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IS THIS ANY WAY TO TREAT OUR TROOPS? PART

III: TRANSITION DELAYS

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

HOMELAND DEFENSE AND FOREIGN OPERATIONS

OF THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED TWELFTH CONGRESS

FIRST SESSION

MAY 4, 2011

Serial No. 112–28

Printed for the use of the Committee on Oversight and Government Reform

(

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

http://www.house.gov/reform

(II)

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

DARRELL E. ISSA, California, Chairman

DAN BURTON, Indiana

JOHN L. MICA, Florida

TODD RUSSELL PLATTS, Pennsylvania

MICHAEL R. TURNER, Ohio

PATRICK T. MCHENRY, North Carolina

JIM JORDAN, Ohio

JASON CHAFFETZ, Utah

CONNIE MACK, Florida

TIM WALBERG, Michigan

JAMES LANKFORD, Oklahoma

JUSTIN AMASH, Michigan

ANN MARIE BUERKLE, New York

PAUL A. GOSAR, Arizona

RAU ́ L R. LABRADOR, Idaho

PATRICK MEEHAN, Pennsylvania

SCOTT DESJARLAIS, Tennessee

JOE WALSH, Illinois

TREY GOWDY, South Carolina

DENNIS A. ROSS, Florida

FRANK C. GUINTA, New Hampshire

BLAKE FARENTHOLD, Texas

MIKE KELLY, Pennsylvania

ELIJAH E. CUMMINGS, Maryland, Ranking

Minority Member

EDOLPHUS TOWNS, New York

CAROLYN B. MALONEY, New York

ELEANOR HOLMES NORTON, District of

Columbia

DENNIS J. KUCINICH, Ohio

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

STEPHEN F. LYNCH, Massachusetts

JIM COOPER, Tennessee

GERALD E. CONNOLLY, Virginia

MIKE QUIGLEY, Illinois

DANNY K. DAVIS, Illinois

BRUCE L. BRALEY, Iowa

PETER WELCH, Vermont

JOHN A. YARMUTH, Kentucky

CHRISTOPHER S. MURPHY, Connecticut

JACKIE SPEIER, California

LAWRENCE J. BRADY, Staff Director

JOHN D. CUADERES, Deputy Staff Director

ROBERT BORDEN, General Counsel

LINDA A. GOOD, Chief Clerk

DAVID RAPALLO, Minority Staff Director

SUBCOMMITTEE ON NATIONAL SECURITY, HOMELAND DEFENSE AND FOREIGN

OPERATIONS

JASON CHAFFETZ, Utah, Chairman

RAU ́ L R. LABRADOR, Idaho, Vice Chairman

DAN BURTON, Indiana

JOHN L. MICA, Florida

TODD RUSSELL PLATTS, Pennsylvania

MICHAEL R. TURNER, Ohio

PAUL A. GOSAR, Arizona

BLAKE FARENTHOLD, Texas

JOHN F. TIERNEY, Massachusetts, Ranking

Minority Member

BRUCE L. BRALEY, Iowa

PETER WELCH, Vermont

JOHN A. YARMUTH, Kentucky

STEPHEN F. LYNCH, Massachusetts

MIKE QUIGLEY, Illinois

(III)

C O N T E N T S

Page

Hearing held on May 4, 2011 ................................................................................. 1

Statement of:

Simpson, Lynn, Acting Principal Deputy Undersecretary of Defense for

Personnel and Readiness, U.S. Department of Defense; John Medve,

Executive Director, VA/DoD Collaboration Service, U.S. Department

of Veterans Affairs; and Daniel Bertoni, Director, Education, Workforce

and Income Security, U.S. Government Accountability Office, accompanied by Randall B. Williamson, Health Care Team Director, USGAO,

and Mark Bird, IT Team Assistant Director, USGAO ............................... 5

Bertoni, Daniel .......................................................................................... 41

Medve, John ............................................................................................... 25

Simpson, Lynn ........................................................................................... 5

Letters, statements, etc., submitted for the record by:

Bertoni, Daniel, Director, Education, Workforce and Income Security,

U.S. Government Accountability Office, prepared statement of ............... 43

Medve, John, Executive Director, VA/DoD Collaboration Service, U.S.

Department of Veterans Affairs, prepared statement of ........................... 27

Simpson, Lynn, Acting Principal Deputy Undersecretary of Defense for

Personnel and Readiness, U.S. Department of Defense, prepared statement of ........................................................................................................... 9

Tierney, Hon. John F., a Representative in Congress from the State

of Massachusetts, prepared statement of ................................................... 78

(1)

IS THIS ANY WAY TO TREAT OUR TROOPS?

PART III: TRANSITION DELAYS

WEDNESDAY, MAY 4, 2011

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON NATIONAL SECURITY, HOMELAND

DEFENSE AND FOREIGN OPERATIONS, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, Washington, DC.

The subcommittee met, pursuant to notice, at 9:30 a.m. in room

2154, Rayburn House Office Building, Hon. Jason Chaffetz (chairman of the subcommittee) presiding.

Present: Representatives Chaffetz, Labrador, Gosar, Farenthold,

Tierney, Welch, Quigley.

Also present: Representatives Issa, Cummings, Buerkle.

Staff present: Thomas A. Alexander, senior counsel; Molly Boyl,

parliamentarian; Kate Dunbar, staff assistant; Adam P. Fromm, director of Member liaison and floor operations; Erin Alexander, fellow; Jaron Bourke, minority director of administration; Kevin

Corbin, minority staff assistant; Ashley Etienne, minority director

of communications; Lucinda Lessley, minority policy director; Scott

Lindsay, minority counsel; Zeita Merchant, minority LCDR, fellow;

Dave Rapallo, minority staff director; and Donald Sherman and

Carlos Uriarte, minority counsels.

Mr. CHAFFETZ. Welcome. The committee will please come to

order.

I appreciate all of you being here on this important topic today,

and I thank those participants in advance.

We want to welcome you to this hearing, which is entitled Is

This Any Way to Treat our Troops? Part III, Transition Delays.

I would like to begin by thanking our military and intelligence

community for their tireless efforts and heroism, as exemplified by

the events of this past weekend. The fact that Osama bin Laden

is no longer the leader of al Qaeda is a victory for the United

States and those who stand against terrorism. A dark chapter in

world history is now closed, but the fight is far from over.

I hope we all take time to pause in our own way and recognize

the victims that have been at the hands of this tyrant, but also to

thank the men and women who have served so tirelessly in the intelligence community, the military, the families that have poured

their efforts to fight the war on terrorism. Undoubtedly, that will

continue. But we need to thank them in our own way, in our own

hearts and in our own communities.

As America redoubles its efforts to defeat global terrorism, let us

never forget the brave men and women of our armed forces who

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have brought us this far. They have sacrificed everything for us,

and have for generations. Since 2001, 6,014 Americans have died

in Operations Enduring Freedom, Iraqi Freedom, and New Dawn.

Another 43,184 people have been injured during this time. In Afghanistan alone, these numbers have risen dramatically since our

current President took office in 2009. You will see some charts here

on the walls.

The total number of deaths has risen from 155 in 2008 to 499

in 2010. The total number of injuries has more than doubled, from

2,144 in 2008 to 5,226 in the year 2010. There have been 81 deaths

and 854 injuries this year alone. Some wounds are visible and

some are not, but were all acquired in the defense of our Nation

and serving our country.

Just as our uniformed men and women took the oath to defend

America, the Federal Government has a duty to provide care for

them upon their return. Of the two, the Federal Government undeniably has the easier end of the equation. Yet we struggle to get

it right. This is why we are here today.

The subcommittee will examine issues associated with the transition of wounded service members from the Department of Defense

to the Department of Veterans Affairs. In recent years, various

oversight bodies have identified significant shortcomings in the

care and treatment of our veterans. These entities include the Government Accountability Office, the Independent Review Group commissioned by Defense Secretary Gates, Inspectors General, as well

as the Dole-Shalala Commission. Each has highlighted deficiencies

in the administrative processing of wounded service members.

A chief concern is the overly bureaucratic and lengthy disability

evaluation system. The lack of seamless transition process is the

source of great frustration for injured combat veterans and their

families. Under the legacy Disability Evaluation System, often referred to as DES, service members wait an average, an average, of

540 days from the time they receive their medical evaluation from

the Department of Defense to the time they receive a benefit check

from the VA. Let me repeat that: 540 days. In some cases, this period is longer than the entire active duty enlistment.

According to reports, there are a number of reasons for this

delay. These include duplicative medical exams, poor IT infrastructure, lack of staffing and others.

After much criticism, the Department agreed to revamp the

DESs. In 2007, a pilot program called the Integrated Disability

Evaluation system was introduced. This program aimed to consolidate programs and eliminate the gap in benefits. The goal is to reduce the 540 day process to 295 days. The average wait, according

to a briefing by DOD and VA to committee staff is now 335 days.

While 335 days is far more preferable than 540 days, it is still too

long. Some of the old problems have yet to be resolved. GAO will

describe some of those challenges here today. We appreciate them

being here with us.

On March 17, 2011, Defense Secretary Gates and VA Secretary

Shinseki agreed to examine ways to reduce the wait time to 75 to

150 days. They also agreed to devise an interagency electronic

health information record. I am trouble it took until 2011 for these

agreements to be reached. However, I do look forward to hearing

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from our administration witnesses about how each department

plans to achieve these goals.

With each new administration, there seems to be a renewed enthusiasm to address veterans issues. There is no doubt that the Department of Defense, the VA and this President are well-intentioned and have veterans’ best interests at heart. We must ensure

that the Federal Government is working smartly at each step of

the way. With the recent increases in the number of deaths and injuries in Afghanistan, we have to get this right.

I look forward to hearing from our panel of witnesses about the

successes and challenges they face. This subcommittee is ready to

work with the Departments in whatever way possible to ensure the

better care of our veterans.

At this time, I would like to recognize the ranking member of the

full committee, Mr. Cummings, for 5 minutes.

Mr. CUMMINGS. Thank you very much, Mr. Chairman. I want to

thank also our ranking member, who is on his way, Mr. Tierney,

for convening this hearing today.

I too join you in saluting our troops, the CIA and all those people

involved, and certainly too the President of the United States, Mr.

Obama, for what was done over the last few days with regard to

Osama bin Laden. I think it is quite appropriate, Mr. Chairman,

that we sit here today addressing the issues confronting people like

the Navy Seals, people like the young people who are right now at

the U.S. Naval Academy in my State, and I serve on their board

of visitors, who go out there, do their job, to protect our freedom,

our rights, and protect our people. So I salute them and all those

who are involved in that successful mission.

