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

74–394 PDF 2012

S. HRG. 112–556 

SEAMLESS TRANSITION: REVIEW OF THE 

INTEGRATED DISABILITY EVALUATION SYSTEM 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

MAY 23, 2012 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

PATTY MURRAY, Washington, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

DANIEL K. AKAKA, Hawaii 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

RICHARD BURR, North Carolina, Ranking 

Member 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

KIM LIPSKY, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

MAY 23, 2012 

SENATORS 

Page 

Murray, Hon. Patty, Chairman, U.S. Senator from Washington ........................ 1 

Boozman, Hon. John, U.S. Senator from Arkansas .............................................. 4 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 5 

Prepared statement .......................................................................................... 5 

Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 6 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 94 

WITNESSES 

Rooney, Jo Ann, Acting Under Secretary of Defense for Personnel and Readiness, U.S. Department of Defense ...................................................................... 6 

Prepared statement .......................................................................................... 9 

Response to prehearing questions submitted by Hon. Richard Burr ........... 12 

Response to posthearing questions submitted by: 

Hon. Patty Murray ........................................................................................ 33 

Hon. Richard Burr ........................................................................................ 47 

Hon. Bernard Sanders .................................................................................. 51 

Response to request arising during the hearing by: 

Hon. Jon Tester and Hon. John Boozman .................................................. 89 

Hon. Patty Murray ........................................................................................ 100 

Gingrich, John R., Chief of Staff, U.S. Department of Veterans Affairs ............ 52 

Prepared statement .......................................................................................... 53 

Response to prehearing questions submitted by Hon. Richard Burr are 

merged in with same to DOD ...................................................................... 13 

Response to posthearing questions submitted by: 

Hon. Patty Murray ........................................................................................ 33 

Hon. Richard Burr ........................................................................................ 47 

Hon. Bernard Sanders .................................................................................. 56 

Response to request arising during the hearing by: 

Hon. Richard Burr ........................................................................................ 89 

Hon. Jon Tester ............................................................................................. 92 

Hon. Patty Murray ........................................................................................ 98 

Bertoni, Daniel, Director, Education, Workforce, and Income Security, U.S. 

Government Accountability Office ...................................................................... 57 

Prepared statement .......................................................................................... 60 

Response to posthearing questions submitted by Hon. Bernard Sanders ... 78 

Response to request arising during the hearing by Hon. Mike Johanns ..... 96 

Interim Committee Staff Report: Investigation of Joint Disability Evaluation 

System ................................................................................................................... 79 

APPENDIX 

Paralyzed Veterans of America; prepared statement ........................................... 103 

(1) 

SEAMLESS TRANSITION: REVIEW OF THE 

INTEGRATED DISABILITY EVALUATION 

SYSTEM 

WEDNESDAY, MAY 23, 2012 

U.S. SENATE, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:05 a.m., in room 

SD–562, Dirksen Senate Office Building, Hon. Patty Murray, 

Chairman of the Committee, presiding. 

Present: Senators Murray, Tester, Burr, Johanns, and Boozman. 

STATEMENT OF HON. PATTY MURRAY, CHAIRMAN, 

U.S. SENATOR FROM WASHINGTON 

Chairman MURRAY. Good morning and welcome to today’s hearing to examine the ongoing efforts of the Department of Defense 

and the Department of Veterans Affairs to provide a truly seamless 

transition for our servicemembers and our veterans. 

Almost a year ago today, this Committee held a hearing on VA 

and DOD efforts to improve transition. We explored a number of 

issues, including the Integrated Disability Evaluation System. At 

the hearing, we had an opportunity to hear from both Departments 

about the state of the joint program. The Departments’ testimony 

that day spoke to how the Departments had created a more transparent, consistent, and expeditious disability evaluation process. 

Their testimony also states IDES is a fairer, faster process. 

Well, now that the joint system has been implemented nationwide, I have to say that I am far from convinced that the Departments have implemented a disability evaluation process that is 

truly transparent, consistent, or expeditious. 

There are now over 27,000 servicemembers involved in the disability evaluation system. As more and more men and women return from Afghanistan and as the military downsizes, we are going 

to see an even larger group of servicemembers transition from the 

military through the disability evaluation process. 

This process impacts every aspect of a servicemember’s life while 

they transition out of the military, but it does not stop there. If the 

system does not work right, it can also negatively affect the servicemember and their family well after they have left active duty. 

Getting this right is a big challenge, but it is one that we have no 

choice but to step up to meet. 

I have seen the impacts of a broken system, whether it is from 

a wrong diagnosis, an improper decision, or never-ending wait 

2 

times, and when the system does not work and servicemembers 

cannot get a proper mental health evaluation or diagnosis, it 

means they are not getting the care that they need. Without the 

proper care, these men and women may find themselves struggling 

to readjust to family or civilian life, and they often struggle to find 

work. 

Worse yet, we have heard stories of soldiers overdosing on drugs, 

and in far too many cases, taking their own lives. These are real 

tragedies affecting real servicemembers, and they are happening 

despite a system intended to provide greater support to our wounded, ill, and injured. I have seen first hand the impact an improper 

decision can have on a soldier and his family. 

Earlier this year, I met Sergeant First Class Stephen Davis and 

his wife, Kim, at Joint Base Lewis-McChord in my homestate of 

Washington. Sergeant Davis led his men in combat in both Iraq 

and Afghanistan. He was exposed to multiple IED explosions during his service, and after being treated by the Army for years for 

PTSD and other mental health disorders, he was told, during the 

disability evaluation process, that he was making up his ailments. 

From speaking with him, I can tell you that Sergeant Davis and 

the hundreds of other men and women at Joint Base LewisMcChord are far from satisfied with the transparency and consistency of the disability evaluation process. All of these men and 

women had been diagnosed with, and in many cases, were receiving treatment for PTSD during service. 

But then during the disability evaluation process, they were told 

they were exaggerating their symptoms, they were labeled as malingerers, and their behavioral health diagnoses were changed. 

Since then, the Army has launched investigations and hundreds of 

soldiers are now being reevaluated in an effort to make this right. 

In fact, the most recent update from the Army shows that out of 

the 196 cases that have been reevaluated, 108 have resulted in a 

diagnosis of PTSD. That is more than half of these men and 

women. 

Still more have received other significant behavioral health diagnoses. Other referrals and reevaluations are still occurring. I am 

still hearing from those who have completed their reevaluations 

only to find themselves stuck back in the same Disability Evaluation System that failed them. 

Despite all these men and women have been through, they continue to have their behavioral health injuries minimized and feel 

like their chain of command does not understand what they are 

going through. Clearly more needs to be done to build uniformity 

and accountability into the process of identifying those who are 

struggling with PTSD and other behavioral health problems. 

In recent weeks, the Army has taken a number of steps in the 

right direction. Their recent policy on the diagnosis and treatment 

of PTSD addresses a number of the concerns that I have raised. It 

standardizes the Army mental health care through the use of proven treatments and assessments, it recognizes how extraordinarily 

rare it is for servicemembers to fake symptoms of PTSD, and this 

acknowledgment is critical, as we saw all too often that accusation 

at Madigan Army Medical Center. 

3 

Additionally, just last week, the Army took another critically important step forward in addressing the concerns I have been raising by announcing a comprehensive Army-wide review of behavioral health evaluations and diagnosis in support of the Disability 

Evaluation System. I want to applaud the Army leadership for taking some significant steps toward addressing these issues. This is 

going to take continued engagement from the Army leadership. 

Now, I know some may argue that this is just a Joint Base 

Lewis-McChord problem or an Army problem, but it is not. This is 

a systemwide problem. We will continue to see issues similar to 

those at Madigan until the DOD and VA ensure policies and actions, like those we have seen from the Army in recent weeks, are 

adopted across the services and throughout the joint system. 

Ensuring servicemembers receive a proper diagnosis in the care 

and benefits they earned is an obligation we have as a Nation. We 

owe it to these men and women to get this right. 

These are not the only challenges confronting the Integrated Disability Evaluation System. We are going to hear today from GAO 

about other challenges facing the Departments, challenges which I 

must say sound all too familiar. Everyone on this Committee 

knows of VA’s struggles to address the claims’ backlog. 

I am troubled because numbers from the Integrated Disability 

Evaluation System paint a similar picture. Enrollment continues to 

climb, the number of servicemembers’ cases meeting the Departments’ timeliness goals is unacceptably low, and the amount of 

time it takes to separate and provide benefits to a servicemember 

through this system has risen each year since its inception. 

This continued rise in the amount of time it takes to provide a 

servicemember with a decision has to be addressed. The goal the 

Departments have set for completing IDES is 295 days for active 

duty and 305 days for reservists. Last year, on average, it took active duty servicemembers 394 days and reservists 420 days. That 

is around 100 days longer than your goal, and it is simply unacceptable. 

Dr. Rooney, Mr. Gingrich, right now the Departments are failing 

these servicemembers. The only thing this Committee is interested 

in are the solutions to this problem and the dedication of your leadership in making things better. We cannot allow the same problems that plague the larger disability claim system to negatively 

impact the transition of thousands of servicemembers in the next 

few years. The consequences are too severe. 

Clearly, a lot of work remains to be done. But we have seen the 

Army moving in the right direction. Now DOD and VA need to take 

these lessons learned and apply them across the entire system. Not 

only will this require quick action, but most importantly, this effort 

is going to require the total engagement, cooperation, and support 

of all senior leaders at both Departments to get this done right. 

While DOD and VA are at a critical juncture, I am confident that 

by working harder and smarter and faster, the Departments can 

improve the system for thousands of men and women who will be 

transitioning in the next couple of years. With that, I will turn to 

Senator Boozman. 

Ranking Member Burr was in another meeting and just joined 

us, so we will first turn to Senator Boozman for his statement. 

4 

STATEMENT OF HON. JOHN BOOZMAN, 

U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Thank you, Chairman Murray, and thank you 

and Senator Burr for holding this hearing to discuss the Integrated 

Disability Evaluation System, including how well it is working and 

what is being done to improve it. Also thank you to our witnesses 

for joining us today. 

As we will hear today, it is clear that the Integrated Disability 

Evaluation System, or IDES, is still facing real and significant 

challenges. Overall, it is taking more than 1 year for servicemembers to go through this process, about one third longer than the VA 

and the Department of Defense intended. At some military bases, 

it is still taking much longer than that. In fact, only 18 percent of 

active duty servicemembers are transitioning to civilian life within 

the agency’s 295-day goal. 

During this time, wounded, ill, and injured servicemembers are 

waiting to find out whether they can continue serving in the military or have to build new lives as civilians. For those who are 

ready and able to move on with their lives, this must seem like an 

eternity. 

I think the number of servicemembers in this process who are 

administratively discharged or court martialed or died from unnatural causes, including suicides and overdoses, raises serious 

questions about what the impact these delays may be having on 

the personal well-being of our Nation’s wounded warriors. Also, I 

think we need to consider whether the IDES is truly setting them 

up to succeed after leaving the military. 

As the Committee has been told by many servicemembers going 

through this process, the uncertainty about when and where they 

might leave the military can actually prevent them from getting 

their civilian lives in order, such as buying a house, finding a 

school, or taking a job. 

On top of that, it appears that this system is not as straightforward or user-friendly as it was intended. Listen to what the 

Wounded Warrior Project said about the IDES process earlier this 

year: ‘‘Our wounded warriors still encounter great difficulty in 

navigating a system they find to be highly complicated, difficult to 

understand, unnecessarily contentious, and often ponderously 

slow.’’ Other words that have been used to describe IDES include 

adversarial, long, and disjointed. 

There is another hidden liability here that I think is important 

to note and that is the potential impact that the backlog may have 

on our military readiness, particularly in a time when some in 

Washington are talking about drawing down our force strength. 

Right now there are about 19,000 soldiers, as in just in the Army, 

who are in this process. I am under the impression that these servicemembers are still considered as being in the military, so that 

comes out of the bottom line for Army’s in-strength and cannot be 

replaced until they have completed the IDES process. 

Based on these and other issues we will hear about today, it is 

clear that we are still a long way from actually having created a 

seamless transition for many wounded, ill, and injured military 

personnel. So I hope the Committee will have a good discussion 

about what can be done to simplify this disability system, speed up 

5 

the process for those who are ready to move on with their civilian 

lives. And with that, I yield back my time. 

Chairman MURRAY. Thank you very much. Senator Burr? 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Madam Chairman, I just ask unanimous consent 

to put my statement in the record. Thank you. 

[The prepared statement of Senator Burr follows:] 

PREPARED STATEMENT OF HON. RICHARD BURR, RANKING MEMBER

Good morning, Chairman Murray. Welcome to you and to our witnesses. Thank 

you for calling this hearing to discuss the Integrated Disability Evaluation System— 

or IDES. 

This joint VA and Department of Defense process was meant to help ease the 

transition to civilian life for injured or ill servicemembers, by allowing them to find 

out before they leave the military what benefits they will receive from both agencies. 

But, as we’ll hear today, there have been consistent performance challenges with 

this new system. 

In fact, at Committee hearings last May, we heard about inadequate IT solutions, 

staffing shortages, and other problems that were leading to delays and frustrations 

for many servicemembers. At that time, it was taking about 400 days to go through 

the process—100 days longer than the target set by the agencies. Also, serious concerns were raised about the personal toll those delays may be having on many servicemembers and about the quality of their lives during this process. 

We heard then about a number of efforts that were underway to improve IDES. 

But—one year later—we’ll hear about some of those same problems, and it’s still 

taking nearly 400 days for injured and ill servicemembers to transition to civilian 

life. For members of the Guard and Reserves, it can take even longer—as much as 

650 days. That’s a long time for servicemembers to be held in limbo—not knowing 

whether their military careers are over and, if so, what benefits and services they 

would receive. 

Also, we continue to hear from servicemembers who are frustrated that they cannot plan for civilian life—like accepting a job or enrolling in school—because they 

don’t know when they will leave the military. What’s worse is the number of servicemembers going through this process who have taken their own lives, succumb to 

drugs, or suffered other unfortunate outcomes. 

Given all of this, it’s understandable that stakeholders have called this process 

convoluted, contentious, and slow. Even the Army’s Deputy Chief of Staff recently 

said this about it (quote): 

The biggest area that we need help is the Disability Evaluation System. It’s 

fundamentally flawed. It causes an adversarial relationship with our medical professionals * * *. It’s long. It’s disjointed * * *. 

The bottom line is that many servicemembers and their families are not being 

well served by this process. So, we need to look at what should be done in the short 

term to bring relief to the 27,000 military personnel going through IDES now. But, 

we also need to seriously look at whether this system—as currently structured—will 

ever provide servicemembers with the high level of service they deserve. 

Madam Chairman, we should not be content with a cumbersome process that 

leaves injured and ill servicemembers in a state of uncertainty for more than a year, 

when they want and need to move on with their lives. The men and women who 

have been harmed while serving our Nation deserve better. So, I hope we can work 

collectively to find solutions that will cut through the bureaucracy and, more importantly, will truly help ease their transition to civilian life. 

I again thank the witnesses for being here, and I thank the Chair. 

Chairman MURRAY. Thank you very much. At this time, I want 

to—oh, Senator Tester, I did not see you come in. 

Senator TESTER. Thanks. 

Chairman MURRAY. You are welcome. 

6 

STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

Senator TESTER. I would just like to say thank you, Dr. Rooney, 

for being here, and Mr. Gingrich, and Mr. Bertoni. I would just say 

that since I have been on this Committee, which has been five-anda-half years now, we have been talking about this issue. Obviously 

it is not an easy issue or it would be done already. 

By the same token, maybe we ought to get the Committee on 

Military Affairs in here, but you are here, Dr. Rooney, but to put 

pressure on the DOD to make sure they are doing their job as we 

put pressure on the VA to make sure they are doing their job. Let 

me just give you a real quick statistic. 

Secretary Shinseki mentioned that his goal for the disability 

compensation and pension claims is 125 days, 98 percent accuracy. 

Right now, according to the report Mr. Bertoni put out, it is 394 

days and it is 79 percent accurate. We have got an issue here, and 

the reason I know we have got an issue here is because I have got 

veterans calling me all the time. It is too complicated, they do not 

know how to get through it, and quite frankly, the folks who serve 

this country deserve better. 

We have got to figure out how to get this right, and I do not 

think IDES is doing it right now, but I could be corrected on that 

and I look forward to that if you do correct me, because the bottom 

line is, what this Committee does is important, but what is even 

more important is the services we give to our vets and the folks 

that need help and have earned that help need to get it and need 

to get it now. Thank you, Madam Chair. 

Chairman MURRAY. OK. Thank you very much. Now, at this 

time, I would like to introduce and welcome today’s witnesses. Representing the Department of Defense is the Acting Under Secretary 

of Defense for Personnel and Readiness, Dr. Jo Ann Rooney. Dr. 

Rooney, we had the chance to talk about several of these issues at 

the field hearing I held in Tacoma a few months ago, and I really 

appreciate your willingness to testify before this Committee again, 

and I am pleased you are continuing to focus on this issue. 

Joining us from the Department of Veterans Affairs is VA’s Chief 

of Staff, Mr. John Gingrich. From the Government Accountability 

Office, we have Mr. Daniel Bertoni, the Director of Education, 

Workforce, and Income Security Issues. I want to thank each one 

of you for joining us this morning and we look forward to hearing 

your testimony. Your prepared remarks will, of course, appear in 

the record. Dr. Rooney, we will begin with you. 

STATEMENT OF JO ANN ROONEY, ACTING UNDER SECRETARY 

OF DEFENSE FOR PERSONNEL AND READINESS, DEPARTMENT OF DEFENSE 

Ms. ROONEY. Thank you. Good morning, Chairman Murray, 

Ranking Member Burr, and Members of the Committee. It is my 

pleasure to be here today to testify on current efforts focused on 

reviewing and improving the Integrated Disability Evaluation System, or IDES. I am pleased to be appearing with one of my partners from the Department of Veterans Affairs. 

As Departments, we are working closely together to provide an 

integrated, seamless process for wounded, ill, or injured serviceVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6601 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
7 

members as they transition to veteran status. Taking care of our 

servicemembers is the absolute highest priority of the Department 

of Defense. Part of taking care of our servicemembers includes ensuring their honorable service is recognized and they are compensated in both DOD and VA systems for injuries and illnesses 

incurred during that service. 

The Department has undertaken many initiatives to accomplish 

this, but we acknowledge there is much more work to be done. 

Over the past 5 years, the Departments of Defense and Veterans 

Affairs have worked together with assistance and guidance from 

Congress to reform the cumbersome and often confusing bureaucratic processes which provide care and benefits to our wounded, 

ill, and injured servicemembers when and where they need them. 

Working closely, deliberately, and collaboratively, our Departments have established governance at the highest levels to facilitate continuous improvements. The Joint Executive Council, or 

JEC, co-chaired by the VA Deputy Secretary Gould and me, devotes part of each bimonthly meeting to reviewing the progress and 

understanding the ongoing actions toward achieving our goal of 

seamless transition from servicemembers to veterans. 

Similarly, the quarterly meeting conducted jointly by the Secretary of Defense and the Secretary of Veterans Affairs, with their 

senior leaders, to oversee and drive progress toward the stated 

goals. One of these efforts is IDES. IDES delivers a more servicemember-centric design, a simpler process, more consistent evaluations, and compensation, easier transition to veteran status, case 

management advocacy, and an established relationship between 

the servicemember and VA prior to separation. 

It also provides increased transparency through better information flow to servicemembers and their families as well as a reduced 

gap between separation, or retirement from service, and receipt of 

VA benefits. 

The IDEA streamlines the Disability Evaluation System with 

servicemembers receiving a single set of physical disability examinations conducted according to VA examination protocols, proposed 

disability ratings prepared by VA that both Departments can use, 

and dual processing to ensure the earliest possible delivery of disability benefits. 

Currently the IDES is in use at 139 locations across all services. 

Since November 2007, 19,518 servicemembers have completed the 

IDES process. The IDES has also reduced that post-separation benefits gap between DOD and VA from an average of 240 days in 

2007 to 50 days currently, which means disabled veterans receive 

their VA benefits 79 percent faster under the current IDES than 

before. 

Even with the marked improvements in performance the IDES 

has brought to the disability evaluation process, we have much 

work remaining. Both Departments are committed to constant 

evaluation of each step throughout the process and will continue to 

seek long-term innovative solutions focused on improving the experience of our wounded warriors. We must do that. 

We also much carefully review the critical steps in IDES to reach 

the 295-day completion goal for at least 60 percent of those entering the process by the end of this calendar year. The military servVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6601 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
8 

ices are each in the process of implementing actions to improve efficiency and effectiveness. Since October 2011, this fall, the Army 

has added 513 medical evaluation board and physical evaluation 

board personnel and enhanced accountability by establishing performance metrics to measure the productivity of board staff. 

The Army has also completed a senior leader assessment of the 

execution of the IDES at installations across the Army. This assessment identified specific actions required to enhance and standardize performance across the Army. The Navy and Marine Corps 

have added ten doctors and 37 case managers to their medical evaluation board staff last year and anticipate the addition of 23 more 

doctors next year. 

Physical evaluation board staffs have increased in both Navy and 

Marine Corps by 47 percent, allowing them to process 75 percent 

of the Navy and 69 percent of the Marine cases through this 

particular phase in less than the 120-day phase goal. The Air Force 

has also leaned forward and started to utilize Air Force National 

Guard personnel to support the evaluation process and established 

a pre-IDES eligibility screening process, again to increase 

efficiency. 

The Office of the Secretary of Defense has also removed policy 

impediments, implemented procedural improvements, and enhanced oversight and assistance to the services. Examples of these 

include reducing minimum informal physical evaluation board 

staffing requirements from three members to two members, authorizing doctoral level psychologists to sign medical evaluation boards. 

Prior they were not able to. 

Allowing military departments to process initial trainees through 

the Legacy system. Additionally, DOD is working with our VA 

partners to improve IDES execution by improving training and 

case management software, implementing a common paperless 

standard for electronic transfer of files by this summer, and developing other integrated electronic record file sharing methods which 

will enhance the efficiency of the IDES. 

The Departments anticipate these improvements when implemented this summer of 2012 will reduce IDES time, on average, by 

20 to 30 days. The Departments are committed to ensuring that 

disability evaluation and compensation of injured, ill, and wounded 

servicemembers is thorough, fair, and accurate. 

We are continually reviewing the process and the requirements 

to adequately staff, and when necessary, surge the IDES so it remains responsive to the needs of recovering servicemembers in the 

services as they draw down and reset their forces. Yet we understand there is room for improvement in all parts of our processes 

and are committed to working toward that end. 

After two decades of war with an all-volunteer force that has 

seen marked improvements in survival of previously unsurvivable 

combat injuries, the expectations of what happens after a servicemember becomes ill or injured are fundamentally different. The Department is now focused on taking advantage of all the advances 

in medical care, restorative therapies, and rehabilitation to allow 

a servicemember to achieve his or her greatest potential. 

This includes retention in military service whenever possible. 

This concept of being made whole reflects a commitment to the serVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6601 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
9 

vicemembers to restore the highest level of function possible physically, mentally, spiritually, and financially and providing all the 

benefits that are justified. 

The target of 295 days to complete the IDES process was originally identified to address the concerns and frustrations of servicemembers who did not believe they were being properly cared for 

and felt they were languishing in an uncoordinated, insensitive system. Since these issues surfaced, many resources have been 

brought to bear to improve the coordination and care and the adjudication of benefits. 

The complexity of injuries, sophisticated treatment strategies, coordination of care, and change in the philosophical approach to the 

goals of patient-centric versus military department-centric has redefined the timeliness for completion of the system. In fact, it has 

become more of a system centered on improving and defining ability rather than singularly focused on transition of a servicemember 

to veteran status and is often individualized in its application to 

achieve this goal. 

The Department reaffirms its commitment to care for and honor 

those who have protected our Nation by serving in uniform. In 

order to meet our sacred responsibilities to this next greatest generation, we must fully leverage the capabilities and strategies and 

strengths of both the Department of Defense and Veterans Affairs. 

We must break down the barriers that prevent us from delivering 

the highest quality care to those who need it and deserve it. 

Thank you again for the opportunity to be with you today, 

Madam Chairman, and I look forward to the Committee’s 

questions. 

[The prepared statement of Ms. Rooney follows:] 

PREPARED STATEMENT OF DR. JO ANN ROONEY, ACTING UNDER SECRETARY OF

DEFENSE, PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE

Chairman Murray, Ranking Member Burr, and Members of the Committee: 

Thank you for inviting me to testify before you on the current status of the Integrated Disability Evaluation System (IDES) and current efforts to improve it. 

