completed as closely
proximate as possible to separation from active duty.
As the program gained momentum, the Department of Defense (DoD) and
VA signed a national memorandum of agreement in 2004 to establish the
specific responsibilities of each department. At the same time, a team
of VBA leaders from central office, area offices, and regional offices
(ROs) developed a proposal in November 2004 for consolidation of BDD
claims processing. This provided an opportunity to improve consistency
in the way BDD claims are received and processed. It also allowed VBA
to reach a greater number of servicemembers as well as improve the
quality and accuracy of rating decisions. The Winston-Salem and Salt
Lake City ROs were selected as consolidated processing locations. BDD
claims from the Eastern and Southern Areas were consolidated to
Winston-Salem, while the BDD claims from the Central and Western Areas
were transferred to Salt Lake City. This consolidation was completed in
April 2007.
BDD claims processing was further streamlined by incorporating
imaging technology to enable paperless processing of these claims.
Paperless BDD claims processing began as a pilot at the Winston-Salem
Rating Activity Site (RAS) in March 2006 and was expanded to the Salt
Lake City RAS in March 2007. The goal was to paperlessly process BDD
claims through their entire life cycle, from initial submission through
adjudication and if applicable, appeal resolution. The advantages to
processing BDD claims in a paperless environment included the reduction
of time and costs associated with shipment of claims folders. In August
2008, all BDD claims were sent to our scanning vendor for paperless
claims processing at the two RAS, and the expansion of BDD paperless
claims processing was complete.
Consolidation of pre-discharge claims continued with the
consolidation of Quick Start claims to the San Diego RO and Winston-
Salem RO in 2009. The San Diego RO handles claims filed within VA's
central and western areas and also those filed from military
installations in Korea. The Winston-Salem RO handles claims filed
within VA's eastern and southern areas and also those filed from
military installations in Germany.
Current Technology Environment
Currently, all BDD claims are sent to VBA's scanning vendor, Hands
On Ventures Services. All information located within a BDD claims
folder is scanned and uploaded into Virtual VA. Virtual VA is the
current image repository and provides image capture, storage, and
retrieval. The existing Virtual VA architecture and configuration are
not a scalable solution for all C&P processing or VBA. The Veterans
Benefits Management System (VBMS) initiative is a large-scale effort to
develop an IT solution that is built on a scalable, agile architecture.
Coupled with VBA's business transformation strategy, the VBMS
initiative will enable our organization to reach its goal of a benefits
delivery model that provides world-class service to our nation's
Veterans.
Staffing
VBA currently has 143 employees dedicated to processing BDD claims
at the Winston-Salem and Salt Lake City RAS, and 129 employees at
Winston-Salem and San Diego dedicated to processing Quick Start claims.
Additional management and administrative staff are assigned to support
BDD and Quick Start claims processing. These employees are dedicated
and provide excellent service to participants in both programs.
Outreach Efforts
To ensure that servicemembers are aware of both the BDD and Quick
Start programs, VA developed several outreach initiatives. Brochures
describing the BDD and Quick Start processes are distributed to
servicemembers approaching separation. They are provided to all
military installations involved with the programs and are handed out to
servicemembers during pre-discharge workshops describing VA benefits.
In addition, a Web page on VA's Internet site describes the pre-
discharge programs and explains all requirements. To simplify the
actual claims process, BDD and Quick Start claimants can now apply
online. These outreach initiatives increase servicemembers' access to
VA benefits and improve claims processing timeliness.
In addition to the BDD and Quick Start programs, VA continues to
collaborate with DoD in the seamless transition initiative, promoting a
smooth and efficient transition for individuals separating from the
military. This includes National Guard and Reserve members who are
demobilizing from overseas deployment and returning to their home
units. VBA and the Veterans Health Administration conduct joint
briefing sessions at military bases designed to provide information on
the entire range of VA benefits and health care services.
One formal pre-discharge outreach program conducted by VA and the
Departments of Defense and Labor is the Transition Assistance Program
(TAP). During TAP briefings, VBA personnel explain the disability
compensation process and provide assistance to servicemembers
interested in filing a claim. The Disabled Transition Assistance
Program (DTAP) is specifically designed to assist servicemembers facing
separation because of disability incurred during service. In addition
to TAP and DTAP briefings, VA conducts informational sessions for
demobilized National Guard and Reserve members at the unit's community
location.
Another major seamless transition project resulting from DoD and VA
collaboration is the Disability Evaluation System (DES) for the 27,000
servicemembers who enter the medical evaluation board process on an
annual basis. The goals are to improve consistency of outcomes,
establish an increased sense of equity by DES participants, increase
transparency, reduce the time servicemembers are in the process, and
ease their transition to civilian life. This joint effort reduced the
time from separation to receipt of initial VA disability payment to an
average of 25 days. By end of March 2010, the pilot will be at 27
installations, accounting for 46 percent of all DES participants. Plans
are underway for full deployment of the pilot process, pending
authorization of the VA/DoD Senior Oversight Committee.
Conclusion
VBA is committed to providing efficient and timely service to our
nation's Veterans. We will continue to evaluate the BDD and Quick Start
programs to identify improvements that can be accomplished with the
current technology platform and to capture requirements for new
technology capabilities to further enhance benefits delivery under
these important programs and improve Veterans' experience. This
concludes my testimony. I would be pleased to address any questions you
may have.
Statement of American Federation of Government Employees,
AFL-CIO and AFGE National Veterans Affairs Council
Thank you for the opportunity to present the views of members of
the American Federation of Government Employees (AFGE) and the AFGE
National Veterans Affairs Council (AFGE NVAC) who process claims under
the Benefits Delivery at Discharge (BDD) and Quick Start Programs.
Recommendation: Eliminate Redundancy
One of the most significant problems plaguing the BDD and Quick
Start Program is the redundancy created by two separate programs that
essentially perform the same task. The only real difference between the
two programs is application deadlines, i.e. between 60 and 180 days
prior to separation for BDD, and 60 days or less for Quick Start.
The operation of two similar program results in the unnecessary
duplication of resources, including supervisory and support personnel.
This arrangement also creates inequities: Since the Quick Start team
works exclusively on claims filed within 60 days prior to separation;
they are necessarily completing more recent claims than those being
processed in BDD.
It would be more efficient and equitable to place both programs
under the BDD umbrella and eliminate the arbitrary restriction that BDD
claims cannot be filed within 60 days prior to separation. In addition,
all claims processed from active military service under the pre-
discharge processes should be processed via a Paperless Claims
Processing System. As the VA is transitioning into the paperless
environment, to continue processing claims outside of the paperless
system, as Quick Start does, will only result in further delays in the
transition.
Recommendation: Improve Training
Our VBA members express great frustration at the lack of adequate
training generally, and specifically for these programs. Current
training requirements for VBA employees processing BDD and Quick Start
claims is minimal, consisting exclusively of emails that list
references to review. Employees are denied the opportunity for
interaction or discussion about many of the complicated tasks required
to process these pre-discharge claims.
Recommendation: Stop consolidation of paperless pre-discharge claims
With regard to claims handled through Supplemental Paperless Claims
Processing, AFGE and AFGE NVAC recommend that all claims be maintained
in the VARO of jurisdiction. Consolidation of paperless pre-discharge
claims to centralized locations is a disservice to veterans, especially
since the paperless claims processing system is now available for use
by all offices. Consolidation results in unnecessary delays in
processing when the need for additional development or examinations
arises, and the claim is no longer located in the state where the
veteran resides.
The current practice of isolating paperless claims (following the
initial rating action) at the VARO Winston Salem and VARO Salt Lake
also results in unnecessary delays in filing supplemental claims.
Veterans who participate in the Quick Start program have their claims
forwarded to the VARO of jurisdiction. Veterans should not be treated
differently due to the time in which they filed their claim during
separation.
Recommendation: Increase the quality and consistency of C&P Exams
The poor quality of many C&P exams, and thus, the need for re-
examination, results in further processing delays. These exam
deficiencies particularly impact pre-discharge claims.