Last month, I visited Walter Reed, along with you, Mr. Chairman, and the Naval Medical Center, to meet with our wounded

warriors and their caregivers. We talked with an Army sergeant

who lost his legs in Laghman Province in Afghanistan, an Army

captain who lost both legs and several fingers in eastern Afghanistan, and a young private from the Midwest who lost a leg and was

there with his mother.

And these are very real costs of war. We owe our wounded warriors the very best health care when they return from the battlefield. For those of us sitting here, and those of you sitting at the

witness table, it is our duty to make sure that the United States

makes good on that promise. It is a very, very important promise.

I have often said that this is not, this must not be about politics.

It must be about purpose. It must be about commitments that we

have made to our men and women in uniform. When the Washington Post published a series of articles in 2007 detailing the appalling conditions at Walter Reed Army Medical center, I was

angry and deeply embarrassed by the poor quality of care, the terrible conditions and the bureaucratic obstacles facing our service

members and veterans.

In the previous Congress, this committee has taken an active

role in holding DOD and VA responsible for improving the care of

our wounded warriors. Representative Tierney, to his credit, held

the very first hearing on this issue in the 110th Congress. Back

then, I wasn’t even on this subcommittee, but I appeared with him

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at his first committee hearing on that, subcommittee hearing on

that, at Walter Reed.

And Chairman Chaffetz, by holding today’s hearing, you are

demonstrating your commitment to continuing our committee’s bipartisan commitment to this cause. This is a situation where Republicans and Democrats must not move to common ground, we

must move to higher ground.

As a result of these vigorous oversight efforts, the Dole-Shalala

Commission was created to assess longstanding health care and

disability evaluation issues within DOD and VA. A joint DOD-VA

senior oversight committee was also established to implement

many of the recommendations made by the Dole-Shalala Commission. One of those recommendations, to improve the military’s complicated and time-consuming disability evaluation system, is in the

process of being fully implemented nationwide. I have one word for

all of those at the witness table: we must move with all deliberate

speed. Our veterans and our servicepeople cannot wait.

I am encouraged that the new Integrated Disability Evaluation

System has simplified the process for our wounded warriors and reduced the time it takes for veterans to get their full benefits. I am

proud to say that when the IDES process is fully implemented, it

will effectively eliminate the benefit gap faced by our newly minted

veterans.

But the process is still too time-consuming. We can do better.

Our service members should not have to wait over a year to determine whether they are fit to continue their military service and the

level of benefits they will receive if they are discharged. Even if

DOD and VA were meeting their goal of completing the IDES process in 295 days, nearly 10 months is simply too long for our service

members to wait while their future hangs in the balance. And by

the way, their families are also affected greatly.

DOD and VA must also do more to improve the exchange of medical records, given the complicated health conditions facing many

of our service members when they leave Iraq or Afghanistan. It is

vitally important therefore that the health care providers of these

two departments communicate seamlessly. As I close, I know that

DOD and VA are in the process of creating the interagency electronic medical records and I look forward to hearing more about

the progress today.

With that, again, Mr. Chairman, I thank you for calling this

hearing and I yield back.

Mr. CHAFFETZ. Thank you. The gentleman yields back.

I now recognize the chairman of the full committee, Mr. Issa of

California.

Mr. ISSA. Thank you, Mr. Chairman. It is a distinct honor to go

after the ranking member, so that I can say I agree with everything the ranking member said. This is an issue that goes beyond

partisanship. This is an issue in which the committee is completely

united.

I am honored to have Camp Pendleton in my district, and the

Wounded Warrior facility that is there. There is no distance between Mr. Cummings and myself. I sometimes do see that there

are reasons that we have 10 months or more in which a marine

continues to try, or a corpsman, to return to full active duty and

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is working through that. But with the exception of those times in

which you are clearly trying to help a soldier, sailor, marine or airman remain on active duty and that extends the determination, I

do believe that the process is too slow and continues to be, we can

do better but we haven’t yet done it.

So again, I thank the chairman for holding this hearing, and I

thank Mr. Cummings for his appropriate remarks, and yield back.

Mr. CHAFFETZ. The gentleman yields back.

Members will have 7 days to submit further opening statements

for the record.

We will now recognize our panel. Ms. Lynn Simpson is the Acting Principal Deputy Undersecretary of Defense for Personnel and

Readiness. Mr. John Medve is the Executive Director of the VA/

DOD Collaboration Service. Mr. Dan Bertoni is the Education,

Workforce and Income Security Team Director at the GAO. Mr.

Randall Williamson is the Health Care Team Director at the GAO.

And Mr. Mark Bird is the IT Team Assistant Director at the Government Accountability Office.

We appreciate you all being here today. My understanding is

that the GAO is going to submit one opening statement, but they

will all participate in the discussion that we have moving forward.

Pursuant to committee rules, all witnesses will be sworn in before they testify. If you would please rise and raise your right

hands.

[Witnesses sworn.]

Mr. CHAFFETZ. Thank you. You may be seated.

Let the record reflect that all the witnesses answered in the affirmative.

In order to allow time for discussion, please try to limit your

verbal testimony to 5 minutes. If there are additional materials or

statements that you want to put into the record, your entire written statement will be made a part of the record.

I again want to thank you for your time, effort, your expertise,

your commitment to our country. I know your hearts are all in the

right places. This is a frustrating issue for the time that it has

taken. But we do want to hear from each of you.

So with that, we will now recognize Ms. Simpson for 5 minutes.

STATEMENTS OF LYNN SIMPSON, ACTING PRINCIPAL DEPUTY

UNDERSECRETARY OF DEFENSE FOR PERSONNEL AND

READINESS, U.S. DEPARTMENT OF DEFENSE; JOHN MEDVE,

EXECUTIVE DIRECTOR, VA/DOD COLLABORATION SERVICE,

U.S. DEPARTMENT OF VETERANS AFFAIRS; AND DANIEL

BERTONI, DIRECTOR, EDUCATION, WORKFORCE AND INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE, ACCOMPANIED BY RANDALL B. WILLIAMSON, HEALTH

CARE TEAM DIRECTOR, USGAO, AND MARK BIRD, IT TEAM

ASSISTANT DIRECTOR, USGAO

STATEMENT OF LYNN SIMPSON

Ms. SIMPSON. Thank you, Mr. Chairman.

Representative Chaffetz, Representative Tierney, members of the

subcommittee, thank you very much and good morning.

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Thank you for the opportunity and the privilege to testify today

on our warriors in transition with my colleague from the VA, John

Medve.

Taking care of our wounded, ill and injured service members is

one of the absolute highest priorities of the Department of Defense,

the service Secretaries and the military chiefs. The Secretary of Defense has said that, other than directly supporting operations in

theater, there is no higher priority for the Department of Defense.

Reforming cumbersome and many times confusing bureaucratic

processes is absolutely essential to ensuring our service members

receive, in a timely manner, the care and benefits to which they

are entitled. The Department’s leaders continue to work to achieve

the highest level of care and management and to standardize care

among the military services and Federal agencies, while maintaining a laser focus on the wide range of needs of our wounded, ill and

injured service members and their families.

Working closely, carefully and collaboratively between our departments is also of the upmost priority. We have established governance at the highest levels of our respective departments on the

wounded, ill and injured issues. The Secretaries of the Departments of Defense and Veterans Affairs have met three times in the

last 90 days with an increased attention on the Disability Evaluation System and electronic health records and have committed also

to meet quarterly to continue the dialog to resolve these critical

areas of collaboration between our departments.

The Secretary of Defense had directed the establishment of the

Department of Defense, Department of Veterans Affairs, Senior

Oversight Committee, referred to as the SOC, on May 3, 2007. It

was established to ensure that recommendations from the groups

that many of you referenced were integrated, implemented and

resourced. The Senior Oversight Committee’s purpose is to ensure

interagency oversight to streamline, deconflict and expedite efforts

to improve the health care process, disability processing and the

seamless transition of service member to veteran status. The Deputy Secretaries of both Departments serve as co-chairs.

The overarching purpose of the Senior Oversight Committee is to

establish a world class, seamless continuum of care that is efficient

and effective. The SOC has had a lengthy record of accomplishments over its 4 years of existence in direct support of and caring

for our wounded, ill and injured. I want to offer a few of the accomplishment highlights: reducing the gap in time service members receive veterans’ benefits after separation; developing new approaches to address psychological health, to include traumatic

brain injury and post-traumatic stress; expanding the implementation of the Integrated Disability Evaluation System; providing

transitioning service members’ health records to the VA prior to

their separation from military service; and implementing the recovery care coordination program, highlighting the need to address

caregiver issues to ensure that they receive support and information.

The Disability Evaluation System was relatively unchanged from

1949 until 2007. As a result of Secretary-level attention, public concern and congressional interest, the Senior Oversight Committee

chartered the DES pilot in November 2007. The SOC vision for this

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pilot was to create a service member-centric, seamless and transparent DES, administered jointly by the DOD and VA.

The pilot transitioned to the Integrated Disability Evaluation

System that integrates DOD and VA DES processes, so that the

service member receives a single set of the physical disability evaluations and disability ratings, conducted and prepared by the Veterans Affairs office, with simultaneous processing by both departments to ensure the earliest possible delivery of disability benefits.

Both departments use the VA protocols for disability examinations

and the VA disability rating to make their respective determinations.

The Department of Defense is partnering closely with the Department of Veterans Affairs as we aggressively move toward the

full implementation of the IDES across all 139 continental United

States and outside the continental United States by the end of this

fiscal year. The IDES constitutes a major improvement over the

legacy system and both DOD and VA are fully committed to the

worldwide expansion of this program.

The Department is, however, continuously exploring new ways to

improve the current system. Because as long as one service member is in the system longer than perceived helpful, we are obligated

and committed to do all we can to enhance the experience and

make improvements. To that end, the Secretaries of Defense and

Veterans Affairs have asked the teams to explore other options

which could shorten the overall length of the disability evaluation

process from its current goal of 295 days.

In addition, the Departments are also looking closely at the

stages of the Disability Evaluation System that are outside the

timeliness tolerances, and developing options to bring these stages

within the goal. We are committed to do all we can within our

areas of influence to enhance the experience and process and will

be sure to keep the Congress informed of this progress along the

way, and as new initiatives are identified that can further advance

the efficiency and effectiveness of the disability evaluation process.

Another highlight from the Senior Oversight Committee that

drove to significant enhancement involves the attention to the caregiver.

Mr. CHAFFETZ. Perhaps if we could submit the balance of that

testimony, so that we have time to get to the full panel.

Ms. SIMPSON. I will jump to the end of my last paragraph that

summarizes what I have been trying to say to you this morning.

Thank you.

Mr. Chairman and subcommittee members, I cannot overstate

how far DOD has come with our VA partners in the past 4 years,

since the SOC and other governance processes were put in place.