The 2007 revelations regarding suboptimum conditions for wounded warriors at 

Walter Reed Army Medical Center made for a stark wakeup call. In the nearly five 

years since, the Department of Defense (DOD) has worked in tandem with our Department of Veterans Affairs (VA) colleagues to improve policies, procedures, and 

conditions that impact care of our wounded warriors. Today, we meet at a time of 

historic cooperation between the Departments of Defense and Veterans Affairs. 

Thanks to President Obama’s commitment to Veterans and delivering the care they 

have earned, we have established a program of support between our Departments 

that is more responsive and comprehensive in scope than ever before. More so than 

at any time in our Nation’s history, those who separate from military service are 

greeted by more comprehensive mental and physical care; by greater opportunity for 

education and jobs, and by a deeper societal commitment to ensuring their welfare. 

When you compare the experience of our troops today to the generation of heroes 

who returned from Vietnam, the progress made toward a single system of lifetime 

care is significant, yet we must continue to make improvements. 

BACKGROUND

After the Career Compensation Act of 1949 created the basic structure of the Department’s Disability Evaluation System (DES), it remained relatively unchanged 

until November 2007. In response to public and Congressional concern after reports 

of inadequate conditions for wounded warriors at Walter Reed, the joint DOD and 

VA Senior Oversight Committee (SOC) chartered a pilot designed to create a more 

Servicemember-centric, seamless, and transparent disability program. The DES 

Pilot implemented many of the changes recommended by groups like the Veterans’ 

10 

Disability Benefits Commission and the President’s Commission on Care for America’s Returning Wounded Warriors to the degree allowed within law. 

The pilot was launched at three major military medical treatment facilities in the 

National Capital Region on November 21, 2007—Walter Reed Army Medical Center, 

National Naval Medical Center, Bethesda, and Malcolm Grow Air Force Medical 

Center. It successfully created an integrated process that delivers Departments of 

Defense and Veterans Affairs benefits as soon as possible following release from active duty and significantly reduced the gap in benefits that existed in the previous 

system. DOD found the DES Pilot to be faster, more equitable, and more efficient 

than previous approaches. In a representative survey of over 1,000 Servicemembers, 

those in the DES Pilot were more satisfied with their experience than those in the 

legacy process. As a result, in July 2010, the Deputy Secretaries of Defense and Veterans Affairs directed worldwide implementation to begin in October 2010, and to 

be completed by September 2011. On December 31, 2010, the DES Pilot officially 

ended and the first Integrated Disability Evaluation System (IDES) site became 

fully operational. 

The IDES, similar to the DES Pilot, streamlines the disability process so Servicemembers receive a single set of physical disability examinations conducted according 

to VA examination protocols and disability ratings prepared by VA. The Departments of Defense and Veterans Affairs share the examination results and ratings 

to relieve Servicemembers of the burden of redundant examination requirements 

and divergent ratings for the same disability. Under Title 10 authority, the Department determines fitness for duty and compensates for unfitting conditions incurred 

in the line of duty, while under Title 38 authority VA compensates for all disabilities resulting from disease or injury incurred or aggravated in line of duty during 

active military, naval, or air service for which a disability rating of 10 percent or 

higher is awarded. It also determines eligibility for other VA benefits and services. 

The IDES permits both Departments to provide disability benefits at the earliest 

point allowed under their respective U.S.C. Titles. In March 2012, the post-separation wait for VA disability benefits was 79% shorter than in 2007 under the separate DOD/VA processes. 

The National Defense Authorization Act (NDAA) for FY 2008, Public Law 110– 

181, required DOD to utilize the VA Schedule for Rating Disabilities (VASRD). The 

Departments of Defense and Veterans Affairs are currently developing a memorandum of understanding that will allow DOD to become a member of the working 

groups updating the VASRD and give DOD the opportunity to make recommendations prior to the publication of proposed changes in the Federal Register. The Department’s ability to provide this input is critical given the direct connection between VASRD ratings and the decision to place Servicemembers on the medical retirement list with annuities, benefits, and healthcare. This issue is being evaluated 

by the Benefits Executive Council, which is a joint DOD/VA forum, and anticipates 

completion over the next several months. 

In summary, IDES delivers a more Servicemember-centric design, a simpler process, more consistent evaluations and compensation, easier transition to Veteran status, case management advocacy, and an established relationship between the Servicemember and VA prior to separation. It also provides increased transparency 

through better information flow to Servicemembers and their families and a reduced 

gap between separation or retirement from service to receipt of VA benefits. 

CASELOAD

The Department evaluated 18,393 Servicemembers for disability during 2011, 22% 

more than in 2001. More than 50% of the Servicemembers evaluated for disability 

in 2011 completed the legacy DES process. Today, fewer than 2,000 Servicemembers 

remain in that legacy process. The Department is rapidly completing the evaluation 

of these legacy cases and will be complete with a small number of exceptions by 

September 2012. 

As the number of Servicemembers in the independent legacy process has declined, 

the number of Servicemembers in IDES has grown. Since November 2007, 49,478 

Servicemembers have entered and 19,518 have completed the IDES, 2,589 members 

did not complete the IDES process due to a host of reasons including death, 

disenrollment, or return to active duty. As of early this month, 27,371 Servicemembers were in the IDES (67 percent Army, 12 percent Marines, 9 percent Navy, 

and 12 percent Air Force). Two decades of war has contributed to the Department’s 

disability case load and many of these ill and injured suffer from complex conditions 

which take time to properly diagnose and evaluate. We anticipate the number of 

Servicemembers in the IDES will continue to grow as members return from Afghanistan and the Services reduce their end strength. 

11 

We are concerned about the IDES performance, both in terms of the quality of 

service provided and time it takes to complete the process, the Department is mindful that disability evaluation has a dual purpose. The first purpose is to ensure our 

Nation maintains a fit fighting force. The second is to compensate disabled Servicemembers and recognize their honorable service. The Department also understands 

that before we evaluate a Servicemember for possible separation from service, we 

must also ensure we provide them the best medical treatment and consider them 

for other duties that allow continued service to their country. Both of these factors 

affect the time required to complete the IDES process to ensure we provide due diligence and process to every Servicemember. It is the Department’s strong conviction 

that we must not simply expedite the process at the expense of eroding these basic 

tenets. However, we must ensure the process is as efficient as possible. The Department is committed to ensuring the disability evaluation and compensation of injured, ill, and wounded Servicemembers is thorough, fair, and accurate. We are continually reviewing the process and the requirements to adequately staff, and when 

necessary, surge the IDES so it remains responsive to the needs of recovering Servicemembers and the Services as they draw-down and reset their forces. 

CURRENT PERFORMANCE

Prior to the IDES, the Departments of Defense and Veterans Affairs used separate disability evaluation processes which resulted in long wait times within each 

department. In addition, in 2007, the Departments of Defense and Veterans Affairs 

estimated disabled Veterans faced a 240-day gap between exiting military service 

and receiving full VA benefits. By March 2012, the IDES enabled the Departments 

of Defense and Veterans Affairs reduce the post-separation benefits gap from an average of 240 days in 2007 to 50 days, which means disabled Veterans received their 

VA benefits 79% faster under the IDES than before. 

Active component Servicemembers averaged 395 days in the IDES in March 2012. 

Approximately 80 days of this time consisted of Servicemembers in transition— 

clearing their installation and taking voluntary earned leave prior to separating 

from military service. Voluntary leave and clearing the barracks are distinct efforts 

from disability processing and vary significantly by individual. Therefore, the Department is evaluating whether this transition time should be excluded as part of 

the IDES time measurement metric. The Department is committed to constant evaluation of all our processes and will continue to seek long-term innovative solutions 

focused on improving the experience of our wounded warriors. Although the Department is not currently meeting the IDES processing time goal, we are focusing on 

the following action areas to close the 100-day gap. 

Staffing. The Services are applying surge manpower where needed. The Army has 

hired 1,218 out of 1,400 additional civilians (87% complete) to staff the IDES in anticipation of current caseload and future spikes in the IDES utilization. The Department of the Navy added staff at Camp Lejeune and reduced cases experiencing time 

delays by 21% in one month. The Department of the Navy also increased its Informal Physical Evaluation Board (IPEB) staffing by 47%, which reduced IPEB processing time from 50 days in January to 11 days in March 2012, well within the goal 

of 15 days. The Department of the Air Force is currently reviewing staffing requirements for their physical evaluation board. 

Leadership. The Services and VA leaders meet regularly (both inter-agency and 

intra-agency) to ensure they oversee and drive progress within their organizations. 

There are several examples of this coordination. The first is the bi-monthly Joint 

Executive Council (JEC) chaired by the Deputy Secretary of Veterans Affairs and 

Under Secretary of Defense for Personnel & Readiness. The second includes monthly reports of the IDES performance provided to the Secretaries of Defense and Veterans Affairs and reviewed at each JEC. The third is the ability of the Services to 

provide examinations of each installation including the performance of individual cohorts and identify under-performing situations. The fourth is the focus Deputy of 

Defense Management Action Group (DMAG) meeting, attended by senior military 

and civilian leaders from across DOD. The DMAG agenda for the summer of 2012 

includes a detailed review of the IDES program. The Department is in the beginning stages of exploring strategic reforms to the process. The Department appreciates the Committee’s support, and looks forward to working with the Congress as 

we continue to improve IDES. 

A LOOK TOWARDS THE FUTURE

In past wars, particularly with a conscripted force, it was expected that seriously 

injured or ill Servicemembers would transition to veteran status and receive longVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
12 

term care through VA. This concept was generally accepted by all stake holders including lawmakers, military leadership, Servicemembers, and society. 

After two decades of war with an all-volunteer force that has seen marked improvements in survival of previously un-survivable combat injuries, the expectations 

of what happens after a Servicemember becomes ill or injured are fundamentally 

different. The Department is now focused on taking advantage of all the advances 

in medical care, restorative therapies, and rehabilitation to allow a Servicemember 

to achieve his or her greatest potential. This includes retention in military service 

when possible. This concept of being made ‘‘whole’’ reflects a commitment to the Servicemember to restore the highest level of function possible—physically, mentally, 

spiritually, and financially—and providing all benefits that are justified. We now 

have many Servicemembers, some of whom are blind, have spinal cord injuries, or 

have lost limbs serving proudly on active duty. 

This strong commitment to rehabilitation and continued productive service in the 

military by ill and injured Servicemembers, many with more complex visible and invisible wounds then previously seen, has lengthened treatment and rehabilitation 

strategies and the time retained on active duty while recovering. It has also created 

a new mind-set for the injured Servicemember. Today there is a focus on attaining 

maximum functional ability before a decision is made to remain in or separate from 

active duty. Lawmakers and senior military leaders have endorsed this philosophy 

and Servicemembers embrace this change, driven by the desire to remain in active 

service because it is their chosen career. 

The target of 295 days to complete the IDES process was originally identified to 

address the concerns and frustrations of Servicemembers who did not believe they 

were being cared for properly and felt they were languishing in an uncoordinated, 

insensitive system. Since these issues surfaced, many resources have been brought 

to bear to improve the coordination of care and the adjudication of benefits. Specifically, Wounded Warrior Regiments and Wounded Warrior Battalions have been established along with other efforts to group, coordinate and focus optimized care and 

recovery for the Servicemembers and provide for families. In addition, much attention and unprecedented resources have focused on addressing the invisible wounds 

of war—PTSD, TBI and Behavioral Health issues—largely ignored in previous conflicts; illnesses which often complicate recovery from other injuries. The complexity 

of injuries, sophisticated treatment strategies, coordination of care and change in 

the philosophical approach to the goals of patient centric vs. military department 

centric care has redefined the timelines for completion of the disability evaluation 

system. In fact, it has become more of a ‘‘system’’ centered on improving and defining ‘‘ability’’ rather than singularly focused on transition of the Servicemember to 

veteran status and is often individualized in its application to achieve this goal. The 

current philosophical commitment to make the Servicemember ‘‘whole’’ and give 

them opportunities to remain in service is now coming in conflict with rigid 

timelines and legacy policies and procedures. As we look to long-term strategic reform being satisfied that we have achieved maximum efficiencies in the current 

IDES, it may be appropriate to focus on developing metrics which consider the number of days along with desired outcomes that measure how the system serves the 

overall needs of wounded warriors and the contemporary military. 

CONCLUSION

While the Department supports the level of effort and progress made, we fully acknowledge there is much more to do. The Department has positioned itself to implement improvements and continue progress in providing support to our Servicemembers, veterans, and their families while supporting recovery, rehabilitation, and 

re-integration. Our dedicated Servicemembers, veterans, and their families deserve 

the very best. We pledge to give our best efforts to supporting their recovery, rehabilitation, and return to their communities. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO DOD, 

OFFICE OF WOUNDED WARRIOR CARE AND TRANSITION POLICY AND VA, OFFICE OF

POLICY AND PLANNING, INTEGRATED DISABILITY EVALUATION SYSTEM

(a) The number of servicemembers expected to enter the IDES process per year 

at each site. 

DOD Response. See attached spreadsheet, WWCTP SVAC Response Data, column 

header, ‘‘Expected Referrals per year (a).’’ 

13 


523PreHQa1.eps
14 


523PreHQa2.eps
15 


523PreHQa3.eps
16 


523PreHQa4.eps
17 


523PreHQa5.eps
18 

Notes: 

(1) Expected referrals per year based on medical evaluation boards the Military 

Departments reported in fiscal year 2011. 

(2) Department of the Navy data represents combined referrals for Navy and Marine Corps servicemembers. 

(3) Referral data for Walter Reed National Military Medical Center includes referrals from Ft. Belvoir and Ft. Meade. 


523PreHQa6.eps
19 

(b) For each site, the total current staffing level for Physical Evaluation Board 

Liaison Officers (PEBLOs) and the ratio of PEBLOs to servicemembers. 

DOD Response. See attached PEBLO ratio spreadsheet for ratio of PEBLOs to servicemembers. 


523PreHQ2Army.eps
20 


523PreHQ2Navy.eps
21 


523PreHQ2AF1.eps
22 

The Services reported staffing for each location based upon the following: 

PEBLO Case ratio is defined as the number of trained PEBLO full-timeequivalent (FTE) staff divided by 100/365 (.27) multiplied by the total number 

of new cases (to be defined by the Military Department) at the location per year. 

(# of PEBLOs) ÷ [(.27) × (# of MEBs per year)] = Current PEBLO Ratio 


523PreHQ2AF2.eps
23 

(c) For each site, the total current staffing level for Military Service Coordinators 

(MSCs) and the ratio of MSCs to servicemembers. 

DOD/VA Response. The attached spreadsheet, ‘‘IDES Sites VA MSC-VSR Staff 

Levels,’’ is the list of IDES Sites and respective military services coordinator caseloads. Monthly volumes at IDES sites range from less than 1 per month to a high 

of nearly 150 cases. VBA supports low-volume sites with part-time staffing. 


523PreHQ8a.eps
24 

(d) The length of time, on average, servicemembers have been pending in the 

IDES process at each site. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘Average Time Pending (d).’’ 

(e) The number of individuals who have been pending in the IDES process for 

longer than 295 days at each site. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Cases Pending > 295 Days (e).’’ 

(f) The number of individuals who have been pending in the IDES process for 

longer than 540 days at each site. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Cases Pending > 540 days (f).’’ 

(g) The total number of individuals who have completed the IDES process at each 

site. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Cases Completed VA Benefits (g).’’ 

(h) The number of individuals from each site who completed the IDES process 

and were placed on the permanent disability retirement list. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# PDRL Cases (h).’’ 


523PreHQ8b.eps
25 

(i) The number of individuals from each site who completed the process and were 

placed on the temporary disability retirement list. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# TDRL Cases (i).’’ 

(j) The number of individuals from each site who completed the process and were 

separated with severance pay. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Separated with Severance (j).’’ 

(k) The total number of individuals from each site who have been removed from 

the IDES process. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Cases Removed from IDES (k).’’ 

(l) The number of individuals from each site who were removed from the IDES 

process and received an Administrative Discharge after court martial. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Court Martial (l).’’ 

(m) The number of individuals from each site who were removed from the IDES 

process and received an Administrative Discharge (excluding court martial). 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), ‘‘# 

Admin Removed excluding Court Martial (m).’’ 

26 

(n) The number of individuals from each site who have died during the IDES 

process and the causes of their deaths. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Deceased (n).’’ For detailed information about causes of death, see 

the following chart from Office of Wounded Warrior Care Transition Policy. 


523PreHQ7p1.eps
27 

(o) The number of individuals in the IDES process at each site who were returned 

to duty. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Cases RTD (o).’’ 

(p) Of the individuals who were returned to duty at each site, the number who 

underwent medical examinations provided by the Department of Veterans Affairs 

(or its contractors) prior to being returned to duty and the total number of examinations that were provided for those individuals. 

DOD Response. See WWCTP SVAC Response Data (response to question (a)), column header, ‘‘# Cases RTD after Exam (p1).’’ 

Note: This column contains the number of cases that were returned to duty after 

receiving IDES exams. DOD was not able to subtract the number of cases in which 

DOD performed the exam and also notes that DOD used these exams in their process to determine fitness for duty. 


523PreHQ7p2.eps
28 

WWCTP SVAC Response Data, column header, ‘‘# Cases with Exams Used by 

DOD But Not for VA Benefits (p2)’’ contains the number of cases with exams that 

were used by DOD but not usable to determine eligibility for VA benefits. 

DOD suggests the SVAC staff query VA to determine the total number of compensation and pension exams provided by the Department of Veterans Affairs (or 

its contractors) prior to Servicemembers being returned to duty. 

VA Response. The cumulative enrollment of Servicemembers in IDES since November 2007 is 50,021. The total number returned to duty (RTD) who also had examinations is 3,270. *The average number of examinations provided by VA for Servicemember returned to duty is four (3,270 x 4 = 13,080) (*sentence added by 

WWCTP). 

The overall percentage of Servicemembers returned to duty who also had examinations is 6.5 percent. The attached spreadsheet, ‘‘VA Analysis of Servicemembers 

Returned-to-Duty After VA Medical Exams since IOC,’’ provides the RTD requested 

information by site. 

29 


523PreHQp1.eps
30 


523PreHQp2.eps
31 

(q) The funding level for the IDES process for each site, including funds that will 

be provided from any source. 

DOD Response. DOD will provide the requested budget execution information as 

soon as possible. DOD is not able to provide the information at this time because 

the Department does not fund disability costs from a single program and collecting 

the information requires an extensive data call to the Military Departments. In the 

interim, the attached funding data was submitted as part of the FY 2013 President’s 

Budget request. In addition, the attached spreadsheet includes the Services estimated FY 2013 funding requirements that were requested within the Overseas Contingency Operations budget request. The Department is developing a future budget 

exhibit to provide this information annually. 

NOTE: The DOD answer is pending final review by OSD Comptroller office. 

VA Response. In FY 2012, VA will spend approximately $70.8 million in support 

of the IDES process. This figure is comprised of $18.2 million for IDES exams 

through the Veterans Health Administration, $38.6 million for General Operating 

Expenditures which includes payroll (salary and benefits), travel, equipment and 

supplies, etc., and $14 million on contract exams through VBA. 

32 

IDES FUNDING FOR SERVICES


523PreHQ1.eps
33 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY TO JO

ANN ROONEY, ACTING UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE AND JOHN R. GINGRICH, CHIEF OF STAFF, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. In 2010, GAO identified the issue of diagnostic disagreement within 

the Integrated Disability Evaluation System (IDES) in their report GA0–11–69, 

Military and Veterans Disability System. Recommendation 2 of GA0–11–69 recommended that the Secretaries of the Departments of Defense (DOD) and Veterans 

Affairs (VA) ‘‘establish a mechanism to continuously monitor disagreements about 

diagnoses between military physicians and VA examiners and between PEBs and 

VA rating offices.’’ In response to this finding: 

a. Has DOD and VA modified the VA’s Veterans Tracking Application (VTA) to 

continuously monitor diagnostic disagreements? 

VA Response. VTA has now been modified to include a Quality Review Tab. The 

Physical Evaluation Board (PEB) can use this tab to identify a diagnostic variance. 

DOD Response. Yes, VA provides IDES IT support and recently modified VT A 

to incorporate a diagnostic difference monitoring capability. 

b. When will this modification be available to all VTA users? 

VA Response. This modification was made available to all VTA users on June 11, 

2012. 

DOD Response. VA made this VTA modification available to all IDES users on 

June 9, 2012. 

c. How will VTA users be instructed to utilize this capability to capture data on 

diagnostic disagreements? 

VA Response. VTA users have been instructed via monthly VTA live meeting 

training to utilize this capability to identify data in cases that have diagnostic disagreements. VTA reporting capability to track and monitor diagnostic disagreements has not been developed at this time. 

DOD Response. The Military Departments received familiarization with the VTA 

2.0 enhanced capabilities during pre-release user acceptance testing. We and our VA 

partners continue to conduct monthly training for PEBLO’s to address basic and advanced/detailed capabilities, such as Quality Review, which includes Diagnostic Disagreement. We continue to improve our training materials through the VT A web 

site and recurrent training teleconferences. 

Question 2. Provide DOD, VA and any individual Service policy guidance that addresses the handling of diagnostic disagreements between DOD and VA. 

VA Response. The process of addressing the issue of diagnostic differences needs 

to include a definitive determination that there is in fact an issue with significant 

impact to the disability process. The Government Accountability Office (GAO) in 

2010 noted that the occurrence and prevalence of diagnostic disagreements and 

their impact on IDES case processing time are unknown because DOD and VA have 

no way to track such disagreements. Following a period of discussion, DOD engaged 

the contractor LMI to study claims of diagnostic disagreements (aka diagnostic difference); LMI issued a report in October 2011. 

a. LMI confirmed that diagnostic disagreements are not tracked by any DOD or 

VA system or reporting process. Because they are not tracked, they were unable to 

quantify the prevalence of diagnostic disagreements and their effect on timeliness 

within IDES. 

b. LMI concluded that generally (1) the issue of diagnostic disagreements is almost completely confined to behavioral and mental health conditions and (2) improved coordination between the VA and DOD has significantly reduced the number 

of disagreements. 

While VA has no written policy guidance regarding diagnostic discrepancies for 

disability evaluations, VA has no objection to such a policy once it is established 

what barriers may exist in executing acceptable disability examinations. Meanwhile, 

opportunities to enhance DOD/VA communications are available. For example, if the 

examiner is aware that there is treatment history in the service medical record, he/ 

she should request the Military Services Coordination to have it provided to him/ 

her. If the Medical Evaluation Board (MEB) clinician determines that a diagnostic 

discrepancy exists, then the most efficient way to manage this is for the MEB clinician to phone the VA mental health disability examiner and provide the additional 

information. This is the same methodology utilized to address a diagnostic discrepancy in the therapeutic arena, clinician-to-clinician follow-up. 

DOD Response. DOD issued policy guidance on handling diagnostic disagreements 

in December 20 II (http://www.dtic.rniVwhs/directives/corres/pdf/DTM–11–0l5.pdf). 

34 

An excerpt of DOD’s guidance, which instructs Military Department Physical Evaluation Boards to apply the diagnostic codes VA provides if the diagnoses differ between the Departments, follows: 

‘‘b. Within 15 days of receiving proposed disability ratings from the D-RAS, 

apply the ratings using the diagnostic code(s) provided by the D-RAS to the 

Servicemember’s unfitting conditions and publish the disposition recommendation. For example, if the PEB identifies a condition to the D-RAS as 

schizophreniform disorder but the D-RAS rates the condition as psychotic 

disorder not otherwise specified (VASRD 9210), the PEB will apply the rating as ‘‘schizophreniform disorder rated as psychotic disorder not otherwise 

specified (VASRD 9210).’’ 

Question 3. Please provide an organizational chart for the management of IDES 

within DOD, VA and within each Service. 

VA Response. Note attached Operational Model Diagram. 


523OrgCh1.eps 523OrgCh2.eps
35 

Question 4. In their March, 2012, briefing to the Committee, the Departments reported, in part: Deputy Chief Management Office (DCMO)—is the single DOD POC 

for IDES Information Technology (IT); leading efforts to define IT strategy, discover 

and map IT portfolio and lead collaboration with VA. 

VA Executive Director Virtual Lifetime Electronic Record (VLER) EPMO identified as VA POC for IDES Information Technology. Please detail the collaboration 

between DOD and VA POCs, including: 

a. A delineation of the Departments’ shared strategic goals, assumptions and 

planning for IDES IT collaboration; 

VA Response. VA’s VLER Enterprise Program Management Office (EPMO) works 

closely with DOD Deputy Chief Management Office (DCMO) and the Under Secretary of Defense for Personnel and Readiness (USD (P&R)) to delineate shared 

strategic goals, assumptions and planning for IDES IT collaboration as part of ongoing governance activities and documentation created under the Joint Executive 

Council (JEC), Benefits Executive Council (BEC), VLER Overarching Integrated 

Project Team (OIPT) and other VA/DOD interagency governance boards. VA VLER 

EPMO regularly meets with DCMO, USD P&R, and the three Military Departments 

during the VLER OIPT to review IDES requirements and perform IT planning, design, and execution. 