Recommendation: Improve tracking of pre-discharge claims
Currently, BDD and Quick Start claims are only tracked after
discharge, when most of the development is already complete. AFGE and
AFGE NVAC concur with GAO's recommendation to track BDD and Quick Start
claims during the development process. Tracking during claims
development would enable VBA to identify areas of deficiencies.
For example, a common problem with pre-discharge cases is the
difficulty of obtaining service treatment records (STRs). The current
practice of requesting a copy of the veteran's STR at his or her DTAP
briefing works well for those who are part of the regular armed forces.
However, some of these veterans have prior periods of service; before
the case can be rated, VBA must obtain the STRs for all periods of
service. This results in additional delay because VBA must then request
STRs from the National Personnel Records Center or Records Management
Center.
Tracking during the development process would enable VBA to spot
deficiencies, such as how many veterans have prior periods of service
and the timeliness delays that are caused by not requesting all STRs up
front.
Another problem concerning STRs involves veterans from the National
Guard or Reserve. They are not required to submit STRs with their
application and the obligation falls on VBA to obtain the STRs from the
state adjutant general or from the reserve unit. This often causes
delays in the claims process because the employee frequently has to
send multiple requests to get these records. Often times records for
these veterans are never received.
Therefore, VBA should be tracking how many cases are submitted by
National Guard and Reservists and the amount of time required to obtain
their STRs, as well as how often the STR is unavailable. Tracking would
also enable VBA to identify improper denials resulting from missing
STRs.
Thank you.
MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Daniel Bertoni
Director, Education, Workforce, and Income Security Issues
U.S. Government Accountability Office
441 G Street, NW
Washington, DC 20548
Dear Mr. Bertoni:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
Committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
U.S. Government Accountability
Washington, DC.
April 16, 2010
The Honorable John J. Hall
Chairman
Subcommittee on Disability and Memorial Affairs
Committee on Veterans' Affairs
House of Representatives
Subject: Responses to Questions for the Record--Hearing Entitled
Examination of the Benefits Delivery at Discharge and Quick Start
Programs
Dear Mr. Chairman:
This letter responds to your March 25, 2010 request that we address
questions for the record related to the Subcommittee's February 24,
2010 hearing examining the Benefits Delivery at Discharge and Quick
Start Programs. Our responses to the questions, which are in the
enclosure, are based on our previous work and knowledge of the subjects
raised by the questions.
If you have any questions about the letter or need additional
information, please contact me at (202) 512-7215 or [email protected].
Sincerely yours,
Daniel Bertoni
Director, Education, Workforce, and Income Security Issues
Enclosure
__________
Response to Questions from the House Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing the ``Examination of Benefits Delivery at Discharge
and Quick Start Programs''
February 24, 2010
1. In your testimony, you recommended that DoD expand
mandatory Transition Assistance Program (TAP) briefings beyond
the Marine Corps to all military service branches.
In our 2008 report, we recommended that to ensure that potentially
eligible participants are aware of the BDD program, DoD should
establish a plan with specific time frames for meeting its goal of 85
percent participation in TAP. Increased participation in the VA
benefits session in TAP may allow more members to self-identify their
eligibility for these programs. Although DoD reported to us in
September 2009 that it is preparing to develop a plan and specific time
frames in the coming months, the longer the agencies lack a plan or a
way to accurately measure progress toward meeting the TAP participation
goal, the less information they will have on the extent to which VA
benefits briefings are reaching all transitioning servicemembers may
benefit from VA's pre-discharge programs.
In your opinion, what are the pros and cons of this proposed
expansion of TAP?
In our 2008 report \1\, we note that according to DoD and VA
personnel, servicemembers most commonly learn about the program through
VA benefits briefings conducted as part of TAP sessions. We found that
without such briefings, some members may not recognize they are
entitled to receive VA benefits, and may file claims through BDD or
Quick Start programs. However, because briefings are not mandatory for
all service branches, whether commanders and supervisors encourage
servicemembers to attend briefings varies by base. Moreover, some DoD
officials told us that servicemembers may not recognize the importance
of the VA benefits briefings if participation is not required, because
members have a host of discharge requirements and limited time to
complete them.
---------------------------------------------------------------------------
\1\ GAO, Veterans' Disability Benefits: Better Accountability and
Access Would Improve the Benefits Delivery at Discharge Program, GAO-
08-901 (Washington, D.C.: Sept. 9, 2008).
---------------------------------------------------------------------------
While VA and DoD have explored the expansion of TAP, they have not
made participation in TAP sessions mandatory for servicemembers. We
reported in a 2005 report \2\ that command supervisors may feel that
mission needs are too pressing to allow some servicemembers to
participate in TAP. In addition, DoD officials have indicated that
because TAP sessions involve components from three federal agencies--
DoD, VA, and DOL--the coordination of a mandated program could be
challenging.
---------------------------------------------------------------------------
\2\ GAO, Military and Veterans' Benefits: Enhanced Services Could
Improve Transition Assistance for Reserves and National Guard, GAO-05-
544 (Washington, D.C.: May 20, 2005).
Could VA's disability claims process be improved by establishing
the BDD or Quick Start programs as automatic components of the
discharge process for all servicemembers, whether they are claiming a
---------------------------------------------------------------------------
service connected disability or not?
Filing a VA disability claim through the BDD program can be faster
than filing a claim as a veteran under the traditional claim process,
because medical records are more readily accessible and key forms
needed to process the claim can be signed immediately. Moreover,
establishing that the claim is related to the member's military service
may be easier, since the member is still on active duty status. On the
other hand, expanding the number of claims processed through the BDD
and Quick Start programs to include all servicemembers who are
discharged regardless of whether they have a service connected
disability will likely result in processing ineligible claims, which in
turn may negate some of the programs' efficiencies. Any decrease in the
overall speed of claims processing may result in less timely receipt of
VA disability compensation for all servicemembers participating in the
programs. This is especially true since, over the last several years,
VA has experienced an increase in disability compensation claims, which
in turn has contributed to a growing number of pending claims.
2. A Veteran Service Organization (VSO) representative
testified that the BDD and Quick Start programs could be
improved by allowing servicemembers to start the pre-discharge
process earlier, perhaps as early as six months before
discharge. What impact would such a move have on further
improving the BDD and Quick Start programs? Do you think that
an earlier start date for the pre-discharge process might
permit disabled veterans to begin receiving benefit
compensation within a month after discharge rather than 180
days after discharge, on average, as is the case now?
Under the BDD program's current structure, servicemembers may
initiate a claim as early as 180 days (6 months) prior to discharge or
as late as 60 days (2 months) prior to discharge. According to VA,
these times frames allow for sufficient time prior to discharge for
local VA personnel at BDD intake sites located on or near the base to
assist members with their disability applications, including scheduling
their exam(s). While a claim may be developed prior to discharge, VA
cannot authorize the award until the member is discharged. To the
extent that 180 days provides sufficient time to process BDD claims and
VA is legislatively restricted regarding when it can authorize and
award payments until discharge, it is unclear how allowing a member to
file a claim earlier than the 180 days currently allowed would improve
the BDD program or expedite receipt of benefits.
Quick Start claims are available for servicemembers--such as
National Guard and Reservists--who are not able to meet BDD program
requirements, such as remaining on base long enough to complete exams
within the 60-180 day time window. Unlike BDD claims, Quick Start
claims generally require additional development after discharge, which
can delay award decisions and receipt of payment. Our prior work did
not explore the feasibility or efficacy of initiating the process
earlier for servicemembers--such as National Guard and Reservists--who,
because they are deactivated quickly after returning to their home
base, generally have difficulty meeting BDD program requirements.
3. In your testimony, you note that most VA and DoD Memos of
Understanding (MOU) require a VA physician to administer the
joint physical exam required by the BDD and Quick Start
programs. As a result, you observe that many servicemembers
stationed on bases with no access to VA physicians cannot
secure the joint exam needed for the BDD program. How should
this problem be fixed, and what can Congress do to assist the
resolution of this issue?
