U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

82–245 2014

DOD AND VA COLLABORATION TO ASSIST 

SERVICEMEMBERS RETURNING TO CIVILIAN LIFE 

JOINT HEARING 

with 

HASC 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

WEDNESDAY, JULY 10, 2013 

Serial No. 113–29 

Printed for the use of the Committee on Veterans’ Affairs 

( 

VACREP180 with DISTILLER

ii 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

BILL FLORES, Texas 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

MICHAEL H. MICHAUD, Maine, Ranking 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

HELEN W. TOLAR, Staff Director and Chief Counsel 

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. 

VACREP180 with DISTILLER

iii 

C O N T E N T S 

July 10, 2013 

Page 

DoD and VA Collaboration To Assist Servicemembers Returning To Civilian 

Life ........................................................................................................................ 1 

OPENING STATEMENTS 

Hon. Jeff Miller, Chairman, .................................................................................... 1 

Prepared Statement of Chairman Miller ........................................................ 44 

Hon. Adam McKeon, U.S. House of Representatives, (CA-25) ............................ 3 

Hon. Michael Michaud, Ranking Minority Member ............................................. 4 

Prepared Statement of Hon. Michaud ............................................................ 45 

Hon. Adam Smith, U.S. House of Representatives, (WA-09) ............................... 6 

Hon. Corrine Brown, U.S. House of Representatives (FL-05), Prepared Statement only .............................................................................................................. 46 

WITNESSES 

Hon. Frank Kendall, Under Secretary of Defense for Acquisition, Technology 

and Logistics, Department of Defense ................................................................ 7 

Prepared Statement of Hon. Kendall .............................................................. 46 

Accompanied by: 

Hon. Jonathan Woodson, M.D., Assistant Secretary of Defense for 

Health Affairs and Director, TRICARE Management Activity, Department of Defense 

Hon. Jessica L. Wright, Acting Under Secretary of Defense for Personnel and Readiness, Department of Defense 

Stephen W. Warren, Acting Assistant Secretary for Information and Technology, Department of Veterans Affairs ............................................................. 10 

Prepared Statement of Mr. Warren ................................................................ 53 

Accompanied by: 

Hon. Robert A. Petzel, M.D., Under Secretary for Health, Veterans 

Health Administration, Department of Veterans Affairs 

Mr. Danny Pummill, Deputy Under Secretary for Benefits, Veterans 

Benefits Administration, Department of Veterans Affairs 

MATERIALS SUBMITTED FOR THE RECORD 

Letter To: Hon. Dan Beniskek, From: Eric Shinseki, VA .................................... 58 

QUESTIONS FOR THE RECORD 

Post-Hearing Questions and Responses ................................................................. 59 

VACREP180 with DISTILLER

VACREP180 with DISTILLER

(1) 

DOD AND VA COLLABORATION TO ASSIST 

SERVICEMEMBERS RETURNING TO CIVILIAN LIFE 

Wednesday, July 10, 2013 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, D.C. 

The Committees met, pursuant to call, at 10:02 a.m., in Room 

2118, Rayburn House Office Building, Hon. Jeff Miller [Chairman 

of the Veterans’ Affairs Committee] presiding. 

OPENING STATEMENT OF HON. JEFF MILLER 

Chairman MILLER. Thank you, everybody, for being here today 

for this second joint hearing of the Veterans’ Affairs Committee 

and the House Armed Services Committee. 

I welcome the Chairman, Buck McKeon, as well as the Ranking 

Member of the HASC, Adam Smith, and of course, my good friend 

from Maine, the Ranking Member of the Full VA Committee, Mike 

Michaud. 

And as I said, this is the second time now that we have gotten 

these two Committees together. And I am proud to serve on both 

of these particular Committees. 

We are going to jointly review the collaborative efforts of the 

DoD and VA, as it pertains to servicemembers and their transition 

from active duty, to civilian life. 

A year ago, we were privileged to have both Secretaries Panetta 

and Shinseki at the witness table, and both of them testified at 

great length regarding the progress VA and DoD were making in 

several key areas. 

And what I would like to do this morning first is to revisit those 

areas in my opening statement. First, the progress made in developing an integrated electronic health record. Secondly, the progress 

that has been made in reducing the wait times associated with VA 

disability claims, which necessarily does involve cooperation from 

DoD in the transfer of records. 

So let’s start, if we can, with the electronic health record. In a 

response to a direct question last year, Secretary Shinseki remarked that the two departments had finally, after 17 months of 

discussion, agreed on a way forward on a single, joint, common-integrated electronic health record that would be completed by 2017. 

The Secretary told us that each of those words—single, joint, and 

common—meant something and that finally we were breaking 

through the cultural issues that existed between the two departments and that really stifled in the past. 

VACREP180 with DISTILLER

2 

And we come here today, and I say what a difference a year 

makes. 

Contrary to the Secretary’s testimony, two departments are once 

again moving on their own tracks, with promises we have heard 

before about making the two separate systems interoperable. 

Pardon my frustration, folks, but it seems the only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done. 

In response to this latest course correction, the House included 

an amendment in the national defense authorization bill, an 

amendment that was developed in collaboration with the leadership of HASC and VA and to direct the completion of an integrated 

health record by October 1 of 2016. The message of the amendment 

is simple—no more excuses, get it done. 

I am anxious to hear from the witnesses today, to hear how they 

will comply with the mandate of the amendment once it is enacted 

into law. 

The second issue I will briefly touch on is on the disability claims 

backlog. It is interesting to note that the progress made in reducing 

the pending inventory of claims the last few months correlates with 

a heightened Congressional oversight and media scrutiny. 

None of us up here are going to take our foot off the gas when 

it comes to ensuring progress is made on the backlog. Every member in this room will agree with that statement. And although 

progress has been made lately, VA is woefully short of its own 

goals for this year. 

So going forward, ending the backlog necessarily requires a 

seamless record transfer from DoD. I look forward to hearing the 

status of the efforts and what more can be done. The problem of 

veterans waiting years for their disability claims to be decided 

must remain at the forefront of our consciences, especially as further troop draw-downs occur over the next 5 years. 

It, too, is an example of where the excuses have to end and real, 

sustained progress must occur. 

To accommodate such a large contingent of members that are 

with us this morning, I have agreed to last year’s framework that 

limited to 2 minutes each member’s time to ask a question of the 

witnesses. Therefore, I ask unanimous consent that each member 

have not more than 2 minutes to question the panel of witnesses, 

starting with my very own question. 

Without objection, so ordered. 

I ask unanimous consent to include all members’ statements in 

the hearing record today. 

Without objection, so ordered. 

And I recognize the Full Committee Chairman of the Armed 

Services Committee, Buck McKeon, for his opening remarks, followed by the Ranking Member Mike Michaud, and then the Ranking Member Adam Smith, for their opening remarks. 

Mr. Chairman? 

[THE PREPARED STATEMENT OF CHAIRMAN MILLER APPEARS IN THE

APPENDIX]

VACREP180 with DISTILLER

3 

OPENING STATEMENT OF HON. HOWARD P. ‘‘BUCK’’ MCKEON 

Chairman MCKEON. Good morning. I join Chairman Miller in 

welcoming everyone here today to the second special joint hearing 

with the Veteran Affairs Committee to continue our oversight on 

the Department of Defense and Department of Veterans Affairs collaboration to assist these members’ transition to civilian life. 

After the successful joint hearing held last year, I want to thank 

Chairman Miller and Ranking Member Michaud for their leadership in continuing the shared efforts to provide our servicemembers 

and veterans and their families the assistance they need 

transitioning out of the military and the benefits they deserve for 

having served this Nation. 

At a time when we are rapidly drawing down our military, which 

I strongly oppose, particularly while we are still actively engaged 

in Afghanistan, the latest announcement of the Army’s plan to restructure the Army below 9/11 force levels is another reminder of 

the impending military draw-down that will force an additional 

100,000 servicemembers and their families on an already overburdened Veterans benefits system. 

Today’s hearing will look at the Department of Veteran Affairs 

system for delivering benefits to veterans and the role of the Department of Defense, specifically providing information and documents necessary for adjudicating a claim for benefits. 

It is no secret that the VA has a backlog of well over 500,000 

claims from veterans. A significant portion of these claims are more 

than 125 days old, with some as old as 2 years. 

These claims are not only from recently transitioned veterans, 

but are from Vietnam veterans and veterans of the wars since 

then. It is easy to talk about a claim as if it is an impersonal object, but behind each of these claims is a veteran. 

You know, each of us, as we go home and talk to our constituents, have people come up to us and tell us horror stories of things 

that have happened to them. And we all—nobody in this room 

wants to see that happen. It is just a very difficult situation to resolve all of these issues with—we are talking so many people. 

A veteran who willingly served this country now is asking only 

what was promised for that service. Alongside many of these veterans are the families, families who stood by these veterans while 

they served, enduring the hardships of military life. 

These are the people behind these claims who are waiting for 

their benefits. We owe them an answer and we owe them our commitment to continue to ask the hard questions until we are satisfied with the accuracy and the timeliness of the benefits system. 

We find ourselves in a situation where it is tempting to place 

blame and look for easy fixes, but that is not our purpose here 

today. 

I want to understand the reasons for the backlog and I want to 

know what is being done by both departments to complete these 

backlog claims and expeditiously provide veterans with their benefits. Lastly, I want to know from the witnesses how the integrated 

electronic health directorate will assist each department to fulfill 

its responsibility for timely delivery of transition assistance and 

benefits, and what role, if any, the IEHR will play in reducing the 

VA backlog of claims. 

VACREP180 with DISTILLER

4 

Furthermore, I understand that DoD already passes a significant 

amount of medical information to the VA and it will be useful for 

all of us to better know how the IEHR will improve that sharing 

of information. I have been encouraged by the attention being paid 

the issue of electronic health records by Secretary Hagel since he 

took office. The DoD acquisition decision memorandum issued on 

June 21st certainly conveys the sense of urgency we hope to instill 

with the amendment to the fiscal year 2014 NDAA, that I sponsored with the Ranking Member, Mr. Smith, and in collaboration 

with Chairman Miller, Chairman Rogers, Chairman Young and 

Chairman Culberson. 

Both press for aggressive deadlines for implementation and increased oversight to ensure that DoD finally is able to field a seamless, integrated electronic health record. What I hope today is to 

see a similar commitment from the VA Department and similar 

mechanisms to address the lack of measurable goals and accountability by VA that the GAO pointed out in its previous investigations in to the issue. 

It is incumbent on this body to make sure that the leadership for 

both departments see this as an important matter deserving their 

personal attention and guidance. Our veterans deserve nothing less 

for the sacrifices they have made for this country. 

With that, I thank you, Chairman Miller, for your leadership in 

pulling this together and look forward to this hearing. 

Chairman MILLER. Thank you, Mr. Chairman. 

Mr. Michaud? 

STATEMENT OF HON. MICHAEL H. MICHAUD 

Mr. MICHAUD. Thank you very much, Mr. Chairman. 

I, too, want to thank the two chairmen and Ranking Member 

Smith for having this joint hearing today. Transition is a critical 

issue that greatly affects our servicemembers and veterans. This 

hearing is the second joint hearing our two Committees have held 

concerning transitions. The purpose of this hearing is to reiterate 

our joint oversight commitment and to ensure that the Department 

of Veterans Administration and the Department of Defense work 

together on behalf of the men and women who are sent into harm’s 

way. 

At last year’s joint hearing on this topic, the two agencies’ secretaries appeared before us sitting side by side. I am disappointed to 

see that neither is here today. I take this as a lack of personal engagement, as a sign that they care less, that they are not as committed as they have been. My big disappointment is solidified by 

receiving testimony in the 11th hour. Clearly, this issue in this 

hearing is not a priority. 

I would submit to you that the government has struggled to fulfill the sacrifice, you know, trust to care for those who have served 

and sacrificed in defense of our Nation. After 12 years of war, we 

know transition is the critical first step, and it requires the cooperation of many agencies to accomplish successfully. 

I do not believe that we have made measurable progress in getting the two agencies before us today to work more effectively together. The Department of Defense has announced it will put out 

a bid for a new system to manage its health records. Such a deciVACREP180 with DISTILLER

5 

sion appears to back an interoperable approach over an integrated 

one—and integrated is integrated, not interoperable. Electronic 

health records is something that Congress has mandated years ago 

and we have spent hundreds of millions of dollars delaying the delivery of an integrated information-sharing system which runs directly against congressional intent and ultimately hurts our veterans. 

Also of particular importance to our Committees is the claims 

backlog. Let me be clear. Both the VA and the DoD have a responsibility to end the backlog by 2015. The claims backlog is not a VA 

issue alone. The Department of Defense must do a better job in 

transferring information needed for the VA to approve or disapprove in a timely manner the claims. This includes records of our 

National Guards and reservists. It also includes late and loose 

records being sent to the VA. 

Because benefits in health care affect so many servicemembers 

and veterans, DoD and VA must put aside their parochial differences and work more effectively together to ensure an integrated 

process addressing transition issues. 

Over the course of the last several months, we sent letters to the 

secretaries and the President asking for their personal commitment 

and support. We requested concrete decisions being made in a 

timely manner. What we received in response is a no-show to this 

hearing from the secretaries and the press conference that kicks 

the decision down the road once again. 

And it would appear that leadership is lacking not just at this 

hearing. During the recent roundtable on the IEHR, industry leaders told us progress is not due to lack of availability—available 

technology solutions, but rather a lack of leadership. That is right. 

Several of the roundtable participants said there is a lack of leadership. When two divisions in their companies can’t or won’t agree, 

the CEO steps in and mandates a direction. Where are the DoD 

and VA CEOs? 

Just recently in a bipartisan effort and due to ongoing congressional concerns with the backlog, with the lack of unified vision between the VA and DoD electronic health records programs, language was included in part of the National Defense Authorization 

Act of 2014. This language creates a deliberate approach in developing joint electronic health records. I am told that strategies have 

been modified and collaborative efforts are ongoing for both records 

transfer and IEHR. However, months continue to go by with seemingly no real progress. 

I look forward to hearing from the panelists today just how far 

you have come, and to learn about the path ahead on this transition issue, and look forward to those questions that we are going 

to be asking. This is a real important issue that we have to deal 

with, and unfortunately there has been a lack of leadership. And 

I don’t only say that without two secretaries—also the President of 

the United States who made it very clear in this first term he 

wants both agencies to work together. And that leadership has 

been lacking as well on this particular issue. 

So, I look forward to hearing your comments and to answering 

the Committees’ questions. 

With that, Mr. Chairman, I yield back. 

VACREP180 with DISTILLER

6 

[THE PREPARED STATEMENT OF HON. MICHAUD APPEARS IN THE

APPENDIX]

Chairman MILLER. Mr. Smith? 

STATEMENT OF HON. ADAM SMITH 

Mr. SMITH. Thank you, Mr. Chairman. 

I think my three colleagues have correctly raised the three issues 

that we are most interested in today: How do we get joint electronic medical records between the DoD and the VA; the transfer 

issue when a veteran goes from being part of active duty DoD over 

to the VA. How do the benefits transfer; how seamless is that process—there are challenges there. And then, of course, the backlog of 

claims that we are trying to meet. And I share my colleagues’ frustration with wanting to get answers to that and wanting to make 

progress on all three of those issues. 

But I am also mindful of a couple of other facts. Over the course 

of the last almost 12 years now, there has been a huge increase in 

the number of injured veterans who have come through, that DoD 

has had to process and that VA has had to process. The initial determination of whether or not a given servicemember can stay 

within the DoD or transfer is not an easy process. It is a difficult 

one for the servicemember as well as their family in making that 

determination. So that is a significant challenge. And the sheer 

numbers are a significant challenge. 

And I would also like to point out that we have had—I have lost 

track now over the course of the last 2-plus years—four, five, six 

threatened government shutdowns which force both the DoD and 

the VA into a position where they don’t know how much money 

they are going to have in a matter of weeks. So there are things 

that Congress could do that would be helpful to you as well. 

Sequestration certainly doesn’t help. I know there are aspects of 

what you do that are exempt from that. There are other aspects 

that are not exempt from that, and you have to absorb those cuts 

while trying to deal with that increased number of veterans and 

while trying to deal with the backlog. 

And then lastly, we have failed to pass appropriations bills in 

anything approaching a timely manner, and in some cases, simply 

outright failed to pass them so that the VA and DoD for an extended period of times are operating with a continuing resolution 

which, again, places them at a huge financial disadvantage. 

So, I definitely want to see more leadership out of the VA and 

out of the DoD, but I think Congress should also take a look in the 

mirror and pass appropriations bills and fund what we claim to be 

our top priority. If we really want to get these systems integrated, 

if we really want to get the backlog cleaned up, then we need to 

start passing appropriations bills. We need to kill sequestration 

right now and actually fund what it is that we claim is such a huge 

priority for us. 

So I hope all parties involved will work together to achieve what 

is clearly our common goal, and that is that our servicemembers 

who have put their lives on the line to protect our country and at 

our request at our order as policymakers are taken care of: that 

they are not part of a backlog, they do not slip through any crack 

in the system, they get the treatment and care that they deserve. 

VACREP180 with DISTILLER

7 

But this is a collective responsibility between Congress and the 

executive branch to get that done. I hope today we will learn more 

about how we can work together to make that happen. 

I yield back. Thank you, Mr. Chairman. 

[THE PREPARED STATEMENT OF HON. ADAM SMITH APPEARS IN THE

APPENDIX]

Chairman MILLER. Thank you very much, Mr. Smith. 

Ladies and gentlemen, I want to welcome our first panel and 

only panel to the hearing this morning. First of all, the Honorable 

Frank Kendall, Under Secretary of Defense for Acquisition, Technology and Logistics at the Department of Defense. 

The Under Secretary is accompanied by the Honorable Jonathan 

Woodson, Assistant Secretary of Defense for Health Affairs and Director, TRICARE Management Activity, Department of Defense; 

and the Honorable Jessica Lynn Wright, Acting Under Secretary of 

Defense for Personnel and Readiness at the Department of Defense. 

And also with us this morning is Mr. Stephen Warren, Acting 

Assistant Secretary for Information and Technology at the Department of Veterans Affairs. And Mr. Warren is accompanied by the 

Honorable Dr. Robert Petzel, Under Secretary for Health with the 

Department of Veterans Affairs; and Mr. Danny Pummill, the Deputy Under Secretary for Benefits with the Department of Veterans 

Affairs. 

And I would say to Danny, congratulations on your new position. 

And we look forward to working with you in the future. 

With that, Under Secretary Kendall, you are now recognized for 

between 5 and 10 minutes. If you can hold it to 5 that would be 

appreciated. 

STATEMENT OF HON. FRANK KENDALL 

Secretary KENDALL. Thank you, Mr. Chairman. I will do my best. 

Chairman Miller and Chairman McKeon, Ranking Members 

Smith and Michaud, Members of the Committees, thank you for 

the opportunity to discuss the department’s effort to improve and 

modernize our existing electronic health care records and our legacy health care management systems. 

I am joined by Acting Under Secretary Wright and Assistant Secretary Woodson. And we were recently informed that we would be 

doing just one opening statement, so I will only cover the information technology part of our testimony. 

If there are questions, obviously, the people who accompany me 

would be happy to answer them in terms of the backlog and other 

elements of health care. 

I would also like to ask, Mr. Chairmen, that our written statement be admitted to the record. 

Chairman MILLER. Without objection, all statements will be entered in the record. 

Secretary KENDALL. My personal involvement in our health care 

management programs is relatively recent. In April, I was tasked 

by Secretary Hagel to conduct a review of the department’s legacy 

health care management system modernization options. The options under consideration were upgrades to DoD’s legacy ALTA sysVACREP180 with DISTILLER

8 

tem, an evolved and enhanced version of VA’s legacy VistA system, 

or conducting a competition that would include modern commercially available heath care management systems, as well as potentially systems based on existing systems like VistA. 

With Acting Secretary Wright, I formed a team of senior DoD 

stakeholders and a working group of experts to evaluate DoD’s options and formulate their recommendation. The team worked for 

approximately a month. It benefited greatly from prior analyses, 

including a recent study that the department’s cost assessment and 

program evaluation direction had conducted, as well as from consultations with VA on the basis of their decision to adopt VistA as 

their future health care management system core. 

CAPE’s analysis was based on extensive market research. The 

conclusion the working group reached, which was endorsed by the 

senior stakeholders and then forwarded to the secretary, was that 

a competition to select a core set of capabilities out of a best value 

basis was the right business decision for the Department of Defense. 

I have made the results of that review available to the Committee staffs, and I would be happy to answer your questions on 

the review, or to brief any of the members on the details. 

Secretary Hagel made a decision to adopt the study recommendations. After VA’s decision a few months ago to stay with VistA as 

the basis of its future health care management system core software, DoD had a very different decision to make than VA did. VA 

has a large installed VistA base, a large in-house staff that maintains and programs software for VistA, and a workforce that is experienced and trained with the current vision of the VistA system. 

There are sound logical business reasons for VA’s decision regarding VistA. But DoD is not in the same position. 

The marketplace that provides health care management systems 

has changed significantly in the last few years as we have been 

going through the process that was alluded to in earlier testimony. 

That marketplace provides a range of products, modern products, 

that have advanced significantly over the period of time that I 

mentioned. This is a vibrant market, and we would like to be able 

to have the opportunity to select a product that includes some of 

the offerings from that market. 

Our market research also showed that we would likely see VistAbased offerings from multiple competitors. The review Ms. Wright 

and I conducted compared cost, risk, performance and growth potential and concluded that a sole-source selection of either VistA or 

DoD’s ALTA system was not the best business decision for DoD. 

A logical and sound business decision for the department would 

be to conduct a competitive source selection on a best value basis. 

Let me assure you that nothing in this decision affects DoD’s 

commitment to the joint near-term fielding of fully seamless integrated health records under the iEHR, our program, being conducted by and managed by the interagency program office today. 

Health care records and health care management systems are 

not the same thing. DoD and VA can share integrated records 

without having the same software to manage those records or to 

assist conditions as they provide care. 

VACREP180 with DISTILLER

9 

The secretary of defense has also asked me to take a more direct 

role in the management of our health records and our health care 

management systems. We will continue to work closely with VA on 

all of these efforts. 

At this point, I am still in the process of reviewing and assessing 

the current programs for iEHR. But the DoD’s commitment to 

fielding data management accelerators with VA this fiscal year and 

next year is firm. 

Chairman McKeon, you mentioned my acquisition decision mandate. That was one of the first steps that I took once the secretary 

asked me to take responsibility. In addition, I have appointed some 

key leaders. Mr. David Bowen is behind me, as well as the program 

manager for our modernization system who will be, I hope, executing some of the leadership that was mentioned earlier. Compatibility with ongoing joint effort to provide seamless, integrated electronic health care records between DoD and VA will be a firm requirement as DoD works to select a core for its health care management software system. 

I am concerned, the language in the House fiscal year 2014 

NDAA and the House fiscal year 2014 MILCON and Veterans Appropriation Act may overly restrict both VA’s and DoD’s options 

going forward, as well as impose significant oversight burdens on 

the program. 

I understand the members’ frustrations—Mr. Chairman, you 

mentioned that, with iEHR—and I have reviewed the history of the 

last few years. But we would like to work with the Congress on less 

restrictive language that would both address your concern and 

allow for efficient program execution. 

I commit to you that DoD will keep the Committees informed of 

our progress and of any major developments in our health care 

record and health care management acquisition programs, and that 

DoD will work closely with VA to ensure that our shared goals of 

a seamless, integrated record in the near term and modernization 

of our health care management systems in the mid-term are accomplished efficiently and effectively. 

Our shared mission with the VA is to fundamentally and positively impact the health outcomes of active duty military, veterans 

and beneficiaries. 

Every one on the panel before you with one exception is a veteran. We understand the needs of these people and we support 

them. 

Health care record and management systems modernization is a 

part of that process. And we believe the course we have chosen is 

a prudent, cost-effective path to achieving our mission. 

I will be happy to take your questions. 

I would like to make one comment on sequestration. It was 

brought up by—in two of the opening remarks. I cannot sit before 

this Committee today, 2 days after we started furloughing our employees and not mention sequestration. 

The effects of sequestration are real. They are distributed all 

across the department. They are not dramatic in any specific instance, but their cumulative impact is dramatic. And they are having—and they will have over time, particularly if allowed to continue in fiscal year 2014, a devastating impact on the department. 

VACREP180 with DISTILLER

10 

I know I am not here to testify about that, but I can’t pass up 

the opportunity to mention that. 

Mr. Chairman, with that I will conclude. 

[THE PREPARED STATEMENT OF SECRETARY KENDALL APPEARS IN

THE APPENDIX]

Chairman MILLER. Mr. Warren? 

STATEMENT OF MR. STEPHEN W. WARREN 

Mr. WARREN. Chairman Miller, Chairman McKeon, Ranking 

Member Smith, Ranking Member Michaud, and Members of the 

Committees, we appreciate the opportunity to appear before you 

today to discuss the collaboration taking place between the Department of Veterans Affairs and the Department of Defense. 

I am accompanied today, on my far left, by Under Secretary Robert Petzel for Health, and to my immediate left, Mr. Danny 

Pummill, the Principal Deputy Under Secretary for Benefits. 

The efforts of our two departments reflect an unprecedented level 

of collaboration on a number of important goals to ensure seamless 

transition from servicemember to veteran. Through DoD and VA 

channels such as the Joint Executive Committee, the Health Executive Committee, the Benefits Executive Committee, independent 

working groups and the day-to-day work of our respective hardworking employees, our two departments are removing barriers 

and challenges which impede seamless transition. 

Our collaboration efforts with DoD are also helping VA meet its 

goals of increasing access to care, ending the benefits claims backlog and ending veterans homelessness. We are making progress together in several key areas. 

Thanks to the VOW to Hire Heroes Act, we now enroll every new 

servicemember in eBenefits. Enrollment has grown to 2.6 million 

since June 2011, an increase of over 648 percent. We now have in 

place that single portal, whether you are a servicemember or veteran, you can, to find out not only what your benefits are, but also 

what the status of your claims are. 

Through eBenefits, the two departments provide veterans and 

servicemembers a central location to research, find, access and 

manage a growing list of benefits. DoD and VA fully implemented 

the Integrated Disability Evaluation System, known as IDES, in 

October 2011. 

IDES is an integrated DoD–VA program for servicemembers 

being evaluated for medical separation from military service that 

leads to faster processing time, increased transparency for the 

servicemember, and a single set of medical exams for single-source 

disability ratings and much more. 

In April of 2009, President Obama directed the DoD and VA to 

work together to define and build a seamless system of integration 

for electronic health records. Today, DoD and VA are already exchanging a significant amount of electronic information and are 

taking aggressive action in 2013 to further expand these efforts. 

But most of the information today is not standardized. A key priority for both departments is to standardize electronic health 

record data and to make it immediately available for clinicians so 

VACREP180 with DISTILLER

11 

that they have the information they need to make informed clinical 

decisions for our patients. 

A critical mission of both departments is to fundamentally and 

positively impact the health outcomes of active duty military, veterans and eligible beneficiaries. As a result, we have two distinct 

goals. Create a seamless health record integrating VA, DoD and 

private provider data, and to modernize the software supporting 

DoD and VA clinicians. 