DOD Response. The DOD Deputy Chief Management Office (DCMO) and the 

Under Secretary of Defense for Personnel and Readiness (USD (P&R)) work closely 

with the Department of Veteran Affairs (VA) Executive Director (ED) Virtual Lifetime Electronic Record (VLER) to delineate shared strategic goals, assumptions and 

planning for IDES IT collaboration. DCMO, USD P&R, and three Military Departments regularly meet with VA VLER during the VLER Overarching Integrated 

Project Team (OIPT) to review IDES requirements and perform IT planning, design, 

and execution. The Departments share IT goals via the Joint Executive Council 

(JEC), the Benefits Executive Council, Information Sharing/Information Technology 

(BEC IS/IT) working group, HEC/IM/IT Information Management Technology Working Group, Interagency Program Office (IPO) and the Virtual Lifetime Electronic 

Record (VLER) office. 

b. A prioritized list of current and planned IDES IT projects, including timeline, 

critical milestones, and planning documents for the development and implementation of each such project; 

VA Response. The VLER EPMO works closely with DCMO and USD (P&R) on 

several IT projects that will provide benefits to our transitioning Servicemembers 

and Veterans: 


523OrgCH3.eps
36 

• Automating Disability Benefits Questionnaire (DBQ) Information Collection: A 

capability to provide a TurboTax®-like, Web-based forms to facilitate the collection 

of specific disability VA Rating Schedule information from VA and private clinicians 

who perform disability examinations. The initial capability will be available by the 

end of Summer 2012, with all Disability Benefits Questionnaire (DBQ) forms available in the automated solution by Fall 2012. • eBenefits: Secure Web portal that provides a central location for Servicemembers, Veterans, and their families to research, find, access, and manage their 

benefits and personal information. VA and DOD are committed to improving the online experience for Veterans and Servicemembers. More than 1.4 million Veterans 

and Servicemembers use eBenefits to access more than 40 capabilities made available via eBenefits.va.gov. • Electronic Case File Transfer (eCFT): Provides VA case managers, Veterans 

Health Administration (VHA) Clinicians, and Veterans Benefits Administration 

(VBA) Rating Adjudicators the ability to receive Service Treatment Records and additional claims information in an electronic format from the DOD, ultimately resulting in more timely and efficient adjudication of disability claims. VA and the DOD 

will deploy the capability at several pilot sites during August 2012. • VLER Data Access Services (DAS): The initial capability to implement core data 

access services for use by producers and consumers of information through the 

VLER DAS will be available by July 2012. 

• Veteran Tracking Application (VTA): Electronic system designed to monitor Servicemembers and Veterans performance of the IDES process. VTA 2.0 was released 

on June 9, 2012 providing enhanced information sharing between VA and DOD case 

managers and additional DD–214 data required for claims processing. 

DOD Response. DCMO and USD (P&R) ED VLER work closely on several IT 

projects that will benefit transitioning Servicemembers. Some of these are ‘‘bridge’’ 

solutions until fielding of Integrated Electronic Health Record (iEHR) and VLER. 

Projects include: 

Automating Disability Benefits Questionnaire (DBQ) Information Collection: VA is 

developing a capability to provide a TurboTax®-like, Web-based forms to facilitate 

the collection of specific disability VA Rating Schedule information from VA and private clinicians who perform disability examinations. The initial capability will be 

available in summer 2012, with all Disability Benefits Questionnaire (DBQ) forms 

available in the automated solution by fall 2012. 

eBenefits: Secure Web portal that provides a central location for Servicemembers, 

Veterans, and their families to research, find, access, and manage their benefits and 

personal information. VA and DOD are committed to improving the online experience for Veterans and Servicemembers. More than 1.4 million Veterans and Servicemembers use eBenefits to access more than 40 capabilities made available via 

eBenefits.va.gov. 

Electronic Case File Transfer (eCFT): Will provide DOD and VA the ability to exchange Service Treatment Records and additional claims information in an electronic format, resulting in more timely and efficient adjudication of disability 

claims. VA and the DOD plan to deploy the capability at several pilot sites in August, 2012. 

VLER Data Access Services (DAS): VA and DOD plan to provide an initial capability to implement core data access services for use by producers and consumers 

of information through the VLER DAS. 

Veteran Tracking Application (VTA): Electronic system designed to monitor Servicemembers and Veterans performance of the IDES process. VA released VTA 2.0 

on June 9, 2012, providing enhanced information sharing between VA and DOD case 

managers and provides additional DD–214 data required for claims processing. 

c. An end-to-end enterprise-wide IDES IT solution; 

VA Response. VA receives over a million claims for benefits each year. IDES is 

a critical program in support of Servicemember transition to Veteran status. As 

such, VLER EPMO has worked closely with subject matter experts and senior leaders within the VA—Veterans Benefits Administration (VBA) and VHA—and the Department of Defense USD (P&R), DCMO, Military Departments—in developing and 

documenting strategies to provide full IT support to the IDES program. Capabilities 

such as tracking, work flow management, reporting, and case file transfer are developed and delivered on incremental basis. 

Under the VLER Initiative, VA delivers enhancements every 6 months to better 

support the field and increase transparency, accountability, and timeliness within 

IDES. In an effort to modernize the tools available to IDES care managers and to 

better serve our Veterans, VLER is transitioning VTA to a new technology platform. 

This platform, which is shared with the Veterans Relationship Management (VRM) 

37 

initiative, will provide VTA users with enhanced functionality and streamline future 

information sharing efforts between VA and DOD case/care management/coordination and benefits assistance lines of business. The Federal Recovery Coordination 

Program (FRCP) was the first VTA module to transition to this new platform on 

June 4, 2012. VA is facilitating the transition of the remaining VTA modules such 

as IDES. In addition, VA and DOD are piloting strategies to exchange case files 

electronically between care coordinators in an effort to diminish the time it takes 

to physically transfer files. 

VLER Data Access Services (DAS), referenced above, in conjunction the Veterans 

Benefit Management Systems (VBMS), represent the latest in technology and business transformation efforts focused on reducing claims backlog for Veterans. Once 

fully implemented, claims information from DOD will be orchestrated by the VLER 

DAS to VBMS for streamlined, paperless claims adjudication. 

DOD Response. DCMO and the Office of Warrior Care Policy (WCP) have worked 

closely with VA and the Military Departments to develop and document strategies 

to provide full IT support to the IDES program. Capabilities such as tracking, work 

flow management, reporting, and case file transfer are developed and delivered on 

incremental basis. The DCMO, supporting the Office of Warrior Care Policy (WCP), 

is providing business process mapping, and business process analysis expertise to 

identify best practices and system architecture best practices. The Department will 

use this effort to inform and integrate IDES IT requirements into larger enterprise 

solutions, including iEHR, VLER, and the VLER Data Access Services (DAS). VLER 

DAS, in conjunction the Veterans Benefit Management Systems (VBMS), represent 

the latest in technology and business transformation efforts focused on reducing 

VA’s claims backlog. Once fully implemented, VLER DAS will enable streamlined, 

paperless claims adjudication from the DOD to VBMS. 

d. Any formal policy, directive(s) or other guidance issued by the Department(s) 

establishing an organizational, leadership and or governance structure for joint 

IDES IT collaboration; and 

VA Response. Business process and requirements validation for VLER Capability 

Area (VCA) 1 is governed by the Health Executive Council (HEC). Business process 

and requirements validation for VCAs 2, 3, and 4 is governed by the Benefits Executive Council (BEC). VCA 1 IT execution is overseen by the DOD/VA IPO Advisory 

Board, which is officially chartered and reports directly to the Secretary of Veterans 

Affairs and Secretary of Defense. VCA 2, 3, and 4 IT execution is overseen by the 

VLER Overarching Integrated Project Team (OIPT), which reports to several Executive Steering Committees and Task Forces. The VLER OIPT charter is currently in 

coordination. 

DOD Response. The DOD/VA Joint Executive Council (JEC) provides overall organization IT governance oversight for functional requirements and IDES/VLER Benefits. The Inter-Agency Program Office Advisory Board, which is officially chartered 

and reports directly to the Secretary of Veterans Affairs and Secretary of Defense, 

provides organization IT governance oversight for iEHR and VLER Health acquisition, and IT execution. The Health Executive Council governs business process and 

requirements validation for VLER Capability Area (VCA) 1. The Benefits Executive 

Council governs business process and requirements validation for VCAs 2, 3, and 

4. The VLER Overarching Integrated Project Team (OIPT), which reports to several 

Executive Steering Committees and Task Forces, oversees IT execution of VCA 2, 

3, and 4. The VLER OIPT charter is currently in coordination between DOD and 

VA. 

e. Metrics or criteria utilized by the Departments (e.g., VA’s project management 

accountability system (PMAS)) to evaluate the status of project-specific and enterprise level IDES IT collaboration between the Departments. 

VA Response. The VA Office of Information and Technology (OIT) Program Management Accountability System (PMAS) sets strict guidance on metrics and criteria 

to evaluate project specific and enterprise level IDES IT. PMAS is a performancebased project management discipline that is mandated by the Assistant Secretary 

for Information & Technology (AS/IT) for all planning, development, and delivery all 

IT development projects. The intent of PMAS is to improve the rate of success of 

VA’s IT projects. PMAS uses incremental product build techniques for IT projects, 

with delivery of new functionality (tested and accepted by the customers) in cycles 

of six months or less. Projects managed under PMAS are tightly monitored and are 

subject to being halted when significant deviations to plan occur and insufficient remediate plans are presented. PMAS is a rigorous management approach intended 

to deliver smaller, more frequent releases of new functionality to customers. 

All IT projects in support of IDES tracking/reporting are governed by PMAS. 

Throughout the lifecycle of the project, status against project milestones (e.g. reVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00041 Fmt 6633 Sfmt 6621 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
38 

quirements complete, development complete, Production Release) is recorded within 

the Primavera scheduling tool, and used to track the progress of the project. 

A monthly Warrior Support IPT meeting is held on the 3rd Wednesday of every 

month, and includes representatives from the business and technical communities. 

VA leadership reviews the status of PMAS projects through regular and consistent 

reporting against established baselines, such red-flag and milestone reviews. 

DOD Response. The VA Office of Information and Technology (OIT) Program 

Management Accountability System (PMAS) sets strict guidance on metrics and criteria to evaluate project specific and enterprise level IDES IT. PMAS is a performance-based project management discipline that is mandated by the Assistant Secretary for Information & Technology (AS/IT) for all planning, development, and delivery all IT development projects. The intent of PMAS is to improve the rate of success of VA’s IT projects. PMAS uses incremental product build techniques for IT 

projects, with delivery of new functionality (tested and accepted by the customers) 

in cycles of six months or less. Projects managed under PMAS are tightly monitored 

and are subject to being halted when significant deviations to plan occur and insufficient remediate plans are presented. PMAS is a rigorous management approach intended to deliver smaller, more frequent releases of new functionality to customers. 

All VA IT projects in support of IDES tracking/reporting are governed by PMAS. 

Throughout the lifecycle of the project, status against project milestones (e.g. requirements complete, development complete, Production Release) is recorded within 

the Primavera scheduling tool, and used to track the progress of the project. VA 

hosts a monthly Warrior Support IPT meeting the 3rd Wednesday of every month, 

which includes representatives from the business and technical communities. VA 

leadership reviews the status of PMAS projects through regular and consistent reporting against established baselines, such red-flag and milestone reviews. 

Question 5. Please describe the steps taken by the Departments to ensure that 

any IT solution for IDES is capable of being integrated into VLER. As part of this 

description, please detail how VLER factors into the Departments’ development of 

a shared IDES IT strategy and ongoing collaboration. 

VA Response. The Departments have taken deliberate steps to ensure any IT solution for IDES is capable of being integrated into VLER. VLER EPMO oversees 

IDES IT systems as an integrated component of the broader VLER EPMO portfolio. 

To ensure the synchronization of current and future IT solutions with the longterm VLER effort, VLER leverages existing projects, carefully defined architecture, 

and web services strategies to ensure that interfaces with the VLER Data Access 

Services can be created. For example, through the Information Sharing Initiative 

(ISI), VA and DOD share case coordinator information across Federal Case Management Tool (FCMT), VTA, and DOD systems. 

DOD Response. The Departments have taken deliberate steps to ensure any IT 

solution for IDES is capable of being integrated into VLER. VLER oversees IDES 

IT systems as an integrated component of the broader VLER portfolio. The DOD/ 

VA Benefits Executive Council Information Sharing/Information Technology (BEC 

IS/IT) group is specifically tasked to coordinate, validate and promote IDES strategic and interagency information sharing to ensure an IDES end-to-end information technology solution within iEHR and VLER. Additionally, the effort to map current DOD, VA and Military Department IT systems (and their funding streams) 

supporting IDES will help inform the BEC IS/IT of near, mid and long term IT requirements. 

To ensure the synchronization of current and future IT solutions with the longterm VLER effort, VLER leverages existing projects, carefully defined architecture, 

and web services strategies to ensure that interfaces with the VLER Data Access 

Services can be created. For example, through the Information Sharing Initiative 

(ISI), VA and DOD share case coordinator information across Federal Case Management Tool (FCMT), VTA, and DOD systems. 

Question 6. Committee oversight has discovered that the current medical evaluation process for soldiers with TBI and PTSD is inconsistent. The medical records 

of reviewed cases reflect these inconsistencies, as some medical records combine and 

document symptoms of both PTSD and TBI and others do not, leaving each as a 

separate diagnosis. 

a. What is the DOD and VA standard of practice for diagnosing TBI and PTSD? 

VA Response. VA clinicians adhere to the standards of practice established by the 

VA/DOD Clinical Practice Guideline for the Management of Concussion/Mild Traumatic Brain Injury (TBI). VA clinicians also adhere to the standards of practice established by the VA/DOD Clinical Practice Guideline for the Management of PostTraumatic Stress. 

39 

DOD Response. The DOD and VA standards of practice for diagnosing TBI and 

PTSD are based on published definitions and clinical practice guidelines. Both the 

Veterans Health Administration (VHA) Directive 2009–028 and the DOD (Health 

Affairs Memorandum, October 2007) define TBI as a traumatically induced structural injury or physiological disruption of brain function as a result of an external 

force. The VHA Directive and DOD Memorandum define severity level of TBI using 

the Glasgow Coma Scale score, length of loss of consciousness, and length of posttraumatic amnesia. In both agencies, the diagnosis of mild TBI (mTBI) is based on 

the injury event as well as changes in mental status occurring during the injury. 

The VA/DOD Clinical Practice Guidelines for the Management of Concussion/Mild 

Traumatic Brain Injury was developed in 2009 and outlines the standard criteria 

for the diagnosis of mTBI. 

Policy Guidance for the Management of Concussion/Mild TBI in the Deployed Setting (DTM 09–033) requires mandatory assessment of a Servicemember (SM) involved in potentially concussive events including vehicle associated with a blast 

event, collision or rollover; any SM within 50 meters of a blast, a direct blow to the 

head or loss of consciousness. The identified potentially concussive events provide 

a standardized method for the implementation of screening and diagnosis of acute 

mTBI in a deployed setting. 

In 2010, the DOD and VA jointly published, ‘‘The Clinical Practice Guidelines for 

the Management of Post-traumatic Stress.’’ This guideline supports the Diagnostic 

and Statistics Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV TR) 

as the standard for all behavioral health providers who work within Military Treatment Facilities (MTFs) to use for the diagnosis of PTSD, as required by licensing 

laws and credentialing agencies. 

b. How is each standard of practice applied? 

VA Response. VA issued VHA Directive 2010–012, ‘‘Screening and Evaluation of 

Possible Traumatic Brain Injury in Operation Enduring Freedom/Operation Iraqi 

Freedom Veterans,’’ in March 2010. This Directive establishes the policy for the administration of the TBI screening, comprehensive evaluation, and treatment of Operation Enduring Freedom/Operation Iraqi Freedom Veterans receiving medical care 

within VHA. 

VA also developed a computerized Comprehensive TBI Evaluation Template that 

is used to document the results of every comprehensive evaluation conducted following positive TBI screening findings. 

The VA Uniform Mental Health Services Handbook (VHA Handbook 1160.01) addresses a multitude of clinical practice issues, and indicates that treatment and assessment for mental health disorders must be consistent with the appropriate clinical practice guidelines. 

DOD Response. VA and DOD application of practice policies and procedures address the deployed and non-deployed DOD settings, as well as the post-separation 

environment of the VA. MTF credentialed providers make a diagnosis of TBI and 

PTSD based on appropriate provider education, clinical references, and compliance 

with licensing laws. These providers combine clinical practice guidelines and clinical 

judgment to arrive at a diagnosis. They may use various methods of assessment, 

including interviews, instruments and psychological screening, to evaluate whether 

or not a given SM meets the criteria for TBI and or PTSD. 

DTM 09–033 is an example of a DOD deployed setting policy for mTBI that is 

a standard applied to practice. DTM 09–033 requires all military personnel involved 

in potentially concussive events be promptly evaluated through use of a standard 

tool, the Military Acute Concussion Evaluation (MACE). There are also comprehensive screening programs for TBI that have been implemented to facilitate the detection of mTBI. The Post Deployment Health Assessment has PTSD and TBI screening questions to identify redeployed SMs who may have a history of concussion or 

have PTSD symptoms. In the non-deployed setting, the standard of practice for both 

PTSD and TBI care is applied through dissemination and implementation of evidence based guidelines. In addition, numerous clinical support tools have been developed and disseminated to assist the provider in navigating the assessment and 

treatment of both PTSD and mild TBI when SMs continue to have symptoms. 

Additionally, programs such as PTSD Treatment in Primary Care Settings, ReEngineering Systems of Primary Care Treatment in the Military (RESPECT-Mil), 

and Behavioral Health Integration enables DOD primary care providers to screen 

and treat health-seeking patients in primary care clinics for PTSD, suicidal ideation, 

and depression while integrating behavioral health care providers into routine care. 

VA issued the VHA Directive 2010–012, ‘‘Screening and evaluation of possible TBI 

in OEF/OIF Veterans,’’ in March 2010. This Directive establishes the policy for the 

administration of the TBI screening, comprehensive evaluation, and treatment of 

40 

OEF/OIF/OND Veterans receiving medical care within VHA. As part of this evaluation protocol, VHA developed a mandatory computerized Comprehensive TBI Evaluation Template that requires a diagnostic conclusion regarding the occurrence of 

TBI to be documented. 

c. What is the DOD and VA standard of practice for documenting differences between TBI and PTSD in the medical record? 

VA Response. VA’s Comprehensive TBI Evaluation Template directs the medical 

provider to make a determination as to whether the Veteran’s current symptoms are 

related to TBI, or to a mental health condition, including Post-Traumatic Stress Disorder (PTSD), or to a combination of TBI and mental health problems. It is not always possible to differentiate between the causes of some symptoms. In those cases, 

the symptoms are related to both conditions. VA’s PTSD and Mental Health Disorders Disability Benefits Questionnaires (DBQs) specifically require the examiner 

to document whether or not the Veteran has a diagnosed TBI, and if so, to document if it is possible to differentiate what symptom(s) is/are attributable to each diagnosis. The topic of differentiating PTSD symptoms from TBI symptoms is addressed during the Office of Disability and Medical Assessment’s online TBI and 

PTSD Certification trainings. 

DOD Response. Although many symptoms of TBI and PTSD overlap, they are two 

separate clinical conditions with two separate diagnostic criteria. The diagnostic criteria for TBI are established through a history and physical exam at time of injury 

and are documented through the use of ICD–9 codes as further defined by published 

definitions and guidelines. Point of injury assessment remains the most accurate approach to early identification of the presence of a TBI through mandatory concussion screening that occurs at various levels to ensure detection and maximize treatment opportunities. If a SM is diagnosed with PTSD and TBI, two separate ICD– 

9 codes are entered into the electronic health record. VA directs the medical provider to determine if the Veteran’s current symptoms are related to TBI, or to a 

mental health condition (to include PTSD), or to a combination of TBI and mental 

health problems. It is not always possible to differentiate between the causes of 

some symptoms. If symptoms are related to both conditions, both diagnoses are 

made. VA’s PTSD and Mental Health Disorders Disability Benefits Questionnaires 

(DBQs) specifically require the examiner to document whether or not the Veteran 

has a diagnosed TBI and if so, to document if it is possible to differentiate what 

symptom(s) is/are attributable to each diagnosis. The topic of differentiating PTSD 

symptoms from TBI symptoms is addressed during Disability and Medical Assessment online TBI and PTSD Certification trainings. 

d. Do all DOD and VA medical facilities adhere to the same standards of practice 

in diagnosing TBI and PTSD? 

VA Response. The policy established by VHA Directive 2010–012 and the Comprehensive TBI Evaluation Template apply across all VA facilities. VHA-wide performance measures allow monitoring of adherence to standards utilizing an External Peer Review Process. This External Peer Review Process would address the 

standards of practice of diagnosing both TBI and PTSD. 

DOD Response. DOD and VA have policies and procedures in place to ensure adherence to standards of practice in TBI and PTSD care by all providers. Some of 

these VA guidelines have already been discussed. The Services generate policies to 

which DOD providers are expected to adhere. Examples of Service policies related 

to these issues include the following: 

• OTSG/ MEDCOM Policy Memo 12–035 Policy Guidance on the Assessment and 

Treatment of Post-Traumatic Stress Disorder 

• OTSG/ MEDCOM Policy Memo 10–040 Screening Requirements for Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury (mTBI) for Administrative 

Separations of Soldiers 

• NAVMED Policy 11–001 Implementing Required Medical Exam before Administration Separation For Post-Traumatic Stress Disorder (PTSD) or Traumatic Brain 

Injury (TBI). 

e. If not, what are the reasons for not adhering to the standard of practice? 

VA Response. VA monitors consistent adherence to the TBI and PTSD standards 

of practice across all medical facilities. 

DOD Response. Providers are expected to meet the standard of care for each individual patient. Policies and guidelines cannot anticipate all of the possible reasons 

a provider may deviate from a standard of practice. Patients may require deviations 

from standard practice due to individual clinical care needs as determined by their 

health care provider. Providers are expected to clearly document rationale and clinVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00044 Fmt 6633 Sfmt 6621 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
41 

ical decisionmaking whenever they deviate from these standards of practice. In addition, an individual may refuse care. 

f. Are there instances in which a provider may deviate from the standard of practice in evaluating TBI or PTSD? If so, please explain these instances. 

VA Response. VA has policy and procedures in place to ensure adherence to 

standards of practice in TBI and PTSD care by all providers. VHA Rehabilitation 

Services and Mental Health Services are not aware of TBI/PTSD assessments or diagnoses being made outside of the standard of practice and do not sanction providers diagnosing outside of standard clinical guidance. DMA has in place Quality 

Assurance programs that can identify compliance with standards of practice. 

DOD Response. TBI and PTSD patients may require deviations from standard 

practice due to individual clinical care needs as determined by their health care provider. At times, standards of practice have difficulty keeping pace with the everevolving science of diagnostics, treatment and care. As a result, providers must use 

reasonable clinical judgment and support their diagnostic and care decisions with 

sound scientific literature and patient care documentation. With respect to TBI care, 

the clinical algorithms and guidelines are applied to each patient. Provider guidance 

addresses individual variations in treatment based upon each SM’s symptoms and 

recovery time. Each Veteran who enters the Polytrauma System of Care, at any 

level of service, requires an Individualized Rehabilitation and Community Reintegration Care Plan (VHA Handbook 1172.04). Differences in treatment approach 

or the need for consultative service with the other specialty care center would be 

documented in these treatment plans. 

Question 7. During testimony, VA referenced the potential impact that passage 

and implementation of the ‘‘VOW to Hire Heroes Act’’ may have on IDES. 

a. Describe how VA anticipates this law will impact IDES. 

VA Response. Section 1631(b) of Pub. L. 110–181, the National Defense Authorization Act of 2008, authorized automatic eligibility to VA’s Vocational Rehabilitation and Employment services for severely injured or ill Servicemembers. Section 

231 of the VOW to Hire Heroes Act (PL 112–56) extended the sunset date of that 

authorization from December 31, 2012, to December 31, 2014. 

VA implemented Pub. L. 110–181 through a memorandum of understanding 

(MOU) with DOD. In this MOU, it was agreed that a Servicemember participating 

in IDES and/or referred to a Physical Evaluation Board (PEB) is automatically eligible. This process allows VA to assist Servicemembers early in their transition to civilian life without waiting for a VA memorandum rating to determine entitlement 

to vocational rehabilitation and employment services. 