Most VA and DoD BDD MOUs require a VA physician to administer the
joint physical exam offered under the BDD program. However, a physical
exam prior to discharge is not a requirement for participation in the
Quick Start program. In our 2008 report, we recommended that to ensure
that servicemembers have full access to a cooperative exam process that
is convenient, efficient, and consistent for servicemembers, the Chairs
of the Joint Executive Council should direct the Benefits Executive
Council to identify and disseminate information on promising practices
that address challenges local officials commonly face. VA and DoD have
taken some steps to implement this recommendation, including
collaborating to identify best practices for dealing with the
cooperative exam process as it relates to the challenges local
personnel commonly face.
In addition, DoD and VA are piloting a joint disability evaluation
process involving a single physical exam for servicemembers who may
need to be discharged due to a disabling condition. The pilot is
currently taking place at 27 military facilities, many of which are
also BDD facilities, and DoD and VA are considering whether to expand
the pilot DoD-wide. The pilot may present an additional opportunity to
improve collaboration and communication between DoD and VA. However, it
could also present challenges, for example, by increasing local VA
offices' exam caseloads. GAO has a review underway of the disability
evaluation system pilot.
4. Your testimony noted that VA consolidated the claims
processing operations for the BDD program into two VA Regional
Offices (ROs), in Winston-Salem, NC and Salt Lake City, UT.
Quick Start claims are also processed in two locations, the
Winston-Salem RO and the San Diego RO. One VSO representative
recommended that the processing of these claims could be
expedited by permitting all ROs to process BDD and Quick Start
claims. Do you agree with this recommendation, or do you
recommend another approach?
In our 2008 report, we noted that in 2006 VA completed its effort
to consolidate rating activities for BDD claims in two regional
offices--Salt Lake City, Utah, and Winston-Salem, North Carolina--in
order to improve the consistency and timeliness of BDD ratings. We
noted that VA had not evaluated whether consistency or timeliness had
improved compared to prior practices, although VA officials told us
they monitored claims workloads between the rating offices and in one
case sent claims from one office to the other so claims could be
processed more quickly. Since our report, in August 2009, VA
consolidated the processing of Quick Start claims to two locations,
Winston-Salem, North Carolina and San Diego, California. Consistent
with our prior recommendation related to another initiative \3\, before
VA considers making changes to its Quick Start processes, such as
adding additional rating sites, it would be prudent for VA to evaluate
the impact of consolidation on timeliness as well as on consistency of
Quick Start claims processing.
---------------------------------------------------------------------------
\3\ In our 2008 report, we recommended that VA conduct an
evaluation of the paperless claims processing initiative to determine
which adjustments, if any, are needed to improve implementation of the
program.
5. In 2009, a reported 65 percent of separating servicemembers
who filed a claim within one year of their discharge did so
through one of these programs. Is this an acceptable level of
---------------------------------------------------------------------------
participation? If not, what should be the proper target?
For several years, VA has had a strategic target that 65 percent of
separating servicemembers who filed a claim within one year of
discharge would file through the BDD program. According to VA, while
the agency has yet to reach that goal, it is striving to do so by 2011.
VA recently modified the measurement of BDD participation by including
only those members who discharge from BDD locations (in the past, it
had included members discharging from any location, including those
that did not accept BDD claims). This change reduces the number of
servicemembers counted in the denominator without changing the
numerator, and therefore makes VA's target of 65 percent easier to
reach.
Beyond this change, VA may also have begun to include claims filed
under the Quick Start program in the BDD participation rate numerator.
In its 2009 Performance and Accountability Report, VA reported that the
BDD participation rate now includes those whose ``date of claim'' is
before discharge, which presumably would include servicemembers who use
the Quick Start program. Because Quick Start claims can be filed from
any location, this adjustment could result in some servicemembers being
counted in the numerator (for filing Quick Start Claims) and not in the
denominator (for filing from non-BDD locations). Further, if the BDD
participation rate does include Quick Start claims, then it may make
sense to have a target that is higher than 65 percent participation,
since the current target was set before Quick Start existed.
In our prior work, we were unable to obtain data from DoD on the
number of servicemembers discharged from BDD versus non-BDD locations
and therefore did not assess the appropriateness of the adjusted 65
percent target. Regardless of the target rate, we continue to believe
that--because servicemembers generally learn about BDD through TAP--it
is important that VA and DoD make progress toward developing a plan and
an accurate measure for achieving their TAP participation goal.
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
The Honorable Noel Koch
Deputy Under Secretary of Defense
Office of Wounded Warrior Care and Transition Policy
U.S. Department of Defense
1400 Defense Pentagon
Washington, DC 20301
Dear Mr. Koch:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
Committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
Questions From the House Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs''
February 24, 2010
Question 1: Your testimony pointed out that servicemembers learn of
the BDD and Quick Start programs during Transition Assistance Program
(TAP) briefings. However, a 2008 report issued by the U.S. Government
Accountability Office (GAO) entitled Veterans' Disability Benefits:
Better Accountability and Access Would Improve the Benefits Delivery at
Discharge Program, revealed that only the Marines have made these
briefings mandatory. The Subcommittee has learned that while Department
of Defense (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 duties to attend the
briefings. Why aren't TAP briefings mandatory for all branches, and
what additional resources, if any, does DoD need to make TAP briefings
mandatory for all of the service branches?
Answer: The Department would have to defer to the Departments of
Labor and Veterans Affairs regarding modifying mandatory servicemember
participation in TAP. DoD does not have the authority to make those
sessions mandatory.
The Joint Executive Committee (JEC) requested the TAP Steering
Committee, an inter-agency body (representatives from Departments of
Defense, Labor, Veterans Affairs, Homeland Security, the Military
Departments, and the Office of Personnel Management) responsible for
monitoring all aspects of TAP, to develop a plan for mandatory TAP
briefings. This plan will be presented at the June JEC meeting.
Question 2: At what point does the pre-discharge process begin once
a servicemember approaches the date of their discharge? Are
servicemembers transferred out of theatre to have their physicals, get
TAP briefings, and complete other decommissioning procedures?
Answer: Servicemembers can file a BDD claim no more than 180-days
but not less than 60 days prior to separation, retirement, or in the
case of a National Guardsman/Reservist, release from active duty. It is
VA policy that the Servicemember filing under BDD must: (1) have a
known separation date; (2) complete a single joint examination; (3)
turn in a complete copy of their medical record at the time they submit
their BDD claim.
Quick Start program claims can be filed no more than 59-days before
but not less than 1 day prior to separation, retirement, or in the case
of a National Guardsman/Reservist, release from active duty. The same
requirements for BDD are applicable to Quick Start claims.
In regard to location, no, DoD does not transfer servicemembers out
of theater to complete physical exams, get TAP briefings, or complete
other decommissioning requirements.
These pre-discharge program requirements were established by the
Department of Veterans Affairs.
Question 3: A veteran service organization (VSO) representative
testified that the BDD and Quick Start programs could be improved by
allowing servicemembers to start the pre-discharge process earlier,
perhaps as early as 6 months before discharge. What are the pros and
cons of starting the pre-discharge process earlier in DoD's opinion?
Answer: The following pros and cons reflect the opinions, not DoD
policy.
Pros of starting the pre-discharge process earlier:
1. Servicemembers would have more time to assimilate the
enormous volume of information on the benefits, services, and
resources they may be entitled to receive.
2. A higher percentage of servicemembers re-enlist the earlier
they start the transition process compared to those starting
the transition process much later (findings from an Informal
Navy survey conducted in the 1990s).
3. Allows servicemembers to submit applications for VA
compensation claims in a timely manner before separating or
retiring.
4. Servicemembers would have more time to compare and weigh
their options for staying in the military vs. actually
separating or retiring.
5. Stressors normally associated with the entire transition
process and experience may be reduced if servicemembers start
the process earlier.