We are committing to doing both of these in the most efficient 

and effective way possible. VA is still on track with your support 

to deploy our core capability at two sites by 1 October 2014, and 

full operational capability by the end of 2017. 

We are also working closely with our DoD colleagues to address 

the benefits claims backlog. Today, many veterans wait too long to 

receive benefits they have earned and deserve. This has never been 

acceptable to the secretary or the dedicated employees of the Veterans Benefit Administration, over half of which are veterans 

themselves. 

VA is implementing a robust plan to ensure we achieve our goal 

of eliminating the claims backlog and improving decision accuracy 

to 98 percent by 2015. We are making progress in reducing the 

processing times for disability claims, and we are on track to meet 

our agency priority goal of eliminating the backlog of claims, those 

pending longer than 125 days, in 2015. 

The total inventory of claims is now below 800,000, the lowest 

since April 2011, and the backlog has been reduced by more than 

14 percent from its highest point just 4 months ago. For the second 

month in a row, VA claims processors set production records by 

completing more claims than in any previous monthly period. 

Collaboration efforts are ongoing with DoD to allow VA to receive 

complete service records, and to receive them electronically for faster and more efficient processing. On December 6, 2012, VBA 

reached an agreement with our partners in DoD requiring the military services to certify a servicemember’s service treatment record 

as complete as possible at the point of transition to VA. 

Effective January 1, 2013, all five military services began implementation of service treatment record certification. By the end of 

this year, each of the military services will be sending all of the 

service treatment records electronically to VA. This will contribute 

to reducing the time it takes to process future disability claims. 

VA and DoD are committed to our collaborations, and we continue to look for ways to improve our decision-making, achieve 

greater efficiencies, and accelerate the transition process for 

servicemembers and veterans. 

Thank you again for your support for our servicemembers, veterans and their families, and your interest in the ongoing collaboration and cooperation between the two departments. We appreciate the opportunity to appear before you today, and we are prepared to answer any questions you may have. 

[THE PREPARED STATEMENT OF STEPHEN W. WARREN APPEARS IN

THE APPENDIX]

Chairman MILLER. Mr. Kendall, first question is in regards to 

the bidding process or the request for proposals that DoD has done. 

VACREP180 with DISTILLER

12 

Do you anticipate VistA being one of the software solutions that 

will be allowed to be reviewed in the process? 

Secretary KENDALL. The answer is yes. Our market research that 

was conducted by CAPE, as I mentioned, had a number of responses. Fifteen of those responses were fully compliant with the 

request. 

And of those 15, three were VistA-based solutions. So we know 

there are vendors out there. And one of the submissions was from 

the VA itself, and the other two were from commercial integrators. 

So we would fully expect that VistA will be included in the things 

that we have to choose from. 

Also, it won’t be today’s VistA. It will be a VistA that is improved 

over the course of the time between now and when we would actually make the award. So we will have an enhanced version of 

VistA, if you will, at the time we do the source selection. 

Chairman MILLER. Mr. Warren, I will say that in reviewing your 

testimony talking about the backlog, you talked about several reasons that there is a backlog out there. The under secretary has 

talked about the surge of personnel that has been used to reduce 

the backlog. 

Nowhere do I see anything about what VA has done wrong, i.e., 

mismanagement of personnel. And my fear is that we are going to 

end up right back in the same place eventually. We may draw the 

numbers down, but if we don’t change the system and how it is 

done, we are going to continue to see the backlog. 

The Nehmer decision and all of the claims associated with that 

decision, I mean, we knew that was coming. The secretary knew it 

was coming. He actually said that by 2013, now, we would be right 

back where we were prior to Nehmer. We are way above where we 

are. 

So, does VA have any culpability in regards to the backlog, or is 

it just things outside their control? 

Mr. WARREN. Mr. Chairman, if I could hand that to my colleague 

from the Benefits Administration to respond. 

Mr. PUMMILL. Chairman Miller, one of the things that we have 

done is the VBMS, the Veterans Benefits Management System. We 

were in a paper system when we started doing the Nehmer cases 

and worked through the Nehmer cases and got the additional 

workload from the current conflict. 

We now have a fully automated system rolled out to all 56 of our 

ROs. And by fully automated, I mean that its position at the ROs 

and we are starting to do claims electronically instead of paper. 

Today, about 20 percent of the total workload that we have is electronic. Eighty percent is still paper. 

Our goal is to, you know, not only knock out the backlog, but to 

get all of that into electronic format. That will put us in a position 

so that if a claim comes in from Ohio, it doesn’t have to be done 

in the state of Iowa by a claims person in Ohio. When the claim 

comes in, the next available person anywhere in the country can 

take that claim and work it because all of the records will be electronic, eliminating the need to mail records around the country and 

things like that. 

We believe with the advent of the Veterans Benefits Management System and the electronic service treatment records that we 

VACREP180 with DISTILLER

13 

are going to be receiving from the Department of Defense, that that 

will go a long way to preventing future backlogs and ending this 

backlog right now. 

Chairman MILLER. Mr. McKeon? 

Chairman MCKEON. Mr. Chairman. Secretary Kendall, Secretary 

Warren, the process for gathering the necessary information to 

complete a veterans claim for benefits requires participation by the 

veteran, the DoD and the VA. 

Some of the information is provided directly to the VA by the 

servicemember. Other information is sent from DoD to the VA either in electronic format or hard copy paper documents. I am particularly interested in the health care and medical information 

records that the DoD sends to the VA. 

What medical information records are provided by the DoD to 

the VA, and when and in what format are they sent, number one? 

And two, who receives the information at the VA, and how is the 

information then linked to a veteran’s claim for benefits? 

Secretary KENDALL. Mr. Chairman, information is generally sent 

electronically in digital form. And we have been doing that for 

quite a few years now. We sent about—over a million elements of 

data per day to the VA electronically. 

The problem with those records is, A, that they are incomplete. 

There are some paper files, often paper that is produced by commercial providers of health care that our servicemen have seen that 

need to be sent as well. 

There are also problems at VA with how accessible and readable 

some of that information is and how much it can be manipulated. 

But we are sending electronic records, and we have been doing that 

for quite some time. And it is the way the bulk of the information 

goes. 

I am going to turn it over to Ms. Wright and Dr. Woodson to give 

you a more full answer. 

Ms. WRIGHT. Sir, if I can add to Mr. Kendall’s statement, we 

have an agreement now with VA that I think is working very well. 

And that is to provide the service treatment records, which includes personnel data, it includes administrative data, it includes 

medical data and dental. 

We also certify that at hubs within our services, within 45 days 

of the servicemember departing the military system and moving 

into the veteran system. We send that electronically and we send 

it paper-wise to the repository in VA. 

By the 31st of December, we will be sending everything electronically to VA, which will increase the speed of processing a claim, 

should that individual choose to file a disability claim. 

Chairman MCKEON. My time is expired. I don’t know if there is 

time for—— 

Chairman MILLER. Mr. Woodson, would you like to add anything? 

Secretary WOODSON. I would. Thank you very much for the question and the invitation to be here today. 

As Secretary Kendall indicated, we send a lot of health record information electronically now. And for anyone who might be interested, I will give you a Web site or a CD that shows the 

VACREP180 with DISTILLER

14 

functionality of the type of data we send that can be used in direct 

patient care, as well as claim adjudication. 

It is rather significant and it really has more information and 

functionality than I would say most private offices in the private 

sector and many of the great hospital systems in the private sector. 

By the end of the year, not only will we be able to exchange that 

information so that it is read—it can be read by whomever might 

need the information in the Veterans Administration system, but 

it will be computable data. 

Through the ongoing projects we have, through the inter-agency 

program office focusing on this accelerator for this data interoperability, which is really an important feature, it will be computable 

data that will be real-time, that allows providers as well as administrators to use that information for the benefit of the transitioning 

servicemember. 

And so, I think—I would be happy to make myself available to 

any member or staff member to walk them through what the capabilities are. I think if you have a chance to look at it, you would 

be surprised at how much capability is there. 

One last comment is that in trying to assist the Veterans Administration in claims adjudication, particularly interfacing with the 

VBA, we have a project, it is called the Health Artifacts Information System, which will take care of electronically transferring all 

of that loose and late paper that is so—ties up the adjudication of 

these claims. 

So we will be able to capture all of that information that is coming from the private sector on care that was delivered to servicemen and women. And remember, from the DoD’s point of view, 

about 60 percent of care comes from the private sector. But we will 

be able to capture that and be able to transfer that electronically 

and interface with their VBMS system, which is part of their reengineering. 

One more point, perhaps, is that as we have gone through this 

process, we have also learned that it is about not only the technology—it is not only about the technology solutions, but it is also 

about the business process reengineering. 

And I want to thank actually our VA colleagues, because we 

have—through information-sharing summits and the like, have illuminated areas where the business processing reengineering 

needs to occur so that they can take advantage of the technology 

solutions. 

So thanks very much for the question. 

Chairman MILLER. Mr. Michaud? 

Mr. MICHAUD. Thank you, Mr. Chairman. This question—I have 

got two questions. 

So the first one is for Mr. Warren and Mr. Kendall. When will 

the two departments have the full capabilities of an integrated, 

seamless health care records that can be used as the President had 

envisioned? The first question. 

The second question is for Mr. Kendall. And I would like to read 

to you from the text of a March 28, 2013 memo from the Office of 

the Secretary of Defense, regarding the pursuit of the President’s 

open standards for electronic health records. 

VACREP180 with DISTILLER

15 

And it reads, in part, and I quote—‘‘Throughout the first term, 

the Department’s actions have been inconsistent with the President’s agenda. The Department’s past and current desire is to completely replace its health care information technology package with 

an existing commercial health care advantage package.’’ 

It goes on to say that, and I quote—‘‘The Department’s resistance 

to the President’s open standard agenda appears to be founded 

largely on an incorrect assumption.’’ 

My question to those quotes is, do you believe that the President’s agenda was worth pursuing, or was there some mix-up at 

the Department of Defense? And please help me understand this 

because this has been going on for 4 years, long before sequester. 

I hoped that you would be able to give us some idea. 

So those are my two questions. 

Chairman MILLER. In 25 seconds or less. 

Secretary KENDALL. All of these terms have—like integrated 

record, carry an awful lot of weight and are interpreted differently 

by different people. 

My view is that by 2014, we will have integrated records that we 

share with VA. That is what the near-term projects are doing. That 

is what the accelerators, which Dr. Woodson mentioned, are doing. 

And it is important for the Committees to distinguish between 

integrated records and health care management software. The 

health care management software doesn’t just make a record. It 

helps the physicians do their job. And that is a very important reason for us to modernize our systems. 

But as far as the records are concerned, we will have records to 

common standards and they will be movable seamlessly between 

DoD and VA, for use by both benefits adjudication purposes and for 

health care purposes. 

Your second question is about the comments that you made 

about the President’s agenda. We are fully supportive of the President’s agenda. So is VA. We are united in our effort to develop common standards and to support the national standards that the 

President articulated as a goal and that we are working on with 

HHS. 

So I don’t know what the source of that quote was, but I think 

it is entirely incorrect. 

Mr. MICHAUD. Actually, the quote was from the Department of 

Defense, the Secretary’s office. And I will give you the memo from 

DoD. They made it very clear it is inconsistent with what the 

President directed them to do. 

Secretary KENDALL. I understand, but it is not correct. 

Chairman MILLER. Mr. Smith? 

Mr. SMITH. As following up on the computer records a little bit, 

is it the case that you are going—and I think you mentioned this, 

but I just want to clarify—is it the case that you are going to have 

to develop a brand new system that both departments can use, or 

do you think that there is a software fix that can get your two systems to begin to better talk to each other? 

Secretary KENDALL. We are currently talking to each other. I 

think there is a misconception about this. We are sending electronic records today. 

VACREP180 with DISTILLER

16 

So in that sense, we are talking to each other. VA can read DoD’s 

records when we send them, okay. We want to have an improved 

system from that, where we are not just reading the records, but 

actually using them and using the data that is provided. 

We also want to eliminate paper that is currently part of the 

records that we are sending, for the reasons that I mentioned that 

were discussed earlier. So we are moving very quickly to accomplish those two things. 

That is a separate thing from the software that manages health 

care provision. 

Mr. SMITH. Right. 

Secretary KENDALL. And that is a distinction I want to make. 

Mr. SMITH. And the software management system, you are saying that you are going to come up with a new, relatively new system beyond what you have now? 

Secretary KENDALL. Our choices are not between—we were on 

the path at one time to develop an entirely new system. 

Mr. SMITH. Right. 

Secretary KENDALL. That was the history of this—— 

Mr. SMITH. That is a tough path. 

Secretary KENDALL. It is a tough path, but we decided to get off 

of it. 

Mr. SMITH. Yes. 

Secretary KENDALL. The costs for that were going to be exorbi- tant. The last estimate that I saw was $28 billion of lifecycle cost. 

So the decision was made a few months ago to get off of that path. 

Once we were off that path, VA made a decision that the best 

path for VA was to continue with VistA and evolve and enhance 

VistA to a modern project—a more modern product. 

For DoD, as I mentioned in my opening comments, we have a little different situation, we have a very different situation. So we are 

not going to develop a new system. We are going to look at a range 

of options that will include commercial, mature products that are 

modern products that are being used throughout the health care 

industry. 

Mr. SMITH. That is where the software improvement comes from. 

We are working with a ton of companies and I think, gosh, going 

back 20 years, we have had this history in a variety of different 

government agencies where they try to come up with some brand 

new system, where what has evolved is software solutions to get 

old systems to better communicate with each other. And that is— 

seems like the better approach. 

Secretary KENDALL. For DoD, it is better to have a choice among 

a range of options that includes those types of systems. 

Mr. SMITH. Right. 

Secretary KENDALL. VA, as I said, is in a different position, and 

I am not—they have VistA and they have in-house programs to 

work with VistA, et cetera. So they have an established base they 

can build on. It is not where we are. 

There is an analogy that you will probably be familiar with from 

your Armed Services Committee activities, with radios, tactical radios that DoD acquires. Where we were doing a program of records 

that took years and years and years, and meanwhile the commercial industry was moving forward very quickly. And we came to a 

VACREP180 with DISTILLER

17 

conclusion to cancel some of those programs and go out and do 

commercial like competitions in lieu of doing our own development. 

We are in a little bit of that situation here. 

Mr. SMITH. The tyranny of the program of record is a phrase that 

occurs to me many times when I look at some of our acquisition 

challenges. And I know you have done a lot of work to try to get 

around that. 

Mr. SMITH. I yield back. Thanks. 

Chairman MILLER. Mr. Runyan? 

Mr. RUNYAN. Thank you, Mr. Chairman. 

I know we have been talking here a lot about moving forward. 

I sit on both of these Committees, both HASC and VA, and I 

chaired a subcommittee that deals with disability assistance and 

memorial affairs. My question is really directed both at the VA and 

the DoD. And this comes from a past VA hearing. 

In the hearing, it was discovered that VA initially—when VA initially requests records from the DoD, and we are talking about 

paper records—we are talking about dealing with the current backlog—VA will wait 60 days before sending a follow-up request. Following that request, VA will wait an additional 30 days to respond—for DoD to respond before making another contact at DoD. 

This is a very large work window. And as VA is trying to adjudicate these claims in 125 days or less, that leaves 35 days before 

they can actually get their hands on the paperwork. It was discovered through the hearing that this rule was probably self-promulgated from the VA’s adjudication manual. 

Is this window necessarily that large? Does the VA need to 

change their protocols on that? And why does it take the DoD so 

long to get the—request of materials? 

Mr. WARREN. If I could hand that to Mr. Pummill to answer. 

Mr. PUMMILL. Congressman, it is the timeframes that you quoted 

are accurate timeframes. And those timeframes are based on the 

requirement that we have in the Veterans Benefits Administration 

to assist veterans—a duty to assist that says that if we get a record 

and we believe that the record is not a complete record, that we 

have certain timeframes that we have to re-request the record 

again. 

Now, we have actually fixed that in some work that we have 

done with Ms. Wright’s office in that the Department of Defense 

has already started, as of January of this year, working to give us 

from the five services certified service treatment records. Basically, 

what they do now is they give us a service treatment record with 

a document on top saying that the Department of Defense certifies 

that this is a full and complete record. That means that the record 

has all of the—we have their personnel information, their dental 

information, their medical information, and not just treatment from 

a military treatment facility, but maybe if they went outside for 

TRICARE or something, that eliminates the need for the VA to go 

out and ask for any additional information—no more 60-day letter, 

no more 30-day letter. 

This will improve again when we get to December of this year 

and we start receiving all of that information electronically, because we will be able to shift it around to different places to adjudicate it. But yes, that was a problem. That still is a problem with 

VACREP180 with DISTILLER

18 

veterans that are from previous conflicts that are not coming directly from the Department of Defense, because we still have to go 

out and request any place they may have been for all their records, 

to ensure that we have everything possible to give that veteran 

every benefit of the doubt when we are adjudicating their claim. 

Mr. RUNYAN. Thank you. 

Mr. Chairman, I yield back. 

Chairman MILLER. Mr. Takano? 

Mr. TAKANO. Thank you, Mr. Chairman. 

I am pleased that DoD and VA, along with several other agencies, have collaborated to improve and reinvent the transition assistance program. However, I heard from the California Department of Veterans Affairs that they are being excluded from participation in transition GPS, the new program. State governments provide key resources and services for veterans, and I think it is important that they are included in the transition program. 

Can any of you address why the California Veterans Affairs Department is being excluded? Or if that is a mistake, what will you 

do to address the issue? 

Ms. WRIGHT. Sir, I would like to address that issue, please. 

Any individual that spends 180 days on active duty is—goes 

through the transition assistance program that is now a very active 

program at 206 installations throughout our system. It is a collaborative effort between Department of Defense, between VA and between Department of Labor. 

The transition GPS will be up and running in the first of October 

of 2013. In fact, we just all had a meeting about that yesterday. 

But there are tracks to that, that those individuals that come 

through the transition program still do. They do MOS comparison 

to civilian. They do a transition plan. They do a financial plan. And 

they do a career readiness solution. 

What will be added onto the transition GPS are three additional 

tracks that could potentially—that are volunteer, the individual 

does not have to go through. So my concern is, I don’t know if you 

are talking about a reservist or guardsman who is leaving the 

Guard and Reserve system, or if you are talking about somebody 

who is leaving the active duty system. 

So, what I have explained is for somebody that has been on active duty. I would like to make an appointment with you and follow 

up to see if it is clearly on the Reserve and Guard side, and then 

I can answer your question. 

Mr. TAKANO. I would appreciate that effort. Thank you. 

Chairman MCKEON. Mr. Forbes? 

Mr. FORBES. Thank you, Mr. Chairman. 

You have heard both Chairman Miller and Chairman McKeon 

mention the collaborative effort we have with DoD and VA. One of 

the concerns that I have is with these furloughs that the secretary 

of defense has ordered. We know that the VA employees are exempt from that, but not DoD employees. 

So my concern is, what impact is that going to have on the transfer of this information over from DoD. And if we have a 20 percent 

loss in the time that these employees have, are we concerned about 

the messaging that we are sending to our servicemembers that 

after a decade of war that they have served their country, that the 

VACREP180 with DISTILLER

19 

country is somehow content to give them 80 percent effort in this 

transitioning. 

Ms. WRIGHT. Sir, if I may, thank you for the question. 

I would like to piggyback onto what Mr. Kendall said. Sequestration is real in our department. 

Mr. FORBES. I understand sequestration is real. Some of us didn’t 

support it, but the decision on the furloughs was the secretary’s. 

Ms. WRIGHT. Absolutely, sir. And furloughs are real and they are 

catastrophic to the department and they are catastrophic to the 

great civilian employees that work for the department. 

Saying that, we realize how important this is for those individuals that have served our country admirably in the military, to 

transfer their records to VA in a whole certified manner, as Mr. 

Pummill brought up—the agreement that we have between the two 

departments. 

We are making that 45-day window. The reason we have a 45- 

day window is to collect all that loose-flowing information from 

TRICARE and other agencies where we can then certify that they 

are correct and send them over to VBA to their repository. So, 

should the individual choose to file a disability, his or her records 

are there and correct. 

So, yes, furloughs are real. Yes, they are damning. But we have 

kind of locked this down as hugely important and we are putting 

a full-court press on it, sir. 

Mr. FORBES. In my 4 seconds, I don’t think you have answered 

the question. But if you could at some point in time give us a 

metrics of a plan so that we can measure independently that we 

are reaching our goals. 

And with that, Mr. Chairman, I yield back. 

Ms. WRIGHT. Sir, we have the—if I may? 

Mr. FORBES. Please. 

Ms. WRIGHT. We have a metric of 100 percent. The last report 

from VA, and we get our numbers from VA, we were at 97 percent 

success rate of getting our records to VA on time. We collaborate 

every day on this. I can provide you more metrics if you choose. 

Mr. FORBES. Thank you. I would love to. Thank you. 

Ms. WRIGHT. Thank you. 

Chairman MILLER. Mrs. Davis? 

Mrs. DAVIS. Thank you, Mr. Chairman. 

Just quickly, since we have little time. How is—how are VA and 

the DoD working together on after-action reports regarding suicides? I am familiar that the different services have their own ways 

of doing that, but how are you integrating those discussions? And 

what have we learned from it? 

And secondly, what are we doing to reduce the stigma so that 

people who are having difficulties actually report those difficulties 

so that that goes on their medical reports when they do apply for 

benefits later on? I understand that a number of people actually do 

not, and so when the VA has to rate them down the line, they have 

nothing on which to base it, even though they have been serving 

for a number of years. 

Secretary PETZEL. Congresswoman Davis, let me begin, at least, 

to answer that question. 

VACREP180 with DISTILLER

20 

The VA and DoD have a joint integrated mental health strategy. 

One element of that strategy is suicide. We recently jointly developed an integrated recordkeeping system for suicide where we collect the data from each one of the states as to the rate of suicide, 

et cetera, amongst veterans; collate that data; and then use it to 

analyze our experiences in the DoD on one hand, and in the VA 

on the other hand. 

The second thing is that we have a number of joint efforts going 

on right now to de-stigmatize suicide. The make-the-connection 

campaign and the stand-by-them campaign are two efforts to destigmatize mental health in general, but suicide in particular, and 

to not glorify suicide. 

The third element is the military-VA crisis hotline, where people 

that are having a difficulty can call. We have received almost 

900,000 calls since it began almost 4–1/2 years ago; 26,000 saves 

from that. That is, people who were in danger of harming themselves or someone else that were rescued from doing that. 

The suicide work group, the mental health work group of our 

health executive council, that VA and DoD jointly chair, regularly 

reviews the suicide experiences within each organization and looks 

for, in further joint efforts—— 

Mrs. DAVIS. Excuse me, are those shared with the family as well? 

Are those reports shared with the family? 

Secretary PETZEL. I can speak only for the VA in terms of the 

family, that when we do a, what we call a psychological autopsy 

on a patient or a review, yes, we would do what we call institutional disclosure and discuss that with the family. 

Mrs. DAVIS. Okay, thank you. 

Chairman MILLER. Dr. Benishek? 

Mr. BENISHEK. Thank you, Mr. Chairman. My question is actually for Dr. Petzel. 

In 2008, the NDNA, a joint DoD–VA vision center of excellence 

was established at Walter Reed. The purpose of this center, along 

with two other joint centers of excellence, was to improve clinical 

coordination and best practices between the DoD and the VA. 

The center was also tasked with developing a joint trauma registry containing up-to-date info on the diagnosis, treatment and the 

follow up for injuries received by our Nation’s military. The vision 

center alone was allocated $6.9 million over 5 years. 

Apparently, there are two current staff members from the VA located at the vision center of excellence, and this is despite repeated 

promises from the Secretary that there would be no less than six. 

Why hasn’t more staff been committed to the vision center? 

Secretary PETZEL. Thank you, Dr. Benishek. My understanding 

is that we have committed the staff that was initially agreed to. I 

will go back, sir, and find out—— 

Mr. BENISHEK. See, I have also heard reports that the VA plans 

to pull out of the centers of excellence. Is there any truth to that? 

Secretary PETZEL. No, we do not plan on—we fully support the 

concept of the centers of excellence. 

Mr. BENISHEK. Well, I would like to be sure that there are six 

staff members as the Secretary promised. 

I have also heard reports that the VA has been refusing DoD IT 

personnel with security clearance to access the VA health records 

VACREP180 with DISTILLER

21 

for purpose of building the trauma registry. Do you have any 

knowledge of that? 

Secretary PETZEL. I do not, sir. I would ask Mr. Warren if he has 

any knowledge of that. 

Mr. WARREN. I would like to take that for the record, but I am 

not aware of that taking place, sir. 

Mr. BENISHEK. Well, let’s follow up with your staffs, so we get 

these answers, because I have got some credible reports that indicate that these questions are valid. 

Mr. WARREN. And can we reach out to your staff for further information? 

Mr. BENISHEK. Yup. 

Mr. WARREN. Thank you. 

Mr. BENISHEK. Thank you. My time is up. 

Chairman MILLER. Mr. Wilson? 

Mr. WILSON. Thank you, Mr. Chairman. 

And thank you, Chairman Miller, Chairman McKeon, for your 

leadership to promote DoD–VA collaboration on behalf of our military servicemembers and military families and retirees. 

Mr. Pummill, how many of the pending claims that VA is waiting 

to process require information to be provided from the DoD to be 

processed? 

Mr. PUMMILL. About 4 percent. It is not very much. 

Mr. WILSON. That is impressive. That is good. 

Ms. Wright, how many pending claims does DoD need to provide 

the VA information? 

Ms. WRIGHT. Sir, we are working on the 4 percent that we are 

required to provide. We are also providing the current service 

treatment records of those that are leaving. But those that are 

within the backlog is about 4 percent. 

Mr. WILSON. And this 4 percent has been a significant reduction 

apparently, is that correct? 

Ms. WRIGHT. We are working together, sir. We have a team on 

the ground, two teams on the ground at VA at their request and 

they are working hand in glove with VA to bring down that number. 

Mr. WILSON. Well, I appreciate very much that information and 

please keep us informed. 

Mr. Pummill, do you believe that a joint DoD–VA integrated electronic health care record would substantially aid the VA in eliminating the current backlog? 

Mr. PUMMILL. A joint electronic health record probably won’t do 

anything for the current backlog. It would be wonderful for the future to have everybody in the government to be able to look at one 

medical record and grab all their information. 

Right now, what we need is the electronic personnel dental and 

medical records, which we have got a commitment from the Department of Defense to get by the end of this calendar year. 

And for claims purposes, that is what I need. The electronic 

health record, if that ever works out for the future, that would be 

great. That would help in the future. But it would not help us in 

eliminating the current backlog. 

VACREP180 with DISTILLER

22 

Mr. WILSON. And finally, for the health and safety, I certainly 

hope every effort is made to expedite the electronic health care 

records. It is just got—for all of you, it is just so important. 

Thank you very much for your service. 

Chairman MILLER. Mr. O’Rourke? 

Mr. O’ROURKE. Thank you, Mr. Chairman. 