Our support for our wounded, ill and injured is night and day from

the events that occurred at Walter Reed in 2007. Each of the services has stood up a very comprehensive and standalone warrior

care program, as many of you are aware and have visited here and

in your districts.

Yet we still have much progress to make. As I close, I would like

to be articulate, again, that one mistake, mistreatment, undue

delay or any other aberration in the care or transition of our

wounded, ill or injured service members is one too many. We will

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continue to work with our teammates at VA and throughout the

interagency to do anything and everything we can to provide our

service members with the absolute best care and treatment that

they so rightfully deserve in return for their selfless service and

sacrifice to our Nation.

Thank you again for the opportunity.

[The prepared statement of Ms. Simpson follows:]

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Mr. CHAFFETZ. Thank you.

Mr. Medve, we will now recognize you for 5 minutes.

STATEMENT OF JOHN MEDVE

Mr. MEDVE. Thank you, Mr. Chairman.

Mr. Chairman, Ranking Member Cummings and members of the

subcommittee, good morning and thank you for the opportunity to

testify before you today.

My name is John Medve, Executive Director of the Department

of Veterans Affairs/Department of Defense Collaboration Service

for VA’s Office of Policy and Planning. I am pleased to be joined

by the chief of staff from the Undersecretary of Defense Office of

Personnel and Readiness, Lynn Simpson.

I would like to provide the subcommittee with an overview of collaboration between the VA and DOD to ensure a seamless transition of our wounded, ill and injured service members from active

duty to veteran status. I ask that my complete statement be included in the record.

Much has been accomplished in the wake of the problems identified at the Walter Reed Army Medical Center in 2007 to improve

the DOD disability process and the resulting transition to veteran

status. The focus of my testimony is VA and DOD’s joint efforts to

make the improvements and to create an integrated disability process for service members who are being medically separated.

Currently we are in the process of implementing the Integrated

Disability Evaluation System, the process used to transition the

wounded, ill and injured who are unfit for continued service from

service member to veteran. In early 2007, VA partnered with DOD

to make changes to the DOD’s existing DES. A modified process

called VA/DOD DES pilot was launched in November 2007. The

DES pilot was intended to simplify the disability process, increase

the transparency, reduce the processing time and improve the consistency of the disability ratings among the services and between

the services and VA. Authorization for the pilot was included in the

National Defense Authorization Act of 2008, and further energized

our efforts for improving DOD’s DES process.

The DES pilot model was launched originally at three operational sites in the National Capital region and recognized a significant improvement over the legacy process. The pilot model was

subsequently expended in 2008 and 2009, ultimately covering 27

sites and 47 percent of the DES population when ended in March

2010.

In July 2010, the co-chairs of the Senior Oversight Committee

agreed to expand the 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 DES

pilot model to all service members.

VA and DOD are now working together to launch IDES enterprise-wide. As a result, in October 2010, we started the transition

from the existing legacy process to IDES using the pilot model

process. Currently, there are 77 IDES sites operational nationwide,

which includes the original 27, covering 72 percent of the DES population. When fully implemented in October 2011, there will be a

total of 139 sites.

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Through the implementation of IDES, the departments hope to

create a more transparent, consistent and expedient disability evaluation process. We believe that through the implementation of the

DES pilot, we have largely achieved that goal. To explain, in contrast to the DES legacy process, the pilot model provides a single

disability examination and a single source disability rating that are

used by both departments in executing their respective responsibility.

This results in more consistent evaluations, faster decisions and

timely benefit delivery for those medically retired or separated. As

a result, VA benefits can be delivered in the shortest period allowed by law following discharge, thus eliminating the pay gap

that previously existed under the legacy process.

The DOD/VA integrated approach has also eliminated much of

the sequential and duplicative processes found in the legacy system. Overall processing time for the delivery of DOD disability benefits will be reduced from an average of 540 days to a goal of 295

days while simultaneously shortening the period until the delivery

of VA disability benefits after separation from an average of 166

days to approximately 30 days.

Through the challenges and lessons learned, DOD recognized

that we expanded outside the NCR, we did not have a robust business processes in place to certify each site’s preparedness before it

became operational. Through analysis of lessons learned and by

working with Congress, we have developed initial operating capability readiness criteria that stress quality over expedience to ensure that future sites are operationally ready for IDES.

Mr. Chairman, I will cut short the rest of my statement in the

interest of time and thank you again for your support of our

wounded, ill and injured service members, veterans and their families, and the opportunity to appear before you today.

[The prepared statement of Mr. Medve follows:]

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Mr. CHAFFETZ. Thank you.

It is my understanding that Mr. Bertoni is going to make the

opening statement for the GAO. You are recognized for 5 minutes.

STATEMENT OF DANIEL BERTONI

Mr. BERTONI. Mr. Chairman, Ranking Member Cummings, members of the subcommittee, good morning.

I am pleased to discuss the Departments of Defense and Veterans Affairs’ efforts to integrate their disability evaluation systems. I am joined today by Randy Williamson of our health care

team, who can address any questions you may have regarding VA’s

Federal recovery coordination program, and Mark Bird, of our information technology team, who can field any questions on systems

integration and data sharing between the departments.

Mr. Chairman, thousands of service members have been wounded or injured in Iraq and Afghanistan, and many who can’t continue their military service must navigate complex disability evaluation systems in both DOD and VA. GAO and others have identified problems with these systems, including delayed decisions, duplicative processes and confusion among service members.

In 2007, DOD and VA piloted an Integrated Disability Evaluation System [IDES], to streamline and expedite the delivery of VA

benefits to service members. My statement today summarizes and

updates key findings of our December 2010 report, which examined

the agencies’ evaluation of pilot results, key implementation challenges and efforts to mitigate those challenges in advance of a

planned worldwide roll-out.

In summary, in their evaluation the departments noted that the

pilot had improved service member satisfaction relative to the legacy system. It met their goal for delivering VA benefits to active

duty and reserve members within 295 and 305 days, respectively.

Despite meeting the overall timeliness goal, not all service

branches achieved the same results. Only the Army, with about 60

percent of all cases, met the established goals, while average processing times for the other services were substantially higher.

Moreover, as caseloads have increased, processing times have

also steadily worsened. And as of March 2010, active duty cases

took an average of 394 days to complete.

The departments have also had difficulty meeting their goal for

their percentage of cases processed on time, and have since adjusted that goal downward from 80 percent to 50 percent. Over the

past 6 months, the data shows that this new, lower goal has never

been met for active duty cases, and only rarely for reserve and National Guard cases.

DOD and VA encountered several implementation challenges

with the pilot that contributed to delays. Nearly all the sites we

visited experienced staffing shortages to some degree, often due to

workloads exceeding original projections. Shortages and delays

were most severe at sites that had large caseload surges related to

deployments. At one location, it took over 140 days to complete a

single medical exam, well in excess of the 45 day goal.

We identified other issues and delays associated with this single

exam, such as problems with completeness and clarity of exam

summaries and disagreements between DOD and VA medical staff

42

on some diagnoses. Pilot sites also experienced logistical challenges

such as incorporating VA staff into military facilities and housing

service members awaiting a decision.

As DOD and VA proceed with rapid expansion worldwide, they

are taking steps to address several challenges. This includes increasing exam and case management personnel, VA additional hiring, staff relocations and contracting, requiring more thorough assessments of site readiness and contingency plans for addressing

caseload surges, and making changes to improve the quality of

exam summaries.

While these initiatives are promising, we have recommended

that DOD and VA take steps to ensure sites have enough military

physicians to handle projected workloads, as well as available housing and operational capacity to absorb service members. It is also

critical that the departments proactively assess and mitigate delays

associated with diagnostic differences and insufficient exam summaries, and going forward, develop a robust data collection and

monitoring mechanism to identify and address local level challenges, such as sudden staffing shortages.

In conclusion, the IDES shows promise for expediting the delivery of VA benefits to service members. However, we have identified

significant challenges that require our careful attention. Although

steps taken to date may mitigate these challenges, the current deployment schedule remains ambitious, in light of substantial unresolved issues and evidence of steadily worsening processing times.

Thus it is unclear whether actions taken will sufficiently and timely support worldwide implementation.

Time frames aside, the ultimate success or failure of IDES will

depend on DOD’s and VA’s ability to quickly and effectively address resource needs, make adjustments and resolve challenges as

they arise, not only at initiation, but on an ongoing basis.

Mr. Chairman, this concludes my statement. I am happy to answer any questions that you or other members of the subcommittee

may have. Thank you.

[The prepared statement of Mr. Bertoni follows:]

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Mr. CHAFFETZ. Thank you. I appreciate that.

I am going to recognize myself for 5 minutes. Ms. Simpson, Mr.

Medve, I appreciate the task that you have before you. When I

hear, see and read what the GAO has to say and I listen to your

statements and presentations, it seems like you are on a different

planet. That is the concern.

Let me ask specifically, because I hope at the conclusion of this

we have at least some sense of the timing, the realistic timing, the

cost of this, I haven’t heard much mention of what this is all costing, and some explanation of why it is taking so long. Because we

talked about May 3, 2007, virtually about 4 years almost to the

date, and yet we feel like we are still sliding backward as opposed

to forward.

Can veterans now download their electronic medical records with

the click of a mouse? Yes or no, Ms. Simpson?

Ms. SIMPSON. Yes, they can, both with the VA and from TriCare

Health Agency.

Mr. CHAFFETZ. Mr. Medve, can they do that?

Mr. MEDVE. They can do it through the Blue Button system, Mr.

Chairman. They can download information from the medical

records into Blue Button.

Mr. CHAFFETZ. Can we get the assessment from the GAO? Is that

something that they can do, click on the mouse and download their

records?

Mr. BIRD. Yes, they can, but the information that is available to

them may be limited.

Mr. CHAFFETZ. Explain that to me.

Mr. BIRD. Well, there are, not all medical records are necessarily

in electronic form.

Mr. CHAFFETZ. So my understanding is that what is in electronic

form is what they self-import, right? What they themselves put

into the system? Or is it broader than that?

Mr. BIRD. No, it is broader.

Mr. CHAFFETZ. But is it complete?

Mr. BIRD. It may not be complete.

Mr. CHAFFETZ. How do they figure out if it is complete or not?

That is one of the issues, right? The President made this quote during the State of the Union: ‘‘Veterans can now download their electronic medical records with the click of a mouse.’’ But then right

after that, we had the Iraq and Afghanistan Veterans of America

president comment that was not true. And he said, ‘‘The President’s comments are misleading to service members, veterans and

the American public who now think that this system is in place

and functional, while it is clearly not.’’

Is he right or is he not right? Mr. Bird.

Mr. BIRD. As I said, there is information that is readily available

at the click of a button. But the information for all veterans in all

cases may not be complete.