6. More spouses may become actively involved in the transition
process if the servicemember began the pre-discharge process
earlier.
7. Professional staffs should be able to manage clients
better, devote more time to those who need the most attention,
and provide more individualized assistance in counseling and
coaching servicemembers.
Cons of starting the pre-discharge process earlier:
1. Will require the Services to increase resources.
Servicemembers who begin the process earlier tend to go back
multiple times for individualized counseling/coaching, compared
to the number of repeat visitors to transition offices when
servicemembers have little time remaining on Active Duty. (This
may be problematic for operations)
2. Demobilizing National Guard and Reservists would begin the
process in theatre. This would require additional facilities,
equipment, personnel, etc. to be permanently placed in theatre
to assist in the early transition process.
3. Conducting pre-discharge counseling in theater may not be
conducive for Servicemembers receiving and assimilating the
information and assistance.
4. For National Guard and Reservists, providing the transition
process earlier at home station would mean increasing the
number of non-training days a member would be called on Active
Duty to receive the necessary counseling and coaching. This
could also be a problem for employers.
5. For deployed National Guard/Reservists, they would not be
able to complete the joint DoD/VA physical examination while in
theater to take advantage of an earlier submission date. For
that reason, DoD would have to defer to the Department of
Veterans Affairs (VA) regarding changes in policy that would
allow earlier acceptance of pre-discharge claims and earlier
administration of the joint DoD/VA physical examination under
VA's program.
Question 4: In your opinion, are there other ways for improving the
pre-discharge process to facilitate increased usage of the BDD and
Quick Start program for transitioning disabled servicemembers?
Answer: Yes, there are other ways to improve the pre-discharge
process. The Department is undertaking several initiatives to improve
usage of BDD and Quick Start, for example Recovery Care Coordinators
will be trained to inform transitioning disabled Servicemembers who
they need to contact for assistance in applying for BDD/Quick Start.
Also, we are modifying the pre-separation counseling checklist for
Active Duty and the transitioning checklist for the Reserve Components
so BDD/Quick Start items will be addressed by transitioning counselors.
Lastly, we have added the pre-discharge link to the official DoD
TurboTAP Web site and are doing strategic messaging on our social
networking sites (i.e., Facebook and Twitter) to encourage early
participation where services are available.
Question 5: GAO noted in its testimony, that most VA and DoD Memos
of Understanding (MOU) require a VA physician to administer the joint
physical exam required by the BDD and Quick Start programs. GAO thus
observed that many servicemembers stationed on bases with no access to
VA physicians cannot secure the joint exam needed for the BDD program.
How should this problem be fixed, and what can Congress do to assist
the resolution of this issue?
Answer: If the military installation is not located near a
Department of Veterans Affairs (VA) hospital, VA can contract out the
joint DoD/VA examination to meet the required examination protocol. At
those military locations where the necessary resources are available
(sufficient medical personnel/type of specialty equipment), DoD
providers can also be trained to conduct the joint DoD/VA examination.
The Department is closely monitoring these situations, and making the
adjustments when needed.
The Department appreciates Congressional support, and we will
continue to work with Congress to provide legislative requests through
the formal legislative request channels.
Question 6: How many military bases are there, and what percentage
of these bases enables servicemembers to access joint DoD/VA exams?
Answer: The joint DoD/VA exam is provided at 131 military
installations, which is 16 percent of the 820 U.S. military
installations.
Question 7: The Quick Start program was created to ensure that our
soldiers serving in active duty from Guard and Reserve units can also
take advantage of the benefits of the pre-discharge program. Are we
offering Quick Start examinations at Guard bases, such as the NY
National Guard's Camp Smith? If so, how many Guard bases have the
resources to perform these Quick Start exams? What resources do you
need to ensure that Quick Start exams can be offered at all bases that
Guard Members and Reservists return after their active duty service?
Answer: Yes, the Department offers examinations at 53 military
installations where demobilization/deactivation of National Guard and
Reserves takes place and there is a VA presence. NY National Guard Camp
Smith is not currently one of those installations.
The Department defers to VA on additional resources required for
expanding the Quick Start program as VA is the administrator of the
program.
Question 8: How much time is needed, on average, to administer a
joint DoD/VA exam?
Answer: The Department of Veterans Affairs reports from October 1,
2009 through March 31, 2010, took an average of 33.2 days to administer
the joint DoD/VA exam.
__________
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Thomas Tarantino
Legislative Associate
Iraq and Afghanistan Veterans of America
292 Madison Avenue, 10th Floor
New York, NY 10017
Dear Mr. Tarantino:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
Committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
TO: House Veterans Affairs Committee
(DAMA)
RE: Follow-Up Questions from IAVA's
Testimony on February 24, 2010
PREPARED BY: Tom Tarantino, Legislative Associate
1. How would it help VA if the Transition Assistance Program
(TAP) briefings and BDD or Quick Start exams were mandatory for
all decommissioning servicemembers? Do you believe VA has the
resources needed for this expansion?
Over the past year, VA has engaged in an ever-increasing effort to
reach out to veterans in hopes of enrolling them into the VA Heath Care
system. Mandatory TAP briefings would provide a captive audience to
reach out to new veterans and explain how the VA can be used as a
resource. Most servicemembers do not have a clear idea as to what the
VA does, or what services it provides. Mandatory briefings at or near
the point of discharge should be a key component to achieving a
seamless transition from DoD to VA Care. These briefings should be
uniform across all services and within a time frame that use of BDD and
Quick Start programs are feasible.
The VA has regional offices all over the Nation that cover every
military base where out-processing is conducted, yet, there is no
established procedure for having VA representatives liaising with DoD
out-processing services. The VA should have a team in every VISN whose
sole function is to be a new veterans first contact with the VA while
processing out of the military. They should be experts in VA services
and have the ability to either enroll them into VA health care, or
direct them to a service officer for assistance with VBA claims. A new
veteran shouldn't have to search to find the benefits that they have
earned.
2. What can Congress do to assist VA and DoD in expanding TAP
briefings and BDD or Quick Start exams to all discharging
servicemembers?
Congress needs to enact legislation that requires TAP briefings for
all exiting servicemembers. While each service will have service
specific components to the briefing, the timeline and the VA benefits
portion should be uniform and explicit in statute. These briefings
should be conducted by a VA expert and mandated in such a time frame
where utilization of BDD and Quick Start programs are both convenient
and realistic.
3. The Memo of Understanding (MOU) between VA and DoD largely
permits only VA physicians to conduct single exams. Is this a
problem and if so, should more training be provided to DoD
physicians so that they can conduct these exams more often?
While it would be ideal for expedience and convenience to have both
DoD and VA physicians conduct the exit physical evaluations, it isn't
realistic. VA physicians are the only ones consistently qualified to
conduct Compensation and Pension examinations and apply the VA schedule
of rating. As the ultimate disability rating is under VA regulations,
the examination should remain a VA function.
4. You testified that even when comprehensive physical exams
are administered, there is not enough time or resources to
complete them effectively. What might Congress do to resolve
this issue?
As mentioned in my answer to question 2, TAP briefings must be
mandatory with uniform benefits briefings. These briefings should be
conducted within a time frame where utilization of BDD is realistic and
covenant. In these briefings servicemembers should be able to begin the
BDD or quick start process. This way, all parties have sufficient time
to conduct the exams and evaluate the results.
5. GAO reported that VA has established only one measure for
gauging the effectiveness of the BDD and Quick Start programs.
However, it seams that VA has several means for measuring
general disability claims. Do you agree additional quality
measurements could assist VA in fully implementing BDD?
Yes. However, the VA does not have a particularly good method for
measuring quality in any of its disability claims. With a 17 percent
error rate in the regular claims process, it's clear that this is an
area that the VA must improve on as a whole. The STAR program is
largely a quality assurance method, which is procedural in nature and
does very little to ensure that the decisions themselves were correct.
The VA needs to reassess its entire quality control program before
extending the current broken evaluation system to BDD and Quick Start.