We are currently finalizing the details of a plan to implement the portion of the 

VOW Act related to Transition Assistance Program (TAP). 

b. What is the expected increase in the number of disability claims that VA anticipates as a result of implementation of this law? 

VA Response. As noted above, we are currently working out the details of a plan 

to implement the portion of the VOW Act related to TAP, which may impact the 

number of disability claims that VA anticipates. Until we have the final plan, we 

are unable to make any estimates. We expect the final plan to be completed in October 2012. 

c. If VA anticipates an increase in disability claims receipts, what actions has VA 

taken to prepare for this anticipated increase? 

VA Response. As noted above, we are currently working out the details of a plan 

to implement the portion of the VOW Act related to TAP, which may impact the 

number of disability claims that VA anticipates. 

Question 8. DOD testimony stated that the Departments ‘‘* * * are currently developing a memorandum of understanding that will allow DOD to become a member 

of the working groups updating the VASRD and give DOD the opportunity to make 

recommendations prior to the publication of proposed changes in the Federal Register.’’ 

a. Has DOD participated in the VASRD update project to date and if so in what 

capacity? 

VA Response. DOD has appeared at the public forums on the VASRD update 

project and offered expertise and assistance at several of its working groups. 

DOD Response. DOD’s participation in the update project has so far been limited 

to the public forums. 

The Deputy Assistant Secretary of Defense (Health Affairs, Clinical and Program 

Policy) attended portions of the VASRD Public Forum in New York City from January 17–26, 2012. DOD will continue to participate by sending representatives to 

these VASRD forums that review updates on ratings for specific body systems whenVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6621 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
42 

ever possible. DOD representatives at these forums may provide input, but will not 

be voting members on the potential adjustments. The Secretary of the VA retains 

ultimate authority for managing changes to the VASRD. 

b. What impact, if any, will the memorandum of understanding and DOD participation have on VA’s timeline for issuance of proposed rules? 

VA Response. The memorandum of understanding states that DOD may participate in the working groups and that VA will provide DOD 30 days to comment before publishing its proposed rules. VA does not anticipate any significant impact to 

the existing project timeline. 

DOD Response. The memorandum of understanding (MOU) mentioned above will 

provide for DOD to have clear methods for requesting any changes to the VASRD. 

It includes a provision for the DOD to apply to have a representative on the VA 

Advisory Committee, subject to approval by the Secretary of the VA. It provides 

DOD with a 30 day period to make comments on any updates to the VASRD prior 

to publication. Given these opportunities for DOD to participate early in the update 

process, it is anticipated that there will be minimal impact on the overall timeline 

for VA issuance of proposed rules and adjustments. This MOU has been coordinated 

at the deputy assistant secretary level at VA and DOD; it requires a legal review 

and then approval through the Secretaries. 

c. VA has announced that a VASRD Status Summit will be held on June 4–8 and 

11–13, 2012 to allow the public to comment on working drafts of proposed regulations for nine body systems. Has or will DOD make recommendations prior to publication of proposed rules on the body systems for which draft proposed regulations 

have already been developed? 

VA Response. As stated above, the MOU gives DOD 30 days to comment before 

VA publishes the proposed rules. 

DOD Response. DOD was invited to send representatives to the conferences referenced, and the invitations and agendas were passed on to the Services, but they 

were not able to send subject matter experts for the particular body systems discussed. DOD was provided opportunity to comment on the proposed rules prior to 

the conferences, but did not have any recommended changes or objections. Based on 

the MOU, in the future DOD will have an opportunity to comment prior to publication of notice for these conferences, and will have longer lead time to ensure that 

DOD subject matter experts can take advantage of that opportunity for review and 

comment as needed. 

Question 9. The minutes of the VA and DOD Secretaries’ February 27 meeting 

state that the ‘‘results of decisions on how redundancy and overlap issues in the VA 

and DOD care coordination programs will be resolved (to be made at May 2012 

JEC)’’ was set as a deliverable for the next Secretaries’ meeting. Please describe 

that decision, the results, and the plan of action to address those issues. 

VA Response. The Joint Executive Council (JEC) formed a VA DOD Warrior Care 

and Coordination Task Force (VA DOD WC2TF). Task force recommendations will 

be briefed to the JEC (via the HEC and BEC) in August 2012. Current work of the 

VA DOD WC2TF includes: 

• Establish overarching care coordination policy for severely injured, ill, and 

wounded warriors in transition 

• Crosswalk the DOD Instructions and VA Handbooks addressing care coordination and case management into a single directive (‘‘common doctrine’’) 

• Create a single, Comprehensive Plan for care, services and benefits for better 

synchronization and integration 

• Establish a formal governance structure, informed by a Community of Practice 

that will serve as an ongoing forum for policy, programming and oversight. 

DOD Response. The Secretaries have directed that the two Departments complete 

the review and resolve the redundancies between the Federal Recovery Coordination 

and Recovery Coordination Programs by their next meeting in the September timeframe. DOD and VA, along with the military services and the Wounded Care Policy 

Department, have formed a Task Force which will forward recommendations to the 

August 10 JEC. 

Question 10. The minutes of the VA and DOD Secretaries’ February 27 meeting 

state that for the next Secretaries’ meeting the Departments will ‘‘i. Determine resource implications of implementing the revised transition program for FY 2012 and 

FY 2013,’’ as well as ‘‘ii. Deliver implementation plan for revised Transition Assistance Program (TAP) and implementation of VOW Act to White House including the 

’virtual delivery’ of TAP so that interagency partners can plan the requisite support.’’ Please provide the determination of resource implications described in (i), as 

43 

well as the implementation plan for revised TAP (including virtual TAP) described 

in (ii). 

VA Response. As noted above, we are currently working out the details of a plan 

to implement the portion of the VOW Act related to TAP, which may impact the 

number of disability claims that VA anticipates. 

DOD Response. 

‘‘i. Determine resource implications of implementing the revised transition program for FY 2012 and FY 2013,’’ 

Members of the DOD/VA Veterans Employment Initiative Joint Task Force are 

in close dialog with the Office of Budget Management and the agencies and Military 

Departments have developed the implementation plan with costing. The IP is currently at the White House awaiting approval. 

In the meantime, the Department of Defense and our Department of Labor and 

Veterans Affairs are working hard to implement the mandate of the VOW to Hire 

Heroes Act. This requires all Servicemembers to attend the DOL Employment 

Workshop, which essentially nearly doubles the throughput for the DOL workshop. 

While some members will receive waivers to participate in the workshop, no member will be exempt from receiving Pre-separation Counseling and the VA Benefits 

briefing. 

‘‘ii. Deliver implementation plan for revised Transition Assistance Program (TAP) 

and implementation of VOW Act to White House including the ‘virtual delivery’ of 

TAP so that interagency partners can plan the requisite support.’’ 

The response is at the end of the first paragraph: 

The DOD/VA Veterans Employment Initiative Task Force Implementation 

Plan is under review by the White House staff. This includes the proposal 

and costing for delivering new curriculums virtually. The Task Force proposes to leverage the Army’s extensive work on virtual curriculums to develop and deploy the revised standardized curriculum in a virtual format. 

It is planned for the pilot to set the stage for expanded virtual delivery of 

instruction to meet the needs of dispersed military members. This will help 

Servicemembers access instruction more readily and prepare for transition 

earlier in the military life cycle. 

Additionally, President Obama announced, at the VFW Convention on July 23, 

the launch of the redesigned Transition Assistance Program (TAP) developed by an 

interagency task force which includes DOD, the Departments of Veterans Affairs 

(VA), Labor (DOL), Homeland Security (DHS), Education (ED), Office of Personnel 

Management (OPM), and the Small Business Administration (SBA). The re-design 

includes modified curriculum that assists in making transitioning Servicemembers 

‘‘career ready’’ upon separation. 

The re-designed DOL Employment Workshop and the core modules for transition 

preparation began being piloted in July and will continue through August 2012. The 

locations include: Fort Hood, Texas; Ft. Sill, Okla.; Utica Army National Guard 

Base, N.Y.; Jacksonville Naval Air Station, N.C.; Norfolk NAS, VA; Randolph Air 

Force Base, Texas and Miramar Marine Corps Air Station, California. Based on results of the pilot, the curriculum will be modified, as appropriate. Using the modified curriculum and standardized learning objectives, the Military Services will expand Department-wide, to deliver service at approximately 250 military installations worldwide preparing Servicemembers to transition confidently from military 

service to the civilian workforce. 

Question 11. Please provide an update on progress made in the merger of the SOC 

and JEC, including any functions of the SOC which have not yet been fully incorporated into JEC operations. Has the Secretary of Defense appointed the DOD Deputy Secretary to co-chair the SOC, does the Department feel it is necessary or appropriate for the Deputy Secretary to continue overseeing the issues following the 

merger of these entities? 

VA Response. As of January 19, 2012, the JEC assumed all of the Senior Oversight Committee (SOC) functions for oversight of IDES. VA’s Deputy Secretary CoChairs the JEC. DOD must decide the appropriate level of participation on the JEC. 

DOD Response. The merger of the SOC and JEC has been completed as of 

20 March 2012 with all the former functions of the SOC incorporated into the JEC 

process. Due to the inclusion of senior leadership and the initiation of the Secretary 

of Defense/Secretary of Veterans Affairs meetings, which discuss specific JEC topics, 

it is not necessary for the Deputy Secretary to oversee JEC issues. Title 38 Section 

320 has identified the Under Secretary of Defense for Personnel and Readiness as 

the DOD chair for the interagency committee. The Under Secretary of Defense for 

Personnel and Readiness has oversight for all policy issues and has direct access 

44 

to the Secretary of Defense. The portfolios of both DOD and VA now line up for 

oversight of former SOC and current JEC topics. 

Question 12. Please describe any recent or planned realignment of components or 

functions of the Office of Wounded Warrior Care and Transition Policy, including 

what improvements the Department expects from such realignment, as well as how 

DOD will oversee and evaluate the efficacy of the realignment. 

VA Response. [VA defers to DOD.] 

DOD Response. The Office of Wounded Warrior Care and Transition Policy 

(WWCTP) was moved, effective June 1, 2012, to the Office of the Assistant Secretary 

of Defense for Health Affairs (ASD HA). Simultaneously, the Transition Assistance 

Program (TAP) component of WWCTP was moved under the office of the Assistant 

Secretary of Defense for Readiness and Force Management (ASD R&FM). WWCTP’s 

name has been changed to Warrior Care Policy (WCP). 

The realignment of WCP, and its TAP component, within the broader Personnel 

and Readiness (P&R) portfolio will strengthen WCP’s effectiveness in carrying out 

the Department’s commitment to wounded warriors and its ability to effect change. 

WCP’s current activities and support for wounded warriors directly relates to the 

health and healthcare of these individuals. WCP’s programs and initiatives in support of wounded, ill and injured Servicemembers will not change; alignment within 

HA will provide enhanced support and coordination for these activities. WCP’s strategic initiatives are being folded into the HA strategic plan and will be monitored 

and tracked during quarterly review and analysis meetings with the Service surgeon generals. The Deputy Assistant Secretary for WCP (DASD WCP) reports directly to the ASD HA and provides regular program updates at weekly ASD HA 

leadership meetings. The DASD WCP also retains responsibility as the principal advisor to the Office of the Under Secretary of Defense for Personnel and Readiness 

for Wounded Warrior matters. 

Likewise, the Transition Assistance Program (TAP), because of its wider applicability to all transitioning Servicemembers, is best aligned with activities and programs of the ASD R&FM. The ASD R&FM has oversight of military personnel policy, education policy and civilian policy, and is in the best position to lead, integrate 

and enhance the Department’s necessary and critical focus on the transition issues 

for our military personnel. Direct oversight for TAP strategic initiatives and policy 

is provided by the deputy director of the newly established Transition to Veterans 

Program Office. The deputy director reports directly the ASD R&FM. 

Question 13. Please describe the activities and findings to date of the VA Wounded, Ill, and Injured Task Force, including a timeline for completion of the Task 

Force’s review and implementation of any recommendations it will make. 

VA Response. The Wounded, Ill, and Injured Task Force conducted a VA-wide survey of programs providing care coordination, case management and/or benefits advisors. This identified a need to synchronize and integrate services amongst programs 

within VA and DOD. Current work of the VA DOD WC2TF includes: 

• Establish overarching care coordination policy with common mission, language 

for severely injured, ill, and wounded warriors in transition 

• Crosswalk the DOD Instructions and VA Handbooks addressing care coordination and case management into a single directive (‘‘common doctrine’’) 

• Create a single, Comprehensive Plan for care, services and benefits for better 

synchronization and integration 

• Establish a formal governance structure, informed by a Community of Practice 

that will serve as an ongoing forum for policy, programming and oversight. 

Recommendations will be briefed to the JEC (via the HEC and BEC) in August 2012. 

DOD Response. DOD defers to VA to provide the activities and findings to date 

of the VA Wounded, III, and Injured Task Force. However, Secretary Panetta directed that an internal DOD task force review the IDES process, with VA’s support, 

and report to him by the end of September 2012 on improvement recommendations. 

Question 14. The Departments have set a goal of having 60 percent of new IDES 

claims processed within 295 (Active) and 305 (Reserve/Guard) days. Why was the 

goal set at only 60 percent of new claims? What is the Departments’ plan for reaching 100 percent of new claims processed within the Departments established 

timelines? 

VA Response. The Departments strive to process all IDES cases within 295 days 

for Active Duty and 305 days for RC members. However, because each case has its 

unique challenges and there are many variables involved 60 percent was established 

as an initial achievable goal for calendar year 2012. In an ongoing effort to achieve 

100 percent of new claims processed within the established timelines, the departVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00048 Fmt 6633 Sfmt 6621 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
45 

ments will continue to streamline and automate as much of the process as possible, 

and explore and implement other process improvement measures. 

DOD Response. The DOD/VA Joint Executive Council established activities and 

milestones for improving the IDES in Joint Strategic Plan for Fiscal Years 2011– 

2013, Goal 3, Efficiency of Operations. The improvement metric is the percentage 

of Servicemembers who complete the IDES process within goal. In the plan, the Departments set a long-term goal that 80% of Servicemembers complete the IDES 

within goal (295 days for active component or 305 days for reserve component). The 

Departments set the interim that 60% of Servicemembers complete the IDES within 

goal in calendar year 2012. The Departments’ goals recognize that each Servicemember’s case is unique and that some Servicemembers will finish IDES in less 

than 295 days while others with more complex cases will take longer than 295 days. 

Although the Departments are striving to accelerate the IDES process for all, the 

current JSP goals incorporate the reality of variations in case complexity and the 

current caseload of Servicemembers awaiting disability evaluation. 

Question 15. Please detail the current operational status, activities, and resource, 

space and personnel allocations for each of the Vision, Traumatic Extremity Injuries 

and Amputation, and Hearing Centers of Excellence. 

VA Response. [VA defers to DOD.] 

DOD Response. 

Hearing Center of Excellence (HCE) 

Operational Status • Achieved Initial Operating Capability (IOC): key staff appointed, plus contracted staff for daily 

operations, strategic communications, registry planning, research administration, and fitness 

for duty support. 

• Full Operating Capability (FOC), defined as an operating hearing data registry, with launch of 

hearing protection campaign-expected December 2013. 

Activities • Published Concept of Operations to guide IOC/FOC progression. 

• Selected HCE Leadership-staff is joint DOD/VA (pending formal appointment process); extremely cohesive team and unified alignment of objectives. 

• Determined overall staffing requirements-pending validation review and approval. 

• Launched Web site (hearing.health.mil). 

• Chartered DOD Fitness for Duty working group to determine auditory standards required for 

specific military occupations. 

• Cataloged portfolio of DOD/VA hearing-related research activities to orchestrate best use of 

limited Federal research funding. 

Resources • Sufficient resources to date and into next FYs (FY 2012 = $10.9M). 

Space • Sufficient space allocated within Wilford Hall Ambulatory Surgical Center (8200 sq. ft. (SF) 

temporary space). Anticipate 3000 SF in permanent space. 

Personnel Allocations • Executive Director appointed; 4 Directorate Chiefs assigned; civil service hiring progressing 

with expected staff late CY 2013. 

Extremity Trauma and Amputation Center of Excellence (EACE) 

Operational Status • Current manning is eight DOD staff, one VA staff, and zero contractors. Key staff hired include the Executive Director, Deputy Director, and Chief of Staff; contract manpower equivalents equal to 2.4 are inbound in July 2012; the VA is hiring four full-time staff and each of 

the DOD Advanced Rehabilitation Center (ARC) sites are initiating actions for hiring personnel 

approved in the Concept of Operations (CONOPS). 

• Planned Initial Operating Capability (IOC) date is 1 October 2012 and is defined as 50% 

manning at each ARC site, staff Directorate, and Executive Office, with the Manpower Concept Plan submitted. We forecast 17 DOD, three contractors, and one VA FTE on-board by our 

projected IOC. Research, global outreach, informatics, clinical care, and leadership sections 

are currently sustained. With future hires we will gain momentum toward greater capability. 

Activities • Published CONOPS and Balanced Scorecard to guide EACE progression. 

• Army Manpower Concept Plan currently being written to conform to the Center of Excellence 

Oversight Board approved CONOPS staffing requirements. Selected EACE leadership team including Executive Director, Interim VA Deputy Director, Chief of Staff, and Deputy Director for 

Research. The four VA staff were approved for hire by VA leadership. 

• Established Capability Integrated Product Team (DOD/VA) to develop the EACE-specific registry requirements for the planned Federated Registry, led by the Vision Center of Excellence. 

• Building EACE Web site on health.mil. Expect completion within 30 days. 

46 

Extremity Trauma and Amputation Center of Excellence (EACE)—Continued 

• EACE executive leadership, VA Amputation System of Care (ASoC) leadership, and DOD ARC 

representatives met in January 2012 to establish strong working relationships and gain better 

understanding of each other’s missions. Currently conducting biweekly conference calls with 

ARC and ASoC leadership to better collaborate and address joint issues. Next EACE, DOD, and 

VA leadership meeting will be held in San Antonio 31 July to 2 August 2012 during the VA 

Amputation Skills Conference. • Building portfolio development for DOD/VA EACE-related research activities. Seeking seats on 

programming boards, i.e. the Medical Research and Materiel Command (MRMC) Joint Program 

Committee for Clinical Rehabilitative Medicine (JPC–8), identifying research gaps and helping 

to establish research priorities. • At the request of the European Command (EUCOM), EACE global outreach consultative activity to enhance amputee care capability in the Republic of Georgia Ministry of Defense is ongoing. 

Resources • Sufficient operations and maintenance (O&M) resourcing to date and in the Future Years Defense Program (FYDP). FY 2012 budget: $5.9 million. 

Space • Sufficient space allocated within all ARCs (San Antonio Military Medical Center (180 SF); 

Walter Reed National Military Medical Center, Bethesda (300 SF); and Naval Medical Center, 

San Diego) and Executive Office in San Antonio, Texas (330 SF). 

Personnel Allocations • Each ARC is actively hiring civil service employees. The Executive Office and VA are also 

placing maximum priority on hiring. The process is lengthy but is progressing well.Extremity 

Trauma and Amputation Center of Excellence (EACE) 

Vision Center of Excellence (VCE) 

Operational Status • DOD and VA executive leadership in place; leadership for 4 of 6 Directorates hired. • Currently, 15.6 government staff hired with 8 contractors providing administrative support to 

two regional locations: National Capital Region and Joint Base Lewis-McChord. 

Activities • Transitioned from TRICARE Management Activity (TMA) to Navy Bureau of Medicine and Surgery (BUMED)—October 2011. • Published and received approval of VCE Strategic Plan and Concept of Operations by the MHS 

CoE Oversight Board—January 2012. • Developing VCE Program Management Plan. • Developed FY11–12 vision research priorities—April 2011. • Research grantee site visits—in process. • Deployed Defense and Veterans Eye Injury and Vision Registry (Vision Registry) Pilot— 

March 2012. • Developing VA Eye Injury Data Store to provide VA clinical data to the Vision Registry. • Leading effort to develop functional requirements of a joint VA/DOD electronic eye note for the 

integrated Electronic Health Record (iEHR). • Partnered with Harvard Medical School/Massachusetts Eye and Ear Infirmary/Schepens Eye Institute and Smith-Kettlewell Research Institute to conduct biannual symposia. • Coordinating monthly Worldwide Ocular Trauma Video Teleconferences—March 2011 (ongoing). • Leading the process to include Fox eye shields in military individual first aid kits. • Developing training initiatives and clinical recommendations for VA and DOD vision care providers. 

• Coordinating with the Committee for Tactical Combat Casualty Care to include Fox eye shield 

use in first-responder training programs. 

• Leading the effort with MHS Office of Strategic Communications for the health.mil Web site 

re-design. 

• Presented/participated in national and international vision care educational programs. 

• Directing gap analysis for assistive technology for the visually impaired. 

• Published Federal Practitioner (circ.∼35,000) update ‘‘Focus on Capabilities Not Disabilities— 

Sports and Recreation for the Visually Impaired Servicemember and Veteran’’—June 2012. • Implementing a pilot vision impairment education center for Servicemembers, Veterans and 

their families at Walter Reed National Military Medical Center, Bethesda, MD. 

Resource Allocation • Budget FY 2012: DOD $17.911M; VA $2.272M. 

Space Allocation • Headquarters: Bethesda, MD (Walter Reed National Military Medical Center), approx. 1,700 sq. 

ft.—opened March 2012; Arlington (Crystal City), VA; approx. 14,500 sq. ft.—opened 

July 2011 

• VCE West: Tacoma, WA (Madigan Army Medical Center), approx. 120 sq. ft. under tenancy negotiation—opened October 2010. 

• VCE South: San Antonio, TX (San Antonio Military Medical Center)—in planning stages. 

Personnel Allocation • Human capital assets as of 6/11/2012: Mil—1, DOD—11, VA—3.6; Total government 

staff—15.6; Total contract staff—8. • Executive Director (DOD) appointment 2008. 

• Deputy Director (VA) initial appointee 2008, successor appointment 2010. 

47 

Vision Center of Excellence (VCE)—Continued 

• Four of six Mission Area Directors hired (Information & Information Management, Technology, 

Rehabilitation & Reintegration, and Education and Training). Two Directors remaining to be 

hired: (Clinical Care Integration, and Research & Development • Human capital, facilities, and resource management administrative support hired. • Vision Services Care Coordinator hired to support DOD and VA clinical care coordination. 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO JO

ANN ROONEY, ACTING UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE AND JOHN R. GINGRICH, CHIEF OF STAFF, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. In written testimony for the record, Paralyzed Veterans of America 

said this about the Integrated Disability Evaluation System (IDES): 

‘‘Servicemembers who are participating in the new approach to discharge 

evaluation are not systematically being encouraged to seek representation 

from a [veterans’ service organization] Service Representative. Most are relying instead on the advisory services of military counsel, yet each service 

provides access to military legal counsel in different manners and circumstances.’’ 

a. What is being done to provide Servicemembers in IDES with access to representatives from veterans’ service organizations (VSOs)? 

VA Response. [VA defers to DOD.] 

DOD Response. DOD policy requires the Military Departments to inform Servicemembers they may seek assistance during the IDES process from Government legal 

counsel provided by the Military Departments, private counsel retained at their own 

expense, or from a VA-accredited representative of a service organization recognized 

by the Secretary of Veterans Affairs, using VA Form 21–22, ‘‘Appointment of Veterans Service Organizations as Claimant’s Representative,’’ or from a VA-accredited 

claims agent or attorney using VA Form 21–22a, ‘‘Appointment of Individual as 

Claimant’s Representative.’’ 

b. Of the 139 sites using the IDES process, how many have representatives from 

VSOs on site to help Servicemembers with the IDES process? 

VA Response. [VA defers to DOD.] 

DOD Response. VA indicates all IDES sites can accommodate VSO’s that choose 

to make themselves available to Servicemembers. Some sites are able to provide 

dedicated space for accredited VSOs, while other sites accommodate VSOs through 

temporary meeting space. 

c. Has the Department of Defense (DOD) provided uniform guidance or requirements about when Servicemembers should have access to counsel during the IDES 

process? If so, please provide a copy to the Committee. 

VA Response. [VA defers to DOD.] 

DOD Response. Yes. DOD policy (Directive-Type Memorandum (DTM) 11–015— 

Integrated Disability Evaluation System (IDES), December, 2011) provided uniform 

guidance or requirements about when Servicemembers should have access to counsel during the IDES process. 

Question 2. In a September 2010 report, VA and DOD identified customer satisfaction as a key indicator of IDES performance. 

a. What is currently being done to gauge customer satisfaction with the IDES 

process? 

VA Response. [VA defers to DOD.] 

DOD Response. The IDES Customer Satisfaction Survey was suspended as of December 6th, 2011, following funding cuts. Currently the VA and DOD are not involved in any systematic data collection efforts for customer satisfaction data. 

b. Does DOD plan to use customer satisfaction surveys in the future? 