Mr. CHAFFETZ. Do you have any sense of how do we get to that

finish line? How much of it is in there? What percentage of this is

actually done? And how do we get to that finish line? It is a huge,

mammoth task, no doubt about it.

Mr. BIRD. Yes. The Departments frankly have been working on

this, the exchange, the electronic exchange of health records, for

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over 10 years. They have slowly been increasing the extent to

which they can exchange records, starting back in 1998, to the

present time.

There are in some cases limitations in the systems within the

Departments that preclude the full exchange of medical records for

any individual.

Mr. CHAFFETZ. How close are they to completing this? Is it next

month? Is it next year? If there is a spectrum, and we are trying

to get to the finish line, and I recognize it is an ongoing process,

but information technology is supposed to make life simpler, easier,

swifter, more effective, more efficient, not more burdensome. Where

are we on that spectrum?

Mr. BIRD. Well, it is difficult to say, because the extent of the

problem hasn’t necessarily been defined yet by the Departments.

The desired end state is frequently moving as technology improves,

and as certain capabilities are delivered, people want more.

Mr. CHAFFETZ. Would anybody else from the GAO care to comment on that?

Mr. BERTONI. I could talk more on that from a logistics and operational standpoint with the IDES. The larger macro issue of data

sharing between DOD and VA affects not only, primarily folks who

have left the services and are in the world and need to get their

records and it is very difficult. In terms of the IDES, that is pretty

much a self-contained unit. You have VA staff, you have DOD staff

in these medical treatment facilities. And the problem they have is

their individual systems haven’t been integrated sufficiently onsite.

So we have work-arounds, we have manual processes, we have

multiple computers on individuals’ desks to sort of access multiple

sites. But in the case of this project, would it expedite if they had

a seamless access to each others’ records? Yes. Would it facilitate

quicker processing? Absolutely. Is it the Achilles heel for this system? No. I think there are bigger issues.

Mr. CHAFFETZ. And what are those bigger issues?

Mr. BERTONI. Initially I think not staffing these sites appropriately, not maintaining the ratios of staff to workloads, to cases.

Just not having the appropriate knowledge, skills and ability on

the ground when these sites were stood up. Primary.

Mr. CHAFFETZ. There is lots more to discuss, but I am coming to

the conclusion of my time with respect to the 5-minutes. We will

now recognize Mr. Welch from Vermont for 5 minutes.

Mr. WELCH. Thank you, Mr. Chairman. I appreciate your calling

this hearing.

Mr. Williamson, I want to thank you for conducting the GAO

study, which I and others had requested after that Washington

Post series of articles. I missed your opening statement, so I apologize if you have to re-cover answers that you have already given.

But can you please share how the findings of that study can help

this committee on how we can move forward in making the transition from DOD to the VA more streamlined for our soldiers?

Mr. WILLIAMSON. The study we completed on March 23rd was on

the Federal Recovery Coordination Program. And as you may

know, that is a program for the most severely catastrophically injured, ill and wounded service members. In the process of that, we

have obviously looked at a variety of other programs.

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As you know, each of the services has their own wounded warrior

program. And in addition to the Federal Recovery Coordination

program, which is administered by VA, there is a recovery coordination program administered by DOD as well. So there are a lot

of organizations that are involved in terms of care coordination and

case management.

Some of the IT issues in terms of coordination, just to kind of follow on what the chairman was talking about, it is very important,

because of the overlap that occurs between all the programs, the

wounded warrior programs that are now ongoing, very important

that these programs coordinate with one another. Right now, the

recovery coordination program has a comprehensive transition plan

and the FRP also has that.

So it is important that if they are not talking to one another, or

can’t communicate with one another, they have problems. We had

a situation where——

Mr. WELCH. I am not going to have a lot of time. What I think

would be helpful is, on the basis of your study, what are the one,

two, three types of recommendations that you might have?

Mr. WILLIAMSON. The recommendations deal with proper identification of potential enrollees. Right now they need to do a better

job of identifying the people who are severely wounded. And that

is an issue because there is no good data base of severely wounded

people.

No. 2, determining a number of staff and the workload ratio, so

that we don’t overload. And three, where to place the people.

Mr. WELCH. All right, thank you.

Let me ask Ms. Simpson and Mr. Medve a question. When the

Vermont Guard returned, we had our largest Guard deployment

since the Second World War, over 200 were kept on medical hold

with the DOD and not able to return home to their family to begin

that reintegration process. The question is, how can members of

the National Guard and Reserve have access to the high quality

care that is provided by the Department of Defense without losing

the opportunity to get the benefits of receiving that care closer to

home? That is particularly a challenge for our members of the

Guard who are, many of them, living in very rural and remote

areas. I will start with you, Ms. Simpson.

Ms. SIMPSON. Thank you, Mr. Welch. I think the issues that you

highlighted for the Guard are of upmost priority to both Departments. Because of the unique nature of the Guard being part of a

community, it is more difficult to get services to them.

However, that being said, there has been an increased emphasis

to ensure that they not only have the benefits and care from these

transition units, but also making an outreach to the community.

The Army in particular has done a good job trying to reach back

to the communities on behalf of the Guard and Reserve community.

There is more to be done, obviously, because that Guard and Reserve community is one of our highest priorities, as some of their

statistics are not as good as some of the others. So we are working

on that exact issue.

Mr. WELCH. Thank you. Mr. Medve.

Mr. MEDVE. Congressman, thank you for the question. As Ms.

Simpson said, we are looking at the specific issues surrounding

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Guard and Reserve. When they return from a deployment, DOD

has been, as we look at somebody that may be unfit, we are working through those specific issues of getting them through the IDES

program and looking for ways that we can do this treatment much

closer to the home base to ensure that we have the requisite staff

that can handle that influx.

Mr. WELCH. Thank you. I yield back.

Mr. CHAFFETZ. The gentleman yields back. Thank you.

We will now recognize the vice chairman, Mr. Labrador from

Idaho, for 5 minutes.

Mr. LABRADOR. Thank you, Mr. Chairman.

Mr. Bird, I just want to followup on a question that the chairman

asked you. I am not sure I understood your answer. In the State

of the Union, President Obama stated that veterans can now

download their electronic medical records with the click of a mouse.

And you said that is somewhat true.

But you were not specific enough, letting us know exactly what

they can download. I am just going to quote the president of the

Iraq and Afghanistan Veterans of America. He said that ‘‘The comments are misleading to service members, veterans and members

of the American public who now think that the system is in place

and functional. This is clearly not.’’ Then he says specifically that

from the VA system what you can download are pharmaceutical

records and personal health information that he or she has self-entered.

Is that an accurate statement?

Mr. BIRD. I believe that is an accurate statement.

Mr. LABRADOR. So that is all you can download right now, is

pharmaceutical records and then self-input information?

Mr. BIRD. That is my understanding.

Mr. LABRADOR. So what do you think the President meant when

he said that veterans can now download all this information?

Mr. BIRD. I wouldn’t want to speculate.

Mr. LABRADOR. Anybody else want to take a crack at that?

OK. Ms. Simpson, could you please comment on that?

Ms. SIMPSON. I was just going to say that I think the Blue Button, as Mr. Medve mentioned, is a reference to trying to get to that

goal that you are talking about, the full electronic health record,

and that has made significant progress. I am not technically detailed in the exact information that the member can get, though.

But the Blue Button, as Mr. Medve said, is the way that they get

the information.

Mr. LABRADOR. So we are trying to achieve this compliance,

where they can actually download. But it sounds like we are not

really there yet.

Now, we have a system, the IDES system, and we also have the

legacy DES system. Ms. Simpson, can you tell me what was the

projected cost of the legacy DES program?

Ms. SIMPSON. I don’t have that figure for the cost, but we can get

that for you.

Mr. LABRADOR. OK. I want to know what the projected cost was,

and I want to know what the actual cost was. Do you, Mr. Medve,

have that information?

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Mr. MEDVE. Sir, DES is a DOD program, so I wouldn’t have that

information on IDES in terms of our projections for health care

with VHA and VA. Those are embedded in their overall budget, because frankly, service members who transition through IDES

would be our customers anyway. So we project for that population.

Mr. LABRADOR. Can you provide that information for the record?

Mr. BERTONI. Sir, I actually have, as of November I have some

numbers.

Mr. LABRADOR. That would be great.

Mr. BERTONI. DOD estimates $63 million annually for the IDES, with VBA’s portion about $33 million and VHA at $17 million. And

additional benefits paid out would be $960 million.

Mr. LABRADOR. What was the projected cost?

Mr. BERTONI. I do not know the projected, just what their estimates were at that time.

Mr. LABRADOR. Thank you.

According to your testimony, Mr. Medve, you said that through

the implementation of IDES, the Departments hope to create a

more transparent, consistent, expeditious program. And you believe

that it will largely achieve the goal of creating a more transparent,

consistent program. Why do you think that is, just largely? Do you

think that it is going to achieve these goals, or do you think that

it is not going to achieve the goals?

Mr. MEDVE. I believe it will achieve the goals. In many cases, we

have, with service members.

Mr. LABRADOR. Does GAO agree with this assessment, Mr.

Bertoni?

Mr. BERTONI. I think the concept of transparency is built into it.

We have a system unlike the legacy system, where we have case

management, clinical, non-clinical case management from referral

through payment of VA benefits. So to the extent that these folks

are able to do their job, they have sufficient workloads and ratios

where they can actually speak with the service member and explain to them why things are happening the way they are, why the

decisions are playing out the way they are. I think you do have a

much more transparent system.

Mr. LABRADOR. Mr. Chairman, I have no more questions, just one

last comment. It seems to me that we have had this problem for

4 years, trying to figure out how the system works. This is a lot

of the same stuff we are going to be doing with the health care system, if it goes national. So I have some concerns about the projected costs in the future for a health care system.

Mr. CHAFFETZ. Thank you. The gentleman yields back.

I now recognize the ranking member of the committee, Mr.

Tierney from Massachusetts, for 5 minutes.

Mr. TIERNEY. I thank the chairman. I thank the chairman for

having this hearing, as well, as the folks on the dais for testifying.

Mr. Bertoni or Mr. Williamson, Mr. Bird, let me ask you folks

one thing. Is it your impression that the Veterans Administration

and the Department of Defense completed all the recommendations

that you made with respect to their pilot program?

Mr. BERTONI. We have made recommendations dating back to

2007. To the extent that we have asked them to institute more robust assessment practices while they were going through the pilot,

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we think they have been fairly responsive. I would say responsive.

I think the design of the pilot was better, the metrics they were

capturing were better because they were responsive to our recommendations.

Down the road, we just issued a report in December where we

have several recommendations in which they have agreed. To the

extent that they complete them, I think they will have a positive

impact.

Mr. TIERNEY. Do you have an estimate of how long it should take

them to complete the recommendations from December?