6. Some Veteran Service Organizations (VSOs) express
frustration by VA's lack of efforts in collaborating with them
in increasing utilization of BDD and Quick Start programs.
Please expand upon the challenges faces by your organization in
this regard? What can Congress do to increase the cooperation
between VA and VSOs with respect to the BDD and Quick Start
Programs?
IAVA helps veterans by raising awareness, advocating for reforms
and assisting veterans and their families to find the best services
available. However, we do not provide traditional services and do not
employ service officers. As such, we have not seen too many
organizational challenges in this regard. We do believe that VSO
Service Officers are invaluable resources for veterans navigating the
VA system. Service officers should be a component to TAP programs and
be included in local BDD and Quick Start Programs. Local service
offices can act as a knowledgeable interface between the veteran, the
DoD and the VA during the process.
7. Are you aware of any unique challenges by members of the
National Guard and Reservists in gaining information about the
Quick Start program and filing claims through this program?
Members of the National Guard and Reserve components are being
mobilized at unprecedented rates. As a result, more members of the
Select Reserve are eligible for a wider range of VA benefits than ever
before. Yet, members of the Select Reserve do not have the same access
to information and benefits, as do their Active Duty peers. To help
bridge this gap IAVA recommends that VA offer training to selected AGR
members of the National Guard and Reserve so that each unit has a
benefits and resources councilor organic to the unit.
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Gerald T. Manar
Deputy Director of National Veterans Service
Veterans of Foreign Wars of the United States
200 Maryland Avenue, SE
Washington, DC 20002
Dear Mr. Manar:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
Questions from the House Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs''
February 24, 2010
This is in response to the questions submitted by the House
Committee on Veteran's Affairs in conjunction with the oversight
hearing on the ``Examination of the Benefits Delivery at Discharge and
Quick Start Programs'' held on February 24, 2010.
1. How would it help VA if the Transition Assistance Program
(TAP) briefings and BDD or Quick Start exams were mandatory for
all decommissioning servicemembers? Do you believe VA has the
resources needed for this expansion?
Response: ``How would it help VA'' is not, in our view, the
appropriate question. Rather, we believe that the question to ask is
``how would it help discharging servicemembers if the TAP briefings
were mandatory and BDD and Quick Start examinations required?''
Clearly, making TAP briefings mandatory for all discharging
servicemembers, including deactivating National Guard and Reserve
personnel would impose an additional and substantial burden on VA.
Although VBA has received substantial increases in FTE over the past
few years, the focus has been on training them to develop, process and
finalize pending claims. Outreach, while very important, only attracts
more claims; it doesn't resolve any. Should Congress decide to make TAP
briefings mandatory, additional FTE would be required for both the
outreach efforts AND claims processing.
We do not believe that VBA currently has the resources to increase
outreach nor the staff to process the additional claims generated from
outreach efforts. FTE provided by Congress in the last few years has
been allocated to processing claims. Claims receipts increased by 14
percent in FY 2009 and, reportedly, by another 10 percent FYTD.
Clearly, they need to focus on the current work at this time.
However, VBA estimates that pending inventories will peak in FY
2012 and begin to fall in the years that follow. Rather than decrease
FTE as anticipated in FY 2014 and beyond, VBA could reallocate staff to
improving outreach to departing servicemembers. While this is not the
ideal approach, it is, in our view, the most practical.\1\
---------------------------------------------------------------------------
\1\ Presentation by Acting Under Secretary for Benefits to the
Advisory Committee on Disability Compensation, April 20, 2010.
2. What can Congress do to assist VA and DoD in expanding TAP
briefings and BDD or Quick Start exams to all discharging
---------------------------------------------------------------------------
servicemembers.
Response: There are several issues here:
What can Congress do to expand TAP briefings? The
simplest thing is to pass legislation requiring every
discharging servicemember, including Guard and reserve
personnel, to participate in mandatory TAP briefings. These
briefings are designed to provide discharging servicemembers
essential information on a wide variety of subjects which help
ease transition from active duty to civilian life.
Since VA does not, in our opinion, currently have the
resources to provide staff to conduct additional TAP briefings,
it would be necessary to either plus-up the Veterans Benefits
Administration (VBA) FTE or utilize alternative methods, such
as computerized training modules or videoconferencing, to
provide this information.
Should Congress require a discharge physical
examination for all discharging servicemembers? At one time
discharging servicemembers were required to undergo a complete
physical examination at discharge. This examination provided a
coda to military service by providing a snapshot at the point
of discharge of the servicemembers physical and mental
condition. It also complimented the entrance examination and
provided VA with information that documented changes, whether
acute or chronic, new or old, at discharge. We believe it is an
extremely useful tool which should be required of all.
A literal reading of the question suggests the
possibility of requiring BDD and Quick Start claims from all
servicemembers at discharge. We believe this to be overly broad
and, frankly, unnecessary. Discharging members must be
thoroughly briefed on the various programs that may be
available to them as they transition from active duty. However,
not everyone leaves service with a chronic condition
potentially entitling them to benefits. Such a requirement
would be overly burdensome on VA and its associates and
wasteful of scarce government resources. We would not endorse
such a proposal.
3. The Memo of Understanding (MOU) between VA and DoD largely
permits only VA physicians to conduct the single exams. Is this
a problem and if so, should more training be provided to DoD
physicians so that they can conduct these exams more often?
Response: We have insufficient information to respond substantively
to this question. We do know that VA uses some QTC contracted
physicians to conduct BDD and Quick Start exams.
4. You testified that even when comprehensive physical exams
are administered, there is not enough time or resources to
complete them effectively. What might Congress do to resolve
this issue?
Response: We regularly receive reports from veterans that the
examinations provided them were quick and, in the veterans lay opinion,
not thorough. These reports come from both discharging servicemembers
undergoing BDD/Quick Start exams and veterans undergoing exams at VA
facilities. Of particular concern are psychiatric examinations which,
by their very nature, rely heavily on a review of medical records,
extensive interviews and testing, all of which take time. Examinations
which experts in the field indicate should normally take 60-90 minutes
are completed in 15-20 minutes. Unfortunately, simply reviewing
examination reports does not provide any indication of the amount of
time afforded servicemembers or veterans since the report invariably
appears to be complete.
We believe that a study of scheduling practices at military
installations where BDD/Quick Start examinations are given would
quickly indicate what the average examination time allotted is,
together with outliers, by body system. We urge a study of scheduling
of psychiatric examinations for compensation purposes, both original
and claims for increase. Further, the study could include post
examination surveys of those examined to better understand what went on
during the examination. This should provide objective data so as to
better inform VA and this Committee.
5. GAO reported that VA has established only one measure for
gauging the effectiveness of the BDD and Quick Start programs.
However, it seems that VA has several means for measuring
general disability claims. Do you agree additional quality
measurements could assist VA in fully implementing the BDD and
Quick Start programs.
Response: Yes.
6. Some Veteran Service Organizations express frustration by
VA's lack of efforts in collaborating with them in increasing
utilization of BDD and Quick Start programs. Please expand upon
the challenges faced by your organization in this regard? What
can Congress do to increase the cooperation between VA and
VSO's with respect to the BDD and Quick Start programs?
Response: Our testimony reflected our experiences with VA and DoD
with regards to the BDD and Quick Start programs. The rank and file
workers, even many VA supervisors on military bases, recognize that
VSO's can provide valuable assistance in educating and assisting
discharging servicemembers. Once we are on a military base, VA staff
and base officials quickly see the positive impact we have on the
claims intake portion of the BDD/Quick Start programs.
Where we have difficulty is getting on a military base in the first
place. VA must negotiate for space and access with local DoD officials,
individuals who are often distracted by the realities of housing and
training servicemembers who are either preparing for deployment or
returning from overseas. Their focus is on the war and the warriors who
fight for our nation. It is our opinion that many within DoD do not
adequately recognize that ensuring a quality transition from military
service to civilian life is just as essential as recruiting, training
and leading men and women in the defense of our nation. As a
consequence, they look on VA, and by extension, VSO's, with suspicion,
thinking that our very presence will somehow distract them and their
troops from their primary mission.