VA Response. [VA defers to DOD.] 

DOD Response. Yes, the DOD plans to resume use of the customer satisfaction 

surveys by October 2012, subject to availability of funds. 

c. If so, when will those surveys begin and what, if any, changes would be made 

to the surveys that were being used previously? 

VA Response. [VA defers to DOD.] 

DOD Response. DOD plans to resume IDES Customer Satisfaction surveys beginning in fiscal year 2013. DOD is currently reviewing previous IDES surveys to determine whether they can be improved. 

48 

Question 3. The Government Accountability Office (GAO) has previously reported 

that staffing shortages are part of the reason for delays during the IDES process. 

a. Of the 139 sites using IDES, how many have enough staff to meet all of the 

agencies’ staffing goals for each phase of the IDES process? 

VA Response. VHA uses a flexible approach to providing staffing options to Veterans Integrated Service Network (VISN) and facility directors. Facilities and VISNs 

have used Locum Tenens and contract providers to supplement their staffs as 

surges have impacted their facilities. They have also managed the schedules of their 

Compensation and Pension (C&P) staff to maximize efforts to meet examination demands. This approach has shown results as VHA has in 9 of the past 10 months 

exceeded the goals for IDES medical examinations at a time when examination demand has more than doubled. Further, VHA’s flexible approach has allowed it to 

meet or exceed national standards for general C&P examinations as well. This agile 

approach was proven necessary as the services often are challenged in identifying 

workload numbers or impact locations in a timeframe allowing for long-term planning/staffing. 

VA is staffed to support the estimated steady state of 27,000 IDES claims per 

year. VA and DOD continue to assess the impact of troop movement and drawdown 

of forces on the IDES program. We will monitor resource needs as part of our overall evaluation of the program. 

DOD Response. All the Services are required to provide quarterly reports of 

PEBLO staffing ratios at each IDES military treatment facility. Navy indicates that 

all but two IDES sites are adequately staffed, with positions being filled at Naval 

Hospital29 Palms and Naval Hospital Beaufort. Army reports indicate adequate 

staffing at 21 sites with hiring actions at the other 15. Air Force reports adequate 

staffing at their 74 sites, though 13 use alternate staff to assist as required. Air 

Force is requesting additional PEBLO assistants for every site. 

b. If any sites are not meeting all staffing goals, please provide a timeline for 

when those sites will have sufficient staff to meet all goals. 

VA Response. As stated to the previous question, it is important to note that a 

flexible staffing approach is necessary given how surges, by definition, ebb and flow. 

Contractors and Locum Tenens are the best approach to these examination needs. 

MSC staffing goals were met at each site as IDES was implemented worldwide, 

and continue to be met at all sites today. 

DOD Response. The Department of the Army projected but did not complete hiring of long-term IDES staff at MTFs in July 2012. Army has filled over 90% of positions for MEB physicians, PEBLOs, and legal assistants. Filling behavioral health 

positions remains the Army’s largest challenge—36% currently filled, expected to 

rise to 69% once current candidates are on boarded. The Army continues hiring efforts for the remaining positions. In addition, the Army is also establishing 5–7 remote IDES processing locations to handle peak overflow volume. The Air Force 

projects completing additional PEBLO assistant hiring in FY 2014. Navy’s hiring actions are currently open and should be filled before the end of the fiscal year. 

c. Do the agencies have plans to use sites other than medical treatment facilities 

to expand IDES capacity? If so, please explain. 

VA Response. The term ‘‘medical treatment facilities’’ is normally associated with 

health care facilities under the auspices of DOD. VA, however, has no plans to conduct IDES C&P examinations at other than facilities agreed upon during the initial 

IDES implementation or locations established by our Disability Examination Management (DEM) Contractors located within the vicinity of the military installations. 

DOD Response. The Air Force and Navy have no plans to use sites other than 

MTFs to expand IDES capacity. The Army is pursuing a strategy to establish 5– 

7 remote IDES processing locations to handle peak overflow volume. The Army anticipates the expansion locations will be located near MTFs to allow sharing of administrative support. The Army’s expansion centers will be located in government 

facilities or leased space adjacent to Army installations. 

d. How many of the 139 IDES sites prepare Narrative Summaries at their own 

locations? 

VA Response. VHA does not prepare Narrative Summaries. This question should 

be redirected to DOD. 

DOD Response. Narrative Summaries are prepared within the MTF at all IDES 

sites. 

Question 4. In May 2011, the Secretary of Defense and Secretary of Veterans Affairs committed to revising IDES so that it could be completed in 150 days. They 

also agreed to explore options so it could be completed in 75 days. For the record, 

please explain the status of those efforts. 

49 

VA Response. The remodeled Integrated Disability System (rIDES) was designed 

to meet the Secretaries intent of completing the process in less than 295 days. However, the Army had concerns about the effectiveness of rIDES and wanted to focus 

their energy on improving IDES. At the December 2011 SOC meeting, the decision 

was made to defer rIDES proof of concept. The SOC directed the workgroup to continue to focus on IDES improvements, harvest best practices from site visits, analyze and test them and continue to move forward. 

DOD Response. We continue to focus on IDES improvements which include actions such as: 

• IDES site visits by interdisciplinary teams to identify and communicate specific 

refinements across the Services. Those visits yielded improvements that have been 

implemented system-wide, such as a locally developed case management tool for 

tracking medical board cases; • Working closely with VA to develop and implement in 2012 an IT capability to 

electronically transfer IDES case files among case workers; • Establishing the task force Secretary Panetta directed to review the IDES process by the end of September 2012 on improvement recommendations; • Evaluating ways to improve utilization of our expedited evaluation process for 

catastrophically ill or injured Servicemembers. 

Question 5. As reflected in VA Fast Letter 12–07, IDES examinations for members 

of the Guard and Reserves are being handled closer to their current locations. 

a. How and when are the local facilities notified of how many Guard and Reserve 

members they should expect to provide with examinations? 

VA Response. The local facilities are notified of how many Reserve Component 

(RC) members they should expect to provide with examinations when the MSC inputs the exam request(s) into the Compensation and Pension Records Interchange 

(CAPRI) system. This occurs after the MSC conducts the initial interview with the 

Servicemember. The request is forwarded electronically to the VA facility closest to 

the RC member’s home that has the clinical capability to satisfy the examination 

requirements. Currently, predictability of the RC workload and the proposed distribution of this workload remains a challenge. 

DOD Response. DOD updates VA on anticipated case flow estimates. In addition, 

DOD and VA require local leaders to communicate anticipated changes in case flow 

or capability and to develop contingency plans to meet unanticipated changes in 

case flow. 

b. When a local facility receives a request to perform an IDES examination, does 

that examination take priority over that facility’s standard compensation and pension examination workload? 

DOD Response. [DOD defers to VA.] 

VA Response. IDES examinations enjoy the same priority as the C&P examinations offered to our Veterans. Facilities do attempt however, to get these examinations scheduled and completed as soon as possible to remain within the IDES goals 

for conducting medical examinations. 

As of May 20, 2012, the VHA average for completing IDES medical exams was 

38 days plus one day for administration; the IDES Program goal for examination 

completion is 45 days. 

Question 6. According to written testimony for the May 23, 2012, hearing, the 

Joint Executive Council (JEC) reviews a monthly report regarding the performance 

of IDES. 

a. Please explain what role the JEC plays in terms of trying to improve IDES performance. 

VA Response. The JEC replaced the SOC on January 12, 2012. The JEC serves 

as the primary VA and DOD coordination body for overseeing and supporting joint 

activities, initiatives and wounded, ill and injured issues. IDES is one of those joint 

initiatives the JEC provides oversight and guidance to. The JEC recommends to the 

respective Secretaries the strategic direction for joint coordination and sharing efforts. The JEC then oversees the execution and implementation of those efforts. 

b. Who ultimately has responsibility for IDES decisionmaking and fixing any existing problems with IDES? 

VA Response. The Secretaries of the VA and DOD are ultimately responsible for 

decisionmaking and fixing any existing problems with IDES. The Deputy Secretary 

of VA and Under Secretary of Defense for Personnel and Readiness serves as cochairs of the Joint Executive Council (JEC) which coordinates and oversees joint 

VA/DOD initiatives. 

c. Please provide an organizational chart showing all offices within VA, DOD, and 

the military services that are involved in the IDES process and the lines of authority for reporting and accountability. 

50 

DOD Response. [DOD defers to VA.] 

VA Response. See Operational Model Diagram (which is displayed previously 

under responses to Senator Murray’s Question 3). 

Question 7. According to written testimony for the May 23, 2012, hearing, there 

are currently over 27,000 military personnel going through the IDES process. 

a. In total, how many additional military personnel are projected to enter the 

IDES process in 2012, 2013, and 2014? 

VA Response. [VA defers to DOD.] 

DOD Response. Army expects their IDES caseload to continue to increase to approximately 30,000 cases by the end of 20 12 and to remain steady through 2014, 

then to decrease back to pre-deployment levels of around 12,000. Navy projects 1275 

additional cases beyond current levels in FY 2012, 541 in FY 2013, and 549 in FY 

2014. The Air Force projects 400 Servicemembers beyond current levels will enter 

the IDES each year FY 2012–FY2014. 

b. Of those military personnel, what portion is expected to be from active components and what portion is expected to be from the Guard and Reserves? 

VA Response. [VA defers to DOD.] 

DOD Response. Army has dedicated new resources to assist in preparing and 

processing Reserve Component disability cases and expects the percentage of Servicemembers entering the IDES who are from the Reserve Components to increase 

temporarily beyond the current 30 percent. 

The Army does not yet have an estimate of the proportions of cases expected from 

the Reserve Components from FY 2012 to FY 2014. Of the additional expected IDES 

cases beyond current levels, the Navy expects 89 Reserve Component members to 

enter the IDES in FY 2012, 38 in FY 2013, and 38 in FY 2014. Of the additional 

expected IDES cases beyond current levels, the Air Force expects 60 Reserve Component members to enter the IDES each year between FY 2012 and FY 2014. 

c. Are all IDES cases treated with the same priority level or are there certain categories of cases that are expedited above other cases? For example, are there procedures to expedite cases based on financial hardship or if the servicemember has received a civilian job offer? 

VA Response. [VA defers to DOD.] 

DOD Response. The Military Departments expedite the cases of catastrophically 

ill or injured Servicemembers who choose to waive the IDES process and participate 

in the Expedited DES process. 

In addition, the Military Departments, where possible, expedite IDES cases of 

Servicemembers with extenuating circumstances. 

Question 8. According to VA’s written testimony, ‘‘VA can deliver benefits in the 

shortest period allowed by law following discharge thus reducing the ‘benefit gap.’ ’’ 

a. For the record, please explain what is the ‘‘shortest period allowed by law’’ for 

making VA disability payments following discharge or release from the military. 

VA Response. The ‘‘shortest period allowed by law’’ for making VA disability payments following discharge or release from the military is the first day of the second 

month after a Servicemember separates. 38 U.S.C. § 5111 states that payment of 

monetary benefits may not be made for any period before the first day of the calendar month following the month in which the award became effective. For example, if the Servicemember separates on July 27, the award is effective the day following discharge, or July 28. Benefits begin to accrue on the first day of the next 

calendar month, or August 1. Payment for the month of August occurs on September 1. 

DOD Response. U.S. Code prohibits VA from providing disability compensation 

prior to the first day of the second month following discharge or release from the 

military. For example, if the Servicemember separates on July 27, the earliest date 

VA can compensate the Veteran for disability is September 1. 

b. Currently, how long on average is it taking for VA to issue a benefits decision 

after an IDES participant is discharged or released from the military? As requested 

at the hearing, please provide any statistics on how long after service IDES participants receive their first VA disability compensation payment (not the VA decision 

letter, but the actual arrival of the first check/deposit). 

VA Response. As of June 8, 2012, VA has processed 7,707 disability payments for 

Servicemembers who have completed the IDES process during fiscal year 2012. Currently, VA is averaging 54 days from the date of separation to process a payment. 

DOD Response. [DOD defers to VA.] 

c. As requested at the hearing, please provide any statistics on how long after 

service IDES participants receive their first VA disability compensation payment 

(not the VA decision letter, but the actual arrival of the first check/deposit). 

51 

VA Response. VA’s benefits letter is mailed within one business day of the date 

on which the Veteran’s compensation award is authorized. Payments are released 

from the Treasury Department within 48 hours of award authorization. 

DOD Response. [DOD defers to VA.] 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. BERNARD SANDERS TO

JO ANN ROONEY, ACTING UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND

READINESS, U.S. DEPARTMENT OF DEFENSE

Question 1. At what point did DOD realize that it needed to 1,400 additional 

staff? 

DOD Response. The Army, Navy and Air Force continuously monitor their DES 

staff requirements and implemented hiring actions to fill shortages beginning in 

2008. After fully implementing theIDES at all locations in October 2011, the Military Departments recognized that caseload exceeded staff capacity. In response, the 

Departments accelerated hiring in late 2011 and efforts to hire and train the additional staff are nearing completion. 

Question 2. What occupations do these additional civilian staff members hold? 

DOD Response. The Military Services are hiring additional IDES civilian staff as 

Medical Evaluation Board and Physical Evaluation Board members and staff, Physical Evaluation Board Liaison Officers (PEBLOs), PEBLO assistants, legal and 

paralegal professionals, physicians, psychologists, social workers, and management 

analysts. 

Question 3. Were any Wounded Warriors hired for these new positions? 

DOD Response. The Services do not have readily available information on the 

numbers of wounded warriors hired for these positions. But, the Army reports it 

hired qualified wounded warriors who applied for these positions. The Navy and Air 

Force report that they did not receive any applications from wounded warriors in 

connection with the job announcements advertised for their positions. 

Question 4. What factors determine where these additional staff members will be 

assigned? 

DOD Response. The Military Departments determine the assignment of additional 

staff members based on case workload and complexity, the co-location of supporting 

functions and established MTF staffing models. 

Question 5. What formal training does the PEB Liaison Official receive and what 

is his or her normal caseload? 

DOD Response. DOD policy requires the Military Departments, at a minimum, to 

train IDES personnel on the statutory and policy requirements of the DES; the electronic and paper record keeping policies of the Military Department; customer service philosophies; familiarization with medical administration processes; the role and 

responsibilities of a Servicemember’s assigned military legal counsel, an overview of 

the services and benefits offered by the VA; knowledge of online and other resources 

pertaining to the DES, DOD and VA departments; knowledge of the chain of supervision and command; and knowledge of Inspector General hotlines for resolution of 

issues. 

DOD policy recommends that PEBLOs manage no more than 20 cases simultaneously. Because active PEBLO case management is concentrated in the MEB portion of the disability evaluation process, DOD defines PEBLO case ratio for a military treatment facility as the number of trained PEBLO staff divided by 100/365 

multiplied by the total number of new cases at the location per year, where 100/ 

365 is the fraction of time devoted to active case management during the MEB portion of the IDES during the year. 

Question 6. When Reservists and National Guard personnel go through the IDES 

process, are they on Federal active-duty orders? 

DOD Response. Severely ill or injured Reserve Component Servicemembers can 

be on Active Duty orders for the entire IDES process. Other Reserve Component 

Servicemembers may be placed on Active Duty orders to complete IDES activities 

(exams, interaction with PEBLO’s, participation at boards, etc.) to accommodate 

their civilian job requirements and family commitments. 

Question 7. Why are there two different timelines for active-duty and Reservists? 

DOD Response. DOD policy defines different timelines for active and reserve component members to provide more time to coordinate active duty periods with Reserve and National Guard members, generate active duty orders, and gather medical records from Reserve units and civilian doctors. Active Component Servicemembers typically do not require this additional time and thus have a shorter overall IDES timeline goal. 

52 

Question 8. If a servicemember expresses no desire to remain on active-duty at 

the beginning of the IDES process, is he or she processed any differently? 

DOD Response. The IDES process requires that participants be in an Active Duty 

status during all portions of the process to qualify for appropriate pay and benefits. 

Reservists may coordinate periods of Active Duty to comply, but generally must be 

available, and in an active duty status (‘‘on orders’’) during those portions of the 

IDES process that requires their participation. 

Question 9. When a servicemember exceeds the goal for an IDES phase, how is 

that flagged to draw attention to the delay in that phase of the process? 

DOD Response. DOD and VA IDES staff monitor case timeliness through a number of reports available from VA’s Veterans Tracking Application (VTA). These reports identify cases exceeding IDES goals in all IDES stages. 

Question 10. Why can’t the Medical Evaluation Board and Physical Evaluation 

Board be consolidated into one Board? 

DOD Response. The law (National Defense Authorization Act of Fiscal Year 2008, 

Section 1602(3)(A)), defines the Disability Evaluation System as ‘‘A system * * * 

comprised of medical evaluation boards, physical evaluation boards, * * *’’ which 

requires the Department to maintain separate medical and physical evaluation 

board processes. 

Chairman MURRAY. Mr. Gingrich? 

STATEMENT OF JOHN R. GINGRICH, CHIEF OF STAFF, 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

Mr. GINGRICH. Good morning, Chairman Murray. I have a cold 

so I have to speak up. Ranking Member Burr, Members of the 

Committee, I am pleased to be joined this morning by Under Secretary Jo Ann Rooney to discuss the IDES system. We have come 

a long way since the issues of Walter Reed Army Medical Center 

were identified in 2007. At that time, VA and the DOD were miles 

apart. Simply stated, the lack of integration and cooperation between the Departments did not serve wounded servicemembers 

well. 

Since that time, together we have committed to achieve a seamless transition through a multi-pronged approach with IDES as one 

of the critical initiatives. The joint IDES process was designed to 

eliminate time consuming and often confusing elements of the separate disability processes. The goals of the joint process were to increase transparency, reduce the processing time, improve consistency, and reduce the benefits gap. 

To achieve greater transparency for servicemembers, we have enhanced our online tools, the My Health Vet and benefits, to allow 

servicemembers in IDES to view appointments and lab results and 

to track their claim. Internally, we have increased transparency 

through the IDES Dashboard that tracks performance at each 

IDES site. 

The Secretaries have charged us to reach a combined performance goal of 295 days for 60 percent of the servicemembers by the 

end of this year. To ensure that we reach this goal, I hold biweekly 

reviews with all 116 stations. In a relatively short period of time, 

we have seen positive results. 

In January, the oldest case being worked for proposed disability 

rating was 254 days. Today there are no cases over 180 days. From 

February 2011 to April 2012, we have reduced the average claim 

development time by 62 percent and the medical examination and 

admin time by 60 percent. 

On April 5th, I committed to the Army Vice Chief of Staff that 

VA would clear, within 60 days, the entire inventory of Army cases 

53 

awaiting proposed rating decisions. We have cleared 76 percent of 

those cases and are well on our way to deliver on that promise not 

only for the Army, but for all the services. 

For both preliminary and final ratings, the combined productivity 

of our three Disability Rating Activity Sites, DRAS, increased 15 

percent in the last month. We have several projects to enhance our 

efficiency and effectiveness such as the Veteran Tracking Application that will increase the flow of information electronically from 

DOD to VA, and the electronic case file transfer system. 

We have made progress in improving transparency, improving 

consistency, and reducing process time. But our biggest achievement to date has been closing the benefit gap. Servicemembers no 

longer wait six to 9 months to receive compensation they have 

earned. Yet, with all these achievements, we are not satisfied because we are not meeting the requirement for every single servicemember. 

We will continue to work with DOD to improve our systems and 

processes until we achieve all of our objectives in 100 days for each 

servicemember. I will often refer to cases or claims here today, but 

let me assure you, I never lose sight of the fact that behind a claim 

is a servicemember and his or her family who depend on VA to get 

it right. 

We will continue to partner with DOD to effectively and efficiently get him or her back to their unit to continue military service, or if discharged, provide the benefits they have earned. As 

partners, we will overcome the remaining challenges together to 

achieve the seamless transition servicemembers deserve. This is a 

commitment we must meet. 

I look forward to answering any questions that you may have. 

[The prepared statement of Mr. Gingrich follows:] 

PREPARED STATEMENT OF JOHN R. GINGRICH, CHIEF OF STAFF, 

U.S. DEPARTMENT OF VETERANS AFFAIRS

Good morning Chairman Murray, Ranking Member Burr, and Members of the 

Committee. I am pleased to be joined this morning by Jo Ann Rooney, Ed.D., J.D., 

Acting Under Secretary for Personnel and Readiness, Department of Defense (DOD) 

to discuss the progress being made by the VA and the DOD toward meeting the 

needs of injured Servicemembers. My testimony will focus on the status of our 

progress toward improving the Integrated Disability Evaluation System (IDES) used 

to transition wounded, ill, and injured Servicemembers from DOD to VA or, if found 

fit, return them quickly to their units to continue their military service. 

INTRODUCTION

VA and DOD have a shared goal: ensuring that Servicemembers’ transition between VA and DOD is as smooth as possible and honors their sacrifice for the greater good. To create a truly seamless transition, we have a multi-pronged approach 

that includes developing a single Integrated Electronic Health Record (iEHR), improving our Federal Recovery Coordination Program (FRCP) and having an efficient 

IDES system. If we are to truly achieve the seamless transition that we both agree 

is necessary, it will be through measurable progress in all three core programs. 

Our commitment is not to create a program or a process; our commitment is to 

create a new paradigm. The old paradigm of two big bureaucracies with completely 

different processes, systems and programs did not work in the past and will not 

work in the future. Seamless transition is the new paradigm; not a slogan. At the 

James A. Lovell Federal Health Care Center (JALFHCC), both Servicemembers and 

Veterans are served by a joint VA/DOD team. JALFHCC embodies this new paradigm. While there are still issues that we must work through at JALFHCC, it is 

strong evidence that we can overcome barriers when the needs of Servicemembers, 

Veterans and their families are our priority. 

54 

Our Departments understand that we are responsible for the same men and 

women, though at different periods of their lives, and that together our Departments can help improve their transition experience as they move from one stage to 

the next. I will focus my remarks today on IDES as one piece of a larger transformation. 

IDES

Much has been accomplished to improve the DOD disability process in the wake 

of the issues identified at the Walter Reed Army Medical Center in 2007. VA’s and 

DOD’s joint efforts have resulted in process improvements and created an integrated 

disability evaluation system for Servicemembers who are being evaluated for medical retirement or separated. In early 2007, VA and DOD partnered to develop a 

modified, integrated Disability Evaluation System (DES) and a DES Pilot was 

launched in November 2007. This new, joint process was designed to eliminate the 

duplicative, time consuming, and often confusing elements of the separate disability 

processes within VA and DOD. The goals of the joint process were to: (1) increase 

transparency of the process for the Servicemember; (2) reduce the processing time; 

(3) improve the consistency of ratings for those who are ultimately medically separated; and (4) reduce the benefits gap that existed between the point of separation 

or retirement and receipt of VA disability compensation. Authorization for the DES 

Pilot was included in the National Defense Authorization Act for Fiscal Year 2008. 

The DES Pilot was launched at three operational sites in the National Capital Region (NCR): Walter Reed Army Medical Center, National Naval Medical Center, and 

Malcolm Grow Medical Center on Andrews Air Force Base. The DES Pilot was recognized as a significant improvement over the legacy DES process, and, as a result 

of the Senior Oversight Committee (SOC) findings and the desire to extend the benefits of the Pilot to more Servicemembers, VA and DOD expanded the Pilot. By the 

end of March 2010, the DES Pilot had expanded to 27 sites and covered 47 percent 

of the DES population. In July 2010, the co-chairs of the SOC agreed to expand the 

DES Pilot and rename it IDES. Senior leadership of VA, the Services, and the Joint 

Chiefs of Staff strongly supported this plan and the need to expand the benefits of 

this improved process to all Servicemembers. Expansion and full implementation of 

IDES was completed by September 30, 2011. Currently, there are 139 IDES sites 

operational worldwide, including the original 27 DES Pilot sites. 

In contrast to the DES legacy process, IDES provides a single set of disability examinations and a single-source disability rating, for use by both Departments in 

executing their respective responsibilities. This results in more consistent evaluations, faster decisions, and timely benefits delivery for those medically retired or 

separated. As a result, VA can deliver benefits in the shortest period allowed by law 

following discharge thus reducing the ‘‘benefit gap’’ that previously existed under 

the legacy process, i.e., the lag time between a Servicemember separating from DOD 

due to disability and receiving his or her first VA disability payment. This lag time 

used to be 6 to 9 months; it now is reduced to 30 to 60 days, with our goal being 

to reach no more than 30 days. The DOD/VA integrated approach has also eliminated many of the sequential and duplicative processes found in the legacy system. 

VA is responsible for four core processes within IDES: claims development, medical examination, proposed disability rating, and VA benefits estimate letter. VA’s 

target for combined processes is 100 days of the 295 day combined VA/DOD target. 