And for Under Secretary Kendall, I wanted to draw your attention to a Reuters investigative piece that was published yesterday, 

entitled ‘‘The Pentagon’s Payroll Quagmire Traps America’s Soldiers.’’ 

And one of the soldiers that they focus on is based at Fort Bliss 

in El Paso, Texas, the community I have the honor of representing. 

And after returning from two combat tours, suffering from severe 

PTSD, traumatic brain injury, nerve damage and chronic pain, his 

pay is mysteriously garnished, and going from $3,300 a month to 

about $1,000 less, without explanation. 

After he complains about it, his pay goes down to a little over $115 a month, forcing he and his family to go to food pantries to 

be able to feed themselves. He has three children. Having to go 

through Operation Santa Claus to get Christmas gifts for his children. 

And the Reuters reporter was able to find that this is not an isolated incident. It is widespread throughout the Department of Defense. There was also a GAO report in 2012 that cited some of 

these same problems. The response from the Department of Defense was to call the GAO report overblown. 

One of the other findings in the article shows that the Department of Defense’s system is a jury-rigged network of incompatible 

computer systems for payroll and accounting that are obsolete and 

unable to speak with each other or communicate with each other 

within the DoD. 

And so, I knew we had a problem communicating DoD to VA, I 

didn’t know we had a problem communicating DoD to DoD. 

Considering the GAO report, the Reuters report, this case of 

medic Aiken, what is your response to this? How are you going to 

fix this and when will you fix this? 

Secretary KENDALL. Congressman, I have to pass that question 

over to Ms. Wright. 

Ms. WRIGHT. I apologize for the microphone. 

First thing I will tell you that I have not seen the article, but 

I will absolutely read it today. It is very important. It is catastrophic if this is happening to our servicemembers, if it is happening to one or if it is happening to a multitude. So I would like 

to do that. 

I am the personnel and readiness person, so I am not responsible 

for DFAS, but I am responsible for the health and welfare of our 

soldiers and our military members. 

So, sir, I don’t have an answer for you. I would like to take it 

for the record, but more importantly, I would like to follow up on 

the one particular person and fix that right away, see what we 

have for the system issues, involve the comptroller, and get back 

to you, if that is okay? 

Mr. O’ROURKE. I look forward to following up with you, thank 

you. 

VACREP180 with DISTILLER

23 

Ms. WRIGHT. Thank you. 

Chairman MILLER. Mr. Loebsack? 

Mr. LOEBSACK. I thank the Chairman. I want to thank the two 

Chairs and the Ranking Members for this hearing. I had seven veterans’ forums last week at the beginning of the week, and what 

Congressman O’Rourke mentioned is something I hear often. 

I could just spend all of my 2 minutes sort of recounting all the 

stories that I have heard over the 7 years that I have been in office, so I won’t do that. I just want to broaden out the discussion 

of mental health a little bit, if I may. 

Good to see you again, Dr. Woodson. I hope you will chime in on 

this, as well. And Dr. Petzel, it is really important what Congresswoman Davis brought up, the suicide issue, but I would like to go 

a little bit further than that, talk about transitioning from DoD to 

VA, in particular from active duty to the VA, and with respect to 

the mental health care system that is in existence now with DoD 

and then going to the VA. 

Can both of you speak to that issue, please? 

Secretary WOODSON. Yes, I would be happy to start and thank 

you again for this question, which is a really important topic. 

As we know, mental health issues have become one of the signature health issues out of the decade-plus of war. As Dr. Petzel said 

several moments ago, he and I have worked very, very closely together to harmonize and advance the care relative to mental 

health. 

It begins with a group that has been working on an integrated 

mental health strategy, so that we are enhancing the practice 

guidelines even as we hand off servicemembers who are 

transitioning to veteran status. 

We have a robust, collaborative effort on research to advance our 

understanding of treatment strategies that are important. We have 

a significant collaborative effort to insure transition is smooth in 

transition programs. Making sure that there is follow up at VA. We 

have developed a series of initiatives that are looking at what kind 

of care is being delivered and its effectiveness. And we discuss this 

every month in terms of how to move this ball forward. 

The development of applications that can be used by individuals 

who might have PTSD to enhance resolution of their symptoms. 

What has been interesting and this goes to a question that was 

asked earlier about suicide, is that we have learned something 

from the studies that have been done in the Department of Defense 

and in the Department of Veteran’s Affairs. That in fact we have 

slightly different issues relative to the cohorts that we need to 

focus on and how we need to tailor some of our suicide prevention 

programs and campaigns. 

So within the Department of Defense, the biggest profile at risk 

are the young individual, first-time enlisted who has financial problems, relation problems, maybe previous family problems prior to 

coming into the service. Whereas in the Veteran’s Affairs, it is the 

vet in their 50s or 60s with additional qualifiers. And so it has 

been very important to understand that bimodal set of events so 

that we can individually address what might be the factors for the 

people in our society and the people that we are responsible for 

that are most at risk. 

VACREP180 with DISTILLER

24 

But the bottom line message I want to leave you with is that Dr. 

Petzel and I, as the people principally responsible for this, work 

enormously closely together to try and enhance our understanding, 

treatment strategies, prevention. And I would just say that you 

know, we are doctors, so we don’t just concentrate on medical 

issues, we are talking about how to develop comprehensive programs writ large to get communities involved, crisis line. Try and 

educate families about risk factors and profiles of people at risk. So 

we co-sponsor suicide prevention conferences to bring our people together to look at what we should be doing and what advances 

should be made. So difficult problem, but we are 110% after this 

together. 

Secretary PETZEL. Thank you. Mr. Chairman could I add just 30 

seconds to what Dr. Woodson said? 

Chairman MILLER. Yes sir. 

Secretary PETZEL. Thank you. Two things. Number one is that 

we have a series of case managers that we share that transit the 

seriously ill and injured people from the DoD into the VA Health 

Care System. And this includes people with serious mental illness. 

We are hoping that the Transition Assistance Program, the new 

TAP, is going to have in it an even better way of making a hot 

transfer for people that are ill, not necessarily in the seriously ill 

or injured group, but do need that kind of transition. 

And the last thing I would comment on, just to reiterate what 

Dr. Woodson said, I have been in the VA for a long time and 

worked with DoD for a long time. The level of collaboration and cooperation in the clinical sphere in medicine right now is unprecedented. I mean absolutely. We share so much and do so many 

things now jointly that we wouldn’t have even dreamed of 5 or 6 

years ago. 

Mr. LOEBSACK. Thank you. And thank you, Mr. Chair, for indulging for such a lengthy period. 

Chairman MILLER. Mr. Coffman. 

Mr. COFFMAN. Thank you, Mr. Chairman. Secretary Wright, 

there has been a three-point series by the Colorado Springs Gazette that an investigative report, reporting, that talked about soldiers receiving less than honorable discharges due to minor infractions. And a lot of those soldiers are combat veterans from Iraq and 

from Afghanistan who also it was reported that had TBI and posttraumatic stress disorder in some of those instances. 

These, the nature of this discharges, disallowed these combat 

veterans from receiving any care under the VA. And so I am wondering if you, I am very concerned about this, and I wonder if you 

can comment on this? 

Ms. WRIGHT. Sir I can comment on the transition portion and 

then I am going to turn it over to Dr. Woodson to comment on the 

medical diagnosis portion. So the minor infraction that you talked 

about could be a multitude of things. These individuals, whether 

they receive an honorable discharge or whether they receive a less 

than honorable, would still go through the transition program that 

all servicemembers leaving the program must go through. During 

that period of time, they receive not only counseling from the Department of Defense and Department of Labor, they also receive 6 

hours of counseling classes from the VA. 

VACREP180 with DISTILLER

25 

So what the Secretary of VA is concerned about is even when 

people leave with a dishonorable discharge, people going into kind 

of the homeless category, and so he wants that warm handoff 

through the VA system and we are working together. 

Now your question involved those that may have PTSD or another type of diagnosis that could have related to the dishonorable 

discharge—— 

Mr. COFFMAN. Less than honorable. There is a difference—less 

than honorable discharge versus dishonorable. There is a pretty 

significant difference. 

Ms. WRIGHT. Yes sir, less than honorable versus dishonorable. So 

I am going to turn that over to Dr. Woodson because we are doing 

something to review those cases. 

Secretary WOODSON. Again, thank you for the question and 

again, just to restate. I think at the heart of your question is 

whether or not some individuals are being discharged with less 

than honorable discharge, being denied benefits, and in fact have 

an injury of war. And so we have enhanced our screening and require screening that if someone is being discharged for what is considered bad conduct, bad conduct discharge, that they have to go 

through certain screening for PTSD and TBI to insure that that is 

not a contributing factor. 

So you know, heretofore, there were examples of individuals because, you know, line leadership just was not clinically oriented 

and someone did a bad thing. But the question was what was the 

root cause of that change in behavior? Was it a brain injury or was 

it PTSD? We now have screening mechanisms to look at those 

issues. 

Ms. WRIGHT. Sir if I can follow up on one more thing. At the beginning of a war, we may have diagnosed them as having an adjustment disorder, which is different than PTSD or TBI of course. 

Mr. COFFMAN. Right. 

Ms. WRIGHT. So we have rescreened those cases within the services. That doesn’t mean we can reverse the discharge because it 

may not have been, you know, I don’t know what the particular 

issue was that created that particular discharge. But we are working through each individual case to see if we, if the missed diagnosis was there, which could have resulted in the, in an unfavorable discharge. 

Mr. COFFMAN. Thank you Mr. Chairman I yield back. I would 

just like to see treatment available to these soldiers, marines, airmen and sailors who have served this country in combat and are 

being discharged for minor, were discharged for minor infractions. 

Chairman MILLER. Mr. Conaway. 

Mr. CONAWAY. Thank you, Mr. Chairman. I was struck by the 

sincerity of each one of your answers, particularly when confronted 

with what appears to be a fail, like Mr. O’Rourke was mentioning 

earlier and wanted to get at. But I would like Mr. Kendall and Mr. 

Warren to think about the word accountability. 

Each of you have talked about deadlines and progress to be made 

in the future and those kind of things. If those things aren’t met, 

what is, is anybody’s performance evaluation effected? Are there 

consequences to anybody in the system for failure to meet the 

deadlines which are being set? 

VACREP180 with DISTILLER

26 

Secretary KENDALL. Absolutely. One of the things I have asked 

for the IPO to do and we will be doing this together with Mr. Warren is to lay out a set of commitments, a list of deliverables with 

schedules that we expect them to deliver. Those will be shared 

commitments between ourselves and DoD and VA And the IPO will 

be held responsible. It is similar to what we do with all of our Program Managers and Program Executive Officers. We are going to 

be managing this program—— 

Mr. CONAWAY. So a year from now, we would be able to look at 

an evaluation report from somebody who had a standard to be met, 

didn’t meet it. There would be a consequence on their personnel 

evaluation and they would either be fired or demoted or held accountable some way? 

Secretary KENDALL. Yes. 

Mr. CONAWAY. Okay. Mr. Warren how about your side? 

Mr. WARREN. The same sir. 

Mr. CONAWAY. Say again? 

Mr. WARREN. Yes, the accountability and the responsibility to 

perform to the standards and the commitments we have made is 

in the performance plans and individuals are held accountable for 

those sir. 

Mr. CONAWAY. Okay. You just used the word ‘‘past tense’’ are or 

currently. So we could look at your system—— 

Mr. WARREN. Are and will be, sir. 

Mr. CONAWAY. But we could look at your system and actually see 

where somebody was disciplined or demoted or fired or something 

because they didn’t meet some important deadline? 

Mr. WARREN. Or their performance rating was less than outstanding. So again, remember the way the performance program 

works is you lay out—— 

Mr. CONAWAY. How many get outstanding? 

Mr. WARREN. I will get you back that number for the record, sir. 

Mr. CONAWAY. My issue is if everybody gets an outstanding, then 

that doesn’t mean anything. So if—— 

Mr. WARREN. I will assure you, sir, that in the senior executive 

cadre at the VA, the number of outstandings has steadily decreased 

over the last couple of years as a result of the system of accountability that Secretary Shinseki has brought to the department, and 

not just for the senior execs but in other areas. And we are glad 

to get that to you for the record, sir. 

Mr. CONAWAY. I appreciate that. 

I yield back. Thank you. 

Chairman MILLER. Which means there are a lot of bonuses being 

given out. 

Ms. Brownley? 

Ms. BROWNLEY. Thank you, Mr. Chair. And I also wanted to sort 

of follow up on this accountability issue and benchmarks, et cetera. 

So you are saying that you have provided them, and I want to 

know how you are going to report back to us and your process by 

which you are meeting those benchmarks, how—what is your recommendation and the best ways for us to hold—to monitor what 

you are doing over the course of the next 18 months, I think you 

said. 

VACREP180 with DISTILLER

27 

I wasn’t here for part of the testimony, but my understanding 

was that you would have this complete by 2014, the integrated system—health system. 

Secretary KENDALL. We have a set of near-term goals that we 

share that the IPO is executing. I haven’t reviewed them in detail 

yet, but I will be doing that very shortly. And we will have commitments on what we will deliver and when. I don’t think it will 

change substantially from the current plan. 

I am concerned about some of the schedule risk in some of the 

things we are doing. We will be in close contact with the Committees and their staffs as we go throughout this process. We know 

there is a lot of interest in these programs and in their success for 

very good reasons. And we also know that the history has been a 

source of some frustration. 

So we are going to keep in close contact. We will have specific 

benchmarks that we have to met, and we will inform you of how 

we are doing against them. 

Ms. BROWNLEY. And you will have those complete by? 

Secretary KENDALL. I should have some of those in place within 

the next few months from my perspective, although I think some 

already exist from the perspective of the VA that they are more 

confident of than I am right now. 

Mr. WARREN. The VA has commitments in place. In fact, the 

near-term accelerators that we have been speaking about today, 

there are sites where we are deploying the integrated viewer. It is 

taking place during the month of July. At the end of the month of 

July, we will have it all—the polytrauma units. So we will complete 

that. 

By the end of December, we will have built that viewer. Where 

today you are seeing the information separate, but as a result of 

the work on data translation, you will be able to see a blended 

view. That will be by the end of December. So that is on the joint 

side. We are still finalizing the deployment schedule of that joint 

viewer at different facilities and capabilities in 2014. That is the 

piece Secretary Kendall was referring to. 

On the VA side, we have a commitment to ensure that we are 

deploying the core capability, which is about 15 percent of the IHR 

that the VA made the decision on back in September, by 1 October 

next year at two locations, Hampton Roads and San Antonio. 

So there is a set of near-term that we are making great process 

on, and there are some out-year commitments that we have made 

in terms of deploying systems and making the necessary enhancements. 

Ms. BROWNLEY. Thank you. I yield back. 

Chairman MILLER. Ms. Tsongas? 

Ms. TSONGAS. Thank you, Mr. Chairman. And thank you all for 

being here today. I am glad that this joint Armed Services-Veterans Affairs hearing is becoming an annual exercise. This is our 

second, and I hope we continue to have it in the coming years. 

There are a wide number of continuum of care issues which we 

have been discussing here today. So I think it just shows us how 

obvious it is and how little sense it makes to treat DoD and the 

VA as two separate stovepipes, when it comes to addressing some 

VACREP180 with DISTILLER

28 

of the most critical health challenges our veterans are facing. And 

I appreciate all the work that you are putting into it. 

Certainly, survivors of military sexual assault are among the 

most vulnerable members of this population, and I greatly appreciate the efforts over the last several years by both DoD and the 

VA to improve the treatment of the victims of this crime within the 

Armed Services. 

I was heartened to learn yesterday in a meeting with senior representatives from the VA, including Assistant Secretary Mooney, 

that the documentary film ‘‘The Invisible War’’ is now mandatory 

viewing for senior VA managers. This is a movie that has really 

helped to draw very important attention to the great challenge of 

this issue. 

Among its many ways in which it did do so, it also painfully 

highlighted the multiple bureaucratic hurdles that a survivor of 

such assault has to endure to prove that their physical and mental 

health symptoms are connected to an incident of military sexual 

trauma within the VA, and shows that too often, victims are unsuccessful in pursuing their claims for assistance. 

So to address one aspect of this problem, the fiscal year 2012 defense authorization included language that required the secretary 

of defense, in consultation with the secretary of the VA, to develop 

a comprehensive policy for the Department of Defense on going 

about the retention of and access to evidence and records relating 

to sexual assault involving members of the Armed Services, because that was one of the issues that we have come to understand. 

So my office continues to closely monitor implementation of this 

and other vital measures. I want to honor the 2-minute time limit. 

I will submit some questions for the record. But just to let you 

know that this is an issue that this Committee takes very seriously. 

And I look forward to—I heard some feedback yesterday as to the 

work you all are doing, and we will continue to monitor it closely. 

Thank you, and I yield back. 

Chairman MILLER. I thank the gentlelady for yielding. Dr. Heck? 

Dr. HECK. Thank you, Mr. Chairman. Thank you all for taking 

the time to be here. My question has to do with the Integrated Disability Evaluation System, which attempts to take what was an almost 540 day process and get it down to about 295 days from profile initiation to either unit reintegration or separation. 

Can you give me an update on the progress of IDES and the cooperation between both DoD and the VA, specifically phase one, the 

MEB process, and phase two, the PEB/PDA process? 

Secondarily, do you believe that when an integrated electronic 

health record is finally achieved that that will help expedite the 

process even further? And what more, if anything, can Congress do 

to help the IDES process along? 

Secretary WOODSON. Thank you, Congressman, for that question. 

Obviously, the Integrated Disability Evaluation System has been 

troublesome, particularly over the early parts of the war. Since we 

have brought a collaborative effort to looking at the process from 

beginning to end, I think a lot of improvement has been made. 

So that if you look particularly in the Navy and the Air Force, 

they are meeting standards relative to the MEB and the PEB procVACREP180 with DISTILLER

29 

ess. The Army still has some outlier sites. And the reason of course 

is they have got the bulk of the wounded warriors and the folks 

in the IDES system. There still are about 36,000 folks in the IDES 

system. 

But we have made a commitment to improving the process of 

that information. So the single disability rating and the information flowing back from the VA to inform the final narrative summaries has improved tremendously. 

And so most of the medical boards are now meeting standards, 

and most of the PEB boards are now meeting standards. We have 

increased of course the number of personnel assigned, and we continue to refine the information management. 

So to the last part of your question about electronic transfer of 

information, it is not only about transfer of the health information, 

which most of the current-era servicemen and women have electronic records, but it is about getting that loose paper that we have 

talked about. And we have got a solution for that which will be in 

place in the near term basically. 

So my expectation is that we will be able to drive down even 

more the number of days relative to that particular process. There 

are some things that contribute to the total number on the periphery which are probably not as important, such as the number of 

leave days that are accrued and those kinds of things. 

But I don’t know that that impacts sort of the quality of the experience and the fairness of the process. But there have been a significant improvement in the overall system. 

Chairman MILLER. Dr. Wenstrup? 

Dr. WENSTRUP. Thank you, Mr. Chairman. 

Dr. WENSTRUP. A couple questions on the health electronic medical records, if you will. And I am just curious how much provider 

input is being given as to how this system is set up. Is there an 

ease for them? And is there anything being done to reduce some 

of the administrative load to the providers so that they can see 

more patients? 

And then lastly, I just want to clarify. Hopefully, we are headed 

towards a goal of not just sharing two systems and having access 

to two systems, but actually having one DoD–VA record. 

And I will address that to both doctors. Thank you. 

Secretary WOODSON. So, thank you so much for that question, 

because I want to point out a couple of things that in the proposed 

legislation, I was struck by the fact that as the Congress was requiring us to set up this advisory committee, there was no requirement for clinical input on that advisory board. And so I am taking 

you have some experience with electronic health records from the 

provider point of view. 

Let me assure you that Dr. Petzel and I represent the functional 

community and we have extensive integrated clinical informatics 

boards made up of clinicians that help develop the requirements. 

So it is functional community-driven, even as we know that the 

system has got to support other administrative processes. 

But it is not the pyramid turned upside-down where the administrative process, which is probably the mistake we made earlier in 

the Department of Defense, where the administrative process 

VACREP180 with DISTILLER

30 

drives the development of the record so that it becomes difficult to 

use by the provider. 

So, I wholeheartedly accept your challenge in your question, and 

I think Dr. Petzel and I are meeting that in terms of how we are 

developing the requirements. 

Secretary PETZEL. Thank you. I would echo what Dr. Woodson 

has said. And I would also point out that the VA record was really 

developed by a group of clinicians as a clinical management platform. It had nothing to do with the administrative functions. 

And the tradition within our organization is that the clinicians 

set the requirements and really drive the process of developing the 

record. And the IPO, with its clinical advisory board, has really 

adopted that principle. The two groups of clinicians from DoD and 

VA have worked very well together developing the requirements for 

the various packets of applications that are going to eventually 

hang on this record. 

And I would also point out that it is my sincere desire that we 

have a single record between these two organizations, as well as 

eventually across the Federal government. 

Dr. WENSTRUP. Thank you. 

Secretary WOODSON. Sir, if I might just add one particular point. 

I would be very happy to work with any clinicians or members of 

Congress who want to look at the functionality of what we are rolling out this year, to make sure that you understand what we are 

really delivering on in terms of that integrated interoperability 

piece. It is usable. That is the key thing. It is usable. So we would 

be happy to demonstrate it to you. 

Dr. WENSTRUP. Thank you. And I would like to get that Web site 

you mentioned earlier. 

Chairman MILLER. Mr. Walz? 

Mr. WALZ. Thank you, Mr. Chairman. 

As a veteran and a citizen, thank you all for what you do. I appreciate the Chairman for holding this, again getting us together, 

and echo my colleagues’ statement this is important. 

Mr. Pummill, two questions to you. I will ask them both together 

and get my response. You have the authority to issue interim, partial or temporary disability benefits. That obviously speeds the 

process along. It gets important things like voc-rehab to our folks 

right away before these become chronic problems. 

I have to tell you it doesn’t appear to be happening in southern 

Minnesota, and when I check around the country. My question to 

you is: Are VA opposed to interim ratings and compensation that 

has been determined there is going to be at least 30 percent? Because I don’t see it happening. 

My other question deals with private medical evidence. You use 

them for—DBQs, but we are having a problem getting that in to 

get some of the ratings done. I have a piece of legislation, along 

with Mr. Denham, to try and use that. Let’s maximize our resources. Let’s have a force-multiplier and use this medical evidence. Get them in. You already use them for DBQs, why not further them along? 

Those are my two questions. 

VACREP180 with DISTILLER

31 

Mr. PUMMILL. The first question, are we opposed to the interim 

ratings? No, we are not. And I will have to check and find out what 

is going on. 

On the second one, we do have a problem getting private medical 

evidence. A lot of the raters that are out there that are actually 

doing the rating of the servicemembers, when I go around and talk 

to them, tell me that, you know, sometimes you have to query a 

doctor’s office three, four times trying to get the private medical 

evidence. So, anything that we can get that would help us speed 

up getting that private medical evidence. We are hoping that the 

DBQs will be a big step in that, where the servicemember can walk 

in and say, ‘‘Doctor, could you please fill out this DBQ?’’ It is pretty 

self-explanatory; easy to fill in the blanks. And they can do it electronically or by hand, and get that from the doctor. And that would 

forego the need for those private medical records. But in the cases 

where we need them, it is tough. 

Mr. WALZ. We have got folks that wander off. Anecdotally, there 

seems to be that the thought is that there is a bias against using 

that outside information, which always sticks in the craw of my 

folks because it is Mayo Clinic in some of those. I hope that is not 

the case. 

Mr. PUMMILL. No, it is not the case. From VBA, not only are we 

not opposed to the private medical records, we actively seek those 

private records and we are required by law to contact those doctors 

and attempt to get those records. 

Mr. WALZ. I am glad to hear it. Thank you. 

I yield back. 

Chairman MILLER. Mr. Barber? 

Mr. BARBER. Thank you, Mr. Chairman. Thank you for convening 

this important hearing. 

I join with my colleagues in wishing that we were listening also 

to the secretaries of defense and veterans affairs, but I am pleased, 

of course, that the witnesses are here. 

I represent a district where there are about 90,000 veterans, one 

of the largest in the country. I also represent the men and women 

of two military installations, Fort Huachuca and Davis-Monthan 

Air Force Base. 

The veterans’ caseload is the highest of any in our office. I think 

that is probably true of all of my colleagues. And the frustration 

that they feel, the veterans that come to us, and my staff feel, in 

getting progress is never-ending. 

And while I understand and appreciate your efforts to develop 

systems that will take care of this backlog, I think one of the ways 

that you might understand our frustration is to spend an hour in 

one of our offices taking calls from veterans and listening to their 

frustration and their concerns. It is very enlightening and obviously a very emotional experience. 

So, my question to you is this. What are leaders of DoD and the 

Veterans Administration doing to set measurable progress metrics 

and holding people accountable? Leadership is about setting goals, 

holding people accountable, measuring progress. And I would like 

to know concretely from both of the departments what concrete 

measurements are you putting in place and how are you holding 

your staff accountable for meeting those measurements. 

VACREP180 with DISTILLER

32 

That is the only way we are going to get this job done, and I 

would appreciate your answers. Thank you. 

Mr. PUMMILL. Congressman, from the benefits side, the compensation side and the backlog, we now, at the behest of Under 

Secretary Hickey, have some very strong and stringent metrics in 

place for not only the individual raters, but their coaches, their supervisors, the regional office directors, all the way up through the 

leadership. 

We know it is—you can look at the math. You can see what we 

have to do to knock out the number of claims that are coming in 

and the backlog. And we have set standards that people have to 

do that. 

We in VBA didn’t meet what we were supposed to meet last year. 

We were—the backlog grew for a lot of reasons. We pushed our automation program, VBMS. We now have it out there. As a result 

of our performance last year, no senior executives in VBA received 

a performance award at the end of the year because we felt that 

it was an overall goal of our administration, of VBA, to make positive progress on the backlog. We didn’t get there, so no performance awards were paid out. 

This year, we will look at the standards. We do see that some 

of the regional offices have really turned the corner. The ones that 

have got—some are really embracing VBMS and starting to churn 

out the claims. Thus, 2 months in a row of breaking an all-time 

record, but it is still not enough. We are still not where we need 

to be. We have a higher standard that we need to reach and we 

will hold people to that standard. 

Mr. BARBER. Thank you. 

And from Defense? 

Ms. WRIGHT. Thank you, sir, for the question. 

As we talked about before, we are the providers of information 

so VA can process the claims. We are not the claims processor. So 

it is our responsibility to provide that information. 

So, working with VA, there was about 4 percent that we owe. We 

have—and those are for the backlog—so we have two teams on the 

ground that are hands-on going through these records, calling back, 

and getting—seeing if this information is in DoD and providing 

that to the disability claims adjusters so they can adjust the claim. 

We also, according to VA, they said the single most important 

thing that we can do to assist them was to provide them with the 

certified service treatment records. So to hold people accountable, 

both myself as the Acting Under Secretary and the Vice Chairman 

of the Joint Chiefs of Staff, receive reports weekly to make sure 

that we are working towards the metric of 100 percent. We are at 

the 97 percentile now and we are working towards the metric of 

100 percent within a 45-day window of when the servicemember 

departs DoD. 