As a consequence, VA often finds it difficult to obtain adequate
space on a military base for its own workers. Since VA fails to include
service organizations in its BDD/Quick Start expansion plans, it is no
surprise that space for service officers is not usually included in
their planning. Once a VSO offers to place a service officer on a base
to help, it must negotiate with both base officials and the VA.
Please allow me to offer the following as an example of the
problems we experience with military personnel when seeking entry to a
base to help servicemembers. Several years ago we became concerned that
Army personnel going through the DES program at Walter Reed were not
adequately represented and, as a result, were receiving decisions which
significantly under evaluated the chronic problems for which they had
to leave service. We decided to place a highly qualified service
officer at Walter Reed to assist interested Army personnel. We met with
a dozen civilian and military officials at the base seeking a minimum
amount of space in which to work. We were rebuffed at every turn. Even
a meeting between high level VA officials, senior VSO executives
representing the major VSO's and DoD personnel at Walter Reed failed to
produce positive results. As a consequence, soldiers at Walter Reed do
not have the opportunity to consult a VFW service officer during the
DES process.
Interestingly, when we decided to shift our efforts to the Bethesda
Naval Hospital, we were able to gain access and office space with
minimal effort. As a consequence, our service officer has started
helping Navy and Marine personnel with BDD and Quick Start claims.
What we would like to see is DoD and VA actively include at least
the major VSO's in planning when BDD/Quick Start expansion is
considered. VA should ask us if we are able to provide service officers
at those military bases to which they are expanding. While we may not
be able to place a service officer at every base where VA has a
presence because of budget reasons, we would certainly appreciate the
opportunity to participate.
7. Are you aware of any unique challenges encountered by
members of the National Guard and Reservists in gaining
information about the Quick Start program and filing claims
through this program?
Response: We know that National Guard and Reservists returning from
deployment are quickly returned to their communities and released from
active duty. Therefore they are often unable to participate in TAP
briefings and do not have the opportunity to participate in the BDD
program because of the short time remaining on active duty.
Much of VA's outreach to servicemembers is focused on over 100
military installations. With Guard units scattered across the United
States and Puerto Rico, it is a challenge for VA to find the resources
to provide TAP style briefings and claims assistance to them.
Many VSO's conduct outreach to Guard and Reserve centers. Some of
these visits are coordinated with VA. At other times we visit at the
request of the Guard or Reserves. However, we are not aware of any
program by VA to ensure that all returning Guard and Reserve personnel
receive a timely TAP briefing along with assistance in completing
claims.
There is no doubt that this is problematic for VA. Outreach is
performed by VA regional office staff, sometimes hundreds of miles
distant from a Guard or Reserve center. Further, the service to be
provided is two-fold: first, brief them on what benefits and services
are available to them; then assist individuals with completing
compensation claims. The first can be done in a matter of hours.
Helping individuals file claims, if done right, will take much longer.
At BDD sites, VFW service officers usually spend about an hour with
each servicemember, helping them fill out the claim, pouring over
service treatment records and ensuring that all chronic conditions
related to service are claimed. It is much more difficult to provide
this service to Guard and Reserve personnel because of the number of
personnel filing all at once and their distance from VA and VSO
personnel.
We believe that VA could construct a plan for conducting systematic
outreach and claims assistance to Guard and Reserve personnel who have
been recently deactivated. VA should work with the VSO's who work in
their regional offices in order to coordinate activities. In this way
it would be possible for a number of VA and VSO personnel to appear at
a Guard or Reserve center and provide information and services to
appropriate personnel. Once such a plan is developed, it could be
tested in a number of states in order to determine the efficacy of the
plan. Data could be gathered and a report provided your Committee.
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Raymond C. Kelley
National Legislative Director
AMVETS
4647 Forbes Boulevard
Lanham MD, 20706
Dear Mr. Kelley:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
Questions from the House Committee on Veteran's Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing on ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs''
February 24, 2010
1. How would it help VA if the Transition Assistance Program
(TAP) briefings and BDD or Quick Start exams were mandatory for
all decommissioning servicemembers? Do you believe VA has the
resources needed for this expansion?
It would help transitioning servicemembers if VA TAP briefings were
mandatory. AMVETS doesn't believe this will cause a resource issue,
because VA is present at most TAP briefings but servicemembers don't
participate. Not all transitioning servicemembers leave service with a
disability; therefore, AMVETS does not believe that BDD or Quick Start
exams need to be mandatory. However, we would like to see the
Disability Evaluation System (DES) program expand and become mandatory
for all transitioning servicemembers.
2. What can Congress do to assist VA and DoD in expanding TAP
briefings and BDD or Quick Start exams to all discharged
servicemembers?
Congress should mandate that all transitioning servicemembers must
attend VA TAP briefings.
3. The Memorandum of Understanding (MOU) between VA and DoD
largely permits only VA physicians to conduct the single exam.
Is this a problem and if so, should more training be provided
to DoD physicians so they can conduct these exams more often.
The MOU between DoD and VA is a general agreement that allows local
DoD facilities to enter into MOUs with local VA facilities. These local
MOUs dictate who is responsible for what aspects of the single exams.
The issues that arise are often ones of logistics. For instance: the
MOU states VA will conduct the physicals and DoD will provide
examination rooms. This seams benign enough; however, DoD may not
understand what equipment will be needed for VA to conduct a thorough
exam. A clearer explanation of what needs and expectations are for each
location so there is not a lack of resources. In cases where DoD will
be conducting the exams, it is important that they provide a medical
evaluation that is complete and in a format that is usable by VA.
AMVETS suggests that VA design medical condition templates for DoD and
civilian doctors to use to ensure all pertinent information is included
so VA will not have to conduct a second exam because critical
information is not included.
4. You testified that even when comprehensive physical exams
are administrated, there is not enough time or resources to
complete them effectively. What might Congress do to resolve
this issue?
Again, AMVETS attributes this to vague MOUs between local DoD and
VA facilities. AMVETS believes this is a problem that can be easily
solved by the two agencies. If upon their recommendations it is
believed that more funding for these programs is needed then Congress
should appropriate sufficient funding.
5. GAO reported that VA has established only one measure for
measure for gauging the effectiveness of the BDD and Quick
Start programs. However, it seems that VA has several means for
measuring general disability claims. Do you agree additional
quality measurements could assist VA in fully implementing the
BDD and Quick Start programs?
Yes, there needs to be a more emphasis on quality. AMVETS is
working with other VSOs to construct a metric to more evenly evaluate
effectiveness.
6. Some Veterans Service Organizations (VSOs) express
frustration by VA's lack of efforts in collaborating with them
in increasing utilization of BDD and Quick Start programs.
Please expand upon the challenges faced by your organization in
this regard? What can Congress do to increase the cooperation
between VA and VSOs with respect to the BDD and Quick Start
programs?
This is more of a problem between DoD and the VSOs. For our service
officers to assist servicemembers with a Quick Start of BDD claim they
need access to them on military installations. This requires
cooperation between the Commanders on each of the bases and the VSOs.
7. Are you aware of any unique challenges encountered by
members of the National Guard and reservists in gaining
information about the Quick Start program and filing claims
through this program?
Time is the largest factor in all Guard and reserve transition
issues. Most demobilizations take less than one week. It is impossible
to conduct a complete physical for hundreds to thousands of returning
servicemembers. The simple solution is to provide a VA briefing prior
to Guard and reserve member's exit exam. This will provide them with
the knowledge to tell the medical professional conduction the
evaluation every condition that started or got worse while on active
duty. As long as the information is in their medical records and the
veteran files for disability within one year they will have a very
quick claims process.