Mr. BERTONI. There are some estimates. We had asked them to

look at the extent to which there are disagreements and diagnoses

between DOD and VA, which we believe could be substantial. I

have been doing this quite a while, and usually Federal disability

programs, cases tend to get mired in the mud when you can’t complete the medical record or you have disagreements about the medical record. They sit on desks, they have to be looked at again.

Medical exams expire and we see the service member on the disability evaluation hamster wheel.

So we think they really need to look at this issue. I believe they

intend to study it and make a determination of whether adjustments need to be made by July 2011. And there are other areas

where they are actively right now making adjustments.

Mr. TIERNEY. To what extent, if any, do you think that this disagreement, or maybe substantial disagreements on disability,

would be a case of hoping that the other department or agency incurs the cost?

Mr. BERTONI. I don’t think that is the issue. I think it just, it

is the way their criteria is laid out in terms of how they assess disability. Terminology, nomenclature, guidance, I think there are just

fundamental differences across the two entities. And things get lost

in the translation.

Right now, there is guidance being developed. We haven’t seen

it, and we really don’t know how it is going to address this problem. What we are really concerned about is, we went to 10 sites.

We heard this at enough sites to raise it to the attention of the

agencies, that you really need to get your hand around extent, nature and the impact on delays. That is good information to make

some adjustments.

Mr. TIERNEY. Mr. Medve and Ms. Simpson, is there any talk in

the Veterans Administration or Department of Defense about kicking this up to the White House level to get a referee? Somebody

has to be able to make a decision, as opposed to letting it keep

being arbitrated and negotiated back and forth. At some point,

somebody has to have some leadership, a sense of direction, make

a decision and force movement.

Mr. MEDVE. Mr. Ranking Member, as Mr. Bertoni said, one of

the recommendations was for us to look at those discrepancies. As

he said, we are undergoing a study right now which will be coming

out in July. We are also looking at a number of variety of ways,

because as he points out, most of the cases that there is a discrepancy, it resolves around the mental health issues. Those are tough

calls to make in terms of service members. So while the DOD doctors will have had a service member for a while and have an opinVerDate 17-JUN-2003 11:34 Sep 22, 2011 Jkt 000000 PO 00000 Frm 00069 Fmt 6633 Sfmt 6633 C:\KATIES\DOCS\68045.TXT KATIE PsN: KATIE
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ion, and then when we do the exam, we may come to a different

conclusion.

So we are working out a way that we can leverage the ongoing

treatment, get that in a form where our raters can look at that,

and then use that as the basis for making the determination which

should help eliminate any discrepancies.

Mr. TIERNEY. Had nobody identified that issue between the time

that you were working on the pilot and the time you decided to

start trying to scale this program up? It sounds to me like there

was no plan on how the scaling up was going to happen.

Mr. MEDVE. I can’t answer that question. I wasn’t there during

the pilot phase of it. I know a number of these issues, we are dealing with individual cases. So as you are dealing with individual

service members——

Mr. TIERNEY. I don’t want to interrupt you, but my time is short.

I know we are dealing with individual cases, and I am aware of all

the difficulties that presents. But when we had a pilot program,

presumably we identified some of the issues there. Before we went

to moving to scaling it up, I would have thought there would have

been a plan, and the plan would have involved resolving some of

these issues.

Mr. Bertoni, are you aware of any plan where they said, these

are the issues, we are going to get these resolve and this is how

we are going to deal with it as we scale it up?

Mr. BERTONI. Certainly the pilot identified challenges that the

DOD and VA have undertaken efforts to address. I think one of the

issues was at the time they issued that report in August 2010 that

there were only 1,300 completed cases. They were working off of

data that was 6 months old at the time they began analyzing it.

So I think some of the emerging issues just hadn’t worked their

way through the system yet. By the time we started to look, a year

later, at some of the data, some of these trends were starting to

play themselves out more fully. So making decisions on the basis

of 1,300 cases on the goodness of the pilot, they were able to do

that in some respects. But I don’t think they knew everything that

was going to be coming down the road.

Mr. TIERNEY. Thank you.

Mr. CHAFFETZ. Thank you. We will now recognize Mr. Gosar of

Arizona for 5 minutes.

Mr. GOSAR. Mr. Williamson, let me make sure I’ve got this right.

You made a comment just a minute ago, because of lack of documentation of the injured. Are you kidding me? Is that true?

Mr. WILLIAMSON. Well, again, the Federal Recovery Coordination

program covers the severely injured. And there is no data base in

DOD or VA that actually defines what severely wounded is, or

keeps track of it. So it makes it difficult for the program to identify

potential enrollees.

Mr. GOSAR. Well, this seems just backward to me. I am a dentist,

and health records are everything to a patient for continuity of

care. And I see this over and over in my district. We collect claims

from White Mountains to Native Americans to Flagstaff to Prescott

to Phoenix all about this. And this is the simplest of tasks. And it

comes back to the lack of an interagency discipline to have someVerDate 17-JUN-2003 11:34 Sep 22, 2011 Jkt 000000 PO 00000 Frm 00070 Fmt 6633 Sfmt 6633 C:\KATIES\DOCS\68045.TXT KATIE PsN: KATIE
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thing that both agencies can agree upon. Would you not agree on

that, Ms. Simpson and Mr. Medve?

Ms. SIMPSON. I think absolutely it requires both departments

working together, throughout the entire department at the senior

levels of leadership to address those specific issues. I believe that

the teams are working to address those.

Mr. GOSAR. Wasn’t there a meeting on May 2nd? What was the

followup on that? Can you give us some details?

Ms. SIMPSON. I was not present at the meeting. We are in the

process of documenting the next steps for both the issues of the

electronic health record and the disability evaluation system and

the way forward. Both departments will be connecting on that to

get specifics in addressing those issues.

Mr. GOSAR. I find a real disconnect, I am sorry, but these are

people’s lives. Having gone over to Walter Reed to see the severely

injured, to see even some of the folks who are looking at problems

with post-traumatic syndrome type aspects, folks, it is that easy.

It seems like we are just studying this over and over and over

again, going nowhere. It is a common theme throughout our whole,

my district, which is laden with veterans and our military supporters. This is unacceptable. Just absolutely unacceptable. Because the whole system is now in place and it is a problem, it is

interfering with the treatment of our soldiers. Would you not

agree?

Ms. SIMPSON. Access to data and information absolutely is critical to being able to address issues, I agree.

Mr. GOSAR. Then why aren’t we prioritizing that record? This is

no different. I am not going to give you any solace. Because in the

private sector, we are not given that leeway. And I don’t see we

should be giving you any more leeway because of what is impounding here. And not to have documentation on severely wounded people that are coming back here, that is the minimum standard,

folks. That is a minimum standard. What you are giving us is unacceptable results, absolutely unacceptable results.

Not knowing what came about on May 2nd, Ms. Simpson, where

would you go with this? You are in a position of making a comment

and putting your weight behind an idea. Where would you like to

see this go?

Ms. SIMPSON. I believe we would like to see it go to exactly what

you are talking about, commitment and service to getting our service members and our wounded warriors into veteran status

seamlessly. It has to be the upmost priority. And the technical aspects of the systems, I am not detailed in that type of information,

but there are very dedicated people in both departments that are

working tirelessly to make sure that the technical, systematic architecture and the details about the infrastructure that is required

to support the record you are referring to is going to be a reality.

Mr. GOSAR. I would hope somebody in leadership would actually

stand up and be counted. Because too many times our men and

women who put their lives on the line are being the victims here.

That is inappropriate.

We have heard this over and over again, throughout my district,

like I said. I would like to say, in a few short weeks, we are going

to celebrate Memorial Day. I hope, especially, it is very important

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during this time, that we remember our obligations. It is not about

saving our jobs, it is not about not speaking up. It is about speaking up on behalf of what is right. I don’t see a lot of that happening.

Thank you, Mr. Chairman.

Mr. CHAFFETZ. Thank you. The gentleman yields back.

We will now recognize Mr. Quigley from Illinois for 5 minutes.

Mr. QUIGLEY. Thank you, Mr. Chairman.

Ms. Simpson, I will ask you but if anyone else wants to chime

in, I would appreciate it. Isn’t it true that the problems at Fort

Carson is really a staffing problem? Are you concerned that this is

not just Fort Carson, but these systemic shortages could lead to

these same delays across the entire system?

Ms. SIMPSON. I think an element of the issues at Fort Carson

was the staffing issue. One of the actual lessons learned from the

pilot, the first pilot, was in fact having accountability and a thorough assessment of making sure that all aspects of the requirements to integrate the systems was in place before going live. So

the teams now are going around to the different sites and looking

at best practices. Not every site has the severity of the issues as

identified in Fort Carson.

But to address that, we are looking at the other sites to incorporate the lessons learned there, and getting more specific in the

metrics, they are consistent across all the sites.

Mr. QUIGLEY. Then how much of it is the staffing issue there,

and what is the danger of it spreading? How do you break it down?

Is it the analysis you are doing now to try to answer that question?

Mr. MEDVE. If you don’t mind, Congressman, one of the things

that we learned in terms of as we move forward with IDES is we

had not instituted a process that brought together the teams before

they stood up in their respective sites and applied a rigorous methodology of making sure they understood what they were getting

into as they were going to implement.

We started that back in September with the first iteration where

we brought them all together. We sat them as groups. We had

them do a site assessment and then from that site assessment it

went through a murder board where people looked at their analysis

and after that analysis, they developed their draft implementation

plan.

So they got a good sense of where they were from a requirements

standpoint, in terms of what they needed for staffing. And then developed their plan and had to be certified by two senior executives,

one from DOD, one from VA, for each local site. That again I think

is building on the recommendations that the GAO made.

As part of that they also had to develop contingency plans,

should there be an influx of how they would handle additional

cases coming into the system. So I think what happened at Fort

Carson, we did learn that lesson, we have embedded it and institutionalized it in our going-forward plan for rolling it out for the rest

of the fiscal year.

Mr. QUIGLEY. I can’t help, Mr. Chairman, my frustration here is

I am flashing back to my academic days in public policy. I feel like

I am getting an answer that would be suitable for a public administration class. In layman’s terms, the essence of the problem, how

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much of it is staffing, how much of it is we just screwed up and

didn’t know how to do this the right way?

Mr. MEDVE. Sir, I think at the beginning we didn’t have as good

a plan as we needed. We did not apply the leadership from the

local level up. And we have now turned that around to where the

Chief of Staff of the Department of Veterans Affairs and the Vice

Chief of Staff of the Army have quarterly VTCs with the Army

IDES sites to hold each site and both Department personnel accountable for that. We are examining the staffing as part of that

process. And if there is a requirement to add more staff, we are

doing it.