While VA is currently meeting the 10-day goal for claims development and the 45- 

day goal for medical examinations, VA is not meeting the 15-day goal for completion 

of the proposed rating and the 30-day standard for delivery of VA benefits estimate 

letters, which currently are 46 and 26 days beyond the target, respectively. To address increased volume at the rating sites during FY 2011, VBA temporarily placed 

on site help teams at the Baltimore and Seattle VA Disability Rating Activity Sites 

(DRASs) and brokered IDES work to other stations. VBA increased the number of 

Rating Veterans Service Representatives (RVSRs) at the Seattle DRAS in 

March 2012 and now has a total of 174 RVSRs dedicated to the IDES mission at 

Baltimore, Providence, and Seattle. Increased staffing levels and maturation of 

skills for newer RVSR trainees will aid VBA in meeting the expected goals for the 

preliminary rating and final benefits stages. The combined productivity of the three 

DRASs for completion of preliminary and final ratings was 3,125 for the month of 

April 2012, which represents a 15 percent increase over March performance of 2,708 

completed cases. VA will begin to receive military separation data electronically in 

Veterans Tracking Application (VTA) in June 2012. It is expected this enhancement 

will reduce the time it takes the DRASs to verify separations, character of service, 

and severance or other pay issues, which must be verified prior to issuance of VA 

benefits. 

55 

Both SECDEF and SECVA have directed their respective Departments to reduce 

the combined processing time to 295 days for 60 percent of Servicemembers in IDES 

by the end of this calendar year with the ultimate goal of 100 percent. We have already made great progress toward that end. For example, at the Disability Rating 

Activity Sites in January 2012, the oldest case being worked for Proposed Disability 

Rating was 254 days. Today, there is not a single case over 180 days. Additionally, 

it is important to note none of these cases are impacting DOD’s ability to move forward with their fitness decision. Today we find ourselves required to process many 

more claims per month than we had originally anticipated. As demand has increased we have adjusted to meet the Servicemember’s needs. In January 2012 VA 

completed 1,254 Proposed Disability Ratings and in April 2012 VA completed 2,363 

Proposed Disability Ratings. That is an 88 percent increase in monthly performance, 

which allowed for a reduction of more than 5,500 of the backlogged claims. We are 

proud of the advancements we have made, but to meet the overall 295-day goal, we 

will need to focus our efforts on ensuring accountability through staffing and governance, utilizing technology, process improvements, and increased management 

oversight to endure successful delivery. 

ACCOUNTABILITY

First, we have institutionalized accountability mechanisms. At each IDES site VA 

has instituted the concept of a lead VA executive, a senior VA official who is directly 

responsible for the overall IDES mission, operations and performance at his/her specific site. With a single individual charged with performance responsibility we believe management will be able to drive change more quickly and resolve problems 

as they arise. To appropriately track our performance in the field, VHA and the Office of VA/DOD Collaboration Service in VA developed the ‘‘IDES Dashboard,’’ a 

comprehensive management chart that tracks performance in each of VA’s four 

IDES phases at each IDES site. Use of the ‘‘IDES Dashboard’’ has led directly to 

improved performance tracking and enabled VA’s leaders to spot trouble spots and 

allocate resources more effectively. 

MANAGEMENT OVERSIGHT

With any project, the appropriate amount of leadership and oversight must be applied. VA has elevated oversight to the most senior levels of the VA. SECVA and 

SECDEF meet quarterly, and IDES has always been on the agenda and they both 

receive monthly updates. On a monthly basis, I meet with the Vice Chief of Staff 

of the Army to review performance at Army IDES sites. These meetings are attended by senior personnel from VA, Office of the Secretary of Defense (OSD), and 

the Army. IDES performance data is reviewed at a very detailed level and senior 

officials in the field are expected to present plans to improve performance if standards are not met. Additionally, since May 2011, I have been leading a Video Teleconference (VTC) every two weeks with senior Veterans Benefits Administration 

(VBA) and Veterans Health Administration (VHA) officials at 116 sites in the field 

who are directly responsible for IDES at their respective sites. During these VTCs 

I review IDES performance at a very detailed level and ask the responsible senior 

official for his/her plan to improve performance. 

VA’s office of VA/DOD Collaboration Service also leads a weekly telephone conference call with VBA and VHA and a weekly telephone conference call with the 

OSD and the Military Services to review IDES performance and problems. Senior 

VA officials also meet on a monthly basis with Navy Bureau of Medicine officials 

to review performance at Navy and Marine Corps IDES sites. IDES performance 

data is reviewed at a very detailed level and senior officials in the field are expected 

to present plans to improve performance if standards are not met. At every level 

of VA, leadership is engaged with our partners in DOD and our management team 

in the field. 

TECHNOLOGY AND PERFORMANCE IMPROVEMENT

Our continuous review of the IDES process revealed two consistent issues: access 

to information and reducing the movement of paper files. In both instances, we believe technology will play a key role. The next series of enhancements to the Veterans Tracking Application (VTA 2.0) will leverage our ability to electronically share 

DD–214 data via VA/DOD Identity Repository (VADIR) to automatically trigger 

work flow in a way that will reduce overall processing time. VADIR database was 

established to support a One VA/DOD data-sharing initiative in order to consolidate 

data transfers between DOD and VA to assist in determining Veteran benefits. The 

expanded data feed will also include key data elements to assist VA Disability Rating Activity Sites (DRAS) in determining entitlements to VA benefits such as: date 

56 

of separation and character of service, among others. VTA 2.0 will also include additional reporting capabilities that will allow VBA’s Office of Field Operations to better manage the workflow of VBA employees and provide the ability to record the 

occurrences of diagnostic differences on IDES exams to identify inconsistencies. 

Based on demonstration performance to date, we believe that the new version of 

VTA, scheduled for release in June 2012 will greatly improve performance management. 

VA is also collaborating with DOD to accomplish the Secretaries’ joint goal of 

achieving electronic case file transfer (CFT) for IDES by July 2012. The planned solution will be a single system that will avoid development time and costs. CTF will 

remove the costly and inefficient transfer of paper records from DOD to VA by eliminating the need for shipping. Our system will accommodate both computable data 

and scanned paper to ensure that the solution we adopt assists both the younger 

Servicemembers with large portions of their records in electronic format and older 

Servicemembers who may still have a significant portion of their records in paper. 

CONCLUSION

Despite these efforts, we know challenges remain, and there is room for significant improvement in IDES. VA and DOD are committed to supporting our Nation’s 

wounded, ill, and injured Warriors and Veterans through an improved IDES, and 

we are taking steps to prepare for future demand for this system. As such, VA believes that its continued partnership with DOD is critical and is nothing less than 

our Servicemembers and Veterans deserve. 

RESPONSE TO PREHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR TO VA, 

OFFICE OF POLICY AND PLANNING, INTEGRATED DISABILITY EVALUATION SYSTEM

AND DOD, OFFICE OF WOUNDED WARRIOR CARE AND TRANSITION POLICY

[Due to their interrelated nature, the responses to the pre-hearing questions submitted by Senator Burr to the Department of Veterans Affairs were merged in with 

the responses from the Department of Defense appearing earlier in this transcript.] 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. PATTY MURRAY AND

HON. RICHARD BURR TO THE U.S. DEPARTMENT OF VETERANS AFFAIRS

[Due to their interrelated nature, the responses to the posthearing questions submitted by Senators Murray and Burr to the Department of Veterans Affairs were 

merged in with the responses from the Department of Defense appearing earlier in 

this transcript.] 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. BERNARD SANDERS TO

JOHN R. GINGRICH, CHIEF OF STAFF, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question 1. From the VA perspective, what would you change in the IDES 

process? 

Response. 

a. Implement some of the remodeled IDES improvements concepts identified 

below: 

• Reduce the number of physical case-file handoffs from 8 to 3. 

• Make fitness decision for further military service up front, before VA enters into 

the process. 

• Ensure VA receives a complete case-file from the Military Services after the fitness decision is made. 

b. Automate the IDES process from beginning to end, and enhance the management reporting capabilities to enable IDES sites to effectively manage their cases. 

c. Identify and implement best practices and implement electronic data sharing 

throughout the IDES process. 

Question 2. What formal training does a VA case manager receive and what is 

his or her normal caseload? 

Response. VA Military Service Coordinators (MSCs) receive the same core technical training for claim processing as Veterans Service Representatives (VSRs) as 

well as IDES process training. Disability Rating Activity Site (DRAS) personnel receive the same national level training as all other claims adjudicators in a regional 

office. As a guide for determining sufficient resources, VA uses a staffing model in 

which each MSC has 30 new cases per month. 

57 

Question 3. Are servicemembers enrolled in the VA health care system upon completion of the IDES process? 

Response. No. However, the enrollment in the VA health care system is highly 

encouraged to Servicemembers receiving disability examinations through IDES. VA 

has worked closely with DOD to implement an online VA Form 10–10EZ, Application for Health Benefits, which is completed by Servicemembers at the time of demobilization or termination of service. Additionally, active duty Servicemembers 

transitioning through TAP are briefed routinely by VA staff and informed on how 

to apply for VA benefits, including enrollment in the VA health care system. 

Question 4. How is a servicemember discharged with mental health issues 

seamlessly transferred from DOD to VA mental health care providers? 

Response. VA has a formal process in place to transition wounded, ill and injured 

Servicemembers from DOD to VA. VA has 33 VA Liaisons for Healthcare, registered 

nurses or licensed social workers, stationed at 18 Military Treatment Facilities 

(MTFs) with concentrations of recovering Servicemembers returning from Iraq and 

Afghanistan to transition ill and/or injured Servicemembers from DOD to the VA 

system of care. VA Liaisons are co-located with the DOD case managers at the 

MTFs, and provide onsite consultation and collaboration regarding VA resources 

and treatment options. Each referral from the DOD treatment team, including referrals for Servicemembers being medically discharged with mental health issues, utilizes a standardized referral form completed by the DOD Nurse Case Manager identifying the ongoing treatment needs. In addition, each referral to a VA medical center (VAMC) includes supporting medical documentation such as progress notes and 

narrative summaries. While VA Liaisons participate in discharge planning at the 

MTF, they are dependent on a referral from the DOD case manager prior to engaging with Active Duty Servicemembers to coordinate ongoing healthcare needs at VA. 

At MTFs without an onsite VA Liaison, DOD Case Managers refer Servicemembers 

directly to the Operation Enduring Freedom/Operation Iraqi Freedom/Operation 

New Dawn (OEF/OIF/OND) Program Manager at the Servicemember’s home VAMC. 

These referrals also utilize the standardized referral form identifying the ongoing 

treatment needs as well as the supporting medical documentation. Servicemembers 

may elect to seek care in the private sector using TRICARE, in which case they 

would not be referred to VA and the transition not managed by the VA Liaison. 

In addition, OEF/OIF/OND Clinical Case Managers screen all returning combat 

Veterans for the need for case management services, including those referred from 

an MTF as well as those, self-presenting for initial care at a VAMC. This screening 

identifies Veterans who may be at risk so VA can intervene early and provide assistance before the Veteran is in crisis. In addition to prevalent medical and mental 

health issues related to deployment such as Post Traumatic Stress Disorder (PTSD), 

this screening includes the risk factors for psychosocial issues such as homelessness, 

unemployment, and substance abuse. Case management needs are identified early, 

a plan of care is developed, and follow up is provided as long as needed. OEF/OIF/ 

OND case managers are experts at identifying and accessing resources within their 

health care system as well as in the local community to help Veterans recover from 

their injuries and readjust to civilian life. 

Question 5. What outreach services does VA provide veterans immediately after 

discharged through the IDES process? 

Response. Like all Servicemembers, individuals released through IDES receive the 

Welcome Home Package, which contains information about all VA benefits for which 

they may be eligible. VA also assigns case managers, who assist in outreach services, to individuals whom DOD classified as seriously injured before discharge. 

Chairman MURRAY. Thank you very much. Mr. Bertoni? 

STATEMENT OF DANIEL BERTONI, DIRECTOR, EDUCATION, 

WORKFORCE, AND INCOME SECURITY, U.S. GOVERNMENT 

ACCOUNTABILITY OFFICE 

Mr. BERTONI. Chairman Murray, Ranking Member Burr, Members of the Committee, good morning. I am pleased to discuss the 

Departments of Defense and Veterans Affairs’ efforts to improve 

the performance of their Integrated Disability Evaluation System, 

or IDES, which is now the standard process for assessing servicemember disabilities worldwide. 

Since its start, GAO has monitored the evolution of this process 

and made several recommendations to address design and other 

58 

challenges. My statement today is based on our ongoing work for 

this Committee and focuses on the extent to which IDES is meeting 

key performance goals and ongoing efforts to improve performance. 

In summary, we found that overall timeliness has worsened, with 

the average number of days to complete claims for active duty servicemembers increasing from 283 days in 2008 to 394 days last 

year, which is well above the stated goal of 295 days. During the 

same period, the proportion of active duty cases that met timeliness goals also decreased very steeply from 63 percent to just 19 

percent. 

With the exception of the physical evaluation board phase, IDES 

claims also fell consistently short of interim timeliness goals with 

the medical evaluation board, transition, and benefits phases. Processing delays were most significant in completing the medical evaluation board process. In 2011, only 20 percent of active duty cases 

met the targeted goal for obtaining a medical board decision. 

In addition to timeliness, DOD and VA assess servicemember 

satisfaction via telephone surveys, which we found to have shortcomings in both design and administration such as unduly limiting 

who actually receives a survey and computing average scores in a 

way that may overstate satisfaction, and limit the usefulness of 

this data as a performance management tool. 

In fact, using an alternative calculation that eliminates neutral 

responses, we found satisfaction rates several times lower than 

DOD reports. DOD and VA have undertaken a number of actions 

to address IDES challenges, many of which we have identified in 

prior work. 

For example, per our recommendation top leadership has developed a more robust monitoring and oversight process to improve 

communication and accountability, which includes more frequent 

contacts between the Secretaries of the Departments to discuss 

progress in various fronts, regular meetings chaired by the Army’s 

Vice Chief of Staff and VA’s Chief of Staff that include reviews of 

site performance and a forum for local and regional facility 

commanders to provide feedback on best practices and current 

challenges. 

VA also holds its own biweekly conferences with local staff responsible for their portion of the process. The Departments are also 

working to address long-standing medical board and VA rating 

staff challenges. In fact, the Army is in the midst of a hiring effort 

to more than double medical board staff, including liaisons, physicians, and support personnel, while VA has more than tripled staffing at IDES rating sites. 

The Departments are also working to address limitations in their 

automated systems, including taking steps to improve the ability of 

local facilities to electronically track and monitor case progress, 

and to improve the quality of case data which we found to be problematic. However, key upgrades are still pending and various sites 

continue to rely on ad hoc, local, and potentially redundant processes to manage their cases. 

Moreover, despite efforts by DOD and the services to improve 

data quality, the current IDES tracking system lacks controls to 

prevent staff from entering erroneous data; thus keeping caseload 

data accurate will remain a challenge going forward. 

59 

And finally, in order to further improve and expedite case processing, DOD has initiated an in-depth business process review to 

better understand how each step impacts processing times and 

identify further IDES streamlining opportunities. Such an effort 

could yield short and long-term recommendations for improvement. 

However, a timetable for completion is yet to be established. 

In conclusion, the merger of two duplicative disability evaluation 

systems shows promise for expediting benefits to servicemembers. 

However, nearly 5 years out, delays continue to affect progress and 

their causes are not fully understood. Recent initiatives to improve 

processing and isolate bottlenecks are promising; however, it remains to be seen what their long-term impacts will be. 

And we will continue to assess DOD’s and VA’s progress in these 

areas as we proceed to do this work for your Committee. Chairman 

Murray, this concludes my statement. I will be happy to answer 

any questions you might have. Thank you. 

[The prepared statement of Mr. Bertoni follows:] 

60 

PREPARED STATEMENT OF DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE, 

AND INCOME SECURITY, U.S. GOVERNMENTACCOUNTABILITY OFFICE


523psGAO1.eps
61 


523psGAO2.eps
62 


523psGAO3.eps
63 


523psGAO4.eps
64 


523psGAO5.eps
65 


523psGAO6.eps
66 


523psGAO7.eps
67 


523psGAO8.eps
68 


523psGAO9.eps
69 


523psGAO10.eps
70 


523psGAO11.eps
71 


523psGAO12.eps
72 


523psGAO13.eps
73 


523psGAO14.eps
74 


523psGAO15.eps
75 


523psGAO16.eps
76 


523psGAO17.eps
77 


523psGAO19.eps
78 

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. BERNARD SANDERS TO

DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE, AND INCOME SECURITY

ISSUES, GOVERNMENT ACCOUNTABILITY OFFICE

Question 1. In your opinion, are the IDES Process and Timeliness goals realistic? 

Response. More information is needed to determine if and how the current IDES 

timeliness goals can be met. While IDES processing times increased as the system 

expanded, the contribution of various factors to timeliness is complex and not fully 

understood. In its testimony and in previous work, GAO highlighted issues, such as 

insufficient staffing and logistical challenges, that contributed to delays in processing cases. In the meantime, the number and range of IDES facilities and enrolled 

cases steadily increased since the inception of IDES in 2007 through the completion 

of its worldwide deployment in 2011, complicating the understanding of whether 

IDES goals are reasonable. DOD and VA are now increasing resources devoted to 

IDES and are at various stages of implementing process improvements. Some of 

these changes are in their early stages and it is too soon to know their impact on 

timeliness. DOD is also undertaking a business process review, which may allow it 

to better understand how different IDES processes and resource levels contribute 

to timeliness. These efforts, along with a fully deployed and more stable IDES process, may provide the departments with an opportunity to reassess resources and 

timeframes, and make adjustments if needed. 

Question 2. Is there any reason why active-duty and Reservists should be held to 

a different timeline in the IDES Process? 

Response. DOD guidance allows for more time in some parts of the IDES process 

to accommodate additional work that may be needed to address circumstances that 

reserve component servicemembers (reservists) face. Overall, DOD and VA established a goal of 305 days for reservists as compared to 295 days for active duty servicemembers. In the medical evaluation board (MEB) phase—during which records 

are compiled and exams conducted—timeliness goals allow an additional 40 days for 

processing reservists’ cases. The additional MEB time is to accommodate reservists 

that may need to be placed on active duty orders and travel to military treatment 

facilities to undergo the IDES process. Also, additional time may be needed to compile medical records for reservists. While the MEB goal for reservists is 40 days 

longer, the 30-day goal for the VA benefits phase does not apply to all reservists 

and therefore was subtracted from the reservist overall goal for the IDES process. 

As such, the net effect is that the overall reservist goal (305) is 10 days longer than 

for active component servicemembers (295). 

Chairman MURRAY. Thank you very much, Mr. Bertoni. 

I just wanted to let our Committee Members know that following 

the revelation that possibly hundreds of soldiers at Joint Base 

Lewis-McChord had their PTSD diagnosis changed because a group 

of people did not want to spend money on the care and benefits 

that these servicemembers would receive, I asked our Committee 

staff to conduct an investigation into the Joint Disability Evaluation System. 

We are at an interim point in this investigation. Up to today, 

staff have reviewed 121 cases from 23 different IDES sites. They 

have focused on cases involving mental health diagnosis in general 

and PTSD diagnoses in particular. 

I am very troubled by what they found. They have found evaluations that focus on perceived malingering or exaggeration of symptoms, similar to what we saw at Madigan, without documentation 

of appropriate standardized interview techniques. They have encountered inadequate VA medical examinations, especially in relation to Traumatic Brain Injury, and VA rating decisions issued as 

part of this joint process contained errors, which in some cases impacted the level of benefits the veteran should have received. 

So before we begin today’s questions, I am entering the results 

of this interim investigation into the record at this point and there 

will be more to come. 

[The report referred to follows:] 

79 


523IntRpt1.eps
80 


523IntRpt2.eps
81 


523IntRpt3.eps
82 


523IntRpt4.eps
83 


523IntRpt5.eps
84 

Chairman MURRAY. Dr. Rooney, let me start with you. We have 

had discussions in the past regarding this Joint Disability Evaluation System and the number of challenges servicemembers face 

while they are going through this process. Recently, it has come to 

my attention that some of our servicemembers involved with the 

disability evaluation process are facing retribution and unsupportive behavior from their chains of command while on limited duty 

and waiting for a disability decision. 

I have heard from servicemembers who were forced to participate 

in activities in direct violation of doctors’ orders, who have been 

disciplined while struggling with behavioral health conditions, and 

who have struggled to get access to care because their leadership 

would not cooperate with their treatment requirements. 

I think you agree with me that is completely unacceptable. 

Whether in a Warrior Transition Unit or not, leaders have to understand these medical issues and the difficult process that these 

servicemembers are going through and they have to provide the 

leadership and support that these men and women need. 

So I wanted to begin with you by asking you, Dr. Rooney, what 

needs to be done to provide supportive and compassionate leadership for these injured servicemembers that are forced to wait for 

a disability decision? 

Ms. ROONEY. Senator, clearly the information you just shared is 

troubling on many levels, and I would be very interested in speaking with you or your staff or that we can actually determine where 

those issues are occurring and make sure that, in fact, the leadership does know, which is the Department’s position and the leadership at many levels that I am familiar with, that that cannot be 

tolerated, that we must understand what is necessary for the care, 

that there are no stigmas associated with being able to address behavioral health or mental health issues, and that really is the Department’s position. 

So in those cases, if there are those substantive issues that you 

mentioned, not only do we need to find out where those are so we 

can work directly with that leadership and correct that situation, 

but we will continue with our ongoing work at all levels of commands, not just at the senior level in the Department, but we understand that needs to go right through the command level of every 

installation to ensure that, in fact, the situations you have described are not occurring. 

Chairman MURRAY. Well, we need to make sure that is happening, because as we all know, these are very challenging situations for these soldiers and any kind of retribution should not be 

tolerated, whether it is one case or many. But I will share those 

with you. But I want to make sure that systemwide, that leaders 

throughout the chain of command all the way to the bottom, are 

clearly understanding what these soldiers are going through and 

are not having any kind of repercussions on those individuals. 

Ms. ROONEY. Absolutely. 

Chairman MURRAY. Mr. Gingrich, from the perspective of someone who has served in many leadership positions within the military, what can we do to educate our military leaders on not only 

this process, but really on the medical issues facing so many of 

these young men and women? 

85 

Mr. GINGRICH. Madam Chairman, I see a lot of things the Army 

is doing and I know that because I have been to their BTCs. They 

have started, as we were told by GAO, they are now bringing in 

layers all the way up to the Vice Chief of Staff. So they have involved the colonel level discussion groups, brigadier general, major 

general, all the way up, and they have included VA in every one 

of those discussion groups. 

So I think getting the information out is the biggest key that we 

have got to go and the biggest challenge we have. The Secretary 

right now, yesterday, spoke to the Sergeant Major Academy in the 

Army and the sergeant majors are now understanding that this is 

a problem that we have to take on as two Departments and not 

just as one, and I think that education is happening. 

Chairman MURRAY. Well, we still have a lot of work to do. 

Mr. GINGRICH. Yes, ma’am, we do. 

Chairman MURRAY. OK. Dr. Rooney, there is no doubt that the 

events at Madigan have shaken the trust and confidence of servicemembers who are in the disability evaluation system. I believe that 

transparency and sharing information about the ongoing reevaluations that are happening today, and actions that the Army and 

DOD are taking to remedy this situation will go a long ways toward restoring some trust in this system. 

I wanted to ask you today what we have learned from the investigations that the Army is conducting into the forensic psychiatry 

unit at Madigan. 

Ms. ROONEY. Well, as you pointed out earlier, there have been 

196 reevaluations completed to date, of which 108 of those have 

been diagnosed as having PTSD where before they had not. We 

also identified—— 

Chairman MURRAY. Let me just say that they had been diagnosed with PTSD. When they went through the evaluation system, 

they were told they did not. Now going back and re-evaluating 

them once they have gone out, we are saying, yes, you did indeed 

have PTSD. 

Ms. ROONEY. Correct. 108 of those 196. 

Chairman MURRAY. More than half. 

Ms. ROONEY. Correct. There are 419 that have been determined 

to be eligible for reevaluation, 287 from the original group that was 

looked at, and as you know, the Army actually opened the aperture 

up to see anybody else that would have gone through the process 

while forensic psychiatrists were being used. So that was 419 totally eligible for reevaluation. 

And at this point, there are three in progress and 12 being scheduled. So what we have learned from that is clearly that the process 

that was put into place at that time did not function as originally 

designed. Evidence did not show that there was a mean-spirited attempt, but really to create similar diagnoses. Obviously that was 

not something that occurred. 