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
John L. Wilson
Assistant National Legislative Director
Disabled American Veteran
807 Maine Avenue, NW
Washington, DC 20024
Dear Mr. Wilson:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
Post-Hearing Questions For John Wilson, Assistant National
Legislative Director of the Disabled American Veterans
Following the February 24, 2010 Hearing of the United States House of
Representatives, House Veterans' Affairs, Subcommittee on Disability
Assistance and Memorial Affairs
1. How would it help VA if the Transition Assistance Program
(TAP) briefings and BDD or Quick Start exams were mandatory for
all decommissioning servicemembers? Do you believe VA has the
resources needed for this expansion?
Response: Mandatory TAP, Disability Transition Assistance Programs
(DTAP) briefings and Benefits Delivery at Discharge (BDD) and Quick
Start medical examinations would ensure all separating military
personnel would be better informed as to the variety of benefits for
which they qualify. Additionally, all medical evidence necessary to
determine service connection for claimed disabilities would be readily
available, which would expedite the claims adjudication process and
facilitate placing any disability compensation that is due in the
``hands'' of the member shortly after transitioning into veterans
status.
Regarding the question of resources, if all decommissioning
servicemembers were required to complete TAP/DTAP and BDD/Quick Start
programs, the Department of Veterans Affairs (VA) would likely need
additional resources to ensure the timely delivery of these services.
2. What can Congress do to assist VA and Department of Defense
(DoD) in expanding TAP briefings and BDD or Quick Start exams
to all discharging servicemembers?
Response: We recommend Congress provide sufficient funding,
staffing and oversight for TAP/DTAP to ensure these services are
available to support all routine discharges per year from each branch
of service.
We further recommend Congress provide sufficient funding to ensure
that members of the National Guard and Reserve forces who are activated
for 12 months or longer be afforded a period of active duty of five
days, within 90 days of separation, in order to attend TAP and DTAP
workshops. Additionally, Congress should require completion of a
separation physical exam and attending TAP/DTAP as mandatory conditions
for all separating military personnel to receive the DD Form 214,
Certificate of Release or Discharge from Active Duty.
3. The Memo of Understanding (MOU) between VA and DoD largely
permits only VA physicians to conduct the single exams. Is this
a problem and if so, should more training be provided to DoD
physicians so they can conduct the exams more often?
Response: The DoD's role in providing separation physical exams was
modified because of previous instances where DoD improperly applied
disability standards specified in the VA Schedule for Rating
Disabilities and also because transitioning personnel who file
disability claims with the VA were subject to duplicative physical
exams in order to meet requirements of both the DoD and VA. A study in
1994 of the Navy and Marine Corps' mandated separation exams found that
while they met the services' needs for a separation physical, 75
percent of the exams' findings were insufficient for the purpose of
disability ratings. Often the diagnosis or findings were not in line
with the requirements of the VA rating schedule.
Maximizing the use of available physician resources whether from
DoD, VA or others provides the greatest flexibility to ensure that
transitioning personnel obtain this critical medical exam. To maximize
their use, duplicative exams can be eliminated by DoD and VA
establishing the use of medical examination templates, as is currently
being done in certain VA pilots, to ensure that all examinations are
adequate for rating purposes regardless of source. It seems prudent to
further clarify MOU procedures accordingly.
4. You testified that even when comprehensive physical exams
are administered, there is not enough time or resources to
complete them effectively. What might Congress do to resolve
this issue?
Response: DAV recommends Congress provide the DoD and VA the
necessary resources to ensure all transitioning military personnel
applying for disability compensation receive separation physicals,
whether active duty, mobilized Reserve or Guard forces. We further
recommend Congress provide sufficient funding to ensure that members of
the National Guard and Reserve forces who are activated for 12 months
or longer be afforded a period of active duty of five days, within 90
days of separation, in order to attend TAP and DTAP workshops.
5. GAO reported that VA has established only one measure for
gauging the effectiveness of the BDD and Quick Start programs.
However, it seems that VA has several means for measuring
general disability claims. Do you agree additional quality
measurements could assist VA in fully implementing the BDD and
Quick Start programs?
Response: The inclusion of additional quality measures could
provide the VA with information that would further enhance the
effectiveness of this important program. For example, monitoring all
actions taken from the date VA receives a claim, as opposed to the
current practice of monitoring all actions taken from the date of
receipt of the DD Form 214, may provide both DoD and VA with important
information that resolves other process problems that are not presently
apparent.
The VA/DoD Joint Executive Council has only a general focus on this
area. Its objective as found in its Strategic Plan for FY 2009 to 2011
is ``to improve participation in the BDD program nationwide and ensure
servicemembers are afforded the single cooperative examinations where
available.'' The plan to streamline benefits application processes,
eliminate duplicative requirements and correct various business
practices that complicate the process will prove more useful however
when there are measureable outcomes. Congressional oversight of the
success of this strategic plan is also recommended.
6. Some Veteran Service Organizations (VSOs) express
frustration by VA's lack of efforts in collaborating with them
in increasing utilization of BDD and Quick Start programs.
Please expand upon the challenges faced by your organization in
this regard. What can Congress do to increase the cooperation
between VA and VSOs with respect to the BDD and Quick Start
programs?
Response: VSOs at a number of military installations were given
access to provide free assistance to military personnel in various
stages of preparation for separation from military services. In 1998,
for example, VSOs at the national, state and county level were
acknowledged as playing an important role with VAROs in VBA
predischarge claims development, examinations and rating decisions (VA
Circular 20-98-2, Change 1 dated January 25, 1999). VSOs were
encouraged to participate with VAROs and to be made an integral part of
the planning and execution of these programs. VSOs were authorized to
conduct TAP and DTAP briefings, consult with personnel on VA benefits,
and conduct reviews of service treatment records in order to advise
claimants and to assist them in preparing benefit applications. In
Appendix A, section 10 of this same circular VSOs were identified as
partners and ``full integration of the veterans' service organizations
is important for the support of the pre-discharge examination and
claims adjudication process.''
Today, VSOs' access to military installations varies, with some
simply not allowing VSOs access. Congressional action directing VSOs'
access to conduct TAP and DTAP briefings, consult with personnel on VA
benefits, and conduct reviews of service treatment records in order to
advise claimants and to assist them in preparing benefit applications
is critical. If VSOs are incorporated as full partners in this area, we
could provide transitioning military personnel a critical adjunct to
existing programs and could offer constructive comments to DoD and VA
on delivery of services to ensure best practices are adopted and less
constructive initiatives discarded.
7. Are you aware of any unique challenges encountered by
members of the National Guard and Reservists in gaining
information about the Quick Start program and filing claims
through this program?
Response: A unique challenge that National Guard and Reserve
personnel often face is their rapid demobilization from active duty
status which may preclude their being fully informed about benefits
potentially available to them. Additionally, since separation physical
exams are not mandatory, this may later impact their eligibility for
disability compensation for service-connected conditions.
Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Diana Rubens
Associate Deputy Under Secretary for Field Operations
Veterans Benefits Administration
U.S. Department of Veterans Affairs
810 Vermont Ave., NW
Washington, DC 20420
Dear Ms. Rubens:
Thank you for testifying at the House Committee on Veterans'
Affairs' Subcommittee on Disability Assistance and Memorial Affairs'
oversight hearing on the ``Examination of the Benefits Delivery at
Discharge and Quick Start Programs,'' held on February 24, 2010. I
would greatly appreciate if you would provide answers to the enclosed
follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for material for all full
committee and subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively on letter size paper,
single-spaced. In addition, please restate the question in its entirety
before the answer.
Due to the delay in receiving mail, please provide your responses
to Ms. Megan Williams by fax at (202) 225-2034. If you have any
questions, please call (202) 225-3608.
Sincerely,
John J. Hall
Chairman
__________
Questions for the Record
House Committee on Veterans' Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Hearing on Examination of the U.S. Department of Veterans Affairs
Benefits Delivery at Discharge and Quick Start Programs
February 24, 2010
Question 1: What percentage of VA's current inventory of disability
claims includes first-time claims from Servicemembers returning from
Iraq and Afghanistan?