Mr. BARBER. Thank you. 

Mr. Chairman, I yield back. 

Chairman MILLER. Mr. Scott? 

Then Dr. Roe? 

Mr. SCOTT. Thank you, Mr. Chairman. 

And ladies and gentlemen, thank you for being here. 

VACREP180 with DISTILLER

33 

And I do believe you are sincere in trying to cure this backlog. 

And my questions will be more for Dr. Petzel and Mr. Warren, if 

you will. 

And we all know, as I just said, that the veterans are waiting 

too long to have their benefits processed and receive the benefits. 

And in the private sector, beneficiaries would actually be receiving 

an interest payment for the time between when the claim should 

have been adjudicated and when it actually was, and that is something that we may need to look at from our side. 

I am glad to hear about the VBMS software, the continued 

progress there that is going in. And my concern comes from the reports and the delays—and I know you have addressed this—just 

the months that may take place before the veteran’s records are 

processed into that VBMS system. 

And I know many of them have to be manually scanned and 

many of them probably have to be transcribed, and that contributes 

to the delay. But some of the things that I think also contributes 

to the confusion, the delays, veterans, because they are unable to 

track their records, resubmit their records, which means there is 

more paper coming into the system and more files. 

And so what is being done to speed up that or at the least track 

the records? And I think if there was a tracking system so that the 

veterans could go online and see that all of the paperwork had 

been received and that their claim was in process and where it was 

in line in being processed that may resolve some of that. And if you 

would speak to that I would appreciate it. 

Mr. PUMMILL. Yes, Congressman, I will answer that question. 

You hit the nail right on the head. Our big problem in VBA is 

always going to be—for the next few years, we are gonna receive 

a million claims a year. Most of those claims are gonna come from 

outside the Department of Defense. The Department of Defense 

claims that we are gonna get from servicemembers that are leaving 

active Guard and Reserve will have the electronic personnel, dental 

and medical records, so we will be able to do exactly what you say. 

For all the other veterans that send us in the paper and multiple 

copies of the paper, we are still going to have to take those records, 

ingest them through some scanning system that we have in place 

and put them into VBMS. 

Right now, as I stated before, we are only at 20 percent done 

with that right now. We still have 80 percent to go, and it is probably gonna take us about a year to get the ones that we have in. 

Meantime, a million new ones are gonna come in, in the same status. So it is a never ending problem that is always gonna be there. 

One of the future things that we have in VBMS is if you go into 

my eBenefits right now and you file a claim, you can see when your 

claim is filed. But what you can’t see is, have we received your 

records, what is the status of your claim. Future upgrades of 

VBMS—I think it is December, 6.0, will allow the veteran to see 

when the claim arrived, what the status of their claim is, and the 

VBMS software has built into it right now for the scanning—if 

you—scan a document and a medical record and then 6 months 

later you send us the same medical record, the system will identify 

it that there is a duplicate of that record, because it is a semi-intelligent system, and will prevent that new record from going in. 

VACREP180 with DISTILLER

34 

What it doesn’t prevent is when it arrives, the clerk that gets it 

doesn’t know that it is already in there, so somebody has to take 

that record and get it to the scanning operation, re-scan it, and 

then once it is there we realize we already have it. 

It will prevent having extra records, but we don’t know how to 

prevent the work in the first place other than to notify the veterans, please go online, my eBenefits, register, look. You will see 

that we did get your file. You will be able to actually go online and 

look at your file. 

Right now I can go into my eBenefits—I went in there last 

week—and I was missing one of my personal files from my time in 

the Army. And through my eBenefits, I linked into my Army electronic record, was able to get the personal file downloaded and ship 

it over to the VA. 

It is still a little complicated, but we are getting better and better 

at it, Congressman. 

Chairman MILLER. Dr. Roe? 

And then Mrs. Kirkpatrick. 

Dr. ROE. Thank the Chairman. 

And thank you all for being here. It is good to see you all again. 

And just a couple or three quick things. One of the—as Mr. Scott 

and Barbara both mentioned, the most common thing that a Congressman, probably everybody up here has, are a backlog of VA 

claims—why can’t they get adjudicated quicker? 

And I know these 800,000 claims are likely a hodge podge of 

World War II, Korea, Vietnam, Desert Storm and so forth. So I 

think that is correct. 

How many of those are in an electronic format where you could 

actually look at them, that you have scanned them in? Where are 

they? That is one. 

And then the second question that I still want to get an answer 

to that I am still not sure I do. I know that the DoD has an orphaned electronic health system, and they are going to have to replace either the software or do new hardware upgrades. 

I think what everybody has asked but is still not clear to me is 

that when a young soldier, an 18-year-old soldier takes the oath 

and goes into the military, will that system that the DoD has, is 

an electronic record, be able to transfer directly to the VA and 

speak seamlessly to the VA when we have spent billions of dollars—we just spent a billion and we couldn’t do that. It just didn’t 

happen. 

So is that gonna happen? Because it is not clear to me—I have 

heard yes or no on that yet. So those are two questions I have. 

Secretary WOODSON. So maybe I can respond to the last question 

first and then my VA colleagues can respond to your questions to 

them. 

The answer is yes. And that is why we have got to concentrate 

on the data interoperability. 

Dr. ROE. Yes. And then when? 

Secretary WOODSON. So, again, by the end of 2013 and rolling 

out in 2014. And, again, I will show you the functionality if you 

would like, as to what that means. 

So the answer is yes. 

VACREP180 with DISTILLER

35 

It is important to understand that we will always be evolving 

system, and we have to communicate, again, with the private sector. Many times this morning we have talked about the loose paper 

and issues relative to what we need to capture from the private 

sector. So it has got to be about data standards so that we can 

transfer information rather than what systems and when it is on, 

because we will never get the entire Nation to be on the same system. 

Dr. ROE. Correct. 

Secretary WOODSON. But we do need to capture that data. 

Dr. ROE. One last thing, Mr. Chairman, just—and I will yield my 

time back—is one of the things the VA is doing I think is very good 

is the video conferencing for VA—for veterans who want to appeal. 

We did our first one in the district the other day. So that a disabled 

veteran doesn’t have to go to Nashville and then drive to Washington, D.C. You can video conference that. 

And that will save tons of money, make it much easier. So I want 

to commend you on doing that and encourage you to continue to 

do that. 

I yield back. 

Chairman MILLER. Ms. Kirkpatrick—then Mr. Kilmer. 

Ms. KIRKPATRICK. Thank you, Mr. Chairman. 

My question to the panel has to do with immediate mental 

health treatment. Twenty-two veterans commit suicide every day. 

Every time a new patient goes to the VA they have to go through 

the enrollment and eligibility process, which includes a physical 

exam. Oftentimes, this physical exam takes 2 months or more to 

set up, and this includes patients who need immediate mental 

health treatment. 

My VA caseworker is contacting hospitals directly to schedule 

these emergency physicals for these veterans who need immediate 

treatment. 

I know the Department of Defense does a quick evaluation before 

discharge, but there is no direct handoff of that evaluation to the 

VA. So my question is, how can the VA and the Department of Defense work together? What kind of system has to be put in place 

as soon as possible to make sure that these veterans get their immediate mental health treatment? 

Secretary PETZEL. Congresswoman Kirkpatrick, let me just address the emergency part of this. If someone has an urgent or 

emergent medical—mental health condition, they will be seen immediately. They don’t have to have a physical, they don’t have to 

have anything else. They will be seen and evaluated for that mental health condition. 

And if it should transpire that they need to be admitted, et 

cetera, they can be admitted. The rest of the work in terms of determining eligibility, et cetera, will occur. 

I would like to talk personally with you about the specific cases. 

If they are something less than urgent or emergent, then, yes, 

there is a step process that one goes through, but it can be done 

in a pretty expeditious way. 

Ms. KIRKPATRICK. Let’s follow up, because evidently it is not happening. And it may be the criteria that is used for what is an emergency. So—— 

VACREP180 with DISTILLER

36 

Secretary PETZEL. I would be delighted to talk with you about it. 

Ms. KIRKPATRICK. The response from the Department of Defense, 

please? 

Secretary WOODSON. Yes, I think previously in testimony, both 

Dr. Petzel and I talked about integrated mental health strategy, 

warm hand-off, case managers that handle servicemembers with 

identified mental health problems that need immediate and followup care. 

So I think over the last couple of years, we have really enhanced 

greatly identifying individuals who have particular mental health 

problems that need to be seen right away, and making sure that 

they get to those—— 

Ms. KIRKPATRICK. Doctor, let me ask, with that evaluation that 

is done right before discharge is there any way to make a quick 

hand-off of to the VA of that information and the results of that? 

Secretary WOODSON. Absolutely. We do that. We transfer—— 

Ms. KIRKPATRICK. That is being done? 

Secretary WOODSON. Yes. We transfer those—— 

Ms. KIRKPATRICK. It—okay. 

Secretary WOODSON. —records. 

Ms. KIRKPATRICK. I yield back. Thank you for the courtesy, Mr. 

Chairman. 

Chairman MILLER. Mr. Kilmer and then Mr. Nugent. 

Mr. KILMER. Thank you, Mr. Chairman. 

My question is for Dr. Petzel and Mr. Pummill. Obviously, admirably, many employers have shown leadership in hiring those who 

served. 

But I want to raise a concern that I have heard over the years 

from servicemembers reintegrating into civilian life who have reported that their military or veteran status has occasionally been 

used against them in the pursuit of employment or in the pursuit 

of housing, with employers or landlords raising concerns—raising 

from fears that someone would potentially get redeployed or—and 

in some cases, folks raising concerns about things like post-traumatic stress. 

In my state, I work with a coalition of veterans’ groups and a bipartisan group to try to address this and expand nondiscrimination 

protections in our state. 

I was hoping if you could briefly tell us if you are aware of this 

type of discrimination against veterans and returning 

servicemembers? 

Mr. PUMMILL. Congressman, I have heard that kind of stuff 

anecdotally, but I can’t relate a specific incident. I do know that 

there was a bill being pushed forward about antidiscrimination 

against veterans. 

And from a VA perspective, we are advocates of veterans. We are 

very supportive of any efforts in that area. We haven’t had a 

chance to study the bill yet. 

I haven’t actually seen it, but because of the subject matter discretion—discrimination, it would probably be an Office of Personnel 

Management and Department of Justice would have to be giving 

the opinions on that. But from a VA perspective, we support it. 

Mr. KILMER. Thank you. 

VACREP180 with DISTILLER

37 

Secretary PETZEL. I would, Congressman, just make a comment. 

The VA has developed an educational package for employers that 

we use often at the employee forums that we have around hiring 

veterans that tend to debunk, if you will, the myths about veteran 

employees around mental health issues, as well as the rest of the 

issues that might arise, as you say, because of someone’s veteran 

status. 

We are trying, working very hard to have employers understand 

that these are excellent employees. They are very well trained. 

They are disciplined. They are used to working hard and they are 

bright and they can contribute tremendously to a workplace. 

Mr. KILMER. Thank you. I certainly agree with you and I am 

hopeful we can have more comprehensive protections. We will be 

getting a copy of that bill to you. Senator Blumenthal and I are 

working on a bill together and we will get that to you. Thank you. 

Chairman MILLER. Mr. Nugent and Ms. Duckworth. 

Mr. NUGENT. Thank you, Mr. Chairman, and I want to thank 

this panel for your service to our country and what you do for our 

veterans. And being a father of three veterans currently serving, I 

do appreciate it. 

But one of the things I hear, and I have about 100,000 veterans 

in my district, is that the vernacular between doctors and claim 

processors sometimes does not match up, which causes them issues 

when it goes to VBA, because they are looking for certain key 

words as they are scanning through it, because there is so much 

there. 

And I understand that. So my question to you is what are we 

doing to try to marry up or delineate the vernacular so it doesn’t 

cause our veterans the problem? Because we know what the doctor’s intent is. They go to the VA, but they haven’t filled out the 

form with the proper wording and then it gets kicked. 

What, if anything, are we doing to address that? 

Secretary PETZEL. Thank you, Congressman Nugent. And you 

have articulated an issue which, in the most part, is in the past. 

The development of the disability questionnaires, we call them 

DBQs, that are to be filled out by the VA doctor or the private doctor, basically answer all the questions. So there is no ambiguity in 

terms of the language. And a rater can take that DBQ and can do 

the rating basically from the DBQ, because it forces the clinician 

to answer the questions in a fashion that will be understood by the 

rater. I would ask Mr. Pummill if he has any other comment about 

that? 

Mr. PUMMILL. I would agree with Dr. Petzel. 

Mr. NUGENT. Let me ask you this question I have. I don’t mean 

to interrupt, we have a short time. Is that currently being done, 

particularly with docs at the VA, believe it or not, that is part of 

the problem. We are hearing that specifically today, still. 

Secretary PETZEL. Yes, it is. And the other thing that I wanted 

to add is that we have, in the main, a separate group of physicians 

that do—and providers that do pension and compensation exams 

that are trained in the vocabulary, if you will, of claims and adjudication. 

I can’t say that there isn’t an occasional issue or problem, but in 

the main, these two systems I think work very well together. 

VACREP180 with DISTILLER

38 

If you have a specific instance, I would love to talk to you about 

it and see if we can find out what happened. 

Mr. NUGENT. Thank you, sir, very much. I yield back. 

Chairman MILLER. Ms. Duckworth? Then Mr. Gibson. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. Well, I first want 

to just note that it is very clear that this panel is very much dedicated to our military men and women and to our veterans. Many 

of you have your own military service, decades of military service, 

as well as your decades in civilian service. 

I just have to note that we have in our midst General Wright, 

who is the first female helicopter pilot in the National Guard. And 

women in aviation stand on your shoulders. So thank you for that. 

Mr. Warren, I think it is widely known that VA’s chief information office has had many successes in terms of the delivery of 

PMAS and other cost-saving measures and new systems. 

I want to make sure that we, as members of Congress, are doing 

the right thing in terms of how we work with you, both Mr. Warren 

and Mr. Kendall, in developing the electronic—integrated electronic 

records system. 

I would like Mr. Warren to answer first and then, if we have 

time, Mr. Kendall. What can we do to help with this process as 

members of Congress? Are there—you mentioned, specifically Mr. 

Warren, there are a lot of reports that you have to do that take 

up a lot of time. 

But are there other things—restrictions on decisions you are 

making, budget authority? Are there different colors of money, developmental money versus acquisition money? What is there that 

Congress can do to help you move forward with this effort? 

Mr. WARREN. Thank you for that question and the offer. I would 

say that holding—continuing to hold us accountable for progress is 

key. And I think a lot of the effort and a lot of the overcoming of 

institutional barriers has been a result of the interest and the desire to make sure we do not only what is right for our 

servicemembers and for our veterans. So thank you for that and I 

believe that is important. 

The challenge we are facing today is that there is language that 

constrains where we can execute dollars. It is pretty acute on the 

VA side. We have made a commitment to make deliveries by the 

end of December and by 1 October next year. Those are at risk because of some of the constraints on us with respect to execution. 

There is an ask for plans. Those are in process to be delivered 

up to the appropriate Committee staff for their review. And any 

help that we could get on making sure those get cleared so we can 

continue to make that critical progress would be greatly appreciated, ma’am. 

Ms. DUCKWORTH. Could you provide that information to my office 

in writing at a later time? 

Mr. WARREN. I would be glad to, ma’am. 

Ms. DUCKWORTH. Thank you. 

Mr. Kendall, just—— 

Secretary KENDALL. If I may, Mr. Chairman, what I would ask 

from you is that you not over-constrain us. So I am very concerned, 

as I mentioned in my opening statement, about some of the language in various bills right now. 

VACREP180 with DISTILLER

39 

But essentially we have to take some steps to get this program 

on track, these programs on track, that if we are overly constrained 

it will be very, very difficult for us. I need a little bit of time to 

sort a few things out. I have just recently been asked to take over 

this by the Secretary. 

For example, tying us to a strategic plan that was written last 

fall, which is very much overcome by events now, is not particularly helpful, I am afraid. It was only submitted to Congress relatively recently, but that plan does not really reflect some very fundamental changes that have been made since it was initially written. 

So there are things like that that would—that kind of tie our 

hands. There are also a lot of reporting requirements. We have no 

problem with keeping the Committees informed. We are happy to 

do that. 

The withholds that are in some of the language, I think, also, are 

becoming increasingly problematic for us. And particularly, right 

now for VA, that is a concern we have that is somewhat imminent. 

So I am—we are very happy to work with the Committees, very 

happy to work with the members and their staffs, and to be very 

transparent about what we are doing, but we ask that, in return, 

you be—relieve some of the constraints that you have in mind right 

now and allow us to take the best path forward and give us the 

opportunity to explain that to you. 

Ms. DUCKWORTH. Thank you. I yield back, Mr. Chairman. 

Chairman MILLER. Mr. Kendall, I appreciate your comments and 

the fact that you just came on board, but there were people before 

you, there is time before you, and there were billions of dollars 

spent before you. 

Mr. Gibson? Then Mr. Johnson. 

Mr. GIBSON. Thank you, Mr. Chairman. I appreciate very much 

your leadership and I found this hearing very helpful this morning. 

Thank you to the panelists for your leadership and your commitment. 

The single integrated health care record, something that we are 

all endeavoring towards. I am the author of a bipartisan, bicameral 

bill to hold us towards that end, towards Mr. Warren’s comment 

just moments ago. 

And my question may have been answered, but I want to just 

offer it again to see if there might be further clarification. It has 

to do with Mr. Kendall’s opening remarks where he alluded to onerous language. And I just heard a listing. 

And I also heard Mr. Woodson, earlier he mentioned that it 

would have been helpful if the language included clinical input. I 

appreciate those remarks. And so, I guess I will ask Mr. Kendall, 

is there anything else that you want to highlight when you were 

talking about onerous language? 

Because we are trying to strike a balance here between, you 

know, not getting in the way of somebody trying to get to where 

we all think we need to go, and at the same time what Mr. Warren 

said, that we have got to hold everyone accountable because the 

American people expect it, and of course they should. So Mr. Kendall? 

VACREP180 with DISTILLER

40 

Secretary KENDALL. Thank you, Congressman. It is a good question. I would like to take it for the record in order to give you a 

more detailed answer. We have been reviewing the language. I am 

a lawyer. I respect lawyers more than most people perhaps. I would 

like to have our lawyers have a chance to take a look at it because 

there is some language in there that isn’t quite clear to us what 

the intent is or what it really does to us. 

I would like to give you a response for the record that just kind 

of lays out specifically what it is that we might have a problem 

with, if that is all right with you. 

Mr. GIBSON. I do appreciate it, and of course that would be fine. 

I just want you to understand that part of the reason why we are 

concerned is because we think we are all moving towards that 

same objective, and then we get these comments that, well, we 

are—it appeared to us like we are taking a step back. Now we have 

gotten some further context about that. But what we really want 

to do is just make sure we all get up on the objective because we 

know we need to get there. So thank you. I look forward to receiving that for the record. And with that, I yield back, Mr. Chairman. 

Chairman MILLER. Mr. Johnson, then Mr. Wittman. 

Mr. JOHNSON. Thank you, Mr. Chairman. And thank you all for 

your service to the Nation. Mr. Petzel and Pummill, I would like 

to ask, are you aware of the situation in Atlanta where three mental health patients were—ended up dead and poor recordkeeping 

and poor management has been cited as one of the reasons for 

that? 

Secretary PETZEL. Yes, sir. I am aware. 

Mr. JOHNSON. And are you aware of the allegation—and it may 

be a fact—that a former top administrator at the Atlanta VA medical center received performance bonuses over a 4-year span as internal audits revealed lengthy wait times for mental health care 

and mismanagement that led to the deaths? 

Secretary PETZEL. I am not specifically aware of the track record 

or the award record for senior managers there, but I certainly can 

find out. 

Mr. JOHNSON. How about you, Mr. Pummill? 

Mr. PUMMILL. No, Congressman. I wouldn’t be involved in the 

Veterans Health Administration. I work over at the Veterans Benefit Administration. 

Mr. JOHNSON. Okay. Well, Dr. Petzel, do top administrators at 

the VA still receive bonuses? 

Secretary PETZEL. Congressman Johnson, yes. Some of the top 

administrators in the VHA, which is what I can speak for, do receive bonuses. They have been dramatically reduced. We call them 

awards, not bonuses. They have been dramatically reduced by almost I believe 50 percent over the last 3 years. But yes, there are 

some people who do receive awards. 

Mr. JOHNSON. And those awards would be based on what? 

Secretary PETZEL. On their performance. They have—all senior 

executives have a performance contract and the awards have to be 

based upon the performance in relationship to their performance 

contract. 

Mr. JOHNSON. And who or what entity determines who gets the 

awards? 

VACREP180 with DISTILLER

41 

Secretary PETZEL. Well, the recommendation for an award, sir, is 

made by the supervisor of the individual. And that then works its 

way up through the administration. It would pass in the case of the 

Veterans Health Administration through me up to the department 

level. And eventually, all the awards are signed off on at the department level. 

Mr. JOHNSON. I see. And so approximately how many awards 

have been granted for the 2013 fiscal year? 

Secretary PETZEL. I would have to take that for the record, Congressman. But the awards I think that we are talking about would 

be administered after the end of the fiscal year. They are based 

upon the performance during this fiscal year, which would be 2013. 

So technically there would be no awards that have been administered yet. 

Mr. JOHNSON. I see. What about 2012? 

Secretary PETZEL. I would have to take that back for the record, 

sir. I do not have that on my mind. 

Mr. JOHNSON. All right. And I yield back. Thank you. 

Chairman MILLER. Mr. Wittman? 

Mr. WITTMAN. Thank you, Mr. Chairman. Panelists, thank you 

so much for joining us today. I want to ask, if you would, to just 

limit your responses to yes or no so I can get through these questions. 

I will begin with Secretary Pummill. With appropriate privacy 

release consent, are you willing to work with pro bono law schools 

like the College of William and Mary’s Veterans Law Clinic and let 

them inside the benefit claims process? 

Mr. PUMMILL. Yes. 

Mr. WITTMAN. Secretary Warren, is a recently discharged, combat-wounded soldier flagged in a system in a way that their claim 

is streamlined electronically for immediate review and processing? 

Mr. WARREN. Sir, I can’t answer that question. But I will get it 

for the record, sir. 

Mr. WITTMAN. Okay. Thank you. Secretary Warren, again, you 

know, you heard from Mr. Runyan, with today’s technology, we can 

pull records faster than we can in the past. The VA’s internal procedure is to wait 60 days after requesting a record, and then an 

additional 30 days to follow up. Ninety days of waiting. This is 

your procedure. Yes or no. Can you change it and reduce the time? 

Mr. WARREN. I believe testimony will show that for individuals 

on active duty that are going through the transition, we have 

changed that. But because of the duty-to-assist requirements—and 

Mr. Pummill can answer that better than I can in terms of what 

legal and legislative requirements are with respect to that. But 

glad to get you a more detailed answer for the record. 

Mr. WITTMAN. Okay. I would like just a straightforward yes or 

no. Seems to be pretty significant. Can you or can you not reduce 

the time? 

Mr. PUMMILL. Yes. 

Mr. WITTMAN. Okay. Thank you. Secretary Woodson, you are discharging servicemembers who you know have serious injuries. Amputees, suicidal PTSD patients. Yes or no. Do you communicate 

with the VA to prioritize these veterans and ensure they have the 

proper paperwork transitioning to the VA? 

VACREP180 with DISTILLER

42 

Secretary WOODSON. Yes. 

Mr. WITTMAN. Also, can a veteran with no recorded—and I will 

ask this of the VA panel members—can a veteran with no recorded 

medical history documenting a service-connected disability claim 

something as service-connected in a VA claim years, even decades 

after the fact, for an injury that very well could be connected with 

aging? 

Mr. PUMMILL. Congressman, I can’t answer that with a yes or no. 

Sorry. You could have something in our personnel record or your 

dental record or a buddy statement, or in the case of military sexual trauma, change in performance that would allow you to make 

a claim later on in your life. 

But for most cases, unless you have something in your medical 

record that is—substantiates a disease, injury or illness that occurred during active duty or a period of active duty for the Guard 

or Reserve, you would not be able to file a claim. 

Mr. WITTMAN. Okay. Very good. Thank you, Mr. Chairman. I 

yield back. 

Chairman MILLER. Mr. Langevin? 

Mr. LANGEVIN. Thank you, Mr. Chairman. I want to thank our 

witnesses for their testimony today, and especially appreciate the 

update on the move to complete the project of transitioning over to 

electronic medical records and hopefully once and for all significantly reducing or eliminating the backlog that our veterans are 

facing. 

It is one of the number-one complaints and problems that I hear 

from among veterans in my district. So I do thank you for your 

work on that, and I hope that the project is completed as expeditiously as possible. The—obviously, the issues that are under discussion today are of course of critical importance and interest to all 

of us, and we certainly appreciate our witnesses sharing their expertise with us today. I want to focus on the path through the DoD 

and VA system for veterans suffering from neurological traumas 

such as TBI and spinal cord injury. 

And I wanted to ask if you can describe for us how their treatment and benefit trajectory varies from the baseline and what supplemental assistance is available other than normal benefits for 

those no longer able to move around comfortably in their homes. 

And let me say that in response to unmet needs that veterans 

organizations throughout—that are brought to my attention, I have 

introduced what is called the Veterans Home Buyer Accessibility 

Act last Congress to aid our injured servicemembers, modify their 

homes to ensure that they are accessible. And I certainly plan to 

introduce it again in this Congress. Has there been an examination 

of benefits shortfalls specific to neurological traumas, particularly 

with regard to adaptive modifications to homes? So if you could 

take both of those questions. 

Secretary PETZEL. Congressman, I can begin. The VA does have 

an adaptive home modification program. Substantial—thousands, I 

think even tens of thousands of dollars can be spent on modifying 

a veteran’s home for mobility with, you know, within that home. 

I am not aware of the fact that there are restrictions or shortfalls 

in the benefit. And I would certainly like to work with you directly 

VACREP180 with DISTILLER

43 

to find out exactly what those shortfalls are. We are not aware of 

them. 

And I would ask Mr. Pummill if he has any other comments, because VBA does administer some of those programs. 

Mr. PUMMILL. No, Congressman, I am not aware either. But 

what I will do is I will get with our veterans service organizations, 

our partners out there. They are our eyes and ears in America, provide us good information on veterans, and see what they have to 

say and what they can provide back to us. 

And I would just like to add, too, that, you know, as we are making progress on the backlog because of the assist we are getting 

from DoD, it is tri-fold. It is VA. It is DoD. And it is the veterans 

service organizations helping us get DBQs, fully developed claims, 

talking to veterans, doing the things that we need to do. So, they 

help us a lot and I will see what they can provide me. 

Mr. LANGEVIN. That would be very helpful. I appreciate that. 

Thank you. 

I yield back. 

Chairman MILLER. Thank you very much, Mr. Langevin. 

Thank you to the witnesses for being with us for a little over 2 

hours. We certainly appreciate that. 

I thank all the members that were here today to ask some very 

pertinent questions. I would ask unanimous consent that all members would have 5 legislative days with which to revise and extend 

their remarks and add any extraneous material, subject to the 

hearing topic today. 