So the Army has taken the lessons from here and is actually 

going back to 2001 to reevaluate all of the cases where we might 

have a similar situation. What we are doing from that point is not 

only learning from what Army is doing and looking at these reevaluations where we are using the new standards, in many ways 

advances in the medical and the behavioral health areas to better 

86 

diagnose PTSD, but also then we will be taking those lessons 

learned across the other services as well. 

So since Army has the greatest majority of people going through, 

currently about 68 percent of the people in the disability evaluation 

process are from Army, we will take the lessons learned from there 

and apply those across to all of the services. 

Chairman MURRAY. Well, I really appreciate the Army’s announcement that they are now going to do a comprehensive review 

of PTSD and behavioral health systemwide throughout the Army. 

I believe that is a first and important major step for the Army to 

be doing. 

But I did want to ask you, Dr. Rooney, I had been told by Secretary McHugh about the issues that we were seeing at Madigan 

were not systemwide. And then the Secretary announced a comprehensive review across all systems. So if we did not believe this 

was a systemwide problem, what led the Army to look into a comprehensive review? 

Ms. ROONEY. Secretary McHugh and I have had numerous conversations, and I believe the use of the forensic psychiatrists was 

primarily isolated to Madigan, and that is where I believe that 

comment of that it was not systemwide, because that type of additional part of the process—— 

Chairman MURRAY. So the forensic system was not systemwide, 

but systemwide we have issues with people who are not being diagnosed correctly? 

Ms. ROONEY. What we want to do is look across the system and 

ensure if we do have issues, that we identify those and we are able 

to get those individuals back into the system. So I believe at this 

point, it was very much a forward leaning approach to say, We 

need to look across the system, not that we are convinced that 

similar problems existed, but that it is the right thing to do for the 

individuals, since as you pointed out, we saw a number of these reevaluations ended up with diagnoses changed. So it is the right 

thing to do for our people to look across. 

Chairman MURRAY. OK. I think it is extremely important that 

we find anybody who was misdiagnosed and get them care. So we 

will be continuing to focus on this. 

Ms. ROONEY. Absolutely. 

Chairman MURRAY. With that, let me turn it over to Senator 

Boozman. 

Senator BOOZMAN. Yes, ma’am. With your permission, what I 

would like to do is go ahead and defer to Senator Burr and then 

come back when it is appropriate. 

Chairman MURRAY. OK, great. 

Senator BURR. I thank my colleague. Madam Chairman, thank 

you for this hearing, and Mr. Gingrich, I share your cold. It is not 

fun. 

Dr. Rooney, do you disagree with the GAO’s testimony today? 

Ms. ROONEY. Sir, we look at the GAO as a partner to help us 

evaluate how we are doing. I think they brought up some very good 

points in their report. Of course, when you are using statistics, we 

may look a little differently at a particular statistic. 

However, I will say that there was nothing in there that we did 

not think really helped us further understand where our emphasis 

87 

needs to be, that there are improvements. We have been very open 

about saying that this is a system that needs significant improvements. I think the GAO very much said the same thing. 

So we are looking to continue to work with them, take the information they provided, and it gives us a roadmap to make sure, as 

we are putting resources to it, we take their report, plus our own 

internal analysis that goes even deeper than theirs, to ask, are 

these improvements making—are the resources making improvements to this system, which we all know and totally agree is not 

where we want it to be. 

Senator BURR. Mr. Gingrich, do you disagree with any of the testimony of GAO? 

Mr. GINGRICH. No, sir. In fact, I look forward to the discussions 

we had before the testimony and the report, because I believe any 

time that somebody gives you insights into what you are doing, 

that you can take care of one more veteran or servicemember to 

make their life better in this transition process, we need to look it 

and make it happen. 

Senator BURR. So we are all in agreement that we are just south 

of 400 days in the cycle of an applicant being processed, 395, I 

think, 394. In May 2011, the Secretary of Defense and the Secretary of Veterans Affairs committed to revising the IDES so that 

it could be completed in 150 days, and went further to agree to explore options for it to be 75 days. 

Now, I have had too many of these hearings. We have them 

every year. And we hear the same thing, Oh, gosh, look at what 

we are doing. I have heard the most glowing progress report from 

both of you. And then I get the realities that the days had not 

changed. You have met some improvement in certain areas. I commend you on that, the timeliness goals in areas have been better. 

But the reality is that we have got a broken system, and we are 

5 years into it. And I hear testimony where we are starting to 

begin to review our business processes. Well, you know, why did it 

take 5 years to get to this? What can you convey to me today that 

is concrete that tells me a year from now we are not going to be 

at 393 days? 

When you said earlier we are instituting IT changes this summer 

that will improve our times by 30 or 40, I thought you were going 

to say percent, and you said days. So now my expectations are that 

if we implement what you just said, we are going to be down to 

360 days, which exceeds the DECSEF (Secretary of Defense) and 

Secretary of VA by 110 days over what their goal was for today. 

So share something with me that will tell me we are actually 

going to do this. 

Ms. ROONEY. Sir, that was one of the steps. The IT solutions are 

not the only steps. In addition, it was indicating that Army has 

hired 1,218 people, so we are also adding people to the process. 

Senator BURR. Are these the first individuals that we have hired 

in the 5 years to plus up? 

Ms. ROONEY. It is the largest group of people that we have hired. 

Senator BURR. OK. We have hired people, we have plussed up, 

and the overall time of completion went up, not down. 

Ms. ROONEY. Many of these changes, sir, are fairly recent. 

88 

Senator BURR. OK. Lt. Gen. Bostick, the Army Deputy Chief of 

Staff, recently called the IDES process fundamentally flawed, adversarial, and disjointed. Do you agree with him? 

Ms. ROONEY. I have sat next to my colleague many times, and 

we have had these discussions. I believe that we are both acknowledging that it is a system that, while initially conceived to be one 

that was smooth, transparent, and easy, we have not achieved that 

result. 

Senator BURR. So what are we doing to change it? 

Ms. ROONEY. As my colleague and I have indicated, at this point 

we are literally looking case-by-case. We are following cohorts 

through each step of the process to see when we add people to it, 

are we actually improving the times? I am not saying that we are 

not able to improve it for those already in the system, but we have 

to make sure that we are also tracking the new ones in to say, Did 

we, in fact, cut that time down? And it is going step-by-step 

through that process. 

Senator BURR. I do not want to seem adversarial, doctor. I think 

we are all after the same goal. But you just agreed with a statement that General Bostick made where he basically said that this 

system cannot be fixed. Now, if you agree with that, my question 

is very simple. 

Is it time for us to start over again, to take a blank sheet of 

paper and say, How do we design this in a way for the benefits of 

the servicemembers—the number 1 priority and the number 1 priority for both, I do not question that—who are caught in a system 

that is unacceptable today from a standpoint in the length of time, 

from a standpoint of the accuracy that Senator Murray talked 

about. 

I guess, you know, my question to you would be, if given a blank 

slate, would the Army design IDES the same way or would you do 

it differently? And if your answer is differently, then for God’s 

sakes, let us do it. Tell us what we can do to be partners to change 

this in a way that it works, versus to keep a structure of something 

that individuals who are involved in like General Bostick says, is 

‘‘Fundamentally flawed, adversarial, disjointed.’’ That is not the relationship we want with our servicemembers that are going 

through this. 

The Chairman has been very kind to me. I just want to ask one 

last question and this is to Mr. Gingrich. You made the statement, 

I think, in your testimony that VA has the capacity to make compensation as early as they choose to after a servicemember is discharged. Is that accurate? 

Mr. GINGRICH. We can make compensation the day after they are 

discharged. That is correct, Senator. 

Senator BURR. The day after they—— 

Mr. GINGRICH. Right. By law, we cannot do compensation until 

they have been discharged. 

Senator BURR. How long, on average, is it taking for the first VA 

check to arrive after a servicemember who went through the IDES 

is discharged from the military, not the decision letter from the VA, 

but the actual check? 

Mr. GINGRICH. Right now it is taking too long. It is taking about 

60 days. Part of the reason—and it is not an excuse—but part of 

89 

the reason is we do it by month. So if the person is discharged before the pay system is set up, you have eaten 30 days. We are 

working through that, and I think one of the things that the VTA 

will give us is that they will give us the information we need electronically at the discharge so that we can speed that process up. 

I am very confident that we are going to get very close to the 30- 

day goal. By the way, VTA—Dan and I talked—VTA will be in 

place in June and that process will not only allow us to track the 

payment, it will also allow us to track the ratings and the discrepancies in the ratings. 

Senator BURR. The Chair has been very kind, and I appreciate 

it. I would ask, would you share with us the data that shows us 

that 60-day average for payment? 

Mr. GINGRICH. I will do that, sir. 

Senator BURR. Thank you. Thank you, Chair. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. RICHARD BURR TO

JOHN R. GINGRICH, CHIEF OF STAFF, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question. Ranking Member Burr requested data showing that there is an average 

60-day time period for a discharged Servicemember whose claim has been processed 

by IDES to begin receiving compensation. 

Response. As of June 8, 2012, VA has processed 7,707 disability payments for Servicemembers who have completed the IDES process during fiscal year 2012. Currently, VA is averaging 54 days from the date of separation to process a payment. 

The ‘‘shortest period allowed by law’’ for making VA disability payments following 

discharge or release from the military is the first day of the second month after a 

Servicemember separates. For example, if the Servicemember separates on July 27, 

the earliest date the Servicemember could be paid is September 1. If payment is due 

at the time of award authorization, it is released from the Treasury Department 

within 48 hours of award authorization. 

Chairman MURRAY. Thank you very much. Senator Tester? 

Senator TESTER. Thank you, Madam Chair. I want to go back to 

what Senator Burr was asking about, and I will start with you, Dr. 

Rooney. Do things need to be changed in IDES? 

Ms. ROONEY. Yes. 

Senator TESTER. Mr. Gingrich, do things need to be changed in 

IDES? 

Mr. GINGRICH. Yes, sir. 

Senator TESTER. Could you—and I do not want to know them 

now, but could you get back to the Committee with your recommendations on what needs to be changed in IDES? 

Ms. ROONEY. Yes. 

Mr. GINGRICH. Yes, sir. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. JON TESTER AND

HON. JOHN BOOZMAN TO JO ANN ROONEY, ACTING UNDER SECRETARY OF DEFENSE

FOR PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE

Question. Senator Tester and Senator Boozman requested that Dr. Rooney give 

recommendations to the Committee on what changes need to made to improve 

IDES. 

Response. IDES is a significant leap forward for our Servicemembers and Veterans, but more can be done. Since 2007, IDES has allowed the Departments of Defense (DOD) and Veterans Affairs (VA) to simultaneously complete disability evaluations before DOD separates a Servicemember so both Departments can provide disability benefits at the earliest point allowed under law. It is faster, equitable, and 

has greatly reduced the pay gap that disabled Veterans previously experienced folVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00093 Fmt 6633 Sfmt 6621 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
90 

lowing their separation from military service and the start of Veterans compensation benefits. Secretary Panetta directed that an internal DOD task force review the 

IDES process, with VA’s support, and report to him by the end of September 2012 

on improvement recommendations. The task force is: 

• Examining methodologies to stratify IDES groups and thus reflect different outcome based measurements depending on the nature of the group. 

• Analyzing the current IDES population and those that have completed it since 

the launch of the pilot effort in 2007 to determine both the points in the process 

where the most failures occur and correlating process events with the illness/injuries of the Servicemember. 

• Reviewing the current Expedited DES process to identify methods to increase 

its usage rate among qualified Servicemembers. 

Separately, DOD and VA are developing an end-to-end strategy IDES Information 

Technology (IT) to enhance case management and data sharing. 

Senator TESTER. OK. I would anticipate that those changes 

would add to this simplifying and consolidating as your goals were 

when this was set up between the VA and DOD, would it not? I 

just want to make sure that changes would add to the simplification. 

Ms. ROONEY. Yes. 

Mr. GINGRICH. Yes, sir. 

Senator TESTER. Mr. Bertoni, as you look at IDES right now, its 

goal was to simplify and consolidate. Has it simplified, was the 

first question? 

Mr. BERTONI. I would say yes. 

Senator TESTER. OK. 

Mr. BERTONI. When you look at what was happening under the 

Legacy system versus now, it is much more simple. 

Senator TESTER. Much simpler. Is there an opportunity through 

this system to get feedback from servicemembers and address their 

questions and concerns about this? Is that part of the system? 

Mr. BERTONI. There is a survey mechanism whereby servicemembers are surveyed after each phase of the process, the medical evaluation board, physical evaluation board, and transition phase, yes. 

Senator TESTER. OK. And so—and that is pretty user-friendly 

from your perspective? 

Mr. BERTONI. I do not know about user-friendliness. It is four 

questions per phase, 12 questions. Our concern is the limited number of folks who are actually receiving that survey. In principle, everyone is eligible to receive it, but if you do not opt to do that early 

on at the med phase, you are excluded at the latter phases. 

So we are really limiting the number of folks who are having an 

opportunity to weigh in here on their experience in regard to timeliness, transparency, and some other factors. 

Senator TESTER. Do you think it is important to get that input? 

Mr. BERTONI. Absolutely. 

Senator TESTER. Should we be expanding those opportunities? 

Mr. BERTONI. I think it would be absolutely a good idea to revise 

and relook at how they are surveying servicemembers right now. 

Senator TESTER. I do not want to get out of my lane here, but 

I am going to for a second with Madigan. You said there was 198 

folks, 108 had their diagnosis changed. Were those people—was 

their rating done under IDES? 

Ms. ROONEY. Many of them were. Some of them were under the 

old process, so those that were before roughly 2008 would have 

been under the old process. 

91 

Senator TESTER. OK. So how many of the 198 were—do you have 

those figures broken out? I guess what I want to get at is, to have 

over half the folks not get the proper rating, to say that it does not 

match up with our goals, is an understatement. The question is, is 

IDES actually doing an accurate job of making the assessment for 

the disability, or is it not doing as good a job as the old system? 

Ms. ROONEY. Actually those people before, since I said most of 

them were before 2008, that would be the old system, and it also 

was adding the forensic psychiatrists in it, which was a different 

aspect of the system. So the new process, and frankly, the protocols 

and the fact that our Departments have an integrated mental 

health strategy for how to do this, should have, and by all data 

that we have seen, improve that significantly under the new 

process. 

Senator TESTER. OK. So does that mean all the folks that got 

rated before 2008 we should call them back up and have them rerated? 

Ms. ROONEY. In essence, that is what the Army is doing at this 

point, and we are going to take the lessons learned, as I indicated 

to Senator Murray, and see if we need to do that across the other 

services. 

Senator TESTER. And what about the other branches of government? 

Chairman MURRAY. Senator, let me just clarify: a large number 

of the ones who were misdiagnosed, or had their diagnosis changed 

inaccurately, were after 2008, after the forensic psychology system 

was put in place. 

Senator TESTER. OK. Appreciate that. I mean, we get a lot of 

calls on this kind of stuff, and although I appreciate folks calling 

their Senator to get this squared away, I mean, what it tells me 

is there is an inherent problem here. And then when you combine 

that with the fact that we have got misdiagnosis over 50 percent, 

that is not acceptable. It has got to be fixed. 

And if it is the fact that we bring in a forensic psychologist and 

that fixes the problem, that tells me then we are talking one person, right? 

Ms. ROONEY. Actually that was the issue, was adding that additional layer. That is when the initial diagnoses were changed and 

then we had a review again. So that piece, adding forensic psychiatrists in the process, has been stopped and that does not occur any 

place across the Department. 

Senator TESTER. OK. All right. I mean, look, I have got a lot of 

questions and my time is long passed. Well, I look forward to your 

recommendations on what can be done to improve IDES. I certainly 

appreciate the work you are trying to do, but we are not where we 

need to be, by a long shot, and so, I mean, when I heard your testimony, there was good stuff here, and you should be touting the 

stuff you do well. But man, oh man, we have got a long ways to 

go, do you not think? 

Ms. ROONEY. Absolutely. 

Senator TESTER. And so, how do we get to a point—I mean, what 

do we need to do? Is it manpower? Is it more professional people? 

What is it? I mean, we have got folks coming back and the numbers are going to get more and more with the Afghanistan drawVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00095 Fmt 6633 Sfmt 6601 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
92 

down. But the question is, these folks need help, they need help 

early. That really saves money long-term, especially with unseen 

injuries, and where do we go? I mean, where do we go to get this 

fixed? 

Ms. ROONEY. Sir, as you indicated earlier on, I believe we are 

going to get back to you with specific recommendations that we are 

seeing from our teams going out as to how we continue to move 

this forward. 

Senator TESTER. I look forward to that. Thank you very much. 

Thank you for your testimony. Thank you for your work. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. JON TESTER TO

JOHN R. GINGRICH, CHIEF OF STAFF, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question. Senator Tester and Senator Boozman requested that Mr. Gingrich give 

recommendations to the Committee on what changes need to be made to improve 

IDES. 

Response: 

a. Implement some of the remodeled IDES improvements identified below: 

• Reduce the number of physical case-file handoffs from 8 to 3. 

• Make fitness decision for further military service up front, before VA enters into the process. 

• Ensure VA receives a complete case-file from the Military Services after 

the fitness decision is made. 

b. Automate the IDES process from beginning to end, and enhance the management reporting capabilities to enable IDES sites to effectively manage their 

cases. 

c. Identify and implement best practices and implement electronic data sharing throughout the IDES process. 

Chairman MURRAY. Thank you very much. 

Senator Boozman? 

Senator BOOZMAN. Thank you, Madam Chair. Mr. Bertoni, who 

is in charge of this? We have DOD here, we have VA. Is there a 

person that is actually in charge of the whole process? 

Mr. BERTONI. I would say the Secretaries would say that they 

were in charge of this process. 

Senator BOOZMAN. The Secretary of Defense and the—— 

Mr. BERTONI. In partnership with capable folks under them 

tasked with doing a very difficult—— 

Senator BOOZMAN. So I guess the question I have got, generally, 

things work better when there is a person to oversee. Is there a 

person that the Secretary of Defense and the Secretary of VA have 

designated to have the authority to get some of these things 

worked out? 

Mr. BERTONI. I know Mr. Gingrich has been pegged as the man 

to address many aspects of this process. 

Senator BOOZMAN. So do you have authority over DOD, also, or 

just VA? 

Mr. GINGRICH. Sir, I do not have authority over DOD, but we 

have been working remarkably well in partnership, and I do not 

say that loosely. As I sit down with the Vice Chief of Staff of the 

Army, for example, because that is 68 percent, and we sit down 

monthly. We sit down at different levels in VA with the Army, and 

we are working through this. 

I think part of the issue to address the problem is, we did not 

have a very good dashboard mechanism prior to when we fully imVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00096 Fmt 6633 Sfmt 6601 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
93 

plemented IDES in September of last year. We now have a mechanism. We can go to every single facility, 116 of our senior executives get up on the—for my VTCs, the Army has the same thing 

where we do it together. We can go installation by installation, individual by individual, which we could not track before. 

And I know it sounds something like we are not moving, but 

when we get the VTA in place, we will be able to track every single 

individual, where they are in the system, what kind of rating they 

got, and where they are going. We have got—— 

Senator BOOZMAN. I do not mean to interrupt. I guess, you know, 

in business and in general things, you like for a person to be accountable. 

Mr. GINGRICH. I am accountable directly to Secretary Shinseki 

for the VA portion of this. 

Senator BOOZMAN. I understand that, but I guess I would like to 

see somebody accountable for the whole system. And you may be 

that person, but it is not fair to you, you know, if you really do not 

have the authority to see it through. So I personally think that the 

two Secretaries need to designate somebody that has got the authority. 

Now, we do not do that very well in government at all, but that 

is a basic thing. Where do you see the bottleneck, Mr. Bertoni? Is 

it that they cannot be seen or is it a decisionmaking process after 

they are seen? 

Mr. BERTONI. I think going—I have sat here many times since 

2007 and talked about this whole program process. It comes down, 

I think, to three critical things: people, processes, and technology. 

On many of these sites, there was a sense of urgency following 

Walter Reed. There was a rush to stand them up. 

They did not have proper technology, did not have proper people 

and sufficient processes in place. Staff to servicemember ratios was 

insufficient in many respects. They were stood up anyway. The 

servicemen came, they were overwhelmed, and I think this system 

is paying for it to this day. 

Processes. We have identified throughout the last several years 

areas of the process that appeared to be inefficient. Clearly, we are 

causing backlogs in inefficiencies. In partnership, DOD and VA 

have addressed some of them; not all. We keep pressing that they 

do. 

And last, technology. We have an Integrated Disability Evaluation System, but the system’s part has not caught up. We have 

processes that are combined, we have decisionmaking that is combined, but the systems have not caught up with the process or the 

demands of the end user. 

Senator BOOZMAN. So do you feel like, in followup to Mr. Burr’s 

comments, do you feel like the framework that we have now, the 

IDES, is such that we can meet the goals that we are wanting to 

get to? 

Mr. BERTONI. It is a simpler system. It is more transparent in 

how it operates. It is sort of like a funnel. If you take a funnel, you 

pour water into it, water comes out the other end, it works. But 

if you pour water in that funnel too quickly, too fast, you will very 

quickly find out where the inefficiencies are. That is what is happening. 

94 

We have had rapid increases in inputs, in enrollments, and the 

inefficiencies and bottlenecks in this system are becoming readily 

apparent, and they need to get behind that with some of this mapping and business process redesign. 

Senator BOOZMAN. My concern is, you know, that we have a culture somewhat that just is difficult to deal with these things. I am 

approached by people all the time that are just separating out of 

VA, just retiring, and it is not uncommon, you know, to wait a year 

before you start drawing your retirement. That is without all of 

this other stuff going on. 

So again, I think we have got some real problems that we need 

to look at, and I would welcome, also—and I think it is important 

that you understand that I am with you, but I do think that it is 

important that we get some feedback as to how we can help you 

to streamline that process and similar processes. Thank you. 

Thank you, Madam Chair. 

Chairman MURRAY. Thank you. Senator Johanns? 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEVADA 

Senator JOHANNS. Madam Chair, thanks for holding this hearing. You can tell the frustration of the Committee Members. In this 

town sometimes it is hard to find bipartisanship, as we all know. 

I will guarantee that frustration here is very bipartisan. Everybody 

is frustrated, regardless of which end of the dais you sit on. 

Here is my concern. I was looking through some of the numbers 

and, Mr. Bertoni, you talked about them a little bit in your testimony. Overall average time to complete IDES active components of 

military, the goal is 295 days; we are at 395. But at Fort Belvoir, 

it is 537 days. That is stunning. I cannot even believe that. Percentage of active duty members who complete IDES within the 

295-day goal, the goal is 60 percent; actual results are 18 percent. 

At Fort Meade, it is 0 percent, nobody, nobody. 

Overall average time to complete IDES for Guard members, excluding those who return to duty, agency’s goal is 305 days; 408 

days is the actual. 651 days at Fort Carson. It is just nearly embarrassing to go through these statistics. 

The concerning thing for me is that I do not hear anything today 

that makes me feel, Gosh, we are going to turn the corner here. 

In fact, I must admit quite the opposite. I am going to walk away 

from this hearing very, very worried that the system is imploding, 

that whatever we have done to try to get on top of this system just 

is not working. 

So, Mr. Bertoni, let me ask you just a very, very direct question. 

How long is it going to take, 1 year, 2 years, 5 years, to actually 

see progress in meeting these goals? 

Mr. BERTONI. I cannot give you a specific timeframe. I would say 

that one thing that the services and VA are dealing with is enrollments are up significantly, doubling each year. In 2009, there were 

4,000 enrollments; 2010, about 9,000; and last year, 19,000. So we 

have multitudes coming into this program very rapidly and that is 

going to increase going further. 

So they really do need to continually look at their processes and 

look for streamlining opportunities. We have said all along they 

95 

need to get their staff to servicemember ratios aligned with what 

they think they need to be doing. 

Again, automation. You can leverage so much with automation, 

accounts for many people. So there are things in play. They must 

continue to look at what they are doing and to look for efficiencies. 

And to their credit, more recent data in the MEB phase shows that 

the data is trending more positively over the last 6 months. 

The VA medical exam, they had never been able to meet that 

goal. At the time of our review it was 70 days. As of this month, 

they are at 39 days, under the 45-day goal. So there is some positive trending in MEB. That is the good news. 

The bad news is, those cases are being pushed further to the 

PEB, and those processing times are rapidly increasing. They have 

a 120-day goal and they are starting to push against that threshold. So what is going on in the PEB, what is causing inefficiencies 

there, what did they do in the MEB to create efficiencies, what can 

you learn from those? 

This mapping exercise, this process, re-engineering exercise, I 

think, could be valuable. Should they have done it earlier? Yes, 

they could have done it before each major phase, and I think they 

would have been in a better position. So I cannot give you a timeframe, but I am hopeful next year the numbers will be better, if 

I am here. 