Response: As of March 31, 2010, the 15,932 initial claims submitted
by Servicemembers returning from Iraq and Afghanistan represent 3.2
percent of VA's inventory of 493,732 disability compensation claims.
Question 2: Would it help VA if the Transition Assistance Program
(TAP) briefings and BDD or Quick Start exams were mandatory for all
decommissioning servicemembers, and if so, how? If VA favors this
expansion, does VA have the resources needed to achieve this objective?
What can Congress do to assist you in expanding TAP briefings and BDD
or Quick Start exams to all discharging servicemembers?
Response: Mandatory TAP briefings would significantly help support
VA's mission. TAP briefings provide VA the opportunity to promote the
BDD and Quick Start programs and provide information about Veterans'
benefits and services. If all separating Servicemembers were required
to attend TAP briefings, VA would need additional resources to reach
all Servicemembers, particularly those separating from remote
locations. VA is working to develop innovative ways of delivering TAP
briefings for Servicemembers in situations and locations where
briefings are difficult to conduct, including those separating from
naval vessels while on deployment, remote locations, Guard and Reserve
units returning from theater, and Servicemembers serving in small
detachments such as embassy guard personnel and recruiters.
VA supports mandatory separation physicals for all separating,
deactivating reserve component personnel and all retirees. Examinations
adequate for use in the claims process are conducted to VA standards
for Veterans who participate in BDD, Quick Start, the Joint DoD/VA
Disability Evaluation System Pilot, and for those Veterans who file a
claim within a year of separation from service. This represents
approximately one half of all initial claims VA receives. The remainder
of the claims are received from Veterans many years post service.
Mandatory separation physicals need not be as extensive as an
examination for a compensation claim, but they would serve critical
needs that are currently not being met. Those needs include the
following: 1. The examination results, if automated, would aid in
predicting future claim activity and would materially aid in VA's
efforts to project future requirements in a manner similar to Social
Security; and 2. The examination results would provide a critical
baseline of the state of a Servicemember's health at time of separation
that could document his/her state of hearing and vision, and determine
whether isolated reports of treatment for routine medical events, such
as strains, have resolved or continue to have residuals that justify an
award of service connection.
Question 3: Despite the Memo of Understanding (MOU) between the VA
and DoD, many units are still failing to execute a single physical exam
that will meet both the VA and DoD's standards. How can we help local
units to get a single examination process established? Can this problem
be solved simply through education and training, or should the policy
be fundamentally changed?
Response: The existing MOUs regarding single examinations do not
mandate separation physicals for all separating Servicemembers. Rather,
they are an agreement as to the standard to which examinations will be
conducted (and by whom) when they are needed for a specific purpose
such as a disability claim or a retirement physical. The policy should
be fundamentally changed. Mandatory separation physicals for all
Servicemembers leaving a period of active duty should be instituted for
those individuals who do not file a claim for disability benefits prior
to separation. It must be recognized that this core baseline reading is
a foundational piece to any future disability decision rendered on a
Veteran who chooses to file a disability claim many years after
service.
Question 4: How does the effectiveness of these programs suffer
through having MOUs with DoD that largely permit only VA physicians to
conduct the single exams? If this is a problem, should more training be
provided to DoD physicians so that they can conduct these exams more
often?
Response: The memorandum of agreement between VA and DoD does not
specify that the examination must be conducted by a VA physician, only
that the examination be conducted in accordance with VA examination
protocols. In this period of conflict, it is not surprising that DoD,
with its own clinical staffing challenges, believes that its primary
focus must be on forward-deployed health and health maintenance of the
force. Locally, individual VA regional offices, VA medical centers and
military treatment facilities (MTFs) will sign a memorandum of
understanding, defining each agency's responsibilities. Responsibility
for completing the exam (or aspects of the exam) is based largely on
the availability of each agency's resources at or near the location.
If DoD physicians are available at MTFs, training in many cases is
provided through VHA's examiner testing protocol to enable DoD
clinicians to conduct examinations in accordance with VA's examination
protocols.
Question 5: The Government Accountability Office (GAO) testified
that VA has established only one measure for gauging the effectiveness
of the BDD and Quick Start programs. However, it seems that VA has
several means for measuring general disability claims including: (a)
how much time a veteran has to wait for a final decision, (b) average
days to complete all work to reach a final decision, and (c) percentage
of claims with no processing errors. I understand that if VA performed
these surveys, such as tracking total time to develop a claim, the
results may suggest that VA has more work to do to achieve its goals.
However, can't these additional performance measurements assist VA in
fully implementing the BDD and Quick Start programs?
Response: The effectiveness of the BDD and Quick Start programs is
generally gauged utilizing the same measurements applied to all other
disability claims. These measurements include ``average days to
complete'' (average days to complete all work) and ``average days
pending'' (average age of the currently pending workload). VA conducts
the same quality assurance reviews for the sites that process BDD and
Quick Start claims as are used for other regional offices.
BDD claims present unique issues with regard to measuring ``average
days to process'' and ``average days pending'' in that there are
significant differences when compared to normal Veterans claims
processing. If VA were to measure from the date the Servicemember filed
his/her claim, both of these measures would be meaningless since they
would be controlled by: (a) when the Servicemember filed his/her claim
in relation to his/her expected separation date; and (b) the fact that
VA cannot influence this time since VA has no legal authority to
finalize the decision and make payment until the member separates.
Thus, we believe that the true measure of the success and effectiveness
of the pre-discharge programs is the time delay between separation and
notification of entitlement.
Question 6: Veterans Service Organizations (VSOs) suggest they can
play a critical role in improving the implementation of BBD and Quick
Start programs. What can we do to increase your cooperation with VSO's
in this regard? What challenges might you face in forging this
cooperation?
Response: At the Transition Assistance Program briefings, VA
advises Servicemembers about the opportunity to be represented by a
VSO. There is no inherent legal or VA-imposed process limitation in the
ability of service organizations to represent Servicemembers in the VA
claims process while they are still on active duty. In fact,
partnerships exist with various organizations, including state
Departments of Veterans' Affairs, at some BDD sites. We are aware,
however, that service organizations sometimes have difficulty obtaining
office space on military installations due to the widespread space
scarcity on most installations following consolidation of facilities
through the BRAC activities.
Question 7: What unique challenges does VA encounter with educating
members of the National Guard and Reservists about the BDD and Quick
Start programs, and processing the Quick Start claims? How many Quick
Start claims do you process each year? How many do you complete
annually?
Response: Normally, deployed members of the reserve components
cannot participate in the BDD program because of the extremely brief
period of time that they have on active duty following return from
theater. VA often receives limited notice of the demobilization events
and has limited time to interact with the Servicemembers.
When VA reaches Servicemembers at the demobilization events, there
is insufficient time to conduct medical examinations and gather
evidence while on active duty. VA accepts Quick Start claims at
demobilization events, but locating and obtaining service treatment
records from individual units can be time consuming. Frequently there
is a delay, sometimes significant, in associating in-theater treatment
records with their medical jacket. VA completed 16,162 Quick Start
claims during FY08, and 22,021 Quick Start claims during FY09. This
fiscal year 11,712 Quick Start claims have been completed through the
end of March. We do not have a report that identifies which of those
claims was from reserve component Servicemembers.
Question 8: What can this Committee do to assist VA in addressing
any technical or training issues related to the BDD and Quick Start
programs? Will the 4,000 additional disability raters requested in the
Administration's FY11 budget make any impact in the ability to expand
the BDD and Quick Start programs?
Response: VA requests the House Committee on Veterans' Affairs
maintain its current level of support to ensure the continuing success
of the BDD and Quick Start programs. The additional staffing in VA's
2011 budget submission are primarily focused on addressing the
increasing demand for services as represented by the unprecedented
claim rate, including claims received through the BDD and Quick Start
programs. VA continues to seek opportunities to reach out and assist
separating Servicemembers while they are on active duty and is
committed to supporting the smooth transition from military to civilian
life.