Mr. QUIGLEY. I respect how difficult this is. I really do. I guess

I don’t understand how it can crop up. It sounds like the first day

on the job. Doing this for a long time, what changed to make it all

of a sudden a problem that you had to uncover?

Mr. BERTONI. Sir, I could take a crack at that from a GAO standpoint. I think, as Mr. Medve stated, the up-front work in terms of

doing a look-back on the history of Carson would have been very

helpful, a more granular look, a month by month look at what the

deployment schedules looked like, what did the impairments look

like, numbers, types of impairments, illnesses, injuries. Then you

can build your knowledge, skills and abilities around that.

In the case of Carson, there was a large shortage in specialty

medical exams. Many of these folks are coming back from multiple

deployments. The science says when you go through multiple deployments, more likely to have PTSD and other mental impairments to deal with.

So if you know the history of the site, you can build your staffing

model around that and be ready for surges. That was not done. We

think it is being done better now.

Mr. QUIGLEY. Is it possible to continue? Thank you, Mr. Chairman. Then it gets to the question, if this is new, is it because we

are in uncharted territory about how many deployments we are

sending our young men and women to? Anybody?

Ms. SIMPSON. The deployments piece is not new. I think the

new——

Mr. QUIGLEY. The deployment what?

Ms. SIMPSON. The deployment assessments is not new.

Mr. QUIGLEY. But what is new is how many deployments we are

asking our people to go on, to go through.

Ms. SIMPSON. I think what we are trying to say, or at least Mr.

Medve and I are trying to say, is the issues that were not addressed in the first look at the pilot were categorized into a plan.

And now they have constant interaction and talking with one another through these various forums that Mr. Medve mentioned.

And the constant attention to making sure that all of the staffing,

the facilities, all of the things that are required to make sure that

the site is able to function at the upmost quality is there.

Mr. QUIGLEY. Mr. Chairman, I want to thank our participants.

With the greatest respect, I am not any smarter—maybe that is an

attack on me—after this discussion than I was coming in and reading this and being prepared. But I do appreciate what you have

done to put this together.

Mr. CHAFFETZ. Thank you. The gentleman yields back.

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We will now recognize the gentleman from Texas, Mr.

Farenthold, for 5 minutes.

Mr. FARENTHOLD. Thank you very much.

I never cease to be amazed at the inability of the Federal Government to create what seems to me to be a relatively simple computer system that works. I am stunned by it.

I want to take a step back and just kind of look at what is actually involved in doing this. We had a comment, I think it was Mr.

Medve, that we had some staffing issues. Are the staffing issues

doctors? Are the staffing issues data input clerks? Where is the

staffing problem? That is my first question.

Mr. MEDVE. In terms of IDES, what we needed to understand

was what the requirement was at each site, based on their specific

requirements. So it was a combination of ensuring that we had the

amount of medical professionals who could do the examinations,

that we had the requisite number of VA military service coordinators to handle the cases. And then correspondingly, the DOD had

the number of physical evaluation board liaison officers.

Mr. FARENTHOLD. OK. Well, here is my concern on this. I actually have a little bit of experience in this. I had a computer company before I came to Congress. We were approached by a chain

of five minor emergency centers that wanted to do an electronic

medical records system, online and Web-based. We did that with

five people in 4 months.

Now, I realize you have a whole lot bigger scale. But it doesn’t

seem like it is a whole lot different project, with maybe the addition of some workflows. You have a doctor in the military that sees

them. They dictate the report, or they enter it into the computer

themselves.

Then they move on, get discharged, they move on to the Veterans

Administration. They get evaluated by another doctor, who dictates

or enters that report. It gets reviewed by somebody that says yes

or no, and the checks start coming.

I realize that is a gross oversimplification. But it seems to me

that is a pretty simple data base application with some workflow.

I would bet if you put it just in simple terms and gave it to a student at Harvard, he could probably get it done in the evening. We

got Facebook up in no time, a kid in his spare time.

Am I missing something here? Can anybody tell me how it is

that much more complicated than that?

Mr. BERTONI. In the case of the IDES, what we found was it was

a people issue. At each stage of the process, there is a workload.

And let’s just talk about ratings. To the extent that there aren’t

enough raters in play, that workload is going to back up. Medical

exams, to the extent that there aren’t enough medical examiners

to handle the workload, and if we get a surge from a deployment

on top of that, that work is going to back up. Yes, computers and

automation can help leverage limited resources. But it has to be

hand in hand with appropriate workload ratios.

Mr. FARENTHOLD. I understand that. But it seems like these are

men and women that have put their lives on the line for our country. There is no way they are going to get discharged from the military before they see a doctor. That doctor ought to be able to make

an initial assessment, and you all ought to trust your brother agenVerDate 17-JUN-2003 11:34 Sep 22, 2011 Jkt 000000 PO 00000 Frm 00074 Fmt 6633 Sfmt 6633 C:\KATIES\DOCS\68045.TXT KATIE PsN: KATIE
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cy that is a good initial assessment, so they can get the money that

they deserve to take care of their family as soon as they get out.

Then you all can take as long as you want to do the second evaluation and say no. We have created too many steps and too much red

tape to get that done.

Would you guys just do me a favor? When you finish, just stand

out in the hall and work out the 10 steps that it takes to get this

done and see how we can implement it. Forget the red tape, forget

the standard, just do a block diagram on the back of a napkin and

then hand it to some kid at Harvard and let him write it. It is simple, basic, undergrad computer science to get the technology to

work. And I think you need to give your brother and sister agencies

the benefit of the doubt.

I apologize for preaching more than I asked questions, but I am

just appalled at the amount of time and the disservice we are doing

to the men and women who have sacrificed life and limb for this

country.

Thank you very much. I yield back.

Mr. CHAFFETZ. Thank you. The gentleman yields back.

We will now recognize the ranking member of the full committee,

Mr. Cummings of Maryland for 5 minutes.

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

Let me go back to what I said in my opening statement. Mr.

Tierney, I complimented you for back in 2007 grabbing hold of this

issue. I was telling them about how we were at Walter Reed and

what we saw back then. We have seen some improvement.

But one of the things I am most concerned about is I think that

we may be accepting a normal that is simply inappropriate. And

I don’t know that we are dealing with what the President talks

about on other issues, and that is the urgency of now. According

to DOD and VA, under the original pilot program, the departments

were able to meet their goals of reducing the average disability

evaluation processing time for an active duty military below 295

days and reducing the average processing time for reservists to

under 305 days. However, according to GAO, the average case processing time has steadily increased.

Let me say that this is simply unacceptable. I am very concerned

about the rapid increase in the average processing time to complete

the IDES system. They are now well above the initial goals of 295

and 305 days. It appears as if DOD and VA are unable to replicate

the success of the pilot program as the IDES program has expanded to additional sites.

Mr. Medve, can you explain why this is the case?

Mr. MEDVE. Congressman, we have noticed an increase. That is

why, as Secretary Shinseki looks at this, he feels very strongly that

this is a leadership issue from the lowest level up to the top. That

is why we have instituted reviews at all levels to understand what

each site is facing in terms of challenges, what resources they

might need, how we can get those resources to them. If there are

people that need to be added or if there is equipment that needs

to be sent there, as I stated before, we have now instituted very

senior leader sessions between the VA and the Army to examine

each one of these sites in detail.

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Mr. CUMMINGS. When can we expect an answer with regard to

the results of what you are talking about? We went out to Walter

Reed, and I cannot get this man off of my mind. We went and we

saw a gentleman, and I feel emotional just talking about it, where

he had both of his legs blown off. And one of them, it was cut so

high, up to about the waist, they basically had nothing to strap it

onto.

And when I see people like that, and we talk about how much

we love our veterans, how much we love our service members, we

applaud what was just done by our Navy Seals and those brave

men and women who resolved the issue of the last few days. And

then it seems like suddenly we are talking about, we are going to

meet, we are going to meet, we are going to meet. At some point,

somebody has to say, wait a minute, these people are suffering

now. Not yesterday, now. They have done their job.

So this constant thing of let’s talk, let’s talk, let’s talk, that is

fine. But when I see numbers increasing, that is a problem. It

seems like alarm bells should go off everywhere. I think that is

why Mr. Chaffetz, Mr. Tierney, are so concerned, and all of us are

concerned about these issues. I am just wondering if we are all getting it.

So to constantly say, we are looking at it at the highest levels,

this is the question: can you tell us when the chairman can bring

you back before us with some answers to the questions that you

just raised? In other words, why is this happening, how is it happening, how do we deal with it, so that we can get on with it. You

know what I fear? I fear in 6 months we will be seeing the same

stuff, and more people will have suffered.

So can you give us a date, Mr. Chairman, this is just something

I think we need to do, to have you all come back and give us some

real answers and show us some progress? Can you do that for us?

Mr. MEDVE. Mr. Chairman, I don’t know if I can give you an

exact date. I know that as we move out to——

Mr. CUMMINGS. Six months? How about 6 months? How about

three?

Mr. MEDVE. Mr. Chairman, we will come back any time we are

invited to——

Mr. CUMMINGS. No, no, you are not listening to me. What I am

asking you to do is give us, I don’t want us to have a hearing and

then we come back and hear the same stuff. So if you tell me 3

months, I would suggest to the chairman, and he will do what he

chooses, I understand, Mr. Chairman, I will give you 31⁄2 if you say

3; if you say 2, I will say 21⁄2. But we have to have answers, and

we have to act on this with the urgency of now.

So how long will it take to get those questions answered that you

just asked?

Mr. MEDVE. All I can tell you, Mr. Chairman, is that we are

holding people accountable now to meet those standards and we

are working toward getting to each of those sites to meet the standards.

Mr. CUMMINGS. Mr. Chairman, I thank you for your indulgence.

I just think, Mr. Chairman, if you don’t mind, and Mr. Ranking

Member, I really think we have to set some deadlines. Because

other than that, we will be hearing this over and over and over

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again. I just hope that we can do that in a bipartisan way where

we can get to the bottom of this.

Mr. TIERNEY. If the gentleman would yield, and if the chairman

would allow me to make a statement on that? Thank you.

Look, I think we are maybe yelling at the wrong people on that.

When we had the hearing out at Walter Reed, when this thing first

broke, we wanted to hold people at the top accountable, not necessarily the people who are out there slugging away every trying

to get these things done and taking the heat on that.

We had the hearing in March 2007. The Army Surgeon General,

who was the top Army officer responsible for the failures out there,

resigned. That was followed by the commander of Walter Reed, the

Army Secretary, they resigned. And in July 2007, the Secretary of

Veterans Affairs.