And without objection, so ordered. 

And with that, this hearing is adjourned. 

[Whereupon, at 12:11 p.m., the Committees were adjourned.] 

VACREP180 with DISTILLER

(44) 

A P P E N D I X 

Prepared Statement of Hon. Jeff Miller, Chairman 

Good morning. Welcome to this joint hearing of the Committees on Veterans’ Affairs and Armed Services. I also welcome Chairman Buck McKeon and Ranking 

Member Adam Smith and, of course, my friend from Maine the Ranking Member 

of the Veterans’ Affairs Committee, Mike Michaud. 

This is the second time in two years that these two Committees on which I am 

proud to serve have met jointly to review the collaborative efforts of the Departments of Defense and Veterans Affairs in assisting servicemembers with their transition from active duty to civilian life. 

A year ago we were privileged to have Secretaries Panetta and Shinseki at the 

witness table. Both of them testified at length regarding the progress VA and DoD 

were making in several key areas. I’d like to revisit two of those areas in my opening statement. First, the progress made in developing an integrated electronic 

health record. Second, the progress made in reducing the wait times associated with 

veterans’ disability claims, which necessarily involves cooperation from DoD in the 

transfer of records. 

I’ll start with the electronic health record. In response to my direct question at 

last year’s hearing Secretary Shinseki remarked that the two departments had finally, after 17 months of discussion, agreed on a way forward on a ‘‘single, joint, 

common Integrated Electronic Health Record’’ that would be completed by 2017. The 

Secretary told us that each of those words – single, joint, and common—meant 

something, and that finally we were breaking through the cultural issues between 

the two departments that had stifled progress in the past. 

What a difference a year makes. Contrary to the Secretaries’ testimony, the two 

departments are, once again, moving on their own tracks, with promises we’ve 

heard before about making two separate systems ‘‘interoperable.’’ Pardon my frustration, but it seems the only thing interoperable we get are the litany of excuses 

flying across both departments every year as to why it’s taking so long to get this 

done. 

In response to this latest course correction, the House included an amendment to 

the National Defense Authorization bill, an amendment developed in collaboration 

with the leadership of the Armed Services, Veterans’ Affairs, and Appropriations 

Committees, to direct the completion of an integrated health record by October 1, 

2016. The message of the amendment is simple: No more excuses, get this done. I’m 

anxious to hear from our witnesses how they’ll comply with the mandate of the 

amendment once it is enacted into law. 

The second issue I’ll briefly touch on is the disability claims backlog. It’s interesting to note that the progress made in reducing the pending inventory of claims 

the last few months correlates with the heightened Congressional oversight and 

media scrutiny. Well, none of us up here are going to take our foot off the gas when 

it comes to ensuring progress on the backlog. And although progress has been made 

lately, VA is woefully short of its own goals for the year. 

Going forward, ending the backlog necessarily requires a seamless records transfer from DoD. I look forward to hearing the status of those efforts and what more 

can be done. This problem of veterans waiting years for their disability claims to 

be decided must remain at the forefront of our consciences, especially as further 

troop draw downs occur over the next five years. It, too, is an issue where the excuses must end, and real, sustained progress must occur. 

Very quickly, just a bit of housekeeping before we proceed. To accommodate such 

a large contingent of members we have agreed to last year’s framework that limited 

to 2 minutes each member’s time to ask questions of the witnesses. Therefore, I ask 

unanimous consent that each member have not more than 2 minutes to question 

the panel of witnesses, starting with my own questions. Without objection, so ordered. 

VACREP180 with DISTILLER

45 

Further, I ask unanimous consent to include all Member statements in today’s 

hearing record. Without objection, so ordered. 

I now recognize Chairman Buck McKeon for his opening remarks to be followed 

by Ranking Member Mike Michaud, and then Ranking Adam Smith for their opening remarks. 

f 

Prepared Statement of Hon. Michael H. Michaud 

I want to thank the Chairs of the House Committee on Veterans’ Affairs and 

Armed Services for holding this joint hearing today. Transition is a critical issue 

that greatly affects our servicemembers and veterans. 

This hearing is the second joint hearing our two Committees have held concerning 

transition. The purpose of this hearing is to reiterate our joint oversight commitment, and ensure that VA and DoD work together on behalf of the men and women 

who are sent into harm’s way. 

At last year’s joint hearing on this topic, the two Agency Secretaries appeared before us, sitting side by side. I am disappointed to see that neither is here today. 

I take this lack of personal engagement as a sign that they care less, that they are 

not as committed, that they have delegated – abdicated – ownership of this issue. 

My disappointment is solidified by receiving testimony in the eleventh hour. Clearly, 

this issue, and this hearing, is not a priority. 

I would submit to you that the government has struggled to fulfill the ‘‘sacred 

trust’’ to care for those who have served and sacrificed in defense of our Nation. 

After twelve years of war, we know transition is the critical first step, and it requires the cooperation of many agencies to accomplish successfully. I do not believe 

we have made any measurable progress in getting the two agencies before us today 

to work more effectively together. 

The Department of Defense has announced it will put out to bid for a new system 

to manage its health records. Such a decision appears to back an interoperable approach over an integrated one. An integrated – integrated, not interoperable - electronic health record is something that Congress mandated years ago. We have spent 

hundreds of millions of dollars. Delaying the delivery of an integrated – that is integrated, not interoperable - information sharing system runs directly against Congressional intent, and ultimately hurts our veterans. 

Also, of particular importance to our Committees is the claims backlog. Let me 

be clear, both VA and DoD have a responsibility to end the backlog by 2015. The 

claims backlog is not a ‘‘VA issue’’. DoD must do a better job of transferring veteran 

and servicemember’s records to VA in a timely and complete manner. 

This includes the records of our National Guard and Reservists. It also includes 

late and loose records being sent to VA. 

Because benefits and health care affect so many servicemembers and veterans, 

DoD and VA must put aside their parochial differences and work more effectively 

together to ensure an integrated – that’s integrated, not interoperable - process addressing transition issues. 

Over the course of the last several months we sent letters to the Secretaries, and 

the President, asking for their personal commitment and support. We requested concrete decisions be made in a timely manner. What we received in response is a noshow to this hearing, and a press conference that kicks the decisions down the road 

. . . again. 

And, it would appear that leadership is lacking not just at this hearing. During 

a recent Roundtable on the iEHR, industry leaders told us progress is not due to 

a lack of available technology solutions, but rather a lack of leadership. When two 

divisions in their companies can’t - or won’t - agree, the CEO steps in and mandates 

a direction. Where is DoD and VA’s ‘‘CEO’’? 

Just recently, in a bi-partisan effort and due to ongoing congressional concerns 

with the lack of a unified vision between VA and DoD electronic health record programs, language was included as part of the National Defense Authorization Act for 

2014. This language created a deliberate approach in developing a joint electronic 

health record. 

I am told that strategies have been modified and collaborative efforts are ongoing 

for both records transfer and iEHR. However, months continue to go by with seemingly no real progress. 

I look forward to hearing from our panelists today just how far they have come, 

and to learn about the path ahead on the transition issues that are the focus of this 

hearing today. 

Thank you and I yield back. 

VACREP180 with DISTILLER

f 

46 

Prepared Statement of Hon. Corrine Brown 

Thank you, Messrs. Chairmen and Messrs. Ranking Members, for calling this 

hearing today. 

I believe it is our duty as Americans to provide proper care for our veterans and 

servicemen who have unselfishly put their lives on the line for our wellbeing. This 

starts with health care. Time has shown that we, as Members of Congress, and Senior Leadership of the Department of Defense, and Department of Veterans Affairs’ 

have not been able to provide timely compensation for the work our servicemen and 

women did to defend this Nation from all enemies. While the VA has made incredible progress with its initiative to resolve all claims older than two years and now 

one year, there are still too many claims not being resolved in a timely manner. 

Secretary Hagel has stated that with the majority of claims being made for those 

veterans who served previous to Iraq and Afghanistan both the DoD and VA need 

to: 

• Certify service treatment records so that claims processors know not to hold up 

processing to request additional records. • Hold data-sharing summits every six weeks to look for ways to improve DoD 

and VA practices. • Conduct separation health assessments to establish baseline medical conditions, 

which will speed future disability benefits claims. • Improve the format of DoD service treatment records so that they are portable 

and can be quickly scanned by other users. 

I am concerned that while talking about pursuing these goals, the DoD is not fully 

behind the plan. Earlier this year, the DoD pulled out of joint program with the VA 

to develop one computer system that would be able to be used by both departments. 

Just the other day, there was an article in the Washington Post regarding a company that created a back-end computer program to have 6 separate accounting programs be able to talk to each other. It cannot be that difficult to do what you each 

propose. 

Both the DoD and VA have a full understanding of what needs to be done to fix 

this issue with the integrated electronic health record program (iEHR), but, efforts 

to progressively move this program forward have proven diligently slow. You must 

put forth a greater effort to ensure that these veterans are awarded their benefits 

in a timely manner and their health care is seamless. I am resolute in my commitment to ensure the DoD and VA work toward their shared goal of achieving full 

interoperability of health care records. It is imperative that the DoD and VA make 

progressive moves together to ensure an effective system is ran between both agencies that will produce consistent service for our current servicemen and veterans. 

f 

Prepared Statement of Hon. Frank Kendall 

Chairman McKeon, Chairman Miller, Ranking Member Smith, Ranking Member 

Michaud, and distinguished members of the Committees, thank you for extending 

the invitation to discuss the recent actions that the Department of Defense (DoD) 

has taken to assist the Department of Veterans Affairs (VA) to eliminate the disability benefits claims backlog and our collaboration on the integrated Electronic 

Health Record (iEHR) program. Although DoD is currently operating under significant resource constraints as a result of sequestration, including civilian furloughs, 

DoD will continue to work in conjunction with VA to provide exceptional care and 

services for America’s service members and veterans. Thank you for your attention 

to this issue and for your continued support of our active and reserve component 

military members, and their families who serve with distinction every day and who 

deserve the best medical care and treatment as both service members and as veterans. 

BACKGROUND - VETERANS’ DISABILITY BENEFIT CLAIM BACKLOG 

Veterans’ benefits are a vital extension of a holistic benefits package to sustain 

an all-volunteer force. DoD and VA are committed to working together to provide 

continuous, accessible, and quality health care for America’s active duty military 

and veterans. When a service member completes his or her service obligation and 

separates from the military, DoD is responsible for ensuring that they are 

seamlessly, efficiently, and quickly transitioned to the care of Veterans Affairs – 

with all of their records. 

VACREP180 with DISTILLER

47 

DoD currently provides VA with electronic access to approximately 98 percent of 

the required personnel and administrative data for claims adjudication, including 

electronic ‘‘read-only’’ health records, and we meet together on a regular basis to 

close the gap on the remainder. We provide VA access to scanned images of all personnel records (including available DD Form 214) through a DoD data system web 

portal, and we are taking action to provide Veterans Benefits Administration employees with enhanced access to our electronic medical record data. DoD has electronically provided VA with the health data of more than 5.9 million 

servicemembers who have separated since 1989. The ability to access and view this 

data has existed between all DoD and VA medical facilities on 4.7 million shared 

patients since 2007. Building upon past successes in real-time data exchange, the 

Departments have sought to go beyond point-to-point interfaces between their systems and to establish full data interoperability. Achieving interoperability will mean 

the Departments will use a common taxonomy that provides access to human and 

machine-interpretable data by doctors and patients anywhere, anytime. Health care 

record transfer from DoD is not a major factor in VA’s current backlog. 

Over the last few months, both Secretary Hagel and Acting Under Secretary 

Wright have met with and listened carefully to the concerns and input from DoD’s 

health care providers, leaders from the VA, and Veterans Service Organizations and 

Military Support Organizations. Their input has been vital to ensuring that our 

service members and veterans receive quality care, and their input has been very 

helpful in defining a path forward. 

On May 22, 2013, the Secretary of Defense and the Secretary of Veterans Affairs 

met with Senator Mikulski and the Senate Appropriations Committee on Defense 

in a roundtable discussion regarding the disability benefits backlog and we provided 

an overview of our actions to support VA. 

Most recently, on July 2, 2013, the Secretary of Defense, Under Secretary Kendall 

and Acting Under Secretary Wright met with Secretary Shinseki, Dr. Robert Petzel, 

the Director of the Veterans Health Administration and Ms. Maureen Coyle, the VA 

Deputy Chief Information Officer, to ensure that the efforts of both of our Departments are aligned and that appropriate progress is being made to address the backlog issue. Our meeting agenda specifically focused on our mutual efforts to help VA 

reduce the veteran disability benefit claim backlog, veteran homelessness, and our 

electronic health record systems. 

DOD EFFORTS TO ASSIST VA WITH THE BACKLOG 

The most important thing DoD does to help VA process claims is to provide VA 

with the information that it needs. DoD provides information to VA in both electronic and paper form. With the exception of some records from visits to private 

health care providers since 2004, medical records have been transferred as electronic records. DoD provides Service Treatment Records (STRs), personnel and administrative data within 45 days from when a Service member separates from the 

military. 

The Department of Defense is working closely with VA to provide any information 

VA needs to enable them to complete the processing of disability claims. In collaboration with VA, we are also refining our processes by which we provide information 

to ensure future disability benefit claims can be processed by in a shorter time. 

For example: 

• DoD has agreed to provide VA with certifications that STRs are complete with 

all known information at the time they are sent to VA. VA claims processors, 

following established VBA claims processing protocols, will not have to delay 

processing to request additional medical records when the service members’ 

claim is not substantiated in the record VA has received from DoD. This will 

reduce one source of additional claims from adding to the current backlog and 

reduce future processing time. Certification began in earnest in April 2013, and, 

with input from the Director of the Veterans Benefits Administration, we continue to refine this process. • DoD provided a team of subject matter experts to the Veterans Benefits Administration in January 2013 to review the disability claims backlog to analyze 

cases where DoD has information that can assist VA in processing claims. The 

team has been assisting VA with the most difficult cases. The team has recently 

shifted to assist with the oldest claims, those that have been in process for over 

one year. 

• Enhancing direct access to DoD electronic medical record data is extremely useful to VA in preparing claims for decisions. Enhanced access can increase VA 

production rates for any claims which are awaiting STR information – not just 

claims in the backlog, but at any stage in the process. We are fielding the Janus 

Joint Legacy Viewer, which will allow both DoD and VA to be able to access 

VACREP180 with DISTILLER

48 

and read the other Department’s electronic health records. The Joint Legacy 

Viewer is in operation now and will be fully deployed by December 2013. On 

July 1, 2013, a DoD Liaison cell comprised of senior military personnel with 

medical, administrative and personnel expertise was placed at VA to assist in 

the reduction and elimination of the backlog. This cell was requested by the 

Secretary of Veterans Affairs and agreed to by the Secretary of Defense to operate for six months. • DoD has provided VA with approximately 5,000 accounts giving direct access 

to the Defense Personnel Record Information System, which allows disability 

claims adjudicators access to Official Military Personnel Files. Additionally, VA 

also has been provided with access to 300 accounts giving direct access to the 

Defense Finance Accounting Service to validate pay and retirement information. 

This same pay and retirement information is also provided daily to the VA Data 

Information Repository system. • DoD also provided 15 Service members to the VA Seattle, WA, Disability Rating 

Activity Site, in support of an Integrated Disability Evaluation System (IDES) 

backlog in May 2013. These service members provide administrative assistance, 

which frees up disability benefits claims processors to speed up the overall 

IDES process. • DoD and VA convene an Information Sharing Summit (usually 80+ participants 

from all Services, Coast Guard, DoD and VA) every 6 to 8 weeks to further the 

electronic exchange of personnel, medical and administrative information between the two Departments. This summit has met 5 times since January 1, 

2013, to monitor process improvement events and major system developments 

to ensure alignment of all efforts in support of reducing the disability claims 

backlog and evolving this interchange to a truly paperless environment. 

The Department of Defense has also initiated the following actions to streamline 

processes for exchanging information, but these actions will assist with reducing the 

processing time for future claims, not claims in the current backlog: 

• In January 2013, DoD initiated the establishment of a Separation Health Assessment (SHA) for all service members who do not request a disability claim 

upon their separation from the military. This assessment will provide VA with 

the ability to better assess the basis for a service connection on future disability 

benefits claims. VA will continue to conduct the assessment for those service 

members who do make a disability benefits claim at the time of separation. DoD 

will make the required policy changes associated with this action by the end 

of fiscal year (FY) 2013. We have begun to implement the SHA at some locations and we plan to complete implementation by the end of FY 2014. 

• In January 2013, DoD committed to accelerate the deployment of the Health 

Artifact and Image Management Solution (HAIMS) in support of a move to a 

digital environment. Deployment is planned to be complete by December 2013. 

HAIMS will consolidate military and private sector treatment and medical images and artifacts and make them available for use by VA medical clinicians 

and VA disability claims processors, who will be provided with direct access. 

Once deployed, this will allow for electronic processing of information; lower 

storage, mailing requirements, and manual processing and facilities costs; and 

accelerate future claims processing. 

• DoD and VA will conduct a pilot, beginning in September 2013, whereby a 

version of the STR will be sent to VA in an electronic document format at the 

time a service member attends mandatory Transition Assistance Program in addition to the certified copy which is sent within 45 days from when the Service 

member separates from the military. This will give VA an archived version of 

the STR, which VA believes may reduce the time required to process a future 

disability claim by as much as 50 days. 

SERVICE MEMBER TRANSITION ASSISTANCE PROGRAM 

In compliance with the Veterans Opportunity to Work (VOW) to Hire Heroes Act 

of 2011 (Public Law 112–526), and in accordance with the recommendations of the 

Veterans Employment Initiative Task Force, the Department of Defense, Military 

Departments and our interagency partners are successfully implementing the redesigned Transition Assistance Program (TAP). The redesigned TAP, including a new 

curriculum called Transition GPS (Goals, Plans, Success), is aligned with the VOW 

Act, as codified in in Chapter 58, title 10 United States Code, which requires all 

eligible Service members discharged or released from active duty after serving their 

first 180 continuous days or more (including National Guard and Reserves) to participate in Pre-separation Counseling, Department of Veterans Affairs (VA) Benefits 

Briefings and the Department of Labor (DOL) Employment Workshop. While some 

VACREP180 with DISTILLER

49 

Service members may be exempted from attending the DOL Employment Workshop, 

as allowed by Congress, every Service member will attend Pre-separation Counseling and the revised VA Benefits Briefings. 

Additional components of the redesigned TAP include specialized tracks developed 

for Service members to tailor their transition program to correspond with their expressed interest in achieving their future employment goals through Higher Education, Career Technical Training, or Entrepreneurship. These specialized tracks are 

being piloted this summer and will be implemented across the Department of Defense by 1 October 2013. The cornerstone of the redesigned TAP is the concept of 

Career Readiness Standards. These standards correspond to deliverables that all 

Service members are to meet prior to separation. The value of the Career Readiness 

Standards is ensuring we equip our service members with the tools they need to 

become valued, productive and employed members of our labor workforce cannot be 

overstated. We are, and have been, fully engaged in implementing the redesigned 

program. 

BACKGROUND - INTEGRATED ELECTRONIC HEALTHCARE RECORDS 

(iEHR) 

In March 2009, President Obama directed the Department of Defense and the Department of Veterans Affairs to ‘‘work together to define and build a seamless system of integration with a simple goal: When a member of the Armed Forces separates from the military, he or she will no longer have to walk paperwork from a 

DoD duty station to a local VA health center; their electronic records will transition 

along with them and remain with them forever.’’ This directive built on the Congressional requirement established in the National Defense Authorization Act for Fiscal 

Year 2008 for the two Departments to ‘‘jointly develop and implement electronic 

health record systems or capabilities that allow for full interoperability of personal 

health care information between the Department of Defense and the Department of 

Veterans Affairs.’’ Our Service members, Veterans, retirees, and eligible family 

members deserve nothing less than the best possible care and service our two Departments can provide. Successfully achieving the goals articulated by Congress and 

the President is fundamental to delivering on our promise to them and we are fully 

committed to doing so. 

In March 2011, DoD and VA agreed on a joint approach to develop a single longitudinal health record to be used by both Departments: the ‘‘integrated electronic 

health record’’ or ‘‘iEHR.’’ This approach was intended to meld the Departments’ ongoing efforts to improve their health information technology: firstly, by achieving 

interoperability of health data, as sought by the President and the Congress; secondly, by modernizing their respective healthcare management systems, which were 

each in need of replacement or upgrade (i.e., replacing the DoD’s Armed Forces 

Health Longitudinal Technology Application (AHLTA) and replacing or upgrading 

the VA’s Veterans Health Information Systems and Technology Architecture 

(VistA)). Acting on this decision, the Departments re-chartered the DoD–VA Interagency Program Office (IPO) –established by Congress in the FY2008 NDAA to 

oversee joint data interoperability efforts – to accomplish this expanded mission. 

Together, the two Departments have made important steps toward achieving 

health data interoperability between DoD and VA and procuring the foundations of 

an underlying joint IT infrastructure. Specifically, we have: 

• Made the DoD Health Data Dictionary (HDD), the common data model used by 

all DoD medical treatment facilities, openly available to the nation and initiated 

VA data mapping to ensure integrated, common data for all patient information 

across DoD and VA; 

• Established the Development Test Center to provide a testing configuration that 

emulates the operational healthcare environment and infrastructure; 

• Selected a joint DoD–VA Single Sign On / Context Management (SSO / CM) solution. ‘‘Single Sign-On’’ enables a user to access multiple applications after logging in only once. ‘‘Context Management’’ allows clinicians to choose a patient 

once during an encounter and ensure all required applications are able to 

present information on the patient being treated. This capability was successfully deployed to the Development Test Center and is now being deployed at 

San Antonio; 

• Implemented a joint Graphical User Interface (GUI) pilot at North Chicago, Tripler, and San Antonio that displays information from both DoD and VA systems; 

• Completed business process mapping for initial clinical capabilities; 

• Developed integrated Program Level Requirements (iPLR), which detail the 

functional requirements for the program, e.g., laboratory, pharmacy, etc.; 

VACREP180 with DISTILLER

50 

• Developed and published the iEHR architecture and Technical Specifications 

Package that provide high-level technical and business requirements to enable 

a standardized and interoperable solution.; and 

• Begun work on a number of data interoperability ‘‘accelerators.’’ 

A SHIFT IN STRATEGY FOR iEHR 

In December of last year, Secretaries Panetta and Shinseki directed a joint review 

of the iEHR program to simplify and accelerate the achievement of data interoperability while reducing the cost and technical risk of what had proven to be a complex and expensive joint IT development program. This February, they agreed to 

specific actions for each Department; these agreements have since been reinforced 

by Secretary Hagel. While some may have interpreted this shift in strategy as backing away from our commitment to achieve an integrated electronic health record, 

that is not the case. 

For the remainder of this calendar year, the two Departments are focused on 

achieving full interoperability of health data through a series of near-term ‘‘Accelerator’’ efforts. These efforts will result in each Service member and Veteran having 

a single, seamless, shared, integrated healthcare record. All patients, and the clinicians serving them, will be able to access all of their health data, whether the patient is currently a military member or Veteran and treated at a DoD or VA hospital. This interoperability will be achieved without replacing the healthcare management software system for either Department. 

In 2012, DoD made its Health Data Dictionary data model openly available for 

use by VA and other interested parties including non-government healthcare providers. VA will map their data to this standard, thereby contributing to the establishment of an authoritative health data source for both Departments by January 

2014. This will fully realize the health element of the President’s vision for a Virtual 

Lifetime Electronic Record, incorporating all clinical care for Service members and 

Veterans into a common, computable and interoperable health record, accessible 

wherever care is provided. 

For the DoD, achieving data interoperability is also the path forward to exchanging health information with private healthcare providers. Today, 65 percent of all 

Service members’, dependents’ and beneficiaries’ healthcare is provided outside the 

military health network through private providers. Capturing this health information can only be accomplished through interoperability standards championed by the 

Department of Health and Human Services and being adopted by commercial health 

care providers. The use of open national standards to express the content and format of the information, not a single healthcare management software system, is the 

cornerstone of seamless exchange of health information. 

Secretaries Panetta and Shinseki also announced that the two Departments were 

revising their strategy for modernizing their legacy healthcare management software systems to use existing EHR technologies rather than bearing the cost and 

risk of designing, building and implementing an entirely new system. The two Departments agreed instead to use a ‘‘core’’ set of applications from existing EHR technology. Based on this core concept, VA determined that its best course of action 

would be to evolve its legacy system, VistA, to serve their modernization purposes. 

This decision left DoD with the need to determine whether modernization based on 

VA’s existing VistA system, DoD’s legacy AHLTA system, or one of the several commercially available modern healthcare management systems was the best course of 

action for DoD. 

DoD’S DECISION MAKING ON iEHR 

In testimony before the House Appropriations Committee and the Senate Armed 

Services Committee on April 16–17, 2013, Secretary Hagel committed to provide 

Congress his decision on the Department’s modernization strategy within thirty 

days. Under Secretary Kendall and Acting Under Secretary Wright commissioned 

a team of senior stakeholders and technical experts to review and assess the options 

and to recommend a course of action for modernization. After confirming that further evolving AHLTA, DoD’s legacy healthcare IT system, was not a viable alternative, the group focused on two alternative courses of actions: (1) pursue an evolution of VistA as the DoD ‘‘core’’ capability or (2) compete a modernization solution 

from a broader field of options. This team reviewed existing artifacts, studies and 

analyses and received briefings from the IPO and from VA/VHA leadership. 

The team concluded and recommended that the DoD and VA continue their ongoing near-term efforts to develop data federation, presentation and interoperability, 

particular through the completion of ongoing ‘‘accelerator’’ efforts. The team recommended that DoD select a core healthcare management system on a ‘‘best value’’ 

basis. 

VACREP180 with DISTILLER

51 

The DoD assessment characterized the alternatives based on estimates of life 

cycle cost, schedule, performance, risk and capacity for further modernization and 

growth. The assessment leveraged data from a formal Request for Information conducted by the OSD Cost Assessment and Program Evaluation (CAPE) organization. 

This market research identified a broad field of existing EHR capability providers, 

with exiting commercial products that spanned a range of maturity, capability, cost 

and implementation risk. The responses to the RFI included commercial offerings 

as well as vendors offering an evolved VISTA solution, as well as a VA proposal for 

an evolved VistA offering. 

The assessment concluded that a competition provided the best opportunity for 

the Department to identify the best value solution – one that offered advanced clinical capabilities, low adoption risk, the potential to evolve further as new innovation 

enters the EHR marketplace and the potential for significant cost savings. 

The Department recognizes that adopting and evolving VA’s current VistA software was a reasonable and sound business decision for VA. The Department of Veterans Affairs already employs a substantial workforce and infrastructure supporting 

the VistA system; VA caregivers are already trained on the system and its processes 

reflect the VA’s organization and business practices. Adopting VistA would require 

the Department to duplicate these ‘‘sunk cost’’ investments by the VA. While evolving and enhancing VistA was a logical business decision for VA, DoD faces a very 

different situation. 