Senator JOHANNS. Do you agree with—let me ask the two other 

witnesses. Do you think you are turning the corner? 

Mr. GINGRICH. Sir, I am absolutely convinced we are turning the 

corner. We have gotten our production up where we are going to 

do about 2,500 cases a month, which we believe is looking at the 

flow that is coming in and the flow that is going out, that it is 

about 2,500. If we can sustain that starting in August, we will be 

able to move forward. 

He is right. We did not get our claims—none of our processes in 

VA last year were meeting the standard. We are now 62 percent, 

in April, of the servicemembers that we processed in the process 

were on time. That is up from 20. Now, one of the things we have 

done to take some risk here is we decided, with at least the Army, 

to say, Let us get all the old jobs—that is why I said the one at 

254 days—and let us get them out of the system because they are 

just holding up everybody and it is extending it. 

So numbers will go up a little bit when you start taking the older 

cases out, but those individuals have been in the system way too 

long. And so, I think we are making progress into a turning phase. 

Will we get to 295 days and 60 percent of the servicemembers by 

31 December? There are risks there, but I think the services and 

DOD and VA, as partners, have come together and said, How are 

we going to get there? 

The Secretary said to us 3 months ago now when we were sitting 

at the meeting of the two Secretaries, We want to get to 60 percent. We want to get to 100 percent, but instead of trying to bite 

the whole thing, let us get to 60 percent by December 31st and 

then we will take on the rest of it to get to 100 percent. 

Because every single one of these servicemembers we are doing 

this to, when they become veterans, as we have talked before, we 

have had them for 50, 60, 70 years and we have got to get them 

96 

in the system right. We have got to take care of them and make 

sure they transition correctly. 

The other part that I would say, to answer your question, if we 

do not get this right by this summer, we are going to be challenged 

when we go to the VOW Act, because this is 10 percent of the population going through, and the VOW Act that you—that Congress 

so graciously gave us to be able to implement, will have a process 

that is even bigger. 

And I think the things that we are putting in place today in VA 

and DOD will help us get both those systems done correctly. 

Senator JOHANNS. I have run out of time, so I hate to cut you 

off, Dr. Rooney, because I am sure you had a thought here, too. 

Feel free to submit that in writing if you would like. But I will just 

wrap up my questions with a request to Mr. Bertoni. I think it 

would be good if you could assess this for us on some kind of periodic basis, just to give us some indication that progress is, in fact, 

being made. 

It would be terribly unfortunate if we showed up in 6 months 

and nothing is happening, and that would be terribly unfortunate. 

So that would be my individual request. The Chair runs the Committee, but it would be something that I certainly would like to see. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. MIKE JOHANNS TO

DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE, AND INCOME SECURITY, 

U.S. GOVERNMENT ACCOUNTABILITY OFFICE

Question. Senator Johanns requested periodic assessments on whether VA and 

DOD are making progress in improving IDES. 

Response. At this time GAO does not plan to conduct ongoing assessments of 

IDES. We will continue to work with your staff to assure that GAO is meeting the 

needs of the Committee regarding our review of IDES. 

Mr. BERTONI. And we have been in this mix since it was a tabletop exercise in 2007. I have testified numerous times, multiple 

products. It would be worse, I think, if we were not in there. And 

I think in regard to your issue of diagnostic differences, 2 years 

ago, I said this was an issue. It could be problematic in terms of 

the treatment of servicemembers in terms of backlogs of the cases. 

If you have a diagnostic difference, you have to keep going back, 

new exams. You get caught on this medical exam hamster wheel 

and cases age out, you have to do it all over again. We asked that 

this issue be looked at. A consultant went in and looked at it, but 

did not do what we thought should be done. 

What should have been is what you are doing now, in-depth case 

file reviews to get extent of nature and extent of these diagnostic 

differences. Then you have guidance around that, you have training 

around that, and then you capture data going forward so you can 

identify hot pockets in trouble areas going forward. 

Had VTA been in place with the data indicating where they were 

having diagnostic differences, it would not have taken servicemembers to come forward making noise about treatment at Madigan. 

You could have that MI data at your fingertips and decide whether 

you need to get out there, see what is going on, do some remedial 

training, et cetera. 

Senator JOHANNS. Thank you. 

97 

Chairman MURRAY. And I would just add, Senator Johanns, as 

a result of what we have looked at at Madigan, that is being reviewed back to 2007, I believe, all cases. But Army-wide now, as 

a result of the work I have done, they are now going back to 2001 

to review all Army cases. But it still is not systemwide. And I think 

that that has to be part of it. So it is something I am very focused 

on. We will work with you on making sure we continue to stay on 

top of this. 

I want to go back, Dr. Rooney. I am very concerned about what 

I continue to hear about the Warrior Transition Units and the 

IDES experience itself. I hear from servicemembers who are in the 

disability process, that they are languishing in this process without 

any meaningful or productive things to do. 

Servicemembers tell us that they feel that their commanders are 

out to get them. And on the other hand, we hear from commanders 

that they feel these servicemembers are being deliberately obstructive in delaying the process in order to be more difficult. That kind 

of adversarial relationship cannot be beneficial for either the unit 

or the servicemember who is trying to move on with their life. 

And worse, frankly, I continue to hear about servicemembers 

who are overdosing on drugs, committing suicide, committing serious crimes, and at Joint Base Lewis-McChord in my homestate of 

Washington, six servicemembers have died from suicide, auto accidents, or drugs while they are in the IDES process. That is happening at bases across the Nation. 

So I hope you share my belief that we can do this better, but I 

wanted to ask you, what is the Department going to do to make 

sure that there is an effective, supportive leadership at all levels 

to make sure that this is not happening? 

Ms. ROONEY. Some of the specifics you pointed out, in terms of 

making sure that we are looking at that transition process 

proactively, working with those servicemembers going through that 

process so that they can identify skills and possible career opportunities, those programs, some of those are already in place. We will 

be doing more and piloting more not just for those in the disability 

process, but throughout transition, as we have talked before, starting this summer. That is one piece of it. 

The second one, as we indicated earlier, is really making sure 

that the communication is not just at the senior leadership, but absolutely is translated down through the chains of command right 

to the base. I believe Mr. Gingrich pointed out some meetings with 

the Sergeant Majors and other senior enlisted and that is going on 

in the Department as well. 

Each of the service chiefs have been going out to meet directly 

with various commands. As you know and I have mentioned to you, 

I spend probably about half of my time on issues surrounding this 

and have been back out to Washington State, have been down to 

San Antonio and others so that I could also go out to the bases and 

help reinforce and see what is happening there so we can identify 

where there are those disconnects and get that message consistently across the Department. 

So it is not only across DOD, but it is also with our partners in 

VA that we are continually sending the message and working at 

this, and where there are issues, not looking aside from those, but 

98 

going right out and identifying where are they, what is the problem. And whether that is because there seems to be a backlog in 

cases and why is that at certain installations, we will target efforts 

to find out, is that a process issue, is it a command issue? What 

are the various pieces to do this? And we do have it broken down 

that succinctly and that is the way we are following through. 

Chairman MURRAY. I appreciate that, and I appreciate your sitting before this Committee and saying this. We want results from 

this, as I am sure you do, too. So it has to be a lot more than just 

testimony before this Committee. It has to be real action all the 

way down and we will be closely following that. We cannot have 

these hearings every 6 months or every year and keep hearing the 

same things. 

One of the things that I hear most often from servicemembers in 

this joint process is that they do not have any idea of when they 

are going to separate from the service. They want to make plans 

to move or go to school or get back with their families or whatever 

they are doing, and as we heard today, those numbers of days 

keeps rising. 

Last fiscal year, the average processing time, as we heard, was 

394 days for active duty, 420 for Guard and Reserve. That is unacceptable for someone who is just waiting to figure out what they 

are going to do with the rest of their lives. 

I really believe that these servicemembers would benefit from 

knowing what the time is actually going to be at the installation 

where they are, rather than just saying we have a goal here of so 

many days, but what is it at your installation? We need an honest 

approach even if it is not what we like, but at least telling them 

a real number. 

I would like both of your Departments to look into that and report back to this Committee on the possibility of having real information for these men and women. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. PATTY MURRAY TO

JOHN R. GINGRICH, CHIEF OF STAFF, U.S. DEPARTMENT OF VETERANS AFFAIRS

Question. Chairman Murray requested that Mr. Gingrich report back to the Committee on giving Servicemembers in WTU’s a realistic estimate of how long it will 

take for their claims to be processed at their installation and for them to be discharged. 

Response. Currently, VA is averaging 54 days from the date of separation to process a payment. VA does not have control over the discharge dates. 

Chairman MURRAY. Let me also say that the only way that we 

are going to restore trust, which is really important, is by focusing 

on consistency and accuracy of decisions, and I hope that both the 

VA and the DOD have really learned from VA’s claim system 

struggles with how important it is to get the disability decisions 

correct the first time. 

I am concerned because Committee oversight has revealed, as I 

talked about earlier, IDES rating decisions with errors. Given that 

the military relies on the disability level assigned by the VA, these 

errors could impact the benefits that servicemembers will receive 

from the military, and also the benefits from the VA. 

99 

So, Mr. Gingrich, when the VA identifies an error in a rating decision, do you alert DOD that the error can be fixed before separation? 

Mr. GINGRICH. Madam Chairman, there are two things we do. If 

it is before separation, we notify the PEB and we notify the individual, and we get the correction done before. If it is after and the 

person is now a veteran and we discover it—we know one case so 

far we found, that the individual had a discrepancy in the rating 

and they would have changed the rating, we have helped that individual and gone back to the service and helped that individual get 

their records corrected. 

Chairman MURRAY. If a servicemember believes that there is an 

incorrect rating or whose claim has been identified as incorrect, 

what recourse do they have to go back and get the DOD rating 

changed? 

Mr. GINGRICH. If we substantiate it, it would be fairly simple for 

them to get it corrected. If it is not a mistake that we made or it 

is not an error that was made at the time and it is the condition 

that has changed later, then it would be very much more difficult. 

But we talked about it yesterday, and we decided that we needed 

to make sure the process is such that the veteran or the active 

duty servicemember does not have to do anything. We take care of 

it and we do it for them. To get it started, we give them the information they need and then they work the system. So we will be 

proactively involved in any of these that we find. 

Chairman MURRAY. OK. Well, we will have more information on 

what we are finding and expect to work with you on that. 

Mr. GINGRICH. And ma’am, we look forward to that and we will 

work each and every case you give us. 

Chairman MURRAY. OK. I have several other questions for the 

record, but I did want to focus on the Integrated Electronic Health 

Record. We know that delays in IDES are driven, in part, by problems accessing information and sharing paper files between the Departments. Those challenges are not unique to IDES, but they do 

affect every aspect of a servicemember’s transition to VA, including 

how their health and benefits information is shared. 

Now, we have heard a lot of talk from VA and DOD that they 

are making progress on data sharing through their work on the Integrated Electronic Health Record and the Virtual Lifetime Electronic Record. But according to this week’s press release, only two 

sites will have initial joint electronic health record capabilities by 

2014, with 2017 actually being the target date for implementation 

of this. 

Now, the Departments have both said that the key to their collaboration and key to the success or failure of disability evaluations 

and transition are these electronic health records. It seems to me 

that this should be a priority for absolutely everybody. The project 

has been plagued, as you well know, by false starts and budget 

issues, and planning is not complete. 

I understand that a lot of positions at the office responsible for 

staffing and managing these projects are unfilled yet. I understand 

it is only 30 percent staffed. But how can the Departments say this 

is a priority when it is only 30 percent staffed, and we are talking 

about 2017 as the target date? 

100 

Ms. ROONEY. I believe regarding staffing—and we will get you 

the most recent numbers—we continually add staff so that we are 

fully staffed up, but that is not impeding progress at the current 

point. There has been substantial progress made in terms of this 

Inter-Agency Program Office with a new director actually named 

within the past 3 months with extensive experience. 

And you are right. Both Secretaries announced jointly this week 

that by 2014, both in San Antonio and at Hampton Roads, we will 

have initial operating capability of this system, which will have 

multiple areas from pharmacy on down to medical records that are 

functional. 

I think they also pointed out when they announced it that we are 

moving forward, but we are also moving forward deliberately because we cannot afford to have any errors in these actual records 

going forward. So this is both safety and concern for individuals, 

to be able to get this right. 

We do have some systems currently and one of the things that 

both Secretaries viewed when they were in north Chicago was an 

example where we have been able to use existing systems, and it 

is not the long-term solution, but it is one that is working now, and 

begin to exchange data much better. So we are learning from that 

and integrating that into this electronic health record. 

So it is a priority. We are growing the staff, but we also want 

to make sure that there is no chance for errors because these are 

people and their information, and we cannot afford to have any errors. 

[The information requested during the hearing follows:] 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. PATTY MURRAY TO

JO ANN ROONEY, ACTING UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND

READINESS, U.S. DEPARTMENT OF DEFENSE

Question. Dr. Rooney stated she would provide the most recent data to Chairman 

Murray on number of new hires to more quickly implement the integrated electronic 

health records system. 

Response. Below is an extract from a larger, more detailed presentation that was 

delivered to SVAC staff to satisfy a due-out from a 23 April 2012 SVAC/SASC 

briefing. 

The following provides a staffing summary as of 31 July 2012: 

• IPO TOTAL FILLED = 48 DOD + 58 VA = 106 / 236 = 44.91% 

– DOD Total Filled = 48 / 116 = 41.37%. 

– VA Total Filled = 58 / 120 = 48.33%. 

o VA-OIT Total = 2 filled, 31 detailed = 33 / 120 = 27.5%. 

– 31 Details to be extended until transfer or hiring action completed. 

o VA-VHA Total = 25 pending reassignment in June 16, 2012 + 1 additional detailed (not pending assignment) = 25 / 120 = 20.83%. 

• The chart below illustrates that the IPO will achieve 100% staffing (236 FTE’s) 

by March 2013. 

• Currently the IPO staffing level is evaluated and tracked on a monthly basis, 

and progress is evaluated by the following criteria: 

– Red: >25% under staffing projections over time. 

– Yellow: 12.5% < Yellow < 25% (half the red criteria). 

– Green: <12.5%. 

Chairman MURRAY. Mr. Gingrich, do you want to comment? 

Mr. GINGRICH. I agree with Secretary Rooney. This is a priority 

of this Department. The Secretary has made it his number 1 priority. He has pushed it hard. And we do see—it sounds like it is 

101 

not much, but its ability to be able, with a single sign-on, be able 

to look at a screen and get data from either VistA or Alta and be 

able to do a medical evaluation, it is clear, it is clean, and it is 

doable. 

We are looking at how do we do that other places. I also think 

the integration of the hospital pharmacy has to be done, as we are 

going to talk about. That is very complicated, but they are doing 

it there, and they are making it work. So we are making progress. 

Are we making progress as fast as both Secretaries like? Probably 

not, but we are making progress, and we are pushing it. 

That is why we talked about things like the VTA. That is not the 

electronic health record, but it will inform the electronic health 

record and it will also inform VBMS and things like that that we 

will have. So we are doing little pieces as we are going along in 

addition to the full electronic health record, ma’am. 

Chairman MURRAY. Senator Boozman? 

Senator BOOZMAN. Well, I really do not have any more questions, 

but I think the point that you made, Madam Chair, about if we 

could really give these folks a realistic idea of what is going on, I 

know in my life, I think all of our lives, the most difficult time is 

when you are in a period of uncertainty. And, you know, these are 

professionals that are used to bureaucracy and this and that, being 

in the service they have been in, but I do think that that is such 

a little thing, but it is a huge deal. And so, if we can work on that? 

The other thing is, is that we have a situation where this is the 

number 1 goal of the Secretaries and things to try and get this 

sorted out. They are meeting on a monthly basis. Something that 

we might consider is maybe you and the Ranking Member, Senator 

Burr, and perhaps Chairman Miller, Ranking Member Filner—I 

know they are as concerned as we are about this—that maybe on 

some sort of a basis—maybe monthly, bi-monthly, whatever—you 

all feel is appropriate, or somebody that you designate, for you all 

to get together and basically, you know, let us talk about how 

things are going. 

And the other thing is how we, as a Congress, if there are things 

that we can do to again facilitate and just really all work together—I know that you all want, in all of your capacities, to get 

this worked out as much as anybody, and certainly we want to be 

there to help you. But it is something that we have to get worked 

out. Thank you, Madam Chair. 

Chairman MURRAY. Thank you very much. Let me just say that 

ensuring an accurate, efficient, and seamless disability evaluation 

process for our servicemembers really is a critical part of making 

sure that they receive the care and benefits that they deserve. 

Clearly, there is a lot more work to be done. We have seen some 

steps in the right direction, but it is going to take continued engagement and cooperation from both Departments to get this right. 

So that is the message that I would really urge both of you, Dr. 

Rooney and Mr. Gingrich, to share with Secretaries Shinseki and 

Panetta. 

We also need to share this message with the lower levels, too. It 

is very clear squad member leaders and squad leaders who interact 

every day with these servicemembers need to get the message as 

well. So I hope you follow up on that. This system has been experiVerDate Nov 24 2008 16:22 Oct 05, 2012 Jkt 000000 PO 00000 Frm 00105 Fmt 6633 Sfmt 6601 H:\ACTIVE\052312.TXT SVETS PsN: PAULIN
102 

encing a lot of challenges for a very long time, but we owe it to our 

military members who have served this country to get this right 

and that is what this Committee is focused on, and we want to 

urge you to really, really, from the top all the way to the bottom, 

work to get this done right. 

So thank you very much for your testimony today and your work 

on this. With that, this hearing is adjourned. 

[Whereupon, at 11:34 a.m., the hearing was adjourned.] 

(103) 

A P P E N D I X 

PREPARED STATEMENT OF PARALYZED VETERANS OF AMERICA

Chairman Murray, Ranking Member Burr, and Members of the Committee, Paralyzed Veterans of America (PVA) appreciates the opportunity to submit a Statement 

for the Record regarding Seamless Transition of servicemembers to veteran status 

and the effect the Integrated Disability Evaluation System (IDES) is having on the 

transition process. This is not only important to PVA, but was also an issue identified in The Independent Budget that was recently published by AMVETS, Disabled 

American Veterans, PVA and the Veterans of Foreign Wars. While in many ways 

the IDES can provide benefits to veterans, PVA has identified potential serious 

issues with the system. 

When the President’s Commission on Care for America’s Returning Wounded 

Warriors recommended that the Department of Defense (DOD) and the Department 

of Veterans Affairs (VA) create a single, comprehensive, standardized medical examination that DOD would administer, Veterans Service Organizations (VSO) supported the recommendation. This exam would serve DOD’s purpose of determining 

fitness for duty and VA’s purpose of determining initial disability level. PVA believes this should be a mandatory examination and an integrated element of the 

military separation process and VA should be responsible for handling this duty as 

VA has the expertise to conduct a more thorough and comprehensive examination. 

The Disability Evaluation System (DES) is the mechanism used to evaluate a servicemember for fitness for duty by the DOD and to compensate for injury or disease 

incurred in the line of duty which inhibits a servicemembers’ ability to perform their 

duties. DES includes a medical evaluation board (MEB) which is an informal process of the medical treatment facility, a physical evaluation board (PEB) which is an 

informal and formal fitness for duty and disability determination, an appellate review process, and a final disposition. A PEB Liaison Officer (PEBLO) is assigned 

to assist the servicemember through the process. The PEB recommends the servicemember either return to duty, be placed on temporary disabled/retired list, separate 

from active duty, or be medically retired. While the DOD Legacy DES process only 

rates those disabilities that directly impact continued military service, the VA evaluation takes into account all disabilities incurred or aggravated during military 

service warranting a disability rating of 10 percent or higher. 

The DES pilot project premised on the President’s Commission on Care for America’s Returning Wounded Warriors recommendation was launched by the DOD and 

VA in 2007. Based on servicemembers’ high satisfaction rates with the revised program, the DOD and VA designed an integrated disability evaluation system (IDES), 

with the goal of speeding the delivery of VA benefits to all transitioning servicemembers. The current 27 locations participating in the pilot program examine about 

47 percent of servicemembers (12,735 in 2010) who enter the DOD disability evaluation system annually. 

The IDES allows servicemembers to file a VA disability claim when they are referred for evaluation. VA provides a disability rating for each condition found during 

the medical exam, and the PEB uses these ratings to determine the type of separation or retirement for which the member is eligible. Under the system, the DOD can 

only consider conditions that are unfitting when determining disability ratings, 

while VA determines disability ratings for all service-connected conditions, even the 

ones that would not result in a finding of unfit for continued military service. The 

104 

DOD uses the VA disability percentages for each condition, but may have a different 

combined disability rating than VA awards because conditions that are not unfitting 

are not considered in the DOD calculations. Thus, a servicemember’s disabilities 

and their functional impact must be delineated for accurate evaluation against the 

VA Combined Rating Table. PVA is concerned that the system does not ensure servicemembers’ records accurately describe numerous possible disabilities. 

While VSOs have been pleased at the progress of the IDES to date, servicemembers who are participating in the new approach to discharge evaluation are not 

systematically being encouraged to seek representation from a VSO Service Representative. Most are relying instead on the advisory services of military counsel, 

yet each service provides access to military legal counsel in different manners and 

circumstances. 

From the outset, PVA does not believe the system was set up for success. VA and 

DOD engaged in working groups early on that did not include input from the VSO 

community. It appears that attorneys and paralegals, who function under Title 10, 

replaced the function of VSO Service Officers, who derived their authority from Title 

38. But since active duty servicemembers fall under Title 10 authority, VSOs are 

essentially cutoff from these men and women until they become veterans. This creates a problem where VSOs are essentially left to clean up and attempt to correct 

a improperly completed claim that was preventable with adequate initial counseling 

and claims development. 

IDES attempts to reconcile the PEB and Compensation and Pension (C&P) processes by having the servicemember submit to one medical exam or series of exams 

serving both purposes. The problem is PEB is meant to determine fitness for duty 

while C&P determines total disability for compensation purposes. Conditions that 

are often not regarded for PEB purposes, such as diabetes, sleep apnea, mild musculoskeletal degeneration, and tinnitus for examples, can have major implications 

in a VA disability rating. When a question or conflict arises, it is unclear whether 

VA or DOD has jurisdiction to resolve the matter before it flowers into a protracted, 

system-clogging appeal once the veteran realizes the mistake. This is often only 

after later consulting with a VSO service officer. Not only will this potentially delay 

proper compensation for the new disabled veteran, it adds an additional strain to 

an already horribly backlogged claims system. 

Finally, PVA questions whether those designated as Soldiers Counsel possess the 

requisite knowledge of VA law and the claims processes to adequately function as 

accredited representatives. Servicemembers have no choice but to rely on the expertise ostensibly wielded by these individuals. If knowledge is lacking, the effects are 

felt downstream, after the servicemember is discharged and it’s too late. What level 

of training are these individuals required to undergo, both initially and continually, 

that meets the same standard directed under Title 38 for service officers? While 

there is no doubt that these are dedicated and conscientious individuals, if the MEB 

staff and PEBLOs are expected to participate in the development of a servicemember’s co-existent fitness-for-service evaluation/VA claim, then these individuals 

should also have some familiarity with the VA claims process insofar as their intervention could impact entitlement to benefits. The end result is a severe disservice 

to the discharged veteran. 

The most important issue should be the best care and support to the servicemember. With this goal, PVA recommends that the DOD and VA provide greater 

information to all military personnel going through IDES about the advantages and 

benefits of using a VSO service officer. They should be provided the option to choose 

between the legal counsel offered by the military and that available at no cost 

through the system of national service officers of chartered Veterans Service Organizations. 

To facilitate this process, it will be critical that DOD allow access to military installations for chartered Veterans Service Organizations to provide services to active 

duty personnel. This should include their incorporation in all Transition Assistance 

Programs. This is in no way to detract from the services being provided by the military, but should be one more resource to better prepare servicemembers for their 

transition to veteran status. 

105 

And finally, even as the current military conflicts drawdown, members of the Reserve and National Guard continue to play a major role in military operations and 

deployments. The DOD mandatory separation physical examination should be required for all demobilizing National Guard and Reserve members, not just active 

duty personnel. In many ways, this may be even more important to these servicemembers who rapidly depart from the support and medical care structure of active 

duty and return to their communities, often widely dispersed rural areas with limited medical care opportunities. 

PVA supports the IDES and believes it is an important program that benefits 

transitioning servicemembers. As with many programs, once implemented unforeseen issues and consequences begin to appear and need to be addressed. It is critical 

that America’s military be provided the best services and support as they leave the 

military and we ask Congress to ensure that both DOD and VA work to correct 

these issues so that our newest veterans have the best opportunity for a new life 

and brighter future as they transition to the civilian community. 

Æ