# Presentation: 769232

## Senior Oversight Committee Serving our Wounded, Ill and Injured Wounded Warrior Update for The DES Pilot Expansion

- October 30, 2008

- Senior Oversight Committee Serving our Wounded, Ill and Injured ***Wounded Warrior Update ******for ******The DES Pilot Expansion***

## Hundreds of Recommendations and Mandates

**Hundreds of Recommendations and Mandates**

***9 Reports/ 573 Recommendations***

## Changing Roles

## Expediting Access to Benefits

## DES Pilot Process - Review

## Problem:  The Disability Evaluation Systems of the Departments are complex, confusing and duplicative

Solution:
Establish pilot in the National Capital Region  – Nov 2007:
 Single DoD/VA physical exam
 DoD determines Line of Duty
 VA determines Disability Rating
 600 in pilot (as of October 19, 2008)
 130 completed Physical Evaluation Board
		 awaiting processing and separation from Service
DES expansion has started with Ft Meade and Belvoir on October 1, 2008, Ft Stewart, Ga. and the Naval Medical Center San Diego (Balboa) in November 2008

**Solution:**
- Establish pilot in the National Capital Region  – Nov 2007:
** **Single DoD/VA physical exam
-  DoD determines Line of Duty
-  VA determines Disability Rating
-  600 in pilot (as of October 19, 2008)
-  130 completed Physical Evaluation Board
- 		 awaiting processing and separation from Service
- DES expansion has started with Ft Meade and Belvoir on October 1, 2008, Ft Stewart, Ga. and the Naval Medical Center San Diego (Balboa) in November 2008

**Implementation of Recommendations:****Disability Evaluation System (LoA #1)**

**Exploring Streamlined**
**DES for Catastrophically**
** ****Wounded OEF/OIF**
**Service members**

**Notes:**
PROBLEM:  The Disability Evaluations Systems of the Departments are complex, confusing and duplicative
VISION:  A seamless and transparent DES, administered jointly by DoD & VA
FEATURES / GOALS (Task Force, Audit and Study Recommendations)
Less complex 
Faster, more consistent evaluations & compensation
Single medical exam & single-source disability rating
Seamless transition to Veteran status
Continuum of care - advocacy & expectation management
Updated Veterans Affairs Schedule for Rating Disability (VASRD) for signature GWOT injuries

## Single Physical Examination

**Single Physical Examination**

**Draft DoD and VA Memorandum of Agreement**
- VA and DoD collaboration
- Provides for single Disability Evaluation/Transition examination of Active Duty (AD) and Reserve Component (RC) Service members referred to DES.
**Exam Content**
- Comprehensive evaluation of both potentially military unfitting conditions identified by military providers and Service member-claimed conditions.
- Veterans Benefits Administration Compensation & Pension Automated Medical Information Exchange (AMIE) Examination Worksheets will be used as guides for examiners.
**Exam locations** - Exams performed at VA medical centers, military Treatment Facilities (MTFs), VA contracted centers, or by TRICARE network providers based on Service member’s needs.
**Training** - Medical providers performing and ordering examinations shall have training regarding the DES, AMIE worksheet criteria and exam requirements.
**Funding**
- Departments will share responsibility on payment of examinations.
- Estimated Cost: $1,400 per member ($3.5M annually for initial expansion).

## Pilot Summary

**Better:**  Seamless, better advocacy, less duplication
**Faster:**  Prior to the Pilot average Army Board was completed in 542 Days
- Average now is 218 days from Pilot entry to VA benefits decision
- 57% reduction days for current DES and VA Claim process
- 21% less than the 275-day initial projection for the Pilot
**Fairer:**  No decisions appealed to Military Secretary to date
**Resources:  **Requires interoperable systems and additional equipment
**Education/Training:  **Comprehensive training required to standardize the DES and _***then***_ implement DES Pilot process
**Automation Support:**  Continues to evolve as business practice evolves -
- Short term:  Pilot case tracking
- Mid term:  “Off the Shelf” workflow and document management
- Long term:  Fully interoperable DoD-VA DES systems

**Pilot Summary**

## Sept. 2008, GAO Draft Report on Expansion

- “...yet to finalize criteria for applying metrics to determine whether the pilot is worthy of eventual full-scale implementation.”
- “...have yet to resolve key challenges associated with expanding the joint process.”
- VA exam no-shows
- Logistical requirements in a larger expansion with regards to VA exam
- Very case-management dependent
- Unknown operational expenses in a full-scale implementation
- “DoD/VA should sustain collaborative executive focus and retain knowledgeable staff...”
- “Expanding the pilot to a few more locations may be prudent as a way to test the process under different conditions such as at locations lacking easy access to a VA medical facility for physical examinations.”