The DoD study confirmed that the Department requires a healthcare software 

management solution that can operate in its unique medical environment, interfacing with VA and private sector providers using open national standards and providing operational medicine capabilities in a variety of environments, often with limited or no connectivity. The Department will also require the capability to easily add 

specialized modules to address DoD needs, such as battlefield casualty care, in a 

timely manner. Given the options available to DoD, the best course of action for 

DoD is to conduct a ‘‘best value’’ competition acquisition of a core healthcare management software system. 

THE DoD WAY AHEAD ON iEHR 

The study team reported its findings and recommendations to Secretary Hagel in 

May. This was formalized on May 21, 2013, with a memo to the Department outlining the way ahead for integrated Electronic Health Records, and reinforcing 

DoD’s commitment to providing high-quality healthcare for current Service members, their dependents and our nation’s Veterans. The Department informed the 

Congress of the Secretary’s decision on May 22, 2013. In his memo, the Secretary 

directed the USD(AT&L) to assume direct responsibility for DoD healthcare records 

related acquisition programs and to conduct a full and open competition for the core 

set of capabilities for DoD Healthcare Management System Modernization. 

USD(AT&L) was tasked to lead DoD coordination with VA on the technical and acquisition aspects of healthcare records and healthcare management systems. 

USD(AT&L)’s first step was to restructure the Department’s health care IT efforts. The former iEHR program is being refocused on two separate but related 

healthcare information technology efforts: the DoD Healthcare Management System 

Modernization (DHMSM) program, and the joint DoD/VA iEHR program. Both efforts will be conducted as highly tailored Major Automated Information System 

(MAIS) programs. USD(AT&L) will serve as the DoD Milestone Decision Authority 

(MDA) for both programs. 

The revised iEHR program will remain focused on the near term goal of delivering 

the tools and supporting data infrastructure to ensure integrated health data can 

move seamlessly between VA, DoD, and commercial healthcare providers with initial fielding targeted for early CY 2014. The IPO is taking the following steps to 

deliver seamless, shared integrated health information on an accelerated basis: 

• Developing and deploying a data management service to give DoD and VA clinicians access to integrated patient health record information by the beginning 

of CY 2014. 

• Accessing data through a single integrated view to nine high priority sites by 

the beginning of CY 2014. 

• Making standardized, integrated clinical record data broadly available to clinicians across the DoD and VA later in CY 2014. 

• Enhancing ‘‘Blue Button’’ functionality, which will give patients the ability to 

download and share their own electronic medical record information, enabling 

them take greater control of their own healthcare. 

The DoD Healthcare Management System Modernization program will focus on 

competitively acquiring a core set of capabilities to replace the DoD legacy Military 

VACREP180 with DISTILLER

52 

Health System (MHS) clinical software systems, including the Armed Forces Health 

Longitudinal Technology Application (AHLTA), Essentris, Composite Health Care 

System (CHCS), and Theater Medical Data Store (TMDS) systems. The objective is 

to field a modernized replacement for legacy systems by 2017. 

The USD(AT&L) has designated a Program Executive Officer (PEO) to oversee 

both iEHR, which will continue to be executed by the Integrated Program Office 

(IPO), and DHMSM. A Program Manager (PM) has also been designated for the 

DHMSM program. The PEO will ensure that DHMSM works in close collaboration 

with iEHR to ensure compatibility and interoperability with the standardized 

healthcare data framework, infrastructure, and exchange standards being made 

available via the iEHR program. 

The PM for DHMSM is initiating internal planning activities for release of a Request for Proposals (RFP) that supports an objective to achieve full fielding of core 

DHMSM capabilities. It is crucial to note that a seamlessly integrated and interoperable electronic health records with full data exchange and read/write capability 

can be achieved without DoD and VA operating a single healthcare management 

software system. Just as someone can send and receive the same e-mails from a 

range of different e-mail software clients, health record information can be made 

available to patients and physicians without every hospital in the nation moving to 

a single healthcare management software system. In fact, private sector experience 

shows using the same software does not guarantee information can be shared. By 

competitively selecting a core to replace its Legacy Systems, DoD will have an opportunity to evaluate a range of modern commercial alternatives in order to determine a best value approach. 

FY14 LEGISLATIVE IMPACTS FOR iEHR 

Current legislation passed by the House of Representatives addressing iEHR include Sections 713 and 726 of the National Defense Authorization Act (NDAA). The 

Department interprets Section 713 as requiring a report describing the Secretary’s 

basis for selecting the preferred alternative. With this interpretation, the Department has no objection to Section 713 since it allows the flexibility to implement the 

Secretary’s direction as outlined in his May 21, 2013, memo. Section 726, however, 

imposes extensive governance, design, schedule and reporting requirements and 

funding withholds that will impede the Department’s ability to compete a full range 

of commercial solutions and significantly increase schedule risk and cost. In particular, the requirement to execute a joint iEHR development program per the Joint 

Strategic Plan is counter to the Department’s competitive approach. Setting a deadline for deploying an integrated electronic health record could preclude a best-value 

solution. Overly restrictive criteria for meeting open architecture standards could 

also disqualify some effective, commercially developed solutions. The Department 

has similar concerns with the Military Construction, Veterans Affairs, and Related 

Agencies Appropriations Act which constrains VA funding for electronic health 

records. The proposed language, as written, constrains the VA funding to agreements established prior to the Secretaries new direction. The Department seeks to 

work with the Congress to streamline the multiple reporting mechanisms, conditions and oversight and advisory functions directed in Sections 713, 726, and the 

MILCON/VA Appropriations Act. 

CONCLUSION 

Chairman McKeon, Ranking Member Smith, Chairman Miller, Ranking Member 

Michaud, and members of these distinguished Committees, again, thank you for the 

opportunity to testify today. The Secretary of Defense has taken very seriously the 

needs and responsibilities of the Department of Defense to provide first-class 

healthcare to our Service members and their dependents, and to enable the seamless sharing of integrated healthcare records between the Departments of Defense 

and Veterans Affairs. The Department is committed to ensure that our Service 

members receive the best service we can provide while in uniform. As importantly, 

we also have the responsibility to ensure that this same quality of health care and 

service is carried through to the end of a Service members’ career when their status 

changes to civilian status as a Veteran. 

The Secretary remains committed to fully cooperating with the Department of 

Veterans Affairs to continue ongoing efforts to create a seamless electronic health 

record integrating VA and DoD data in the near-term. In addition, the Secretary 

believes a competitive acquisition to acquire a healthcare software modernization solution will achieve the best value for the Department’s Service members by evaluating all potential solutions and considering the costs and risks of the options that 

will be offered to the Department. 

VACREP180 with DISTILLER

53 

The Secretary and the Department greatly appreciate the Congress’ continued interest and efforts to help us deliver the healthcare that our nation’s Veterans, Service members, and their dependents deserve. Whether it is on the battlefield, at home 

with their families, or after they have faithfully concluded their military service, the 

Department of Defense and our colleagues at the Department of Veterans Affairs 

will continue to work closely together, in partnership with Congress, to deliver benefits and services to those who sacrifice so willingly for our Nation. 

We look forward to your questions. 

f 

Prepared Statement of Stephen W. Warren 

Chairman McKeon, Chairman Miller, Ranking Member Smith, Ranking Member 

Michaud, and Members of the Committees, we appreciate the opportunity to appear 

before you today to discuss the Department of Veterans Affairs’ efforts to reduce the 

backlog of disability compensation claims and to develop an Electronic Health 

Record (EHR) with the Department of Defense (DoD). 

Disability Compensation Claims Backlog 

Today, many Veterans wait too long to receive benefits they have earned and deserve. That has never been acceptable to the Secretary, or the dedicated employees 

of the Veterans Benefits Administration (VBA); over half are Veterans themselves. 

VA is implementing a robust plan to ensure we achieve our goal of eliminating the 

claims backlog and improving decision accuracy to 98 percent in 2015. 

Over the last 3 years, the claims backlog has grown from 180,000 at the end of 

fiscal year (FY) 2009, to approximately 530,000 claims as of June 19, 2013. To meet 

the goal of eliminating the backlog by 2015, we have set to transform VBA into a 

21st century organization. VBA’s transformation is demanded by a new era, emerging technologies, and the latest demographic realities 

As background, it is important to note that over 60 percent of the pending claims 

are ‘‘supplemental’’ claims from Veterans seeking to address worsening conditions 

or file for new conditions (‘‘issues’’). Seventy-seven percent of these Veterans are already receiving disability compensation and are eligible for VA health care. Additionally, as VA does not limit claims submissions, Veterans can continue to apply 

for additional service-connected disabilities while their claims are pending. 

There are several factors that have impacted on the volume of incoming claims. 

In 2009, based on all available scientific evidence and the Institute of Medicine’s 

Veterans and Agent Orange: Update 2008, VA made the decision to add three presumptive conditions (Parkinson’s disease, ischemic heart disease, and B-cell leukemias) for Veterans who served in the Republic of Vietnam or were otherwise exposed to the herbicide Agent Orange. 

Due to this policy change, the number of compensation and pension claims received increased from 1 million in 2009 to 1.3 million in 2011 (a 30 percent increase). In addition, beginning in October 2010, VBA identified these claims for special handling to ensure compliance with the provisions in the Nehmer court decision 

that requires VA to re-adjudicate claims for these three conditions that were previously denied. VBA dedicated over 2,300 claims staff to re-adjudicating these complex claims, which required time-consuming and detailed review. Nehmer claims for 

all live Veterans were completed as of April 2012 and Nehmer survivor claims were 

completed in October 2012. The claims staff previously focused on these Agent Orange claims are now working on reducing the backlog. As of June 19, 2013, VA has 

processed approximately 280,000 claims and awarded over $4.5 billion in retroactive 

benefits for the three new Agent Orange presumptive conditions to more than 

166,000 Veterans and survivors. Our focus on processing these complex claims contributed to a larger claims backlog, but it remains the right thing to do for our Vietnam Veterans, many of whom waited a long time for these benefits. In 2010, VA 

also made an important decision to simplify the process to file disability claims for 

combat Post-traumatic Stress Disorder. These decisions expanded access to benefits 

for hundreds of thousands of Veterans and brought significantly more claims into 

the system. 

There are several other factors that have resulted in the submission of more disability claims and contributed to the backlog. These include VA initiatives to increase access and externally driven demand to address unmet disability compensation needs such as: increased use of technology and social media by Veterans, families, and survivors to self-inform about available benefits and resources; improved 

access to benefits through the joint VA and DoD Pre-Discharge programs; and increased outreach programs to inform more Veterans of their earned benefits, which 

VACREP180 with DISTILLER

54 

can include compensation claims. The demand for disability compensation has also 

been impacted by: ten years of war with increased survival rates for our wounded; 

an aging population of previous era Veterans such as Vietnam and Korea, whose 

conditions are worsening; a difficult economy, and the growth in the complexity of 

claims decisions as of result of the increase in the average number of medical conditions for which each claimant files. 

The current composition of the inventory and backlog also includes claims from 

Veterans of all eras – from Veterans of the current conflicts to World War II Veterans who are just now filing a claim for the first time. The largest cohort of claims 

comes from our Vietnam-era Veterans who filed 448,000 claims in FY 2012, and 

made up 36 percent of the inventory and 37 percent of the backlog as of May 31, 

2013. Gulf War Era Veterans make up 23 percent of the total inventory and 22 percent of the backlog. Veterans of Iraq and Afghanistan conflicts make up 20 percent 

of the total inventory and 22 percent of the backlog. Veterans of the Korean War, 

World War II and all other eras make up less than 10 percent of both total inventory and backlog. The remainder of the inventory and backlog is from peacetime era 

Veterans. 

To meet the goal of eliminating the backlog, VBA is aggressively implementing 

its Transformation Plan, a series of tightly integrated people, process, and technology initiatives designed to achieve our goal of processing all claims within 125 

days with 98 percent accuracy in 2015. VBA is retraining, reorganizing, streamlining business processes, and building and implementing technology solutions 

based on the newly redesigned processes in order to improve benefits delivery. 

VBA is deploying technology solutions that improve access, drive automation, reduce variance, and enable faster and more efficient operations. VBA’s digital, 

paperless environment also enables greater exchange of information and increased 

transparency to Veterans, the workforce, and stakeholders. Our technology initiatives are designed to transform claims processing from the time the Servicemember 

first enrolls in the joint VA and DoD eBenefits system and submits an online application, to the issuance of the claims decision and receipt of compensation payments. 

VBA’s major technology initiative to reduce the backlog is the Veterans Benefit 

Management System (VBMS). VBMS is a powerful paperless, Web-based, and electronic claims processing solution complemented by improved business processes. It 

is assisting in eliminating the existing claims backlog and serves as the technology 

platform for quicker, more accurate claims processing. 

National deployment of VBMS began in 2012, with 18 regional offices (RO) operational by the end of calendar year (CY) 2012. As of June 10, 2013, all 56 ROs and 

our Appeals Management Center have fielded the first generation of VBMS 

paperless processing capabilities. All new incoming claims are being established and 

processed using the new system, which will gradually eliminate paper processing of 

claims. We estimate that with the development of additional automated 

functionality in the future generations of VBMS, it will help improve VBA’s production by at least 20 percent (in each of FYs 2014 and 2015) and accuracy by at least 

8 percent. 

There are over 12,400 users of VBMS to include Veterans Health Administration 

(VHA) staff and VSO representatives. VBMS has also successfully converted 133 

million documents to images, which is the main mechanism for transitioning from 

paper-based claim folders to the new electronic environment. Veterans enrolled in 

the VA/DoD portal, eBenefits, receive electronic notification of changes in status of 

their disability claims, including notification of the claims decision and any benefit 

payments due. 

In addition, through the Veterans Relationship Management (VRM) process VBA 

engages, empowers, and serves Veterans and other claimants with seamless, secure, 

and on-demand access to benefits and military service information. Veterans have 

access to benefits information through multiple VA sources or channels – on the 

phone, online, or through eBenefits. VRM provides multiple self-service options for 

Veterans and other stakeholders. 

Also, as part of VBA’s technology initiatives, the Veterans On-Line Application 

(VONAPP) Direct Connect (VDC) incorporates a complete redesign of the legacy Veterans On-line Application (VONAPP) system, leveraging the eBenefits portal. 

Claims filed through eBenefits use VDC to load information and data directly into 

the new VBMS application for paperless processing. Veterans can now file both 

original and supplemental compensation claims through VDC. 

Support from our partners and stakeholders is critical to better serving our Veterans, Servicemembers, and their families. VA’s claims transformation changes our 

interactions with employees, other Federal agencies, Veterans Service Organizations 

(VSO), and state and county service officers. 

VACREP180 with DISTILLER

55 

Fully Developed Claims (FDC) are critical to achieving VBA’s goals and provide 

a method for our VSOs, DoD, and State and county partners to assist in gathering 

the necessary evidence to decide a claim. An FDC is a claim submitted to VA with 

all the material required for VA to make a decision, along with the Veteran’s certification that nothing further will be provided. An FDC is critical to reducing ‘‘wait 

time’’ and ‘‘rework.’’ VBA currently receives 9.5 percent of claims in fully developed 

form. When a qualified FDC is received, VBA is able to discharge its evidence-gathering responsibilities under the Veterans Claims Assistance Act much more efficiently than in traditional claims. VA currently completes FDCs in about average 

time to complete all other claims. VBA’s target for FY 2013 is to receive 20 percent 

of claims in the fully developed format with the help of our DoD and VSO partners. 

In addition, collaborative efforts are ongoing with DoD to allow VA to receive complete service treatment records (STR) – and to receive them electronically for faster 

and more efficient claims processing. In December 2012, VBA reached agreement 

with DoD to require the military services to certify a Servicemember’s STRs as complete at the point of transfer to VA. The final medical treatment facility at each 

military service, including the National Guard and Reserve component, will certify 

the completeness of all STRs at the point of separation from military service. This 

will further increase the number of FDCs. This action has potential to cut as much 

as 60–90 days from the ‘‘awaiting evidence’’ portion of claims processing, and reduce 

the time needed to make a claim ‘‘ready for decision’’ from 133 days currently to 

73 days for departing Servicemembers. 

We are working with DoD to be able to view DoD electronic health records information, which will enable VBA to review any DoD records that VBA does not already possess in order to complete claims. We are also working with DoD on a capability to provide information in the Armed Forces Health Longitudinal Technology 

Application system (AHLTA) as a print-to-portable document format (PDF). A pilot 

of this capability will begin in September 2013 to provide VA electronic data (PDF) 

of information contained in AHLTA at the time a Service member separates from 

the military. DoD will deploy the Healthcare Artifact and Image Management Solution (HAIMS) to provide a mechanism for scanning and uploading paper documents 

to make them readily available to VA. Additionally, the technology could also be 

used to scan and upload paper medical record items received from private-sector 

providers. DoD has initiated an accelerated deployment schedule for HAIMS with 

a goal of stopping the flow of paper STRs to VA by December 2013. 

On April 19, 2013, VA announced a new initiative to expedite compensation 

claims decisions for Veterans who have waited 1 year or longer. VA claims raters 

are making provisional decisions on the oldest claims in inventory, which allows 

Veterans to begin collecting compensation benefits more quickly, if eligible. Veterans 

are able to submit additional evidence for consideration a full year after the provisional rating, before VA issues a final decision. Provisional decisions are based on 

all evidence provided to date by the Veteran or obtained on their behalf by VA. If 

a VA medical examination is needed to decide the claim, it is ordered and expedited. 

As a result of this initiative, more than 65,000 claims – or 97 percent of all claims 

over two years old in the inventory – have been eliminated from the backlog. VBA 

staff are now focusing their efforts on completing all disability claims of Veterans 

who have been waiting over one year for a decision. 

It is important to understand that as a result of this initiative, metrics used to 

track the timeliness of benefit claim decisions will fluctuate. The focus on processing 

the oldest claims will cause the overall measure of the average length of time to 

complete a claim to rise in the near term because of the number of old claims that 

are being completed. VA’s average time to complete claims will improve as the backlog of oldest claims is cleared and more of the incoming claims are processed electronically through VA’s new paperless processing system. In addition, the average 

days pending metric – or the average age of a claim in the inventory – will decrease, 

since the oldest claims will no longer be part of the inventory. 

The Department already prioritizes processing of some claims, including the 

claims of seriously injured and Servicemembers separating through IDES as well as 

those of Medal of Honor recipients, former prisoners of war, the homeless, terminally ill, and those experiencing extreme financial hardship. The Department also 

prioritizes FDCs. 

VA has made huge strides in its journey to improve technology and provide all 

generations of Veterans the best possible health care and benefits that they earned 

through their selfless service. VA is committed to continue that journey, especially 

as the numbers of Veterans using VA services increase in the coming years. 

VACREP180 with DISTILLER

56 

Electronic Health Records 

In April of 2009, President Obama directed the DoD and VA to, ‘‘work together 

to define and build a seamless system of integration with a simple goal: When a 

member of the Armed Forces separates from the military, he or she will no longer 

have to walk paperwork from a DoD duty station to a local VA health center; their 

electronic records will transition along with them and remain with them forever.’’ 

The mission of both Departments is to fundamentally and positively impact the 

health outcomes of active duty military, Veterans, and eligible beneficiaries. As a 

result, VA and DoD are committed to creating a seamless health record integrating 

VA and DoD data, while modernizing the software supporting VA and DoD clinicians in the most efficient and effective way possible. 

Today, DoD and VA are already exchanging a significant amount of electronic information and are taking aggressive actions in 2013 to further expand these efforts. 

But, most of the information shared today is not standardized to support use in electronic clinical decisions. As an example, different names for ‘‘blood glucose’’ in the 

DoD and VA systems make it impossible to integrate and track blood sugar levels 

for diabetics across the two systems. Once this data is mapped to standard codes 

it will be possible to chart and track blood sugar levels across DoD and VA records. 

A key priority for both Departments is to standardize electronic health record data 

and make it immediately available for clinicians so they have the information they 

need to make informed medical decisions for our patients. 

In December of 2012, when presented with the revised cost and schedule information, the Secretaries directed that the Interagency Program Office (IPO) Advisory 

Board Co-Chairs and the Health Executive Committee (HEC) Co-Chairs prepare 

and provide ‘‘quick win’’ recommendations to accelerate interoperability and recommend changes to the governance structure and budget impacts. As a result, the 

IPO Advisory Board Co-Chairs and HEC Co-Chairs provided a plan which the Secretaries approved that included: 

Program Strategy: Adjusted the March 2011 iEHR acquisition business rules from 

‘‘buy’’ commercially available solutions for joint use, ‘‘adopt’’ a Department-developed 

application if a modular commercial solution is not available and one Department 

has a solution, ‘‘create’’ a joint application on a case by case basis if neither a modular commercial or Department-developed solution are available, to ‘‘adopt, buy, create’’ to leverage existing capabilities for joint use. The Departments will also define 

a ‘‘core’’ set of iEHR capabilities that would allow us to evaluate the selection of existing EHR products to reduce program risks and costs while accelerating implementation. 

Quick Wins: On February 5, 2013 VA and DoD agreed to four accelerators. First, 

VA and DoD clinical health data will be made interoperable and available in near 

real-time using translation mechanisms such as the Health Data Dictionary and 

DoD’s adoption of Blue Button. This data interoperability work will be completed 

by January 2014. Second, we approved deployment of the presentation software 

called JANUS Graphical User Interface to five VA polytrauma rehabilitation centers 

and two associated Military Treatment Facilities. JANUS is the tool clinicians use 

to view VA and DoD health data simultaneously. Third, the Departments will create 

a VA–DoD Medical Community of Interest network and security infrastructure to 

enable the creation of a logical ‘‘single medical enclave’’ that meets both Departments’ security requirements, provides equal access to iEHR services by both Departments, leverages existing DoD and VA existing infrastructure, and provides 

connectivity between DoD and VA medical networks. Fourth, the Departments will 

rapidly adopt an identity management solution to establish consistent methods for 

identifying patients across the two organizations. 

Under this plan, VA has committed to deploying an iEHR ‘‘core’’ based on VistA 

while DoD committed to evaluating available alternatives in order to make a ‘‘core’’ 

technology selection that will best fit its needs. In order to achieve the desired data 

interoperability between both Departments, both ‘‘cores’’ will conform to an agreedupon set of standards that enable the secure and interoperable exchange of information. 

While the immediate focus is on accelerating data interoperability between the 

two Departments, the end goal remains the same – to make certain that VA and 

DoD are creating a seamless health record integrating VA and DoD data and modernizing the software supporting DoD and VA clinicians. As a result of a DoD review directed by Secretary Hagel to determine the best way forward for improvements in interoperability and EHR modernization, DoD has decided that they will 

use a competitive process in choosing their ‘‘core.’’ This will allow DoD to consider 

commercial alternatives that may offer them reduced cost, reduced schedule, and 

VACREP180 with DISTILLER

57 

technical risk and access to increased current capability and future growth in capability by leveraging ongoing advances in the commercial marketplace. 

In today’s world that means that VA and DoD don’t have to utilize the same EHR 

software. Health record data integration and exchange is possible regardless of the 

software systems. In fact, as private sector experience has shown, using the same 

system does not guarantee that information can be shared. The important thing is 

that both systems use national standards and a common language to express the 

content and format of the information they share. 

To achieve the goal, the Departments are taking the following steps that will deliver seamless, integrated health information on an accelerated basis: We are creating a Data Management Service that will give DoD and VA clinicians access to 

integrated patient health record information. The service will retrieve data from 

across DoD and VA for a given patient in seven critical clinical areas— medications, 

problems, allergies, lab results, vitals, immunizations, and note titles—representing 

the vast majority of patients’ clinical information. The data will be mapped to open 

national standards—the same as those being adopted by the private sector—making 

the data computable and supporting health information sharing not only across DoD 

and the VA, but also with private sector providers. The data will be available in 

near real-time, so clinicians can rely on it for urgent clinical decisions. The standardized, integrated data will fuel a variety of apps, tools and views supporting clinicians. 

The Data Management Service will be developed and deployed by the beginning 

of CY 2014. Nine high priority sites will have access to these data through a single 

integrated view. DoD and VA intend to make standardized, integrated clinical 

record data broadly available to clinicians across DoD and VA later in CY 2014. We 

are also enhancing ‘‘Blue Button’’ functionality, giving patients the ability to 

download and share their own electronic medical record information (in structured 

and coded format), helping them take control of their own health. 

Efforts to deliver the Data Management Service are currently funded through 

FY13 and are in the President’s FY14 budget submission. This work leverages previous health data interoperability efforts funded through the Joint DoD/VA Interagency Program Office (IPO). The IPO’s efforts to date to standardize data and provide the infrastructure to integrate and view electronic health information across 

the Departments are the foundation for the efforts to create a seamless health 

record by 2014. 

In the mid-term, both VA and DoD have identified the need to update their respective healthcare management systems, replacing or enhancing existing legacy 

systems to give clinicians and patients the best healthcare software support, including state-of-the-art clinical decision support and analytics, to provide our 

Servicemembers, their dependents and our Veterans with the best healthcare possible. VA with its large installed base, trained workforce and in-house development 

and support capacity has chosen to enhance its healthcare management system core 

capability based on an evolved VistA. This is a logical choice and a sound business 

decision for VA. But, the Departments will ensure that the acquisition of their respective healthcare management systems will deliver the capabilities needed to 

meet each Department’s clinical requirements, while delivering the best value to the 

American taxpayer. 

The Departments intend to jointly determine and then leverage open standards, 

open architecture, and open published application programming interfaces (API), 

while still ensuring accessibility for users with disabilities, that will provide a 

strong shared foundation for both healthcare management systems. The Departments will also use mature solution approaches and will apply acquisition best practices (to include maximum use of competition) to efficiently address clinical needs. 

Where appropriate, VA and DoD will jointly acquire capabilities. 

To meet its need for modernized software to support clinicians and Veterans VA 

chose the ‘‘core’’ technology of VistA to reduce the costs and risks associated with 

the selection and implementation of a different technology. Most importantly, while 

we are engaged in continuously improving VistA, it is still one of the best electronic 

health record systems available worldwide. Because the source code to VistA is 

available via Open Source, we know that we will be able to achieve competitive pricing for any changes we need to make. The basis of the decision to utilize an evolved 

VistA as the iEHR core include: VistA satisfactorily meets the majority of the core 

criteria; VistA has an enormous investment of clinical and business knowledge 

imbedded into the system; VistA is able to be progressively modernize the system 

module by module with less risk; and a thriving and growing Open Source community exists to engage in evolving VistA to meet future needs. 

Through the President’s leadership and the strong support of Congress, VA has 

made huge strides in providing all generations of Veterans the best possible health 

VACREP180 with DISTILLER

58 

care and benefits through improved technology. VA in concert with its DoD partners 

is committed to creating a seamless record and to modernizing its health record software, in order to realize the President’s vision of healthcare records that can be 

used across the range of national healthcare providers, including Defense, Veterans 

Affairs and commercial providers. This course of action will also ensure that we 

meet our commitment to providing our active duty military, Veterans, and beneficiaries with the healthcare they deserve now and in the future. 