I suggest, Mr. Chairman, at the next hearing, we don’t keep pestering this group of people who are out there working, trying to

take orders. We kick it up a notch and we have some accountability

for the people who are supposed to do this. We found out the Army

Surgeon General lived across from Walter Reed, so he was a surgeon, he was a member of the services, and he was a neighbor, and

hadn’t visited. These things are just unacceptable.

And to keep forcing these folks, the good folks that come in front

of us and explain what is going wrong, they can only do so much

unless somebody at the top takes responsibility for working out

these things. If a large part of it is personnel, then these folks

aren’t necessarily going to be able to make that decision. Somebody

has to call to Congress’ attention that we need X amount of dollars

for the following personnel, they are to be assigned to the following

locations and move it on.

So my respectful recommendation is that we consider bringing in

folks at the top level decisionmaking thing and holding them responsible. I think the American people would have the same response, they will require some accountability on this.

Mr. CHAFFETZ. I would concur with both the ranking member

and Mr. Cummings as well. While I appreciate the two people who

have been here testifying today, it is an embarrassment to the Veterans Affairs, it is an embarrassment to the Department of Defense, to not send the most senior-most people to this committee.

They owe these responses to the American people. I would hope we

could work in a bipartisan way. If we have to issue subpoenas to

get them here, we will issue subpoenas.

To have people come here who aren’t even in the meeting on May

2nd, with all due respect, is an embarrassment to those two agencies. We need answers. This has gone on for years and years and

years. And no longer will this committee put up with the tolerance

of just saying, well, we are putting together and we are having

meetings. It is not acceptable. It is absolutely not acceptable.

We will work together in a bipartisan way to make that happen.

I totally concur with the comments that were just made here.

I would now like to recognize a member of our full committee,

Ms. Buerkle from New York. She is also the chairman of the Veterans Affairs Subcommittee on Health. We will recognize her for a

very lenient 5 minutes.

74

Ms. BUERKLE. Thank you very much, Mr. Chairman, and thank

you for allowing me to participate in this hearing this morning.

I come here as the chairman of the Subcommittee on Health for

Veterans Affairs, and I sit here this morning appalled at what I am

hearing. As was echoed by my colleagues, we can’t hold you accountable, but we can hold the Veterans Administration and DOD.

This is shameful. This is absolutely shameful. Our men and women

provide and protect us, and the very least we can do is, when they

come home, we can provide them with the services and the health

care that they need.

So I am trying to understand what happened here. In 2007, we

identified problems. And then were there parallel systems? And

now as of March there will be an integrated system? Am I understanding that correctly?

Mr. MEDVE. I think we had, what we termed a legacy Disability

Evaluation System, which the DOD used to put the service member

through who was going to be determined unfit. And then they were

separated from the service. At that point then, they filed a claim

with the VA. So they had a medical examination under DOD, they

were separated, they came to the VA, and they went through another medical examination in order to get a rating.

What we have done since we have started both the pilot and now

the full implementation is integrate both of those processes. So as

a service member is identified as potentially being unfit for service,

when they get into this process, they are then given one, we call

it one medical exam, but it is composed of a number of them, because they may have a number of things, on the issues that make

them unfit for continued service. At the same time, we also catalog

all those things of which is service-connected for them. So we are

doing all those examinations at one time.

Once those are done, then the record is sent to the VA for a disability rating for us, and at the same time sent to the DOD for an

evaluation on the unfitting conditions. So that is happening now.

But we still have a mixture of both legacy and the new system in

place.

Ms. BUERKLE. So earlier, Mr. Bird, you testified that when a veteran downloads their medical record, they will at least get the

pharmaceutical portion and then any other information that they

may have entered into the system. Is that correct?

Mr. BIRD. That is correct.

Ms. BUERKLE. So we are then asking someone, their laboratory

results aren’t in there? Physical examination? Any examinations

conducted by a physician? If they downloaded their medical

records, all they are getting are those two components?

Mr. BIRD. Yes, that is correct.

Ms. BUERKLE. Does anybody realize how ineffective and inefficient that is? How that just doesn’t work? We just had a vet here

sitting in this committee download her medical records, Healthy

Vet. And all she got when she downloaded her medical records was

her name and address and anything she entered into that record.

She didn’t choose to enter her blood type in, so that didn’t show

up.

So it sounds to me like we haven’t made a whole lot of progress.

And what I hear from the veterans over and over and over again

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is they can’t get processed out. They are in such a hurry, because

this process takes so long, they are in such a hurry that they just,

they wash their hands of it and they just move on because they

want to go spend time with their family and process out.

This isn’t some theoretical problem we have here. This is very

real. And I echo my trip to Walter Reed and to Bethesda and the

suffering that these veterans are going through. The very least this

Nation can do, the very least, is to get this process up and running

and help them facilitate their discharge from their service to this

country.

I was an attorney and represented a large teaching hospital. We

integrated electronic medical records, the whole world is doing it.

The Department of Defense and Veterans Affairs and Veterans Administration should be able to do it. We have the resources, you

have bipartisan support that you don’t get anywhere else. When it

comes to our veterans and our military, there is bipartisan support.

There is no reason why we shouldn’t be able to do this. I agree

with my colleague, we need to set a timeframe, we need to get a

time line. And I will echo what was said, we need to hold leadership responsible. I realize you folks are here just testifying. But we

need to hold leadership responsible, because this is not theoretical,

these are very real people, real veterans, and they are really suffering.

I yield back. Thank you, Mr. Chairman.

Mr. CHAFFETZ. Thank you. I appreciate that.

Let me make sure I have these numbers right. Processing was

taking about 540 days. But I believe, Mr. Bertoni, you say that is

now back up to 394? The goal was, I believe the number I wrote

down during part of the testimony was 394 days is the average

time.

Mr. BERTONI. Yes. Under the legacy system, they calculated a

540 day total processing time from referral to VA benefits. Right

now, or as of March 31st, they are at 394 for active. If you are a

marine, you are at 455 days. So these numbers are quickly closing

in on the 540.

Mr. CHAFFETZ. How do you explain this? You have a family

whose loved one has been serving overseas. It takes over a year to

get them through the process and get them a check? What would

you say to those veterans and their families? Ms. Simpson, go

ahead.

Ms. SIMPSON. I don’t think there is anything we could say that

would make their situation better. I was not, I regret that I was

not aware that the average time had gotten that high.

Mr. CHAFFETZ. How is that? That scares me unto itself. I appreciate your candor. I think you are right, I don’t think there is an

excuse any more. These reports that came out in 2004, then in

2007, then we are going to have a meeting. And I realize you are

in the hot seat and it is much bigger and broader than just you.

But you can understand why we are so infuriated. We are going

backward at this point.

Mr. Medve.

Mr. MEDVE. Mr. Chairman, all I can tell you is, it is my responsibility, because I am part of the team to ensure that we are——

Mr. CHAFFETZ. Were you at the meeting on May 2nd?

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Mr. MEDVE. I was.

Mr. CHAFFETZ. What was said? What were the conclusions?

Mr. MEDVE. The two topics they covered were IDES and electronic health records. And there is commitment by both Secretaries

to improve IDES and to work toward a——

Mr. CHAFFETZ. So they sat down and said, we are committed to

this, just like they had said before. There had to be some more detail or goals or particulars that came out of that meeting.

Mr. MEDVE. We have been charged with getting the system more

efficient and effective and get——

Mr. CHAFFETZ. But that was the goal before, was it not? Come

on, there had to be something new that came out of this. When is

this thing going to work, fully work, like when can you say, this

thing works?

Mr. MEDVE. Mr. Chairman, I can’t give you a specific date.

Mr. CHAFFETZ. You are in a meeting with the Secretaries, we expect to hear an understanding of what the conclusion of that was.

You have no specifics to share with us as to what was said?

Mr. MEDVE. Mr. Chairman——

Mr. CHAFFETZ. How long did the meeting last?

Mr. MEDVE. An hour.

Mr. CHAFFETZ. What specifics came out of that meeting? I have

to believe that two Secretaries, in the midst of tackling Osama bin

Laden, came up with some sort of conclusions and didn’t just waste

their time in this meeting.

Mr. MEDVE. Mr. Chairman, we are working toward getting this

system for IDES as good as we can get it. That is the commitment.

Mr. CHAFFETZ. Now, one of the goals that the Secretaries put out

is that they wanted to reducing the waiting time to 75 to 150 days.

How in the world did they come up with that? We are still over

a year and the number is sliding backward. How did they come to

that conclusion?

Mr. MEDVE. Sir, that is an aspiration. We are looking closely at

what we can actually achieve in terms of time. Embedded in this

total time we do have appellate rights for the service members, we

have transition——

Mr. CHAFFETZ. I didn’t come up with the goal. They did. When

would we expect, when can service men and women expect that we

would meet the goal laid out by Secretaries Gates and Shinseki?

Mr. MEDVE. I can’t give you a specific date, Mr. Chairman.

Mr. CHAFFETZ. Can you give me a year?

Mr. MEDVE. We are committed to come up with a

recommendation——

Mr. CHAFFETZ. The answer is no, isn’t it? The answer is no. And

that’s the frustration. You can’t even tell me what year you think

we are going to accomplish this. And as was pointed out here earlier—I am beyond words to understand why this is taking so long.

We were chatting, and maybe one of the things we should do is,

what if we went back and just photocopied the records and put

them on 3 x 5 cards? Would that speed up the process at this

point?

Mr. MEDVE. Mr. Chairman, if there is an impression that there

aren’t records, we——

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Mr. CHAFFETZ. No, there are records. They just can’t seem to talk

to each other. We can’t get them to go from the DOD to the VA.

Mr. MEDVE. We do have, when a service member transitions out

to veteran standard, their electronic versions of what they have in

their medical records are sent to a data warehouse that the VA can

access, if you apply for——

Mr. CHAFFETZ. We will get through the minutiae. It scares me

that you cannot even tell me what year you think we are going to

get to these ‘‘aspirational’’ days. I think the servicemen and women

are being misled in this understanding that this is accelerating,

when the reality is, the numbers are getting worse. The wait times

are getting worse. And we can’t even, we have meetings with the

Cabinet Secretaries that last for an hour, and they have aspirational goals, oh, it is going to get better.

Well, it is not getting better. And that is why we need more definitive answers.

I am over my time and will yield to the gentleman from Massachusetts, Mr. Tierney.

Mr. TIERNEY. Thank you. Before I forget, Mr. Chairman, may I

ask unanimous consent that my opening statement be submitted

into the record?

Mr. CHAFFETZ. Absolutely.

[The prepared statement of Hon. John F. Tierney follows:]

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Mr. TIERNEY. Thank you.

I would like to move on to how we are going to resolve this, if

we can. Have we, and anybody that feels qualified can answer this,

have we identified all of the technical problems that exist in this

system, and have we identified all the personnel problems and

whatever other problems are there? Do we know where the problems lie?