## What We Did:
DoD/VA briefed the OIPT and SOC on DES Pilot Expansion Plan August 12, 2008

Based on SOC decision for DES Pilot expansion acceleration
DoD Hotwash August 26-27, 2008
VA Hotwash September 4-5, 2008
DoD/VA combined Hotwash week of September 8-12, 2008

Return to SOC and Co-Chairs with accelerated expansion plan
Project Plans, Kickoff dates and sites

- DoD/VA briefed the OIPT and SOC on DES Pilot Expansion Plan August 12, 2008
- Based on SOC decision for DES Pilot expansion acceleration
- DoD Hotwash August 26-27, 2008
- VA Hotwash September 4-5, 2008
- DoD/VA combined Hotwash week of September 8-12, 2008
- Return to SOC and Co-Chairs with accelerated expansion plan
- Project Plans, Kickoff dates and sites

**DES Pilot Expansion Plan**

## Overarching Timeline

## Phase I Initial Operating Capability Rollout At-A-Glance

## DES Expansion Sites(Phase I-Oct 08-May 09)

## Medical Examination Locations

- Ft. Belvoir----Washington VAMC
- Ft. Meade----Baltimore VAMC
- Balboa NMC----VHA C&P Unit at CBOC
- Ft. Stewart----VBA Contract at MTF
- Camp Pendleton----VBA Contract in area
- Bremerton NH----VBA Contract in area (multiple sites)
- Vance AFB----VBA Contract in area
- Ft. Polk----Alexandria VAMC, with Long Term Plan to use CBOC
- Jacksonville NH----VBA Contract at MTF
- Nellis AFB---- VHA Shared facility
- MacDill AFB----VBA Contract in area
- Camp LeJeune---- VBA Contract in area
- Ft. Rich/Wainwright----Under Discussion
- Ft. Drum----VHA, CBOC-type facility near Ft. Drum
- Elmendorf----Under Discussion
- Travis AFB----both MTF & VHA
- Ft. Carson---- Under Discussion

## Current VHA Staff Assigned toMilitary Treatment Facilities

**Ft. Lewis**

**Ft. Lewis**

**Ft. Carson**

**Ft. Carson**

**NNMC**
** ****WRAMC**

**NNMC**
** ****WRAMC**

**Ft. Hood**

**Ft. Hood**

**Ft. Sam Houston**

**Ft. Sam Houston**

**Ft. Gordon**

**Ft. Gordon**

**Ft. Bragg**

**Ft. Bragg**

**Current VHA Staff Assigned to****Military Treatment Facilities**

- 4 VA Liaisons

- 2 VA Liaisons

- 2 VA Liaisons

- 5 VA Liaisons

- 1 VA Liaison

- 2 VA Liaisons

- 1 VA Liaison

- 1 VA Liaison

- 2 VA Liaisons

- 1 VA Liaison

**Ft. Benning**

- 1 VA Liaison

**Ft. Stewart**

- 1 VA Liaison

**Notes:**
Brooke Army Medical Center  Ft. Sam Houston, Texas
Darnall Army Medical Center Ft. Hood, Texas
Eisenhower Army Medical Center Ft. Gordon, Georgia
Evans Army Community Hospital Ft. Carson, Colorado
Madigan Army Medical Center Ft. Lewis, Washington
Naval Hospital Camp Pendleton Camp Pendleton, CA
National Naval Medical Center, Bethesda, MD
Naval Medical Center San Diego, CA*
Walter Reed Army Medical Center, Washington, DC
Womack Army Medical Center, Ft. Bragg, NC*

## VA Liaisons for Healthcare

- OEF/OIF Program Managers at each VA Medical Center  serve as POC for referrals from MTFs without VA Liaisons.  VA Liaisons (20) are currently at 9 Army Installations.  Additional VA Liaisons were requested and will arrive (within 120 days) at Forts Lewis, Carson, Gordon and Bragg.

## VBA Support to Warrior Transition Unitsand Soldier Family Assistance Center 

- VBA Military Service Coordinators (MSC) support Warrior Transition Units (WTU’s) and Soldier Family Assistance Center (SFAC’s) at 33 Army Installations (Also supporting 6 Community Based (CBWTU’s)) by providing benefits briefings, assisting with claims submission and acting as a VBA OEF/OIF POC, BDD Site on the installation. There may be increased support based on volume of WTs.
- VBA Voc Rehab Counselor (VR&E) are supporting 32 WTU’s (and 7 CBWTU’s) by  testing, counseling and help finding careers for Warriors in Transition. The Director of VR&E is looking to expand this support.

## Questions