VA and DoD are committed to our collaborations, and we continue to look for 

ways to improve our decision-making, achieve greater efficiencies, and accelerate the 

transition process for Servicemembers and Veterans. Thank you again for your support to our Servicemembers, Veterans, and their families and your interest in the 

ongoing collaboration and cooperation between our Departments. We appreciate the 

opportunity to appear before you today, and we are prepared to respond to any 

questions you may have. 

f 

Materials Submitted For The Record 

Letter To: Hon. Dan Beniskek, From: Eric Shinseki, (VA) 

THE SECRETARY OF VETERANS AFFAIRS 

WASHINGTON 

JANUARY 4, 2014 

The Honorable Dan Benishek 

U.S. House of Representatives 

Washington, DC 20515 

Dear Congressman Benishek: 

Thank you for your cosigned letter regarding the Department of Defense (DoD) 

Centers of Excellence (CoE) for Vision and Hearing, and the Department of Veterans Affairs (VA)/DoD Extremity Trauma and Amputation Center of Excellence. 

Congressionally-directed CoEs work collaboratively to address the needs of 

Servicemembers and Veterans. The three CoEs you write about each receive guidance and direction through a joi nt DoDNA CoE Oversight Board. The Board consists of members from each of the military services, DoD Health Affairs, VA, the 

Joint Staff, and the Uniformed Services University of Health Services. This Board 

helps to ensure that the missions and goals of the CoEs are well-defined and create 

value by achieving improvement in outcomes through clinical, educational, and research activities. 

For fiscal year (FY) 201O through 2014, VA allocated $6.9 million to the Vision 

CoE. For FY 2012 through 2014, VA allocated $1.65 million to the Extremity Trauma and Amputati on CoE, and $1.74 million to the Hearing CoE. VA funding requirements for FY 2015 through FY 2018 are currently under review and planning. 

VA has contributed 6.6 full-time equivalent employees (FTEE) for the Vision CoE; 

2.6 FTEE are currently filled, and four FTEE are in the hiring process. VA provides 

four FTEE for the Extremity Trauma and Amputation CoE, for which two positions 

are presently filled and individuals have been selected for the other two positions. 

VA staffing for the Hearing CoE is four FTEE for which one position is currently 

filled, and three FTEE are in the hiring process. 

The current governance agreements are Memorandums of Agreement (MOA) 

signed by the Acting Assistant Secretary of Defense (Health Affairs) and the VA 

Under Secretary for Health for the Vision CoE (signed October 2009), and for the 

Extremity Trauma and Amputation CoE (signed August 2010). 

There are 17,375 Servicemember records entered in the Defense and Veterans Eye 

Injury and Vision Registry as of August 28, 2013 . .Development of the joint military 

Hearing Loss and Auditory System Injury Registry by DoD is underway and should 

be completed in FY 2015. VA will provide data, in accordance with existing data 

sharing agreements between VA and DoD, to help populate this registry once it is 

completed by DoD. Although the Extremity Trauma and Amputation CoE does not 

have a requirement for a patient registry, this Center has used an online database 

to track all DoD amputee patients from Operation Enduring Freedom, Operation 

Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) since 2003. There have 

been a reported total of 1,626 amputee patients from the OEF/OIF/OND cohort 

VACREP180 with DISTILLER

59 

treated in all military treatment facilities. As of April 2013, a total of 1,265 OEF/ 

OIF/OND amputees have been provided some level of prosthetic services and health 

care by VA. Not all injuries to these patients were necessarily combat related; some 

are due to motor vehicle accidents, training accidents, and other causes. 

VA remains committed to partnering with DoD to provide comprehensive highquality care and services to Servicemembers, and to our Nation’s Veterans. If you 

have additional questions, please have a member of your staff contact Mr. Omara 

Boulware, Congressional Relations Officer, at (202) 461–6468 or by e-mail at 

Omara.Boulware@va.gov. A similar letter has been sent to the other cosigners of 

your letter. 

Thank you for your continued support of our mission. 

Sincerely, 

Eric K. Shinseki 

f 

Questions For The Record 

QFR submitted by Thornberry, Mac 

House Committee on Armed Services 

Question for: Honorable Frank Kendall 

1) Please describe the process that led to SECDEF’s electronic health 

record (EHR) procurement decision. What steps is DOD taking, both internally and jointly with VA, to improve oversight and management to support the effective implementation for this decision? 

The Secretary of Defense convened an internal Department of Defense (DoD) review following his April 2013 budget hearings to examine the current state of the 

iEHR program and identify a way ahead for future EHR development and deployment. Based on the results of this internal review, which included inputs from previous analyses performed by the Director, Cost Analysis and Program Evaluation, 

as well as an assessment of the current Department of Veterans Affairs (VA) internal information technology, the Secretary of Defense issued a memorandum on May 

21, 2013, reinforcing DoD’s commitment to working with VA to establish healthcare 

data interoperability and directing the Under Secretary of Defense for Acquisition, 

Technology, and Logistics (USD(AT&L)) to oversee a competitive acquisition to modernize DoD healthcare management systems. 

Following the issuance of the memorandum, USD(AT&L) restructured DoD’s 

health care information technology (IT) efforts to focus on both the DoD Healthcare 

Management System Modernization program and the joint DoD/VA iEHR program. 

By pursuing these efforts separately, the Interagency Program Office is able to focus 

near-term efforts to establish standards-based healthcare data interoperability between DoD and VA. Concurrently, DoD can pursue a competitive acquisition, consistent with sound acquisition business practices, to obtain the most capable clinical 

support system for our Service Members at the best value to American taxpayers. 

QFR submitted by Thornberry, Mac 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

2) Please describe the decision-making process the VA used to determine 

that maintaining the existing Veterans Health Information Systems and 

Technology Architecture, or VistA, was the best approach for your organization. 

See attachment 

QFR submitted by Langevin, James R. 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

3) I want to focus on the path through the DoD and VA system for our 

veterans suffering from neurological traumas, such as TBI and spinal cord 

VACREP180 with DISTILLER

60 

injury. Can you describe for us how their treatment and benefit trajectory 

varies from the baseline, and what supplemental assistance is available 

other than normal benefits for those no longer able to move around comfortably in their homes? 

Outcomes data collected in the VA Spinal Cord Injury/Disorders (SCI/D) and 

Polytrauma/Traumatic Brain Injury (TBI) Systems of Care show that Veterans with 

SCI/D and TBI that receive rehabilitation in VA medical centers meet or exceed external non-Veteran benchmarks in functioning, community participation, and satisfaction with life. These outcomes reflect the outstanding rehabilitative care, prosthetic services, benefits, and adaptive modifications to the home and automobile 

that help Veterans with these severe disabilities to overcome common obstacles to 

achieve personal independence, positive life adjustment, and opportunities in meaningful areas of life. VA provides a wide variety of mobility aids for eligible Veterans 

with functional limitations due to neurological traumas and other health conditions. 

Mobility aids, like all other prosthetic devices and sensory aids, are made available 

based on a treatment plan developed by health care providers to address the specific 

needs of the Veteran to optimize independent mobility and home and community accessibility, and assist with other activities of daily living. Mobility aids provided by 

VA range from simple items, such as transfer boards and canes, to complex devices 

and installations, such as wheeled mobility and overhead lift systems that can help 

maneuver Veterans with severe mobility limitations around the home. Mobility aids 

are often augmented by devices that support activities of daily living such as environmental controls for activating home mechanisms and appliances, adaptive bathroom equipment to support self-care, and alternative communication devices and 

adaptive computer access for persons with communication challenges. Supplemental 

adaptations and specialized devices are provided for Veterans with cognitive difficulties such as memory lapses due to TBI. The Veteran and caregivers receive comprehensive education and training from VA clinical providers to ensure the provided 

equipment is used effectively and safely. Additionally, VA has a robust Housing Adaptation program that serves to modify certain Veterans or Servicemembers residences to accommodate their disabilities. Such adaptations afford individuals with 

functional limitations the capability to live at home in a barrier-free environment. 

Disability compensation claims for neurological conditions such as TBI and spinal 

cord injury receive expedited processing for seriously injured and very seriously injured Veterans. A large portion of these claims are handled through the joint VA/ 

DoD Integrated Disability Evaluation System, resulting in disability compensation 

awards for separating Servicemembers at the time of discharge from military service. In addition to compensation, Servicemembers with a traumatic brain or spinal 

cord injury who meet certain criteria may be eligible for additional assistance for 

home adaptations and modifications, automobile allowances and adaptations, and 

statutorily-authorized special monthly compensation. 

QFR submitted by Langevin, James R. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

4) I want to focus on the path through the DoD and VA system for our 

veterans suffering from neurological traumas, such as TBI and spinal cord 

injury. Can you describe for us how their treatment and benefit trajectory 

varies from the baseline, and what supplemental assistance is available 

other than normal benefits for those no longer able to move around comfortably in their homes? 

Outcomes data collected in the VA Spinal Cord Injury/Disorders (SCI/D) and 

Polytrauma/Traumatic Brain Injury (TBI) Systems of Care show that Veterans with 

SCI/D and TBI that receive rehabilitation in VA medical centers meet or exceed external non-Veteran benchmarks in functioning, community participation, and satisfaction with life. These outcomes reflect the outstanding rehabilitative care, prosthetic services, benefits, and adaptive modifications to the home and automobile 

that help Veterans with these severe disabilities to overcome common obstacles to 

achieve personal independence, positive life adjustment, and opportunities in meaningful areas of life. VA provides a wide variety of mobility aids for eligible Veterans 

with functional limitations due to neurological traumas and other health conditions. 

Mobility aids, like all other prosthetic devices and sensory aids, are made available 

based on a treatment plan developed by health care providers to address the specific 

needs of the Veteran to optimize independent mobility and home and community accessibility, and assist with other activities of daily living. Mobility aids provided by 

VA range from simple items, such as transfer boards and canes, to complex devices 

VACREP180 with DISTILLER

61 

and installations, such as wheeled mobility and overhead lift systems that can help 

maneuver Veterans with severe mobility limitations around the home. Mobility aids 

are often augmented by devices that support activities of daily living such as environmental controls for activating home mechanisms and appliances, adaptive bathroom equipment to support self-care, and alternative communication devices and 

adaptive computer access for persons with communication challenges. Supplemental 

adaptations and specialized devices are provided for Veterans with cognitive difficulties such as memory lapses due to TBI. The Veteran and caregivers receive comprehensive education and training from VA clinical providers to ensure the provided 

equipment is used effectively and safely. Additionally, VA has a robust Housing Adaptation program that serves to modify certain Veterans or Servicemembers residences to accommodate their disabilities. Such adaptations afford individuals with 

functional limitations the capability to live at home in a barrier-free environment. 

Claims for neurological conditions such as TBI and spinal cord injury receive expedited processing for seriously injured and very seriously injured Veterans. A large 

portion of these claims are handled through the joint VA/DoD Integrated Disability 

Evaluation System, resulting in disability compensation awards for separating 

Servicemembers at the time of discharge from military service. In addition to compensation, Servicemembers with a traumatic brain or spinal cord injury who meet 

certain criteria may be eligible for additional assistance for home adaptations and 

modifications, automobile allowances and adaptations, and statutorily-authorized 

special monthly compensation. 

The Veterans Benefits Administration (VBA) and Veterans Health Administration 

are also working together to revise the sections of the VA rating schedule for disabilities pertaining to neurological conditions. As part of the upcoming revisions to 

the schedule, VBA is considering how best to address the issue of neurological traumas. 

QFR submitted by Langevin, James R. 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

5) In response to unmet needs that veterans organizations brought to my 

attention, I introduced the Veterans Homebuyer Accessibility Act last Congress to aid our injured servicemembers modify their homes to ensure they 

are accessible, and I plan to introduce it again this Congress. Has there 

been an examination of benefit shortfalls specific to neurological traumas, 

particularly with regard to adaptive modifications to homes? 

The Veterans Health Administration (VHA) has a number of housing adaptation 

programs that serve to adapt and/or modify a Veteran’s/Servicemember’s residence 

to accommodate their disability or disabilities. These programs are managed under 

the Home Improvements and Structural Alterations grant; or the Veterans Benefits 

Administration (VBA) under the Specially Adapted Housing (SAH), Special Housing 

Adaptation, Temporary Residence Adaptation; or Vocational Rehabilitation & Employment Independent Living program. 

Adaptations and/or modifications are individually determined based on the medical feasibility for the Veteran/Servicemember to reside in their home, continuation 

with medical treatment and rehabilitation, and capability to live independently in 

a barrier-free environment. VBA’s SAH program may assist with the purchase of 

a home to accommodate a Veteran’s/Servicemember’s disability or disabilities. VBA 

routinely reviews the program to ensure the program is meeting the needs of eligible Veterans. VBA also works closely with Veterans Service Organizations to incorporate their feedback. 

Veterans with neurological traumas such as traumatic brain injuries or spinal 

cord injuries may be eligible for SAH grants if they meet the statutorily defined 

medical eligibility criteria. Specifically, the SAH grant is available to Veterans and 

Servicemembers who are entitled to disability compensation for a service-connected, 

permanent and total disability due to: • Loss or loss of use of both lower extremities, 

such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; • Blindness in both eyes, plus loss or loss of use of one lower extremity; • 

Loss or loss of use of one lower extremity together with: 1) residuals of organic disease or injury, or 2) the loss or loss of use of one upper extremity, affecting balance 

and propulsion as to preclude locomotion without the aid of braces, crutches, cases, 

or a wheelchair; • Loss or loss of use of both upper extremities at or above the elbows; or • A severe burn injury. 

VACREP180 with DISTILLER

62 

Additionally, Public Law 112–154 authorized a temporary expansion of eligibility 

for a Veteran or Servicemember who served after September 11, 2001, and is entitled to compensation for permanent service-connected disability that was incurred 

on or after September 11, 2001, and that is due to the loss or loss of use of one 

or more lower extremities which so affects the functions of balance or propulsion as 

to preclude ambulating without the aid of braces, crutches, canes, or a wheelchair. 

This expansion is set to expire on September 30, 2014, and VA may not approve 

more than 30 applications for assistance in fiscal year 2014. 

QFR submitted by Langevin, James R. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

6) In response to unmet needs that veterans organizations brought to my 

attention, I introduced the Veterans Homebuyer Accessibility Act last Congress to aid our injured servicemembers modify their homes to ensure they 

are accessible, and I plan to introduce it again this Congress. Has there 

been an examination of benefit shortfalls specific to neurological traumas, 

particularly with regard to adaptive modifications to homes? 

The Veterans Benefits Administration’s Specially Adapted Housing (SAH) staff 

routinely review the program to ensure the program is meeting the needs of eligible 

Veterans. SAH staff also work closely with Veterans Service Organizations to incorporate their feedback. 

Veterans and Servicemembers with neurological traumas such as traumatic brain 

injuries or spinal cord injuries may be eligible for SAH grants if they meet the 

statutorily defined medical eligibility criteria. Specifically, the SAH grant is available to Veterans and Servicemembers who are entitled to disability compensation 

for a service-connected, permanent and total disability due to: • Loss or loss of use 

of both lower extremities, such as to preclude locomotion without the aid of braces, 

crutches, canes, or a wheelchair; • Blindness in both eyes, plus loss or loss of use 

of one lower extremity; • Loss or loss of use of one lower extremity together with: 

1) residuals of organic disease or injury, or 2) the loss or loss of use of one upper 

extremity, affecting balance or propulsion as to preclude locomotion without the aid 

of braces, crutches, cases, or a wheelchair; • Loss or loss of use of both upper extremities at or above the elbows; or • A severe burn injury. 

Additionally, Public Law 112–154 authorized a temporary expansion of eligibility 

for a Veteran or Servicemember who served after September 11, 2001, and is entitled to compensation for a permanent service-connected disability that was incurred 

on or after September 11, 2001, and that is due to the loss or loss of use of one 

or more lower extremities which so affects the functions of balance or propulsion as 

to preclude ambulating without the aid of braces, crutches, canes, or a wheelchair. 

This expansion is set to expire on September 30, 2014, and VA may not approve 

more than 30 applications for assistance in fiscal year 2014. 

QFR submitted by Coffman, Mike 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

7) What are VA unique requirements for the electronic health record that 

you don’t feel a commercial solution addresses and requires continued investment in a VA-specific solution? 

VA’s rich history and success with its internally-developed electronic health record 

(EHR) can be attributed to the outstanding collaboration that has, and continues 

to, exist between our clinical users and the software developers. VA clinicians play 

a pivotal role in defining and prioritizing the EHR enhancements that most directly 

impact delivery of care to the Veterans we are proud to serve. Our VA system intentionally and necessarily contains software specific to the eligibility of our unique patient population. For example, VA providers document in the EHR whether care is 

related to a Veteran’s service-connected condition and this information then determines whether the Veteran pays a co-pay for the visit and whether we send a bill 

to a third party insurance company. The EHR contains VA-specific determinations 

related to exposures such as ionizing radiation or Agent Orange and is currently 

being expanded to capture care for health conditions that may be related to time 

on the Camp Lejeune Base. VA’s EHR has also been modified over time to capture 

and continually improve treatment for military sexual trauma, posttraumatic stress 

VACREP180 with DISTILLER

63 

disorder, traumatic brain injury, amputations, and an evolving list of conditions that 

our Veteran population faces based on their military service. By having an internally-developed core, we are able to rapidly implement additional VA-specific 

changes when needed to meet internal or external demands and we are able to rapidly share treatment best practices in new and evolving areas in order to improve 

care for our Veterans. Such modifications would not be made quickly, if at all, by 

a commercial vendor. VA’s EHR is published in the open source and is used by 

many non-VA health facilities. Those non-VA facilities, in turn, enhance the software to meet industry-wide evolving health management needs and contribute those 

changes back to the open source community. By using an open Source EHR, VA is 

able to integrate enhancements made by others immediately without the significant 

planning and financial investments that would have to be made to have such enhancements made by a commercial vendor. 

Having core EHR functionality built and maintained by VA enables us to continue 

to rapidly expand our health data exchanges with private health care providers to 

expand the amount of health care data used in clinical decision-making. In an environment of rapidly evolving health IT solutions, having a VA-specific EHR core allows VA to integrate with best-of-breed components rather than purchasing a single, 

commercial EHR solution which may excel in some capabilities, but fall far short 

in others. VA feels strongly that a continued investment in a VA-specific EHR core 

with integration of appropriate open source and commercial products provides the 

best solution for our patients, our providers, and the taxpayers. VA is committed 

to developing an EHR record that can exploit the value of a service-based architecture (SOA). SOA will enable us to modify clinical decision support in near-real time, 

improve care coordination, and facilitate the integration of new software applications into our health information technology stack. 

QFR submitted by Maffei, Daniel B. 

House Committee on Armed Services 

Question for: Honorable Frank Kendall 

8) The DoD and VA are now working to implement a Service-Oriented Architectures (SoA) suite to achieve interoperability. Can you speak to the 

progress of this effort and why a SoA suite is the best solution for interoperability? What issues stand in the way for interoperability? 

An SOA can facilitate the delivery and use of healthcare data services by the Department of Defense (DoD) and the Department of Veterans Affairs (VA) by ‘‘transporting’’ messages between any DoD and VA electronic health record systems implemented in the future and the numerous information management systems used by 

private providers. Because of the complexities of medical record exchanges, such as 

mediating terminologies, simply transmitting messages is insufficient to provide 

interoperability between applications or even within the same application. To overcome these challenges, an SOA is envisioned to provide messaging services that ensure access for applications via standard protocols and support interoperability and 

data sharing. 

The SOA suite efforts completed to date include design, testing, engineering demonstration (proof of concept), security certification, and accreditation. Key milestones 

achieved include: 

• Award of an SOA suite acquisition contract in March 2012; • Establishment 

of commercial and Government development test environments to allow DoD 

and VA product developers and other approved users an opportunity to develop 

trial integrations with the SOA suite (the Government test site is in the PacificJoint Information Technology Center; the commercial test site is located in a 

contractor facility in Melbourne, Florida); and, • Implementation of the SOA 

suite at DoD sites in Hampton Roads and San Antonio. 

There are two challenges associated with achieving this level of interoperability. 

First, there is a technical challenge to ensure all Government and commercial capabilities adhere to the same data exchange standards required for interoperability. 

Second, the business process engineering efforts required of both parties must ensure the successful integration of standardized data. 

QFR submitted by Maffei, Daniel B. 

House Committee on Armed Services 

Question for: Honorable Frank Kendall 

VACREP180 with DISTILLER

64 

9) As DoD and VA continue to address health records interoperability, it 

would seem that a modular approach that allows the departments to 

choose and integrate the best of each electronic health records provider 

would be ideal - delivering the best product at the best price. Have your 

offices studied this approach? 

Yes, the Interagency Program Office has considered modular development, as 

highlighted in the February 2013 Request for Information. The Department of Defense will continue to consider the appropriate degree of system modularity and its 

inherent trade-offs in the forthcoming competitive source selection process. It is important to note that there are significant benefits to acquiring a more tightly coupled group of key capabilities that will have been developed and tested to be both 

secure and fully integrated. Conversely, increased modularity brings with it increased development and integration risks which may introduce patient safety risks 

in addition to measured costs that would be borne by the Government. 

QFR submitted by Scott, Austin 

House Committee on Armed Services 

Question for: Honorable Jonathan Woodson 

10) A recent GAO report sites that acceptance of TRICARE by civilian 

physicians has declined to an estimated 70% between 2008 and 2011. In 

some areas of the nation, TRICARE acceptance is under 50% for doctors accepting new TRICARE patients. 

There is also a disparity between Medicare and TRICARE reimbursement 

rates, and fourteen percent of civilian physicians in the GAO study said 

they do not take TRICARE because of the low reimbursement rates. 

What factors do you attribute to the declining acceptance of TRICARE? 

What factors account for the disparity between TRICARE and Medicare 

reimbursement rates? 

The number of TRICARE participating providers has actually risen slightly. In 

Fiscal Year 2012, the number of participating providers increased to a total of 

415,500 providers. This followed a similar increase in Fiscal Year 2011, when there 

were 399,200 participating providers. The total number of participating providers 

increased by 15% in areas near military bases and by 2% in areas not near military 

bases. 

About 90% of the 9.6 million Uniformed Services beneficiaries enjoy access to a 

contracted provider network near where they work or live. However, we remain concerned with access for our beneficiaries and have submitted a legislative proposal 

to require providers who participate with Medicare to also participate with 

TRICARE. By law, TRICARE is required to follow Medicare’s reimbursement fee 

schedule. Although we have not experienced any significant issues with contracting 

for sufficient numbers of providers to meet the health care needs of beneficiaries 

that live or work near our contracted networks (military bases or base closure sites), 

the intent of the legislative proposal is to improve access for our TRICARE Standard 

beneficiaries who live outside of the network areas. 

Our surveys indicate that, on average, only three to seven percent of a provider’s 

practice in the United States, particularly those practices not located near military 

installations, is dedicated to treating TRICARE beneficiaries. We believe survey results indicating that seven of ten physicians are accepting TRICARE patients, if 

they are accepting new patients at all, is actually a good news story considering the 

small percentage of TRICARE patients seen in any typical provider practice. Beneficiaries may easily find providers who have accepted TRICARE patients in the recent past by using the online TRICARE Provider Search Tool, maintained by 

TRICARE contractors, that lists non-network providers who have submitted one or 

more TRICARE claims during the previous 14 months. 

QFR submitted by Barber, Ron 

House Committee on Armed Services 

Question for: Honorable Jonathan Woodson 

11) Secretary Woodson, I wanted to ask a question about TRICARE and 

our beneficiaries in the Philippines. For years, the Department of Defense 

has said there has been a problem of fraud by providers to TRICARE Management Activity in that country. TMA has implemented a number of policies that has had the result of reducing access to care, yet failing to combat 

VACREP180 with DISTILLER

65 

fraud. At this time, TMA is six months into a new demonstration project, 

and a constituent of mine has kept me well informed on how it is proceeding. Mr. Secretary, I must say I am dismayed to report that the demonstration program has seen many flaws and I am quite concerned that 

beneficiaries are being limited to a number of providers, for example, one 

authorized hospital in a city larger than New York City. Many have seen 

their fees doubled or have had to pay up front for office visits. What is the 

Department’s response to this situation? Can you please provide me a detailed report on the implementation of TMA’s demonstration program since 

January 2013, how much fraud DoD has found in TMA’s work with Philippine providers, and how this new demonstration program is combating 

this fraud? Thank you for your timely consideration to these questions. 

(1) Providers have a choice to participate as approved providers, which may result 

in an insufficient mix of primary and specialty providers. The TRICARE Management Activity has approved specialty waivers in designated demonstration areas for 

beneficiaries to receive inpatient services at hospitals that are approved providers 

for outpatient services only. As of July 2013, there are 8 institutional providers and 

151 professional providers delivering health care in designated demonstration areas 

for Phase I. Beneficiaries can still seek care from certified providers, professional 

and institutional, outside designated demonstration areas. 

TRICARE reimburses health care costs based on the lesser of billed charges or 

the Philippine fee schedule located online at http://www.tricare.mil/CMAC/ 

ProcedurePricing/SearchResults.aspx. To participate in the TRICARE Department of 

Defense Philippine Demonstration Project, providers have agreed to bill at the lesser of the billed charges or the Philippine Foreign Fee Schedule. Approved providers 

have agreed to collect only the appropriate deductible and cost-shares from 

TRICARE Standard under the Demonstration Project. According to TRICARE policy, beneficiaries who use TRICARE Standard, whether they reside overseas or in 

the United States may be required to pay their deductible and cost-shares up front 

when receiving medical services. 

(2) In response to your request for a detailed report on the implementation of 

TMA’s demonstration program, we have enclosed a document outlining the Philippine Demonstration Project. 

(3) In 2008, the Department’s aggressive action resulted in seventeen individuals 

convicted of defrauding the TRICARE program of more than $100 million. The Department’s health care antifraud initiatives have resulted in a cost avoidance of approximately $255 million from 2006 through the end of Fiscal Year 2011. 

(4) To combat fraud under the Demonstration Project, the establishment of an approved provider network allows the TOP contractor to screen out providers under 

prepayment review because of the providers’ historical fraudulent claims activity before they become approved demonstration providers for TRICARE. Approved providers must comply with the on-site verification, certification, and credentialing requirements. The TOP contractor provides one-to-one education to approved providers to ensure the approved providers understand how to submit accurate claims. 

To date, there have been no identified fraudulent billing activities under the Demonstration Project. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

12) How many disability claims is the VA processing annually which were 

filed by sexual assault victims? Of those, what percentage is submitted by 

male victims? 

VA tracks ‘‘sexual assault’’ claims as posttraumatic stress disorder (PTSD) disability claims based on military sexual trauma (MST). The number of PTSD/MST 

claims processed varies. However, from August 2012 through July 2013, VA processed approximately 5,060 PTSD/MST claims. Male Veterans filed approximately 

1,480 (29 percent) of these claims. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

VACREP180 with DISTILLER

66 

13) How many disability claims is the VA processing annually which were 

filed by sexual assault victims? Of those, what percentage is submitted by 

male victims? 