Mr. MEDVE. We have identified those areas resource-wise, facility-wise, and all, that we examine prior to any site going into the

new process. We have actually held up sites because they either

didn’t have the right number of personnel or the right number of

facilities. Because they weren’t ready. So yes, I think we have——

Mr. TIERNEY. You think we know what the challenges are, and

if we solve those challenges we will be doing better?

Mr. MEDVE. We know what the challenges are, and as we are

moving forward with implementation, we are holding people to

those standards, and we are not moving into it until they are read.

Mr. TIERNEY. So is there a plan for each of those areas, and how

are you going to go bout solving the technology problems? How are

you going to go about solving the personnel problems, whatever? Is

there a large plan on that, an overlying plan?

Mr. MEDVE. Each site develops their own assessment. They develop their own concept plan of how to——

Mr. TIERNEY. But I would hope there is somebody a step up from

that making sure that each site does that.

Mr. MEDVE. There are, absolutely.

Mr. TIERNEY. Who is responsible for that? Who is the ultimate

go-to person that anybody would go to for an answer or to report

the progress on each of these sites?

Mr. MEDVE. Each of these sites are briefed to both deputy secretaries in the Senior Oversight Council.

Mr. TIERNEY. And do those deputy secretaries have the final say

in what software is used, what hardware is used, the numbers of

personnel that are hired and where they are situated?

Mr. MEDVE. They don’t get to that level of detail. Because each

of the services in the VA has their responsibility.

Mr. TIERNEY. So you think the decisionmaking and all that steps

a level lower than that?

Mr. MEDVE. Yes, in terms of the recommendations for that, what

gets briefed to the deputy secretaries are, are you on target, do you

have the number of resources——

Mr. TIERNEY. So it stops at the deputy secretaries, they know

what the targets are and it is their responsibility to hold——

Mr. MEDVE. But I thought you were asking number of computers

and that sort of thing.

Mr. TIERNEY. No, no, but I want the level of the person who says,

have you solved this problem in hardware, have you solved this

problem in software, have you got the right personnel in place, are

we deciding whether it is cheaper to fly these people to a central

location to get all the myriad physical and mental exams, or is it

better to try to have that kind of personnel available at the site,

those types of things, it is the deputy secretary level?

Mr. MEDVE. There is a brief during the SOC.

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Mr. TIERNEY. And we think we have identified what the challenges are, that now just somebody has to monitor it for implementation and resolution?

Mr. MEDVE. Yes, sir, and that is where I think we are at now.

Mr. TIERNEY. And we know which services, which service

branches, aren’t doing as well as others, for instance, Air Force is

not doing as well as Army?

Mr. MEDVE. Correct.

Mr. TIERNEY. One of the things that disturbed me in reading this

was that when we didn’t meet the goals, instead of deciding how

we were going to meet them, we lowered the goal. I don’t think

that is the preferred path here, and I hope it is going to be reversed on that.

So if we really wanted an answer, instead of pounding at you and

Ms. Simpson, it would be better to go to the deputy secretaries and

find out just how much they are riding this. It seems to me if you

really want to prioritize something, and you think this is the important thing, then a deputy secretary would be having a meeting

every week, not every quarter or half year, but every week, asking

the responsible people that report to them, just where are we on

this and why aren’t we further along. Does that sound reasonable,

if we were to question those folks?

Mr. MEDVE. You can be assured that we are having those accountability meetings at a variety of levels currently.

Mr. TIERNEY. Do you have access to whatever kind of technical

expertise you think you might need, in other words, outside computer analysts, computer specialists, computer entrepreneurs,

whatever, are you able to resource those people and get them in to

discuss with you some of the larger, more technical problems that

you might be having challenges with?

Mr. MEDVE. I can’t speak for our IT people, but we have set up

workgroups to look at the technical challenges for the existing IT

systems we have supporting this, to see where we can improve it.

Mr. TIERNEY. And those support groups go outside of just what

we have in the Department of Defense and VA? We use other people as well?

Mr. MEDVE. I would assume so.

Mr. TIERNEY. What recommendations would you have for this

committee in terms of, how can we best drill down on this and get

ourselves an answer as to when we could expect this thing to be

moving smoothly?

Mr. MEDVE. All I can tell you, Mr. Ranking Member, is that we

are committed to implementing this through the rest of the fiscal

year. As you know, each case takes a number of times. So in terms

of getting more data, the sites we are bringing online now are at

least, even if we hit our goal, 295 days down the line until we have

any data in order to see if they are on target or off target with

terms of the whole process. We can start to get glimpses in terms

of how long it is taking to do the exams and those incremental

pieces. But it does take a while.

Mr. TIERNEY. I understand the implications of each case and how

sensitive that is. But Mr. Bertoni, do you get the feel that there

is some sort of systematic approach to this, that somebody has an

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overarching plan to get this resolve on the level of systems and

plans as opposed to the individual cases?

Mr. BERTONI. I testified in December that I had not seen what

I call a service delivery plan that puts all these pieces together.

Mr. TIERNEY. Exactly.

Mr. BERTONI. Would that be great for us to get our hands on and

to assess? Absolutely.

Mr. TIERNEY. Who do you think would be responsible for doing

that from your vantage point, when you look at what is being done

and who is responsible for whatever over there, who would you look

to for that?

Mr. BERTONI. I think there are some very talented people at VA

and DOD that we have been working with that know this program,

know the data. And those folks would be the people to do that.

Mr. TIERNEY. And who do they answer to?

Mr. BERTONI. Mr. Medve, for one. [Laughter.]

Mr. TIERNEY. OK, Mr. Medve. And who do you answer to?

Mr. MEDVE. Sir, I answer to the Assistant Secretary for Planning

and Policy.

Mr. TIERNEY. The Assistant Secretary.

Mr. MEDVE. Yes, Assistant Secretary.

Mr. TIERNEY. And that person reports to the Deputy?

Mr. MEDVE. Yes, sir.

Mr. TIERNEY. Thank you all very much. I appreciate your testimony.

Mr. CHAFFETZ. Thank you. I would like to maybe just go down

the row here, and just one last thing. I want to be very crystal

clear, just the succinct, simple biggest problems and challenges

that you see, and the recommendation or suggestion of what we

need to have happen.

What I would like to do is start with Ms. Simpson and Mr.

Medve, then go to Mr. Williamson, Mr. Bird and end on Mr.

Bertoni, if we could, please.

Ms. SIMPSON. Thank you, Mr. Chairman.

My understanding is that the access to data, making sure that

information is accurate, valid and succinct and that the metrics are

held to, that is one thing. Second thing, to take a look at each of

the sites, at each step in the process, and find out what specifically

is going on to account for the length of time. I knew it was higher

than 295, but I wasn’t aware it was that high, that was just mentioned earlier.

And then the followup that is required to actually get to the

place of the electronic health record, that we have very senior IT

specialists who have reach-back capability to outside experts, outside the Federal Government, to be able to provide that foundation

to use those records.

Mr. CHAFFETZ. Thank you.

Mr. MEDVE. Mr. Chairman, I would echo what Ms. Simpson said,

in terms of the process. We are taking a hard look at ensuring that

we have the requisite amount of medical personnel and outsourced

personnel to do that. We are also monitoring that very closely to

ensure that we have the required number. I am happy to come

back again as we move through this implementation to show you

how things are going and to brief the staff.

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Mr. CHAFFETZ. Thank you.

Mr. Williamson.

Mr. WILLIAMSON. I would say from my standpoint, there are IT

issues associated with the wounded warrior programs that would

allow them to communicate and talk with one another. Without

that, you are going to get confusion and consternation and conflicting kinds of recovery plans for our veterans and service members.

Mr. CHAFFETZ. How bad is the problem and how close are we to

solving it?

Mr. WILLIAMSON. We are a ways away. There are some things

that are going on right now in terms of the Federal Recovery Coordination program, that is a VA program, that requires DOD cooperation. It is the same thing you have been talking about

throughout here.

Mr. CHAFFETZ. Thank you.

Mr. Bird.

Mr. BIRD. Developing large scale IT solutions is challenging

enough for anybody. The Department of Defense has capabilities

and VA has capabilities. They need to establish joint capabilities to

tackle some of these large scale problems.

Mr. CHAFFETZ. Have they started that process?

Mr. BIRD. As I mentioned earlier, they started over 10 years ago.

And they have frankly slowly been increasing their capabilities as

well as increasing their capabilities to work together to tackle some

of the challenges.

Mr. CHAFFETZ. But we are nowhere close to getting to the finish

line?

Mr. BIRD. It is difficult to say, because the finish line has not yet

been defined.

Mr. CHAFFETZ. Who should define that? Who should define the

finish line?

Mr. BIRD. The department should define the finish line.

Mr. CHAFFETZ. The Secretaries, is what we need. That is encouraging.

Mr. Bertoni.

Mr. BERTONI. I think over the last several years, we have identified specific challenges I think that have impacted this program

negatively. To DOD and VA’s credit, I think they have tried to get

in front of many of those. In particular, the issue of standing up

sites, readiness, lookbacks, making sure that down the road, they

are going to have appropriate staff in play.

Beyond that, I think there needs to be additional data collection

at a more granular level. You need to know at particular site level

locations, what are your ratios looking like? What are the problems

with the diagnoses, problems with the exam summaries? Those are

the things you need to know that are bogging the system down.

Right now, that capability is not there.

So that is something that we definitely would see them do more

granular data analysis and collection and monitoring, so they can

make the adjustments. And this way, you could get in front of

problems. You don’t have to wait until you are 295 days down the

road to say, we have a problem with ratings, we have a problem

with exam summaries. But if you start to see this emerging, you

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can make the adjustments, you can apply the training and you can

apply the technology to get in front of those problems.

Mr. CHAFFETZ. Thank you. I want to thank you all for your participation. I know your heart is in the right spot in all these things.

It is terribly frustrating, it is terribly frustrating. These men and

women, our American military does amazing things. We just saw

that play out. But when it comes time, when they come home to

take care of, we are failing. And it is about time that we at the

Secretary level, at the Presidential level, that we get somebody who

is irate who can actually move the ball forward and do some things

to actually make this thing happen.

I know that members on this committee, I know Mr. Tierney has

worked tirelessly on this. I will continue to pour my efforts into it.

But we have to demand that we actually achieve these goals. That

is going to take some serious leadership. I think that leadership is

lacking within the highest levels with the Department of Defense

and within the Veterans Administration.

I thank you all again for your information. You are pouring your

hearts, like I said, in the right direction. We look forward, unfortunately, we will be having another one of these hearings again. But

hopefully the news will be better and we will be making more

progress.

Thank you again for your expertise and your testimony today.

The committee stands adjourned.

[Whereupon, at 11:17 a.m., the committee was adjourned.]

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