VA tracks ‘‘sexual assault’’ claims as posttraumatic stress disorder (PTSD) disability claims based on military sexual trauma (MST). The number of PTSD/MST 

claims processed varies. However, from August 2012 through July 2013, VA processed approximately 5,060 PTSD/MST claims. Male Veterans filed approximately 

1,480 (29 percent) of these claims. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Honorable Frank Kendall 

14) We are hearing a lot about musculoskeletal injuries that come as a 

result of long term wear of body armor and/or other equipment. How many 

disability claims are you processing annually that involve musculoskeletal 

injuries incurred as a result of the wear of heavy body armor and/or equipment? What are some of the most common ailments cited by veterans? 

The Department of Defense (DoD) continues to look for ways to reduce the load 

weight carried by its troops. More specifically, the Army is leveraging new material 

construction and design approaches to reduce the weight of the Improved Outer Tactical Vest (IOTV) and Soldier Plate Carrier System (SPCS). The current Generation 

III IOTV, which weighs 31 pounds (lbs) (with plates) for a size medium, is four percent lighter than the previous IOTV variant. These same approaches are applied to 

the SPCS, which weighs 23 lbs (with plates) for a size medium, to reduce the weight 

by three percent. As newer weight saving technologies become available, DoD will 

incorporate them to lessen the burden on the troops. DoD defers to the Department 

of Veterans Affairs for specifics regarding disability claims processing and common 

ailments cited by veterans. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

15) We are hearing a lot about musculoskeletal injuries that come as a 

result of long term wear of body armor and/or other equipment. How many 

disability claims are you processing annually that involve musculoskeletal 

injuries incurred as a result of the wear of heavy body armor and/or equipment? What are some of the most common ailments cited by veterans? 

VA does not track musculoskeletal injuries that are caused specifically by the 

wearing of heavy body armor and/or equipment, only these injuries generally. For 

all Veterans, the most common ailments are: 1. Tinnitus, recurring; 2. Hearing loss; 

3. Post-traumatic stress disorder; 4. Scars, other; 5. Diabetes mellitus; 6. 

Lumbosacral or cervical strain; 7. Hypertensive vascular disease; 8. Limitation of 

the flexion of the leg; 9. Degenerative arthritis of the spine; and 10. Limited motion 

of the ankle. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

16) We are hearing a lot about musculoskeletal injuries that come as a 

result of long term wear of body armor and/or other equipment. How many 

disability claims are you processing annually that involve musculoskeletal 

injuries incurred as a result of the wear of heavy body armor and/or equipment? What are some of the most common ailments cited by veterans? 

VA does not track musculoskeletal injuries that are caused specifically by the 

wearing of heavy body armor and/or equipment, only these injuries generally. For 

all Veterans, the most common ailments are: 1. Tinnitus, recurring; 2. Hearing loss; 

3. Post-traumatic stress disorder; 4. Scars, other; 5. Diabetes mellitus; 6. 

Lumbosacral or cervical strain; 7. Hypertensive vascular disease; 8. Limitation of 

the flexion of the leg; 9. Degenerative arthritis of the spine; and 10. Limited motion 

of the ankle. 

VACREP180 with DISTILLER

67 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

17) Information technology is critical to helping tackle the backlog of disability claims. What percentage of veterans are currently able to retrieve 

their Official Military Personnel File through the eBenefits online portal? 

What is the timeline and strategy to make this an option for all veterans 

(going back to Vietnam, Korea, World War II)? 

The Official Military Personnel File (OMPF) records are maintained in each of the 

military service’s records management systems. Active duty Servicemembers and 

Veterans (including Reserve and National Guard members) who separated or retired 

from their respective branch of service on or after the dates specified below may access their OMPFs through the eBenefits online portal: • Army - Since October 1994, 

4.2 million OMPF records have been uploaded in its Interactive Personnel Electronic 

Records Management System. • Air Force - Since October 2004, 1.6 million OMPF 

records have been uploaded in its Automated Records Management System. • Navy 

- Since January 1995, 1.6 million OMPF records have been uploaded in its Electronic Military Personnel Record System. • Marine Corps - Since January 1999, 

nearly 900 thousand OMPF records have been uploaded in its Optical Digital Imaging-Records Management System. • Coast Guard – The Personnel Data Record 

(PDR), the Coast Guard’s equivalent to DoD’s OMPF, is unavailable electronically. 

The PDR is still maintained in paper format and is sent to National Personnel 

Records Center upon separation or retirement. 

As of July 22, 2013, 8.3 million OMPF records were available through the 

eBenefits online portal. VA does not have any information as to whether the Department of Defense plans on making this option available to all Veterans. If a Veteran’s 

OMPF is not available electronically through eBenefits due to his or her military 

service ending prior to the date when his or her service branch digitalized its OMPF 

records, the records are maintained in paper form at the National Archives and 

Records Administration’s National Personnel Records Center (NPRC) in St. Louis, 

Missouri. In these instances, eBenefits provides the Veteran with links to the request form (SF 180) and to the NPRC Web site. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

18) Information technology is critical to helping tackle the backlog of disability claims. What percentage of veterans are currently able to retrieve 

their Official Military Personnel File through the eBenefits online portal? 

What is the timeline and strategy to make this an option for all veterans 

(going back to Vietnam, Korea, World War II)? 

The Official Military Personnel File (OMPF) records are maintained in each of the 

military service’s records management systems. Active duty Servicemembers and 

Veterans (including Reserve and National Guardsmen) who separated or retired 

from their respective branch of service on or after the dates specified below may access their OMPFs through the eBenefits online portal: • Army - Since October 1994, 

4.2 million OMPF records have been uploaded in its Interactive Personnel Electronic 

Records Management System. • Air Force - Since October 2004, 1.6 million OMPF 

records have been uploaded in its Automated Records Management System. • Navy 

- Since January 1995, 1.6 million OMPF records have been uploaded in its Electronic Military Personnel Record System. • Marine Corps - Since January 1999, 

nearly 900 thousand OMPF records have been uploaded in its Optical Digital Imaging-Records Management System. • Coast Guard – The Personnel Data Record 

(PDR) is unavailable electronically. The PDR (Coast Guard’s equivalent to DoD’s 

OMPF) is still maintained in paper format which is sent to National Personnel 

Records Center upon separation or retirement. 

As of July 22, 2013, 8.3 million OMPF records were available through the 

eBenefits online portal. VA does not have any information as to whether the Department of Defense plans on making this option available to all Veterans. If a Veteran’s 

OMPF is not available electronically through eBenefits due to his or her military 

service ending prior to the date when his or her service branch digitalized its OMPF 

records, the records are maintained in paper form at the National Archives and 

Records Administration’s National Personnel Records Center (NPRC) in St. Louis, 

VACREP180 with DISTILLER

68 

Missouri. In these instances, eBenefits provides the Veteran with links to the request form (SF 180) and to the NPRC Web site. 

QFR submitted by Tsongas, Niki 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

19) Information technology is critical to helping tackle the backlog of disability claims. What percentage of veterans are currently able to retrieve 

their Official Military Personnel File through the eBenefits online portal? 

What is the timeline and strategy to make this an option for all veterans 

(going back to Vietnam, Korea, World War II)? 

The Official Military Personnel File (OMPF) records are maintained in each of the 

military service’s records management systems. Active duty Servicemembers and 

Veterans (including Reserve and National Guardsmen) who separated or retired 

from their respective branch of service on or after the dates specified below may access their OMPFs through the eBenefits online portal: • Army - Since October 1994, 

4.2 million OMPF records have been uploaded in its Interactive Personnel Electronic 

Records Management System. • Air Force - Since October 2004, 1.6 million OMPF 

records have been uploaded in its Automated Records Management System. • Navy 

- Since January 1995, 1.6 million OMPF records have been uploaded in its Electronic Military Personnel Record System. • Marine Corps - Since January 1999, 

nearly 900 thousand OMPF records have been uploaded in its Optical Digital Imaging-Records Management System. • Coast Guard – The Personnel Data Record 

(PDR) is unavailable electronically. The PDR (Coast Guard’s equivalent to DoD’s 

OMPF) is still maintained in paper format which is sent to National Personnel 

Records Center upon separation or retirement. 

As of July 22, 2013, 8.3 million OMPF records were available through the 

eBenefits online portal. VA does not have any information as to whether the Department of Defense plans on making this option available to all Veterans. If a Veteran’s 

OMPF is not available electronically through eBenefits due to his or her military 

service ending prior to the date when his or her service branch digitalized its OMPF 

records, the records are maintained in paper form at the National Archives and 

Records Administration’s National Personnel Records Center (NPRC) in St. Louis, 

Missouri. In these instances, eBenefits provides the Veteran with links to the request form (SF 180) and to the NPRC Web site. 

QFR submitted by Kilmer, Derek 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

20) Please outline the difficulties in replacing staff in field offices. I have 

been told it takes as many as nine months. Specifically: a. How long does 

it take to replace a staff member? Are there any particular obstacles that 

make it more difficult to staff field offices? b. During that length of time, 

what happens to the caseload and the referrals that the vacant field staff 

position would normally work on? 

A) According to the Office of Personnel Management, a position should be filled 

within 80 days of being announced. The Veterans Benefits Administration is in-line 

with this guidance and typically fills positions at regional offices within 2–3 months 

of being announced. A number of factors may impact the time required to fill these 

positions. For example, bargaining unit positions must be posted for a specific 

length of time. Also, labor markets greatly vary from one geographic location to the 

next. Regional offices in large cities may face challenges recruiting and retaining 

qualified employees based on a higher cost of living. Regional offices in rural areas 

may be an employer of choice but have fewer applicants with necessary skill sets. 

B) During periods of time when field positions are vacant, the caseloads are redistributed to other employees who continue to work on them until new staff are hired 

and fully trained. Management takes necessary steps to adjust workload and help 

staff keep up with increased demands. 

VACREP180 with DISTILLER

69 

QFR submitted by Kilmer, Derek 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

21) I have heard from a number of stakeholders concern over how HUD– 

VASH vouchers are allocated and the data that both HUD and the VA use 

to make these determinations. In order to help promote better understanding of how decisions are made, please explain: a. how the VA uses 

state point-in-time data to determine number of homeless veterans who 

need vouchers, b. the method used by the VA to allocate this data to regions, and c. how the regions are ranked within the VA to determine need. 

The Department of Housing and Urban Development – Veterans Affairs Supportive Housing (HUD–VASH) program is an interagency effort to end Veteran 

homelessness, where HUD provides Section 8 Housing Choice Vouchers and VA provides wrap around case management and supportive services to promote Veteran 

participants’ sustainment in permanent housing. Although the HUD–VASH program has been a notable success in the Administration’s efforts to end Veteran 

homelessness, HUD–VASH vouchers are a finite resource that must be allocated in 

areas where the most need is identified, and these vouchers must be targeted to the 

most vulnerable and chronically homeless Veterans. VA and HUD work collaboratively to fairly and objectively determine the location of HUD–VASH vouchers 

based on the best data presently available to HUD and VA. 

A) It is clear that in order to end Veteran homelessness, the finite and limited 

number of HUD–VASH vouchers must be targeted towards those Veterans who are 

chronically homeless and/or especially vulnerable. Thus, to determine the location 

of fiscal year (FY) 2013 HUD–VASH vouchers, HUD and VA formulated data methodology to target these valuable HUD–VASH resources towards the chronically 

homeless and/or especially vulnerable homeless Veteran population. HUD uses a 

formula to assess relative need for HUD–VASH vouchers throughout the United 

States. HUD runs the point-in-time (PIT) data, VA data related to contacts with 

homeless Veterans, and PHA and VAMC performance data through the formula to 

determine the proportional allocation of relative need for each HUD continuum of 

care (CoC). Because HUD distributes HUD–VASH vouchers through local Public 

Housing Authorities (PHA), it is critical that the proportionate allocation of relative 

need is determined for each CoC. To better target chronically homeless and vulnerable homeless Veterans, the FY 2013 allocation of the HUD–VASH vouchers had 

greater weight applied to the local PIT number of unsheltered homeless Veterans 

and the percent of chronically homeless Veterans served in the VA medical centers 

(VAMC). 

B)HUD and VA use applicable data resources to determine the proportional allocation of relative need by each CoC. The CoCs are then matched with VAMC and 

Community-Based Outpatient Clinics (CBOC) that serve Veterans in the CoCs’ geographic area. It is through this matching process that HUD determines that a CoC 

within a particular VAMC or CBOC catchment area should be allocated HUD– 

VASH vouchers. Once the CoC allocations are determined, HUD begins the process 

of identifying PHAs that cover each CoC location to be invited to participate in the 

HUD–VASH program by administering the voucher allocations 

C)During the collaborative allocation process, VA and HUD do not rank regions 

to determine need. VA and HUD process data to determine the locations with the 

highest relative need. Vouchers are allocated proportionally through the data formula that HUD and VA use. This allows locations with the highest relative need 

to get a proportionally higher number of HUD–VASH vouchers than a location with 

fewer chronically homeless Veterans and less relative need. 

QFR submitted by Wittman, Robert J. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

22) Is a recently discharged, combat wounded, amputee prioritized or 

triaged in a way that his/her claim is reviewed and processed before, for 

example, a 45 year old vet discharged 20 years ago claiming a service connected disability for knee pain? 

Servicemembers who are separated due to wounds, injuries, or illness are evaluated in the Integrated Disability Evaluation System (IDES). This system started in 

2007 when DoD and VA collaborated to design a more seamless transition for 

VACREP180 with DISTILLER

70 

Servicemembers who could no longer continue their military careers for medical reasons. Claims for VA benefits from Servicemembers enrolled in IDES are adjudicated 

by staff solely dedicated to this mission. For Servicemembers enrolled in IDES and 

identified as seriously injured or very seriously injured, VA prioritizes their claims 

at all stages of processing to ensure benefits decisions are issued as quickly as possible. 

QFR submitted by Wittman, Robert J. 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

23) Is there an administrative triage process in place to service our combat wounded or members seriously injured in training accident claims 

first? 

Servicemembers who are separated due to wounds, injuries, or illness are evaluated in the Integrated Disability Evaluation System (IDES). This system started in 

2007 when DoD and VA collaborated to design a more seamless transition for 

Servicemembers who could no longer continue their military careers for medical reasons. Claims for VA benefits from Servicemembers enrolled in IDES are adjudicated 

by staff solely dedicated to this mission. For Servicemembers enrolled in IDES and 

identified as seriously injured or very seriously injured, VA prioritizes their claims 

at all stages of processing to ensure benefits decisions are issued as quickly as possible. 

QFR submitted by Wittman, Robert J. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

24) Are you looking at sleep apnea as a disability, which may be treated 

with a CPAP machine and yet still rates a 50% disability? 

: The rating criteria for sleep apnea were published in the Federal Register as 

a Final Rule on September 5, 1996, and have remained unchanged since that time. 

However, significant medical advances regarding the diagnosis, classification, and 

management of this disability have occurred since the initial introduction of the diagnostic code. VA has established a Respiratory Workgroup for the purpose of evaluating all diagnostic codes and rating criteria in the Respiratory System under the 

Schedule for Rating Disabilities (38 Code of Federal Regulations, Part 4), to include 

sleep apnea. The references relied upon by the Respiratory Workgroup for proposed 

revisions to the rating schedule criteria comprise a reflection of the current medical 

standards for the diagnosis, measurement of severity, and response to treatment of 

sleep apnea. 

QFR submitted by Wittman, Robert J. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

25) Would you please expand on what a ‘‘buddy statement’’ is and the 

process for validating this type of statement? 

A ‘‘buddy statement’’ is lay testimony from any person who knows facts relevant 

to a claimant’s claim. They most often relate to a sickness, disease, injury, or event 

in service which may support a Veteran’s claim for service-connected disability compensation benefits. A ‘‘buddy statement’’ can serve as a secondary or alternative 

source of evidence to corroborate certain elements of a Veteran’s claim when considered in light of all available evidence, such as corroborating an in-service stressor, 

establishing proof of service in the Republic of Vietnam, supporting involvement in 

combat, or establishing that service treatment records (STR) have been destroyed. 

Most often they are submitted by, but not restricted to, fellow Servicemembers who 

can corroborate the Veteran’s claim. Under VA regulations, a lay person is competent to testify to issues that do not require specialized education, training, or experience, so long as the person providing the testimony has knowledge of the facts 

or circumstances of the matter at hand and the matter can be observed and described by a lay person. While each statement is evaluated on a case-by-case basis 

in accordance with individual facts, ‘‘buddy statements’’ in general are accepted if 

VACREP180 with DISTILLER

71 

the statement is consistent with the times, places, and circumstances of the service 

of both the Veteran and the ‘‘buddy.’’ If the evidence available calls into question 

the qualifications of the ‘‘buddy’’ to make such a statement, the ‘‘buddy’’ is asked 

to submit his or her DD Form 214, or other evidence of service with the claimant. 

QFR submitted by Wittman, Robert J. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

26) You indicated your willingness to work with pro-bono law clinics 

such as the Lewis B. Puller, Jr. Veterans Benefit Clinic at William and 

Mary’s Law School. At this point pro-bono law clinics are able to help veterans compile their claims and could significantly assist the VA’s efforts to 

process claims. Are you willing, with appropriate privacy release forms, to 

have regional offices interact with pro-bono law clinics regarding specific 

cases both for initial claims and for appeal claims to help work through 

specific details on claims as they are being processed through the system? 

What are your thoughts on developing a pilot program to work on a Fully 

Developed Claims type program for appeal cases? Have you considered 

working to establish Centers of Excellence to disseminate information and 

training on how pro-bono clinics might best work with the VA to support 

out nation’s veterans? 

VA appreciates the assistance of organizations like William and Mary’s Puller 

Veterans Benefits Law Clinic in helping Veterans complete their claims. This assistance also helps reduce the claims backlog. Although our primary focus is currently 

on eliminating the backlog, we are also actively seeking ways to expedite the appeals process. We are evaluating several proposals submitted by the Puller Clinic, 

which include establishing a Center of Excellence as well as developing an integrated training program that could be used as a model for improving collaboration 

between VA and law school clinics. Although VA shares your interest in having law 

schools serve Veterans nationwide, we are also mindful of constraints to entering 

a formal partnership with a private entity. As such, we are carefully considering the 

various options available. In the meantime, we have established a Community of 

Practice, which is a partnership between VA and organizations that commit to submitting claims as Fully Developed Claims (FDC). On August 22, 2013, the Puller 

Clinic was welcomed to the FDC Community of Practice. The Puller Clinic joins The 

American Legion and Disabled American Veterans, both Veterans Service Organizations who are charter members of the community. 

IFR submitted by Forbes, J. Randy 

House Committee on Armed Services 

Question for: Ms. Jessica Wright 

1) Page 47 Line 1116 

The Department of Defense and the Department (DoD) of Veterans Affairs (VA) 

agreed on 22 February 2013 to certify that Service Treatment Records (STR) are 

complete with all known medical record information at the time they are transferred 

to VA, within 45 days of Service member’s separation from the military. VA previously measured DoD compliance based on the percentage of Complete STRs— 

those containing both medical and dental components—that also contained a Certification Letter. Between April and June 2013, DoD improved from 26% the first week 

the metric was tracked, to over 99%. 

The VA introduced a new metric on 24 June 2013. DoD and VA agreed to use 

a more stringent metric for certifying STRs and have developed the new DD Form 

2963 to attach to all STRs sent to VA from DoD. This will verify that the STR is 

complete, and will ensure that VA has all proper documents to process STRs. This 

new metric is effective as of 1 August 2013 and it is our intent to be 100% by 1 

Nov 2013. 

IFR submitted by Conaway, K. Michael 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

2) page 64 line 1522 

VACREP180 with DISTILLER

72 

VA Performance Rating FY2012 Total On Board at VA GS Employees Rated Outstanding 89,456 204,142 SES Employees Rated Outstanding 111 459 

IFR submitted by Conaway, K. Michael 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

3) Page 64 Line 1531 

VA Performance Rating FY2012 Total On Board at VA GS Employees Rated Outstanding 89,456 204,142 SES Employees Rated Outstanding 111 459 

IFR submitted by Wenstrup, Brad R. 

House Committee on Armed Services 

Question for: Honorable Jonathan Woodson 

4) Page 73 Line 1754 

A narrated, close captioned online demonstration of the Joint Legacy Viewer 

(JLV) can be viewed at the following link: http://www.pacifichui.org/hui/ext/JLV— 

Demo/JLV—demo.html JLV provides an integrated, read-only view of health data 

from DoD and VA sources in a common viewer. 

An important stepping stone toward modernizing our VA and DoD health information systems, JLV supports care of our Wounded Warriors and Veterans by improving access to electronic patient records and reducing the need to transfer information by fax, mail or CD. 

The JLV will be accessible to DoD and VA clinicians at nine sites using their DoD 

or VA credentials by the end of this month. 

IFR submitted by Duckworth, Tammy 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

5) Page 93 Line 2246 

As Mr. Frank Kendall stated in testimony, VA and DoD seek help on this issue 

in the following ways: ‘‘If I may, Mr. Chairman, what I would ask from you is that 

you not over-constrain us. So I am very concerned, as I mentioned in my opening 

statement, about some of the language in various bills right now... For example, 

tying us to a strategic plan that was written last fall, which is very much overcome 

by events now, is not particularly helpful ... It was only submitted to Congress relatively recently, but that plan does not really reflect some very fundamental 

changes that have been made since it was initially written. So there are things like 

that ... tie our hands. There are also a lot of reporting requirements. We have no 

problem with keeping the committees informed. We are happy to do that. The withholds that are in some of the language ... are becoming increasingly problematic for 

us. And particularly, right now for VA, that is a concern we have that is somewhat 

imminent. So [we are] very happy to work with the committees, very happy to work 

with the members and their staffs, and to be very transparent about what we are 

doing, but we ask that, in return, you relieve some of the constraints that you have 

in mind right now and allow us to take the best path forward and give us the opportunity to explain that to you.’’ 

IFR submitted by Gibson, Christopher P. 

House Committee on Armed Services 

Question for: Honorable Frank Kendall 

6) Page 96 Line 2318 

No Answer 

IFR submitted by Johnson, Henry C. ‘‘Hank’’ 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

7) Page 98 Line 2373 

VACREP180 with DISTILLER

73 

Please see attached list of SES and SES–Equivalent FY 2012 Performance 

Awards for the Department of Veterans Affairs. (Attachment B). 

IFR submitted by Johnson, Henry C. ‘‘Hank’’ 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

8) Page 98 Line 2381 

Please see attached list of SES and SES–Equivalent FY 2012 Performance 

Awards for the Department of Veterans Affairs. (Attachment B). 

IFR submitted by Wittman, Robert J. 

House Committee on Armed Services 

Question for: Mr. Stephen Warren 

10) Page 99 Line 2413 

The timeline outlined in the hearing transcript only applies to service treatment 

record (STR) requests for Veterans currently serving in the National Guard and Reserves. National Guard and Reserve STRs are maintained at the unit level, and the 

60/30-day timeframe was established to allow unit record custodians adequate time 

to gather records and appropriately reply to requests. VA’s duty to assist claimants, 

an obligation created by 38 U.S.C. § 5103A, requires VA to undertake certain efforts 

to obtain Federal records as outlined in paragraph (c)(2): 

Whenever the Secretary attempts to obtain records from a Federal department or 

agency under this subsection, the efforts to obtain those records shall continue until 

the records are obtained unless it is reasonably certain that such records do not 

exist or that further efforts to obtain those records would be futile. 

To obtain National Guard and Reserve STRs VA takes the following steps: 1. The 

VA regional office mails a letter to the Veteran’s assigned National Guard State Adjutant General’s Office or Reserve Unit requesting the military records necessary to 

process the claim. An internal 60-day suspense is set in VA claim processing 

records. 2. If no response is received after 60 days, VA phones the National Guard 

or Reserve Unit to request the records again, and the call is documented in VA systems. An internal 30-day suspense is set in VA claim processing records. 3. If no 

response is received, or if the response is not legally adequate, VA phones the Veteran and asks him/her to contact the National Guard or Reserve Unit to request 

that the unit send the records to VA for processing. An internal 30-day suspense 

is set in VA claim processing records. 4. To satisfy VA’s duty-to-assist obligations, 

VA must continue to request records from all Federal agencies until the records or 

a negative response from the Federal record custodian is received. VA conducts follow-up requests to the National Guard, Reserve Unit, and Veteran every 30 days 

until the duty-to-assist obligation is satisfied. 

As service department records are being digitized, VA can build and update systems and revise its procedures to take advantage of digital-to-digital transfer capabilities. While VA continues to rely on paper service records (the only records available in many cases), current procedures must be continued. 

IFR submitted by Langevin, James R. 

House Committee on Armed Services 

Question for: Honorable Robert Petzel 

11) Page 102 Line 2483 

Outcomes data collected in the VA Spinal Cord Injury/Disorders (SCI/D) and 

Polytrauma/Traumatic Brain Injury (TBI) Systems of Care show that Veterans with 

SCI/D and TBI that receive rehabilitation in VA medical centers meet or exceed external non-Veteran benchmarks in functioning, community participation, and satisfaction with life. These outcomes reflect the outstanding rehabilitative care, prosthetic services, benefits, and adaptive modifications to the home and automobile 

that help Veterans with these severe disabilities to overcome common obstacles to 

achieve personal independence, positive life adjustment, and opportunities in meaningful areas of life. VA provides a wide variety of mobility aids for Veterans with 

functional limitations due to neurological traumas and other health conditions. Mobility aids, like all other prosthetic devices and sensory aids, are made available 

based on a treatment plan developed by health care providers to address the specific 

VACREP180 with DISTILLER

74 

needs of the Veteran to optimize independent mobility and home and community accessibility, and assist with other activities of daily living. Mobility aids provided by 

VA range from simple items, such as transfer boards and canes, to complex devices 

and installations, such as wheeled mobility and overhead lift systems that can help 

maneuver Veterans with severe mobility limitations around the home. Mobility aids 

are often augmented by devices that support activities of daily living such as environmental controls for activating home mechanisms and appliances, adaptive bathroom equipment to support self-care, and alternative communication devices and 

adaptive computer access for persons with communication challenges. Supplemental 

adaptations and specialized devices are provided for Veterans with cognitive difficulties such as memory lapses due to TBI. The Veteran and caregivers receive comprehensive education and training from VA clinical providers to ensure the provided 

equipment is used effectively and safely. 

Additionally, VA has a robust Housing Adaptation program that serves to modify 

a Veteran’s or Servicemember’s residence to accommodate their disability. Such adaptations afford individuals with functional limitations the capability to live at 

home in a barrier-free environment. 

IFR submitted by Langevin, James R. 

House Committee on Armed Services 

Question for: Mr. Danny Pummill 

12) Page 103 Line 2498 

The Veterans Benefits Administration’s Specially Adapted Housing (SAH) staff 

routinely review the program to ensure the program is meeting the needs of eligible 

Veterans. SAH staff also work closely with Veterans Service Organizations to incorporate their feedback. 

Veterans and Servicemembers with neurological traumas such as traumatic brain 

injuries or spinal cord injuries may be eligible for SAH grants if they meet the 

statutorily defined medical eligibility criteria. Specifically, the SAH grant is available to Veterans and Servicemembers who are entitled to disability compensation 

for a service-connected, permanent and total disability due to: 

Æ 

VACREP180 with DISTILLER